Laguna Honda Hospital, seen here in 1956, was founded some 166 years ago as an almshouse for geriatric pioneers. In recent years, however, younger, more ambulatory and oft-mentally ill and/or substance addicted patients have been placed here — leading to the site's present existential crisis. Photo courtesy of

Laguna Honda Hospital is a facility with a rich history of scandal and mismanagement. For it to be facing an existential crisis now, over a series of comparatively minor violations, feels a bit like Al Capone going to prison over tax evasion. 

But Capone did, indeed, go to the slammer; you can buy the commemorative t-shirt at Pier 39. And, as mind-boggling as it may be, the 700-odd vulnerable patients at Laguna Honda may be out on their ears before year’s end if the hospital fails to meet the latest terms imposed by the federal government. If Laguna Honda comes up short in a top-to-bottom recertification process, it could lose Medicare and Medi-Cal funding in four to six months’ time

This would blow a roughly $20 million a month hole in the city’s budget and open up the real possibility of patients being transferred hundreds, if not thousands, of miles away — or, tragically, to the curb and immediate homelessness. A high percentage of Laguna Honda’s patients exhibit behaviors that would’ve led to them being screened out of almost any other nursing facility, and it’s unrealistic to expect beds to be found for them. 

“They would probably have to soak up a bed at General Hospital until they ended up in jail, or a bed comes up in a locked facility for people who are criminally insane,” sums up Dr. Teresa Palmer, a geriatrician who worked at Laguna Honda from 1989 to 2004.

This assessment is as harsh as it sounds. The fate of both this city and its most vulnerable populations are not in a solid place right now. 

Laguna Honda Hospital in 1926
Laguna Honda, seen in 1926. Photo courtesy of

You may have missed the existential crisis unfolding at this 156-year-old institution. It’s easy to miss. Laguna Honda shelters the people society is most eager to overlook: The frail elderly and, increasingly, mentally ill and/or drug-addicted younger patients. This is a combustible and counterintuitive mix, and plays no small role in the fix Laguna Honda now finds itself in.

“There are a huge number of men here between ages 50 and 70,” says Palmer. At most nursing homes, she continues, you’d be more likely to find “a majority of ladies in their 80s.”  

Between 1999 and 2021, the percentage of women at Laguna Honda dropped from 56 percent to 37 percent.

The problems at Laguna Honda, like Hemingway’s description of bankruptcy, have come gradually, then suddenly. As would actual bankruptcy, so to speak, if federal funding is yanked. 

Laguna Honda was founded in 1866 as an almshouse for geriatric Gold Rush forty-niners. We could start this story then. Or we could start it in 1999, when voters approved a $299 million bond to “save” the hospital. Or in 2006, when a licensing survey noted that the younger, more ambulatory patients flowing into Laguna Honda were toting drugs, alcohol, loaded firearms, and abusing the elders; staff even futilely erected signs reading “no hitting.” 

Or we could start in 2019, when Laguna Honda staff took demeaning, nude photos of incapacitated patients and doped them up with non-prescribed medication (the first of several lawsuits settled last year for $800,000). 

Nursing director: “Our team have exhausted most options in helping eliminate or minimize the contraband and illicit substances into the unit.” … (Resident 2) voluntarily handed the burnt aluminum foil, plastic pen body case burned on one end and a cigarette lighter that he’s holding. … Resident even stated “they know I’m doing this.” 

California Department of Public Health Survey of Laguna Honda Hospital, March 28, 2022

But, instead, we’ll start in July, 2021, when two of the younger, more ambulatory patients here purportedly wandered off campus, wandered back on with methamphetamine and fentanyl, and suffered non-fatal overdoses.  

The hospital reported the overdoses to regulators. Not to do so would be unthinkable, following the 2019 scandals that led to $780,000 in fines and a slew of lawsuits. And this triggered a concatenation of regulatory procedures that led to where we are today and put the hospital on the brink. 

Laguna Honda, on multiple subsequent occasions, did not meet inspectors’ expectations on its “termination revisit survey.” In April, inspectors found 27 different violations. Some of these were significant: Incomplete patient assessments, or staff wearing improper or inadequate PPE around patients. Other assessments seemed to be more of the ticky-tack variety: medicated shampoo without a prescription, medicated creams and lotions in patients’ rooms, “three open plastic bags were hanging (unattended) in a dirty hamper.”

These are the infractions that triggered the feds last month to broach the possibility of yanking funding. Laguna Honda announced this month that it now must go through the rigmarole of working to demonstrate that it could relocate all of its residents; if it doesn’t, it may not receive funding. It will receive that funding while it works to recertify and avoid relocating anyone. It’s a Kafkaesque turn of events. Laguna Honda has so much to answer for going back through the years, but it’s the medicated shampoo, et al., that was noted on this most recent report. 

Adding to the surreal nature of these proceedings, the federal agency currently calling the shots, the Centers for Medicare & Medicaid Services (CMS), is responsible for overseeing all the truly horrific, for-profit, deathtrap nursing homes you saw on “60 Minutes.” There is no universe in which Laguna Honda compares to these charnel houses, and the overseers’ Inspector Javert-like focus on this public hospital is hard to explain. As is any “solution” that might result in the dispersal of its residents. 

Laguna Honda Hospital corridor
Laguna Honda Hospital. Photo by Christopher Michel.

“I don’t know why they are being so harsh,” says Dr. Derek Kerr, a 21-year physician at Laguna Honda who has since turned into a whistleblower and critic of the facility. “Laguna Honda is always judged harshly. If you have one violation in a 700-bed unit that is as bad as one violation in a 15-bed nursing home. They don’t take into account the denominator.” 

And, while 27 violations sounds like a lot, says Charlene Harrington, a professor emeritus at the University of California, San Francisco, Laguna Honda is seven times the size of an average nursing home facility. And, she continues, the average number of violations recorded on such an inspection is eight, meaning Laguna Honda had about half what you’d expect, per-capita. 

