Rebuttal to the Chambers Case: A Disingenuous Lawsuit If There Ever Was One

About the Chambers Lawsuit
The Chambers† First Amended Complaint
Rebuttal to the Chambers First Amended Complaint
Rebuttal Enclosures:
A. San Francisco Health Commission Resolution 14-05, November 13, 2007.
B. San Francisco Nursing Facility Bed Study, Hospital Council of Northern and Central California.
1. Targeted Case Management Monthly (Summary) Report for August 2007.
2. “Facility Characteristics Report” for Laguna Honda Hospital, July 2, 2007.
3. Targeted Case Management Monthly Report for May 2007, Aggregate Data Report.
4. “Current Levels of DPH Community Placement [Options] for Single Adult’s”.

What follows is a brief summary of the “Rebuttal to the Chambers First Amended Complaint” hyperlinked above, which document is admittedly a detailed analysis of complex issues that involved reading and digesting well over a hundred pages of public records, analyzing extensive data in Excel files obtained under public records requests, and researching data available on the Internet.

Although the six individual Plaintiffs in the Chambers case and one of their organizational Plaintiffs — Protection and Advocacy Inc. — would have the U.S. District Court and the public believe people are unnecessarily being “institutionalized¨ at Laguna Honda Hospital, a November 2007 public records request reveals that fully 68 percent of Laguna Honda’s current residents have resided there less than three years, and fully 82.2 percent have resided there for five years or less.


As shown above, only 76 people — just 7.4 percent of current residents — have resided at Laguna Honda for greater than 10 years; they aren’t representative of, and don’t speak for, the overwhelming majority of people served at Laguna Honda.

Public records also show that in a five-year-and-nine-month period between 2002 and September 2007, Laguna Honda has admitted 3,199 people, and has discharged at least 4,304 during the same period, as shown in Tables A and B, below.

There can’t have been 3,199 admissions to a 1,060-bed facility over a five-year-and-nine-month period without frequent turnover, suggesting institutionalization is not occurring, given the massive number of patients served at LHH. Obviously, LHH is meeting a huge part of the demand for skilled nursing level of level of care.

The Court, and the public, might also take note in a Rebuttal document (on a hyperlink at the top of this page and also available here) that although there were 323 admissions from home that represented only 10.1% of the admissions, fully 34.5% of the 4,304 external discharges, or 1,487 people, were returned to home, illustrating that LHH may be doing everything it can to return people to the community. Contrary to organizational plaintiff Protection and Advocacy, Inc.’s assertion of unnecessary institutionalization, discharges to home are 4.5 times higher than the 323 people admitted from home. LHH is returning more people to the community than it had admitted directly from the community. LHH is clearly needed as a “step-down” facility to transition people from acute hospitals who can’t be discharged directly to home without a temporary short-stay at LHH.

The Chambers Plaintiffs are advocating that Laguna Honda be replaced with far fewer than the current 780-bed replacement project currently under construction.  That would be disastrous for safety-net San Franciscans who rely on Medi-Cal for skilled nursing care at Laguna Honda, as there is a rapidly diminishing capacity of Medi-Cal beds available in San Francisco:

Surely, the Olmstead decision did not intend to disenfranchise San Franciscans of their residency by forcing them out-of-county to receive skilled nursing care.

The Chambers Plaintiffs assert 50% to 70% of potential class members prefer return to the community; assessments of Laguna Honda residents performed by the Targeted Case Management (TCM) program show 49% of 1,626 residents assessed stated a preference for nursing home placement††. You can’t have a class of 70% of people preferring community placement, if fully 49% of the respondents have expressed a preference for nursing home placement. (Notably, three months after its May 2007 Aggregate report claimed 70% of LHH residents preferred return to community, TCM’s August Aggregate report lowers the 70% rate to 68%. and it will likely keep falling as Laguna Honda admits more people over time who have complex co-morbidities and who tend to be sicker.)

Among other disinformation presented in the Chambers First Amended Complaint presented to the U.S. District Court is the misguided assertion that only 3% of Laguna Honda residents have “extensive special care needs.”  In stark contrast, the nursing home comparison feature at “California Nursing Home Search,” a partnership with the California Healthcare Foundation (a UCSF program), notes that (as of 10/7/07), 46.2% of LHH’s residents have “extensive, special care, or complex care” needs, compared to the statewide average of 35.5%, and 35.9% of LHH’s residents have “reduced physical function,” compared to the statewide average of 28.7%, disproving Plaintiffs ridiculous claim that only 3% of LHH residents have extensive special care needs.

Between the Davis case and the Chambers case, a total of 11 of Laguna Honda’s residents appear to have possibly been “cherry-picked” to wrongly allege institutionalization is improperly occurring.  The 11 Plaintiffs across the Davis and Chambers cases represent far less than 1% — indeed, only 0.275%, or just over one-quarter of one percent — of nearly 4,000 patients served at Laguna Honda since 2001.

The six Individual Plaintiffs in the instant Chambers case cannot presume to speak as a “class” for nearly 3,994 other patients served by Laguna Honda since the year 2001.  To assert that these six Plaintiffs presume to speak for nearly 4,000 people is absurdity to the nth degree.

For the reasons presented in the Rebuttal to the Chambers case, the Court should reject certifying as a class action additional Plaintiffs to this case.

If “true choice” is one goal of the Chambers lawsuit, doesn't that imply that institutional-based skilled nursing facilities should be among the choices offered? If so, the District Court should not restrict options that our local jurisdiction may want to consider — including more skilled nursing facilities on land San Francisco already owns — given unique demographics San Francisco faces.


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.

†† Targeted Case Management Monthly Report for May 2007, Aggregate Data Report for the Laguna Honda Settlement Agreement, San Francisco Department of Public Health, Enclosure 3, page 4.

Page Uploaded 11/25/07


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