Issue:  Vol. 48 / No. 3 / 18 January 2018

Prop. D's effects on patients disputed


The future of Laguna Honda Hospital will be decided by voters on June 6. Photo: Rick Gerharter
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AIDS patients with dementia and people with other psychiatric disorders, including Alzheimer's disease, would be adversely impacted if voters approve a June ballot measure dealing with admission policies at the city's Laguna Honda Hospital, argue AIDS advocates and mental health professionals.

Opponents of Proposition D, the Laguna Honda Hospital Zoning for Health Care Facilities Initiative, are against the measure because they argue it would restrict people whose primary diagnosis is psychiatric or behavioral but cause no harm to anyone from being admitted to the hospital.

"There is a certain group behind this that would like Laguna Honda to return to being a rest home for little old ladies. People with AIDS never met that profile. They are younger, more active, and have other interests," said Health Commissioner Jim Illig, director of government relations at Project Open Hand. "If someone was coming in with AIDS or they have substance abuse issues or depression they would be excluded."

Bill Hirsh, the executive director of the AIDS Legal Referral Panel, who spoke for himself and not his agency, said he personally has problems with the way the measure is written.

"I have strong reservations about the proposal. I think it's discriminatory against people with mental health disabilities and people with HIV and AIDS," he said. "I would say people should not vote for the proposition."

Health Director Dr. Mitch Katz, in a letter to elections officials in March, wrote that 300 current residents at Laguna Honda would need to be discharged under Proposition D. While the largest group would be Alzheimer's patients, he wrote that "other patients who would need to be discharged include those with AIDS and dementia and/or behavioral problems."

Proponents of the measure disagree with Katz's arguments. They say the measure is needed in order to prevent violent patients from being sent to the hospital. They point to numerous incidents of violence against other patients in recent years and the decision by state health regulators to fine the city $1,000 per day earlier this year if it did not improve conditions at Laguna Honda.

According to the Yes on Prop D campaign's Web site ( the measure will have no impact on Laguna Honda's AIDS, rehab, hospice or respite care programs. In fact, the campaign argues that Proposition D "preserves these essential programs."

Doug Comstock, treasurer of San Franciscans for Laguna Honda, said accusations that the measure would harm such patients are "simply not true. There is no way it can affect anyone with AIDS or Alzheimer's or any of those things."

He said if anything the measure would help protect such patients from being subjected to violence and allow them to receive care in a peaceful setting.

"My main concern is about the safety of people who are too vulnerable to be mixed in with dangerous types. I am getting to that age and I may end up there and don't want psychotic types or alcoholics coming down from a binge next to me," said Comstock. "It is for people who are too poor and can't afford private care. Just because they are poor we shouldn't compromise their safety."

Comstock said Laguna Honda is meant to be a skilled care facility and is not licensed to take care of psychiatric patients or patients primarily psychiatrically diagnosed. He criticized Katz for turning such a facility at San Francisco General Hospital into a day treatment program and trying to send such patients to Laguna Honda, where he argued voters only gave the city money to rebuild the hospital for taking care of seniors and disabled people.

"It used to be a rest home. It should be restful," he said. "It is just too dangerous over there for patients."

In a letter sent in March to the city's controller, Dr. Maria V. Rivero, who has worked with patients at the hospital for the last 18 years as the attending and screening physician on the admissions ward, disputed Katz' conclusions, saying his numbers "are inaccurate."

"In my experience, there is no basis for stating that ..." Alzheimer's and AIDS patients "... would 'need to be discharged," wrote Rivero. "This ballot initiative will not exclude patients with psychiatric disorders from being admitted to Laguna Honda Hospital, nor does it discriminate against patients with psychiatric illness."

But patient advocacy groups say the measure is in fact illegal because it is discriminatory toward people with mental health issues. Protection and Advocacy Inc., in its analysis of the measure, determined that if enacted, the city would be in violation of numerous laws, including the Americans with Disabilities Act, the Fair Housing Act as amended, Federal Medicaid Law, California Government Code Section 11135, the Unruh Civil Rights Act, and the California Fair Housing and Employment Act.

"Prop D violates nine different laws in California. It puts Laguna Honda and the city at risk of failing to secure federal funds," said Belinda Lyons, executive director of the Mental Health Association of San Francisco."

But Comstock said the measure's backers believe it will hold up in court.

The measure is also drawing fire because it not only would regulate who can be admitted to the 100-plus-year-old public hospital but also create a special use district that would allow for healthcare facilities to be built in residential areas using public lands.

Due to the measure's impact on zoning, a politically active builders' group, the Residential Builders Association led by Joe O'Donoghue, supports it. But the city's Planning Department opposes Proposition D because it "... seeks to substitute" planners for medical personnel and require them to ensure the hospital and other care facilities are compliant with Proposition D, wrote Larry Badiner, the city's zoning administrator, to elections officials.

"We think who is admitted and not admitted to a hospital is not a land use issue and should not be determined by a planning official," added Lyons. "San Francisco would not pass something this discriminatory. I am optimistic San Franciscans will do the right thing. It is important they are educated and understand the details of what Prop D is and not buy into the rhetoric about violence or protecting seniors."

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