SAN FRANCISCO — The San Francisco Board of Supervisors on Tuesday expressed concern and frustration over potential patient discharges happening once again at the Laguna Honda Hospital and Rehabilitation Center in light of an agreed-upon grace period coming to a close on Friday.

At Tuesday’s board meeting, Laguna Honda interim CEO Roland Pickens laid out the hospital’s progress in reaching federal and state recertification, two days before the hospital may have to begin discharging its patients once again.

The discussion comes after federal and state regulators cited safety concerns at Laguna Honda last April, stripped it of its Medicare and Medicaid provider agreements and required the hospital to move all 700 patients out of the facility by September. Among the concerns were drug paraphernalia in the facility, a lack of infection prevention and control, and missed doses of medication.

Thanks to a settlement agreement initiated by City Attorney David Chiu in the summerthe US Department of Health and Human Services allowed the hospital to postpone patient discharges until February, and the federal Centers for Medicare and Medicaid Services (CMS) agreed to keep funding Laguna Honda, so long as they worked to find solutions to the cited issues .

Days before the no-eviction window closes, city supervisors and health leaders are once again concerned about the dangers of quickly discharging and transferring patients, many of whom have complex medical conditions.

The hospital alleges that of the 57 residents who were transferred into other facilities last summer, at least 12 died within three months.

In response, CMS has issued a dozen citations against Laguna Honda for the deaths, though Pickens alleges that the regulators were partially responsible because of their pressurizing, expedited timeline and lack of guidance.

“We maintain to this day that the best place for those residents [who died] was Laguna, and the best place for the residents at Laguna now is Laguna, which is why we are doing everything we can to ensure that we do not have to resume transfers,” said Pickens.

The organization California Advocates for Nursing Home Reform alleges that Laguna Honda evicted extremely sick patients “known to be at high risk for transfer trauma” to nursing homes outside of the city with “poor track records,” some even being sent to homeless shelters.

CANHR said the series of $3,000 fines were “a mere slap on the wrist for repeated and lethal acts of elder abuse.” They added that federal and state regulators played a “lead role” in the deaths by forcing Laguna Honda to evict patients quickly, without safety in mind.

Patricia McGinnis, CANHR’s executive director, called on the Legislature to investigate the leadership of the California Department of Public Health.

“CDPH must not be allowed to whitewash the deaths of these vulnerable residents and its own role in them,” McGinnis said.

dr Grant Colfax, head of the San Francisco Department of Public Health, said the department has issued a letter to CMS seeking out another pause in transfers, and CMS promised to respond before Friday. Concurrently, Laguna Honda is continuing to make improvements to become recertified, Colfax said.

“While we’ve made great progress over the last six months, and while there is more work ahead, I am confident in our direction,” said Colfax. “As we go through this process, we are again unwavering in our dedication to our residents and their families. The health, safety and well-being of our residents remains our top priority.”

Pickens said the hospital has worked closely with quality improvement experts to identify eight key issues that led to Laguna Honda’s decertification based on regulatory surveys from the past 18 months and developed an action plan to address all the concerns.

Some of the actions Laguna Honda plans to make to achieve the 300-plus milestones needed to reach recertification include creating better individualized care plans for its residents, especially those with mental health and substance abuse issues, creating better infrastructure to prevent residents from bringing illicit materials into the facility, and switching to in-person emergency preparedness drills rather than training their staff via online modules.

Laguna Honda has until May 13 to demonstrate progress toward meeting regulatory requirements before it resubmits its certification application.

“We are hopeful that when CMS comes back for their second monitoring survey, that they will see improvements and that the results will be better than they were for the first survey,” Pickens said.

Supervisor Dean Preston said he felt CMS was acting in bad faith for not responding to a request for an extension on the transfer pause.

“I cannot believe after a dozen people are dead as a result of how this has gone down to date, that CMS is not being more responsive and working with us around an extension,” said Preston at Tuesday’s meeting.

Supervisor Rafael Mandelman said he was “struck” by how much harm the oversight agencies have allegedly caused, and called their leadership “unaccountable” and “disconnected.”

“I’m sure they think they’re just following the rules they’re supposed to follow, but the real-life, on-the-ground impacts of the way in which they are proceeding is causing huge distress and stress, and in 12 cases, deaths,” Mandelman said.

Supervisor Hillary Ronen said CMS’s requests are “truly cruel and unbelievable.” She thanked Laguna Honda staff for “trying to accomplish the impossible” in meeting the regulators’ guidelines without much help.

“They don’t seem to take that into account on how much Laguna has bent over backwards to try to be helpful in resolving the crisis on our streets and with mental illness, that certainly the state and the feds don’t seem to provide any funding nor help,” Ronen said. “This whole thing is just mind-boggling.”

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House Speaker Nancy Pelosi said her husband, Paul Pelosi, was released from the hospital Thursday after his treatment for injuries from a violent assault last week in which he was attacked with a hammer.

Pelosi said, “Paul remains under doctors’ care as he continues to progress on a long recovery process and convalescence. He’s home now.”

