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June 2012 at

Laguna Honda Hospital Book Review
Errors Haunt “God’s Hotel”

by Patrick Monette-Shaw

One wonders whether God’s Hotel — just published by former Laguna Honda Hospital physician Victoria Sweet, MD, PhD — uses LHH as a backdrop to illustrate her career, or to lament the loss of long-term care skilled nursing beds, a necessary component of the “Slow Medicine” she advocates for.

While in many places the book is insightful, to those who worked there and know the hospital’s history intimately, the book’s omissions and factual errors are disturbing.

Glowing reviews of God’s Hotel have appeared in publications ranging from the Wall Street Journal, to the Boston Globe, to the Huffington Post. But those reviewers hadn’t witnessed events that transpired at Laguna Honda as this reporter has for 13 years, and aren’t aware of key errors in, and omissions from, God’s Hotel.

Aware since May 2010 Sweet’s book was in development, during an invitation-only April 28, 2012 book launch party this reporter was startled when Dr. Sweet indicated — literally while passing — “Patrick, I hope you won’t be too disappointed by what I left out,” (or words to that effect).

I wondered: Why had Sweet anticipated disappointment?

The book is an amalgam — part memoir, part a story involving Sweet’s journey acquiring a PhD in the history of medicine, and part an extended Op-Ed arguing for a return to “slow medicine” — set against a backdrop of a very selective history of nearly two decades of patients and staff at Laguna Honda as it was transformed from a “medical model of care” for poor, safety-net patients to a “social rehabilitation model of care” for San Francisco’s homeless.

A central character in God’s Hotel — a title taken from the French “Hôtel-Dieu,” a Middle Ages “almshouse” taking care of the chronically disabled — is twelfth-century mystic, nun, and medical practitioner Hildegard von Bingen, whose idea was that human bodies are more like a plant to be carefully gardened, rather than a machine of broken parts. Sweet’s premise is that doctors should be more like gardeners than mechanics, and that many non-desperate illnesses might be better treated by Slow Medicine, by nurturing viriditas, the natural greening power of healing.

Throughout the book, Sweet offers many insights that take your breath away. In one patient vignette about having an accurate diagnosis, Sweet notes she saved the healthcare system approximately $400,000 by making the correct diagnosis that an artificial hip had been dislocated from its socket, detected by a relatively inexpensive X-ray. “If doctors were going to held accountable for [healthcare] costs,” Sweet writes, “why shouldn’t we get some kind of credit for savings?”

In another vignette, Sweet acknowledges that “almost every patient I admitted had incorrect or outmoded diagnoses,” often taking medications for diagnoses they didn’t have and placing patients at risk for adverse outcomes. Many of the misdiagnoses Sweet attributes to over-zealous medical student interns at San Francisco General Hospital, who are apparently never held accountable for misdiagnoses that drive up healthcare costs and endanger patient outcomes.

She wonders how outcomes might be improved with correct diagnoses, instead of incorrect ones, and visits to emergency rooms avoided if doctors are provided sufficient time to spend with patients. These insights — and others — make God’s Hotel an important read.

But maddeningly, although Sweet acknowledges Hildegard “took care to mention dates in her writing … to preserve her work for the future,” Sweet avoided including any dates throughout God’s Hotel’s 348 pages (although a few dates do appear in the end notes at the end of the book), making it all but impossible for readers to place events at LHH and during her PhD studies into perspective. How could any historian with a doctorate in medical history write a book with no dates documenting a hospital’s history?

From the vignettes, Sweet concludes LHH’s three principles are “hospitality,” “community,” and “charity.” She relates these principles by examining the etymology of many Latin words, including curare, splitting cure (doctors) and care (nurses), that has long fueled a battle for command and control of hospitals. Which model — care (nurses) or cure (doctors) — would triumph at Laguna Honda?

Sweet notes that during the French Revolution, medicine began to change; doctors wanted control of the Hôtel-Dieu in Paris to correlate medical treatments with patient outcomes. The nuns, of course, objected on moral grounds that using patients as experimental things was a bad idea; they protested, refusing to serve under the doctors and refusing to leave. Eventually, administration rescinded its order giving doctors control, returning control of the Hôtel-Dieu to the nuns providing nursing, until they left after it was secularized in the 1900’s.

