Laguna Honda hospital is simultaneously moving patients out over its decertification while working on its recertification so it can keep patients there, and four fatalities highlight the tragic folly of this seemingly contradictory process.

The regulatory penalties being placed on Laguna Honda hospital have felt extreme, given that it’s a pretty well-respected skilled nursing care facility, and the only one in the country that’s still publicly owned. Yes, they had two patients overdose (non-fatally) on illegal drugs on their watch last summer, and in follow-up inspections, state and federal regulators found minor-sounding infractions like patients smoking in common rooms and cigarette lighters on the premises. But to force the place to relocate patients in a closure plan, while simultaneously correcting the problems so they can avoid closure, sure feels like regulatory overkill.  

And now we mean “overkill” literally and not just figuratively. While the hospital is being forced to move patients out to comply with their closure plan (a closure which may not even happen), the Chronicle reports that four patients have now died within days or weeks of being transferred out of Laguna Honda.

“This is a total mess and it’s turning into a tragedy with the deaths we are hearing about now,” California Advocates for Nursing Home Reform staff attorney Tony Chicotel told the Examiner. “Residents are dying with some of these transfers and it shouldn’t be happening.”

Many of these patients are quite elderly, so it’s not a great idea to move them around. Some are being sent to homeless shelters (!), and others to facilities elsewhere in the Bay Area, which in some cases are for-profit nursing homes that do not have such a great track record themselves.

Image: SF.Gov

Laguna Honda is not a for-profit facility — it’s run by the SF Department of Public Health. And as such, they at least try to be somewhat transparent about their doings. They have an online dashboard of patients they’re releasing (OK it is actually a PDF, but updated weekly) which as you see above, 40 have been moved to other skilled nursing facilities, while 16 have been discharged “to the community,” for a total of 56 moved out.

The four fatalities were all transferred to other nursing facilities. The Chronicle broke the story Tuesday that two of them were women with dementia, aged 95 and 102. That story also mentioned, “Little is known about the third person, who was 80.” In terms of the fourth patent, the Chron reported that “The patient whose death was confirmed Wednesday died on July 17, roughly three weeks after being transferred to the Department of Public Health Medical Respite on June 23.”

As one expert tells the Chronicle, for patients with dementia especially, changes of environment are very traumatic.

Hey federal and state regulators, notice how the consequences of moving these patients is far worse than than the original infraction of two drug overdoses and some cigarettes! Yet Laguna Honda, despite that it may be re-certified, still has to present (and begin implementing) a plan to move all 700-plus patients out by mid-September. Yes, that totally overlaps with their next inspection, where they can win regulatory forgiveness for all this, which makes little logical sense.

“Those are two incongruent ideas, but yet, that’s where we find ourself,” Laguna Honda interim CEO Roland Pickens told the Board of Supervisors last month. “Perhaps they offer us some accommodation. But that accommodation has not extended at this point.”

Image: SF Board of Supervisors

So best case scenario, when does this nightmare end? Laguna Honda's timeline is seen above; their next inspection is in September, and even if they pass, they have to be inspected again in December. If all goes well, they can stop shipping patients out by the end of the year.

Related: Laguna Honda Presents Plan to Shut Down and Relocate Nearly 700 Patients, Even Though They May Not Have To [SFist]

Image: @mwichary via Twitter