A cyclist rides past the San Francisco Mental Health Rehabilitation Center on the SF General Hospital campus along Potrero Avenue on Tuesday, Aug. 20, 2019. (Kevin N. Hume/S.F. Examiner)

Health Department promises plan for long-term mental health beds before end of month

Public Health Director Grant Colfax has given his staff until mid-October to create a plan to fix chronic understaffing and compliance issues in a long-term care unit for adults with severe mental illness, health department officials said Tuesday.

Colfax and other health officials addressed the Health Commission Tuesday for the first time since a decision to suspend 41 of 55 residential treatment beds in the Adult Residential Facility on the Zuckerberg San Francisco General Hospital campus became public. The news, which came out after 18 residents received 60-day relocation notices in August, sparked protests from nurses, family members of patients and members of the Board of Supervisors.

The ARF Performance Improvement Plan will include information on patient care, staff training and enrichment, culture and workflow within the unit, staffing levels and address issues “that have been raised by staff, management, community, HR and [state] regulators,” according to a health department spokesperson. After the plan is submitted, the Health Commission is expected to review it at a public hearing.

In statements made to the press, the health department over the past month has defended the bed reductions in the first floor unit of ZSFGH’s Behavioral Health Center as a necessary step in ensuring patient safety following a number of citations from a state licensing body due to medication errors and negative staff behavior.

“We always intended to go back to expanding the ARF as we are able to build capacity and staff but also correct underlying performance issues … and in the interim have Hummingbird Place provide capacity to take people as we fix for the 32 and solve for the 55,” Colfax said at Tuesday’s hearing, referring to the 32 ARF beds that are currently occupied.

“That’s where it is confusing to many. We do think 55 [beds] is where we need to be in the ARF [but] we are already having challenges with managing the 32. It’s not a judgment. It’s just a fact that the state has given us a number of citations,” Colfax added.

The department has also said that hiring to staff the ARF has been difficult. Kelly Hiramoto, DPH’s former director of transitions who now works as a consultant for the department, said Tuesday that nine staff vacancies within the unit are preventing it from operating at full capacity or safely admitting new clients.

Both the planned relocations of residents to a second-floor unit in the ARF reserved for seniors and the proposed 27-bed expansion at Hummingbird Place, a psychiatric respite where client stays average around two weeks, have been paused following pushback from the public.

San Francisco Health Network Director Roland Pickens on Tuesday painted the ARF as riddled with problems. He said that multiple citations from the state relating to staff errors and misconduct over the past five years and complaints to Human Resources about staff-on-staff harassment led to the BHC being placed on a plan of correction, requiring numerous staff trainings and education sessions about resident and workplace safety.

“In some cases, even after the training and education, some staff continued to make errors in the same areas for which they received training,” said Pickens.

Between 2014 and 2018, the ARF was “unable to go five months without staff concerns or Community Care Licensing coming on site to investigate the facility,” he said.

The ARF received two “Level A” citations, which are given for serious violations, in 2018 in “the area of medication use,” placing the facility at risk of losing its license and “putting our ARF clients at risk,” according to Pickens.

Commissioners appeared confused during the presentation.

“I have heard different stories about the issue of the ARF,” said Commissioner Edward Chow. “Is there a staffing problem? Is it hiring that prevents us from having additional beds at the ARF?”

But after being grilled by the commissioners, Pickens appeared to walk back previous explanations given for the bed reductions by stating that “there are no barriers to filling [staff] positions at the ARF [other than retaining] that space for the Hummingbird program.”

That program has proven successful in addressing The City’s growing homelessness crisis, Pickens said. Some 30 percent of referrals to Hummingbird Place come from ZSFGH’s Psychiatric Emergency Services, he said.

Hospital workers have said that the long-term treatment beds are badly needed to relieve “log jams” in other departments at the hospital, and on Tuesday filled the commission’s chamber holding up signs that read “save the ARF” and “DPH has got to change!”

They demanded that the department rescind the relocations notices given to residents of the ARF, fill the unit to capacity and restructure its leadership.

“We were told [the beds] are suspended because of a combination of medical errors and conflict, but it looks more like incompetence of leadership,” said Sarah Larsen, a mental health treatment specialist. “Closing these beds is a political decision, not a necessity.”

Jennifer Esteen, a psychiatric nurse at ZSFGH, said that The City is set to lose 54 beds across three different board and care providers it contracts with by the end of the year.

“We have open beds right now, sitting vacant, that we could put [those patients] in to,” said Esteen.

The San Francisco Examiner has previously reported on incarcerated mental health patients languishing in jail for as long as nine months because they have been unable to receive bed placements.

“This is a scandal of the highest proportion — people are waiting in jail [because] we can’t find them a bed for nine months. I am angry,” said Supervisor Hillary Ronen, who attended Tuesday’s hearing.

Ronen lambasted the department’s leadership for reducing its residential mental health bed count at a time when The City is “losing private board and care facilities at rapid rates” and for blaming problem within the ARF on workers.

“These problems at the ARF have been happening for the past five years. Where has been the leadership on part of management?” said Ronen. “When there are conflicts on my staff, if people aren’t getting along, mistakes are made, I don’t blame it on them. I’m their boss, I set up the system, I correct the situation.”

“I don’t understand where the leadership of DPH is to act with the urgency that I have. This is not the DPH I know,” said Ronen.

lwaxmann@sfexaminer.com

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