Flawed Report Recommends Replacing Laguna Honda Hospital Doctors … and a Critical Analysis "Rebuttal"

The Ja Report ...

The Davis Ja and Associates report recommends replacing Laguna Honda Hosptial’s physicians with registered nurses, social workers, and psychologists. This may lead to adverse health outcomes for LHH’s vulnerable patients, who are all admittted for medical reasons.

The Ja report was contracted for by the Department of Public Health’s Community Behavioral Health Services (CBHS) section, as part of the Chambers settlement agreement that required assessment of behavioral health services at Laguna Honda Hospital, patient flow within DPH, and linkages to behavioral health services following discharge to the community.  The Ja report contains a number of flawed assumptions and startling admissions, but it failed to assess the availability of community linkages to behavioral health services (or to primary medical care services) following discharge, which had been part of the scope of work to be performed under the contract.

That Ja was awarded this contract may involve an actual, or perceived, conflict of interest from not adequately acknowledging his personal relationships with staff employed by the City’s CBHS department that commissioned the Ja study.

The personal and financial relationship between Ja and the Director of Research, Evaluation and Quality Management for CBHS (who is a direct subordinate of CBHS’ Director now appointed to a committee to determine the role of LHH in providing behavioral health services) were not disclosed in the Ja report.  This relationship may have potentially influenced:  1) The development of the content and context of the contract eventually developed; 2) The award of the contract to Davis Y. Ja & Associates; and 3) The findings of the Ja final report, which appears to have been edited by CBHS prior to being finalized, given the gushing acknolwedgement that the CBHS director helped develop the final report.  Despite Ja’s “Disclaimer” section indicating the “opinions” expressed in his final report reflect the opinions of the authors and are not intended to represent the views, positions, or polices of CBHS, Appendix 1, “Acknowledgements” indicates Bob Cabaj, Director of CBHS, was “particularly helpful” in developing and facilitating completion of the Ja final report.

When the former Mental Health Rehabilitation Center (MHRF) was set to open and suddenly changed its mission from serving psychiatric patients to other mixed uses, a “Blue Ribbon Committee” was formed with various community “partners” to determine how the MHRF would be used.  When California Pacific Medical Center proposed shutting down St. Luke’s hospital, another Blue Ribbon Committee was formed with community “partners” to determine how to service St. Luke’s’ patient population.  So why is the future of Laguna Honda’s services being turned over to an in-house committee of Department of Public Health staff, rather than to a Blue Ribbon Committee?  Why shouldn’t there be a “Blue Ribbon Committee on Laguna Honda Hospital” evaluating the Ja Report’s recommendations — before LHH is turned into a mixed-use facility?

... and A Critical Analysis of the Ja Report

A Critical Analysis of the Ja Report has been written by two medical doctors, who each have 20 years of direct patient care experience at Laguna Honda, and who have cared for many hundreds of patients with behavioral health needs.  The opinions expressed in the Critical Analysis are theirs alone and are not intended to reflect those of LHH, or of its Medical Staff.  Their analysis was written in response to widespread concerns among LHH’s Medical Staff about the Ja report’s recommendation to subtract primary medical services at LHH in order to increase behavioral health services.  They note that the Ja report’s recommendation to reduce medical services for LHH residents is unacceptable, is potentially harmful, may likely increase barriers to safe community discharges, and may increase adverse outcomes after discharge.

Twenty LHH physicians signed a resolution rejecting the Ja report’s recommendation to reduce physician staffing, due to Ja’s bias, inadequate data, flawed methodology, and lack of professional qualifications to assess physician services at LHH.



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