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Letter to the Editor  
Westside Observer
November 2009, at

I would just like to comment on the article “Laguna Honda’s Unkindest Cut”
by Jennifer Serafin

I would just like to comment on the article “Laguna Honda’s Unkindest Cut”, [sic; commas go inside quote marks] by Patrick Manette-Shaw [sic; it’s “Monette-Shaw,” not “Manette-Shaw,” Ms. Serafin], published in the October 2009 issue.  I have worked for over 10 years as a Nurse Practitioner in another Long Term Care facility in San Francisco, and I would like to clarify some of the comments made in the article.  First, there is effort underway in all nursing homes to reduce costs, so Laguna Honda Hospital (LHH) is no exception.  During this economic downturn, most hospitals and nursing homes are slashing staff positions to cut costs.  However, the author feels that these cuts would be detrimental for the types of patients that LHH contains.  He mentions the “Ja Report” is an incomplete analysis, and feels that their data is flawed.  First, [sic; just how many “first’s” is Serafin relying on?  And who’s on third?] there are no studies in any literature that I have read that states that reducing the number of physicians and replacing them with nurses, social workers, and psychologists will worsen patient care, especially in regards to substance abuse treatment [sic; Serafin ignored my October notation that Dr. Paul Katz’s research in the literature that the quality of care in nursing homes is directly linked to physician practice].

Secondly, the article voices concerns that losing staff physicians and using “traveling” physicians instead will cause patients to have to “wait weeks for medical care”. [sic; periods want to be inside quote marks]  Let me assure the public that this absolutely not the case.  While it is true that federally mandated visits (every 60 days) are required if the patient is stable, if a patient becomes medically ill or needs more medical attention, then more frequent visits are warranted, and can be provided by physicians and other health care professionals that come in to the nursing home.  In fact, this is how the great majority of nursing homes across the country operate.  Most nursing homes do not have staff physicians [sic; Serafin failed to note most nursing homes don’t employ seven clinical nurse specialists on staff, as LHH does costing almost $1 million annually; Serafin ignored another $5 million LHH spends on Nursing Administration]; all medical care is provided by outside doctors.  The reason for this is that most physicians bill Medicare/Medicaid directly for their services, and most nursing homes cannot support a large medical group as LHH can.  Therefore, LHH is lucky to have this kind of set-up, as it is expensive, so this is why there is talk of cutting this extra expense out.

I would also like to clear up the concerns the author has about the CNAs in LHH.  First off [sic; here’s another pesky “first,” not followed by a “second”], CNAs are not considered “skilled-care” providers.  Most CNAs train for just a few months to be able to provide care to patients. In fact, the care they provide is the basics, like feeding and bathing, not management of behavioral or substance abuse problems.  On the other hand, nurses, social workers, and psychologists are all positions which require more skill and training, which should improve the quality of care [sic; Again, Serafin ignores that MDs also improve the quality of care] for most patients with behavioral health problems.

With our current health care system, unfortunately cost cutting is a necessary part of life.  However, I do not agree with the author’s comments that losing physicians and CNAs while replacing them with nurses and other health care professionals would be a negative move [sic; Finally, Serafin completely ignores that the U.S. Department of Justice has been continuously monitoring LHH for a decade, since 1998; the DOJ has had concerns all along that the uni-disciplinary “nursing” model of care provided at LHH in past decades may have led to substandard care].

Jennifer Serafin, RN, GNP



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