San Francisco Health Commission hears Laguna Honda recertification update; commission enters closed session

San Francisco health officials on Sept. 20 told the Health Commission they have implemented a sweeping set of corrective measures at Laguna Honda Hospital and are working toward recertification by the Centers for Medicare & Medicaid Services (CMS).

Roland Pickens, director of the San Francisco Health Network and acting Laguna Honda CEO, said the city's immediate priorities after the April 2022 decertification were securing expert consultants, running mock surveys and executing a facility-specific training program for roughly 1,200 staff. "Our number one priority is recertification," Pickens said during his presentation.

Pickens recounted that the decertification followed state and federal surveys triggered by reports tied to two nonfatal overdoses earlier in the pandemic. A mock survey completed July 20 identified about 101 CMS standards needing improvement; Pickens said staff and consultants developed and began implementing roughly 344 corrective actions, monitored through a daily 10 a.m. plan-of-correction huddle and a weekly KPI dashboard.

Officials cited measurable gains in several areas: environment-of-care metrics (a 144-item checklist) recently met the 90% target, hand-hygiene observations were reported at about 99% and training completion exceeded 95% as of the presentation. Infection-prevention metrics trended upward but had not yet reached the stated 90% goal.

Pickens also addressed a 2016 CMS rule change that tightened shared-room standards and affects about 120 beds at Laguna Honda. He said the city is resubmitting the facility license for the current bed complement and that how many beds CMS will certify remains subject to CMS and California Department of Public Health decisions.

On patient transfers and closure planning, Pickens said an original 18-month closure plan submitted to CMS was rejected and CMS required a four-month timetable (with a possible two-month extension). The city later obtained a pause in transfers and an extension of Medicare and Medicaid payments through Nov. 13, 2022, which Pickens described as "a temporary reprieve" that allowed the facility to focus on recertification.

During public comment, Dr. Teresa Palmer, who identified herself as a retired Laguna Honda physician, praised the effort to save Laguna Honda but sharply criticized past management and asked how the city will prevent unsafe discharges and protect beds if recertification is delayed. Palmer said, "Management neglect is what led to this mess," and asked why the city should not pay to bridge care costs if federal funding is paused. The number she cited for post-transfer deaths ("9 out of 57") was asserted by the commenter and is not a figure presented earlier in the commission's staff update.

Commissioners questioned staffing and morale. Pickens told the commission Laguna meets HPPD patient-to-staff ratio requirements and uses per diem and registry staff to fill gaps, and he said morale dropped after decertification but improved markedly after the August training. He described the transfer/discharge screening as a multidisciplinary process approved by CDPH and CMS and said the facility had engaged state and local ombudspersons in outreach to residents and families.

After the presentation and public comment, the commission moved into a 45-minute closed session focused on Laguna Honda. The motion to enter closed session was moved by Commissioner Guillermo and seconded by Commissioner Jurado; a subsequent roll call recorded unanimous 'yes' votes. Upon reconvening, the commission voted to not disclose the closed-session discussions by roll call (unanimous).