June 2012 at www.WestsideObserver.com
Laguna Honda Hospital Book Review
Haunt Gods Hotel
by Patrick Monette-Shaw
One wonders whether Gods 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
hospitals history intimately, the books omissions
and factual errors are disturbing.
Glowing reviews of Gods Hotel have appeared in
publications ranging from the Wall Street Journal, to the
Boston Globe, to the Huffington Post. But those
reviewers hadnt witnessed events that transpired at Laguna
Honda as this reporter has for 13 years, and arent aware
of key errors in, and omissions from, Gods Hotel.
Aware since May 2010 Sweets 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 wont 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
Sweets 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 Franciscos homeless.
A central character in Gods 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. Sweets 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 shouldnt
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 didnt 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
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 Gods 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
Gods Hotels 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 hospitals
From the vignettes, Sweet concludes LHHs 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 1900s.
Much of Laguna Hondas 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, Sweets 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 patients natural healing
powers and their environments, what she could do to remove it.
Throughout the book, it becomes clear that Sweet didnt
venture into the political environment at Laguna Honda, and didnt
become involved in efforts to stop the transformation of its medical
model of care, or efforts to permanently alter LHHs 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 Hondas 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 Hondas name out of the media and asked me to pipe
down. I told him, No deal, and that was the end of
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.
Kanaleys 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
Miriams May 2008 Westside Observer article Farewell
to Laguna Hondas 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
Many Minor Errors
- In the chapter Wedding
at Cana, Sweet describes the wedding of two patients
the Teals in LHHs chapel, comparing
it to Jesus first miracle, the transformation of water
into wine at a wedding in Cana. From this, Sweet concludes
quite ironically that Laguna Hondas second principle
Sweet asserts almost all of Laguna Honda poured into
LHHs Chapel for the Teals wedding, but observers
report that attendance was actually quite low. Some observers
wonder whether the stretched attendance was carried over into
other areas of Gods Hotel for literary effect. The
exaggeration, in itself, wasnt terrible, but why do it,
But the irony is that the low turnout may have been because most
staff at LHH were painfully aware that Bride Teal was, in fact,
already married to another man; many staff may have stayed away
from the wedding, not wanting to witness polygamy being blessed.
Why a minister was brought in ostensibly with LHH administrations
approval to conduct marriage vows for a woman already
married amounted to sanctioning polygamy. Bride Teal didnt
want her family to know about her latest wedding. Rather than
providing her with a reality check that she could have a party
with her new love, but couldnt throw a full-fledged wedding
because she was already married to someone else, a handful of
staff chose to enable Bride Teal, fueling her fantasies.
Could Sweets new definition of community involve
polygamy? Why did Sweet choose this story to illustrate community,
when there were so many other examples of real community at LHH
that she could have drawn from?
- Sweet reports that voters passed Prop. A in 1999
to rebuild LHH for $500 million, and that half would come from
a general obligation bond and half from the tobacco settlement
revenue account. This is untrue: First, voters were told the
hospitals replacement budget was $401 million, not $500
million (although the cost overruns 12 years later pushed the
cost to well over $593 million). Second, the bond was for $299
million, and just $100 million was to come from the TSR account,
not half and half.
- Sweet accurately reports there were two committees involved
in the 2006 Prop. D ballot measure: San Franciscans
for Laguna Honda, and the Committee to Save Laguna
Honda. But she misreports that doctors Kerr and Rivero
were members of both committees. This is patently untrue. The
latter committee was formed by this author, Sister Miriam, Virginia
Leishman, LHH resident Robert Neil who was then president of
the Residents Council, and family members of the Traumatic
Brain Injury Support Group. At the time, Kerr and Rivero made
the correct ethical decision that they could not violate their
doctor-patient relationships by joining an advocacy group that
included patients of the facility.
- Sweet asserts the hospitals 1,200-bed replacement plans
had included three identical six-story buildings. In fact, the
third residential tower eventually eliminated was a 420-bed,
seven-story building containing crucial infrastructure elements
like the data center that then had to be shoehorned into one
of the two remaining 320-bed six-story buildings.
- Sweet reports that following a meeting between Sister Miriam
and Mayor Gavin Newsom, Newsom ordered then Director of Public
Health Mitch Katz to halt the many incarnations of the so-called
Flow Project shuttling SFGH patients to LHH. Since
this reporter attended that meeting, I can vouch that meeting
wasnt with the Mayor, it was with his Chief of Staff Steve
Kawa, who has long been considered San Franciscos real
mayor ever since Willie Browns tenure. Earlier, this reporter
had also attended a meeting between Sister Miriam and Mayor Newsom,
which also included former City Attorney Louise Renne
the chairperson of the Laguna Honda Foundation but Sweet
makes no mention anywhere in Gods Hotel about Rennes
meddling in Laguna Hondas affairs.
