Laguna Honda not yet out of the woods: Report

San Francisco supervisors spent much of their Tuesday meeting trying to understand the thornier aspects of getting Laguna Honda Hospital back into regular operation in advance of a looming deadline. They also urged stronger action on finding shelter beds, gun safety and set the date for a hearing on a proposed controversial reparations plan.  

Supervisors spent over two hours listening to representatives of the Department of Public Health and concerned members of the public during an often emotional hearing on the status of Laguna Honda Hospital and its road to recertification by the Centers for Medicare and Medicaid Services (CMS). 

One big pain point for the supervisors was the impending Feb. 2 deadline for CMS to decide whether it would extend the freeze on forced patient transfers—with no word from the agency on how it will decide. 

District 5 member Dean Preston compared the lack of communication from CMS to that of “a sadistic and abusive landlord,” characterizing it as a sign of bad faith on the part of the agency. 

District 8 Supervisor Rafael Mandelman concurred. “It is shocking to me that with 12 dead people, that we don’t know four days in advance that we’re not going to be right back in that place,” he said, referring to Laguna Honda patients who were forced to transfer to other facilities, mostly outside of San Francisco, in the wake of the facility’s decertification last April. 

Adding insult to injury, it was revealed at the hearing that the State Department of Public Health cited Laguna Honda for the transfer-related deaths, assessing $36,000 in penalties. City Attorney David Chiu is appealing the fines. 

District 7 Supervisor Myrna Melgar, who convened the hearing, noted that CMS’ lack of communication and inflexibility in allowing more vulnerable patients to defer transfer means that it’s entirely possible that patients could get forcibly transferred again, with many risking significant harm from what she called “transfer trauma.” 

Meanwhile, Health Director Grant Colfax and Laguna Honda’s Interim Director Roland Pickens expressed confidence that not only would CMS extend the freeze on transfers, but that there was also a clearer—if longer—road to recertification for Laguna Honda. 

Under a settlement approved by the city last November, CMS will continue funding care for current patients at the facility until next November, while the hospital implements an action plan to resolve deficiencies in care. 

Pickens told the supervisors he expected the action plan to be fully implemented by a May 13 deadline. 

In the meantime, the hospital’s quality improvement expert will make monthly reports, and CMS is expected to conduct another monitoring survey before that time. Pickens told the supervisors that the timeline should provide “a good indication” that Laguna Honda would be ready for recertification. 

The process will require some significant changes in how the hospital currently functions. 

Laguna Honda is unique in that it has functioned as a skilled nursing facility, as originally intended, and increasingly as an acute care facility, causing many of its policies and practices to “become out of sync with high-performing skilled nursing homes.” 

Part of the hospital’s dual mission has been a result of a gradual increase over time in the number of behavioral health patients admitted to the facility. In response to questions from District 4 Supervisor Joel Engardio, Pickens noted 1 in 8 patients are in this category but integrated into the general patient population.

“It appears we have a mix of patients who are not mixing well,” Engardio said. 

District 11 member Ahsha Safaí also explored this issue in his questioning of Pickens, who described it as “a vexing and challenging issue” and noted that the hospital would have to explore alternatives such as “cohorting” behavioral health patients together, or in the long-term, creating a separate facility for them. 

The board voted to continue the hearing until May 9, when they will hear another progress report. 

Outside of the Laguna Honda hearing, Mandelman raised more issues over the direction and capacity of the city’s behavioral health care, in particular for persons experiencing homelessness. During a vote approving the extension of a behavioral health services agreement with Progress Foundation, he voiced disappointment that the increase wasn’t larger. 

“We have spent four-and-a-half years talking about a great need for additional beds for people with severe mental illness. […] If we were effective in our sincerity on this issue, this contract would be larger, or there would be other contracts for this work and that has not happened,” Mandelman said ahead of the unanimous vote. 

Mandelman went further on the issue during roll call when he requested a Committee of the Whole hearing on the Department of Homelessness and Supportive Housing’s (HSH) “Place for All” report on the implementation of the shelter-on-demand ordinance passed by supervisors last June. 

“It is not a remotely realistic or actionable plan to end unsheltered homelessness in San Francisco,” the supervisor said, noting HSH’s recommendations favored more permanent supportive housing over shelter beds.  

“It’s as if they’re hoping to show us that ending unsheltered homelessness is impossible, so we shouldn’t bother trying, and we certainly can’t hold them accountable for the fact that our sidewalks continue to serve as the waiting room for permanent supportive housing.” 

Supervisors passed resolutions introduced by District 2 Supervisor Catherine Stefani urging Congress to pass a renewed ban on assault weapons, and recognizing National Gun Violence Survivors Week, in response to the recent spike in mass shootings. During roll call, Stefani then introduced a letter of inquiry to city law enforcement agencies on their firearm procurement practices. 

The latest move is in response to a recent report by the Brady Center that revealed at least 67 police agencies bought firearms and equipment from LC Action Police Supply, a San Jose gun dealer with a long history of violating federal firearms laws, including selling guns to possible straw purchasers and failing to verify whether buyers were barred from owning guns.

Before adjourning for the evening, the board also voted unanimously to review the controversial draft plan for African American reparations prepared by a committee of the city’s Human Rights Commission. More on that story here.