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Myrna Melgar

Supervisor Melgar Has Been Disastrous for Her District

District 7 Needs a New Supervisor Come November!

Melgar Led the Board of Supervisors’ Faux Inquiries About Stopping Cohorting of Behavioral Health Patients at Laguna Honda Hospital.

Matt Boschetto Appears to Be the Best Candidate to Replace Her.

Editor’s Note:The Westside Observer does not endorse candidates or issues, opinions of its authors and reporters are their own, not the Westside Observer.

Patrick Monette-Shaw
Patrick
Monette-Shaw

• • • • • • • • • • September 25, 2024 • • • • • • • • • •

None of my fairly conservative and moderate friends and associates who live in District 7 will vote to reelect Myna Melgar for a second term as D-7 Supervisor on November 5. They’ve all pledged not to vote for her again.

They’re inclined to vote for Matt Boschetto or Stephen Martin-Pinto. My advice is to cast ballots for Boschetto! I will explain why.

Melgar squeaked through the November 3, 2020 ranked choice election by the skin of her teeth to enter the “House of Supervisors,” as my election analysis below shows. In this election cycle, voters need to elect Boschetto with a 50%+1 to 67% margin in round one of ranked-choice voting!

I commend the Westside Observer for publishing, during recent months, several District 7 candidate surveys in election feature articles posing editorial and policy questions about key issues facing District 7 voters. I hope that responses to those survey questions from the four candidates seeking to represent District 7 have made it clear that Melgar stands on the wrong side of issues facing both District 7 residents and the City writ large.

Here’s a sampling of Melgar’s flubs and transgressions.

The West Portal Station Debacle

Following the March 2024 accident on Ulloa Street that killed a family of four, Melgar rushed to join the SFMTA in developing a solution. My former colleague at the Westside Observer, retired police officer Lou Barberini, wrote a terrific Substack article on June 24 about how Melgar and the SFMTA ignored both D-7 residents’ and neighborhood merchants’ voices.

His article followed after Barberini, a bicycle advocate, was invited to participate in a “Connected San Francisco” Zoom call on June 11 attended by Matt Boschetto, Stephen Martin-Pinto, Pat Dunbar, and Melgar’s Legislative Aide, Michael Farrah. Apparently, Melgar didn’t join the Zoom call, even though it was billed as a forum for candidates for D-7 Supervisor to hear from constituents and allow residents to hear how candidates would represent the District. Melgar deliberately chose not to listen to her constituents, nor did she even participate in the call. Instead, she dispatched Farrah in her place!

Barberini noted Melgar and the SFMTA dusted off an existing, but rejected, plan from 2019 to give the West Portal Station a facelift. The plan featured closing Ulloa in front of the horseshoe to all traffic except MUNI and commercial vehicles, closing one of three cross intersections. The existing bus stop where the family was killed was there because five years ago, bus stops were removed from the tunnel entrance and placed on multiple street locations, forcing transit riders to cross multiple intersections. Closing Ulloa would worsen the situation.

Barberini noted SFMTA’s own staff admitted none of SFMTA’s proposed street redesign options would have prevented the tragic accident on March 13th.

Lou noted the SFMTA created a survey so residents could weigh in on what design elements they preferred, rather than presenting an actual proposal residents could weigh in on. That didn’t go well. Residents and business owners outraged by proposed changes significantly reducing vehicle traffic to West Portal pushed back.

Their resistance forced Melgar to cobble together “The Welcoming West Portal Committee,” and schedule three, then four, community meetings. Melgar handpicked the “Welcoming Committee” of 11 residents and merchants. Melgar’s press release announcing the formation of her committee falsely claimed she recognized the importance of active community engagement and inclusive decision-making in analyzing the proposals and identifying areas of improvement for them.

Ten of the 11 Committee members voiced their strong desire for a stop sign or traffic signal at Wawona and Ulloa. But SFMTA shot down both options, alternately saying it wanted a “consistent experience” for streetcar riders, stop signs interfere with streetcar “flow,” a traffic signal was “too expensive,” and stop signs aren’t “traffic calming.”

