The Shame of Laguna Honda
Plans at the Department of Public Health are, apparently, to place 34 of its “behavioral health” patients into Laguna Honda Hospital (LHH), possibly placing more psychotic patients into the mix with the frail elderly and disabled. History repeats itself with the proposed reconfiguration yet again.
On April 20, San Francisco City Attorney Dennis Herrera launched an investigation into whether Nevada’s primary state psychiatric center, Rawson-Neal Psychiatric Hospital, had engaged in patient “dumping” by sending patients out of state using one-way bus tickets. A San Francisco Chronicle article on April 21 quoted Herrera as saying that the practice of psychiatric patient dumping is “shockingly inhumane and illegal.”
She (Therapist Blaustein) and the physician assigned to the North Mezzanine raised concerns and protested placement of inappropriate patients, indicating the two patient populations don’t thrive well together because the behaviors of people with dementia agitate psychotic people, and then psychotic patients want to harm the demented ones.”
Herrera’s concern appears limited to in-bound patient dumping and the increased costs to San Francisco for caring for psychiatric patients. But Herrera has been strangely silent regarding out-bound patient dumping from San Francisco to other jurisdictions, and potential patient dumping between San Francisco facilities. His hypocrisy is breathtaking.
This is the same hapless Herrera featured in the article “High Costs of City Attorney’s Advice” in last month’s Westside Observer.
The Chronicle article also reported that Paul Boden, the director of a nonprofit that highlights civil rights abuses against the homeless, the Western Regional Advocacy Project, said “it’s a little hypocritical of San Francisco officials to feign shock at the Las Vegas hospital’s [patient dumping] practice when [San Francisco officials] too, hand out one-way bus tickets to homeless people.”
The Department of Public Health (DPH) is proposing to re-configure the Mental Health Rehabilitation Facility (MHRF) on the San Francisco General Hospital campus, renamed the Behavioral Health Center (BHC) in order to be politically correct, into a residential care and respite care facility, and transferring 34 behavioral health patients to Laguna Honda Hospital (LHH)
Is transferring behavioral health patients to LHH a form of patient dumping into a setting where they may not receive the appropriate level of mental health care?
Battery Against LHH Staff
Alerted this April that LHH had accepted transfer of about 11 BHC patients during 2012, and that an Institutional Police Officer had informed SEIU members at LHH in October 2012 that assault cases at the facility had drastically increased, many were concerned. When it was learned that a food service worker was assaulted on the job in May 2012, subsequently required shoulder surgery following the battery, and has yet to return to work 10 months after being attacked, concern mounted. The worker was so badly beaten that emergency room staff treating her were shocked by her injuries, and the obvious emotional trauma.
She entered a locked dementia unit at LHH — the North Mezzanine, which serves patients at risk of wandering, elopement, or harm — she was assaulted when she encountered a patient who was supposed to be being watched by a “sitter.” The North Mezzanine unit has traditionally housed and cared for demented, but ambulatory, patients, it is a locked unit implemented to protect patient safety.
But LHH placed behavioral health care patients on the North Mezzanine, possibly agitating demented patients. The patient who assaulted her was finally sent on a “5150” psychiatric hold to SFGH after going on another rampage. A separate patient who had been discharged was eventually readmitted to LHH, despite being a sexual predator.
An investigation revealed that the injured staff member is now suing the City, possibly alleging negligence and mishandling of the situation following her assault and battery. The lawsuit appears to be sealed, most likely to protect patient privacy, even though the patient has reportedly since died. As a reminder, assault is any reasonable threat of physical harm to another person; battery is actual physical contact and actual harm.
Staff Retraining Required
Her battery case may not be the only one, but her assault was a big deal in LHH. Multiple meetings were held to calm staff, and hospital administration spent a lot of money to have all employees go through SMART training — staff training presented by a licensed Psychiatric Technician on how to remain safe around violent patients.
SMART training is definitely not part of the training typically provided to staff in long-term care skilled nursing facilities; it is more typically presented to staff working in psychiatric and mental health settings. The SMART training at LHH was introduced in 2005 to deal with its then-new patient population during the ruckus over implementing the “psycho-social rehabilitation” model of care exported to LHH when Mozietta Henley, RN, PhD was shunted from the MHRF to LHH, toting along her “BioPsychoSocialSpirtual (BPSS)” model of care proposal that was never tested or implemented at the MHRF.
