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Note:  The link to Dr. Rivero's analysis is a large file (over 1 megabyte). You may want to right-mouse click on that link, save it to your hard drive, and then open it externally from within Acrobat Reader, not through your web browser.

A Committee to Save Laguna Honda Hospital and Rehabilitation Center flyer is now posted to this web site.  The flyer is titled “Rebuttal to Economic Impact of the SFGH to LHH Patient Flow Project” that was presented as part of public testimony during the Friday, February 18 Mayor’s Disability Council (MDC) meeting in San Francisco’s City Hall.

Readers of the San Francisco Chronicle were fed continuing misinformation by Dr. Katz on the same date as the MDC meeting.  In an article by Ilene Lelchuk in the Chronicle on February 18, the esteemed Dr. Katz repeats in the media his assertion that due to the “Flow Project” between San Francisco General Hospital and Laguna Honda Hospital “it's clear the (March) [change to the LHH admissions] policy saves $1.7 million a year.”  While it may be “clear"” to Katz, it’s clear-as-mud to the rest of us.   Often, given Katzian-math, nothing is as clear to the rest of us that seems clear to him.

Katz claims this, despite having been sent on January 24 an analysis by an LHH admitting physician, Dr. Maria Rivero who rebutted the flawed rationale used by DPH Chief Financial Officer Gregg Sass in his December 16 “economic impact analysis” memo [that is also embedded in the Rivero analysis in the hyperlink above].  Rivero notes that, at best, only $510,000 could be saved, not $1.7 million.  Surely, Katz and Sass received Rivero’s analysis, so it is inconceivable that they would ignore evidence to the contrary, and even more inconceivable that Katz continues to raise this untenable assertion, unsupported by evidence-based data. After all, Sass attended the Mayor’s Disability Council meeting in February and heard public testimony that he, Sass, had not examined the expenses side of the equation when he wrote his December 16 memo to Dr. Katz.

While Katz wants “negative publicity” about LHH appearing in the press to stop (for which he is largely responsible for having caused in his own right, since his so-called “critics” would have had no fodder had there not been horseshit to oppose to begin with), Katz has not stopped to consider the likely impact that his spin control of assserting misinformation in the media is contributing directly to the negative publicity about LHH.  You can misrepresent information to the public only so long before they start investigating independently “math challenged spin control.”  Just ask George Bush.

However, neither Sass nor Rivero included new safety-related “expenses” in their respective analysis of the Flow Project, both of which focused only on the “revenue” side of the equation.  The Committee to Save Laguna Honda Hospital flyer noted above included a first estimate of reported expenses for just security personnel alone.  The flyer notes that hiring a reported 14 additional security personnel reduces the $510,000 so-caled “savings” by an additional $675,000, leaving a gap of $165,000 in increased costs (not savings) annually, that will likely have to come from the General Fund.  Clearly, that $165,000 could be used to save other public health programs, such as the $100,000 community-based falls prevention program that Dr. Katz didn’t fund in FY 04–05, when that program lost its grant and may not fund in his FY 05-06 budget submission, despite the fact that falls-related injuries cost the City $57 million a year.  Katz appears to prefer spending at least $165,000 a year for increased security, than to spend $100,000 to reduce the City’s need to dole out $57 million treating injuries resulting from falls.  Just ask Michael Radetsky, who lost his falls-prevention grant that Katz didn’t want to fund, despite the fact that the savings from preventing $57 million in falls could (conceivably) hand Dr. Katz the very savings in funds he needs to prevent cutting other programs in the future.  Duh!

I’d call the $100K to help reduce the $57M in falls-related expenses “math challenged.” Maybe Gregg Sass, or Ed Harrington’s employee Monique Zmuda, if not Ed himself, can weigh in on this conundrum.  Perhaps they’re not as math-challenged as Mitch, dealing day in and day out, as they do, with numbers.

Next, there’s the problem of amortizing one-time start up costs, and possibly cotinuing annual expenses for capital improvement projects to make LHH safe enough for the patient population he had been trying to route to LHH.  First reports are that in the curent, or next, budget period, $150,000 is being planned for capital improvements to LHH's “physical plant” (say panic buttons, increased lighting, new card reader ID access to all exists and entrances at LHH, bubble mirrors, etc.).  Unknown are the coss that will be deferred to a subsequent budget cycle, even before the new replacement facility is brought on line, to improve security at LHH.  Those costs — curent and projected — need to be amortized, and annualized as a cost of doing business for accepting the patients at LHH Mayor Newsom has now deigned inappropriate. The $165,000 annual “gap” resulting from additional security may well soar signfiicantly when annualized capital improvement costs are rightly factored in.  Update: Katz’s FY 05-06 budget submission also includes a new $606,000 behavior health program at LHH that needs to be added in to the expenses side of the equation.)

Pity the poor taxpayers kicking in to the General Fund.  There goes more neighborhood programs, or new cuts to DPH services elsewhere in the system of care.

Then there's the other “math challenged” problem Dr. Katz has.  In the same Chronicle story yesterday, Katz was attributed as saying that there has been “some” behavioral incidents at LHH, but “not a great deal more than usual.”