Nonsense. Hell, all along Market Street — from the Castro to the Embarcadero — street cars stop at traffic lights along the entire way, just as they do elsewhere in the Avenues, Nob Hill, and SOMA.

In the end, Melgar and the SFMTA ignored the recommendations of the “Welcoming Committee,” and pushed through SFMTA’s proposal with Melgar’s help and blessing. Weirdly, they did so without SFMTA publishing the costs of the project or a cost-benefit analysis of the remodel to West Portal Station, which may end up featuring multi-colored painted polka dots on the pavement in front of the station — which is over 500 feet away from where the family was killed on Ulloa.

Is Melgar listening to her District constituents or to voters’ voices? It wasn’t the first or last time she’d made that choice.

Density vs. D-7 Neighborhood Character

A day after Barberini’s article, the Westside Observer publishedDo You Support the Mayor’s Upzoning Plan?,” on June 25, 2024 as a special feature for the November 5 election. Responses from the four candidates vying to become D-7’s District Supervisor were instructive.

Candidate Dr. Edward Yee’s mere 30-word response deserves no discussion here, except to say if that’s all he could muster D-7 voters shouldn’t expect Yee to represent their interests at City Hall very well. Don’t waste your vote.

Incumbent Supervisor Myrna Melgar responded touting her bona fides as chairperson of the Board of Supervisors Land Use and Transportation Committee. She didn’t specifically answer whether she supports the mayor’s upzoning plan, but did state she supports upzoning along commercial and transportation corridors. She rightly noted D-7 — like all other Districts in the City — needs a variety of housing for D-7’s diverse population, including middle-class and low-income housing, student and elderly housing, and family housing. Somewhat worrying, Melgar noted housing must be close to public transportation so future generations can be less dependent on automobiles.

You can be sure Melgar’s anti-car agenda has influenced opposition to cars using the Great Highway, a big issue facing West side district voters in November. Unfortunately, she didn’t wade in to discuss height or density issues in her response.

Challenger Stephen Martin-Pinto thoughtfully replied, saying the mayor’s plan needs further refinement and doesn’t consider limitations of street size, infrastructure, and geologic conditions in many locations. Martin-Pinto suggested it would be more appropriate to shift some of the development onto Stonestown, Parkmerced, or San Francisco State University property, and noted greenbelt space in D-7 should be protected.

He rightly noted the eight-story, 85-foot height limit is too aggressive, even for West Portal and Ocean Avenues. Martin-Pinto thinks two- to six-story building height limits may be acceptable in most locations, apparently along both commercial and transportation corridors and streets.

He believes the mayor’s proposed upzoning plan doesn’t meet the objective of protecting and preserving neighborhood character important to D-7 voters, an issue Melgar remains silent on. Of some concern, Martin-Pinto believes rent control policies need to be modified. Tell that to D-7 renters who treasure their rent-controlled units!

Voters wonder if Martin-Pinto is aware that rent control was passed in San Francisco in June 1979. After 45 years of being in effect, Martin-Pinto faces an uphill struggle to modify San Francisco’s rent control laws to “entice homeowners.”

San Francisco’s elected officials should expand rent control protections in our City, which is long overdue. They should start by restricting how much landlords can raise rents when one tenant moves out and a new renter moves in. Otherwise, the middle-class renters Melgar professes to care about will vanish in San Francisco.

As for challenger Matt Boschetto, he admirably replied to the Observer the Mayor’s upzoning plan has been politically disastrous in D-7. He believes housing goals can be met without compromising neighborhood character. He noted neighborhood character and “community voice” must be balanced with building more housing.

But like Martin-Pinto, Boschetto is misguided, believing rent control and affordable housing requirements are “overly stringent.” Stagnant real estate investment is not due to rent control.

Laguna Honda Hospital

On July 19, the Observer published Laguna Honda’s Struggles? recounting for D-7 voters:

Since the budget-related closure of the Mental Health Rehabilitation Facility at SFGH (MHRF) ten years ago, the Health Department began relocating mentally troubled patients, including those with drug addiction behaviors, to Laguna Honda Hospital, mixing them with frail senior and disabled populations. Problems of cohorting patients began immediately, culminating in the loss of certification.”