Law enforcement officers who responded to the break-in early last Friday witnessed Paul Pelosi being struck in the head with the hammer at least once, according to court documents. Officials said the assault was captured on the officers’ body cameras.

Pelosi was taken to Zuckerberg San Francisco General Hospital. Speaker Pelosi said her husband was grateful to the 911 operator who directed police to the family residence, emergency responders and the entire hospital staff for “their excellent and compassionate life-saving treatment.”

“The Pelosi family is thankful for the beautiful outpouring of love, support and prayers from around the world,” she said.

Paul Pelosi’s release from the hospital comes as a federal official says the Canadian man accused of breaking into their home and attacking him should have been flagged by immigration officials and blocked from getting back into the US after overstaying his authorized entry more than two decades ago.

David DePape, 42, legally entered the United States in 2000 and later left the country and returned a few times, including entering in March 2008 at San Diego’s San Ysidro border crossing, said a US official who spoke on the condition of anonymity because they were not authorized to discuss the matter.

Most Canadians are not required to obtain a visa to enter the US as tourists and can stay for up to six months. The official said it was unclear why US authorities admitted DePape after he overstayed his entry in 2000.

The Department of Homeland Security did not immediately respond to questions about DePape’s entry to the United States after he violated immigration law. It acknowledged in a statement that DePape was allowed into San Diego from Tijuana on March 8, 2008, but didn’t address any other entries.

San Francisco police said DePape confronted Paul Pelosi in the family’s Pacific Heights home Oct. 28 and demanded to know where the House Speaker was. DePape pleaded not guilty to state charges on Tuesday and was ordered held without bail. His public defender, Adam Lipson, said he looks forward to providing him with a “vigorous legal defense.”

DePape faces state charges of attempted murder, burglary and elder abuse. He also faces federal charges including attempted kidnapping of a US official. His state case will continue Friday, though the defendant will not appear in the courtroom. An arrangement on federal charges has not been scheduled.

In the state court filing, prosecutors detailed the attack in stark terms, saying Paul Pelosi, 82, was knocked unconscious by the hammer attack and woke up in a pool of his own blood.

DePape grew up in Powell River, British Columbia, but relocated to California to be with a girlfriend, stepfather Gene DePape told The Associated Press last week. He has three children with two women, he said. Gene DePape said the suspect had lived with him in Canada until he was 14 and had been a quiet boy.

DePape’s ex-girlfriend, Bay Area nudist activist Oxane “Gypsy” Taub, told the San Francisco Chronicle she met DePape in Hawaii in 2000. The pair lived in Berkeley and had two children during their 15-year relationship.

US officials have long struggled to quantify — let alone track down — people who enter the country legally and overstay visas, believed to be about 40% of the population who are in the country illegally.

There were 684,499 visa overstays from October 2019 through September 2020 among visitors who arrived by plane or ship — more than the population of Vermont or Wyoming – according to the Department of Homeland Security’s latest annual report. The total number of overstays is much larger but has not been quantified because it doesn’t include how many people arrive by land, the primary way for Canadians and Mexicans to enter the United States.

The cost and technological hurdles to develop a checkout system at congested land crossings with Canada and Mexico are enormous. In the 12-month period through September 2020, more than 52,000 Canadians who came to the US by air or sea had overstayed their legally authorized entry.

Despite the challenges, the US official said DePape’s overstay should have been noted in immigration records, which, in theory, should have prevented authorities from admitting him.

The post Paul Pelosi launched from hospital per week after assault appeared first on Los Gatos News And Events.

Six days after suffering a fractured skull in a vicious attack, Paul Pelosi, the husband of Speaker Nancy Pelosi, has been discharged from the Zuckerberg San Francisco General Hospital.

Mr. Pelosi, 82, is resting at home, recovering from injuries to his head, arm and hand. He spent most of his time at the hospital in the intensive care unit, according to a person familiar with the matter.

“The Pelosi family is thankful for the beautiful outpouring of love, support and prayers from around the world,” Ms. Pelosi said in a statement. “Paul is grateful to the 911 operator, emergency responders, trauma care team, ICU staff and the entire ZSFGH medical staff for their excellent and compassionate lifesaving treatment he received after the violent assault in our home.”

She added that her husband “remains under doctors’ care as he continues to progress on a long recovery process and convalescence. He is now home surrounded by his family who request privacy.”

A 42-year-old man, David DePape, has been charged by federal prosecutors with attempting to kidnap Ms. Pelosi and assaulting a relative of a federal official after breaking into the couple’s San Francisco home on Oct. 28. He also pleaded not guilty on Tuesday to several state felony charges.

Mr. DePape, who had embraced far-right conspiracy theories, struck Mr. Pelosi with a hammer in front of the police, according to prosecutors, and told investigators that he wished to break Ms. Pelosi’s kneecaps if she “lied” and see her “wheeled into Congress” as a lesson to other lawmakers.

His early morning break-in to the Pelosis’ house, in the upscale neighborhood of Pacific Heights, was detailed in a filing made by local prosecutors this week as they argued Mr. DePape should be detained without bail. On Friday, prosecutors and Mr. DePape’s defense team will appear before a San Francisco judge, who will set a date for his preliminary hearing and a bail hearing.

