>> good morning. i want to thank all of you for joining us i'm david which you the city attorney of san francisco we are here to announce 2 lawsuits fileed protect the patients of laguna honda and keep this institution open. my office filed a case on behalf of the city of san francisco, the reigning law group fileod behalf of the patients of laguna honda. for over 150 years willing lag provided critical skilled nursing and rehab service for our most vulnerable for seniors, family members with disabilities, those who can't take care of themselves. we are here because the federal government ordered laguna honda's closure. transfer and

discharge of 700 patients and the end of the federal funding. by september 13th a mont away. our lawsuit describes how the federal government put laguna honda and the stele in an impossible situation. with the lives of hundreds of patients at stake. the hospital had challenges, our lawsuit describes our city bent over backwards trying to address issues and keep laguna honda open. every step we met with resistance by the centers for medicare and medicaid service. cms rigid in prop and unwilling to collaborate with our city and laguna honda. our city highlights how the deadline is completely arbitrary. we proposed a recertification press that would not require simultaneously kicking parents out of the hospital.

it was rejected by cms. we asked for 18 months to ensure parents transfer and discharged, rejected. asked phase transfer for vulnerable transferred last, rejected. for weeks willing lag staff called an average of over 1 thousand skilled nursing fasills in california and the counts real have not been able to find beds for our medicare and medicaid parents. that did not change the mindses of the cms bureaucrats. our lawsuit highlights how the city due process rights violated. filed 3 appeals in february, april and may. those appeals will not be decided before the unreasonable september 13th dead line rendering the pel's process meaningless. a fake showing of due process. laguna honda and our city deserve real process not a sham. so are we asking for with this

lawsuit? we are asking for the federal government simple low to continue funding. at least until the appeals process is complete and all patients relocated, which we know will not be by september 13th. we are asking the federal gentleman to exercise compassion and common sense. if the funding ends and the dead line is not changed there are not enough places to transfer the patients. and in the left weeks, 9 former laguna honda parents have died after transferred or discharged. 9 people. we need to protect patients from this rushed process and dead line. hundreds of lives are literally at stake. let me ends with this the federal government is the last thing we wanted to do. but after attempts, the federal government left us with no

choice but legal action. our hope is this cms will come to the table. work with us on the plan that protects the remaining 610 patients preserving an institution that has been the last safety net for so many. for our patients, this hospital has been their last resort. with 5 and a half we've beenings to go, this lawsuit is our last resort. we must save laguna honda. thank you. >> i want to take a moment and acknowledge the fact that -- the entire city is united in our ask here. i want to thank all of our elected officials. we have supervisor peskin here and thank melgar and supervisor mandelman and others who have been tremendous add roindicates. our next speaker the granddaughter of a former laguna honda resident a champ for laguna honda needs no introduction. our office is suing on behalf of

the city of san francisco the ceo of our city the 45th mayor of san francisco mayor london breed. >> thank you, david. i want to start by acknowledging and everyone thattinging our city attorney for his work and efforts and finding a possible solution to deal with this really challenging and complex problem. fact is, we should not have to be here. we should not have to be here to protect patients. and what is interesting is the arguments that have been used to protect patients have been the arguments to protect patients from the federal government. and in fact this is a long very frustrating process that started left year. when the leader of the laguna honda self reported challenges with those who over dozed who did in the die and the need to develop systems to support this

hospital to ensure patients safety. cms did not come to us we went to them because laguna honda we understand have complex challenges, but important low, we have systems and regulations we know we must follow. so we went to them. and there was a discovery that there were things we needed to change. and we moved forward in making changes. and later on, this year, fact, early 30 year. we were notified that there were additional things that needed to be changed. to be clear we know this laguna honda has challenges. we understand that the need to make corrective actions. and we have already implemented significant amounts of corrective actions based on the recommendations of cms and we know we have to do. and we are in the process of making changes. that are necessary to get laguna honda on the right path.