“California has had extremely poor enforcement of nursing homes, and has some of the worst nursing homes in the country. And that has gone on for years,” says Harrington. “Laguna Honda had some deficiencies, and I am not excusing the deficiencies. But the [overseers’] behavior in this case is inexplicable. They have let other facilities go for years … awful, for-profit facilities where really terrible things are going on.” 

Multiple emails to CMS officials have not yet been returned. 

Harrington has studied nursing homes and regulation for 40 years. And she is at a loss to explain what is going on here: “I can’t think of any case like this before.” 

Laguna Honda Hospital 1875
Laguna Honda in 1875. Photo courtesy of

There is nothing like a threat from outside to cement allegiances inside. So, at noon on Wednesday, Mayor London Breed and the SEIU 1021 — who maintain a Ralph Wolf-and-Sam Sheepdog relationship — will both appear at a rally to save this hospital. 

Government officials across San Francisco described CMS as rigid and intractable. Former California Attorney General Xavier Becerra is now the head of the Department of Health and Human Services, which runs CMS. But, city officials say, he may be trying extra hard not to be seen as playing favorites. 

CMS, city officials say, intransigently insists that its procedures are proscribed and must be done by-the-book, come what may. And you know the mayor’s office has been bending their ears, as has the office of Rep. Nancy Pelosi — and, if need be, every California politician there is will join the queue. 

What a predicament: At last, San Francisco has run into a situation in which it can’t just have its political mommy and daddy make some calls and get it out of its longstanding ineptitude. The process, at least thus far, seems to be politically impenetrable. How unfortunate, then, that this appears to be a process devoid of common sense or empathy in which, ostensibly for the patients’ own safety, hundreds of them may be jettisoned to parts unknown or pushed to the street. 

That’s just plain stupid. 

Maybe that will come up at the rally tomorrow. It’s doubtful, however, the city officials will examine their own role in this fine mess. But we can. So let’s go back to that bond measure in 1999. 

“Laguna Honda had some deficiencies, and I am not excusing the deficiencies. But the [overseers’] behavior in this case is inexplicable. They have let other facilities go for years … awful, for-profit facilities where really terrible things are going on.” 

Charlene Harrington, UCSF professor emeritus

Voters, you may recall, agreed to go into $299 million in bonded debt to build a new, 1,200-bed facility. They were promised that this would house the city’s frail elders. 

But that didn’t happen. The price tag ballooned by hundreds of millions of dollars and the capacity of the hospital was reduced by hundreds of beds. And, top it off, the city began transferring younger, mentally ill and/or substance-addicted patients into the hospital. 

So yes, we paid more, got less, and the hospital is not exclusively serving the elderly population that voters were enticed to pony up and help.

As noted earlier, this situation is longstanding. By 2004, Palmer left Laguna Honda, in large part because she felt the influx of “out-of-control” mentally ill and/or substance abuse addicts was unsafe. “They are deforming the hospital to accommodate an antisocial minority,” says Kerr, who was forced out in 2010. 

There is no scenario in which crippling and defunding Laguna Honda and ejecting its patients is in anybody’s best interests. Palmer still describes it as “a better nursing home than most” and a place where she would’ve put her own mother. 

The city must do all it can to fend off this doomsday scenario, and a consulting firm with an expertise in re-certification has already been hired. 

But the city must also address the untenable situation of commingling the frail elderly and ambulatory mentally ill and/or addicts. In 1999, you’ll recall, 56 percent of Laguna Honda’s residents were women, and the average age was 76. By 2021, only 37 percent of the residents were women. And while patients’ average age wasn’t disclosed in ’21, it had dropped to 64 by 2013. 

A state Department of Public Health survey from March, 2022, obtained by Kerr and shared with Mission Local, notes staff observing residents overtly smoking drugs off aluminum foil and seeing little they could do to prevent this. 

“Our team have exhausted most options in helping eliminate or minimize the contraband and illicit substances,” a nursing director is quoted as saying. The patient in question surrendered his burnt aluminum foil, plastic pen and lighter. “They know I’m doing this,” he said.

This city has chosen to serve populations nobody else would. But it has chosen to do so in a manner that has proven to be unworkable and led to the current crisis. 

San Francisco owes it to itself and Laguna Honda’s residents to solve this crisis. But also to ponder its own role in it. And make things right. Gradually, then suddenly.  

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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.

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  1. Looks like special interest big organisation is looking to take over this facility. Like maybe a medical biotech research organisation. This is such a valuable location with repurposing the existing buildings to labs and research facilities by special interest in DC.

    We should look deeper into the Federal Government actions, and the behind the scene strings being pulled by special interest …. highly suspicious.

  2. But the former residents may well be transferred to places where they will get worse care.

  3. I wrote a comment that was not posted. It was not long, certainly not as long and as frequent as one of the posters. It was positive and responded to the article. Since then I have this to say.
    Question: why is one of the frequently cited ‘experts’ Dr Teresa Palmer used for this article not worked at Laguna Honda since 2004 — before the new addition was even built. Her bias against some of the population at LH is clear: “A high percentage of Laguna Honda’s patients exhibit behaviors that would’ve led to them being screened out of almost any other nursing facility, and it’s unrealistic to expect beds to be found for them. ..They would probably have to soak up a bed at General Hospital until they ended up in jail, or a bed comes up in a locked facility for people who are criminally insane.” This statement truly needs some fact checking and is the kind of bias that is found about LH in so many mediated articles about why it is “CLOSING”.
    At the JUNE 14 BOS meeting at City Hall Roland Pickens CEO at San Francisco Health Network spoke about how MINOR violations were remedied in April, only to have new ones added to the list and the decision to close LH. There was time for Pickens and his team to look at 600 institutions and assess every patient at the same time. Was this a deal done in advance with CMS? regardless of violations, to rid the hospital of certain residents?
    MISSION LOCAL: ” Federal regulators issued warnings to the facility over incidents involving resident patients who left the hospital during the day and then returned suffering from drug overdoses, as well as isolated safety and sanitation violations. The incidents reflect a change in the patient population at Laguna Honda, where younger people—often in conservatorship or other behavioral health care—are increasingly admitted. The violations culminated in a decision by the Centers for Medicare and Medicaid Services to terminate Laguna Honda’s participation in its programs, which account for up to two-thirds of the hospital’s budget. That is, up to $15 million a month”.

