How did it happen that the nature of the Laguna Honda patient population changed so drastically?
As of 2002 Mayor Willie Brown, the SF Chronicle, and the Chamber of Commerce had been trying to blame escalating social breakdown on District Attorney Hallinan’s supposed leniency. In 2003 Gavin Newsom ran for mayor pledging to end the crisis by providing “Care Not Cash” (a Clintonesque slogan from a Clintonesque politician). To achieve visible results after he got elected, Newsom was enabled by Mitch Katz, director of the Department of Public Health. DPH instituted a “Flow Project” to transfer incorrigible addicts and people with intractable “behavior problems” from San Francisco General Hospital to Laguna Honda. Administrators at the hospital protested that the program would undermine their ability to carry out their primary mission –caring for patients who were severely disabled and/or elderly and incapacitated. Katz, like a two-bit Stalin, replaced them with Administrators from SFGH.
According to a self-congratulatory DPH press release, “Removing barriers that impede patient flow allows patients to be cared for at the proper level of care… In 2004 (January through May), 78 percent of LHH’s patients were admitted to LHH from SFGH, 13 percent were admitted from other facilities and 9 percent from home.”
By February 2005 it was obvious that the “Flow Project” had destroyed the equanimity that once prevailed at Laguna Honda, so Newsom cancelled it – but in name only. The all-important power to decide which patients are manageable at Laguna Honda continued to reside with the San Francisco Department of Public Health (DPH), which owns and oversees Laguna Honda. The hospital’s population had been 54% female. Today it is 63% male.
San Francisco politicians pleaded with the Democratic Administration in Washington to cancel the evacuation order and give Laguna Honda more time to solve its problems. In July City Attorney David Chiu filed a suit to stay the feds’ hand. Mayor London Breed declared, “We are working hard to address issues that have been raised at Laguna Honda, and that important work will continue. But closing this facility and forcing residents and families to go through the trauma of transfers should not be part of that process. This facility provides care and support for some of the most vulnerable people in our City, and that support must continue to keep them healthy and safe.”
San Francisco’s DPH, which is run by Dr. Grant Colfax (formerly of Boonville), has spent $5.6 million on consultants who specialize in helping hospitals pass CMS inspections. The consultants completed a mock inspection last month and Laguna Honda did not pass. A second mock inspection is being conducted. If and when the hospital gets the consultants’ thumbs up, re-certification by the feds will be requested. They may have to ask for another extension.
The humility this woman seemed to exude when she first took office is long gone. Politically she is a Democratic Party hack, in perfect sync with her predecessors Ed Lee, Gavin Newsom and Willie Brown. I was surprised to come across her name when I was writing my disjointed memoir about working for Terence Hallinan some 20 years ago. As his press secretary and “liaison to the medical marijuana community,” I suggested that San Francisco should grow its own to provide medical users with an inexpensive, organically grown supply. The progressive DA was not adverse to the idea. One option I suggested as a site for the grow was Hunters’ Point Naval Shipyard, which had been decommissioned along with Treasure Island and the Presidio.
According to Kayo there had been a divvying up of the spoils, with Nancy Pelosi getting to decide the fate of the Presidio and Willie Brown making the big decisions on Hunters Point. “The Supervisors have some sway on Treasure Island” he said. He wanted T.I. to be the site of housing for those people living on the streets of the city or in vehicles who could fend for themselves, and a mental health hospital for the homeless who could not. I thought his idea was great but the real estate would prove too valuable. Kayo said, “You have no idea how miserable Treasure Island gets when the wind comes whipping off the bay —which is half the time.” He had me draft a press release emphasizing the suitability of T.I. for housing and treatment of San Francisco’s homeless population.
The city’s Treasure Island Development Authority was executive-directed by Annemarie Conroy, a rightwing former Supervisor. Conroy employed the young London Breed as a “development specialist.” Matier & Ross reported in the Chronicle, “Annemarie Conroy, Willie Brown’s commodore of Treasure Island, has two words for District Attorney Terence Hallinan’s much publicized ideas of setting up drug rehab centers out on the island. ‘No dice.’ And those are the nice words…
“‘Here we are, getting ready to hold a pre-bid conference for people interested in developing the island, and he comes out with idea of dumping drug rehab programs out here,’ Conroy fumed. ‘It’s a public relations nightmare.”
“Hallinan isn’t showing any signs of backing down. ‘Annemarie should keep in mind that Treasure Island belongs to the people of San Francisco not the developers,’ Hallinan said. ‘Its use will be decided by the Board of Supervisors not by Conroy or her staff…”
“It turns out that Hallinan’s office leases space out on the island for a check-bouncing program. ‘Those leases are up this week,’ Conroy told us ‘and I’m sending him a termination notice right now. As far as I’m concerned he’s been voted off the island.”
Ol’ Kayo is looking better and better in the rear-view mirror. His plan for a Drug Rehab center on Treasure Island would have obviated the flow of active users into Laguna Honda. The city’s failure to provide adequate drug and psychiatric treatment programs under Brown, Newsom and Ed Lee finally led to the decertification under London Breed.
Mitch Katz, whose MD is in Psychology, left SF in 2010 to run the LA Department of Health Services. Then he tritzed off to New York to become President and CEO of the nation’s biggest public health bureaucracy. Gavin Newsom got elected Governor and aspires to be President of the United States of Amnesia.