Mr. DePape, who brought zip-ties and two hammers, smashed through a glass door at the back of the house and confronted Mr. Pelosi, who had been asleep in his bedroom, according to two filings issued this week by state and federal prosecutors . The suspected demanded to see Ms. Pelosi, who was in Washington at the time, according to the authorities.

After some discussion, Mr. DePape allowed Mr. Pelosi to use the bathroom, where Mr. Pelosi called 911, and tried to signal surreptitiously to the dispatcher that he was in trouble while Mr. DePape listened to the call, the prosecutors said. When police officers arrived at the house, they witnessed the two men, who had moved downstairs, struggling for control of one of the hammers.

Mr. DePape pulled the hammer away from Mr. Pelosi and smashed him on the head with it before being tackled and restrained by officers. “Mr. Pelosi remained unresponsive for about three minutes, waking up in a pool of his own blood,” according to the local prosecutors’ filing.

Later, according to the same filing, Mr. DePape told officers that he was there on a “suicide mission,” looking for Ms. Pelosi, and that he had other targets as well: a local professor and several state and federal politicians, as well as their relatives.

“I’m sick of the insane fucking level of lies coming out of Washington, DC,” Mr. DePape told officers, according to the authorities.

Mr. DePape grew up in British Columbia in Canada and moved to California about two decades ago. For years, Mr. DePape was living in Berkeley, Calif., where he was at times homeless, before moving to a garage in nearby Richmond about two years ago.

Mr. DePape was easygoing, quiet and a diligent worker, according to Frank Ciccarelli, a carpenter who employed him for the past six years. But he also began embracing political conspiracy theories and believed that the 2020 election had been stolen, Mr. Ciccarelli said.

A few years ago, Mr. Ciccarelli tried to help out Mr. DePape, moving him off the street and into his friend’s garage. But Mr. Ciccarelli believed that gave Mr. DePape greater access to the internet, allowing him to become more isolated and captive to his darkest thoughts.

Mr DePape appeared to have written a blog filled with rants about the 2020 election, antisemitic beliefs and QAnon conspiracy theories. “He went down the rabbit hole,” Mr. Ciccarelli said.

On Tuesday, Adam Lipson, Mr. DePape’s public defender, signaled that his client’s “vulnerability” to political misinformation and propaganda could be a possible strategy for his legal defense.

“That’s certainly something we’re going to look into,” Mr Lipson said.

Holly Secon contributed reporting.

The post Paul Pelosi Leaves San Francisco Hospital After Assault appeared first on Los Gatos News And Events.

Six days after suffering a fractured skull in a vicious attack, Paul Pelosi, the husband of Speaker Nancy Pelosi, has been discharged from the Zuckerberg San Francisco General Hospital.

Mr. Pelosi, 82, is resting at home, recovering from injuries to his head, arm and hand. He spent most of his time at the hospital in the intensive care unit, according to a person familiar with the matter.

“The Pelosi family is thankful for the beautiful outpouring of love, support and prayers from around the world,” Ms. Pelosi said in a statement. “Paul is grateful to the 911 operator, emergency responders, trauma care team, ICU staff and the entire ZSFGH medical staff for their excellent and compassionate lifesaving treatment he received after the violent assault in our home.”

She added that her husband “remains under doctors’ care as he continues to progress on a long recovery process and convalescence. He is now home surrounded by his family who request privacy.”

A 42-year-old man, David DePape, has been charged by federal prosecutors with attempting to kidnap Ms. Pelosi and assaulting a relative of a federal official after breaking into the couple’s San Francisco home on Oct. 28. He also pleaded not guilty on Tuesday to several state felony charges.

More on the Paul Pelosi Attack

Mr. DePape, who had embraced far-right conspiracy theories, struck Mr. Pelosi with a hammer in front of the police, according to prosecutors, and told investigators that he wished to break Ms. Pelosi’s kneecaps if she “lied” and see her “wheeled into Congress” as a lesson to other lawmakers.

His early morning break-in to the Pelosis’ house, in the upscale neighborhood of Pacific Heights, was detailed in a filing made by local prosecutors this week as they argued Mr. DePape should be detained without bail. On Friday, prosecutors and Mr. DePape’s defense team will appear before a San Francisco judge, who will set a date for his preliminary hearing and a bail hearing.

Mr. DePape, who brought zip-ties and two hammers, smashed through a glass door at the back of the house and confronted Mr. Pelosi, who had been asleep in his bedroom, according to two filings issued this week by state and federal prosecutors . The suspected demanded to see Ms. Pelosi, who was in Washington at the time, according to the authorities.

After some discussion, Mr. DePape allowed Mr. Pelosi to use the bathroom, where Mr. Pelosi called 911, and tried to signal surreptitiously to the dispatcher that he was in trouble while Mr. DePape listened to the call, the prosecutors said. When police officers arrived at the house, they witnessed the two men, who had moved downstairs, struggling for control of one of the hammers.

