A demonstrator at an Aug. 22 rally regarding the slated downsizing of the Adult Residential Facility posits a salient question to the city. Photo by Abraham Rodriguez

Lorraine, who is 80, was apparently given two choices: Leave the Bernal Heights board-and-care facility for the elderly with the suspended license and head to one 155 miles away in Oroville — or else. 

She chose “or else.” 

On Aug. 29, the octogenarian walked out of her home and didn’t come back. A police report was filed. An “Unusual Incident Report” was sent to the state’s Community Care Licensing division. But, tragically, the sight of an elderly person left on his or her own to deteriorate on the pavement is hardly an unusual incident in San Francisco.

So, it wasn’t until late last week, we are told, that Lorraine was discovered on Market Street. 

Your humble narrator is informed she had sepsis. Your humble narrator is informed that maggots had infested her wounds. She is, as of this writing, still undergoing treatment on San Francisco General Hospital’s sixth floor. When we called the police on Friday to inquire, it was news to them that Lorraine had been located, and they dispatched officers from Ingleside Station to the hospital to take a “found person report.” 

We phoned Lorraine’s hospital room, but we were told that she didn’t feel like talking. Who can blame her? 

An elderly person living hard on this city’s streets is tragic. And tragically ubiquitous. What distinguishes and elevates this situation is that perhaps a football field’s length from Lorraine’s hospital bed, a doable walk even for an unwell 80-year-old, are 45 empty beds at the city’s Behavioral Health Center, right there on the SFGH campus — 23 at the first-floor Adult Residential Facility and 22 at the Residential Care for the Elderly facility on the second floor. 

These beds are being kept empty. By choice. 

The Mission, March 2017. Photo by Lola M. Chavez.

Last month, the office of the mayor and the Department of Public Health triggered a firestorm when they revealed plans to transfer 41 permanent housing beds for the mentally ill at the Adult Residential Facility into a temporary homeless respite. 

Transitioning permanent housing into temporary shelter, like being asked to change a $20 bill and handing over three fives and a 10, seems like a bad deal on its face.

When asked why this was the best course of action, the Department of Public Health revealed it wasn’t using the beds. This was, of course, even more troubling. 

City residents have grown downright inured to the sight of mentally ill homeless people on the streets of one of the wealthiest cities in the history of wealth or cities — yet dozens of permanent beds created to meet the needs of this population have been kept willfully unused. 

Nobody has been admitted to the Adult Residential Facility since September 2018. Nobody has been admitted to Residential Care for the Elderly since April 2019. (These beds were apparently kept empty in anticipation of consolidating the two facilities.) 

Explanations prompting additional, disturbing questions have become a pattern here. To wit: 

  • The Department of Public Health first said it had been unable to expediently make hires to staff the facilities properly. Staffers, however, told us of open positions languishing for more than a year. A quick Sept. 12 search on the DPH’s job portal shows only two open jobs here — and both are earmarked for lateral transfers, not new workers. What’s more, Janel Holland, who ran the Adult Residential Facility from 2009 to 2015, says she warned higher-ups about understaffing a decade ago. In 2013, 14 beds were added to the facility and, she says, she was told to make do without any additional staff; 
  • Mental health workers here — and we have spoken to well more than a dozen — say they were told by management that new patients could not be admitted because the facilities were “on probation” from the state licensing board. The Department of Public Health confirmed that management did tell staff this. But it’s not true. And, in fact, three days after Mission Local’s Sept. 2 article about management’s “probation” claims, state licensing personnel dropped by Potrero Street unannounced and “explained” to top managers “that the facility is not on probation and not restricted to not admit residents;
  • Finally, in an above-the-fold A1 story in the San Francisco Chronicle, DPH special projects manager Kelly Hiramoto last week said it was the “unprofessional conduct” from workers that led to a freeze on admissions (citations, as you can see here, have been amassing over the years). DPH director Dr. Grant Colfax added that the facility was “not performing to our standards.” 
The encampment on 19th Street between Folsom and Harrison streets in September, before it was cleared on Oct. 5, 2016. Photo by Lola M. Chavez.

After weeks of seemingly taking pains to not throw its workers under the bus, the DPH abruptly opted to throw its workers under the bus with gusto. 

It is odd, when you think about it, for an institution claiming to have a desire to beef up hiring to then demonstrate a willingness to defame the entire workforce on the front page of the city’s newspaper of record. That’s a perverse recruitment tool. 

It’s also odd to claim that concern for patient safety led to a curtailment of new admissions — but those already residing here were left in place, come what may. 

The workforce at the Behavioral Health Center did not invade the facilities like a pack of Visigoths. They were hired. They were trained, or not trained. They were disciplined, or not disciplined (and while Hirimoto told the Chronicle that some staffers have been “terminated,” union reps with both the SEIU and Local 21 denied this). 

Management claiming that, in effect, a loss of institutional control has forced it to largely abandon its raison d’être — boarding and caring for patients — is a profound self-indictment. 

Management is supposed to solve these types of problems — problems that have, evidently, persisted for years. Curtailing access to this housing is the very opposite of “solving” the problem. It is more akin to scuttling the ship.

