Chambers Lawsuit Against Laguna Honda Hospital —
And Why Testimony Is Needed Now

About the Chambers Lawsuit
Disparity Between Current Community-Based Alternatives and Laguna Honda's Skilled Nursing Beds
U.S. District Court Testimony Needed
U.S. District Court Class Action Notice
New Chambers Lawsuit Rebuttal

Residents of Laguna Honda Hospital, former residents of Laguna Honda, family members, and legal guardians and other caregivers of Laguna Honda residents need to write to the U.S. District Court now to support San Francisco’s contention that the City complies with disability rights laws requiring community-based care.

On February 1, 2007, San Francisco's Long-Term Care Coordinating Council (LTCCC) — a policy advisory body who are all appointed by San Francisco Mayor Gavin Newsom — released a document dealing with whether the City's budget process is developing community-based long-term care services for seniors and adults with disabilities. The LTCCC noted that “key factors in determining whether or not the City is providing a real choice of community living alternatives is how existing departmental funds are allocated.”

Given the fact that 92% of the City's current placement options are community-based, and not institutional-based, and since only 8% of the City's long-term care “beds” are in skilled nursing facility “institutions,” it appears the City is complying with the U.S. Supreme Court’s Olmstead decision.  In Appendix B to the LTCCC's February 1 document, the LTCCC noted “The Court cautioned that the ADA [Americans with Disabilities Act] does not require elimination of institutional settings for persons who choose not, or are unable, to be treated in community settings, and that the state's responsibility, once it provides community-based treatment to qualified persons with disabilities, is not unlimited” [emphasis added].

Yet, Elissa Gershon — one of the co-counsels who filed the Chambers case against the City and County of San Francisco and Laguna Honda Hospital — stated during the Laguna Honda Hospital Replacement Project Town Hall meeting on August 15 regarding the Assisted Living Project/Senior Housing plan, that if the City would only build assisted living units elsewhere in the City there would be no need to construct any assisted living housing on the Laguna Honda campus. Gershon’s remarks closely resemble those of Herb Levine, the Executive Director of the Independent Living Resource Center–San Fancisco, who has previously stated that if the City were to build community-based alternatives elsewhere in the City, that there would be a need for zero skilled nursing beds at Laguna Honda.

About the Chambers Lawsuit

The so-called Chambers† case — filed, in part, by Protection & Advocacy, Inc. (PAI), a non-profit agency with responsibility for providing advocacy services, as one of the co-counsel’s — asserts in U.S. District Court that “According to TCM [Targeted Case Management program ordered by the Davis settlement] assessments, the vast majority of the over 1,000 Laguna Honda residents could live at home or in the community if housing and appropriate services were provided to them.”  [For a discussion of whether the “vast majority” of Laguna Honda residents could be discharged to the community, see the article “LHH Releases MDS Data Showing 73% of Residents Have No Discharge Potential” on this web site.]

The Chambers case asserts that the City and County of San Francisco has not attempted to develop a sufficient number of home- and community-based alternatives to Laguna Honda Hospital.

Nothing could be further from the truth.

Disparity Between Current Community-Based Alternatives and Laguna Honda's Skilled Nursing Beds

On April 19, 1999, the San Francisco Board of Supervisors passed Resolution 336-99, authored by then Supervisors Sue Bierman and Mark Leno, acknowledging San Francisco’s commitment to “developing sufficient institutional care [placements], in addition to developing [community-based] alternatives to institutional care for seniors and people with disabilities” [emphasis added]. Notably, then-supervisor Gavin Newsom was absent from the April 19, 1999 Board of Supervisors meeting when the measure passed with nine votes, given two absences.  Resolution 336-99 noted that as early as 1999, San Francisco was already facing “a shortage of quality institutional care services,” and the shortage of skilled nursing care beds in San Francisco has only grown worse since 1999.

The Department of Public Health’s Placement Task Force issued a document in November 2006 titled “Current Levels of DPH Community Placement [Options] for Single Adults,” (obtained as a public record) that lists 8,259 beds available in community settings as of January 2007. Another 1,080 beds have been completed or are under construction by the Mayor’s Office of Housing (MOH), and the MOH has another 995 beds in preconstruction planning, totaling 10,334 community placement options, or 92% of options available to comply with the Olmstead decision. Cutting 420 of LHH’s skilled nursing facility (SNF) beds leaves DPH only 863 SNF beds (including the 780 skilled nursing beds at Laguna Honda currently under construction), or only 8% of placement options, which is insufficient and not the intent of Board of Supervisor's 1999 resolution to build sufficient infrastructure to care for San Franciscans in need of SNF-level of institutional care.

While San Francisco has committed to, and developed, community placement options in order to comply with the U.S. Supreme Court’s 1999 Olmstead decision, an insufficient number of skilled nursing “institutional” beds are available citywide. The Alzheimer’s Association released updated data on March 20, 2007 indicating that 1 in 8 people over age 65, and 1 in 2 people over the age of 85, will face Alzheimer’s by the year 2011. Testimony presented during a May 10 Town Hall meeting organized by community members indicates that by the year 2020, San Francisco will have 12,400 residents with Alzheimer’s, 10,000 of whom will be over the age of 85. Many of the 10,000 Alzheimer’s patients over the age of 85 will most likely eventually need skilled nursing care at some point in their disease progression. If for no other reason, San Francisco needs to rededicate its commitment to people with dementia in need of skilled nursing care.