Hasn’t anyone been sending Dr. Katz any accurate data?  Or does he just not know how to comprehend data that has been made available under public records requests, and reports issued by LHH’s new CEO, John Kanaley, whom Dr. Katz appointed to replace the former LHH CEO?  Kanaley’s background is in hazardous waste removal, so presumably, he knows how to compile and analyze data, assuming that obtaining a degree in such a specialty requires coursework in mathematics.

Data released by Mr. Kanaley — Katz’s hand-picked wizard who has no background in long-term care, skilled nursing environments — indicates that behavioral “incidents” at LHH have doubled between 2003 and 2004, after having doubled in the first month following implementation of Katz’s ill-advised change to LHH’s admissions policy in March 2004 (and has stayed elevated since then).  Moreover, the number of AWOL’s have nearly tripled between 2003 and 2004 (an indicator LHH patients transferred from SFGH simply don’t want to be there), and the number of involuntarily hold discharges under the 5150 program for patients who pose a danger to themselves and others has also nearly doubled between 2003 and 2004, another indicator of “problem behaviors” that Katz wants everyone except the elephant in the room to ignore.  This data was exposed under public records requests, or data Mr. Kanaley has included in his January 2005 “frequently asked questions” document about LHH.

So what is Mitch saying?  That “not a great deal” has changed with behavioral issues at LHH?  For someone math challenged, perhaps doubling of data points isn't a “big deal.” To other community observers, and for long-term care residents who have been at LHH for years, it’s a very big deal.

Meanwhile, several SEIU unions are keeping mum, failing to recognize these disturbing trends affecting the City’s union employees.  Interestingly, neither SEIU 790 nor SEIU 250 became involved in trying to overturn math-challenged Katz’s December 16 admission policy bait-and-switch.  

Sister Mooney, Brother Rosselli: When are you going to take your own math class to get over the Josie-math miscalculations?  How do I explain to the members I represent that 790 did next to nothing to challenge the esteemed, albeit challenged mathematically, Dr. Katz?  How do I tell my members that increasing patient-on-staff and patient-on-patient assaults at LHH aren’t being seriously addresssed by SEIU, after they have payed up to $1,000, or more, in union dues annually?  I pay about $850 annually in union dues, and I’ve been assaulted.  How am I expected to explain to my members SEIU’s inaction?  When can my members expect that SEIU will finally get on board the train to protect LHH employees and LHH residents?

More interestingly, the social rehab grant that had been designed for a “new” changing patient population demographics that directly resulted from the admissions policy the Mayor has now overturned, was reportedly run by the LHH chapter of SEIU 790-Nursing (or so goes the spin control), but was definitely not presented for consideration by the LHH-Miscellaneous chapter (now called the LHH Ancillary Professionals chapter) of SEIU 790 prior to the grant application submission. That grant implied SEIU 790 had signed off on, or had been consulted about, the new programming being introduced at LHH, but as President of the LHH Ancillary Professionals chapter of SEIU 790, I was never approached prior to the grant application being submitted, either in a professional role, or in a union role. (Update: It now turns out that SEIU 790-Nursing was not consulted about the social rehab grant prior to the grant submission, either, calling into question whether SEIU 250 had been consulted, as was also claimed.)

Even widely-respected AIDS physicians in San Francisco are reportedly beginning to raise publicly serious concerns about the veracity of Katz’s AIDS statistics.  Katz — who has published prolifically in AIDS peer-reviewed journals, possibly while on the job as Director of Public Health — must have some grasp of valid mathematical principles.  His grasp and veracity may be being called into question from multiple sectors, just as former Supervisor Hall called into question Dr. Katz’s decision-making skills on June 24, 2004.

For Katz to assert that there has been no appreciable behavioral incidents at LHH as a direct result of his unilateral LHH admissions policy change is laughable.

But Mayor Newsom — who reportedly eats data for breakfast as a side dish to his Wheaties — can’t be laughing just about now.  Not unless Newsom is ignoring the same doubling of statistics that Katz is, since Newsom has met repeatedly with Kanaley, who wouldn’t dare withhold hazardous waste data regarding LHH from the Mayor, even if Supervisor Sean Elsbernd might.  Katz’s unilateral change to LHH admissionss policy is now being viewed widely as having been designed to be part of Mayor Newsom’s Care Not Cash strategies.

It’s incomprehensible that Newsom, who greatly admires Richard Branson, has ignored verifiable data for so long.  Branson’s Virgin Airlines would never have taken flight had Katz been in charge of Branson’s math department.

Which leads me back to my pre-November 2004 election conclusion: Angela Alioto would have been a better mayor.  She likely would have given us the “gay marriage” platform that appears to be Newsom’s sole coat tail, and she may have seriously pondered whether having a math-challenged Director of Public Health was in San Francisco’s best interests.

That Newom keeps Katz on as a department head raises serious questions about Newsom’s capacity to serve at higher elected office, or indeed, in a second term in his current office.  Just ask Sean Elsbernd, who will likely turn out to be one of the few single-term Supervisors in City history.

Ignoring-at-your-peril both accurate data and constituent concerns does not lead to longevity, either as a wanna-be Mayor, or as a wanna-be district Supervisor.

Patrick Monette-Shaw

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