Article
Westside Observer
December 2009, at www.westsideobserver.com
Déjà
Vu Haunts Laguna Honda
by Patrick Monette-Shaw
When it comes to Laguna Honda Hospital,
community members often experience the illusion they’re reliving
the past, even if it is the first time they’ve encountered
Laguna Honda accountability issues. But the term déjà
vu has evolved to include repetitive events and actions, and
is also used to describe boring familiarity and tedium, along
with repetitiveness. Each of these meanings haunt Laguna Honda’s
house, in part because officials continue to evade members of
the public they ostensibly serve. Let’s stroll down LHH’s
déjà vu lane.
Diversion of Funds: The tobacco settlement revenue
(TSR) account intended to rebuild LHH had previously been raided
of at least $41.3 million: In 2003, former Mayor Willie Brown
diverted $25 million from the TSR account in order to balance
his final city budget. In July 2008, Mayor Newsom diverted $18.3
million in TSR’s to help balance the Department of Public
Health’s budget and to fund new community-based housing subsidies.
Déjà vu:
A new report from the LHH Replacement Project presented to the
Citizen’s General Obligation Bond Oversight Committee on
October 22, 2009 indicates Newsom has diverted another $9 million
in TSR’s to “address unfunded operating costs”
in the Department of Public Health’s current fiscal year
’09–’10 budget. This brings the total of diverted
TSR’s initially earmarked for the LHH rebuild to $50.3 million.
City Controller Ben Rosenfield and Nadia Sesay, the Mayor’s
Director of Public Finance, indicated on October 22 that unlike
other sources of LHH rebuild funds, TSR’s can be diverted
to the City’s general fund.
Changes in Project Scope: Leading up to now, San Franciscans
have seen the scope of the LHH rebuild project reduced in multiple
ways: First, there was Newsom’s decision to reduce the replacement
hospital from a 1,200-bed skilled nursing facility to only 780
beds, cutting 420 beds from the project scope. Then, the Assisted
Living component of the replacement project, which had been planned
to add a continuum of housing for an additional 200 people, was
scuttled from the project. Following that, LHH’s on-site
Adult Day Health Care (ADHC) center was closed, and plans for
LHH’s award-winning hospice was cut by 50 percent, from 30
beds to only 15.
Déjà vu: Fast forward to 2009. Included
in the $9 million of TSR funding reduction are plans to eliminate
space for the ADHC in the replacement facility, meaning that it
is effectively gone. Still unknown is whether LHH renewed its
ADHC’s license by November 15, or whether it let the license
expire, knowing the State has a moratorium against issuing new
ADHC licenses. As well, previous planning to keep a 15-bed hospice
appears to remain on the “project scope” potential chopping
block. In addition, previous “key plans” describing
the use of each floor in the replacement facility had indicated
the “acute” hospital and admitting unit beds would be
located in the residential towers; now they are being moved to
the Rehabilitation unit in what is known as the Pavilion Building,
decreasing the number (scope) of skilled-nursing rehabilitation
beds from 45 to 28. There will be fewer beds available at LHH
for people needing skilled-nursing rehabilitation to recover from
strokes, brain injuries, motor vehicle- and bicycle-accidents,
and cerebrovascular accidents brought on by old age.
Laguna Honda’s annual
report for 2009 posted on its web site reports on page 10 that
up to 45% of its capital construction costs could be paid for
using federal dollars. So if the project may be reimbursed $158
million by the feds for 45% of the approximate $350 million construction
portion of the Laguna Honda rebuild, why is $9 million now being
cut from the project (including the ADHC space), when it could
be reimbursed by the feds? (Note: The total cost of the project,
now being reduced from $593 million to $584 million, includes
approximately $234 million in so-called "soft costs,"
including architectural design and consultant services.) Offsetting
the $9 million in scope reductions eliminating space for the ADHC,
is a déjà vu new increase of $4.6 million in additional
architectural and engineering consultant services.
Failures to Meet With
Neighbors and the Community: Neighbors so concerned
about unilateral changes made by the Department of Public Health
to Laguna Honda’s admission policies and LHH’s “mission”
held a Town Hall meeting at St. Brendan’s Parish Hall on
December 4, 2004. Neighborhood concerns led to the June 2006 Proposition
D ballot measure to protect Laguna Honda residents. Three years
after the defeat of Prop. D, neighbors remained so concerned about
the displacement of senior citizens at LHH needing skilled nursing
care, that they convened another Town Hall meeting held May 10,
2007 at the Forest Hills Christian Church. Neighbors have had
lots of questions about the LHH replacement project over the years,
but all along have received few answers from City officials.
