April 4, 2006
Planning for Elders in the Central
1370 Mission Street, 3rd Floor
San Francisco, CA 94103
Dear Planning for Elders,
I am concerned to hear of your decision to oppose Proposition D, which appears to have been based on insufficient information about this important initiative. As a psychiatrist who worked at Laguna Honda Hospital for the past 13 years (1992 - Sept. 2005), I have been directly involved in these issues since they began. In early 2004, the Health Dept. began to admit many younger, behaviorally unstable patients to LHH, causing unprecedented levels of violence and endangerment of the frail elderly and younger severely disabled residents of the hospital. This has resulted in numerous citations from State and Federal regulatory agencies.
Many of us tried from the outset to remediate these unsafe conditions through discussions with the Health Dept., testifying before the Board of Supervisors and the Health Commission, and meeting with the Mayor. To my surprise, our concerns fell on deaf ears. So we had to seek another solution in order to protect the frailest and most vulnerable of our citizens. Proposition D is that solution. It creates a Special Use District for Laguna Honda, and strengthens existing laws and regulations governing safety in skilled nursing facilities, which have been repeatedly violated by the very people and agencies who are supposed to uphold them. Since the Health Dept. and other City agencies have shown that they lack the intent and the ability to protect the residents of LHH, greater oversight is needed from outside the Health Dept.
Proposition D does not discriminate against psychiatric patients, as you state in your recent newletter. As a psychiatrist, I would never support any initiative that would do so. Laguna Honda has long had residents who, in addition to the primary medical conditions for which they require 24-hour skilled nursing care, have stable secondary psychiatric illnesses, and who do not endanger others. Current regulations governing skilled nursing facilities, with which I assume your organization is familiar, prohibit the admission of patients with primary psychiatric disorders (i.e., patients who have psychiatric disorders, but who do not have sufficient medical needs to require 24-hour skilled nursing care) to Laguna Honda and similar institutions. Likewise, psychiatric hospitals do not admit patients with primary medical illnesses, or patients whose psychiatric illnesses are not severe enough to require admission to their facility. This can in no way be considered discrimination. In fact, the dumping of mental patients into nursing homes is discriminatory and prevents those patients from getting the specialized psychiatric care they need. (Sadly, this is not only happening here in San Francisco, but in other parts of the country as well. Please read the attached New York Times article.)
It is not true that if Proposition D passes, over 300 current residents of LHH with Alzheimer's disease, AIDs dementia, traumatic brain injury, and psychiatric disorders would have to be discharged. Most residents of Laguna Honda with these diagnoses are not dangerous and can be safely cared for there. Medical experts including UCSF experts in Neurology and Dementia, as well as the Alzheimer's Association of Northern California, have refuted these false claims. Please read the attached letters. Proposition D is about keeping Laguna Honda safe. I respectfully suggest that you review both sides of this issue, and reconsider your position on Proposition D.
The mission of PECC, as posted on your website, includes the following:
You ought to support Proposition D, because it furthers this mission. As you may realize, over the next 2 decades, the number of elderly persons in San Francisco will increase considerably. The Health Dept.'s own data, published in 1998, projects that San Francisco will have a shortage of 2,380 long-term skilled nursing beds by 2020, even if Laguna Honda Hospital's 1,200 beds are rebuilt. If Proposition D does not pass, the Health Dept. will continue to populate Laguna Honda with younger, more able-bodied and behaviorally unstable patients, and more and more frail elderly who need this level of care will be displaced to facilities far out of county (as has already happened to some). I fully support community living options, and I worked for years at LHH to keep institutional stays short, to help many patients return to community settings. But you all know as well as I do that some people eventually require institutional care. Laguna Honda is one of the City's only remaining refuges for San Franciscans who need long-term care, especially those with limited financial resources and severe, complex illnesses.
What I find most distressing that instead of working on a master plan to solve the challenges of how San Francisco is going to take care of ALL these populations (including frail elderly, severely disabled people, people with severe psychiatric illness, developmental delay, substance abuse problems, and homeless people), our City leaders are instead pitting the needs of one group of vulnerable people against another. Does this make sense? Who is looking at the big picture? Why can't we all work together to solve these problems, now and for future generations? It's very sad that Proposition D is necessary but it is.
If you are interested in more information or dialogue about these issues, I'd be glad to speak with you. I can be contacted at [ ] or [by e-mail].
Thank you for taking the time to read my letter. I hope you will take the time to learn more about these complex issues, and that you will support Proposition D.
René K. A. Thomas, MD
Former Laguna Honda Hospital Staff Psychiatrist, 1992-2005