SAN FRANCISCO: Nursing Home Under Justice Department Fire
San Francisco's 130-year-old Laguna Honda nursing home received a "blistering report" from the Justice Department yesterday, "citing a 'pattern of egregious conditions' that endanger county patients and violate their civil rights." The San Francisco Chronicle reports that "[m]uch of the criticism centered on Laguna Honda's antiquated design, which crowds patients into open wards of 30 or more beds," mainly in a central structure built in 1926. The report, which was sent to Mayor Willie Brown, could force the replacement of the facility -- "the largest one caring for the chronically ill in the country." The hospital cares for some 1,200 "physically or mentally disabled" patients, as well as the chronically and acutely ill; many of the patients suffer from dementia and over one-half are wheelchair-bound.
A Failing Grade
The report, which was based on "a weeklong inspection ... in June and a two-day follow-up visit in November" and prompted by an anonymous complaint, concluded that Laguna Honda was a "kind of modern-day Bedlam" where demented patients are left unattended and allowed to wander. While the report praised the medical care provided by doctors at the facility, it "faulted the nursing home for failing to provide nursing, rehabilitation and recreational activities." Among the findings were "[n]ursing staffers untrained in seizure management, medication side effects, mealtime precautions and 'appropriate positioning of residents with physical disabilities.'" Mentally impaired residents were not properly supervised and allowed to wander, and there was one report of a patient performing sexual favors in return for money.
Laguna Honda Executive Administrator Anthony Wagner "fiercely defended the quality of care at the facility he has overseen for the past nine years." He said, "It's the best care I've ever seen." Dr. Mitch Katz, San Francisco director of Public Health, conceded that the open-ward arrangement of the hospital "isn't how things are medically done anymore." But he said he doesn't think the "overall audit is fair," contending that while the "nursing home had its problems," the "report took isolated incidents and made them seem like the norm." The report now "sets in motion a legal mechanism by which the city either can cooperate with federal authorities to work out the problems amicably or face a federal lawsuit." The Chronicle reports that the Justice Department has "given San Francisco 49 days to respond to the charges, after which Attorney General Janet Reno is empowered to seek court-ordered improvements." San Francisco has been making improvements to the facility since last June, although a state "deficiency report" due within days may end the facility's special waiver to operate open wards. The Chronicle notes that the report came "just days before San Francisco expects to receive criticism from state nursing home investigators" who are threatening to withhold Laguna Honda's Medi-Cal payments. Previous attempts to rebuild or revamp the facility have failed and city officials say "building a new hospital might cost half a billion dollars" (Russell, 5/7).