  4. This week, the Board of Supervisors ended up kicking the can down the road on controversial housing legislation, including an upzoning plan that was picked apart in committee.

    They also heard about the pitfall-laden road to restoring Laguna Honda Hospital’s federal funding, new legislation targeting open-air drug dealing and some stark foreshadowing for the coming budget process. (As always, wonks looking for the full kit and caboodle can check out the complete agenda.)

    Housing Bills: Back to Development Hell
    When District 8 Supervisor Rafael Mandelman introduced legislation last year to legalize denser housing in districts zoned for single-family homes, there was some optimism among housing advocates. Since that time, the legislation has endured the political equivalent of development hell, with multiple amendments in committee and at the Planning Commission.

    The bill, paired with another by District 3 Supervisor Aaron Peskin to curb certain “micro unit” developments, was expected to pass Tuesday, but Mandelman asked that the items be continued due to advice from the city attorney, who recommended further amendments.

    Over time, supervisors offered affordability amendments which evolved into making new units developed under the ordinance subject to rent control, among other potentially onerous restrictions.
    The Planning Commission suggested allowing duplexes in districts zoned for single-family housing, but in doing so also exempts San Francisco from state laws that expedite approval for such projects, allowing a return to the discretionary permitting model favored by NIMBYs.
    The Peskin bill would essentially ban certain kinds of studio apartments in the Tenderloin and Chinatown. It’s also being continued since state law won’t allow it to be enacted without the density bill also passing.
    The two bills are the latest round in the city’s housing policy shell game that housing advocates—including Mayor London Breed and California lawmakers like state Sen. Scott Wiener—say supervisors have been playing against their wishes and those of the public.
    Another showdown over the future of housing in the city is coming to the November ballot. The mayor and a coalition of housing advocates are gathering support for Affordable Homes Now, which aims to speed up many affordable and market-rate housing projects.
    District 1 Supervisor Connie Chan has fielded a rival measure with more stringent affordability requirements. Meanwhile, Peskin has proffered a measure to expand rent control to some new housing, and District 5 Supervisor Dean Preston wants to spin off and reorganize the Mayor’s Office of Housing.
    Laguna Honda’s “Kafkaesque” Road to Recertification
    The meeting also included a hearing on the crisis at Laguna Honda Hospital, which revealed the dilemma the facility now faces: in order to be recertified for federal funding, the hospital has to close down temporarily, forcing close to 700 patients to be transferred or be discharged.

    Here’s some of what was uncovered:


    Public Health
    Sup. Dorsey Proposes ‘Right to Recovery’ Zones With Targeted Drug Enforcement
    Laguna Honda’s patients receive different kinds of long-term care, from rehabilitation to hospice care. It’s the kind of facility that most other cities have given up on. The hospital has been in operation in one form or another for over 150 years.
    Federal regulators issued warnings to the facility over incidents involving resident patients who left the hospital during the day and then returned suffering from drug overdoses, as well as isolated safety and sanitation violations.
    The incidents reflect a change in the patient population at Laguna Honda, where younger people—often in conservatorship or other behavioral health care—are increasingly admitted.
    The violations culminated in a decision by the Centers for Medicare and Medicaid Services to terminate Laguna Honda’s participation in its programs, which account for up to two-thirds of the hospital’s budget. That is, up to $15 million a month.
    Health Network and interim hospital director Roland Pickens outlined the process, which revealed good news and bad news. First, the good news: recertification could happen by year’s end. The bad news? The hospital will have to transfer or discharge patients, and there are only a handful of beds available in the city—most would have to be transferred elsewhere in the state.
    Mandelman deemed the process “Kafkaesque” and “mind boggling.” Preston called it “bonkers.” Board President Shamann Walton questioned any assurances that the hospital has a chance of regaining certification.
    Representatives of the hospital union SEIU 1021, as well as public commenters, urged the city to take the issue up the chain of command—anything to avoid shutting down the hospital.
    In 1999, the last time the facility fell under federal scrutiny, 73% of San Francisco voters approved a $300 million bond to rebuild it.
    The hearing has been continued to Sept. 13.
    New Business and Budget Foreshadowing

    Supervisor Hillary Ronen, center I File photo by Camille Cohen
    Supervisors held an emergency hearing on yet another beleaguered behavioral health provider: the recently merged Baker Places and Positive Resource Center. The facility provides drug treatment and care for AIDS patients at a number of locations, including a recently built “Hummingbird Center” psychiatric respite center in the Mission.

    The nature of the hearing prompted District 9 Supervisor and Budget Chair Hillary Ronen to let slip a bit of a shocker about the coming budget process.

    Mayor London Breed, along with Mandelman and District 6 Supervisor Matt Dorsey, sponsored grant agreement amendments totaling $3.2 million to bail the nonprofit out of fiscal problems that threatened to shut it down.
    Most of Mandelman and Dorsey’s colleagues were downright incredulous. Ronen, Peskin, Walton, along with District 7 Supervisor Myrna Melgar and District 11 Supervisor Ahsha Safai, demanded clearer answers from staffers at the Department of Public Health, which they didn’t get.
    Ronen noted that $1.5 billion in add-backs to the city budget were being requested by departments. That’s right, $1.5 billion—the highest amount of requests received in city history. It’s pretty certain that not all would be granted, but Ronen said “she couldn’t sleep at night” because of the list.
    Ronen moved that the combined aid in the related legislation be reduced to $1.25 million, as long as the funds be used only for staff pay and preventing patient displacement—at least until DPH could provide more information. The amended ordinances passed unanimously.
    More budget foreshadowing was introduced when Supervisor Chan, along with Peskin and District 4 Supervisor Gordon Mar, said they want $118 million to create an “API Equity Fund” as reparations for past policies that discriminated against people of Asian descent. The funds, which would be used by nonprofit groups for community reinvestment, would come out of the city’s rainy day reserves. Read more about it here.
    During Roll Call, Dorsey introduced legislation to create “Right to Recovery” drug enforcement zones where people looking for substance-use treatment can be shielded from drug use and dealing. Read more about that here.
    Finally Preston introduced a resolution urging alternative plans for the Plaza East public housing in the Western Addition, where Mayor Breed grew up. He voiced concern over MBS’ plans to include 300 market-rate units, and instead urged the builder to make any additions below market-rate where possible.
    Mike Ege can be reached at
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    June 15, 2022 at 2:03 am
    Your comment is awaiting moderation. This is a preview; your comment will be visible after it has been approved.
    The Laguna Honda deal is a land grab, The Poor people simply have had too good a view for 150 years and now it will be ceded to condos for the rich. Same thing happened to blacks in Western Addition back when they got kicked out and given worthless vouchers that are still floating around out there as zero value family heirlooms. Key point here is when electeds allowed intermediary bursars to claim and enforce eviction powers. Go Warriors !! h.

