The Department of Public Health this week blamed its decision to suspend 41 city-run long-term mental health beds at Zuckerberg San Francisco General Hospital on understaffing and problematic staff behavior that allegedly created safety issues.
On Thursday, angry workers who felt they were being scapegoated protested outside Laguna Honda Hospital, putting the blame squarely back on management for creating a toxic work environment.
More than two dozen hospital workers from both SFGH and Laguna Honda joined the protest organized by Service Employees International Union Local 1021, alleging that perpetual understaffing coupled with a lack of respect from administrators has contributed to low morale at both health department-operated hospitals. They criticized the department for failing to respond to staffing issues and alleged that abuse from management has reduced the quality of care and threatened patient and worker safety at both hospitals.
The workers said that “dysfunction from management” also set the stage for a scandal involving the abuse of 23 patients by six staff members over the past three years that rocked Laguna Honda Hospital earlier this summer.
“It is a shame that The City and County of San Francisco has decided, instead of addressing the bad management, the issue of homelessness, the major mental health care issues we have, they [instead] hide behind protocols, [and are] lying and trying to blame workers for the dysfunction,” said Theresa Rutherford, vice president of Local 1021 and a 16-year nursing assistant at Laguna Honda.
“These issues are a dysfunction of management. [Staffing] is not an employee issue,” she said.
Health department spokesperson Rachael Kagan told the San Francisco Examiner on Tuesday that the department stopped admitting patients to the ZSFGH’s Adult Residential Facility (ARF) — a 55-bed unit on the ZSFGH campus where patients with severe mental health issues live for as long as they need care — about a year ago because of understaffing in that unit.
She added that state regulatory issues related to “staff behavior” prompted the health department to repurpose some of the beds into short-term shelter beds, drawing the ire of nurses at that hospital as well as some city leaders who have proposed legislation to prevent bed reductions at the ARF.
“There’s the staffing to bed ratio…but we also want to make sure clients and staff are coming into a good environment,” said Kagan about the ARF. “When we were not certain of that we stopped admitting additional clients.”
Last month, the Examiner first reported that the health department plans to downsize the ARF to just 14 beds to enable a 27-bed expansion at Hummingbird Place, a psychiatric respite facility also located on the ZSFGH campus. Clients there — many of whom are homeless and suffering from mental health and substance use disorders — stay for an average of 19 days.
The conversion of the beds is slated for October and is supported by Mayor London Breed, who shortly after her election last June announced plans to add 1,000 new shelter beds to The City’s portfolio by 2020. However, the decision to reduce long term treatment beds for some of The City’s most vulnerable residents infuriated hospital workers and city leaders like supervisors Matt Haney and Hillary Ronen, who said that they were kept in the dark about the conversion.
Kagan told the Examiner that the ARF had been placed on a plan of correction by state regulators in October 2018, and directed to address compliance compliance issues with state licensing regulations.
“When you’re on a plan of correction you don’t want additional violations after that because you’re working to solve problems,” said Kagan, adding that besides being in violation of the staff-to-patient-ratio mandated for the ARF, there were also a slew of anonymous complaints filed with the state pointing to “a hostile work environment” and “medication errors.”
Kagan said that since about 2015, there have been a number of “complaints that staff lodged with Human Resources” as well as complaints made to state regulators, some of which have been substantiated and some of which have not.
“[The complaints were] one of the contributing factors of our decision to not continue to admit patients,” she said. “We don’t see the ARF as a place that is living up to our standards or the state’s standards. We didn’t want to bring new clients into the current environment. We wanted to take a different approach for the ARF and in the meantime expand a service like Hummingbird Place.”
Holding signs that read “Safe Staff Not Scapegoats,” the hospital workers on Thursday criticized the department for succumbing to a “political agenda” that prioritizes outsourcing city employee positions as a cost saving measure over hiring additional staff, as well as offering relief to an increasingly ill and visible homeless population at the expense of long-term care services.
“What’s happening with ARF is clearly a case of undermining publicly provided beds for severely mentally ill, presumably to outsource that function, as has been done with most of the board and care [facilities] in The City,” said Dean Preston, a supervisorial candidate for District 5, who stood in solidarity with the workers on Thursday.
“I think it’s a pretty fundamental question of is The City going to provide these critical services or continue to try to save funds by outsourcing to folks who are not municipal workers and aren’t paid as well?” Preston said.
“We have some awesome people that work here that really love our patients and our patients love them. The incident [abuse] that happened, that was bad choices on those people’s parts,” said Voloira Russell Benson, a 23-year-old certified nursing assistant at Laguna Honda. “But the majority of the people here are loving and caring. We don’t have adequate training. We are short staffed. We have burnout.”
Russell Benson said she often works the “a.m. shift,” during which no more than 10 patients are supposed to be assigned to one CNA — yet staffing shortages that have intensified over the last two years at times have left her overseeing anywhere between 15 to 30 patients.
“It’s definitely out of ratio. You make do with it. But how can you adequately serve our residents when you do not have enough hands?” she said. “We have patients that have to be turned every two hours. To keep those patients healthy, you need adequate staffing.”
Rutherford said that Laguna Honda’s Nutrition Department once had three chefs, but for the past year, only one chef has remained and is expected to serve meals for some 800 patients.
“They have cut the staff by one-third but are expecting the same quality of work,” said Rutherford. “When the [workers] are not able to deliver, they are penalized.”
Brent Andrew, a spokesperson for the hospitals, said in a statement to the Examiner that the health departments’ “top concern is improving patient care and safety.”
“All members of our staff have important roles to play in that process. No part is being singled out and no part is exempt. Improvement happens together,” Andrew said.
But many of the workers who protested Thursday said that they and their colleagues are at risk of retaliation for speaking up about inadequate working conditions and gaps in patient care.
“The code of silence going on here is because people are scared. They don’t want to lose their jobs. They don’t want to be retaliated against, feel targeted or singled out or labeled. Nobody wants to feel like that,” said Russell Benson.