'Mind-boggling;' San Francisco officials seek halt to further discharges from Laguna Honda Hospital

SAN FRANCISCO -- The San Francisco Board of Supervisors on Tuesday expressed concern and frustration over potential patient discharges happening once again at the Laguna Honda Hospital and Rehabilitation Center in light of an agreed-upon grace period coming to a close on Friday.

At Tuesday's board meeting, Laguna Honda interim CEO Roland Pickens laid out the hospital's progress in reaching federal and state recertification, two days before the hospital may have to begin discharging its patients once again.

The discussion comes after federal and state regulators cited safety concerns at Laguna Honda last April, stripped it of its Medicare and Medicaid provider agreements and required the hospital to move all 700 patients out of the facility by September. Among the concerns were drug paraphernalia in the facility, a lack of infection prevention and control, and missed doses of medication.

Thanks to a settlement agreement initiated by City Attorney David Chiu in the summer, the U.S. Department of Health and Human Services allowed the hospital to postpone patient discharges until February, and the federal Centers for Medicare and Medicaid Services (CMS) agreed to keep funding Laguna Honda, so long as they worked to find solutions to the cited issues.

Days before the no-eviction window closes, city supervisors and health leaders are once again concerned about the dangers of quickly discharging and transferring patients, many of whom have complex medical conditions.

The hospital alleges that of the 57 residents who were transferred into other facilities last summer, at least 12 died within three months.

In response, CMS has issued a dozen citations against Laguna Honda for the deaths, though Pickens alleges that the regulators were partially responsible because of their pressurizing, expedited timeline and lack of guidance.

"We maintain to this day that the best place for those residents [who died] was Laguna, and the best place for the residents at Laguna now is Laguna, which is why we are doing everything we can to ensure that we do not have to resume transfers," said Pickens.

The organization California Advocates for Nursing Home Reform alleges that Laguna Honda evicted extremely sick patients "known to be at high risk for transfer trauma" to nursing homes outside of the city with "poor track records," some even being sent to homeless shelters.

CANHR said the series of $3,000 fines were "a mere slap on the wrist for repeated and lethal acts of elder abuse." They added that federal and state regulators played a "lead role" in the deaths by forcing Laguna Honda to evict patients quickly, without safety in mind.

Patricia McGinnis, CANHR's executive director, called on the Legislature to investigate the leadership of the California Department of Public Health.

"CDPH must not be allowed to whitewash the deaths of these vulnerable residents and its own role in them," McGinnis said.

Dr. Grant Colfax, head of the San Francisco Department of Public Health, said the department has issued a letter to CMS seeking out another pause in transfers, and CMS promised to respond before Friday. Concurrently, Laguna Honda is continuing to make improvements to become recertified, Colfax said.

"While we've made great progress over the last six months, and while there is more work ahead, I am confident in our direction," said Colfax. "As we go through this process, we are again unwavering in our dedication to our residents and their families. The health, safety and well-being of our residents remains our top priority."

Pickens said the hospital has worked closely with quality improvement experts to identify eight key issues that led to Laguna Honda's decertification based on regulatory surveys from the past 18 months and developed an action plan to address all the concerns.

Some of the actions Laguna Honda plans to make to achieve the 300-plus milestones needed to reach recertification include creating better individualized care plans for its residents, especially those with mental health and substance abuse issues, creating better infrastructure to prevent residents from bringing illicit materials into the facility, and switching to in-person emergency preparedness drills rather than training their staff via online modules.

Laguna Honda has until May 13 to demonstrate progress toward meeting regulatory requirements before it resubmits its certification application.

"We are hopeful that when CMS comes back for their second monitoring survey, that they will see improvements and that the results will be better than they were for the first survey," Pickens said.

Supervisor Dean Preston said he felt CMS was acting in bad faith for not responding to a request for an extension on the transfer pause.

"I cannot believe after a dozen people are dead as a result of how this has gone down, to date, that CMS is not being more responsive and working with us around an extension," said Preston at Tuesday's meeting.

Supervisor Rafael Mandelman said he was "struck" by how much harm the oversight agencies have allegedly caused, and called their leadership "unaccountable" and "disconnected."

"I'm sure they think they're just following the rules they're supposed to follow, but the real-life, on-the-ground impacts of the way in which they are proceeding is causing huge distress and stress, and in 12 cases, deaths," Mandelman said.

Supervisor Hillary Ronen said CMS's requests are "truly cruel and unbelievable." She thanked Laguna Honda staff for "trying to accomplish the impossible" in meeting the regulators' guidelines without much help.

"They don't seem to take that into account on how much Laguna has bent over backwards to try to be helpful in resolving the crisis on our streets and with mental illness, that certainly the state and the feds don't seem to provide any funding nor help," Ronen said. "This whole thing is just mind-boggling."