Hospital, Heal Thyself

Another black cloud is looming in the gray sky of Laguna Honda's future. In June 1999, the U.S. Supreme Court ruled that public health systems using federal money must give institutionalized disabled people the option of receiving treatment in a community setting. In July 2000, 10 long-term residents of Laguna Honda, along with the Independent Living Resource Center of San Francisco, sued the city to do exactly that. Their class-action lawsuit alleges that the city and several state agencies are discriminating against people with disabilities by failing to use federal funds for home- and community-based services. San Francisco's Department of Public Health favors long-term institutional care over community care, the plaintiffs claim.

The plaintiffs in the suit do not need to live in the hospital, one of their lawyers argues. "They are medically stable," says Larisa Cummings of the Disability Rights Education and Defense Fund in Berkeley. "Some of them have lived at Laguna Honda for 20 years. They are just sit-ting there, trapped. They would benefit from living in the community. Laguna Honda is an arcane model. It is dehumanizing."

Cummings and social workers who deal with severely disabled people say skilled nursing hospitals have a vital role to play, but it is unfair (and illegal) to keep scores of people cooped up inside Laguna Honda when they can have active lives in the community. Cummings points out that the Laguna Honda bond money does not have to be used to replace the hospital with a hospital. It can be used to construct assisted-living complexes (which provide for home treatment) at the Laguna Honda site and around the city.

In a recent interview, Janice Caldwell, associate regional administrator of the Centers for Medicare and Medicaid Services, said, "I never said build a new hospital. There are other ways to skin the cat, other service options available, such as home care, community-based treatment. That's a different philosophy, but it provides a better quality of life."

If the plaintiffs get their way, the city will have to prioritize community-based care, which would reduce the amount of money available for funding Laguna Honda's daily operations no matter what size the new hospital ends up being. Nonetheless, the city is proceeding with the replacement project as if it is good public policy and financially possible. Both of those attributes now seem debatable.