Committee advances subacute care reporting ordinance after debate, continues item for final vote

The Public Safety & Neighborhood Services Committee on March 24 advanced an ordinance that would require general acute care hospitals — and under recent amendments, certain skilled nursing providers — to report annually to the Department of Public Health on patients transferred out of San Francisco County for subacute and nursing care and on in‑county patients who qualify for such care but are not transferred.

Sponsor Supervisor Safa (Safaee) framed the measure as a transparency and accountability tool to track how and why San Franciscans requiring subacute and skilled nursing care are moved out of county. He described five years of advocacy after closures of hospital‑based subacute capacity and said the proposed amendments broaden reporting to include non‑hospital skilled nursing programs and to delay the initial reporting deadline to Oct. 1, 2022 at DPH’s request.

Kelly Hiramoto, Director of Special Programs at DPH, said the department supports the data collection efforts and is already working with hospitals to compile datasets from 2020–2021 and to develop mechanisms for timely, complete reporting. Hiramoto noted DPH’s work to obtain consulting support and to prepare a public Health Commission briefing on the results.

Family members and advocates who called into the hearing urged further action. Callers from the Rivera family asked the city to require shared responsibility among hospitals for permanent subacute beds and for higher nurse‑to‑patient ratios; other callers from the Mental Health Association and clinicians asked that residential and psychiatric facilities be included in tracking to capture the full picture of out‑of‑county placements.

After discussion, the committee voted to accept the amendments as described by Supervisor Safa and to continue the ordinance—"as amended"—to the committee’s April 14 meeting to allow DPH and stakeholders to finalize technical changes. Vice Chair Stephanie and Chair Marr voted aye; Member Haney was recorded absent. The action does not adopt the ordinance; it advances the amended draft for further review and public consideration.

The ordinance’s stated aim is to surface where San Franciscans are being transferred for subacute/skilled nursing care so policymakers can monitor capacity, wait times and equity of access. DPH and supervisors repeatedly cited competition with other Bay Area counties for a limited number of locked subacute and psychiatric nursing beds as a chief implementation constraint.