  5. “It’s like a jungle sometimes, it makes me wonder how I keep from going under…” Melle Mel & Grandmaster Flash, “The Message”

  6. Do NOT stand up for these monsters who run this hell hole. My friends have wound up in there. We’re homeless. They got neglected, abused & the staff are like a bunch of sociopath prison inmates. Disgusting & very very scary. Shut it down. & The fact that this city has not worked on increasing long term skilled nursing facilities…..Why do people in this city put up with this crap????? There’s SO MUCH MONEY here to do SO MUCH BETTER. & then for the author of this article to use the word “punitive” in reference to anyone anywhere in this story is just another part of the problem. Yah, let’s let people entrusted to care for the most vulnerable post them being sexually/physically/emotionally abused on the internet, fail to give them medication, steal their belongings, ignore patients smoking & using illegal drugs in favor of surfing the internet, playing video games & socializing with friends/coworkers, etc & when an authority who actually gives a crap about the patients shuts it down, let’s blame the authority for being “punitive”. No, you, author are the punitive one. The staff are the punitive ones. The authority that shut it down is the savior of all those who suffered as patients there. Furthermore, you probably never even went there except to get info & photos for your article. What do you know about the Dickensian Poorhouse conditions? Get a clue….

    1. You assume that the the place they are sent to (which ultimately lands some of them on the streets after they temporary housing runs out) will be better than Laguna Honda. You also prefer it be closed than reformed.

  7. Look, the real problem is administration. Safely caring for the entire population is feasible at Laguna Honda if the organization were managed properly by knowledgeable and responsible individuals, not by selfish people who simply sit at their ivory towers, collect their pay and pension and spend their time playing politics and pushing their personal agenda! Period!

    1. But that means less beds (currently in short supply) for the traditional Laguna Honda patient who is well up in years and can longer take care of themselves on their own and those incapacitated by serious physical illnesses (other than primarily psychiatric) and disabilities.

  8. Make it a locked facility, and rescind the previous decision of allowing younger patients with substance abuse and mental issues to stay here. No one under the age of 70 should be allowed to receive care here, in my opinion. This is why we need to reopen state hospitals for the clinically-insane, and those who are a danger to the public. Lock those lunatics away, and throw away the key. The frail and elderly should be allowed to receive care with dignity, without worrying about 50-70 years olds wandering off the campus and returning with drugs.

    1. equating a suffering human life to refuse and simply disposing of it is appalling. we are not disposable simply for our age nor our inadequacies.

    2. Oh & the reason it was left open was cuz they’re too cheap to hire enough security & arrange for it to be safely secured. There’s a big problem in this city with extreme cheapskates

    3. Many people with advanced Alzheimers or serious disabling conditions have been sent to nursing homes regardless of age. And that includes Laguna Honda. Age has little to do with in the end.

  9. Disclaimer: The views expressed here are my own and are not on behalf of my employer, SFDPH. I do not speak in any official capacity. No non-public nor protected health information is shared in the following, and no DPH time was utilized in composing this message.

    I am a board-certified Psychiatrist and Addiction Medicine specialist, with training in Public Psychiatry, who has experience in subacute locked psychiatric and unlocked skilled nursing facility care – including Laguna Honda.

    Of note, persons with serious mental illness and substance use disorders are at higher risk for numerous medical conditions – including anoxic/traumatic brain injuries, paralysis, infective endocarditis/osteomyelitis, severe strokes, neurocognitive disorders, untreated HIV – that at times require skilled nursing facility care. Such medical care is NOT necessarily available in most psychiatric or substance use disorder treatment facilities. Many patients are not clinically or legally appropriate for the locked facility placements alluded to in the article. There are no magical placement alternatives for patients at Laguna Honda, who all have medical issues that warranted skilled nursing facility placement. Those with co-morbid serious mental illness or substance use disorders have even less placement alternatives. These patients often require multiple healthcare providers of complementary disciplines (such as medicine, nursing, social work, behavioral health, occupational/physical therapy, activity therapy, etc.) collaborating for patient well-being. Prior to coming to Laguna Honda, many of these patients’ health significantly worsened in lower levels of care, where such services can be less accessible or less coordinated.

    I disagree with the notion that persons with substance use disorders or serious mental illness don’t deserve skilled nursing facility care. At Laguna Honda, I have treated professionals, grandmothers, persons who have never been housed, veterans, victims of sexual violence, 20 to 80 year olds – who use substances, suffer from serious mental illness, or both. They have loved ones who deeply care for them. These patients are not an “antisocial minority” nor “out-of-control” – they are us.

    There are problems at Laguna Honda, and there are problems in our entire healthcare system. We need a variety of levels of care and housing options that are accessible to patients and providers, without exorbitant wait times or prohibitive costs. We need proper staffing, training, support, and supervision for the staff in our facilities to be able to care for a complex and vulnerable population. We need more harm-reduction and safe-use spaces, including ones patients of Laguna Honda can access.

    Denying or restricting care to our most vulnerable loved ones does not solve these problems, but only causes harm.

