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Supervisors press hospitals and DPH for plan after families allege neglect and deaths at transferred subacute unit
Summary
Following testimony by families and advocates alleging inadequate staffing, slow alarm responses and multiple deaths after St. Luke’s subacute patients were transferred to Davies, supervisors directed the Department of Public Health and hospital partners to return with proposals to expand subacute capacity; Milliman presented preliminary findings and DPH aims to produce proposals by November.
The Board’s Public Safety and Neighborhood Services Committee spent the bulk of its Sept. 26 meeting on the shortage of subacute skilled‑nursing capacity in San Francisco and on testimony alleging substandard care after St. Luke’s subacute patients were transferred to Davies.
Supervisor Safaei opened the item recounting community concern after CPMC transferred St. Luke’s subacute patients in 2018 and saying the board had pressed for a long‑term solution. Kelly Hiramoto, a project manager with the Department of Public Health, summarized the department’s work to update an environmental scan and to identify partners and proposals to expand subacute capacity.
Milliman consultant Susan Phillips presented preliminary findings from interviews and data requests. Milliman reported a shortage of subacute beds in Northern California relative to Southern California and said Bay Area counties had limited capacity. The consultant gave a preliminary estimate of roughly 49 discharges in 2018 and reported that wait times for placement commonly averaged “around 30 to 45 days,” with extreme cases exceeding 500 days. Milliman and DPH identified payment (Medi‑Cal per‑diem rates), licensing and staffing ratio rules as barriers to new subacute capacity.
Families of patients transferred from St. Luke’s to Davies described urgent problems. Gloria Rivera, speaking for family members, said "half of the 17 subacute patients that were transferred from St. Luke's died within 1 year" and alleged a pattern of inadequate staffing, untrained float staff, failure to respond to call lights and other quality‑of‑care failures. The California Nurses Association, the Long‑Term Care Ombudsman and other advocates urged that CPMC maintain permanent subacute beds and that the City secure a citywide plan to serve medically frail patients.
Representatives of Sutter/CPMC (Jim Maxude) told the committee that the facility meets state‑posted staffing ratios for the remaining patients, that staff are trained and that recent CDPH survey activity produced no findings. Maxude said privacy rules limit the hospital’s ability to discuss individual patients, and the hospital emphasized quarterly interdisciplinary meetings with families.
Supervisors pushed for more data and for concrete commitments. DPH said it has been in discussions with potential partners: Chinese Hospital (which it said has a 23‑bed unit that could be designated subacute pending state approval and kitchen/capital remediation), Dignity Health (Saint Mary’s) and Kentfield as possible operators or partners, and freestanding nursing‑home operators who expressed interest. DPH and Milliman said they would solicit proposals and hoped to return to the Board with options by November and an implementation plan by December. The consultants suggested a starting target range for city capacity of roughly 49 to 80 subacute beds.
Supervisor Safaei moved to continue the item to the call of the chair so the Board could receive updates; the motion passed without objection. The committee instructed DPH to continue engagement with hospital partners and to report back with proposals and timelines.
