By Thomas K. Pendergast

For the third time in a year, regulatory authorities granted Laguna Honda Hospital a pause in transferring out all of its patients, but with a warning that this will be the last time it will receive an extension.

They now have until Sept. 19 to rectify the deficiencies in health and safety processes.

“Laguna Honda will receive no additional pauses on any aspect of the implementation of its Revised Closure Plan, including transfer and discharge obligations, or any further extension of federal payments,” James Bossenmeyer stated in a May 18 letter on behalf of the Centers for Medicare and Medicaid Services (CMS), which is under the U.S. Health and Human Services Department.

The hospital has not lost its license, but most patients there are covered by Medicare and Medicaid. Both programs terminated the hospital’s participation in April 2022 after CMS decertified it because of deficiencies in safety protocols, improper hygiene practices by the staff and two nearly fatal overdoses from illegal drugs brought into the hospital by patients.

The CMS did, however, commit to giving the hospital financial help in relocating approximately 670 patients by mid-September, 2022.

Coincidentally, the 156-year-old hospital located on a 62-acre campus will be applying for recertification, which is a lengthy process involving multiple surveys.

The hospital transferred 41 patients to other skilled nursing facilities (SNF) and discharged an additional 16 residents. Of those, 12 people died within weeks of being transferred or discharged, so federal and state regulators temporarily paused all patient transfers and discharges.

San Francisco sued the feds for failing to provide adequate time to repeal the original citations. The City and CMS agreed in July 2022 to continue pausing all transfers until Feb. 2.

As part of this settlement, CMS extended Medicare and Medicaid payments for services through Nov. 13, contingent upon the hospital making health and safety improvements.

The CMS agreed to continue pausing patient transfers and discharges on Feb. 1, until May 19.

In its most recent letter, CMS offered to extend Medical and Medicare payments to March 19, 2024, but with the caveat that “CMS will not consider any other amendments to the agreement or any further extensions.”

The letter further stated that after the hospital requested another extension on May 8, they were cited for failing to ensure that one resident with a history of two suicide attempts had an adequate care plan to monitor the patient and provide adequate interventions to address “previous methods of attempting self harm.”

Then the letter stated that the hospital “abated the immediate jeopardy on May 12, and has represented that it is attempting to enact an action plan to correct the regulatory violation.”

“CMS initially endeavored to provide Laguna Honda with its decision on the second extension request by May 8, as Laguna Honda requested. Laguna Honda’s immediate jeopardy violation, however, delayed CMS’s decision on this subject while CMS waited to receive reasonable assurance from Laguna Honda that the facility’s immediate jeopardy had been abated.”

After receiving word of a third pause extension, Mayor London Breed tweeted “Laguna Honda Hospital is essential for taking care of some of our most vulnerable residents. We’ve been working (for) months with state and federal partners to ensure the long-term success of this hospital.

“I want to thank CMS for their partnership and for giving us time to continue our work to keep this hospital open,” Breed wrote.

The hospital is in District 7. The supervisor for that district, Myrna Melgar, has been leading efforts to prevent patient transfers and keep the Medicaid and Medicare money coming.

“I am super relieved,” Melgar said. “I think that after (U.S. Secretary of Health and Human Services Xavier) Becerra came to Laguna Honda, we developed a relationship with him, gained some trust and I think he was blown away when he toured Laguna Honda.

“It didn’t meet what he had in his mind about a failing assisted living facility,” she said. “So I think that after his visit there was a marked change in the communication, the attitude and the cooperation with the (California) State Department of Public Health (DPH).

“And I also have to give kudos to the staff at Laguna Honda and the union because they busted their butts to do all of the things that we needed them to do … because they knew how much was at stake,” Melgar said. “We still have a long way to go.

“But the more important part is that the families have some certainty. Can you imagine if your loved one was there and you’re thinking, ‘Oh my God, they might move my grandma and she might not be OK’? I mean that’s just terrible.”

At an SF Board of Supervisors meeting on May 9, the hospital’s Interim CEO Roland Pickens explained that the settlement agreement requires CMS and the DPH to visit the hospital every 90 days and do a monitoring survey.

Roland said there have already been two such surveys and they expect another one sometime in May or June. They are hopeful they will have a successful third monitoring and will rely on the results of that survey to indicate that sufficient progress has been made and they should, at that point, consider submitting their application for recertification. He estimated that should happen sometime this summer.

Also at that meeting was Dr. Melanie Grossman, president of the Older Women’s League San Francisco, claimed that the root cause of the current situation is systemic, regardless of hospital staff violations.

“Laguna Honda got into trouble because of the ‘flow project’ at San Francisco General. These patients were difficult to place and therefore they were sent to Laguna Honda,” Grossman said. “Now Laguna Honda is in trouble and again, patients are very difficult to place.

“The City for years has allowed our institutions, our hospitals to close their skilled nursing beds slowly but surely. People who cared about the elderly objected but here we are … we have very few skilled nursing beds in the City.

Grossman emphasized the urgent need for skilled care.

“We have our parks. We have our libraries. We have wonderful things in San Francisco, and we should definitely have them,” Grossman said. “But (skilled nursing beds) are for the oldest, the most vulnerable, the most impoverished people in the City who have no place else to go, many of whom are women. We cannot allow Laguna Honda to close.”