[Author’s Note: The 147-bed MHRF was actually closed and “repurposedtwo decades ago (not just 10 years ago) in January 2004, according to Health Commission Resolution 01-04 adopted on January 20, 2004.]

The Observer posed this question to the four District 7 candidates: “What would you recommend to the Health Department to permanently fix the problem, or do you think the steps that have been initiated to regain certification are sufficient?

Shamefully, candidate Dr. Edward Yee did not respond to the question asked by the Observer. This should disqualify Yee as a serious candidate. It suggests that as a physician, he has no empathy for our precious long-term skilled nursing facility (SNF) at LHH as worthy of preserving, so vulnerable San Franciscans who eventually need SNF level of care don’t wind up dumped into out-of-county SNF’s.

Challenger Stephen Martin-Pinto again thoughtfully replied, writing in part:

The failure of the Department of Public Health to understand the second and third order effects of not properly sorting and quarantining patients with mental illness and drug addiction from the senior and disabled populations was profound. It was clear that the proper risk assessment of mixing patient populations was never completed. This was a failure of leadership and I have concerns in the competency within the Department of Public Health. I would do a deep dive investigation into who made the decision to move these incompatible patient populations next to each other, and how it was approved and justified.” [Emphasis added.]

For his part, challenger Matt Boschetto responded astutely, writing in part:

Since the closure of the [MHRF] facility at SFGH ten years ago, relocating mentally troubled patients, including those with drug addiction behaviors, to Laguna Honda Hospital has caused significant issues. These problems culminated in the loss of certification due to the mixing of frail senior and disabled populations with patients requiring different care levels. While our elected leaders have been part of the recent recertification process, it’s crucial to recognize that their failure to address the underlying issues contributed to the crisis.

To achieve permanent stability and prevent future lapses in certification, the Health Department must address the root causes of patient cohorting issues. This includes establishing specialized facilities for mentally troubled patients and those with addiction behaviors to ensure appropriate care without compromising the safety and well-being of frail seniors and disabled individuals. [Emphasis added.]

quote marks

Peskin wanted SFDPH to present a clear plan for reinstatement of these programs. Melgar essentially stopped holding that item-specific hearing, but not before she added her name as the main sponsor calling for the hearing. Peskin was forced to take a back seat to another hearing Melgar had in the works, a hearing that didn’t address Peskin’s specific concerns. Melgar essentially asserted her prerogative as D-7’s Supervisor over which hearing topics could be addressed. ”

Martin-Pinto is right: The “failure of leadership” deserves a deep dive investigation into who made the decision to move incompatible patient populations next to each other at LHH and how it was approved and justified. Part of that involved the Board of Supervisors, including their collective inaction to have stopped it from ever starting in 2004 in the first place.

The Board of Supervisors has collectively turned a blind eye to investigating patient “cohorting” at LHH as an underlying issue. One of the reasons I know that the president of the Board of Supervisors — now Supervisor Aaron Peskin and before him Supervisor Shamann Walton — have always deferred to whoever the incumbent D-7 Supervisor is at a given point in time, including now Supervisor Melgar and before her then Supervisor Norman Yee. I learned this from Board President Peskin privately. The Board President — and indeed all other Supervisors — wrongly believe that because Laguna Honda Hospital sits in District 7, it is the purview of only the D-7 Supervisor to introduce hearings and launch investigations about any issue involving LHH. It’s a long-held, archaic Board custom that has never been overcome.

On May 3, 2022, Supervisor Peskin introduced a hearing request (File No. 220526) asking that the Board of Supervisors Government Audit and Oversight Committee hold a hearing to receive an update on the City’s plan from San Francisco’s Department of Public Health to address “hand hygiene, documentation, contraband, and infection prevention and control” inspection deficiencies CMS had issued that led to LHH’s decertification on April 14, 2022 and its loss of accreditation. Peskin wanted SFDPH to present a clear plan for reinstatement of these programs. Melgar essentially stopped holding that item-specific hearing, but not before she added her name as the main sponsor calling for the hearing. Peskin was forced to take a back seat to another hearing Melgar had in the works, a hearing that didn’t address Peskin’s specific concerns. Melgar essentially asserted her prerogative as D-7’s Supervisor over which hearing topics could be addressed. Peskin obediently fell in line.