Mr. DePape pulled the hammer away from Mr. Pelosi and smashed him on the head with it before being tackled and restrained by officers. “Mr. Pelosi remained unresponsive for about three minutes, waking up in a pool of his own blood,” according to the local prosecutors’ filing.

Later, according to the same filing, Mr. DePape told officers that he was there on a “suicide mission,” looking for Ms. Pelosi, and that he had other targets as well: a local professor and several state and federal politicians, as well as their relatives.

“I’m sick of the insane fucking level of lies coming out of Washington, DC,” Mr. DePape told officers, according to the authorities.

Mr. DePape grew up in British Columbia in Canada and moved to California about two decades ago. For years, Mr. DePape was living in Berkeley, Calif., where he was at times homeless, before moving to a garage in nearby Richmond about two years ago.

Mr. DePape was easygoing, quiet and a diligent worker, according to Frank Ciccarelli, a carpenter who employed him for the past six years. But he also began embracing political conspiracy theories and believed that the 2020 election had been stolen, Mr. Ciccarelli said.

A few years ago, Mr. Ciccarelli tried to help out Mr. DePape, moving him off the street and into his friend’s garage. But Mr. Ciccarelli believed that gave Mr. DePape greater access to the internet, allowing him to become more isolated and captive to his darkest thoughts.

Mr DePape appeared to have written a blog filled with rants about the 2020 election, antisemitic beliefs and QAnon conspiracy theories. “He went down the rabbit hole,” Mr. Ciccarelli said.

On Tuesday, Adam Lipson, Mr. DePape’s public defender, signaled that his client’s “vulnerability” to political misinformation and propaganda could be a possible strategy for his legal defense.

“That’s certainly something we’re going to look into,” Mr Lipson said.

Holly Secon contributed reporting.

The post Paul Pelosi Leaves San Francisco Hospital After Assault appeared first on Los Gatos News And Events.

SAN FRANCISCO, Nov 7, 2022 /PRNewswire/ — Noe Animal Hospital officially opened its doors to the public on Wednesday, November 2, 2022and now offers the full spectrum of veterinary services to san francisco and the surrounding neighborhoods.

dr Nicole Goodrich with her patient.

Complete with state-of-the-art diagnostic and treatment areas and a highly experienced, compassionate team, the new Noe Valley neighborhood veterinary hospital is set to become one of the best veterinary practices in san francisco. Crucially, it also increases access to veterinary care for Bay Area residents struggling to find appointments amid unprecedented post-pandemic demand for pet services.

New San Francisco Veterinarian Practice Ready To Welcome Pet Parents

Services offered at the new Noe Animal Hospital include wellness check-ups, vaccinations, microchipping, dental care, soft tissue surgeries, including spaying and neutering, urgent medical care, and chronic disease management. Appointments can be booked via the hospital’s website.

the new san francisco Veterinary clinic is the endeavor of two dedicated Bay Area veterinarians, Drs. Viru Gopisetty other Nicole Goodrich. Between them, they bring particular professional interests in geriatric pet care, soft tissue surgery, and preventative medicine, as well as a lifetime of experience as compassionate pet parents themselves.

“Whether you want to discuss ongoing management of a chronic condition, or you come to us needing urgent care for your furry companion, we hope you will find our style of knowledgeable, compassionate care perfect for your pet.”

“And with such a squeeze on veterinary services in the san francisco area, we’re delighted to offer more pet parents the opportunity to access timely care when their animals need it.” Says Noe Animal Hospital Co-Medical Director, Dr. Viru Gopisetty.

Improving Access to Veterinary Care in san francisco

The opening of a new Bay Area animal hospital is welcome news to san francisco residents struggling to access veterinary care for their animals.

A post-pandemic national shortage of veterinarians is acutely felt in the Bay Area, where many pet parents have been taking to social media to document nightmare journeys to distant cities to find emergency veterinary care or long waits for treatment at their local clinic. Wait times for standard wellness appointments may be weeks to months.

According to the American Veterinary Medical Association, a national shortage of veterinary staff has been compounded by an unprecedented demand for services, with booked vet appointments in 2021 up 6.5%. The association attributes the increase to more owners working from home. Spending more time with their animals is enabling pet parents to notice more health issues as they arise.

Noe Animal Hospital offers anxious pet parents’ greater access to services when research estimates that 75 million pets could lose access to veterinary care by 2030.

About the Noe Animal Hospital

Noe Animal Hospital is a brand new san francisco veterinary facility in the Noe Valley neighborhood. Opened in the Fall of 2022 to pet parents across the Bay Area, the Noe Animal Hospital provides a full spectrum of veterinary services. It prides itself on its compassionate, caring approach and highly experienced veterinary team. To learn more, please visit www.noeanimalhospital.com.

Contact:
Susan Chiari
MarketingDirector
[email protected]

SOURCE Noe Animal Hospital

The post New San Francisco Animal Hospital Opens to Ease the Squeeze on Bay Space Veterinary Providers appeared first on Los Gatos News And Events.