but let's be clear, our city attorney told you 9 patients died after transferred. during the covid pandemic we only lost 6 lives -- 6 people died from covid. and one of the largest skilled nursing facilities in the country we saw on the news people with lower amounts of residents carrying out patient in body bags. with a lot of uncertainty and fear. everyone was concerned about laguna honda. and the people who work there, they save lives. they protected the residents of laguna honda. that should count for manage we when we do over the 150 year history of this hospital. we have not seen large numbers of lives losteen though we than many people have passed away

from natural causes. at laguna honda hospital. and now look where we are. forced to move patients. to move patients to homeless shelters. outside of the county where their families can't visit. we know this creates trauma. and until the numbers have climbed in terms of the number of dwaeth deaths the only time cms said hold off don't move more patients but with no date whether or not we need to continue. the problem is the uncertainty. we get mixed mess ammings. lack of clarity. not clear in our written communication. we are told one thing and another. this is frustrating and it is scary, we have a lot of questions that both the staff and the patients and their

familiesment to answer that we can't always answer. the finger is pointed and we are blamed butt fact is we have to work with cms. almost 70% of funding come from ked cal and medicaid these are parents this don't have money to pay for their care. if any of us end up in i situation like these patients we should be luck that he there is a facility like laguna honda that can take care of us. they took care of my grand mother for 14 years suffer friday dementia. we tried take care of her at home and it was very difficult. laguna honda they took care of her. bathed her and gave her medication and make sure she was fed when she could not chew they made changes. this is not just a facility,

this is a pasillity filled with people. nurses in the clinicians and all of the people who work there they treat the patients like they are their family. my grand mother passed away. her main nurse showed up to her service. and a could you remember of others who took care of her. they grieved like our family grieved. they loved and cared for my granted mother. that is happening at laguna honda hospital. the technicalities that get introduced that create the challenges that put us in this situation are really unfortunate. and i don't think we are asking for anything that is unreasonable. we are asking for clarity. of a date. specific. of when cms anticipates lifting the requirement for us to transfer patients where we are asking them thot not to ask us to do that to halt. we understand there are some

patients that node to be treasured and we are working on that. we cannot turn them out in the street. that is not an option. that is not caring for the patient. that is not putting them first. we are also asked, to continue funding as we go through this process to bring laguna honda up to the appropriate standards that meet the cms guidelines. so giving us a deadline of september 18th to retrain staff for new guideline and make adjustments to many of the things we have not had to before, it is unrealistic. we have been working on this and making the adjustments and moving as quickly as we can we tr football responsible so when the changes are made this they work. we are not telling people what to do but we are demonstrating when than i ned to do that ask differents than what they have

always done before. well is a lot of work that has to go into this. we are asking to provide clear direction in writing. just clarity about the things they are asking us to do. this is not unreasonable. we have been asking for this kind of information and support now for months. again, i understand, we have work to do. but think about it. sick lives sadly lost to covid. compared to 9 lives, 9 people who have been transferred. this is a problem. we are here to work with our federal partners. we are here to make laguna honda what it needs to be because it is needed. we don't want to see this facility closed we want patient and families and the staff

assurances that this facility will be around for another 150 years. this is a matter of life or death. this is a last resort. we did not want to be here but we are. and we have a lot of work to do. we ask respectfully to meet the request that we have in the lawsuit. so we don't have to continue down this path and we can work together to ultimate low protect the people that truly are the most vulnerable in our city. thank you. >> thank you, mayor. appreciate your leadership as well as the leadership of public health institution in san francisco. i'm grateful to our next speaker not the founding partner of public law group filing the companion lawsuit in this matter

not just the former city attorney of san francisco, while city attorney she sued the tobacco industry and brought a judgment for half billion dollars and championed the use of the fundses to rebuild the laguna honda that is in our city today. with that, of course i like to welcome louis remy >> thank you mayor breed and city attorney, thank you, both for your leadership and the health department officials and the attorneys that have been working on this matter. i have a long involvement with laguna honda. going become to the days when i was on the board of supervisors like supervisor peskin. and then and there diane feinstein came and said louis let's look at laguna honda. and i was immediately impressed with the mission and the care

that laguna honda provides for the neediest in our city. with needs that require good care. that has been true over the years. and i'm here today representing the residence and families who cannot believe that they are going to be required to be discharged from laguna honda through no fault of their's. but under everunder the diabolical plan of cms, with the help of the state department of health, all must go regardless of innocence and regardless of medical needs. for example, one was plaintiff in our class action suit is a long time residents of san francisco. but suffers from diabetes a

difficult form of diabetes. her treatment requires a machine to measure the insulin she has and the blood surety count. from time to time when were that machine needs to be maintained, she has to go to san francisco general to receive this level of care that to keep her arc live. where is she going to go? there are not 700 skilled nursing beds for people without special needs. where is she going to go? another client and representative of our class has denent mentia and probably at the end of her life. seriously, cms department of health, you are going to sends your people out to die?

