Laguna Honda Hospital and Rehabilitation Center officials in San Francisco are still waiting to hear back from regulators on their request to continue protecting patients from being discharged or transferred.

At the latest Board of Supervisors meeting on Tuesday, Laguna Honda interim CEO Roland Pickens provided an update on the hospital’s journey to state and federal recertification as it awaits hearing back on its request to extend an agreed-upon grace period.

Pickens said the hospital is on track to complete its action plan items by mid-May, and has already implemented hundreds of changes around the facility. If the hospital has a strong performance in its third monitoring survey, it will be ready to apply for recertification.

The discussion comes after federal and state regulators cited safety concerns at Laguna Honda last April and removed its Medicare and Medicaid provider agreements. Regulators also required the hospital to move all 700 patients out of the facility by September. Drug paraphernalia in the facility, a lack of infection prevention and control, and missed doses of medication were among the cited concerns.

A settlement agreement initiated by City Attorney David Chiu halted the patient discharges until February, after 12 patients who moved out of the hospital allegedly died three months after being discharged.

Then in February, the federal Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services agreed to allow the hospital to postpone involuntary patient discharges until May, which was not approved until 24 hours before the grace period ended. The hospital once again asked regulators to extend the grace period past May 19, so it can recertify without negatively affecting residents.

Working to avoid a repeat

“Last time we only had 24 hours’ notice,” said Pickens at the meeting. “You can imagine the stress and strain that caused for our residents, their families and communities. We stressed to them we did not want to be in that position again.”

Pickens said the hospital is doing everything it can to ensure it will never have to implement its approved closure plan, which was required by regulators, but just in case, he reminded residents that they have the right to appeal a transfer or discharge.

He said he was hopeful after city health officials and the mayor hosted U.S. Department of Health and Human Services Secretary Xavier Becerra for a tour of Laguna Honda in February.

“He seemed to be very impressed and commented that based upon his visit, the reports didn’t match what he was seeing with his own eyes, that he saw Laguna as a high-quality facility and really questioned all of the reports that have been put forth,” Pickens said.

Pickens added that the hospital is seeking to fill new, permanent leadership positions to bring in skilled nursing home practitioners. Laguna Honda expects to send an offer to a new nursing home administrator soon.

“It’s very cruel. It’s not the way that any government agency should be treating the most vulnerable patients among us.”

Supervisor Hillary Ronen

“I’m invested to make sure that this sticks, that the person is successful and that all the improvements and redesign systems are really baked into the fabric and organizational culture of Laguna Honda, so that we don’t ever find ourselves in this position again,” Pickens said.

Supervisors Hillary Ronen and Rafael Mandelman still expressed concern and frustration that CMS is still letting the deadline loom over patients after February’s request put people into distress.

“It’s very cruel. It’s not the way that any government agency should be treating the most vulnerable patients among us,” Ronen said.

“I think many of us share Supervisor Ronen’s frustration and feeling that this is a pretty bonkers way to try to improve an institution that actually is doing critically important work in San Francisco,” Mandelman said.

Supervisor Myrna Melgar requested to continue the hearing to September, before the upcoming deadline for CMS and MediCal reimbursements in November.