Last week, federal regulators agreed to pause the transfers after several patients died within days or weeks of being moved from the hospital and rehabilitation center but the deadline to shut down the hospital remains.

Speaking at the press conference, Renne urged CMS to “come to your senses.”

“How much longer are we going to keep this up before more deaths occur?” Renne said.

CMS terminated its payments to Laguna Honda in April after two patients had nonfatal overdoses at the facility in 2021, and inspectors with the California Department of Public Health declared it to be “in a state of substandard care.”

The federal agency, which pays for care for the majority of the nursing home’s 700 patients, also ordered the facility to start discharging or transferring its patients ahead of a mid-September mandated closure.

Founded in 1866, the sprawling facility serves people who need long-term care but who can’t afford private nursing homes. Many of the patients have dementia, drug addiction and other complex medical needs.

City officials say patients and their families are the ones suffering the most because of the forced closure. Debra Bauer spoke Thursday about how the facility has helped her son, who has a traumatic brain injury, and has been a resident at the hospital for about 20 years.

“My son feels safe there, I don’t want that taken away from him,” she said. “I don’t want it taken away from him or any of the other residents that I see and we wave to in the hallways.”

The post San Francisco Sues Feds Over Compelled Closure of Laguna Honda Hospital appeared first on Los Gatos News And Events.

SAN FRANCISCO (CBS SF) — The city of San Francisco announced Thursday that it’s suing the federal government over its decision to cut off funding to Laguna Honda Hospital and the order forcing the nursing home to transfer all patients out of the facility by Sept. 13.

The lawsuit was filed Wednesday against the US Department of Health and Human Services (HHS) and Secretary Xavier Becerra. It alleges that the Centers for Medicare & Medicaid Services (CMS), which operates under HHS, forced the City to implement an unworkable closure and patient transfer plan that put them at risk and denies the City due process.

In April, CMS terminated Laguna Honda’s participation in its Medicare/Medicaid programs after the hospital was found out of compliance on multiple safety inspections, including finding contraband like drug paraphernalia on site, and failure to adhere to hand hygiene, documentation and infection prevention protocols.

Laguna Honda Hospital

CBS

As a result of being decertified, the hospital lost federal funding that financed more than two-thirds of its services for nearly 700 patients with complex medical needs and low incomes.

The federal government also directed the facility to wind down its patient population, and the hospital transferred several dozen patients over 10 weeks. At least four patients were reportedly dead within a few days after their relocation, including three that were sent to homeless shelters. A total of nine patients died within days or weeks after transfer or discharge, according to City Attorney David Chiu.

Last week, Laguna Honda maintained transfers for its remaining 600 patients following the deaths.

The complaint alleges the CMS imposed an arbitrary Sept. 13 deadline for patient transfers and required it to close before the city’s appeals could be decided, which might make the transfers unnecessary.

In a press release, Chiu said a second-class-action lawsuit against both the State of California and the federal government filed by former City Attorney Louise Renne alleges the closure and transfer process violates the Americans with Disabilities Act and denies patients and their families due process .

“The federal government has put Laguna Honda and our City in an impossible situation,” said Chiu in a prepared statement. “As the final safety net for many of our most vulnerable San Franciscans, Laguna Honda serves too critical a need to be closed due to an arbitrary, bureaucratic decision. The City has been forced into an unworkable closure and transfer plan that has done far more harm than good.”

The lawsuit seeks declaratory and injunctive relief to eliminate the Sept. 13 deadline and extend federal funding to Laguna Honda at least until the appeals can be decided and all patients can be safely transferred or discharged.

“We are working hard to address issues that have been raised at Laguna Honda, and that important work will continue,” said Mayor London Breed in a prepared statement. “But closing this facility and forcing residents and families to go through the trauma of transfers should not be part of that process. This facility provides care and support for some of the most vulnerable people in our city, and that support must continue to keep them healthy and safe.”

“For over 150 years, San Franciscans have relied on Laguna Honda to provide critical care to our most vulnerable,” Renne said in a prepared statement. “We simply cannot allow Laguna Honda to close. The actions of CMS and the California Department of Health are illegal, unnecessary, and cruel.

Theresa Rutherford, the President-Elect of the SEIU 1021 and a longtime certified nursing assistant at Laguna Honda Hospital, released the following statement in response to the announcement of the lawsuits:

“Laguna Honda Hospital is more than just a hospital, it is a long-term home for many. Keeping patients at Laguna Honda, where they are provided some of the most unique and comprehensive care available in this country, must be a priority for our community and for elected officials at all levels.We support patients and families who are advocating to help stop the closure because we know it will save lives.

We understand how stressful and scary the last few months have been for workers and patients alike. Transfer trauma is a real danger for the people we care for, which is why our union is doing everything we can to get Laguna Honda Hospital recertified. We encourage community members to join us by contacting their elected leaders at all levels and asking them to stand with us.”

In May, Sen. Dianne Feinstein wrote a letter to Becerra asking to reverse the CMS decision to terminate Laguna Honda’s participation in its programs and force the relocation of its vulnerable patients.