Déjà vu: Late
in the fall of 2009, a small community delegation met privately
with LHH’s new executive administrator, Mivic Hirose, but
again they received few answers to a laundry list of community
concerns. She was subsequently invited to speak at the West of
Twin Peak Central Council’s September 28 meeting, but reportedly
went far over her allotted time discussing her career progression,
issues related to the move into the new facility, and selected
"success stories" of Laguna Honda residents. Legitimate
neighborhood questions remain unanswered, since reportedly Hirose
avoided addressing substantive issues. Taxpayers are increasingly
asking for answers and information, not new-building tours, since
there have been no community meetings held despite the Wide Angle
Communications recommendation in November 2008 that Laguna Honda
should hold more meetings with neighborhoods. A year has elapsed,
and déjà vu, no community meetings have been
held. And no neighborhood newsletters have been distributed, which
Wide Angle had also recommended, despite LHH’s three-member
Communications Department costing nearly $400,000 in salaries
and fringe benefits. The community’s mantra, "Answers,
not tours!" is being ignored.
Continuing Government
Secrecy: A November 3, 2004 meeting scheduled
by the Laguna Honda Replacement Project was suddenly cancelled,
potentially to stifle public debate about the future of LHH. Similarly,
meetings of the Health Commission to discuss LHH’s future
have also been cancelled on short notice, including the then long-awaited
November 16, 2004 full Health Commission meeting at LHH.
Déjà vu: A
Health Commission sub-committee known as the LHH-Joint Conference
Committee inexplicably changed its decades-long monthly meetings
to quarterly meetings in early 2009, shortly before the untimely
death of LHH’s former executive administrator John Kanaley.
It is widely believed that the LHH-JCC, under the stewardship
of Health Commission president Jim Illig, wants to stifle public
comment during its meetings. Illig has made a number of changes
to how the JCC meetings are conducted, and has refused to take
public comment during some of the meetings. So it was another
instance of déjà vu when the long-scheduled
quarterly meeting of the LHH-JCC on October 21, 2009 (that DPH
wrongly then claimed was scheduled for October 28) was suddenly
cancelled and rescheduled to December 9. Why Illig canceled a
JCC meeting just six months before LHH’s new facility is
scheduled to open is shocking. Will the now December 9 JCC meeting
also be cancelled, in another bald attempt to limit public accountability
and citizen involvement?
When the City decided to
change the mission of the Mental Health Rehabilitation Facility
(MHRF) on the grounds of San Francisco General Hospital, a Blue
Ribbon Committee was formed in response. When CPMC announced that
it wanted to change the operation of St. Luke’s Hospital
in the Mission District, another Blue Ribbon Committee on the
future of St. Luke’s was formed. Why is there no Blue Ribbon
Committee being formed to examine the implications of changes
at Laguna Honda Hospital, particularly given the dearth, when
not complete absence, of meetings with the community? (Kanaley
must be rolling in his grave over LHH’s retreat into a bunker
mentality following his death.)
Laguna Honda’s Changing
Mission: Over the years, neighbors and others
have been concerned about Laguna Honda’s changing mission
during the Newsom administration, which the City has adamantly
refused to discuss openly. Beginning in 1999, when LHH’s
elderly residents with chronic and progressive medical conditions
were pushed out to make room for six psychosocial wards, LHH’s
mission to provide long-term care for the frail elderly has been
hijacked by the 2004 "flow project" to move San Francisco
General Hospital’s patients to LHH (which is still occurring
today). This came to a head in 2005 when Mayor Newsom was pressured
into ordering the Department of Public Health to re-instate LHH’s
previous admissions policy.
Déjà vu: The
recent Davis Ja report recommends, among other issues the report
raised, that a new organizational effectiveness consultant review
LHH’s mission — again! Laguna Honda is still an
island of safety for complex geriatric patients who may also have
mental health needs. The pattern of inadequate care for complex
geriatric patients, which is a huge problem, will continue as
long as consultants such as the Ja report’s authors continue
recommending replacing medical care and medical staff with behavioral
care — without adequately evaluating either set of patients
for both their medical care and behavioral care needs. Not surprisingly,
the committee appointed to implement the Ja report recommendations
are also meeting in secret — a Newsomian tradition —
and will likely never hold meetings open to the public.
LHH isn’t talking with the community about any of these
changes. Until the community demands, and gets, an open-to-the-public
Blue Ribbon Committee addressing the future of Laguna Honda, you
can expect that LHH’s roller-coaster déjà
vu track record will continue to haunt it — and us —
with boring repetitiveness.
Patrick Monette-Shaw
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