    Anand Iyer MD

    1. There’s way more money in this city to pay for this. The privileged elite (RICH) would rather buy themselves huge houses & spend it on luxuries for themselves like the Urban School High School on Page st with $40,000/year tuition. That’s the problem right there. Spend that $40,000/year on a patient at Laguna Honda send your kid to public high school & you will watch these problems melt away. “It’s all about money, Ain’t a damn thing funny….” – Grandmaster Flash & Melle Mell from “The Message”

  10. All I know, and it means a lot to me, is that Laguna Honda never became a site of COVID spread in the early, worst, days of the pandemic. How many nursing home facilities can say that, much less huge ones?

    1. The reason LHH did well with COVID was because CDC, CDPH & SFDPH Infection Control oversaw the process at LHH and the entire frontline staffs came together and did the work to mitigate the spread. These frontline staffs knew the ineptitude of some LHH leaders and put aside any grudges and ill will because this was a matter of life and death for all. The COVID unit became designated as such because that unit’s leadership couldn’t control the spread within the unit. So it had to be quickly closed off from the rest of the hospital. That nurse “leader” who got the accolades for all the work EVERYONE put it to avert COVID disaster is the same one who is the leader for the disastrous unit where the majority of illicit use and the dealers for the rest of the hospital came from. In this case, the rest of the nursing team could not come to her rescue because she maintained the culture of silence, citing HIPAA. Yes, this is the same one who is very careful to be politically astute because she wants to be the next chief nurse. She developed a clique with with chief quality officer and others in the c-suite that ran the LHH narrative. These people have no clue what it’s really like to provide hands on care. They sit in their ivory towers holding their closed door, exclusive meetings, then start barking orders to everyone. If you don’t follow, you are called out as a scape goat for their failed interventions. If you sound an alarm that attention needs to be placed on other processes in addition to the illicit drugs mess, infection control, for example, they ignore you and push their agenda. So here we are….. The fish stink at the head. The elite few ran LHH to the ground while the rest of the well meaning, hard working nurse directors, managers and frontline staffs did the heavy lifting and will soon have to scramble to find another a job. I will not be surprised if these elites get cushy jobs elsewhere within CCSF. It’s just how SF works. The inept, yet politically astute, are rewarded.

    2. & Finally, no one is going to “have to scramble to find a new job” the land won’t be sold, all the residents won’t be moved out before they get re-certified. They’re just going through a short period of restructuring. They’ll straighten things out so that they comply- whatever money they need to put whatever systems in place that the medicare & medicaid services representatives tell them to do will be made available to them by the city & county & they’ll get into compliance. It’s like a restaurant getting shut down for health violations; within several months they’ll be back open with a new better way of doing things. No Bomb is coming. Though it makes for an attention getting headline.

      1. Some residents are being moved out but as I said before in a reply earlier, they’re the ones who get no visitors, have no one listed on their contact in case of emergency & are those who are (& frankly always were) totally on their own in this World. Those who have family/loved ones who visit & handle their affairs will be there the duration. When it’s re-certified they’ll still be there. The real trouble is where they’re putting people who need to go in Laguna Honda today, tomorrow & the next day: the medicaid people who today right now are being discharged from San Francisco general hospital who need to go into a nursing home. San Francisco Medicaid patients have no other long-term Care facility that accepts Medicaid in San Francisco. That’s the only place that accepts medicaid. I know I said that twice but it needs to be said twice because where else can these people be sent? I called my managed Care organization that serves me, a Medicaid patient, San Francisco health plan, three times in the past 3 weeks asking them where I will be sent if I should need long-term care and they can’t even give me an answer. A snarky supervisor there named Oscar told me to call the department of health so I did and the man who answered my call at sfdph said “why are you calling us and asking us?” He said that has nothing to do with sfdph that is up to the department of managed healthcare services & the three managed Care organizations that serve the Medicaid population of San Francisco to figure out. This scares me because my own Medicaid managed Care organization San Francisco health plan has no plan. I can’t even find out where I will be sent for long-term care. That seems wrong to me. Where is the transparency? If someone at mission local can please look into this I would be very grateful. It seems to me like a scandal for my healthcare organization to not even be able to tell me what long-term care facility or facilities they will be working with now that Laguna Honda is off the table. Why they were ever allowed to function with only one long-term care facility that serves their population is beyond me. It seems like an irresponsible and unaccountable thing to do. It is not right for them to only contract with one facility in a very wealthy city of a million people. That was a recipe for disaster and now the chickens have come home to roost. So please yes look into at the very least San Francisco health plan because I don’t know what Blue Cross or Kaiser, which are the other two medicaid managed care contractors are doing for long-term care facilities but I know for a fact that San Francisco health plan has no answer for their client; me. To fail to inform me of what their plans are is just plain wrong & possibly is a breach of their contract. Thank you for looking into the matter. I appreciate it very much.

  11. What I don’t get is that no one is calling out the gross ineptitude of the Chief Executive Officer and the Chief Quality Officer! Both have absolutely no experience in running this type of facility at this large a scale. Both are learning on the job and bullying the nurses to do their bidding, taking advantage of the lack of an active, responsible Chief Nursing Officer and listening only to the two most senior nursing directors who have absolutely no clue what really goes on at the frontlines, yet taking all the credit for nursing’s work because they have the eyes and ears of the C-suite and they have their own eyes on the prize- being chosen as the next Chief Nursing Officer. Politics, culture of silence, and cliques continue at Laguna Honda hospital. They’ve run this organization to the ground.

    1. Yes! Incompetence at the top is killing our city. In all the lhh reform hearings the go to is hiring consultants. And scapegoat ing whistleblowers. The nepotism at dph is staggering. There is no accountability for admin, or their minions.