“If CMS does not reverse its decision, these patients would again be put at risk as they’re transferred to other facilities,” Feinstein said in a statement last month. “This is particularly concerning after some patients were reportedly sent to homeless shelters ill-equipped to provide the necessary medical services.”

The hospital remains open and licensed as it continues to work on rejoining the federal programs.

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A nursing home run by the city of San Francisco will stop discharging patients as part of a federally-mandated closure plan after at least four patients died within days or weeks of being moved from Laguna Honda Hospital, officials said.

In April, the federal Centers for Medicare and Medicaid Services terminated its payments to Laguna Honda after two patients had nonfatal overdoses at the facility in 2021, and inspectors with the California Department of Public Health declared it to be “in a state of substandard care. ”

The federal agency, which pays for care for the majority of the nursing home’s 700 patients, also ordered the facility to start discharging or transferring its patients ahead of a mid-September mandated closure.

On Thursday, regulators agreed to pause the transfers, San Francisco’s Department of Public Health said in a statement.

San Francisco Department of Public Health is working to get the nursing home recertified ahead of a Sept. 13 closure deadline but it is still required to transfer or discharge all patients, according to a closure plan.

The city, supported by San Francisco representatives in Washington, including Sen. Diane Feinstein, asked the federal Medicare and Medicaid agency to pause all transfers from Laguna Honda Hospital, saying it has been a challenge to find places that can care for the patients’ complex health care needs.

Until Thursday, Laguna Honda had transferred or discharged 57 patients, including a few to homeless shelters. At least four patients died within days or weeks of being moved from Laguna Honda, the San Francisco Chronicle reported.

The transfers and discharges will be paused “while an assessment occurs over the coming weeks,” US Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure told the newspaper, adding that the agency posted a representative there on Tuesday.

Founded in 1866, the sprawling facility serves people who need long-term care but can’t afford private nursing homes. Many of the patients have dementia, drug addiction and other complex medical needs.

“Laguna Honda has served San Francisco’s most vulnerable residents for 150 years and we plan to do so for another 150 years,” Roland Pickens, Laguna Honda’s interim CEO, said in a statement.

Sen. Diane Feinstein in May called on Health and Human Services Secretary Xavier Becerra to reverse the federal agency’s decision to terminate Laguna Honda Hospital’s participation in Medicare and Medicaid programs and force the relocation of its vulnerable patients.

Feinstein said Friday that the hospital provides services for many patients who have no other options and that she hopes the federal agency works with the city of San Francisco to make the necessary improvements at the hospital so it can rejoin the Medicare and Medicaid programs.

“If (Centers for Medicare and Medicaid Services) does not reverse its decision, these patients would again be put at risk as they’re transferred to other facilities,” she said in a statement sent to homeless shelters ill-equipped to provide the necessary medical services.”

Pickens wrote in a letter to patients and their families that it’s not clear how long the transferring and discharging of patients will be suspended.

“We know the uncertainty is challenging but we hope this pause provides our community with relief,” he wrote.

The post San Francisco’s Laguna Honda Hospital to Cease Discharging Sufferers After Deaths – NBC Bay Space appeared first on Los Gatos News And Events.

When the COVID-19 pandemic hit, many hospitals struggled to find negative pressure rooms approved by the Centers for Disease Control and Prevention (CDC) for the sudden influx of COVID-19 patients. However, many hospital systems had a very limited number of negative pressure rooms (Table). One of the main considerations was the recirculation of air. If the air used is not 100% outside air, would the air being recirculated transport viral-containing particles from one patient room to the next?

A recent study, “Requirements to Reduce Viral Pathogen Transmission in Health Care HVAC Systems,” presented at the Society for Healthcare Epidemiology of America (SHEA) Spring conference, held April 12-14 in Colorado Springs, Colorado, explained that the viral-containing Particles can be transported through the HVAC system even with high efficiency particulate air (HEPA) filters. The study was presented by Werner Bischoff, MD, MS, PHD, MS, the medical director of infection prevention and health system epidemiology at the Atrium Health Wake Forest Baptist Hospital System and a professor at Wake Forest School of Medicine.

“CDC sets [a limited] risk of transmission of pathogens that are emitted from one patient inside a patient room that is then transferred through a heating, ventilation, and air conditioning (HVAC) system back to maybe an adjacent patient room or an entire unit,” Bishoff told Infection Control Today ® (ICT®) in an exclusive interview. “What you don’t want is to have a tone of transmissions and in a very closed-up area through the HVAC system.”

For the first time, this study demonstrates that “viral containing particles can be transported via a hospital HVAC system from one patient room to the next,” Bishoff wrote in the study. “Taking into account the loss of virus within the HVAC system, the combination of MERV8+MERV16 filters reduces the virus burden reaching an adjacent room to levels well below the human infectious dosages for influenza and other highly infective viruses. Our findings indicate that MERV8+MERV16 filters provide protection against virus transmission through HVAC systems and are a cost-conscious alternative to HEPA filters.”

