Laguna Honda Hearing Draws Families, Staff and Officials Over Patient Safety and Admissions

Supervisor Joo convened extended hearings on Laguna Honda Hospital following two recent patient deaths and a state "AA" preventable-death citation, saying the Board must understand whether changes to admissions policy and patient mix have affected safety and whether the hospital's response meets state standards.

Multiple family members described events surrounding deaths and alleged lapses in clinical judgment or communication. One speaker said her aunt was not given a CT scan after a fall despite anticoagulant medication and later suffered a fatal intracranial bleed; another recounted delays securing a physician response and late imaging. Those complaints prompted pleas for investigation and for the Board to secure missing clinical records and timelines.

John Keneally, executive administrator at Laguna Honda, expressed condolences and defended clinical staff. He said the hospital is "committed to building a medical model assisted living facility at Laguna Honda Hospital as part of the continuum of care" and emphasized the facility remains a skilled nursing provider that screens admissions for skilled-nursing needs. He acknowledged community anxiety about patient mix and said that while some residents have behavioral health or substance-use histories, the primary criterion for admission is a skilled-nursing need.

On quality indicators, Keneally presented internal data comparing Laguna Honda favorably with state and national averages on three common nursing-home metrics: falls, use of restraints and pressure ulcers. He said Laguna Honda's prevalence of falls is approximately 6 percent (below national and California averages), restraint use about 2.5 percent, and pressure ulcer prevalence about 9 percent. He reported nursing staffing rose from 3.3 to about 3.8 hours per patient day in recent years and described extensive staff training and performance-improvement processes.

Supervisors pressed for more concrete figures and clarity: Keneally said 57 percent of 2006 admissions came from San Francisco General Hospital but did not have immediate numbers for how many residents are classified as homeless or the precise count with mental-illness diagnoses; he offered to provide those figures. He also acknowledged increases in security measures (cadet staffing at entrances) and an ongoing need for IT and staffing resources, and he described several pending supplemental budget requests and a capital supplemental under consideration.

Public testimony was divided. Advocates and neighborhood groups urged adherence to the 1999 bond promise to provide long-term skilled nursing beds and criticized any shift that mixes acute behavioral-health populations with frail elders. Many Laguna Honda staff, union representatives and volunteers defended the quality of daily care, cultural programs and language services and said staff are committed to residents.

The committee moved portions of patient-specific questioning to closed session and continued both items to the call of the chair while asking Laguna Honda and the Department of Public Health for detailed follow-up reporting on admissions sources, patient classifications, citations history and staffing and budget items.