  12. It was Mitch Katz former director of DPH who starting in 2004 led SF down this road. That same year he attempted to close the 120 bed skilled nursing locked facility on the SFGH campus that was build with a bond issue for conserved seriously mentally ill patients. Katz wanted to turn the facility into a board and care in order to save money. After a blue ribbon committee met for a year the facility was broken into three parts, one part board and care ( later DPH director Barbara Garcia tired to close that part ) 40 beds saved for conserved patients but staff decimated and patients are being sent out of county or to jail or the streets OR TO LAGUNA HONDA. And one third for dementia patients ( one woman found dead in an outbuilding in 2019 or 2020) The FBI should do an investigation of Department of Health

  13. IN THE BEGINNING. Way back in the day I was one of the first ZHP Volunteers when the Hospice Unit first opened, at the time we were caring for clients at Page Street and in the community. I have fond memories of Derek Kerr’s cocktail parties.I spent over 15 years as a Home Visit Hospice RN. Now retired I was comforted by the thought that Laguna Honda might be my back up option. It is shameful that we can not maintain this refuge for those approaching death. San Francisco, the city that has forgotten how. Patrick Monk.RN. Noe Valley.

    1. “San Francisco, the city that has forgotten how” & in so very many ways…. wow that’s so true. Thank you for summing it up so perfectly.

  14. Closing Laguna Honda is unconscionable. There has to be a land grab conspiracy somehow between CMS and a developer. Investigative journalism is our last resort when stuff like this goes down. Thank you, Joe, for your terrific work.

    And. There are still insufficient skilled nursing-home-style beds for seniors in SF. The current system, which is only getting worse, goes like this. When we get old and wind up in the hospital after a fall, the discharge planner will determine we can no longer live alone and then decide for us where we will live out our days, and it will most likely not be in the city/county of SF. We’ll be shipped away, against our will, to a facility usually described as “the only place that will take you.”

    There are strict policies at ZSFGH that preclude shipped-off seniors from returning to SF.

    I accompanied a 94-year-old who was REFUSED SERVICE at ZSFGH because she had crossed county lines in order to try to get into a bed in SF. She was a 25-year SF resident/tax payer, was sent by discharge planners, against her will, to a sketchy board and care home in San Bruno.

    Consulting with social workers in SF, we brought her to ZSFGH in hopes that they would relocate her somewhere accessible to her support network of friends, church and family in SF. To show her and her family who’s boss, ZSFGH sent her San Mateo General, where she was immediately hospitalized and treated. ZSFGH had even taken her blood pressure!

    The discharge planners in San Mateo shipped her to a nursing facility in Menlo Park, where she died alone in “the only place that would take her.” Many times I tried to file a complaint against ZSFGH, and they refused to take it, as did the City of SF. They even stooped to employing the smokescreen of HIPAA. I used to work at CPMC, where medical staff would claim HIPAA to get out of any kind of work that might benefit non-patients or the greater good.

    It’s brutal to age in a city that has lost its soul.

    OK, blood pressure. Thanks for reading.

  15. Like spoiled brats, if the parents keeping bailing them out, they’ll never learn. Unfortunately, in order for change to actually occur, suffering must happen. SF leaders did this and deserve to suffer the consequences…

  16. I recall similar problems coming up before the big bond issue was approved. LHH had, for years, been warned about open wards threatening their accreditation, yet management and the rest of the City oversight structure did nothing but kick the can down the road repeatedly.

    The problems now seem to revolve around patient care and patient security. The security problems need to be addressed by figuring out what they want LHH to be. It can be a nursing home for frail and elderly or it can be a locked facility, but it can’t be both without adversely impacting the frail and elderly.

    1. To my knowledge, there are no open wards in the new buildings. The old, now defunct building had opened wards.

      1. I was talking about the old building when I said that. Sorry if I posted it in a confusing manner.

    2. Many nursing homes have door alarms so residents can’t leave without their knowing.

  17. Why has this woman not been recalled and directed to one of the bridges, tunnels or freeways leading out of San Francisco?

    They’ve got their eyes on Laguna Honda for condos.

  18. My dog and I are a therapy team, and visited Laguna Honda several times pre-pandemic. Our family also has an acquaintance whose husband receives permanent, inpatient care there after a terrible traffic accident many years ago.

    Our limited experience getting to know some of the residents/patients at this facility is that the place is necessary to care for our citizens who do not otherwise have the resources to receive care elsewhere.

    This situation is just tragic.

  19. “…we paid more, got less, and the hospital is not exclusively serving the elderly population that voters were enticed to pony up and help.

    …By 2004, Palmer left Laguna Honda, in large part because she felt the influx of “out-of-control” mentally ill and/or substance abuse addicts was unsafe. “They are deforming the hospital to accommodate an antisocial minority,” says Kerr, who was forced out in 2010. ”

    San Francisco in microcosm. What a tragedy. It is also infuriating on multiple levels. This has been going on for how many years?

    The article starts with a declaration that the place has a history of “scandal and mismanagement” — and then argues that we should still keep it going, because the alternative is worse!

    We are stuck either continuing to fund and operate this catastrophe or putting the infirm, elderly, insane, and drug-addicted on the streets? It feels like extortion.

    I have to stop reading these stories in the morning.

    1. AK — 

      This article does *not* argue that we should continue the status quo at Laguna Honda. Clearly. But we should also avoid the doomsday scenario of 700-odd vulnerable people being emptied out, likely onto the street. This would be a humanitarian nightmare. But many in the city would also wish to prevent an influx onto the streets of even more unstable, drug-addicted, mentally ill people for reasons beyond altruism.

      If you think it’s costly and problematic to minister to these people behind closed doors, try doing it on the street.



      1. Everything is bad in SF now, so unless you do what the alt right conservative reactionaries say, then you support the bad status quo, as if doubling down on right wing failure is our only choice forward.