Although San Francisco desperately needs housing projects of all types, the crisis of an insufficient number of skilled nursing beds, particularly for medically indigent San Franciscans relying on Medi-Cal, is even more desperate. City officials have long known San Francisco has lost 300 skilled nursing beds since 1992 due to nursing home closures. The Health Department projected in 1998 the City would be short 2,380 skilled beds by the year 2020 even if all 1,200 beds at LHH were rebuilt. Between a disputed number of beds that accept Medi-Cal patients and current proposals to eliminate 420 of LHH’s skilled nursing beds by not constructing the West Residential tower, the City may end up 3,767 skilled nursing beds short just 13 years from now in 2020.  When, not if, disaster strikes San Francisco, we’re going to need those 420 nursing beds … and more!

The City’s long-term care ombudsman has reported that between 1992 and 2004, 1,693 new assisted living units were built, although most are out of the financial reach of Medi-Cal patients. Since 2005, many more assisted living and supportive housing beds have also been built, even while San Francisco has lost at least another 170 skilled nursing beds due to nursing home closures between 2006 and 2007 on top of the 300 skilled nursing beds lost since 1992.  So why would the Court consider cutting even more skilled nursing or assisted living beds at LHH simply to appease Protection & Advocacy, Inc. in the Chambers case?

Here’s two tables illustrating the disparity between community-based alternatives and the skilled nursing beds operated by the City:

Additional information can be found in a flyer about LHH’s full 1,200-bed replacement project, and in another flyer regarding planning for the assisted living beds at Laguna Honda.



U.S. District Court Testimony Needed

While the Chambers lawsuit claims that the defendent [the City and County of San Francisco] “is responsbile for securing and/or providing a range of community-based, long-term care services,” the Chambers lawsuit completely ignores that the City has done just that, given the 92% vs. 8% dispartiy between community-based placement locations and the availability of skilled nursing care noted above.

Because people seeking admission to, or retention at, Laguna Honda Hospital will be legally bound by future orders and rulings from the Court in the Chambers case, testimony regarding why those who desire being able to choose care at Laguna Honda should be allowed to do so should be addressed to:

    James M. Emery
    Kathleen S. Morris
    City Attorney’s Office
    City and County of San Francisco
    Fox Plaza
    1390 Market Street, 6th Floor
    San Francisco, CA 94102

with a subject line that reads: “Testimony Regarding Chambers v. City and County of San Francisco, Case No. C06-06346.”  “Talking points” in correspondence with the Court should note the disparities between currently available community-based placement alternative facilities (see above), and the dearth of skilled nursing and affordable assisted living facilities available to medically-indigent San Franciscans who desire skilled nursing level of care, who are relying on Medi-Cal as their safety net, and who have freely chosen to remain at, or be admitted to, Laguna Honda.


U.S. District Court Class Action Notice

Below is a facsimile of a class action notice distributed during the Town Hall meeting held at Laguna Honda Hospital on August15 regarding the assisted living/senior housing plan for the Laguna Honda campus.


The federal court has authorized a class action lawsuit against the City and County of San Francisco on behalf of LHH residents. If you are an adult Medi-Cal beneficiary, and you are now a LHH resident, or were a LHH resident within the last two years, or eligible for admission to LHH or on a wait list for admission, then you are a member of the class and this Lawsuit will affect your rights. This Lawsuit, called Chambers v. City and County of San Francisco, Case No. C06-06346, is pending in federal district court, at 450 Golden Gate Avenue, San Francisco, CA 94102.

The Plaintiffs are asking the Court to find that the City has violated the Americans with Disabilities Act and related laws that prohibit discrimination against people with disabilities. They are also asking the Court to order the City to take steps to ensure that people with disabilities do not have to go to or stay in LHH, if they want to and can receive care in a home or community setting. This Lawsuit does not include any claims for monetary damages. The City contends that it already complies with all disability rights laws requiring community-based care.

The Court desires broad community involvement and invites class members to intervene, consistent with Court rules. The Court wishes to have the benefit of as much input as practical and to give class members a say in any relief that is ordered.

If you have any questions about his Lawsuit or if you wish to provide input on the appropriate relief or remedy, you may contact the attorneys for the parties:
  Attorneys for the plaintiffs:
    Elissa Gershon
    Kimberly Swain
    Elizabeth Zirker
    1330 Broadway, Suite 500
    Oakland, CA 94612
    Telephone:   (800) 776-5746
    TTY:    (800) 649-0154
    Facsimile:    (510) 267-1201
Attorneys for the City:
    James M. Emery
    Kathleen S. Morris
    Fox Plaza
    1390 Market Street, 6th Floor
    San Francisco, CA 94102
    Telephone:    (415) 554-3800
    Facsimile:      (415) 554-3837
Please do not telephone the Court or the Court clerk’s office for information.

If you are a member of the class, you do not need to take any action at this time. You will be informed in future notices of any final orders from the Court and any settlement of the case. If you believe that your interests will not be adequately represented by Plaintiffs’ counsel, you have a right to ask the Court to let you intervene to present any clams you may have. If you wish to intervene, you should consult your own lawyer if you have one.  Please review the contents of this Notice carefully.  
If you are a member of the class, you will be legally bound by future orders and rulings from the Court [emphassis added].

Dated: _______, 2007



Mark Chambers, Woodrow Falls, Jr., M.H., Phillip K., Gerald Scott, Mary T. and the Independent Living Resource Center of San Francisco, et al., Plaintiffs, vs. City and County of San Francisco, Defendant, Case No. C06-06346 WHA.

Page Updated 8/18/07


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