LHH is a citywide facility that admits patients from every supervisorial district. Suppose Melgar — or Yee before her — are uninterested in any given issue involving LHH. In that case, they are allowed to kill it single-handedly, because the full Board mistakenly believes it has to defer to the whims and follies of the incumbent D-7 Supervisor. Nonsense! Unless and until that misguided mindset changes, the deep-dive investigation into who made the decision to move incompatible patient populations next to each other at LHH Martin-Pinto called for will never occur.

Boschetto is also right: One of the elected officials whose failures led to LHH’s decertification is none other than Myrna Melgar. And before her, former D-7 Supervisor Norman Yee and his failures. Both of them, as D-7 Supervisor, ignored the underlying root cause of LHH’s troubles — the patient “cohorting” issue — just as former D-7 Supervisor Sean Elsbernd ignored the same issue when it began 20 years ago in 2004.

Boschetto and Martin-Pinto may not know that Melgar is chiefly responsible for the Board of Supervisors never holding a deep-dive hearing focused on reviewing either the root causes of patient cohorting issues, or the plethora of reports issued by the “Quality Improvement Expert” (QIE) that LHH was forced to hire by the Centers of Medicare and Medicaid Services to look into the root causes that led to LHH’s decertification.

Following LHH’s decertification, Health Services Advisory Group (HSAG) was awarded four contracts totalling $36.9 million to help LHH regain certification. Three more consulting companies were hired at a total cost of an additional $16.7 million (for a combined total of $53.6 million just for consultants). The HSAG contract to act as LHH’s QIE generated 198 pages of detailed findings across nine separate “Root Cause Analysis Reports,” and another 219 pages across seven separate “Monthly Monitoring Reports.” both gauged LHH’s progress toward compliance with federal regulatory standards applicable to all nursing homes and 91 pages across the two “Action Plans” listing nearly 1,000 corrective action “milestones” LHH was required to undertake to regain certification.

I’ve read all 507 pages across those reports. It’s not known whether Melgar — or any of the other 10 members of the Board of Supervisors — bothered to read them. What is known is that Melgar never once called for a hearing on the combined 507 pages of documents HSAG generated.

One of the most damning root cause findings HSAG uncovered was that far too many LHH employees — including senior managers — lack “critical thinking” skills to identify, examine, and solve problems. It’s almost as if the Board of Supervisors — in particular Supervisors Melgar, Peskin, and Mandelman — critical thinking skills never entered their own brains, let alone the brains of Health Commissioners, and LHH and SFDPH senior management.

Another of HSAG’s findings was the decades-long failures of LHH’s “governing body” — the Health Commission itself — to intervene before (and after) LHH’s decertification. HSAG’s findings about the Health Commission as LHH’s governing body has become a key part of lawsuits filed against LHH. As part of Melgar’s blind eye and hands-off neglect, none of the meager Board of Supervisors hearings Melgar deigned to call since June of 2022 have addressed the Health Commission’s “governing body” failures.

Wielding sole authority to call for such a hearing, she deliberately chose not to hold deep-dive hearings. Following LHH’s April 2022 decertification, Melgar called for only four Board of Supervisors “Committee of the Whole Hearings” during the ensuing 26 months. Each hearing was remarkably short and didn’t investigate substantive issues. She glossed over LHH’s problems, essentially slapping lipstick on a pig, and entertaining LHH acting CEO Roland Pickens’ misinformation. More on this below.

Apparently, she had no interest in publicly airing the dirty laundry of the many underlying failures and mismanagement at Laguna Honda Hospital or in examining whether specific City employees were at fault, including senior SFDPH managers and, indeed, the San Francisco Health Commission itself. Melgar chose, instead, to help cover this up in her role as D-7 Supervisor.