Considering future investigations, Bishoff said to ICT®, “I think it would be nice to look at the more novel technologies that are coming out [like] neurons that are highly promoted, especially by industry—that is ionization…Mechanical ventilation isn’t established [with] These newer technologies, we need a lot more data to say that [air filtration systems] are really safe and do what they promised to do.” Previously, ICT® has reported on this topic here, here, and here.

The post HVAC Techniques Show Adequate to Cut back Viral Pathogen Transmission Inside a Hospital appeared first on Los Gatos News And Events.

Laguna Honda Hospital is a facility with a rich history of scandal and mismanagement. For it to now be facing an existential crisis over a series of comparatively minor violations feels a bit like Al Capone going to prison over tax evasion.

But Capone did indeed go to the slammer — you can buy the commemorative t-shirt at Pier 39. And, as mind-boggling as it may be, the 700-odd vulnerable patients here may be out on their ears before year’s end if the hospital fails to meet the latest terms imposed by the federal government. If Laguna Honda comes up short in a top-to-bottom recertification process, it could lose Medicare and Medi-Cal funding in four to six months’ time.

This would blow a roughly $20 million a month hole in the city’s budget and open up the real possibility of patients being transferred hundreds if not thousands of miles away — or, tragically, to the curb and immediate homelessness. A high percentage of Laguna Honda’s patients exhibit behaviors that would’ve led to them being screened out of almost any other nursing facility, and it’s unrealistic to expect beds to be found for them.

“They would probably have to soak up a bed at General Hospital until they ended up in jail, or a bed comes up in a locked facility for people who are criminally insane,” sums up Dr. Teresa Palmer, a geriatrician who worked at Laguna Honda from 1989 to 2004.

This assessment is as harsh as it sounds. The fate of both this city and its most vulnerable populations are not in a solid place right now.

Laguna Honda, seen in 1926. Photo courtesy of OpenSFHistory.org

You may have missed the existential crisis unfolding at this 156-year-old institution. It’s easy to. Laguna Honda shelters the people society is most eager to overlook: The frail elderly and — increasingly — mentally ill and/or drug-addicted younger patients. This is a combustible and counterintuitive mix, and plays no small role in the fix Laguna Honda now finds itself in.

“There are a huge number of men here between ages 50 and 70,” says Palmer. At most nursing homes, she continues, you’d be more likely to find “a majority of ladies in their 80s.”

Between 1999 and 2021, the percentage of women at Laguna Honda dropped from 56 percent to 37 percent.

The problems at Laguna Honda, like Hemingway’s description of bankruptcy, have come gradually then suddenly. As would bankruptcy, so to speak, if federal funding is yanked.

Laguna Honda was founded in 1866 as an almshouse for geriatric Gold Rush forty-niners. We could start this story then. Or we could start it in 1999, when voters approved a $299 million bond to “save” the hospital. Or in 2006, when a licensing survey noted that the younger, more ambulatory patients flowing into Laguna Honda were toting drugs, alcohol, loaded firearms, and abusing the elders — staff even futilely erected signs reading “no hitting.”

Or we could start in 2019, when Laguna Honda staff took demeaning, nude photos of incapacitated patients and doped them up with non-prescribed medication (the first of several lawsuits settled last year for $800,000).

Nursing Director: “Our team have exhausted most options in helping eliminate or minimize the contraband and illicit substances into the unit.” … (Resident 2) voluntarily handed the burnt aluminum foil, plastic pen body case burned on one end and a cigarette lighter that he’s holding. … Resident even stated “they know I’m doing this.”

California Department of Public Health Survey of Laguna Honda Hospital, March 28, 2022

But, instead, we’ll start in July 2021, when two of the younger, more ambulatory patients here purportedly wandered off campus, wandered back on with methamphetamine and fentanyl, and suffered non-fatal overdoses.

The hospital reported the overdoses to regulators — to not do so would be unthinkable following the 2019 scandals that led to $780,000 in fines and a slew of lawsuits. And this triggered a concatenation of regulatory procedures that led to where we are today and put the hospital at the brink.

Laguna Honda, on multiple subsequent occasions, did not meet inspectors’ expectations on its “termination revisit survey.” In April, inspectors found 27 different violations. Some of these were not insignificant — incomplete patient assessments or staff wearing improper or inadequate PPE around patients. Other assessments seemed to be more of the ticky-tack variety: medicated shampoo without a prescription, medicated creams and lotions in patient rooms, “three open plastic bags were hanging (unattended) in a dirty hamper.”

These are the infractions that triggered the feds to last month broach the possibility of yanking funding. Laguna Honda announced this month that it now must go through the rigmarole of working to demonstrate that it could relocate all of its residents as a condition to continue receiving government funding. It will receive that funding while it works to recertify and avoid relocating anyone. It’s a Kafkaesque turn of events. Laguna Honda has so much to answer for going back through the years — but it’s the medicated shampoo et al. that was noted on this most recent report.

Adding to the surreal nature of these proceedings, the federal agency currently calling the shots, the Centers for Medicare & Medicaid Services (CMS), is responsible for overseeing all the truly horrific, for-profit, deathtrap nursing homes you saw on 60 minutes. There is no universe in which Laguna Honda compares to these charnel houses, and the overseers’ Inspector Javert-like focus on this public hospital is hard to explain. As is any “solution” that might result in the dispersal of its residents.

