By Thomas K. Pendergast

Federal authorities once again paused the forced removal of more than 600 patients from Laguna Honda Hospital (LHH) until May. The 157-year-old institution, however, still lingers in an existential ICU of bureaucracy. 

The hospital has not lost its license, but most patients there are covered by Medicare and Medicaid. Both programs terminated the hospital’s participation after the U.S. Centers for Medicare and Medicaid Services (CMS) decertified it because of deficiencies in safety protocols, improper hygiene practices by the staff and two nearly-fatal overdoses from illegal drugs brought into the hospital by patients.

In April 2022, the CMS terminated its Medicare and Medicaid payments to Laguna Honda. 

Centers for Medicare and Medicaid Services committed to giving the hospital financial help in relocating approximately 670 patients by mid-September, 2022. 

Laguna Honda Hospital transferred 41 residents to other skilled nursing facilities and discharged an additional 16 residents. Of those, 12 people died within weeks or months of being transferred.

San Francisco sued the federal government for failing to provide adequate time to repeal the original citations. The City and CMS came to an agreement in July 2022 to pause transfers until Feb. 2.

On Jan. 13, the City Attorney’s Office wrote the U.S. Department of Health and Human Services (HHS) requesting the pause in patient transfers be extended to May 30 of this year. 

“LHH has satisfied its milestone obligations under the Settlement Agreement, has successfully implemented many improvements in care, is making progress in addressing remaining issues and is well on its way toward recertification,” according to the letter sent by the City Attorney’s Office. 

On Feb. 1, CMS notified the hospital that they now have until May 19 to come up with a recertification plan. 

“CMS has considered Laguna Honda’s request and agrees to provide Laguna Honda extended federal funding while the facility continues to pause resident transfers and discharges, until May 19, 2023, under the terms of the settlement/systems improvement agreement,” according to the response letter sent by Jean C. Ay, the HHS San Francisco and Seattle Survey and Enforcement Division director. 

“This extension of the pause does not extend federal funding past Nov. 13, 2023. Laguna Honda, therefore, is advised to manage its resources, including its plans to safely discharge and transfer residents, accordingly, and with that date in mind for when the skilled nursing facility will no longer receive any federal funding.”

The city attorney’s Jan. 13 letter requesting the extension of the pause in patient transfers discussed the impact that not doing so would have on the patients and their families. 

“Because of its size, history, amenities and patient population, LHH is a unique facility in the country, providing critical care for many of San Francisco’s most vulnerable residents, and its residents would be best served by avoiding unnecessary transfer trauma and remaining at LHH through the recertification process,” the City’s letter said. 

“If transfers resume, elderly residents with dementia will face the confusion, disruption and the ordeal of being transferred away from their long-term caregivers for reasons they might not understand. For elderly residents, maintaining familiarity with people, place and surroundings is important for their orientation and stability. 

“The harm that residents could face from being unnecessarily transferred from LHH is compounded by the fact that there are few skilled nursing beds available for LHH’s residents in the Bay Area, or surrounding communities. Therefore, it is likely that LHH would be forced to transfer patients to counties outside of the Bay Area or even out of state. Transferring patients hundreds of miles from their home would uproot them from their family and friends, as well as removing them from the only caregivers they know,” the city attorney’s letter said.

The hospital faces yet another challenge, however, because when it renews its license, it might have to follow new rules wherein no more than two patients can share one bathroom, as opposed to three patients, which the old rules had allowed. 

Unless there is a compromise on that as well, if it wants its license renewed, the hospital might have to remove 120 beds regardless, according to the hospital’s Interim Chief Executive Officer Roland Pickens, who called this an “unsettled issue.” 

Meanwhile, another lawsuit seeking an injunction to stop further patient transfers has been filed against officials at both the CMS and the California Department of Public Health by attorney Louise H. Renne on behalf of four patients residing there.  

“Our clients appreciate the pause; it’s a step in the right direction, but frankly there ought to be no transfers whatsoever,” Renne said. “There’s no need for it. There’s no place elsewhere for the residents of Laguna Honda.”

She also noted that the hospital is currently forbidden to accept new residents.

“That means there’s a real backup at places like San Francisco General, where people who are in need of skilled nursing care and rehabilitation can’t be placed at Laguna Honda. And because they’re mostly poor people there’s no place for them to go,” she said. 

Renne acknowledges that CMS found serious problems with the hospital’s procedures and health standards, however, “that’s no reason to evict innocent people. It’s wrong and it’s cruel. Why take it out on the patients?”

“Any mistakes have to be corrected; there’s no doubt about that. But there’s nobody that’s died at Laguna Honda because of Laguna Honda care. They died because the feds and the state have ousted them. That’s what’s so outrageous about this,” Renne said.

“This idea of ‘we’ll pause it here; we’ll pause it there.’ They’re just toying with people’s emotions.” 

San Francisco Archbishop Salvatore J. Cordileone released a statement about Laguna Honda Hospital patients as well.  

“For many decades, the hospital has been one of the very few publicly funded nursing homes in the country, one where many residents have found a haven,” Cordileone said. “In the face of the current prospect of some infirm and elderly patients being transferred from their residences due to regulatory and funding concerns, I urge community leaders to ensure the stability and protection of vulnerable individuals. We pray that Laguna Honda may continue to be a haven for the poor, sick and elderly and that our brothers and sisters in San Francisco will be cared for as they face trials and illness.”