There are a host of other minor errors.
Along With Many
- When Sweet turned her attention to the U.S. Department of
Justices first letter to then mayor Willie Brown in May
1998, she speculates the DOJ had been tipped off
to investigate LHH. Sweet dissembles, first speculating it may
have been doctors Kerr or Rivero who contacted the DOJ, before
Sweet then speculates it may have been LHHs forty-four-year
Director of Nursing Virginia Leishman who provided the DOJ a
tip, an allegation Leishman adamantly denies. (Leishman has,
reportedly, received numerous calls since Gods Hotel
was published, some encouraging her to consider slander.)
Observers at the time note that it may have been a former LHH
Executive Administrator who may have tipped off the
DOJ if anyone had, since he may have been miffed when plans to
hand him a job converting the Department of Public Health into
an enterprise department that would receive no City
General Fund support fizzled, along with his promised job. Regardless,
there is no proof that the DOJ had received any
tips, and may have launched its investigation simply by reviewing
sentinel event, or annual inspection, reports.
- Referring to the same first letter from the DOJ, Sweet asserts
the DOJ was initially concerned only about LHHs Nursing
department, saying the DOJ blamed Nursing for almost everything,
except LHHs old-fashioned wards and aging infrastructure.
This is also patently untrue. The DOJ, in effect, also blamed
the Department of Medicine which had then rightfully contained
the sub-specialty of physical medical rehabilitation, including
speech therapy, occupational therapy, and physical therapy, all
components of physical medicine for failing to provide
specialized rehabilitation therapy. The DOJ asserted in 1998
that only 50 residents were receiving physical, occupational,
or speech therapy which services require referrals from
physicians to prevent functional decline, failing health,
and premature death.
Speech Therapy, the DOJ claimed, had only assessed one-third
of residents at LHH who were at risk for aspiration, and had
assessed only 70 of 700 residents requiring eating assistance.
As a result of the DOJs claim in 1998, Laguna Honda hired
within a year a new senior physical therapist, an occupational
therapist, and a speech pathologist charged with developing a
functional maintenance and restorative care program that subsequently
hired four therapy aides to implement the program, which initially
proved to be a success. (Unfortunately, that program has fallen
into disrepair, given intermittent curtailment of restorative
care services on long-term care units.) Before each return DOJ
visit across the next decade, LHH physicians increased their
rehabilitation physician orders to avoid further DOJ wrath. That
meant doctors were finally paying attention to writing rehab
The DOJ was also critical in 1998 of LHHs Activity Therapy
Department for not providing meaningful activity needs of LHH
residents. The DOJs concerns werent attributable
solely to Nursing.
- Sweet reduces to a single page the 2006 Proposition D
ballot measure to protect Laguna Honda for the frail elderly
with skilled nursing needs, as voters were promised by Prop.
A in 1999. Sweet wrongly regurgitates with
no critical analysis the lies Prop. D opponents
used to defeat the measure: That the proposition would permit
the Residential Builders Association to build for-profit residential
care facilities on city land, would put a zoning administrator
in charge of making hospital admission decisions, and would require
LHH to discharge 300 Alzheimers and AIDS patients, all
of which were lies.
The RBA had no interest in building residential care facilities.
The land use attorney who crafted the language for Prop. D
being an associate of former City Attorney Louise Renne
who now operates the Laguna Honda Foundation slipped in
arcane language thought required for Planning laws, but was actually
twisted into possibly allowing for for-profit private development.
Nothing in Prop. D allowed for-private development,
but once City Attorney Dennis Herrera wrote that Prop. D
would provide a land grab by private interests, the
lie stuck, despite being a canard uncovered by a respected journalist
who looked into the issue and exposed it to be false.
Worse, lacking further critical analysis, Sweet omitted that
LHHs then Rehabilitation Coordinator was the only LHH staff
member not affiliated with Prop. D who had correctly
noted in 2006 that Prop. D used the exact
same language that was contained in Title 22 and LHHs own
admission policies; he had read Title 22. The dullards running
the anti-Prop. D campaign including the Director
of Public Health Mitch Katz, Mr. Kanaley, Mivic Hirose, and many
MDs on LHHs staff all appeared to have turned
a blind eye to Title 22, as if theyd never read it.