Post Script
David Kerr, MD, was working at Laguna Honda in 2004 when newly elected Mayor Gavin Newsom’s Director of Public Health, Mitch Katz, oversaw the transfer of deranged and actively addicted patients from San Francisco General Hospital to Laguna Honda, instead of to the streets or shelters.
Kerr immediately understood the implications of Newsom’s “Care not Cash” scheme. would have on the hospital. He foresaw that a large influx of predominately middle-aged, male intractable drug addicts and patients with serious “behavioral problems” would destroy the calm, quiet atmosphere that had prevailed when the population was the elderly and patients with grave physical disabilities.
Kerr explained in an interview with your correspondent, “The mayor wanted to make sure that the homeless population visibly decreased. One way to do that was: instead of San Francisco General Hospital discharging patients to shelters or to the street, to send them to Laguna Honda. This is what we inferred and it was confirmed by our political allies. Also, the mayor wanted the Health Department to improve its financial balance, and keeping people at San Francisco General was expensive.”
Kerr and a group of colleagues put a measure on the ballot in 2006 that would have restored the right of Laguna Honda doctors and administrators to reject patients they figured would be unmanageable. The entire San Francisco political establishment was in sync with Newsom, except for Senator Leland Yee (an ally of Terence Hallinan’s).
” We were just physicians and we didn’t have a lot of political savvy,” Kerr recalls. “People who knew the workings of City Hall told us that this was driven by the mayor, not by the Department of Public Health.
The Flow Project said “You guys are a barrier to flow, You can’t just deny people because they’re active drug users, or violent, or setting fires. From now on so SF General will define who goes into laguna honda hospital.
Conditions soon got worse and the medical director, Dr. Terry Hill, drew a line in the sand and insisted on the doctors at Laguna Honda making the final decision. In February 2005 Gavin Newsom announced that the Flow Project was going to end, and that Laguna Honda would get to decide who to admit. But then his Department of Public Health fired Terry Hill! The CEO was replaced by somebody from San Francisco General. The COO was replaced by somebody from San Francisco General. The nursing director was replaced. And the admissions coordinator was replaced by somebody from San Francisco General. So the opposition evaporated and the Flow Project really continued. People were afraid they might get fired.
They made some modifications –mainly increased security
FG: When the Medicare inspectors withdrew certification this spring, DPH spent $5.6 million on consultants who could tell them how the place should be run. Isn’t that something the doctors and nurses could tell them? Aren’t there knowledgeable people on staff?
They hired two sets of contractors because Laguna Honda had never before been terminated by CMS. Recovering from termination requires specialized knowledge and these consultants have helped other nursing homes that had lost their accreditation from CMS. It was kind of a do-or-die situation. They didn’t feel they had the expertise to recover on their own.
FG: Could you have done it personally? You and one knowledgable nurse?
DK I would not have gotten into this situation. I would never have admitted active drug users into the hospital. One of their psychiatrists admitted (to the inspectors) that they had a patient who was smoking fentanyl during the psychiatric interview and the patient said “Oh it’s no big deal, don’t worry about it.” The psychiatrist told the inspectors, “I don’t know how to manage this patient.” That’s the problem –they don’t know how to manage these patients– and that’s what got CMS riled up. There were two overdoses which they called “non-fatal” but one of them ended up being sent out and placed on a ventilator. The other one was in the hospital for several weeks with recurrent seizures.
FG. It seems so scary for the old ladies.
DK. That was the problem way back, from the start of the Flow Project. Historically the percentage of women was around 54%. And now it’s 37%.
FG. A feminist issue!
DK. They haven’t said a word. We once got support from the National Organization for Women. They supported the ballot initiative in 2006 because of the violence. There had been altercations in the hospital, staff were threatened. The Union of American Physicians and Dentists also supported us because the doctors had lost their ability to admit patients.
FG. Where was the press?
DK. My recollection is that they did not support our opposition to the Flow Project. They supported the mayor.
FG. What could or should Grant Colfax be doing at this point.
DK. The main thing is: he has to let the doctors at Laguna Honda assess who they can safely manage. This pressure from San Francisco General has to be neutralized.
FG. Could Colfax tell whoever’s doing it to cut it out?
DK Yes, I think that’s the solution. The whole Flow Project has to be reevaluated. Flow is good –you want to get the patients out. But to an appropriate place! And they’ve closed Talmadge and Napa. It has to be clinically appropriate. It can’t just be fiscally driven. The fiscal has to be a secondary concern.
I should also point out that we opposed the Flow Project because it was going against federal and state regulations. You are not allowed to admit somebody for whom you cannot provide adequate care. The Flow Project put us in conflict with CMS by bringing in these active drug users who overdosed, that is a deficiency by CMS standards. And the hospital (SFGH) is saying ‘Well, drug addiction is like that: people use and stop and continue. Well, that’s true. But it’s a violation of CMS regulations.
They got away with it for a long time. CMS brought in investigators and did a lot of surveys but they never shut the hospital like they did this time.
FG: Will they now try to separate the two separate populations?
DK Psychiatric services are not adequately funded by the state. It’s crazy. I don’t understand what’s going on.
FG. I’m afraid that you do, doctor.
