Commentary: Sandra Lee Fewer

Laguna Honda’s Failures

By Sandra Lee Fewer

I am shocked that there has not been more outrage at what has befallen Laguna Honda Hospital and the 681 patients that call Laguna Honda Hospital home.  

I first saw Laguna Honda Hospital while visiting my husband’s grandmother with my 3-year-old daughter, Sara, in 1985. Lulu had been a career retail clerk at the White House department store and had raised three children as a single mother. In her late 80s, unable to care for herself, she entered Laguna Honda Hospital where her son had been living after having both legs amputated due to complications from diabetes. They were typical of the patients Laguna Honda Hospital has served and still continues to serve – for now. 

In fact, Laguna Honda Hospital has served the poor, indigent and medically fragile in San Francisco for more than 150 years and is one of the largest skilled-nursing facilities in the country. But our safety net is about to change, drastically impacting the lives of more than 600 patients, and the outlook is bleak.

In April 2022, the Center for Medicare and Medicaid Services (CMS), the government regulatory agency that oversees skilled nursing facilities, discontinued all Medicare and Medicaid reimbursements for Laguna Honda patients after repeated warnings to the Department of Public Health (DPH) of substandard care. 

The amount needed to keep Laguna Honda afloat is more than $500,000 a day. Without federal payments, it is unsustainable for San Francisco to continue operations at Laguna Honda. If San Francisco hopes to be recertified, CMS requires the Department of Public Health (DPH) to adopt a closure plan, which includes evicting patients from Laguna Honda. 

So far, 40 patients have been transferred to other skilled nursing facilities and 16 were discharged to the community. There is an extreme shortage of skilled nursing beds in San Francisco and, since May, Laguna Honda Hospital leadership has only identified 61 skilled nursing beds in San Francisco. 

Of the 40 patients transferred, 39 have been transferred out of the county, distancing them from their families and friends. The closure plan will mean that almost all of the patients will be transferred out of the county, and DPH must transfer all patients by Sept. 13. More disturbing, some of these transfers have proved fatal; four patients have died following their moves. 

How did it get so bad? In June 2019, the California Department of Public Health (CDPH) detailed in its report the abuse patients have suffered at Laguna Honda. In July 2021, the Board of Supervisors approved the first settlement of $800,000 with a Laguna Honda patient that suffered abuse. The Chronicle reported that “staff allegedly masturbated the plaintiff and put objects up his rectum, kicked and hit him, failed to clean him and gave him unprescribed medication that caused him to be asleep or sedated for hours or days.” 

In July 2021, DPH reported two non-fatal overdoses at Laguna Honda to the California Department of Public Health (CDPH), which triggered an extended state investigation. In October 2021, the CDPH’s survey found Laguna Honda to be in a state of substandard care. In January 2022, Laguna Honda remained in noncompliance. In March 2022, CDPH returned for a second visit and Laguna Honda remained in noncompliance due to an incident involving smoking and a lighter near oxygen tanks. March 2022, CMS put Laguna Honda on notice for possible termination. April 2022, CMS terminated Laguna Honda’s Medicare/Medicaid program participation. 

When politicians talk about San Francisco as a dangerous place, they should talk about this crisis. They should talk about DPH’s incompetence, and CMS’s callous disregard for the lives of Laguna Honda residents. 

It is dangerous not only to the patients of Laguna Honda, but to all San Franciscans who will be medically fragile, indigent and elderly. This has been a safety net for them and their families for more than 150 years and is the largest safety net the City has for this population. Coupled with a severe shortage of skilled nursing beds, this is catastrophic for thousands of people and families who need to be served in an institution like Laguna Honda. 

This clearly could have been prevented and could have been remedied. This is huge. Either people made mistakes, didn’t care enough to be diligent or lacked leadership and follow through. Regardless, DPH and CMS need to own this, fix this and save as many lives as possible. The City is discussing whether or not it should try to recertify Laguna Hospital as a large skilled nursing facility but have offered no other options for those who need this level of care. When our institutions fail to serve those who are wholly dependent on them, we as a city have failed and that is what real danger looks like.

Sandra Lee Fewer is a fourth-generation Chinese-American San Franciscan, former Board of Education commissioner, former member of the SF Board of Supervisors representing the Richmond District and has lived in the Richmond for more than 60 years.

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