Supervisors hear update on Laguna Honda recertification, press feds for pause on transfers

The San Francisco Board of Supervisors held a Committee of the Whole public hearing Jan. 31 to review Laguna Honda Hospital's progress toward recertification by the Centers for Medicare & Medicaid Services (CMS) and to consider the hospital's revised closure, transfer and relocation planning.

Department of Public Health officials and Laguna Honda leadership described corrective work underway, while supervisors and advocates urged federal regulators to extend an administrative pause on transfers after earlier relocations were followed by multiple deaths.

Why it matters: Laguna Honda is San Francisco's long-term public skilled-nursing hospital serving people with complex medical, behavioral health and long-term care needs. The facility's CMS decertification in 2022 put roughly $200 million a year in federal funding at risk and led to a settlement that requires accelerated monitoring, a root-cause analysis (RCA) and a detailed action plan with hundreds of milestones to be met by mid-May.

Department of Public Health (DPH) official Dr. Grant Colfax said the department has asked CMS, via the city attorney, to pause transfers and that the city is "hopeful we will have an answer from CMS soon and hopefully before February 3." Dr. Colfax added, "the safety and health of our Laguna Honda residents is our number 1 priority." Roland Pickens, Laguna Honda's interim CEO, described steps the hospital has taken since the April 2022 decertification, including hiring consultants approved by CMS, conducting a root-cause analysis and implementing a corrective action plan with weekly performance indicators.

Pickens said CMS conducted an intensive 90-day monitoring survey in late November–December that identified remaining deficiencies including fire life-safety performance during a live alarm. That finding triggered an "immediate jeopardy" designation that was later removed after the hospital deployed additional expertise and training. "The immediate jeopardy was removed," Pickens said during his presentation.

The root-cause analysis completed by the hospital's CMS-approved quality improvement expert identified eight broad areas for corrective work: quality assurance and performance improvement (QAPI), infection prevention and control, behavioral health and substance use services, medication management and administration, resident rights, individualized care plans, emergency preparedness (including fire life safety) and clinical documentation. Pickens and DPH officials said the action plan addresses each of these areas and that daily and weekly key performance indicators will be published internally and shared with CMS.

Supervisors probed specific dates and remaining risks. Supervisor Matt Dorsey, Supervisor Rafael Mandelmann and others pressed staff on whether the hospital can safely stop transfers and what would happen if CMS declines the city's request to extend the pause. Supervisor Dean Preston asked whether CMS had communicated criteria for any extension; Pickens said CMS was reviewing the city attorney's letter and had indicated it would respond "prior to February 3," but officials did not provide a firm commitment at the hearing.

Numbers and reporting: Supervisors and speakers repeatedly cited deaths that followed earlier transfers. During the hearing Supervisor Melgar said 11 of 41 discharged residents died within weeks of their transfers; Pickens later referenced 12 deaths. DPH and Laguna Honda officials said they have appealed monetary penalties and findings issued by the California Department of Public Health and that they disagree with some state conclusions.

Public comment running more than an hour included family members of Laguna Honda residents, advocates and professionals. Benson Adel, manager of San Francisco's long-term care ombudsman program, said discharge planning in the prior round of transfers was "traumatic" and that some families were pressured to accept the "first bed they can find." Multiple speakers, including long-time advocates with the Gray Panthers, members of HIV and senior advocacy organizations, and DPH union representatives, urged the city not to resume involuntary transfers and called for continued oversight and resources to support staffing and safety.

Board action and next steps: The Board moved to continue the item for additional review. Supervisor Matt Dorsey seconded a motion by Supervisor Gordon? (note: motion made and seconded on the record) to continue the Committee of the Whole schedule; Supervisor Melgar made the formal motion to continue the matter to May 9, 2023. The motion passed 10–0 (Supervisor Ronan absent). The board also recorded that the city attorney had requested a pause from CMS; city officials said they expected a response before the February 3 date but had not received it at the time of the hearing.

Officials said the RCA and the hospital's action plan together include more than 300 milestones that must be met by May 13 under the settlement agreement, and that the hospital will face additional 90-day CMS monitoring surveys in the run-up to that deadline.

What to watch: The Board set a follow-up Committee of the Whole on May 9, 2023, to review progress and the RCA. City officials said they will continue to press CMS to extend the transfer pause and will publish regular performance indicators tied to the action plan. Advocates continue to call for greater transparency about transfers, post-transfer outcomes and the details of appeal filings with state regulators.