      2. They can’t put anyone out on the street. They have the legal obligation to re-institutionalize each & every one. Stop being a drama king. Not going to happen. Ever. Sending some to nursing homes in Texas, Mississippi, Montana, North Carolina? Yes, I reckon some will wind up that far away, however, it’ll be the ones like Chico Mike & Leah & Mario who once admitted into LH had only 1 visitor: me. All the other friends of these people were too addicted to go visit someone. Anywhere. If you aren’t in the places they cop drugs, or alcohol use those drugs/alcohol, go to get food or use a bathroom, you’re not going to see them no more. They can’t even call on a phone. They’re utterly & totally preoccupied with getting the money to get, then getting & using whichever intoxicants they prefer. When Troll was in Saint Mary’s I could see our friends from his room window, they were right there sitting on the ground in the Panhandle, yet not a one could walk the 2& 1/2 blocks to St Mary’s & go up to his room. I was the only one. So it’s not like they’d be missing out on having friends unable to visit them. Whether it’s 2&1/2 blocks or 2 & 1/2 thousand miles makes no difference & multiply Chico, Leah, Mario,Troll by however many people at LH in the same peer group, there’s plenty of people in there who won’t miss any visitors being moved out of the area to some nursing home far away.

  20. What about the multiple wings of the hospital that appear to be in disrepair with broken, missing, and boarded up windows common in wings A and B. It seems that the hospital is operating below capacity, potentially you could house different patient types in different wings and avoid some of the problems mentioned in this article is the building were repaired.

    1. You’re probably referring to the old building which is no longer used. The new buildings are in excellent shape, and anything that is not working properly is inspected by the engineers.

    2. The old buildings are not seismically safe and, if used as a hospital, have open wards, which are no longer allowed and one of the driving reasons behind the bond issue.

      1. The old building is solid as a rock and on the historic registry. There are many highly redecorated offices for admin. This is an asset that I suspect the city doesn’t want to pay living wages to staff. The old wards are intirely separate and could be configured to house many different types of populations.

  21. i had to look up two of the many literary references to best understand this excellently report!

  22. Joe, I did not see any mention in the article about the ownership of the land. It is a vast site and presumably if the land was sold with permission for redevelopment as housing, vast amount of money could be raised? Presumably enough to rehouse the current inhabitants?

    An option?

    1. & buy land where in this city to build a new facility? (which will cost like a billion dollars to build, ok?) If you sell a piece of land in SF & buy yet another piece of land in SF, you’ll be breaking even cuz land suitable to build a hospital on in SF costs the same whether it’s in Diamond Heights or Dog Patch.

  23. Joe,

    They’re after the land.

    Pure and simple.

    Like Jonathan Winters in, ‘The Loved One’ as cemetery owner who shoots the bodies from his property into Geosynchronous orbit of 22,300 miles so they can be seen as new stars by loved ones …

    Actually, his motivation is not to make them stars but, as he says …

    ” Get those stiffs off my land !!! ”

    Same thing happening at 21st and Hill Street where one billionaire who wants his name kept out of it has purchased 7 properties and maneuvered to get them leveled to build what, so far, looks like the tomb of a minor Pharaoh.

    I believe that’s illegal to take housing units off the market and combine their square footage to make single huge unit ??

    The guy who runs a big bank I won’t mention (not cause I’m discreet … it’s cause I forgot) …

    guy on Nob Hill bought small (1,000 square foot) apartment adjoining his penthouse and paid $6,000 a square foot for it and they had a hearing before the Appeals board about it.

    Whomever is doing this Russian Army type destruction of the structures atop 21st Street has seen no opposition I’ve seen and I’m a nosey so and so.

    They want the property.

    That simple.


    Read my accounts of the changing of federal legislation from Lyndon Johnson’s Medicare and Medicaid programs which got the Feds in the front door and now they’re using that foothold to take over the whole place …

    Go Giants !!


      1. Hello Patrick. This is Bob from Mission Market Fish & Poultry. Glad to see you are still a passionate advocate in the health care industry. Best always

    1. The federal government is after the land?????? Ummm……….. What’s the federal government going to do with that land??? How would they even get control of it???? Let me get this straight: the federal department of medicare & medicaid services is after the land that Laguna Honda sits on. Right…… Conspiracy theories waste thought & time. We have a crisis on our hands here & making bizarre nonsensical claims about a federal agency wanting land in SF is hurting not helping. What do you say they want the land for? To secretly store all the crashed UFO’s they’re hiding from us? Or or do autopsies on Big Foot specimens they’ve collected?……

  24. I hope for the best to keep Laguna Honda (LHH) open. It was the DPH director at the time who mandated LHH to accept younger patients with substance abuse and mental issues into LHH. He’s off the hook and took another position elsewhere after he set these policies that I believe, ruined Laguna.
    I voted for the Laguna Rebuild to house the elderly, and not to co-mingle abusive population from SF General Hospital simply because it was cheaper to transfer to LHH than stay at SFGH. Really sad.

    1. Can the Department of Public Health under the new management rescind their previous decision?

    2. No. Accepting those patients didn’t ruin it. Gross mismanagement of those patients & underfunding (staff misbehaving due to understaffing, lack of oversight [put in WAAAAAY more cameras & monitor them with a LARGE staff of “watchers” looking out for those getting hurt & those hurting them] & hiring people who should be on disability for behavioral disorders! Not entrusted to care for the most vulnerable!!!) is what ruined it. Don’t blame the victims here. Patients who have little impulse control, who’s existence is one decision based on utter selfishness after another are about as much to blame here as the farm animals on the property are. If you let the goats wander around where they have access to curtains, bedclothes, interior flooring, they’ll chew everything up, urinate & defecate on the floor & “ruin it” but who’s fault is it then? The goats? Or those who were supposed to be in charge of minding them? & No I’m not out of line comparing those patients to farm animals. I have been homeless in SF for 15 years now. I’m talking about my friends & peers. I know what I’m talking about. None of the rest of you are friends with 100 homeless addicts like I am. I was (am?) Friends with Joel Armstrong who shot & killed Milkos & shot Booze & car jacked some poor lady & wound up in a shoot out with police DeHaro & Alameda in Feb of 2018, ok? I knew him for 10 years before that. I know what I’m talking about here. He should’ve been locked up after he got shot in Mc Donald’s & ran up on the roof is Whole Foods & dove off into the cart corral. Milk would still be alive, ok? So, no. Those patients didn’t ruin it. Those who were being paid good money to keep those patients in line are the ones who ruined it.

