By Thomas K. Pendergast

Federal and state regulators have paused all patient transfers and discharges from Laguna Honda Hospital after nine patients died following their removal from the facility. 

This decision comes on the heels of a resolution unanimously passed by the San Francisco Board of Supervisors urging U.S. Secretary for Health and Human Services Xavier Becerra to intervene in the hospital’s impending closure.

The Center for Medicare and Medicaid Services (CMS), along with the California Department of Public Health (CDPH) and the California Department of Health Care Services, agreed to allow a pause in patient transfers and discharges while the hospital seeks recertification in the Medicare and Medicaid Provider Participation Programs. 

“No other city in the nation has made the commitment San Francisco has made for a public skilled nursing facility to serve its most vulnerable residents,” San Francisco Department of Public Health Director Dr. Grant Colfax said. “Today’s agreement to halt all patients’ discharges and transfers will allow the dedicated Laguna Honda staff to focus on caring for patients and not moving them.”

“We are glad to be in agreement with CMS and CDPH and all understand the Laguna Honda residents have complex needs and that transferring them is often a challenge,” the hospital’s Interim Chief Executive Officer Roland Pickens said. “Our staff are providing Laguna Honda residents with the best care possible while we all work towards recertification with CMS. Laguna Honda has served San Francisco’s most vulnerable residents for 150 years and we plan to do so for another 150 years.”’

The hospital is in the territory of District 7 Supervisor Myrna Melgar, who sponsored the resolution. 

Before the decision to halt relocations was reached, there were plenty of critical opinions of the relocation plan.

“As we all know, this critical health institution is in crisis,” Melgar said. 

The hospital lost its certification to receive Medi-Cal and Medicare in April, after CMS found deficiencies in safety protocols, hygiene practices by the staff and two nearly fatal overdoses by patients from illegal drugs brought into the hospital last year.

Medicaid and Medicare pay the bills for most of the patients there, so the CMS promised financial help in relocating about 670 patients by mid-September, with possibly a two-month extension of benefits provided this deadline was met. 

At the latest count, only 56 patients have been relocated and of those, nine died not long after.

“We are getting mixed messages from CMS and whether we are doing enough, that we’re not being aggressive enough in moving people out,” Melgar told the Board when she introduced the resolution. “Four patients now, who have been transferred, have died, that we are aware of. Two of them were very elderly. And while we always know that there is high risk, there’s truly no rationale for this, nor a moral excuse.

“We must ask ourselves, as a City, how far we are willing to go to meet the terms of this agreement with CMS at the expense of the lives and the health of our City’s most acutely vulnerable patients, many of whom will likely not survive this transfer.”

District 8 Supervisor Rafael Mandelman joined others in criticizing the federal government.

“I think that what is happening to folks who are being turned out of Laguna Honda, in some cases to die; in other cases to be sent to homeless shelters, is an embarrassment to the Biden Administration,” Mandelman said. “Laguna Honda is the country’s largest skilled nursing facility. San Francisco is the only county that has tried to bear the responsibility of operating a facility like this.”

Pickens said they initially offered CMS an 18-month plan to transfer patients out and regain certification, but this was rejected. Instead, CMS required the hospital to go with a four-month closure plan from May to September with the possibility of an additional two-months extension.

Hospital administrators have met weekly with CMS, he said, where they have been told the staff was not moving fast enough or having enough discharges to meet their Sept. 13 deadline. 

“In fact, in California, there is a statutory requirement that if a skilled nursing facility goes through a closure process, transfer trauma has to be part of your planning process,” Pickens said. “Transfer trauma is one of the things that is specifically addressed in the assessment for each of those patients.”

He acknowledged that four patients have passed away after being discharged and transferred out. (The number has since been updated to nine patients.)

“While we don’t have specific information as to whether or not transfer trauma impacted their expiration, we don’t know. But we also don’t know if it didn’t,” he said. 

Of the 56 discharged, 40 went to other skilled nursing facilities (SNF), of those only one went to an SNF in the City, while the majority went to facilities in San Mateo County and four went to Alameda County. 

Three patients went to Navigation Centers; seven went to board-and-care or residential care facilities. Three have gone to Medical Respite and three have gone either home or to family-owned housing arrangements. 

“We’ve been working with CMS in trying to urge them to extend the date in which Laguna Honda will be closed,” said Blanca Castro, long-term-care ombudsman for California. “We’ve also been trying to work with the California Department of Public Health and other agencies because we do know first-hand that families and residents are not being followed-up with a care plan. We have people that are being released to shelters without a care plan and they have nowhere to go.

“At this point I’m really grateful (for) the resolution to urge Secretary Becerra to discontinue any discharges and then allow for Laguna Honda to get in compliance.” 

During public comment Dr. Teresa Palmer addressed the Board.

“If Laguna Honda management needs to clean up its act on patient care in order to please the federal government and the state, let them clean up their act without them discharging the most vulnerable people you can imagine at the same time and killing them,” Palmer said. “It makes no sense to destroy the nursing home to fix it.”

Also during public comment, Michael Lyon did not limit blame for the situation to only the feds. He focused on long-term San Francisco policies as well. 

“What does it say about a system that lets people die because they are old and poor?” Lyon said. “The City colluded with the private hospitals and allowed them to avoid having Medi-Cal sick beds, so that instead they could have higher-paying acute care beds. 

“The City scrimped and cut low-level mental health and substance abuse services, so people went into full-blown crises,” he said. “So, people with mental health and substance use problems were sent to Laguna Honda, which had neither the staff, the equipment, or the setup to care for them. 

“And then CMS came in and now residents are dying. It’s all about profits.”