If for no other reason, that’s why voters should deny her reelection!

For her part, incumbent Supervisor Myrna Melgar, responded to the Westside Observer’s special election candidate survey in July, she back-peddled as fast as she could in her 161-word response:

“[LHH’s]recent decertification crisis has been averted for now, thanks to the hard work of staff, and the City’s leadership who all came together to address all the findings that led to the decertification in the first place.

The initial incident that resulted in the hospital being scrutinized was due to drugs being found on a patient, but many of the subsequent findings in the survey that led to the decertification were not. Many of the findings had to do with protocols, some even had to do with the physical facility. The population of folks who have substance use disorder and/or mental illness is here in our city and many of these folks are aging, and homeless. Now that California voters have made funding available to build facilities for this population in ‘Proposition 1,’ I think we need to plan to build a facility for this specific use. “

When Melgar responded to the Observer last July, she essentially lied when she inferred the initial incident resulting in LHH’s decertification was due to drugs being found on a single patient. She was right many of the subsequent findings that led to the decertification didn’t involve substance abuse issues and “behavioral health” patients. But she pooh-poohed the other root causes of LHH’s problems across multiple CMS inspections. It didn’t involve a single incident, as she averred.

First, Melgar should have known LHH had received 253 citations between 2019 and December 2023, 27 of which involved actual harm and immediate jeopardy to LHH residents’ health and safety. She turned a blind eye to those 253 Federal and State citations, minimizing the severity of LHH’s problems.

Second, Melgar should have known that HSAG’s nine QIE “Root Cause Analysis” reports issued by August 10, 2023 had uncovered 13 “foundational root cause” problem categories that had identified a total of 168 different root causes that led to LHH’s decertification, including categories for “behavioral health,” resident rights and freedom from harm, quality of resident’s care, comprehensive patient care plans, infection control and prevention, food and nutrition services, medication management, staff competency, fire and life safety, and — worst of all — “patient abuse and neglect,” among other categories Melgar all but ignored, trying to deceive voters.

As the table below illustrates, the 20 “behavioral health” root cause problems accounted for fully 12% of LHH’s underlying problems. That’s not insignificant, as Melgar downplayed.

LHH Root Cause Analysis Category Findings.jpg

Indeed, the top six root cause categories accounted for 73% of the problems, over two-thirds of which Melgar had also attempted to minimize as not in the “behavioral health” category. The root causes were widespread despite Melgar’s spin.

In addition to the $53.6 million in consultant costs that Melgar has studiously ignored, I’ve tracked that the City has spent another $139.5 million on other expenses at LHH to ensure the facility remains open. That brings total costs to date to rescue LHH from its mismanagement problems to $193.2 million. Since May 26, 2024 when costs then stood at $177.5 million, I’ve uncovered another $15.7 million included in the adjusted $193.2 million total, which continues to grow.

Melgar has all but ignored this massive $193.2 million in expenses. San Franciscans writ large, and D-7 residents in particular, deserve an explanation of why Melgar has been so cavalier about holding SFDPH employees responsible for these expenses to account.

In her Westside Observer response, Melgar essentially lied when she claimed the City’s leadership had come together to address all the findings that led to LHH’s decertification. That never happened, and certainly didn’t happen during any robust Board of Supervisors hearings on LHH.

Her written Observer response asserted that folks who have substance use disorder and/or mental illness are here in our City, and as discussed below, she asserted these are the patients LHH didn’t have 50 years ago, but does now. More nonsense.

Melgar failed to even mention the cohorting problem. She failed to answer the Observer’s question of whether the steps the City and SFDPH have taken to date to gain Centers for Medicare and Medicaid (CMS) re-certification were sufficient. Instead, she suggested the City needs to begin to plan to build a facility for “mentally troubled patients, including those with drug addiction behaviors.” It’s almost as if Melgar completely ignored that the Observer had noted problems of cohorting patients with mental health disorders at LHH as a direct result of having closed the MHRF 20 years ago.