- Sweet doesnt report that in March 2006 despite
a prohibition in San Franciscos Administrative Code Section
12G against using city funds to attempt influencing political
activity, including ballot measures then City Controller
Ed Harrington, City Services Auditor Leticia Miranda in the Controllers
Office, and Health Management Associates employee Nicola Moulton
exchanged a series of e-mails outlining the Prop. D
ballot initiative and themes that might be used to
defeat the measure, including whether 300 Alzheimers and
Parkinsons patients were part of those who would face discharge
if Prop. D passed. Harrington and Miranda had to
have known if Sweet didnt that Health Management
Associates was a contractor receiving city funds who had made
recommendations in 2005 to alter Laguna Hondas service
mix. They also had to have known that using a city contractor
to help develop arguments to defeat a ballot measure clearly
violated Section 12G. Sweet mentions nothing of this.
Nor does Sweet mention that prior to publication of Gods
Hotel, she had to have heard news that San Franciscos Director
of Public Health Mitch Katz had been paid $30,000 over a three-year
period by Health Management Associates, the same firm he had
steered a contract to.
- Sweet reports that Dr. Katz had given Mr. Kanaley an additional
$10 million for more administrative staff, but she
neglected to mention the $10 million was for transition planning
to the new facility, including a host of duplicative doctors
and nurses not administrators to ensure regulatory
compliance. And Sweet omits that much of the $10 million wasnt
encumbered until after the move into the new facility
had been completed; was possibly not used as intended by the
initial earmark; that as of May 2012, only 74% of the $10 million
had been spent; and that the remaining 26% ($2.6 million), had
been cost-shifted to funding facility maintenance contracts,
There are other major errors too long for this review.
- Sweet mentions nothing about the closure of LHHs adult
day health care program, nor does she discuss the loss of 200
to 300 assisted living facility beds planned for the facility.
Nor does she discuss the impact of the loss of LHHs 420
skilled nursing beds on the rest of the city, and its effect
on discharge locations, either. None of this is discussed in
relation to slow medicine.
- There is no mention of the $190 million in cost overruns
of the replacement facility, nor the shoddy workmanship in the
new buildings (mold in the new kitchen is but just one problem)
that will cost additional millions to repair.
- While Sweet acknowledges LHHs current medical director
relocated her offices to the front of the building to signal
that the Medical Staff was falling into alignment with the Hospitals
Administration to transform LHH, Sweet fails to note that this
medical director also jettisoned the medical staffs autonomy
when she permitted Rehabilitation Services whether or
not with concurrence by LHHs Chief of Rehabilitation Services
Lisa Pascual, MD, and LHHs then Rehabilitation Coordinator,
Paul Carlisle to be placed under the auspices of the hospitals
Facility Operations Department. As far as is known, no other
physical medicine rehabilitation department or their parent medical
services department in Bay Area hospitals have permitted being
placed under the control of facilities operations staff.
- While Sweet reports doctors Rivero and Kerr had filed a whistleblower
complaint about abuse of LHHs patient gift fund, Sweet
never mentions that following a long-delayed City Controllers
audit of the gift fund the hospital was eventually ordered to
restore over $350,000 misappropriated from patient benefit.
- Similarly, while Sweet notes that doctors Kerr and Rivero
had authored a brilliant rebuttal to the Davis Ja
report that recommended higher-salaried physicians be replaced
by registered nursing staff, social workers, and psychologists,
Sweet excluded reporting that over 20 physicians at LHH had signed
a letter of support, finding that the Ja report had been illegal,
unethical, and harmful to patients, since Ja lacked professional
qualifications to assess physician services.
- Although Sweet rightfully lambasts in Gods Hotel
the social rehabilitation grant LHHs Executive
Administrator Mivic Hirose secured that became the focus of a
heated, politically charged Board of Supervisors hearing in 2005,
Sweet failed to note that during the final PowerPoint presentation
at the end of the grant, the Nursing Team involved admitted it
had not actually implemented any Nursing intervention
portion of the grant designed to prove to the funding source
the efficacy of social rehab interventions, a glaring admission
Nowhere does Sweet delve into the LHH public relations directors
spin control deconstruction; hes the guy who
claimed LHHs patient gift fund isnt 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 doesnt
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 Slavins
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 doesnt wade in to whether Slavins 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 LHHs patient auditorium into
a revenue-generating community theater to support Rennes
non-profit Laguna Honda Foundation.
Sweet never addresses LHH Administrations ascendancy
under Slavin, and the negative impact Administration has had on
patient outcomes, while casting Nursing and Medicine asunder.
Gods Hotel is certainly no match against Slavins
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 Gods Hotel, it may still
be worth a read.
Monette-Shaw is an open-government accountability advocate,
a patient advocate, and a member of Californias First Amendment
Coalition. He received the Society of Professional JournalistsNorthern
California Chapters James Madison Freedom of Information
Award in the Advocacy category in March 2012.
Copyright (c) 2011 by Committee to Save LHH. All rights
reserved. This work may not be reposted anywhere on the
Web, or reprinted in any print media, without express written
permission. E-mail the Committee
to Save LHH.