The following guest opinion piece was picked up on the San Francisco Sentinel.website, and is available at www.SanFranciscoSentinel.com/id308.htm.
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with Teresa Palmer, M.D.
Change In Mission at Laguna Honda: Whose Idea Is it?

Thursday, November 11, 2004
In 1999 voters approved rebuilding Laguna Honda Hospital (LHH) to serve all San Franciscans.  The idea was to comply with concerns raised by the U.S. Department of Justice in 1998 about living conditions at LHH, among other issues.  After voters approved the bond measure to rebuild LHH, the LHH Replacement Facility’s web site painted a glowing picture of how the replacement facility would be reconfigured to provide LHH residents with a more home-like setting:

“Instead of inhabiting 30-bed open wards, as they do today, residents will live in 15-person households, each with its own identity. Private and semi-private rooms - for one, two, or three people - will enable personalized care. Living rooms and dining rooms, centrally located within each household, will provide places to visit with relatives, neighbors and guests.”
— From a guest opinion piece by Louise Renne published in the June 3, 2004 San Francisco Chronicle

But now, (accompanying a change in the LHH admissions policy put in place by Dr. Mitchell Katz, Director of the Department of Public Health, in March 2004) LHH’s mission to help the elderly AND any sick person not already at San Francisco General Hospital has been minimized.  San Franciscans outside of San Francisco General Hospital just don’t have priority at Laguna Honda anymore.

The staff at Laguna Honda sees more admissions from San Francisco General now, and less and less from anywhere else. Comparative numbers confirm this.  Between March 1 and November 1 in 2003 vs. 2004, admissions from SFGH increased by 36.6%, while at the same time admissions from other facilities plummeted by 40.2% and admissions from home dropped by 39.4%.   From a different view, in 2003, 52.5% of admission to LHH were referred by SFGH, 34.8% were from other facilities, and 12.7% were admissions from home. By 2004, the percent mix had changed to 71.7% from SFGH, 20.8% from other facilities, and only 7.5% were admissions from home.

This has raised concerns from a variety of sectors in San Francisco.  In March of 2004, Dr. Katz unilaterally changed the admission policy without any discussion or input from the LHH staff and without required approval. In June 2004, City Supervisors Tony Hall, Jake McGoldrick and Bevan Dufty (City Services Committee) held a hearing on the issue.  When Dr. Katz stated during the hearing that the change had been his sole decision, Supervisor Hall called into question Dr. Katz’s decision-making ability.

In 1999, the mission of the “new” Laguna Honda was summarized by Dr. Edward Chow, who is the current president of the Health Commission. He wrote:

“In this election voters can support the passage of a $299 million bond measure, Proposition A, which will fund the cost of rebuilding Laguna Honda Hospital into a state-of-the-art skilled nursing facility.  ...  We have a moral imperative to save this hospital from reduced funding. If we fail, the effects will be devastating. In the short term we would have an immediate moratorium on admissions, fail in our ability to meet San Francisco’s need for skilled nursing care, and put pressure on acute hospitals, which will raise the cost of care. In the long term, San Francisco ís growing population of elderly will not have a sufficient health care infrastructure to meet its needs.”
— Dr. Edward Chow, AsianWeek, Thursday, October 28, 1999

The voters in 1999 eventually approved Proposition A to rebuild LHH as a skilled nursing home for the frail elderly, as promised in the paid ballot arguments.  However, fast forwarding to the present, current movements by Dr. Katz are towards using LHH as a “social rehabilitation center” for those who can’t stay at San Francisco General Hospital.  Laguna Honda staff who questions the wisdom of this are told to “get behind it,” or to “try harder” to get some of these patients, who are frightening to the elderly and frail as well as to the staff, to “fit in.”

This is an issue of concern to Louise Renne, who is president of the LHH Foundation, a new non-profit organization which has been raising money to purchase furniture and amenities not covered by the LHH rebuild fund.  Mayor Newsom mentioned to some medical staff from Laguna Honda Hospital during a rally on Saturday October 30, 2004 that he had scheduled meetings for the following week with former City Attorney Louise Renne, Sister Miriam Walsh, from LHH's pastoral care department, and Dr. Mitch Katz.  Ms. Renne and other benefactors who work with the Laguna Honda Hospital Foundation cannot be too happy about recent developments!

I hope that Renne feels it necessary to clarify whether the new Laguna Honda Hospital would match concepts advanced in the $300 million Bond Measure of 1999, and the “Options for Laguna Honda Hospital White Paper” issued by Dr. Katz in 1998, upon which public policy paper the LHH Foundation’s efforts are based.

I’m baffled by the change in LHH's mission.  San Franciscans as a group are growing older, but entry for them into Laguna Honda grows less available.  I venture that if the voters had approved a bond initiative to build a new freeway and got a parking lot instead, or had voted for a grade school and had gotten a prison instead, that there would be all sorts of public outcry, forcing politicians to deliver on their promises.  Why should this be any different for mental health centers like the Mental Health Rehabilitation Facility or long-term care facilities like LHH? Why have the MHRF and LHH missions changed after voters passed bond initiatives promised for needed uses?

Meanwhile, there is ongoing negotiating between public health administrators, a city attorney, and staff at Laguna Honda about current and past posted admissions policies.  This may be related to a sudden change of CEO at Laguna Honda, recent OSHA and State Licensing concerns with unsafe patients, and a public interest lawsuit filed by Michael Lyon and Lynn Carmen, Esq. earlier this year.

I heartily encourage Louse Renne and the other good people at the Laguna Honda Foundation to speak up for the many frail and elderly in San Francisco who may not be able to speak up for themselves.  The will of the voters who approved proposition A in 1999 is not being honored.

In fact, my 87 year old mother has instructed me to speak up for her.  We both hope Mayor Newsom and Dr. Katz are all ears!

Teresa Palmer, M.D.


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