Laguna Honda Hospital. Photo by Christopher Michel.

“I don’t know why they are being so harsh,” says Dr. Derek Kerr, a 21-year physician at Laguna Honda who has since turned into a whistleblower and critic of the facility. “Laguna Honda is always judged harshly. If you have one violation in a 700-bed unit that is as bad as one violation in a 15-bed nursing home. They don’t take into account the denominator.”

And while 27 violations sounds like a lot, says Charlene Harrington, a professor emeritus at UC San Francisco, Laguna Honda is seven times the size of an average nursing home facility. And, she continues, the average number of violations recorded on such an inspection is eight — meaning Laguna Honda had about half what you’d expect, per capita.

“California has had extremely poor enforcement of nursing homes, and has some of the worst nursing homes in the country. And that has gone on for years,” says Harrington. “Laguna Honda had some deficiencies, and I am not excusing the deficiencies. But the [overseers’] behavior in this case is inexplicable. They have let other facilities go for years … awful, for-profit facilities where really terrible things are going on.”

Multiple emails to CMS officials have not yet been returned.

Harrington has studied nursing homes and regulation for 40 years. And she is at a loss to explain what is going on here: “I can’t think of any case like this before.”

Laguna Honda in 1875. Photo courtesy of OpenSFHistory.org

There is nothing like a threat from outside to cement allegiances inside. So, at noon on Wednesday, Mayor London Breed and the SEIU 1021 — who maintain a Ralph Wolf-and-Sam Sheepdog relationship — will both appear at a rally to save this hospital.

Government officials across San Francisco described CMS as rigid and intractable. Former California Attorney General Xavier Becerra is now the head of the Department of Health and Human Services, which runs CMS. But, city officials say, he may be trying extra hard not to be seen as playing favorites.

CMS, city officials say, intransigently insists that its procedures are proscribed and must be done by the book, come what may. And you know the mayor’s office has been bending their ears, as has the office of Rep. Nancy Pelosi — and, if need be, every California politician there is will join the queue.

What a predicament: At last San Francisco has run into a situation in which it can’t just have his political mommy and daddy make some calls and get it out of his longstanding ineptitude. The process, at least thus far, seems to be politically impenetrable. How unfortunate, then, that this appears to be a process devoid of common sense or empathy in which, ostensibly for the patients’ own safety, hundreds of them may be jettisoned to parts unknown or pushed to the street.

That’s just plain stupid.

Maybe that will come up at the rally tomorrow. It’s doubtful, however, the city officials will examine their own role in this fine mess. But we can. So let’s go back to that bond measure in 1999.

“Laguna Honda had some deficiencies, and I am not excusing the deficiencies. But the [overseers’] behavior in this case is inexplicable. They have let other facilities go for years … awful, for-profit facilities where really terrible things are going on.”

Charlene Harrington, UCSF professor emeritus

Voters, you may recall, agreed to go into $299 million in bonded debt to build a new, 1,200-bed facility. They were promised that this would house the city’s frail elders.

But that didn’t happen. The price tag ballooned by hundreds of millions of dollars and the capacity of the hospital was reduced by hundreds of beds. And, top it off, the city began transferring younger, mentally ill and/or substance addicted patients into the hospital.

So yes, we paid more, got less, and the hospital is not exclusively serving the elderly population that voters were enticed to pony up and help.

As noted earlier, this situation is longstanding. By 2004, Palmer left Laguna Honda, in large part because she felt the influx of “out-of-control” mentally ill and/or substance abuse addicts was unsafe. “They are deforming the hospital to accommodate an antisocial minority,” says Kerr, who was forced out in 2010.

There is no scenario in which crippling and defunding Laguna Honda and ejecting its patients is in anybody’s best interests — and, Palmer still describes it as “a better nursing home than most” and a place where she would’ve put her own mother.

The city must do all it can to fend off this doomsday scenario, and a consulting firm with an expertise in re-certification has already been hired.

But the city must also address the untenable situation of commingling the frail elderly and ambulatory mentally ill and/or addicts. In 1999, you’ll recall, 56 percent of Laguna Honda’s residents were female — and the average age was 76. By 2021, only 37 percent of the residents were women. And while patients’ average age wasn’t disclosed in ’21, it had dropped to 64 by 2013.

A state Department of Public Health survey from March, 2022 obtained by Kerr and shared with Mission Local notes staff observing residents overtly smoking drugs off aluminum foil and seeing little they could do to prevent this.

“Our team have exhausted most options in helping eliminate or minimize the contraband and illicit substances,” a nursing director is quoted as saying. The patient in question surrendered his burnt aluminum foil, plastic pen and lighter. “They know I’m doing this,” he said.

This city has chosen to serve populations nobody else would. But it has chosen to do so in a manner that has proven to be unworkable and led to the current crisis.

San Francisco owes it to itself and Laguna Honda’s residents to solve this crisis. But also to ponder its own role in it. And make things right. Gradually then suddenly.

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