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Wednesday, December 29, 2004

THE DANCE OF DEATH TO LONG-TERM SKILLED NURSING FACILITY CARE IN SAN FRANCISCO

A Tsunami Sized Death-Dance Change To Laguna Honda Hospital’s Mission Overturns 1999 Prop A Promises to Voters

By Patrick Monette-Shaw / pmonette-shaw@earthlink.net

[Mr. Shaw is a healthcare accountability activist who has filed a lawsuit seeking to make the City return $25 million misappropriated from the LHH replacement facility budget.]

MISSION CHANGE

On November 11, the www.SanFranciscoSentinel.com web site ran a story titled “Change in Mission at Laguna Honda: Whose idea is it?” I thought then that I suspected who's idea this was; I hoped, simultaneously, that I was wrong. With less than week-old news now in my hip pocket, my first thoughts, based on the Sentinel's coverage, proved true.

Six weeks later, on December 23, a tsunami sized death-dance change to LHH’s mission was announced at the Joint Conference Committee for LHH, a committee comprised of two Health Commissioners and the Executive Committee of LHH. The mission statement change will remove “long term care” as a key component of LHH’s mission, replacing it with a “skilled nursing” mission instead. This represents a major sea change to LHH’s mission, as the two terms are not interchangeable.

Additionally, the LHH-JCC announced that a "compromise" admissions policy for LHH has been completed and approved by LHH’s Executive Committee, but those present December 23 neglected to mention that a bait-and-switch maneuver had taken place over the admissions policy, which bait-and-switch appears to have perhaps been designed to undercut a public interest lawsuit to overturn the policy change.

The mission change was announced just one week after LHH’s new Executive Administrator, John Kanaley, assured neighbors and homeowners at a Town Hall meeting on December 16 sponsored by the Committee to Save Laguna Honda Hospital and Rehabilitation Center that the mission of LHH was not going to change. Surely Kanaley knew of LHH’s changing mission statement even as he attempted to put spin control on the issue at the Town Hall meeting held at St. Brendan’s Parish Hall.

NOVEMBER 2, 1999 ELECTION PROMISES TO VOTERS: LAGUNA HONDA HOSPITAL WOULD BE REBUILT FOR THE FRAIL ELDERLY OF SAN FRANCISCO

In fact, San Francisco voters were promised in the November 2, 1999 voter guide seeking to pass Proposition A to rebuild LHH that the new facility would be used to care for San Francisco’s frail elderly. The voter guide contained 42 paid arguments in favor of the LHH bond measure, 34 of which were paid for by the Committee to Save Laguna Honda (a separate committee from that mentioned above), using funds from the three highest contributors to the 1999 Committee: SEIU 790, the Residential Builder’s Association PAC, and Dr. Mitchell Katz, Director of Public Health.

Throughout those paid arguments in favor of the rebuild, San Franciscans were told repeatedly that LHH would be rebuilt for frail “elderly” (24 such mentions), would be used for people with “disabilities” or the “disabled” (12 mentions), would continue the “medical” model focus (14 mentions), would be used for long-term care (13 mentions), would be used for “seniors” (7 mentions), would be rebuilt with 1,200 beds (4 mentions), would provide “skilled nursing” (9 mentions), and would continue to be used as a nursing home (2 mentions). These various assertions created a “compact” with the voters, who were led to believe that the assertions being made in the voter guide were part and parcel of what was being voted on. It was these assertions, among others, that convinced voters to overwhelming approve the bond measure known as Prop A by 73% of the electorate.

WHO PAID FOR THE PROMISES?

And it wasn’t just anybody paying for those assertions, it was prominent San Franciscans the voters were trusting. Former Mayors Willie Brown and Senator Diane Feinstein both asserted LHH would be rebuilt for “long-term care”; so did Congresswoman Nancy Pelosi, the San Francisco Board of Supervisors, and the Health Commission, including current- and then-Health Commissioners Dr. Edward Chow, Roma Guy, and Lee Ann Monfredini. Feinstein, who had two separate ballot arguments, also asserted LHH would be used as a nursing home, and as a medical facility. Joining Feinstein, the then Board of Supervisors, along with former Directors of Public Health Sandra Hernandez and Mervyn Silverman, also asserted LHH would continue to be a “medical facility,” as did SEIU 790 members Richard Rothman and Laura Blue, an RN at LHH who is currently Chapter President of the LHH Chapter of SEIU 790-Nurses.

WHO MADE THE PROMISES?

The arguments LHH would be used for “skilled nursing” included both the Health Commission, and Melissa Welch, the Chief Medical Officer for the Health Community Network who also served at one point as LHH’s Acting Medical Director. Those arguing that LHH would be used for the “elderly” included the Health Commission; Dr. Katz, as then and current Director of Public Health; Louise Renne, Esq., former City Attorney and now President of the new non-profit LHH Foundation; Robert Haaland, an organizer for SEIU 790 and a recent candidate for the Board of Supervisors; Ms. Blue; and the Golden Gate Restaurant Association, a key backer of Mayor Gavin Newsom.

