Health Secretary Xavier Becerra Visits San Francisco Hospital Fighting Off Closure

U.S. Department of Health and Human Services Secretary Xavier Becerra on Friday toured the country’s largest public nursing home, based in San Francisco, which continues to face threats of closure.

The one-hour tour marked Becerra’s first visit to Laguna Honda Hospital and Rehabilitation Center since he became head of the country’s health care arm in 2021.

“This tour was indispensable,” Becerra told KQED after the visit. “Going through, meeting a lot of the personnel, many who have been here for decades, it’s important to get a sense from them how they feel.”

He visited the facility to observe some of the areas and processes that Laguna Honda must bring up to code in order to get recertified, such as medicine storage and cleaning, and to see how patients with mental illness and substance use disorder are cared for at the facility.

Reporters were not allowed on the tour, but Becerra said he spoke to nurses and patients who told him they hope he will protect Laguna Honda.

“Most of them said, ‘Help us keep Laguna Honda open,’” Becerra said. “A facility like this is critical to a community, and a facility like this understands it has to meet standards so that anyone who needs to send their loved ones here can know that the health and safety that we would all expect is being provided.”

It’s been a year of constant uncertainty and crisis for staff and patients at Laguna Honda. In 2022, federal regulators decertified the hospital after it was found to be out of compliance on a number of safety issues, including medication storage, hygiene practices and having a lighter near an oxygen tank.

Despite objections from hospital and city leaders, the regulators mandated that the hospital remove as many of the patients as possible while staff simultaneously worked toward regaining certification.

Regulators paused their initial transfer requirement in July 2022, after reports that some of the 57 patients who had initially been moved from the hospital had died. In total, 12 former patients are confirmed to have died, nearly all of whom had been transferred last year to other skilled nursing facilities.

Becerra’s tour comes months after local and national leaders including Mayor London Breed and Sen. Dianne Feinstein called on Becerra to halt involuntary patient transfers out of the hospital, which previously held more than 700 patients and now has below 600.

Laguna Honda is still a licensed nursing facility. But losing certification with the Centers for Medicare and Medicaid Services, which Becerra oversees, would mean cutting the 156-year-old hospital from government subsidized health care plans, which the vast majority of Laguna Honda patients rely on.

The hospital is now working toward recertification, and CMS has agreed to continue Medicare and Medi-Cal payments through November. And any involuntary transfers will be paused until at least May.

Becerra, who previously served as California attorney general, toured the facility alongside Mayor London Breed, California Health and Human Services Agency Secretary Dr. Mark Ghaly, San Francisco City Attorney David Chiu, San Francisco Public Health Department Director Grant Colfax and Laguna Honda interim CEO Roland Pickens.

Regarding progress toward recertification, Colfax said that the hospital successfully met the 126 action items that regulators told the hospital to correct in January, and that they are on track to meet the 133 milestones required by the end of February.

“We are really supporting a new culture of accountability,” Colfax said.

Some of those changes have included repeated training for staff on infection control and prevention. More than 6,000 clinical observations take place every week, where staff check whether nurses and other staff are appropriately washing hands, wearing masks, cleaning and disinfecting, according to Pickens.

Pickens also shared that the hospital is continuing to explore options for how to better care for patients with mental illness and substance use disorders. That will be critical to operations moving forward, because the initial series of inspections that led to the hospital getting decertified were triggered after two nonfatal overdoses occurred at the hospital with substances brought from outside.

Recertification likely will not occur before May, Pickens said, but he did not further speculate on the exact timeline ahead.

“Laguna Honda is here to serve the needs of the San Francisco community. And in our community, we know we have individuals with substance use disorders and mental illness. That doesn't go away just because someone becomes old or elderly,” Pickens said. “We are looking at how we provide those services … and will be proposing new models for how we can do a better job at that.”