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West of Twin Peaks Observer
May 2008
Should Voters
Trust the Department of Public Health (DPH)?
by George Wooding
The DPH has a terrible history of not delivering on bond promises made to San Francisco voters. The DPH repeatedly convinces voters to approve bond financing for specific projects, and then delivers results far different than plans originally presented to voters. What the DPH doesn’t want you to know is that two previous bond measures provide a great lesson for voters on how it operates with arrogance and impunity.
In 1985, voters approved a proposition authorizing $26 million in bonds to construct a 147-bed psychiatric facility, the Mental Health Rehabilitation Facility, on the grounds of San Francisco General Hospital (SFGH) to keep psychiatric patients in county. Eleven years later, the “MHRF” opened in 1996. By 2003, when the City was facing a huge deficit, DPH proposed closing the MHRF. A “Blue Ribbon Committee” eventually split the three-story building into multiple uses, and today, the MHRF operates only 47 psychiatric beds. Many of its patients were discharged out-of-county.
In 1999, Proposition A voters were told by the DPH that Laguna Honda Hospital (LHH) would be rebuilt as a 1,200-bed, long-term care skilled nursing facility to care for San Francisco’s low income, frail elderly, and disabled populations. Seventy-three percent, or 139,000, of voters agreed to have property taxes increased to rebuild LHH. The Proposition A bond measure is currently $152 million over budget, and two phases of the project yet to be bid may be reduced in scope. Only 780 beds, or two-thirds, of the project will be constructed, when it, too, opens ten years after the bonds were approved.
LHH’s new focus will be for 90-day short-stay and rehabilitation patients. Many LHH long-term patients will be moved back into the community, supposedly to save money. Potentially, there may be no long-term care patients at LHH. The DPH will be forcing LHH residents back into the community or out-of-county, regardless of age, situation, or circumstance. Thirty-year-old drug users will be taking the beds meant for 85-year-old women. LHH is currently in the process of reducing its census from 1,060 to 780 patients, and is taking almost no new admissions.
Sadly, the forced displacement of long-term patients into the community has been poorly planned. No comprehensive studies have been done on the costs, the quality of housing, or the quality of medical care patients will receive in the community. The City has conducted a single financial analysis dated April 2, titled “scattered housing,” which claims it will only cost San Francisco $1,000 per month per resident for community housing subsidies. All other living costs will supposedly be covered by Medicare and Medi-Cal. But Medicare and Medi-Cal are currently planning major funding cuts to San Francisco due to state and federal budget deficits. This is a house of cards; the real bill will eventually be paid for by voters.
As of April 15, the DPH has only been able to utilize 11 of 500 Medi-Cal “super waivers” providing $77,640 in services for LHH residents discharged into the community, due a lack of service providers who will participate in the program.
The DPH has also proposed cutting $36 million to $44.5 million in community-based services to help the Mayor balance the City’s purported $338 million deficit, even as DPH is sending LHH residents back to the community promising they’ll receive community services.
Three DPH employees played key roles in both the MHRF and LHH operational changes: Mitch Katz, Director of Public Health; Marc Trotz, Director of DPH’s Housing and Urban Health; and Liz Gray, who oversaw patient placement for DPH’s Community Behavioral Health Services Division and is now DPH’s Director of Placement.
Between the MHRF and LHH, none of this is what we voted for.
The DPH has deliberately tried to hide these LHH rebuild bond changes from the voters by spending over $200,000 annually for public relations employees, and an unknown amount on an outside public relations firm. The main goals of this public relations campaign are to: 1) Hide from the public what has happened to the LHH rebuild, 2) Hide what is happening to long-term LHH residents being discharged into the community, and 3) Encourage San Francisco voters to pass a $887.4 million bond measure in November to rebuild SFGH, the largest bond measure in San Francisco’s history. The DPH has already spent $25 million dollars on preliminary studies for the SFGH rebuild. Laughably, a final draft report for the SFGH bond measure dated April 1 cites the LHH rebuild as an example of what NOT to do.
The DPH has shown no respect for
the “will of San Francisco voters,” but they will try
very hard to get your vote and your money next November. Please
remember that the DPH needs to be judged on its accountability
to San Francisco voters and its previous bond track record, not
on its public relations campaigns.
George Wooding
Mid-Town Terrace Home
Owners Association