Finally, those arguing LHH would be used for people with “disabilities” — in the classic sense of physical disabilities, not drug addiction, homelessness, or social adaptation problems — included, among others, the full Health Commission, Rothman, Haaland, and Blue. Implicit, or implied, promises to rebuild LHH with 1,200 beds were made by the full Board of Supervisors, Pelosi, and Sal Rosselli, Executive Director of SEIU 250.

UNILATERAL 2004 MISSION CHANGES MADE WITHOUT VOTER CONSENT

Fast forward to December 2004. Now we are told that LHH’s mission, which voters were lured into believing in 1999 included providing long-term care for frail, elderly, seniors and those with “traditional” disabilities using a medical model approach has suddenly had its mission changed by a small tribe led by Health Commissioner Jim Illig, who has been asserting for now a full year that Laguna Honda’s Hospital mission would indeed change.

Despite John Kanaley’s spin-driven assertion to homeowners and neighbors of LHH at the December 16, 2004 Town Hall meeting that no such plot was afoot, the change in LHH’s mission has come to pass, barely a week after Kanaley’s bald-faced assertion nothing of the sort was being planned.

After Kanaley announced on December 23 LHH’s mission statement change — contradicting his December 16 statements to homeowner neighbors surrounding LHH’s property — and that a planned retreat of LHH’s Executive Committee in January will further consider changing LHH’s mission due to matching the hospital’s budget to its mission, Commissioner Illig asked if everyone was “happy” with the mission change. The Executive Committee nodded its unanimous consent: Everyone is happy they’ve now succumbed to Health Commissioner Monfredini’s “get on board this train, we’re leaving the station” metaphor she announced at the October LHH-JCC meeting Fait accompli!

More despicably, and more ominously, during the December 23 LHH-JCC meeting, there was an announcement three LHH bodies — the Medical Staff, the Medical Executive Committee, and the hospitalwide Executive Committee — have now approved yet another change to LHH’s admissions policy.

MORE UNILATERAL MISSION CHANGES WITHOUT CONSENT OF MEDICAL STAFF

For almost a year, an intense battle over LHH’s improper admission policy change has been waged. Dr. Katz unilaterally changed the admissions policy on March 2, 2004, without seeking required permission from LHH’s medical staff to do so beforehand. Due to improprieties in the March 2 version, DPH issued a modified version on June 10, 2004. On June 24, 2004, then Supervisor Tony Hall called into question Dr. Katz’s decision-making abilities in light of Katz’s unilateral decisions. As a result, a citizen-taxpayer lawsuit filed was by Michael Lyon in July 2004 seeking to overturn and vacate the admission policy changes.

CITIZEN-TAXPAYER LAWSUIT FILED TO OVERTURN ADMISSION POLICY CHANGES

Just before Lyon’s lawsuit was to be heard in Superior Court on December 13, LHH mysteriously changed the proposed policy back to its original pre-March 2004 wording.

Lyon had alleged that only the hospital’s Executive Director could be the final arbiter of any disputes over potentially dangerous and unsafe admissions of behaviorally disturbed patients, and

That the policy of placing both people at home awaiting admissions on an equal footing with patients at SFGH as a two-bullet point category of the first priority for admission to LHH was improper.

BAIT AND SWITCH TACTICS

Somewhere between late November and December 3, LHH posted to its intranet an admissions policy change, which, in hindsight, appears to have been nothing more than a bait-and-switch tactic.

When the change back to the original version of the admissions policy was discovered on or about November 30, Lyon and his attorney withdrew Lyon’s lawsuit on December 3, thinking the Superior Court would rule that DPH had complied with the specifics of Lyon’s complaint, by returning LHH’s admissions policy to its pre-March 2004 status.

But a mere 13 days after Lyon’s lawsuit was withdrawn – and dated exactly with the same date as the December 16 Town Hall meeting organized to oppose LHH’s changing mission and planned downsizing — LHH reached a new “compromise” with Teflon Dr. Katz, who has all along improperly insisted that as Director of Public Health he has the final authority of which patients will be admitted to LHH.

