Outraged over plans to close dozens of permanent mental health beds at Zuckerberg San Francisco Hospital, Supervisor Hillary Ronen plans to put forth legislation that would fund and mandate the City to operate no less than 55 residential treatment beds for mental health clients at all times.
Supervisor Rafael Mandelman on Tuesday requested legislation also requiring the department to fill all 55 long-term residential treatment beds in the Adult Residential Facility (ARF), a unit in the hospitals’ Behavioral Health Center. However his legislation calls for the beds to be filled “as soon as possible,” but no later than 2021.
Ronen, who on Tuesday called for a public hearing on the issue along with Supervisor Matt Haney, called that time frame “misguided” given The City’s severely impacted mental health system and called for immediate action. With the two pieces of legislation, she is challenging The City’s Department of Public Health to reverse its plan within a month.
“On my way home from work yesterday I saw three people in complete mental health crisis on the street. I am afraid that those people are going to die if we don’t get them the help that they need and they deserve,” said Ronen. “I’m not willing to wait two years when we have beds that are licensed that could be opened immediately.”
At a Board of Supervisors hearing scheduled for Tuesday, Ronen said that she will make a supplemental budget request to provide DPH with the funding it needs to operate “55 long-term board and care beds for the most mentally ill people in San Francisco” through the end of the fiscal year.
And in two weeks, she plans to follow up that effort with legislation that would require The City to run a board and care facility with a minimum of 55 permanent beds and to create an “urgent hiring plan” to staff that facility.
A total of 55 beds are currently licensed by the state to provide long term housing to mental health patients too sick to care for themselves within the ARF. However, nurses at the hospital last month revealed that health officials planned to close down 41 beds in that unit to enable a 27-bed expansion at Hummingbird Place, a psychiatric respite facility also housed at the hospital where client stays average 19 days.
At least 18 ARF patients and their families were blindsided by 60-day relocation notices last month. Outrage over the move grew after it was revealed that 32 of the 55 ARF beds have gone unfilled for nearly a year, despite an urgent need for assisted living placements.
DPH leaders have cited staffing issues as a reason for the empty beds and said the ARF beds were underutilized.
“We want an expansion of Hummingbird Place, so they can do that, and we don’t want to take away that money. But we absolutely need them to maintain 55 beds for the most mentally ill patients,” said Ronen, adding that “as long as there is a city run public board and care facility with 55 beds, we don’t care where it is.”
City leaders attempting to stop the permanent loss of the residential beds agree in spirit, but opinions on how to most effectively address the issue vary.
On Wednesday, Mandelman said that the point of his ordinance is to “say that as soon as possible, we want [the ARF] to be a public long term residential care facility,” but added that he did not believe that this could be done in a month.
“We need more information to understand what needs to change,” said Mandelman. “The presumption of Ronen is we need to apply more pressure on bureaucrats to get this done in a month. She may be right and I’m not fully convinced she is,” he said.
While he believes it to be “absolutely important to listen to frontline staff” opposing the reconfiguration, Mandelman said that “it’s also important to listen to management in the department who say they have been trying to solve this problem for a long time and that it is difficult and complicated.”
“That doesn’t mean that we don’t need to be pushing them, but I think it’s important to listen to those who run a public hospital — that’s not the workers or the Board of Supervisors,” he said.
Nurses who have struggled to place patients in appropriate care settings, however, have called Mandelman’s legislation “disappointing.”
“It’s pretty ridiculous to hold a private entity to a higher standard than we hold our public institutions,” said Jennifer Esteen, a psychiatric nurse at the hospital, referring to a local law that requires any changes or reductions to services at private hospitals to be subject to a public hearing.
“We don’t need new legislation that repeats old patterns. We certainly don’t need to allow DPH to regulate ourselves less than we regulate private enterprises. We are the example setters,” she added.
Esteen, who has helped to publicize the ARF bed reconfiguration, added that per state law, county hospitals such as ZSFGH must also undergo a public process when modifying services. It is unclear whether the law, called the Beilenson Act, applies to ZSFGH’s Behavioral Health Center.
“The BHC was created based on the auspice of better care provided by more skilled workers. The pay supports that. But now we are attempting to shift beds and staffing to nonprofits and a different category of care,” said Esteen.