As D-7 Supervisor, Melgar all but avoided calling for a deep dive investigation into who made the decision to move incompatible patient populations next to each other at LHH, and how it was approved and justified, as Martin-Pinto rightly noted. Nor did Melgar acknowledge any culpability that elected leaders — including her — had been part of the failure to address the underlying issues that had contributed to the crisis of LHH’s decertification, as Boschetto also rightly noted.

Boschetto noted the Health Commission must address the root causes of LHH’s patient cohorting problems. But sadly, Melgar never once asked the Health Department during the Board of Supervisors four “Committee of the Whole” hearings anything at all about the patient cohorting disasters at LHH. Nor has the Health Department addressed this across approximately 70 Health Commission meetings over the 26 months since April 2022. More on this, also below.

It’s also obvious Melgar can’t face the truth about the two-decades long mismanagement of Laguna Honda. That’s because the truth is painful, in part painful given her own failures to look at the truth.

It’s instructive that in the three-and-a-half years Melgar has served as D-7 Supervisor, she also has not taken any action as a sitting Supervisor to introduce legislation, or even advocate for, the City to begin taking steps to reduce, or eliminate entirely, transferring mentally troubled patients, including those with drug addiction behaviors, to Laguna Honda Hospital. It’s as if Melgar is OK with mixing mentally ill and substance abusing patients in with frail senior and disabled populations at LHH, and hasn’t been interested in exploring building a new facility for mental health patients.

D-7 voters deserve better from their incumbent supervisor.
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Melgar Ignored LHH Residents as Constituent Voters

Melgar failed her own District constituents who reside at Laguna Honda Hospital, throwing them under the bus.

A summary outline of key points raised during four Board of Supervisors hearings on LHH’s decertification is available on-line in a summary report and timeline, here. Key issues include:

On June 14, 2022 the Board of Supervisors held its first “Committee of the Whole” hearing on the crisis at LHH. Roland Pickens, LHH’s then-Interim CEO noted that one of the HSAG consultant recommendations LHH was considering as early as June 2022 was “cohorting” [grouping] patients with disparate healthcare issues into separate areas, perhaps in LHH’s two patient Towers. Responding to a question from Supervisor Ahsha Safai, Pickens stated LHH basically has two [patient] Towers, suggesting “So, it sets itself up for being able to have one set of programming in one Tower and another set [of programming] in another Tower.”

  • It’s instructive to note from a partial verbatim transcript of the first June 14, 2022 hearing that Melgar tried her best to downplay the patient cohorting issue, trying to absolve the Health Commission. That’s the issue Boschetto believes the Health Department and Health Commission must address as root causes of patient cohorting problems. Melgar served as an apologist for SFDPH:

 

Laguna Honda has a different patient population than it did 50 years ago. I want it to be on the record that of course [LHH] serves a different patient population, because 50 years ago was 50 years ago. … But the cure is not to serve a different population, or serve a population that we served 50 years ago. It is to come up with systems that deal with the population that we have to-day.”
Melgar was being deceptive. That’s because frail elderly patients needing traditional skilled nursing care were usurped by behavioral health patients 20 years ago, not 50 years ago. San Francisco still has those types of patients — to-day. Those traditional skilled nursing patients are being massively dumped into out-of-county facilities precisely because LHH’s beds are used for patients with mental health and substance abuse problems.

A year later, on May 9, 2023 Pickens indicated during a second “Committee of the Whole” hearing that a behavioral 0health workgroup had been formed that was exploring behavioral health programming options within Laguna Honda in separate units.
On September 26, 2023 Pickens told the third “Committee of the Whole” hearing “a fuller, more robust, behavioral health needs analysis focused on expanding the number of Behavioral Health bed capacity in San Francisco was underway and would be presented to this Commission in October” 2023. For his part, Supervisor Mandelman asked Pickens if the Workgroup was ongoing, whether the Board of Supervisors would see a proposal, and where that proposal was at. Pickens responded to Mandelman saying the Workgroup had been meeting over the last year and would be presenting to the Health Commission at the meeting in October 2023.
On October 10, 2023 a “Behavioral Health Improvement Project at Laguna Honda Hospitalreport was presented by LHH’s then Interim Chief Medical Officer, Dr. Neda Ratanawongsa to the LHH-JCC meeting. Her report did not present the Workgroup Study about cohorting “behavioral” patients at LHH. Ratanawongsa noted that the Workgroup was still conducting a literature review of models of focused units for behavioral health patients.