    3. Right you are Jas. The decision was made to close a behavioral health facility and transfer/admit those patients, with a history of risky behavior which landed them in the hospital in the first place, to LHH instead. This resulted in mixing younger risk takers with the older traditionally envisioned “nursing home patients.” One’s life long risky behavior doesn’t stop just because a person is hospitalized. It’s very difficult to discharge a person who is medically/physically compromised, needs care, and has behavioral and/or cognitive issues. Instead of focusing only on the negative, how about examining how day in and out the majority of the LHH staff work hard to provide compassionate care to a challenging population. I agree there’s room for improvement but a lot of good happens at Laguna Honda that goes unheralded. And media please, stop showing pictures of the old building (currently used for office space only) further promoting the notion that LHH is an asylum.

  25. Thank you Joe for your thoughtful and comprehensive presentation of the current mess San Francisco and the Department of Public Health find themselves in. Many on the ‘front lines’ have been trying to warn city administrators of these conditions for years. The city of San Francisco prides itself on being a progressive haven of acceptance for some of the nation’s most challenging populations. But those commitments all to often end in the headlines, the glossy political flyers and the well meaning (highly convoluted) ballot measures. San Francisco fails to put it’s money where it’s mouth is when it comes to making those commitments a reality and at the end of the day the people who suffer are the ones who do not have the resources to advocate for themselves. The very people we claim to treat better. San Francisco has an opportunity to pull itself out of the glaring hypocrisy that the situation at Laguna Honda represents, but doing so will require the people who have benefitted the most from this city to dedicate real resources to the problem instead of buzzwords and empty promises. For those of us who remain dedicated to public health and it’s mission we certainly hope they are willing to do so.

    1. “But those commitments all to often end in the headlines, the glossy political flyers and the well meaning (highly convoluted) ballot measures. San Francisco fails to put it’s money where it’s mouth is when it comes to making those commitments a reality and at the end of the day the people who suffer are the ones who do not have the resources to advocate for themselves. The very people we claim to treat better. San Francisco has an opportunity to pull itself out of the glaring hypocrisy that the situation at Laguna Honda represents, but doing so will require the people who have benefitted the most from this city to dedicate real resources to the problem instead of buzzwords and empty promises.” that’s the most true, excellent statements on this entire page. Mission local should’ve had you write the whole article. THANK YOU!!!!!!!!!

  26. Well, what do I know, but it seems pretty obvious that the standards for performance that are being applied to Laguna Honda are double standards. Everyone you cite in the article is aware that small and medium sized nursing homes that are privately owned are not held to the same standard. Nor do they deliver the same level of care. They are not inspected with the same rigor and they routinely are given extension after extension to correct health violations that are dangerous to their patients.

    The Laguna Honda situation reminds me a little of the City College situation, and also the situation with Oakland Public Schools. The way I see it, all of these institutions are under attack – using the guise of “accountability”, or “fiscal responsibility” The clients – be they students or patients – will suffer all of the negative consequences. And what is the benefit to the public? Nothing that I can see. The consequences seem to be entirely negative. As you point out in the article, from a policy perspective and a human perspective – this move makes no sense.

    Unless we look at this move as just one of many others that have gone on for years. This is the push we see, all across the country, to take public institutions and privatize the work they do. More for profit charter schools, and the ongoing privatization of public sector healthcare operations is well documented – most egregiously at the moment – by the assigning of Medicare beneficiaries to healthcare operations run by private equity firms – who are then permitted to keep up to 40% of the dollars they are given by the federal government for “overhead” and profit.

    The bottom line – Laguna Honda is not being attacked because it is failing, or incompetently run. It is being attacked because it is public.

    1. As a taxpayer in this town I expect government gets governing right, regardless of how much leeway somebody else may get. It’s irrelevant. To add insult to injury: There’s vastly more money available to San Francisco local level governments than any other place in the country. Where does all that money go? What are 37000 City and County employees plus non-profits, consultants etc. doing all year long?

    2. No. Sexually/emotionally/physically abusing patients, making patients breathe cigarette smoke, not giving them their medications & being punished for that is not being attacked for being a public institution. It is being attacked for being a disgusting pathetic excuse for a nursing home. No. No. And No. Stop with the conspiracy theory.

  27. Unbelievable — more incompetence/corruption at our government-run institutions;

    City College of San Francisco (chronic mismanagement; teetering on insolvency),

    San Francisco Unified School District (mismanagement; hemorrhaging teaching staff; families going elsewhere)

    Dept of Building Inspection (rampant corruption; former leadership under Federal indictment)

    San Francisco Public Utilities Commission (corruption and rot at the top; former leadership under Federal indictment)

    Department of Public Works (thoroughly corrupt; former leadership under Federal indictment)

    Department of the Environment (corruption; allowing million$ in illegal/over-charges by sole sourcing trash/recycling services to Recology.)

    Mayor’s office of Homelessness Services (hundreds of supportive housing units sit vacant — for years!),

    Office of the District Attorney (fleckless, incompetent management,misplaced priorities, increasing property crime,runaway fentanyl dealing in the Tenderloin),

    San Francisco Police Dept. (refusing to pursue property crimes and make arrests, excessive use of force)

    San Francisco Metropolitan Transit Authority (every single capital project goes wildly over budget and over schedule — takes 5+ years to paint “red bus lanes”; first approved in 2003, construction start 2017, completion 2022; $40M over budget and 3 years late; numerous businesses financially ruined.)

    and now Laguna Honda.


    And the City believes that it could competently run a proposed public bank or take over responsibility for gas and electric utility services?

    Even as bad as P,G&E is, it’s all but certain that SF City government would be catastrophically worse!

    1. C’mon, I’m expecting for you to blame the supes for strong mayoral maliciousness and incompetence.

  28. Dr. Derek Kerr has been reporting on the issues at Laguna Honda for many years. Interested readers can do what Joe has done; google Dr. Kerr’s articles at the Westside Observer and see the long, long story of the decline of Laguna Honda.

    1. The “Medicated Shampoo” cited by the State Inspector is Sulfur 8 Shampoo and Conditioner. It is on a list of “best anti-dandruff shampoos”, and is the most effective shampoo I have used to stop itching.