that have already. and the worse part about it transfer trauma resulting in death is medically documented and should be well known to every competent health official. cms and the state department of health had to know that there would be deaths that occur. how much longer are we going to keep this up before more deaths occur? we have today somebody with us who is the mother of a patient at laguna honda. and can tell his story very well. but if you go to laguna honda as i have on so many occasions, you will see the good care that is received -- the workers the medical staff at laguna honda are special. they dot lord's work.

i am very hopeful i know mayor breed, city attorney chew and all involved we welcome cms and the state department of health come to your senses. come to your senses before more people die. before more people are thrust in homeless shelters. please, come to your senses. >> thank you. as she e ludzed we are here because there are hundreds of patients lives at stake. we are here because the patients are our grand upon parents our partners, our children. here to represent one of those parent system deb wra rabower the mother of sean. >> i'm excited have this

opportunity, i told my friends i would stand up in the court of the world to speak how i believe about laguna honda and its care. my son has been there 20 years. had a brain injury. does not have a short term memory. diagnosed with decline to speak means he can't speak but does not often. he uses q to express himself. monster mom with intercept that q does not like it to be touched. hard to get him take treatment where his body is touched. and because of his loss of short term memory it is hard to build up familiarity and degree of security anywhere. and hoe has that at laguna honda. i feel like the staff there guess out of their way to understand the quirks of the patients and the units that house as many with dementia and

memory issues and they have formed a family this makes way for each other. when i come in the unit and i visited 6,000 times sean is there in this room or point him out the new guy will say is that your son. i say, yes. and the guy is happy that he figured something out. staff is so supportive of trying to intercept different nationalities, different languages and codes of behavior and try to figure out and make the patients exist in the same unit together. i think they are successful. because i visit so much i'm snoopy and observant and watch how they treat other parents. if i saw something i would r and report it. but i have in the seen that. when he needs to go to the dentive if i'm not in town

because i go to all his appointments on the bus i'm a bus queen in san francisco. the dental clinic will call and say we got him in the chair. i will persuade him and they call me at the end of the appointment with their victory report of how successful they were. i think it is amazing. they pass that on to any other technician who will handle my son. and he is just a sweet, complicated guy who makes odd noises and very loud and has strange behavior but he is an ancient and he will gentle and he feels safe at laguna honda. and. i commend them at all times on their ability to make the patients feel safe. my son feels safe there i don't want this taken away from him. i don't typeset taken away from him or the others i wave to in

the hall. and hearing covid they made sure all the time that we got connected on the phone or by a face time call and that the -- some of the technicians say they were vigilent in making sure we had this daily connection and the mayor said, it is a family. as a mother for me to say that, i can apply that word, family to something other then and there what i provide myself. a big journey for me to get to that place. now i say, yes, willing lag is a good and safe and proper family for my son. and i want them to continue. i want them to make changes. i believe in it and believe in you know you walk down it is sxhaul there is drag queens in the room and sometimes or there are things going on there you could not find a wider selection of human life than at laguna honda hospital. that are all trying to get along and are brought together and are

supported by the staff. that's what i got to say. thank you very much for giving me the opportunity. i have been itching to get my opinions out. >> thank you we pray for you your family and the willing lag family. >> our final speaker today -- represents -- the hundreds of folk who is as we referenced dot lord's work. reason laguna honda has been nationally recognized for work with alzheimer's patient and work with hiv and aids patients the reason they received top honors during this covid time by the colleagues in the public hospital community. is because of the workers. and not only do weep want to thank the workers we appreciate the leadership of the workers. i want to take a mobile home we are joined bite executive director of san francisco labor council kim. and i like to invite our final

speaker theresa who is the president elect of [inaudible] 1021. >> thank you, mr. chiou. i want to rescue niedz our mayor and recognize all the other partners the board of supervisors who are here. i'm theresa rutherford i represent 1021 and i'm a nurse at laguna honda. and just to give away a secret, i did help to take care of the mayor's grand mother and at the time, if i recall she was not mayor we were not giving her special care. we were giving the care we always give. which is compassion, kindness and just seeing a patient as our own family.