A homeless man sleeps on the sidewalk. By Moch N. Kurniawan

Meanwhile, the sharpening of bayonets and digging of trenches for a traditional San Francisco labor-management standoff obfuscates the focus from where it should be — on needy people like Lorraine. On the patients. And on the potential patients, who may be prevented from getting the care they need, and may instead be forced to waste away in a locked facility, in jail, or on the streets. 

People in need were — and are — being denied care. That’s the issue — period, full stop.

And, even giving the benefit of the doubt to DPH management that it felt it was acting for the best in curtailing access to housing at the Behavioral Health Center, it’s hard to imagine a similar reaction if citations piled up in the Emergency Room or pharmacy. 

Would the Health Department restrict access to emergency treatment or life-saving drugs as it has cut patients off from housing? 

“Being denied the resource of permanent housing has the same impact on recovery,” says Aimée Armata, a former behavioral health clinician here. “This has become a power dynamic between staff and management. But our responsibility is to solve that, and focus on care. The solution isn’t to restrict access to care. This is a mismanagement of public resources.” 

Rancor, however, may be in surer supply than solutions. Competing legislation regarding the empty beds is wending its way through the Board of Supervisors. Both Supervisors Hillary Ronen and Rafael Mandelman seem open if not adamant about the Behavioral Health Center being audited. 

“I think we need someone other than the Board of Supervisors digging around on this. And, honestly, even journalists,” says Mandelman. “We have not been able to unpackage and fully understand what are the issues that made the Adult Residential Facility impossible to operate. So I would be interested in getting the controller engaged. I think [city controller] Ben Rosenfield is gonna spend some time on this.” 

So we may have that to look forward to. As well as input from the state licensing board.

On Sept. 10, just five days after a state official dropped by the Behavioral Health Center to “clarify any possible miscommunication” about being on probation, they were back again — buttonholing workers. 

“The State is here, interviewing staff,” texted one worker. Then they sent a Gif file. 

It was, literally, a film of shit hitting a fan. 

Follow Us

Managing Editor/Columnist. Joe was born in San Francisco, raised in the Bay Area, and attended U.C. Berkeley. He never left.

“Your humble narrator” was a writer and columnist for SF Weekly from 2007 to 2015, and a senior editor at San Francisco Magazine from 2015 to 2017. You may also have read his work in the Guardian (U.S. and U.K.); San Francisco Public Press; San Francisco Chronicle; San Francisco Examiner; Dallas Morning News; and elsewhere.

He resides in the Excelsior with his wife and three (!) kids, 4.3 miles from his birthplace and 5,474 from hers.

The Northern California branch of the Society of Professional Journalists named Eskenazi the 2019 Journalist of the Year.

Join the Conversation


  1. Thank you for pointing out the true problem here – DoH’s poor management.The Dept. of Health has known the unit is troubled for years, took action against the bad apples in the staff, and then did NOTHING to change the culture or practices other than restrict new admissions since 2018? All the mid-level and seniors managers that knew about this need to be called on the carpet and fired if they can’t show what actions they were taking to rectify all the problems. I would bet there is plenty of blame to go around – civil service protections for poor staff and managers, union resistance to wholesale staffing changes, lack of accountability for actual performance, etc. Too often career managers in City government never have any consequences (how many got fired for the Muni meltdown, Central subway cost overruns, etc?). DoH needs to bring in outside experts to get that unit in shape and staffed up to fill all those beds which are desperately needed. People are dying on the streets and they dithered for more than a year!!!

    votes. Sign in to vote
    1. Corruption.

      – The Brown machine has run the City as an extraction operation for almost 30 years now.

      – The machine has domesticated the nonprofits such that not playing ball with the machine is punished.

      – The unions are only interested in headcount.

      – The advocates have been unable to execute politically to change any of this

      votes. Sign in to vote
  2. All of these eyes on the problem, City staffers, supervisors, advocates, service providers and nobody was able to see this until now?

    votes. Sign in to vote
  3. Nobody has all the facts. And the reported facts(like terminations and whether there is endemic mistreatment) are contested. One thing’s for sure, no one wants to be held accountable for another “snake pit” patient abuse (ala Laguna Honda) scandal. After all, that was part of rationale for the 1967 LPS Act(along reducing public expense for mental health care) and later buttressed by emotional impacts of One Flew Over the Cuckoo’s Nest, The King of Hearts, and Rainman).

    Practically, there can never be sufficient long term care capacity of the kind being discussed. After all, individuals will be there for their lifetime of more than 80 years annually. Given there are 4,000 homeless SF people who need that level of care, it’s a annual cost of $800M.

    votes. Sign in to vote
    1. Without residential beds people end up in the street with maggots infecting their cuts. We have no choice but to choose to help

      votes. Sign in to vote
      1. Endless talking and compassioneering is not helping. There are no ready solutions to this. The best we can do is to intervene to get those in crisis on the streets stabilized.

        If this means moving already stablized people to Oroville, then that is a reasonable public health trade off.

        votes. Sign in to vote
  4. Outstanding Joe. We are so grateful for both of your articles. You have a gift and we appreciate you sharing it in our story

    votes. Sign in to vote
Leave a comment
Please keep your comments short and civil. Do not leave multiple comments under multiple names on one article. We will zap comments that fail to adhere to these short and very easy-to-follow rules.

Your email address will not be published. Required fields are marked *