Henley’s model of care comically became the basis for a small California HealthCare Foundation grant LHH’s Mivic Hirose was awarded for “Social Rehabilitation.” [I was there: Hirose’s January 2005 grant ended as a notorious flop, probably an embarrassment to the California HealthCare Foundation, and created a ruckus at City Hall.]
This followed on the heels of former Director of Public Health Mitch Katz’s nervous announcement on October 20, 2004 during LHH’s Executive Committee meeting of his “vision” that LHH would become a “social rehabilitation facility for the homeless poor,” a statement the City soon denied had been made, but the cat was out of the bag since numerous LHH staff had heard Katz speak clearly. Previously, the not-too-esteemed Dr. Katz lured the MHRF Blue Ribbon Committee into believing that the “future LHH” would provide “the same kind of services as offered at the MHRF.” If the City accepts DPH’s proposal to reconfigure the MHRF and dump more psych patients into LHH, we’ll have come full circle to Katz’s prediction of offering MHRF services at LHH.
Uptick in Sheriff’s Statistics
Alerted that an uptick in assaults at LHH may have occurred between calendar years 2011 and 2012, Sunshine records requests were made to the SF Sheriff’s Department, knowing that asking LHH’s administrators for this data would meet with dead silence, if not endless delays and denials.
Data provided by the Sheriff’s Department on May 21 shows that between 2011 and 2012, battery incidents increased at LHH by 18.2%, from 22 to 26 such cases, which is statistically significant. Across the same time period, “disturbances by resident” incidents summarized on the monthly Sheriff’s Activity Reports increased 227.8%, from 115 to 337 at LHH, and “disturbances by visitors” increased 309.4%, from 32 to 131 cases.
It’s no wonder that in October 2012 an Institutional Police officer from the Sheriff’s Department advised SEIU members working at LHH that assault cases had drastically increased.
Three Questions Lead to Bullying
Laguna Honda staff brave enough to ask questions are frequently targeted for retaliation. Indeed, the culture of staff intimidation was increased soon after Hirose was appointed CEO in 2009, and after Slavin came on board in 2007 to “stop the negative news about Laguna Honda” for his benefactress, former City Attorney Louise Renne. The intimidation was designed to silence and weed out any remaining staff who dared to question agendas that violated State laws and existing hospital policies.
Randy Ellen Blaustein, a therapeutic recreation therapist on the North Mezzanine unit who worked at LHH for eight years, raised three questions about the mixing of ambulatory demented patients with patients having psychiatric diagnoses from the BHC transferred to the North Mezzanine. She and the physician assigned to the North Mezzanine raised concerns and protested placement of inappropriate patients, indicating the two patient populations don’t thrive well together because the behaviors of people with dementia agitate psychotic people, and then psychotic patients want to harm the demented ones.
Blaustein noted the North Mezzanine physician had complained to hospital administration about no longer being able to provide input to admission decisions to their unit, and protested inappropriate placements, but was ignored.
During a key meeting with hospital administration, Randy apparently asked three questions that landed her in a lot of trouble:
1) Why hadn’t LHH’s Administration honored its vow not to place residents with histories of physical aggression and violent behaviors on the North Mezzanine?
2) Why did the unit no longer have input into admission processes? and
3) Why wasn’t their unit granted a lower census, since they had been afforded that in the old facility, given their patient population?
Apparently, someone reported to her supervisor, Bill Frazier the Director of the Activity Therapy Department, that Randy had “overstepped boundaries; was negative and didn’t offer solutions; wasn’t supportive of the new LHH; and (gasp!), had insinuated that Administration didn’t know what they were doing.” Instead of supporting Blaustein, Frazier asked her to cease asking contentious questions in meetings. Randy says she had previously gotten into trouble for upsetting Dr. Colleen Riley, LHH’s Medical Director, in another meeting.
“With severe dementia, less is more. I’ve never heard of any other facility that places nearly 60 ambulatory people with severe dementia in the same living area, with psychotic people in the mix,” Blaustein says. “The North Mezzanine received new admissions that required 1:1 ‘sitters’ at all times, because of their physically aggressive behaviors, placing other residents and staff at risk.”
After Clarendon Hall closed, LHH never re-created the three locked psych units that had been on the second floor of Clarendon. Many of LHH’s staff, including Blaustein, believe that’s, in part, why the new LHH is such a mess.
Another source reports that the staff member who was assaulted, subsequently requiring shoulder surgery, who is now suing, was assaulted by the North Mezzanine patient who was supposed to have a 1:1 sitter, but somehow got out of the inner door to the unit and attacked her before the outer door. So much for sitters.