that's how laguna honda operates. i just want to also point out that -- reasonable, i got a call from one of our nurses and she was in tears. because one of the patients this she takes care of who has dementia and blinds was being considered for a transfer. and she was broken. she could not imagine how that patient was going to survive if she had to leave laguna honda. because part of the dementia process is that you have to be in familiar surroundings, the appeal have to know you. you have to have been them. you have to feel comfortable in order to be able to tloif and have quality of life. that's what laguna honda does. it does not just give medicine.

it is about the whole person. and so, as we look at this situation, i doment to raise the reality of that, cms is an over site body they have a job to do. but oversight must come with compassion. oversight must come with the understanding heck is in the just a process it is a process about people and the people at laguna honda are not widgets they are humans, individuals with families. and they must come first. they must come before any oversight. if oversight is going to be effective it must, must consider the individuals the patients who's lives are impacted bite rowels and the decisions. when we do know at this point is the closure plan is not working.

the closure plan is causing more harm than good. and as a labor organization, we are advocating for patients and advocating for the community. we know that laguna honda is a health care facility that is unique. it is the only one of its kind in the united states. it is also a fundamental part of the health care resource that we need in this counts real. and so by no means bino means, can we close an important facility that serves people and serves the elderly that serves the most vulnerable in our community. i call on cms to think this and apply a different approach. it is not going to be okay to close laguna honda. and send out the all of the parents wherever homeless

shelters. we seen that 9 patients have died and that's not by not -- happenstance that is because of the trauma of having to move. the fear. the reality you don't know where you are going. the reality you are moved from your family. i will tell you this i took care of my grand mother a couple years ago until she was 92 years old. and when i took her to the hospital, all our family members took attorney staying with her. when she did not have her family around her blood pressure went up. started failing. butt mobile home family members were there, showed up it was like a different person. having your family, having a security place kin place where you stay is a big part of caring. it is a big part of being able to bounce back from an illness.

willing laguna honda provides round the clock care. does art, music does all the things that your average long-term care facility does noprovide and cannot, does not have resources or capable. we must keep laguna honda open. it is not a factory temperature is not a building it it is a place of people, real people with families. the patients are in the widgets and i am calling and urging cms take a turn. keep the patients there and the building open and let's keep this hospital going. it it is vital to the city and county of san francisco. but also fund amally important as we talk about health care and as we talk about creating resources, for poor people and people don't have enough.

this pandemic shown us that the people who are hurt the most when there is a pandemic when there is a major health care issue. our black and brown and poor people. let us not create a harder make it harder for people to have resources let us not remove the maker who is depends on laguna honda and need this vital service. let's not remove that option or opportunity or resource from them. because to do that is death. to do that is the condemn them to a life of further harm and hardship. oversight must make sings better. cannot add to the problem. as i see it now as we see it now, this oversight is an over reach. it is not serving the purpose that it was made to do. it is supposed to make it better

not worse. i want to close with a reminder to all of us and cms and -- this is a quote from gandhi. says a civilization is measured by how it treats itself weakest members. let's not forget that. i would reach out to cms and say note this, oversight only has value had it makes things better. when it improves the environment and the circumstances that it is tasked with. this oversight is over reach, take a step back. get back to the table. yes, willing lag has issues let's address them but not use the patients as you know a game. not use them as football. not put them as target practice. they are human beings they belong at laguna honda they deserve the best care.

let's give the best care. give good over sight and be responsible. let's do oversight with compassion. cms, come become to the table. let's talk and work together. thank you. >> thank you theresa for the powerful word and reminding us why we are here that is the end of our remarks. want to open up to questions. i want to note that here to help answer questions we have the director of our san francisco department of public health doctor colfax and have the ceo of laguna honda. i want to thank a number of deputies in my office but we have with us also to answer legal questions steel and he henry lipton. with that, happy to answer questions.