  • On October 17, Health Commissioner Tessie Guillermo presented a summary of the LHH-JCC’s October 10 “Behavioral Health Improvement Project” presentation to the full Health Commission. Guillermo indicated the Behavioral Health Workgroup was still working with the HSAG consultants to “explore models” having focused units for behavioral health patients.

On September 8, 2024, this writer placed a records request to Supervisors Peskin, Melgar and Mandelman seeking the formal Workgroup proposal Supervisor Mandelman had asked for a year earlier in September 2023 about options for placing patients with serious mental health or substance abuse issues at LHH. On September 10 a Board of Supervisors Legislative Aide responded saying the Supervisors had received no such report, but suggested a July 2, 2024 PowerPoint presentation about resuming admissions at LHH “may potentially be responsive.” It wasn’t. It didn’t include the Workgroup’s study.

Also on September 8, this writer also placed a records request to SFDPH seeking the Behavioral Health Workgroup report promised to Mandelman and Health Commissioners. SFDPH also replied on September 10 saying that after conducting a “diligent search,” no responsive records were found. This means that the report Pickens promised Mandelman in 2023 was a prevarication.

Following LHH’s decertification in April 2022, many advocates in San Francisco repeatedly testified during Health Commission and Board of Supervisors hearings that we need greater regulatory oversight of LHH. Some advocated for placing LHH in receivership to increase oversight, given the Health Commission’s failures as LHH’s “governing body.”

Indeed, during the May 9, 2023 Board of Supervisors “Committee of the Whole” hearing on LHH, Supervisor Melgar herself said that she had not seen where San Francisco’s “Long-Term [Care] Coordinating Council” (LTCCC) is regarding protecting LHH. Melgar stated on videotape:

I do think that there is something to be said about [developing] a regulatory … a better regulatory structure to make sure that what we are seeing happen at Laguna Honda doesn’t happen again. When we do achieve [LHH’s]recertification, the onus will be on us [the Board of Supervisors] to make sure that this never happens again.

As LHH’s “governing body,” San Francisco’s Health Commission oversight failures during the past 20 years contributed in large measure to LHH’s decertification in April 2022.

Unfortunately across the four “Committee of the Whole” hearings Melgar held (one in 2022 and three in 2023), she didn’t lift a finger to discuss or put into place “better regulatory structures” for overseeing LHH. By the last “Committee of the Whole” hearing on September 26, 2023 Melgar brought up no further mention of any “better regulatory oversight” ideas for discussion, let alone adoption.

Unfortunately, despite Melgar’s claim the onus would be on the Board of Supervisors, she has essentially done nothing to ensure LHH’s problems never happen again. The onus is now on her to explain her inaction to D-7 voters.

What Boschetto and Martin-Pinto may not have understood, or didn’t know, was that it’s not just the Health Department that has hidden the “patient cohorting” issues. Melgar needs to own that she hidthis and failed to address the problem.

As a reminder for readers, in May 2017 I published an article describing that as far back as 2004, San Francisco’s then-Director of Public Health, Mitch Katz, had launched his misguided attempt to convert LHH into a “psychosocial rehabilitation center for the urban poor.” Dr. Maria Rivero, the then-attending physician on LHH’s Admitting Ward had published a letter to the editor published in the West Portal Monthly detailing the changes to LHH admissions as far back as November 2004. In addition, end note #1 below documents that as early as October 2003 Katz had indicated the future, larger replacement of LHH would offer the same kind of services as formerly offered at the MHRF — for mental health patients. Surely Melgar knows this history.

