'Down to the Wire Again': SF Officials Blast Feds for Silence on Laguna Honda Patient-Transfer Decision, Just Days Before Deadline

Update, 6 p.m. Tuesday: Federal officials have yet to say whether they will allow San Francisco to continue postponing the transfer of hundreds of Laguna Honda Hospital patients to other skilled nursing facilities, frustrated city leaders said Tuesday.

The clock is ticking. If the Biden administration rejects the city’s requests to continue halting transfers, the hospital could be required to resume relocating its more than 550 remaining patients, many of whom are elderly and lower-income, to other skilled nursing facilities as early as Friday.

“It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged,” San Francisco Supervisor Myrna Melgar, whose district includes the hospital, said at Tuesday’s Board of Supervisors hearing. “The rigid bureaucracy of the U.S. government has put us into this position.”

Hospital officials have said they have no plans to resume transferring patients unless compelled to do so. Twelve of the 57 patients who were initially transferred from the hospital last summer — some of whom had dementia and limited physical and cognitive ability — died within weeks or months of being relocated.

“Laguna Honda strongly advocated against these transfers. We warned CMS (the Center for Medicare and Medicaid Services) that the four-month deadline to transfer nearly 700 residents to other facilities was entirely insufficient given the complex nature of our resident population and the lack of available beds at SNFs (skilled nursing facilities) anywhere in the region or the state,” hospital officials said in a public statement earlier this month in response to regulatory citations it received following the deaths of the transferred patients.

Roland Pickens, Laguna Honda’s interim CEO, said he is hopeful the current pause on patient transfers will be extended, allowing the hospital to continue working to address deficiencies cited by state and federal regulators.

At Tuesday’s hearing, other San Francisco leaders blasted federal officials for so far failing to respond to the city’s extension request, just days before the hospital could be required to resume patient transfers.

“This is a powerful and unaccountable bureaucracy,” Supervisor Rafael Mandelman said. “They [CMS] have done significant harm. They have created a ton of stress and anxiety for hundreds more people.”

Original story, 6 a.m. Tuesday: San Francisco officials are expected to find out this week whether federal regulators will allow the city to continue postponing the transfer of patients out of Laguna Honda Hospital.

An extension would allow patients and their families to breathe a temporary sigh of relief, just days before the recently decertified hospital could be required to resume relocating its more than 550 remaining charges.

Regulators paused their initial transfer requirement in July 2022, after reports that some of the 57 patients who had initially been moved from the hospital had died. In total, 12 former patients are confirmed to have died, nearly all of whom had been transferred last year to other skilled nursing facilities.

San Francisco City Attorney David Chiu is now requesting that the pause on transfers extend until at least May 30, 2023, and the status of the relocation plan is scheduled to be addressed at a Board of Supervisors hearing on Tuesday afternoon.

“There is a moral and ethical imperative to not continue the transfers,” said Joseph Urban, a health care consultant whose mother-in-law, Betty Campbell, was a resident at Laguna Honda. “We’re down to the wire again.”

Citing Campbell's frail state, Urban and his spouse turned down the hospital's offer last summer to relocate her. The 86-year-old died recently at the hospital.

Opened in 1866, Laguna Honda is one of the oldest and largest public skilled nursing facilities in the country, treating a wide range of medical conditions including dementia, stroke, mental illness and HIV.

Although the hospital is still licensed, it was decertified last year by the federal Centers for Medicare and Medicaid Services (CMS) for a series of safety violations. That means it is no longer in good standing with government-provided health care options like Medicare and Medi-Cal, which fund medical costs for the vast majority of its patients.

After Laguna Honda lost certification, CMS required the hospital to create and implement a closure plan, including the transfer of all of its nearly 700 patients, many of them elderly and frail.

At the same time, the hospital has been working with consultants to prepare for recertification.

“The focus of this meeting needs to be primarily on how the Board of Supervisors can be a force for protecting the most vulnerable: those who are now residents at Laguna Honda and those of us could need a bed there at any time,” Teresa Palmer, a former Laguna Honda physician and geriatrician, wrote in a letter to the board ahead of its Tuesday hearing. “Administration at Laguna Honda and consultants obviously need more time to ‘turn the ship around.’ In order to prevent death and harm to current and future residents, this time needs to be made available by CMS.”

Last month, the California Department of Public Health fined Laguna Honda $36,000 for providing inadequate care to the patients who died after their transfers. Nearly all of those patients, who ranged in age from 63 to 100, were considered severely disabled, including some who were on feeding tubes, living with dementia or nonverbal, the agency’s citations show.

The citations also noted that the patients who died were identified as “not discharge ready” because they were frail or otherwise not in a condition to be relocated.

The current regulatory crisis facing Laguna Honda began last spring, when federal regulators decertified the hospital after conducting a series of safety inspections triggered by two nonfatal drug overdoses the previous year.

Because San Francisco lacks an adequate supply of skilled nursing options, especially for people who rely on government health care plans like Medicare, most of those 57 patients were transferred out of the county. Two of the patients were sent to homeless shelters after discharge.

In August, city leaders responded to the relocation requirement and subsequent deaths by suing the federal government, arguing that CMS had imposed an arbitrary and unrealistic closure deadline that didn't give the city enough time to appeal the original infractions.

Several months later, however, the city agreed to drop the lawsuit in exchange for federal regulators temporarily halting the transfers and continuing to pay the $18 million in monthly Medicare and Medi-Cal costs for the remaining residents through November 2023.

Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, called out the hurried transfers as a form of abuse and criticized state and federal regulators for pressuring the hospital to carry out the closure plan, despite the severe risk it posed to many patients.

“We call on CMS to stop the Laguna Honda closure before more residents are killed, and the Legislature to investigate CDPH and hold its leaders accountable,” she said.