Supervisors press CMS and DPH as Laguna Honda transfers continue amid deaths and appeals

The Government Audit & Oversight Committee devoted substantial time on July 21 to Laguna Honda Hospital's status after Centers for Medicare & Medicaid Services (CMS) decertified the facility and required a closure and patient-transfer plan.

Supervisor Ahsha Safaí's colleague Supervisor Melgar (sponsor) said the hearing would focus on the plan's status, patient protections, appeal rights and how the city is prioritizing transfers. Laguna Honda and Department of Public Health officials described the sequence of events: the city proposed an 18-month plan but CMS rejected it and approved a four-month closure/transfer plan (May through Sept. 13, 2022, with a possible two-month extension) that conditions federal Medicare/Medicaid payments on implementation milestones.

Roland Pickens,who is leading the closure effort, described an exhaustive patient-assessment workflow and said Laguna Honda had made thousands of outreach calls to identify appropriate skilled nursing placements and that 56 patients had been discharged or transferred so far, most to facilities outside San Francisco. He said the hospital had asked CMS for clarity on what constitutes "satisfactory progress" that would make the facility eligible for the potential two-month funding extension but had not received a written benchmark; DPH said CMS had told them they were "not moving fast enough." Pickens acknowledged the transfers are traumatic and noted there is an administrative appeals process run by the state; the city's social work teams and an ombudsperson are assisting patients and families.

Committee members and public commenters pressed for immediate action after multiple family members and advocates linked recent post-transfer deaths to transfer trauma; several speakers urged the city to stop transfers immediately. Former City Attorney Louise Renne and union and community speakers characterized the situation as an urgent humanitarian crisis and urged the Board and Mayor to intervene with HHS and CMS. Deputy City Attorney Anne Pearson said the City Attorney's Office has filed administrative appeals challenging CMS findings and the termination itself and is pursuing relief as quickly as possible.

Committee action: Supervisor Melgar moved to continue additional oversight to the call of the chair so the committee can reconvene quickly; the motion passed 3-0. Supervisors asked DPH and the city attorney to produce written documentation of CMS communications, clarify the legal effect of appeals on transfers and continue regular updates.

Next steps: Committee oversight will continue; the Board may consider a formal resolution to request HHS/CMS reconsider the timeline and the city attorney will pursue appeals in the administrative venue cited.