Melgar Gamed Rank Choice Voting in 2020

D-7 Voters might want to take a look at granular details of how Melgar benefitted from ranked-choice voting in 2020 to win her seat as D-7’s Supervisor, posted online separately here. It’s a 920-word detailed look (a tad too long to include in this article) but it may be instructive to voters. It contains a link to a fuller analysis of the results posted on the San Francisco Department of Elections web site, revealing that fully 12.9% of D-7 registered voters sat out the election entirely and another 8% of those who did vote, didn’t vote for any of the candidates running for Supervisor.

Another 8.8% of D-7 voters made errors that invalidated their ballots, suggesting that 30% of the ballots of D-7’s registered voters didn’t qualify.

The link explores how she squeaked into office by the skin of her teeth. She had ranked in third place for the first three rounds of counting ballots, only advancing to second place in Rounds 4 and 5. In Round 6 was she declared the winner, which could easily have been handed to Joel Engardio.

But that wouldn’t have happened had 10,680 votes not been transferred to her from other candidates whose supporters eventually listed Melgar as potentially their final choice, after initially staring in third place. Had more of Martin-Pinto’s supporters in 2020 been transferred to Engardio, Melgar wouldn’t have won.

D-7 residents who have not registered to vote have just weeks remaining to register. Low-interest D-7 registered voters toying with not voting at all for their District Supervisor need to rethink it. If you aren’t registered, or don’t vote, you can’t complain later when your supervisor votes against your best interests.

Unseat Melgar Now; Vote for Boschetto

This election cycle, D-7 voters need to elect Boschetto with a 50%+1 to 67% margin in Round One of ranked-choice voting to knock Melgar out of contention and out of office.

D-7 voters must watch out for more of Melgar’s flip-flops! They need to rapidly encourage their neighborhood associations, neighbors, neighborhood merchants, faith institution leaders, and friends to make sure they vote. Boschetto and D-7 leaders need to focus on motivating voters and getting out the vote from registered D-7 voters who fail to vote at all! They should encourage Martin-Pinto’s voters — and hell, Martin-Pinto himself — to make sure they rank Boschetto as their first choice in an effort to stop Melgar from advancing past Round 1.

Since Martin-Pinto ranked fifth out of seven candidates in Round 1, and wasn’t eliminated until the end of Round 4 in 2020, he might give serious thought to dropping out of the race early and encourage his supporters to vote for Boschetto, instead. That would help immensely in preventing handing Melgar a second term.

Barberini rightly noted the purpose of District elections is for supervisors to represent their neighborhood Districts. It’s clear Melgar has failed to do that.

Begging for their votes, Melgar is asking a heckuva lot from voters annoyed with her stances on issues facing the City, LHH, and her D-7 constituents.

Politicians need to be held accountable to their constituents again.

Vote for Matt Boschetto for D-7 Supervisor on November 5!

End Note:

On August 13, 2007 I updated a page on my www.stopLHHdownsize.com website to document that LHH’s mission was being converted from its use as a long-term care skilled nursing facility to being a form of a sub-acute psychiatric hospital.

In a statement memorialized in the MHRF Blue Ribbon Committee’s October 22, 2003 meeting minutes, Director of Public Health Mitch Katz stated LHH is being oriented “toward being able to care for people with mental health issues ...” and “... although it is not feasible today to move all people who need long-term care from the MHRF to LHH, the future larger LHH will offer ... the same kind of services as offered at the MHRF.”

In addition, then San Francisco Health Commissioner Jim Illig stated “The DPH Strategic Plan, which is in the process of being updated, will [change] the role of Laguna Honda. “While there are process problems, the structure of service [delivered at the new and current LHH] is going to change,” as recorded in the May 27, 2005 LHH-JCC meeting minutes.

Melgar — just like other D-7 Supervisors before her — totally ignores LHH’s change in mission ushered in, in 2004.

Monette-Shaw is a columnist for San Francisco’s Westside Observer newspaper, and a member of the California First Amendment Coalition (FAC) and the ACLU. He is a “Childless Cat Gentleman” and operates stopLHHdownsize.com. Contact him at monette-shaw@westsideobserver.com.

September 2024

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