Laguna Honda is under the gun again.
The hospital is temporarily instituting tighter safety measures following threats from state and federal regulators to withdraw Medi-Cal and Medicare funding, putting the hospital in jeopardy of closing.
The warning comes after the hospital reported two nonfatal overdoses at the facility last year.
New security measures include stricter rules around visitors, such as searching care packages, and an increased number of safety searches among residents and patients.
But regulatory scrutiny at Laguna Honda is not new. It dates back to a 2019 scandal when an investigation found 130 patients at the hospital had been affected by multiple workers who violated patient privacy rights and both physically and psychologically abused patients.
The City paid a $780,000 fine as a result of the case, and more than tripled the staff in the hospital’s quality management department. It also made changes to its safety and reporting protocols. That in turn led to the hospital reporting two overdoses in July 2021, according to a statement from the San Francisco Department of Public Health, which owns and oversees Laguna Honda.
The two nonfatal overdoses involved methamphetamine and fentanyl, according to Wilmie Hathaway, chief medical officer for Laguna Honda.
The overdose incidents spurred an extended review by the California Department of Public Health. In October 2021, that review found the hospital to be in a state of “substandard quality of care,” according to a statement provided by SFDPH.
Now, one of San Francisco’s largest skilled nursing facilities is facing possible closure after failing to meet compliance in a series of state follow-up visits between October 2021 and March 2022.
In January 2022, during one follow-up inspection, a staff member was found not following undisclosed protocols and the hospital remained in noncompliance.
Then on March 16, during a second revisit from the state department of public health, a patient was found smoking in a community bathroom; smoking is prohibited indoors at the hospital. During the same inspection, another patient who was on oxygen was found in possession of a lighter, which can pose an extreme fire risk.
The hospital is now nearing the end of the six-month window it was given in October to get back on track, and it has until April 14 to resolve any remaining issues that put the hospital out of compliance.
Hospital officials are now working with the Centers for Medicare and Medicaid Services, also known as CMS, to move forward and avoid terminating the patient funding channels.
“(CMS) have made it clear they believe it’s in the best interest of San Francisco that Laguna Honda remain open and they are extending every resource to make that happen,” Roland Pickens, director of the San Francisco Health Network, which Laguna Honda is a part of.
The vast majority of patient care at Laguna Honda is funded through Medi-Cal and Medicare. Losing the funding programs would severely impact the hospital’s 700 patients, many of who are extremely low income. Losing participation in Medicare and Medi-Cal programs could put the hospital at risk of closure.
Patients and live-in residents at Laguna Honda have a wide range of complex health challenges, including severe mental illness, dementia, substance use disorder and more. It is not a locked facility, meaning most patients can come and go.
“We are an open campus. We allow visitors to come and visit loved ones and we do allow patients to go in and out of the campus if they are capable of it,” Hathaway said, adding that it’s possible that is how the contraband could have been brought in undetected. “There are patients rights and human rights we need to follow.”
Pickens added that the overdoses at the hospital mirror a broader health crisis that The City is now facing.
“Laguna Honda is reflective of the San Francisco community, and we all know the Mayor’s emergency declaration about substance use in The City,” said Pickens. “Many of our patients are able to go into the community, we don’t have control of what they get in the community but at least now we can do increased searches so they don’t bring anything inappropriate or illicit back into the community.”
Hospital officials said they are optimistic that compliance will be reached. But it’s unclear what would happen to the more than 700 Laguna Honda patients and residents if their correction actions fall short.
“That hopefully is a road we will never have to go down,” Pickens said.