The following testimony was presented at the
October 28, Joint Conference Committee, a body comprsied of two
health Commissioners and the Executive Adminsitration team
at Laguna Honda Hospital. It should be noted that a third Health
Commission, Lee Ann Monfredini, who is not an appointed member
to the LHH-JCC, arrived at this meeting to deliver a veiled threat
to LHH staff to get on board the train, or risk the
train leaving the station without them. The preceived threat?:
Go along, and get aboard, with us or be left in the
train station while we head this train in a different direction!
Derek Kerr, MD, CNA
Attending Physician, LHH Hospice
Agenda Item 8, Public Testimony
In order to optimize our role in the long-term-care continuum, we need to address three "silos" that have recently arisen:
First is the "Other People Silo." We seldom imagine ourselves being sick, vulnerable and bedridden at Laguna Honda. What I learned from former Health Director Dr. Francis Curry, from former Supervisor George Chinn, and from former Supervisor Jose Medina's father - all of whom died with us - is that any one of us, or a friend or family member could end up here. Lately, admissions decisions involving the safety of our patients were made as if they were "other people." That is a silo. It may help to imagine ourselves as needing care at Laguna Honda.
Second is the "Information Silo." Despite unsettling changes over the past nine months, employees have not received information about the plans and intentions of the Health Department. We don't know what's going on. That information is locked up in a silo. Similarly, the collective experience and knowledge of the Laguna Honda caregiver community has not been tapped in the making of big decisions that affect us. So we ourselves are in a silo - without opportunities for input or feedback. Major change, without the understanding and participation of those involved, creates turmoil. It would help if the Health Department attended to the process of information sharing.
Third is the "Silo of Fear." When a process is forced and conducted without information or participation, those affected feel threatened. Especially alarming was the forced resignation of our stellar CEO Larry Funk. Threatened persons are contracted. They are not good care-givers. Care-giving flows best when staff feel safe and valued. Right now, there is fear at Laguna Honda, and I feel badly for our patients. So we need a collaborative process wherein people feel safe, heard, and respected. Anything you can do to open up these three silos will be appreciated.
Maria V. Rivero, MD
Attending Physician, LHH Admitting Ward
Agenda Item 8, Public Testimony
Drastic changes to the mission and patient population of LHH driven largely by fiscal concerns have occurred with the Patient Flow project. The lack of forums for clinical feedback and apparent disregard for our professional opinions during this transitional period has created a perception that the Director of Health and the Health Commission are less concerned about patient safety and quality of care than about dollars and cents.
The dismantling of the top administrative level at LHH has furthered this perception, beginning with the abrupt resignation of Dr Terry Hill after he refused admission to a dangerous patient considered a "test case" by Dr. Jimmy Jones, an arbiter for the Patient Flow project.
This was followed by the deletion of the positions of CFO, Medical Director, and Director of Nursing, as well as a crippling downsizing of executive secretaries and,, finally the forced resignation of our experienced and committed CEO, Mr. Larry Funk.
The announcement of a new CEO came within a day of his resignation, and without a search for candidates with experience in a long-term care environment, and without clinically-based qualifications. This gives the impression that experience commensurate with the position of LHH CEO is expendable. Rather, a novice CEO, who may be unlikely to recognize or act on care issues, is preferable.
Commissioners your action is critical to uphold standards of care at LHH and avert the degradation of this venerable San Francisco institution. A joint LHH-SFGH clinical forum and a Blue Ribbon Commission are needed to review the potential adverse impacts of the Flow Project and the recent sweeping administrative changes.
President, LHH Chapter, SEIU 790-Miscellaneous
Agenda Item 4, Executive Administrator's Report
I am presenting a copy of a petition to Health Commission President Edward Chow with a copy to Mayor Newsom. The petition is signed by 447 employees of LHH who believe Mr. Funk has performed admirably as LHH's Executive Officer, and we believe he should be reinstated as our CEO. Mr. Funk is a nationally recognized advocate for long-term care skilled nursing facilities such as LHH, and is highly regarded nationally for his skills and dedication to SNF's. Mr. Funk has striven to work collaboratively with LHH's staff, and is dedicated to listening to the advice of his subordinates. This petition, like the separate "vote of no confidence" petition languishing on the desk of a City Supervisor, asserts that top management in DPH is unwilling to listen to middle managers and line staff; both petitions reflect that DPH employees are concerned about the management of the Department of Public Health.
Agenda Item 5, LHH Rebuild Project Architect's Report
The LHH Replacement Facility Project Manager, Michael Lane, just indicated that not all of the bids have been received for the 42 bid packages. We were told earlier the bids were due back in mid-October, and here at the end of October, bidders appear to be dragging their feet. Mr. Lane indicated he will present his recommendation on downsizing LHH at the full Health Commission meeting November 16. I am presenting copies of a fact sheet from the Committee to Save LHH, which outlines the plans to downsize LHH from the 1,200 beds promised voters who passed the 1999 Proposition A bond measure for financing the new hospital. This report is posted on the Internet at www.stopLHHdownsize.com. The public is being kept in the dark about the plans to downsize LHH, and are unable to consider carefully the consequences of opening a much smaller replacement hospital. This secrecy must stop.
Agenda Item 6, Operations Report
Mr. Christmas, our COO, addressed the LHH laundry. It is unfortunate that the Replacement Project Manager, Michael Lane has left this meeting after his presentation. I bumped into Mr. Lane at a recent Board of Supervisors Finance Committee hearing, and asked him about the news that the Mayor has indicated the $6 million budgeted for purchasing a building in San Francisco's city limits for the laundry must come from the LHH Replacement Project budget. Lane indicated at the time that he was unaware that the Mayor had indicated the funds were to come from Lane's budget. That $6 million, coupled with the $44 million cost overrun estimate prepared by Turner Construction Company, brings the project shortfall to a staggering $50 million. It seems there is a big pink elephant in the room, and the elephant is the $50 million that this Committee has failed to discuss openly, or at all.
Agenda Item 7, Clinical Care Report
Health Commissioner Monfredini, who is not a member of JCC, indicated the presentation about LHH's role in the long-term care continuum for San Francisco contains too much information and excessive data. She wants it pared down to a "laser-scopic" view when it is presented to the full Health Commission on November 16. Monfredini also issued a veiled threat to LHH staff, claiming the train has pulled into the station, LHH staff must get on board with the changing mission expected by Dr. Katz, because the train is about to leave the station. Has Mayor Newsom, switchman, thrown the switch, diverting the train from going toward a long-term care skilled nursing home, and now the tracks are headed toward solving his homeless problem, instead? If Ms. Monfredini is unwilling to look at the data, then she's heading toward a train wreck like the one that derailed the Mental Health Rehabilitation Facility.
Agenda Item 8, Public Testimony
It's clear the train tracks were diverted from providing a long-term care skilled nursing home and re-routed towards solving homeless issues, but LHH has for 50 years been a medical-model skilled nursing facility. Perhaps the train tracks are now simply not going anywhere, except around and around in a circle, like a toy train under a Christmas tree. The Christmas tree represents the political winds in San Francisco, and under the tree is a present for the Mayor: If he solves his homeless problem, becoming more of a hero, the gift box will be his next political job, as he climbs the ladder to the top of the political tree. But it is time to stop playing politics with both the future of LHH and DPH. These train tracks need to be pointed in the direction that voters in 1999 mandated: Toward a skilled nursing facility for the frail elderly.
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