PUBLIC HEALTH DIRECTOR, MITCH KATZ, TAKES “FINAL AUTHORITY”

And in the new (final?) version of the “compromise” policy that Health Commissioner Illig has had a strong hand in influencing, we suddenly see a brand new paragraph, granting Dr. Katz “final authority” to resolve any problems in admission decisions that are not resolved between LHH’s admitting physicians and LHH’s Executive Administrator, Mr. Kanaley — the latter of whom is desperate to please his boss, Dr. Katz, at all costs in order to keep his new job. The new paragraph of December 16 granting Dr. Katz his long-sought authority, which appears to continue to contradict State law, regarding medical staff autonomy from undue pressure, also eliminates both the June 10 and the nebulously dated late-November versions of the admission policy, in which both versions asserted that it would be the LHH Executive Committee — not Dr. Katz — who would resolve any “perceived discriminatory admission policies.”

DISCRIMINATORY ADMISSIONS POLICIES?

Indeed, the paragraph entitled “Resolution of perceived discriminatory admission practices” noted in the June 10 and mid-November versions of the admission policy has been wordsmithed to read “Resolution of problem screening and admissions,” possibly in order to exculpate Dr. Katz from future claims his admission decisions to LHH may be, in fact, discriminatory.

DANCERS OF DEATH

So who has changed LHH’s mission and the patients who can be safely admitted? Well, there’s a few key dancers named in this story who cannot be separated from the dance. It’s known as the “Dancers in Death of San Francisco’s Long-Term Care of Our Frail Elderly.”

The next dance, perhaps a waltz, will be the change in LHH’s mission from long-term care to “social rehabilitation of the urban poor,” instead. Stay tuned for more about this rapidly-changing dance designed to facilitate Mayor Newsom’s quest for re-election as “the mayor who ended homelessness,” and who ended our focus on long-term care for frail elderly San Franciscans. Since Newsom — supervisor for seven years and mayor for one — remains speechless on his “vision” for LHH’s mission and future, while he continues to search for clues that are readily available to everyone else, we’re going to have to rely on the news that broke on Thursday, December 23: That the LHH-JCC and LHH’s Executive Committee has decided LHH’s future and mission without Mayor Newsom having uttered a single word, with District 7 Supervisor Sean Elsbernd’s potentially complicitly abetted silence.

So goes the dance of death to long-term skilled nursing care in San Francisco. In its wake, we will likely get short-term care instead ... while Katz remains water-boy to the Mayor, while Monfredini waltzes with Illig, and while Guy boogies down with Chow — all henchmen to one another beheading long-term care to San Francisco’s aging baby boomers, just as Bush is about to behead Social Security for the elderly. Same theme, different dance, same music (albeit, a different stanza).

We can’t separate dancers from their dance, any more than we can separate a sea change facing California’s coastline. Or any more than we could stop a tsunami’s death dance from hitting LHH’s long-term care shores.

Knowing some of the dancers, and suspecting that an impending tsunami-size train wreck may soon hit our shores, might we succeed in stopping them?

I remain hopeful,

Patrick Monette-Shaw


Saturday, December 25, 2004

UPDATE: SEDUCED AND ABANDONED

MAYOR GAVIN NEWSOM AND PUBLIC HEALTH DIRECTOR MITCH KATZ CONTINUE TO OVERRIDE THE WILL OF SAN FRANCISCO VOTERS TO FUND LAGUNA HONDA HOSPITAL FOR THE FRAIL ELDERLY

Against the will of San Francisco voters, elderly female San Franciscans are being forced out of County for skilled nursing facility care.

According to an unnamed source, a recent bed count by admitting physicians at Laguna Honda Hospital reveals a “significant drop in admissions of people over 70, especially women” in the past year. There is a corresponding shift representing “a significant rise in admissions of people under 60, especially men. Women’s beds are being changed over to male beds.” These admissions especially represent patients who require hospital care to heal from traumatic wounds or physical complications resulting from alcoholism.

Such an admissions pattern shift benefits San Francisco General Hospital by freeing up more beds in that facility. It does not benefit elderly San Francisco females who, as a consequence, are forced out of the City and County of San Francisco to find nursing home placement elsewhere.

In addition, compared to previous years, fewer Chinese elderly are being admitted to Laguna Honda Hospital. They tend to end up at Chinese Hospital and St. Francis Hospital instead of San Francisco General Hospital whose patients get admission preference at Laguna Honda.

In place of the “medical/protective care” model traditional for the frail elderly, a new "social rehabilitation" model is being introduced at Laguna Honda Hospital targeting an under-60 population.

The unnamed source sees social rehabilitation programs as a way to facilitate people reaching their full potential.

However, they worry that the reasonable expectation of Laguna Honda Hospital as a place for all San Franciscans is being undermined.

They fear that Laguna Honda Hospital has suffered by becoming “an extension of the defunding of public health” to make San Francisco General Hospital run “efficiently.”

They express concern that, without asking anyone, Mayor Gavin Newsom and Public Health Director, Mitch Katz, et al, have decided that, even though in 1999 voters approved a $300 million bond measure, San Francisco cannot afford to provide protective skilled nursing facility care for its frail elderly.

Sunday, December 19, 2004

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