Healthy Investment

Ignore Davis, Fang, O'Donoghue, and Roselli; here's how renovating Laguna Honda could save taxpayers $500 million

Most of the severely disabled people who live at Laguna Honda Hospital spend much of their time in bed. Although some engage in therapy and social activities, many of the elderly residents watch television all day, or simply stare into space.

It is, therefore, reasonable to suppose that the vast majority of the hospital's 1,200 patients weren't aware of the strange political storm that raged around them for a few recent weeks, and then cleared overnight. For that matter, most San Francisco citizens are probably still befuddled by the Board of Supervisors' rush to place a $500 million Laguna Honda bond issue on this fall's election ballot -- and then the board's rush not to have a bond issue, all within the space of less than a week.

The hospital bond flip-flop has given rise to much political handicapping. Whose interests would have been served by a November vote? Who killed the bonds? Similarly, there has been a sudden spate of hand-wringing over the fate of Laguna Honda residents, who have been largely ignored by the city's political establishment for years, and who by most accounts receive good care. How will they ever survive, bond proponents moan, without a new, $500 million hospital to serve them?

In recent weeks, almost no public attention has been given to one salient fact: There is no pressing legal or other reason to build a new hospital, and no need to increase the city's debt load to make whatever changes are necessary at Laguna Honda. A few relatively inexpensive renovations -- renovations that probably would be funded directly by the state or federal government -- could allow Laguna Honda to safely and legally serve most of its current population, at less than 20 percent of the cost of a new hospital.

The most recent Laguna Honda fiasco started in June, with the release of two government audits claiming that Laguna Honda is too crowded; that the residents are hopelessly bored; and that the vast majority of the hospital's patients are unjustly restrained by straps and psychotropic drugs.

The allegations of unwarranted restraint are disputed by hospital administrators, and those claims are not actually central to the long-term future of Laguna Honda. The U.S. Health Care Finance Administration generally praises the overall quality of care at Laguna Honda.

But this summer, HCFA threatened to shut down the hospital if it did not limit its population to four patients per room. Because most Laguna Honda residents live in large, open, 30-bed wards -- which qualify as one room under federal regulations -- hospital administrators contend they found themselves in a double bind. The administrators say that if they reduced the population of the wards, they would lose so much federal money the hospital would be forced to close. (Some federal funding for long-term care facilities such as Laguna Honda is doled out proportionately, according to the number of people served.)

On the other hand, administrators claim, if they did not reduce the patient population, they would be shut down for defying the federal order on patients-per-room. The only way out of the double bind, administrators cheerfully chirp, was to build a new $500 million hospital that had all the modern bells and whistles any federal regulator could desire.

Seizing on HCFA's threats -- and public sympathy for the plight of the old and infirm residents of Laguna Honda -- a chorus of political players began screaming for Mayor Willie Brown to put the largest bond issue in San Francisco history on the November ballot. Rushing to save Laguna Honda were political consultant Jack Davis; Ted Fang, publisher of the San Francisco Independent; Joe O'Donoghue, head of the Residential Builders Association and a City Hall lobbyist; and Sal Roselli, business agent for the city's service employee union, SEIU Local 250, and therefore a representative of the union's precinct-walking muscle.

Not long afterward, Mayor Brown reversed his earlier opposition to the rebuilding of Laguna Honda and asked the Board of Supervisors to rush a $500 million hospital bond issue onto the ballot with little discussion of cost or options.

In late July, a poll run by Davis showed that voter sentiment was running against approval of the Laguna Honda bond. (Why such a poll was not taken before the supervisors were asked to act remains a mystery.) Mayor Brown and the supervisors raced backward to remove the bond from the ballot. Attempting to divert the blame for their sudden about-face, most of the bond supporters complained about heartless "tenant groups," who supposedly refused to support the bond issue because some of the cost of the new hospital would have been passed through to tenants as rent increases.

But the political blame-game that followed the collapse of the bond proposal obscured a fundamental question: Is it really necessary to spend $500 million to make Laguna Honda a safe and legal long-term care hospital? The answer, clearly, is no.

From a distance, Laguna Honda's Spanish Revival buildings, built in 1926, resemble a posh hotel grandly sitting amid acres of lush garden. And the magnificent grounds are well-kept in spots. Overall, though, the place has a past-its-prime feel. Concrete patios are cracked and unswept. Abandoned barbecues rust in odd nooks. Windows are dirty and old paint peels off crumbling sills. The place oozes sadness of the morning-after variety and, more to the point, it stinks of deferred maintenance.

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