Executive Memo: Laguna Honda Closure Lays Bare Our Delicate Ecosystem of Care

Conrad Amenta, SFMMS Executive Director

LAGUNA HONDA CLOSURE LAYS BARE OUR DELICATE ECOSYSTEM OF CARE

In April 2022, federal regulators decertified Laguna Honda Hospital and Rehabilitation Center in San Francisco follow-

ing inspections from 2021-2022. The decertification ended Medicare and Medicaid payments, requiring closure of the hospital and the transfer of approximately 700 medically fragile patients, sending shockwaves throughout the community of care in San Francisco and laying bare just how fragile our ecosystem can be.

For those unfamiliar, Laguna Honda has a long and storied history dating back to its founding in 1866, two years before the San Francisco Medical Society, when it was referred to as “the Almshouse.” It was a place of refuge for the chronically ill or impoverished with nowhere else to go. In the 20th Century, Laguna Honda housed a cancer research center and provided occupational therapy. In 1963, it was accredited as a hospital, and today is a hospital specializing in skilled nursing and rehabilitation.

Laguna Honda serves the most medically fragile and complex members of our community, many of whom simply have no place else to go, and as a publicly funded hospital, owned by the City and County of San Francisco and operated by the San Francisco Department of Public Health, Laguna Honda is a glowing but all-too-rare example of how a city can invest in care for its community’s most vulnerable.

When the Centers for Medicare & Medicaid Services (CMS) decertified the Hospital in April and ordered that its patients must be transferred, it set off a frantic search by the Hospital’s staff to find alternative beds. Thousands of phone calls were made. There were simply no beds to be found. Approximately fifty patients out of 700 were transferred to facilities in Contra Costa and San Mateo counties. Some patients landed in homeless shelters in San Francisco. At least four patients died following the transfers, leading to an outcry from community stakeholders and regulators agreeing to a pause in transfers.

San Francisco has been given a brief, nightmarish glimpse of what it would look like if the publicly funded hospital responsible for the most vulnerable patients were to disappear. Patients paid for this perspective with their lives. We must learn from it.

The physician community is already contending with the COVID-19 pandemic, an epidemic of opioid and heroin overdoses, a public health emergency due to monkeypox, all of which are exacerbated by a chronically inadequate housing supply. Vulnerable and complex patients cycle through our emergency medicine departments and criminal justice system, neither of which are designed to link these patients to social services. Many of these patients had been transferred to Laguna Honda Hospital. If you remove the hospital of last resort, failures cascade through the system, and it threatens collapse.

The Medical Society has collaborated with our partners in the community to communicate these and other concerns to CMS and will continue to do so until Laguna Honda is recertified. As of this writing, patient transfers remain paused and the federal payments upon which the hospital relies have resumed. But even if Laguna Honda returns to full capacity in a permanent fashion, we must look at the reality of our health systems squarely. We now know what a world without Laguna Honda looks like, and we cannot allow that to happen again.