Bond Foes Say Rebuilt Hospital in S.F. Would Still Be a Relic
A $299 million bond measure to rebuild Laguna Honda Hospital has divided the city over the type of care San Francisco should supply for its elderly and disabled residents. Supporters of Proposition A on the November 2 ballot say the city needs the 1,200 skilled-nursing beds a renovated Laguna Honda Hospital would provide.
“This is a very good opportunity to follow through with an exciting and visionary plan for Laguna Honda,” said City Attorney Louise Renne, who led the committee that recommended a bond measure to replace the aging hospital.
Opponents see the huge facility, which was founded 133 years ago, as a relic of times gone by, when the frail elderly and disabled were dumped into large public institutions and forgotten. Today, there are better, more cost-effective ways to provide the services those people need, they say.
“There’s no model anywhere for what we’re doing here,” said Supervisor Gavin Newsom, who opposes the bond measure. “We’re putting all our resources into one institution that the day it opens won’t meet the needs of the community.”
The bond money in Proposition A would account for most of the $400 million-plus it will cost to replace Laguna Honda, which sits on 62 acres in the city’s Forest Hill neighborhood. A new hospital would be built, the present hospital building would be remodeled as an administrative and program center, and a 140-unit assisted-living facility would be constructed.
The measure would require San Francisco to spend most of the money it will receive from a national settlement with tobacco companies on the hospital. The city expects to get about $21 million a year as its share, and under Proposition A, the only non-Laguna Honda spending would be $1 million annually allocated for anti-smoking programs.
The idea angers many local health-care groups that want the money to go for a wider range of uses.
“There was no debate at the (Board of Supervisors) and no public debate at all on how to spend the tobacco settlement money,” Newsom said. “It’s absolutely unfair to take all but $1 million a year for Laguna Honda.”
Complaints like Newsom’s will make it harder for Proposition A to get the two-thirds vote it needs to pass. Backers of the plan already have reduced the size of the bond from its original jaw-dropping $437 million to the more palatable $299 million by cutting the number of single rooms by two-thirds.
They are also trying to whittle down the tax increase that property owners would pay.
According to City Controller Ed Harrington, the owner of a $300,000 home would pay a maximum of $120 a year extra for the 20-year life of the bonds if the city does not use the tobacco money.
“That’s a high figure,” said Tom Hsieh Jr., who is running the Yes on Proposition A campaign. “With the tobacco money, the cost drops to $78 a year, and a new state law could allow the city to receive federal reimbursement for some of the Laguna Honda construction costs, which could make the cost even lower.”
Still, it will take a major campaign to persuade voters to back the bonds — and that costs money.
Enter San Francisco’s public employee unions, which, so far, have put up a big chunk of the money to promote the Laguna Honda bonds.
Through September 18, the cutoff date for the most recent campaign finance report, the Committee to Save Laguna Honda Hospital had collected $146,278 to back Proposition A. The Service Employees International Union Local 790, which represents most of the 1,500 union workers at the hospital, contributed nearly $70,000 of that amount. SEIU Local 535, which also represents workers there, added an additional $2,000, while other unions pitched in with $21,000.
Other major donations included $25,000 from the Residential Builders of San Francisco and $1,000 from Nan Tucker McEvoy, a member of the family that owns The Chronicle.
The labor backing has prompted grumbles that the plan to rebuild Laguna Honda is as much an attempt to save high-paid union jobs as it is to help San Francisco’s elderly.
“The fact of the matter is that San Franciscans deserve the highest level of services we can afford to give them,” Hsieh said. “Union jobs tend to pay more, but we find the quality of care is higher than with minimum-wage workers.”
Union workers are walking precincts, making phone calls and otherwise supporting Proposition A, but jobs are not the only concern, said Tim Reagan, a spokesman for SEIU 790.
“Unions are honor-bound to defend union jobs, but if our own people were saying, `It’s not worth it,’ we wouldn’t be out front on this,” he said. “This is a case where our interests really coincide with the community’s cares.”
The most heart-rending dispute surrounding the Laguna Honda bonds is in the local disabled community. On one side, many advocates for the disabled believe that the money being spent on Laguna Honda could be better used to help the disabled and the elderly live on their own.
“Rebuilding a 1,200-bed facility is turning the clock backwards,” said Arlene Mayerson, an attorney for the Berkeley-based Disability Rights Education and Defense Fund. “The whole point should be to get people back into the community. Very few people need to be in a place like Laguna Honda.”
Then there are people like 49-year-old Patricia Sancinito, for whom Laguna Honda is home.
For the past six years, Sancinito, who suffers from multiple sclerosis, has lived at the city-run facility, which provides her with the 24-hour, seven-day-a-week care she needs.
Sancinito developed MS when she was 38. For a few years, she used her federal disability pension to pay the bills. But as her condition worsened, she could not afford to pay for her rent, her medication and the medical support she needed.
“I’m scared that if Laguna Honda closes, where would I go?” she said. “The last thing I wanted to do was give up my apartment, but I couldn’t live there anymore. But (independent living advocates) think because they can do it, everyone should do it.”
The money being spent on Laguna Honda could give a lot of people like Sancinito the help they need to stay in their apartments, near their family and friends, said Herb Levine of the Independent Living Resource Center in San Francisco.
“There are no services within the four walls of a room that can’t be provided in the community,” he said. “But the fundamental premise of the (independent living) movement is choice. If people choose to stay in a nursing home, it’s their choice to stay there.”
But if people opt to stay in a nursing home, it very likely will not be at Laguna Honda unless the bond measure passes, said Dr. Mitch Katz, head of the city’s Department of Public Health.
The buildings at Laguna Honda are 70 to 90 years old and do not meet earthquake safety codes. They also represent another era of nursing care. It is the last hospital in the nation with 30-bed open wards, and the federal government already has forced the city to cut the number of patients there from a peak of 1,193 to an average of 1,065.
“If the bond measure doesn’t pass, we will be asked to reduce our census again,” Katz said. “Certain people will have to be placed in facilities outside of the county, even though we always felt it was wrong to send people away from their families.”
About 9 percent of the patients at Laguna Honda are in a persistent vegetative state and need constant care, Katz said. About 45 percent suffer severe dementia. Few can be transferred to other local nursing homes, which often are not equipped to deal with the range of problems that many Laguna Honda residents have.
“San Francisco has always treated its elderly in a humane way,” Katz said. “That’s more expensive than if we just neglect them.”
Critics argue that Katz and other backers of the rebuilding plan paint too bleak a picture of the future. Regardless of what happens on election day, no one’s grandmother is going to be kicked out onto the street.
“Laguna Honda certainly isn’t going to be closed immediately,” Newsom said. “It will take at least until 2006 even to build a new hospital, so the government will give us until 2008 or 2009 to make any needed changes.”
Newsom and independent living advocates want the question of Laguna Honda returned to a new committee that will study the city’s future medical needs and decide on the mix of nursing hospital beds and community services that will best serve San Francisco.
“Our concern is not about the rebuilding of Laguna Honda,”Levine said. “It’s about rebuilding it at 1,200 beds without a commitment to other types of care.”
But city studies show that even a rebuilt Laguna Honda Hospital will not supply all the skilled nursing beds the city’s steadily aging population is going to require in the future, Renne said. And unless the bond measure passes for the reconstruction project, she said, San Francisco will not be able to provide the type of care many people will need.
“I believe the future lies in an array of services, both community based and skilled nursing, like Laguna Honda provides,” Renne said.