[inaudible]. >> what we hope will happen immediately is that cms will come to the table. we want a conversation about what the next steps are. we only have 5 and a half weeks. we have 2 lawsuits and we will be considering all options if they don't come to the table and when we mead to compel that conversation. >> so, the city attorney's office we are bringing a lawsuit on behalf of the city of san francisco. and specific low we are asking the federal government cms, to continue the funding at least until the end of the administrative appeal's process as well as to the end when we know parents could be transferred orb discharged safely. i will ask mrs. rainy if you want to answer. >> thank you. i'm specific low our team is

representing the residence den and families. we are bringing a class action for all residents and families. we are insisting that the discharge stop. period. unless there is a valid medical reason or the end of rehab care. people move out in an informal course of things. we want the discharge to stop, period. we also want the recertification order with drawn. you know, just for those of who you might remember a new laguna honda built and open in the 2010. as the first green hospital in california. it is literally brand-new. why, why would you recertify a

brand-new hospital? and to add injury to the injustice, in the course of it, cms made clear that they are going to reduce the number of available skilled nursing beds by 130. if you take a look, there is already a skilled nursing beds available in california. we can't afford to lose 130 beds and still take care of the people in need. i know there is a cohort within cms and the state that have felt laguna honda was too complarj is nursing homes should be scattered. this is in the possible in san francisco we are 7 by 7. secondly as pointed out, there are amenities at laguna honda

that are not available at all. in other nursing homes. medical staff is on do you every day. and some of the private homes you are lucky if the doctor passes by once a month. and we have petting zoos. a swimming pool. we have art classes. a hair salon. all sorts of things this others don't have. frankly, we want to go back to no discharge and no recertificationch and i will add this, yes, mention made of the deficiencies. there are deficiencies in every single skilled nursing center and hospital in california. because we are dealing with human beings. but you take a look as a deficiencies that cms and the

state department of health pointed to they pale in comparison when we know and our investigation shows goos in other facilities. yet cms and the state department of health have chosen to 3 the box at laguna honda. why? nobody figured out why. our let yous are going to get to the bottom of that. and i think that is going to provide very interesting reading and media attention when we do. >> yes. [inaudible]

>> we wish that our city policy makers could make the decision here, unfortunately than i are decisions driven by gentlemanal actors outside of san francisco. this is why we are asking the federal government the cms to make different decisions than the ones they made. they said we need to close the facility by september 13th they are cutting off our funning. told us we need to transfer and discharge patients and under federal law that is their they could do that if they chose but they don't have to. and when we are asking them to do is use their discretion to make different decisions to save lives and not abuse the discretion with arbitrary decisions like the ones we believe they made here. >> the transfers -- exactly not

because of the board. so -- so right. so, for starters the board resolution it reflects the united position of san francisco but cannot compel a different decision by the good government. one other part to the question. so. last week, cms said they would temporarily pause transfers but we understand we have been told this does not change the september 13th date. so it is an attach rarely pause. while we welcomed what we thought was going to be a true pause for us to be able to catch our breath and engage in a conversation when we issue told it is the deadline it made things even more difficult we may have to transfer all the patients in a short period of time this is in part why we filed the lawsuit.

one more question. one more hand? all right. if not thank you, i want to thank all the partners here today. and stay tuned for further developmentos this matter. thank you very much. .

the tenderloin is home to families, immigrants, seniors, merchants, workers and the housed and unhoused who all deserve a thriving neighborhood to call home. the tenderloin initiative was launched to improve safety, reduce crime, connect people to services and increase investments in the neighborhood. as city and community-based

partners, we work daily to make these changes a reality. we invite you to the tenderloin history, inclusivity make this neighborhood special. >> we're all citizens of san francisco and we deserve food, water, shelter, all of those things that any system would. >> what i find the most fulfilling about being in the tenderloin is that it's really basically a big family here and i love working and living here. >> [speaking foreign language] >> my hopes and dreams for the tenderloin are what any other community organizer would want for their community, safe, clean streets for everyone and

good operating conditions for small businesses. >> everything in the tenderloin is very good. the food is very good. if you go to any restaurant in san francisco, you will feel like oh, wow, the food is great. the people are nice. >> it is a place where it embraces all walks of life and different cultures. so this is the soul of the tenderloin. it's really welcoming. the. >> the tenderloin is so full of color and so full of people. so with all of us being together and making it feel very safe is challenging, but we are working on it and we are getting there.

>> welcome to the small business commission meeting on july 25, 2022. the meeting is being called to order at 4:30 p.m. this meeting is held in person at city hall room 400 and broadcast live and available to view on line by calling 415-655-0001. government code 54953e and mayor breed 45 supplemental to february 25, 2022 emergency proclamations it is possible the members may attend remotely. viewed on sfgovtv tv 2. we welcome public participation. there is a opportunity for general public comment at the end of the meeting and there been a