Randy says that, after being repeatedly bullied, she chose to resign. Shortly before she left in mid-December 2012, a discussion began to consider changing the admission criteria to the North Mezzanine from “dementia” to using “cognitive impairment,” but she doesn’t know the outcome of that discussion. Like many former employees, Blaustein still cares deeply about LHH’s residents and staff, and their safety.
Earning His Comeuppance
Bill Frazier appears to be his own worst enemy. Comeuppance was bound to catch up with him, since what goes ’round, typically comes back ’round. All staff at LHH are required to take sexual harassment prevention training annually. It was widely known throughout LHH that during his 15 years as Director of Activity Therapy, a number of complaints were filed against Frazier by subordinates for such things as sexual harassment, unequal treatment, and failure to comply with union agreements. It is unclear how LHH’s Administration responded to these voiced concerns, since the reported pattern was observed to continue from year to year.
The training may have been lost on him, since in early 2013 he was overheard screaming in his office at an Activity Therapist for over ten minutes, and allegedly called her a “selfish bitch” — clearly a sexist term that has no place in public service.
This might have been brushed under the carpet as a “he said, she said” situation, except it was overheard and reported by a witness willing to come forward. This may have been the straw that broke the camel’s back, when Frazier suddenly vanished in February; some of his duties assigned to an acting director, and other duties split to other departments.
But a month after his disappearance, amid reports he would not be back, Frazier resurfaced in LHH’s Accounting Department in a newly-created position as liaison to Friends of Laguna Honda (formerly known as Laguna Honda Volunteers, Inc., the non-profit dedicated to LHH’s patients, that never needed for 50 years any “liaison” on LHH’s staff paid from taxpayer funds).
Frazier is now in charge of LHH’s Patient Gift Fund, which should not be a 40-hour full-time job. It’s akin to having the fox guarding the hen house. That LHH created the position as a soft spot for him to land may mean the hospital is worried about potential shenanigans with the gift fund, or worried that he knew too much about the great gift fund scandal of 2010. After supervising approximately 40 staff for over a decade and a half, he no longer has direct reports or anyone to supervise.
Out of County, Out of Mind
As just one example of out-of-county patient dumping, consider the case of a middle-aged gay man who suffered a stroke one evening while at a tavern, and was taken to SFGH where he languished for months. His close friends tried to get him admitted to LHH, but were rebuffed when told he needed too much physical rehabilitation therapy and couldn’t be sent to LHH. It’s well known that delays in receiving rehabilitative therapy following strokes leads to poorer patient outcomes and progressive functional decline.
He languished at SFGH for more months until being discharged out-of-county to a facility in Antioch that principally houses patients with dementia and Alzheimer’s. Since he is not demented, he now languishes in an environment in which he has nobody to communicate with, and his friends are unable to endure the obstacles of travelling to Antioch to visit him. His family is now trying to get him discharged to take him back to Ohio for care.
There are many other similar stories of patients needing skilled nursing care who are being dumped.
Many of LHH’s department heads are concerned about DPH’s decision to reconfigure the MHRF/BHC and place the 34 BHC patients into LHH. But they remember that when former LHH Executive Administrator Larry Funk opposed admission of violent patients to LHH, he was replaced and demoted.
Other staff who opposed admission of unsafe patients, including former Medical Director Dr. Terry Hill; Dr. Maria Rivero, LHH’s former admitting physician; and others, were forced to resign.
Many dedicated staff want to make LHH a safe place for staff and patients, and they’re concerned Herrera may not know LHH doesn’t have a psych license.
There are huge human costs to patients and staff from patient dumping, and Herrera is correct that the practice is “shockingly inhumane and illegal” — and obviously unethical. But where is Herrera’s concern for out-bound patient dumping to other counties, or internal dumping between DPH’s facilities? Is he concerned only about the cost of in-bound dumping, not the costs of out-bound dumping? How does Herrera’s ethical barometer work? Will Herrera ever look in the mirror and investigate patient dumping occurring in his home town’s back yard, or is he just grandstanding?
One test of Herrera’s ethics may involve how quickly the lawsuit filed by LHH’s battered staff member is resolved. Hopefully, Herrera’s underlings won’t introduce a flaky motion for summary judgment to stall her case and delay justice in a misguided attempt to scuttle her settlement, since that would only add further insult on top of injuries.
Monette-Shaw is an open-government accountability advocate, a patient advocate, and a member of California’s First Amendment Coalition. Feedback: firstname.lastname@example.org.