Much of Laguna Honda’s history during the past 20 years parallels the same battle for control, a feud between doctors, nurses, and administration played out in most hospitals to this day. For her part, Sweet acknowledges the dynamic between the Nursing, Hospital Administration, and Medicine departments needs to be kept in close check to advance optimal patient outcomes.

In a long vignette about a patient with transverse myelitis, an inflammation of the spinal cord, Sweet’s point of view changed from focusing on her patients “vaguely surrounded by his environment.” Instead, she stepped back and learned to focus on the environment surrounding her patients, asking herself when anything interfered with her patient’s natural healing powers and their environments, what she could do to remove it.

Throughout the book, it becomes clear that Sweet didn’t venture into the political environment at Laguna Honda, and didn’t become involved in efforts to stop the transformation of its medical model of care, or efforts to permanently alter LHH’s environment.

Sweet acknowledges that the same disability rights activist lawyers who disastrously shut down state mental hospitals around the country are now the same people hell bent on shutting down skilled nursing facilities caring for the frail elderly. Their test case was shutting down Laguna Honda Hospital.

Sweet erroneously reports that just after John Kanaley was appointed as Laguna Honda’s Executive Administrator in 2004, Sister Miriam Walsh requested a meeting with him. In fact, within the first month of his tenure, Kanaley summoned three vocal LHH staff members to his office in a bald attempt to exert his authority. None of the three had requested meeting with him.

First, he summoned Sister Miriam Walsh to his office for a discussion about her advocacy against the “flow project” involving the transfer of psycho-social patients from San Francisco General Hospital to LHH. When asked what Kanaley wanted, Sister Miriam reported “He wanted me to agree to a deal to keep Laguna Honda’s name out of the media and asked me to pipe down. I told him, ’No deal,’ and that was the end of the meeting.“

In short order, Kanaley summoned Dr. Maria Rivero and this reporter, separately, to his office for the same talk, and we both essentially told him the same thing: “No deal.” Kanaley’s attempt to bully vocal staffers by intimidation set the tone for the duration of his bull-in-a-China-shop administration.

In another act of bullying, in June 2008 — following Sister Miriam’s May 2008 Westside Observer article “Farewell to Laguna Honda’s Clarendon Hall” — Kanaley wrongly accused this author of abusing Sister Miriam as a frail, elderly woman to advance my political and personal “gain,” because he falsely assumed I had written her article, which was a complete lie.

Many Minor Errors …

There are a host of other minor errors.

… Along With Many Major Errors

There are other major errors too long for this review.

Glaring Omissions

Nowhere does Sweet delve into the LHH public relations director’s spin control “deconstruction”; he’s the guy who claimed “LHH’s patient gift fund isn’t for patients.” Marc Slavin was hired in 2007 to squelch “negative publicity about LHH” to help out his benefactress, former City Attorney Louise Renee, now head of the Laguna Honda Foundation non-profit that refuses to release any details of its income and expenses, a fact Sweet must have know about for years, but doesn’t address.

To her credit, Sweet does acknowledge that San Francisco mounted no legal defense against either the Davis lawsuit or the Chambers settlement agreement; the City, with Slavin’s help, simply capitulated to the disability rights activists intent on shutting down Laguna Honda Hospital, contributing to the abuse of this civic institution.

Slavin is reportedly pursuing a PhD degree. While Sweet rightfully wonders about efforts to re-brand a public hospital with a new name that Slavin had proposed eliminating “hospital” from, she doesn’t wade in to whether Slavin’s marketing efforts over the years are designed to re-frame, for advertising purposes, that LHH can be used for just about anything, perhaps part of his pursuit of a PhD. He and Renne are at it again, now trying to “re-brand” LHH’s patient auditorium into a revenue-generating community theater to support Renne’s non-profit Laguna Honda Foundation.

Sweet never addresses LHH Administration’s ascendancy under Slavin, and the negative impact Administration has had on patient outcomes, while casting Nursing and Medicine asunder.

God’s Hotel is certainly no match against Slavin’s considerable skills in on-going deconstruction, and may be too little, too late to stop the transformation in how we provide “slow medicine” to care for the sick poor.

Despite errors haunting God’s Hotel, it may still be worth a read.

Monette-Shaw is an open-government accountability advocate, a patient advocate, and a member of California’s First Amendment Coalition.  He received the Society of Professional Journalists–Northern California Chapter’s James Madison Freedom of Information Award in the Advocacy category in March 2012.  Feedback:  


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