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“People are fed up with it,” said San Francisco Police Chief Bill Scott at a news conference on Friday. “We are fed up with it. And our attention needs to be on the people who are causing the problems, not on each other.”

But the emphasis on law enforcement for addressing the city’s drug crisis has distressed public defense attorneys and harm reduction advocates who fear the move may worsen the rate of fatal overdoses.

“Right now, we’re losing four people a day to overdose deaths on the street, and that’s up from two a day from last year,” said Sujung Kim, an attorney at the San Francisco Public Defender’s Office. “Driving everything underground is part of what makes it so unsafe.”

Kim said she would love to see fewer people addicted to drugs, but cracking down on street level dealing will only worsen fatalities because people will be less likely to call 911 for fear of arrest, and it will drive drug users to buy from unfamiliar sources, heightening the risk of overdose.

Research has shown that incarceration increases risk of overdose. According to a study by the Oregon Health & Science University, Oregon State University and the Oregon Department of Corrections that was published last month in the Journal of Substance Use and Addiction Treatment, people recently released from incarceration face a risk of opioid overdose 10 times greater than the general public.

Gov. Gavin Newsom’s announcement on April 21 that he was sending the National Guard and Highway Patrol to San Francisco stated that the new law enforcement partnership would not target drug users, only drug dealers and traffickers.

Scott reiterated that the operation would target drug dealers. But he suggested that police would also focus on open drug use, saying, “It’s not OK — not only to deal drugs on the streets, but to use drugs on the streets.”

Matthew Beevers, deputy adjutant general of the California National Guard, said at Friday’s news conference that he wanted to “dispel rumors” that the military’s involvement would include “boots on the ground in San Francisco.” Instead, he said, the soldiers and airmen would synthesize information gathered by all enforcement agencies into “actionable information that we can map.”

They would track “cartel networks both operating in the city and outside the city — understand those networks, build a common operating picture of it, and then work to dismantle those networks,” Beevers said.

Gary McCoy, vice president of policy and public affairs for HealthRight 360, which is contracted to run numerous harm reduction programs in the city, said he understood the pressure facing city officials and law enforcement, but believed it to be the wrong approach.

“I think that folks are just very frustrated with where we’re at right now, with what they’re seeing that’s more visible in the streets,” McCoy said. “But really, the challenges that we’re seeing on the streets right now are largely due to the war on drugs, and it’s been the punitive approaches to people who use drugs and the high rates of incarceration.”

McCoy advocates reducing drug demand by stepping up access to long-term treatment, and by taking a more forgiving approach to recovery, in which individuals are not kicked out of residential treatment facilities for briefly returning to drug use. He added that 90-day residential treatment programs were not enough to get people with substance use disorder stabilized. Although a new two-year “step-down” facility just opened on Treasure Island offering 70 spots, a lot more is needed, he said.

“The ideal number of step-down beds would be three to four times the amount of residential treatment beds, because you’re cycling more people out of residential treatment,” he said. “We’re getting there. The city’s made fast improvements to that stock.”

There are currently a total of 245 residential treatment beds in San Francisco and 193 step-down beds.

Studying Divergent Approaches

Alex Kral is an epidemiologist with independent research institute RTI International who has been studying harm reduction programs for more than 30 years. Kral said he was baffled by the law enforcement approach because no research has shown that expending resources and efforts on reducing drug supply has led to either reduced demand or reduced health complications related to drug use. Since the adoption of the Controlled Substances Act of 1970, he said, resources dedicated to drug supply law enforcement have “far outspent” measures to prevent drug addiction, provide treatment and reduce harm. Meanwhile, “We’ve just seen things get worse and worse and worse.”

“I get it,” Kral said. “If you don’t understand much about drug use or drug markets or any of that, it makes sense to me that people are like ‘Well, if we just prevent there being drugs in the community, it will stop.’ But this is not how it’s ever worked in any society in the world. And definitely the U.S. is a prime example of a place where this has turned out miserably for 50 years.”

In 2008, the Brookings Institution analyzed three approaches to global counternarcotics policies: “the punishment model” of the U.S., which uses incarceration to deter use; “the depenalization model” used in Italy and Spain, which keeps illicit drugs illegal but does not punish personal use below certain amounts; and “the decriminalization model” used in the Netherlands. Findings were most critical of the punishment model of the U.S., where incarceration rates have soared — to more than 350,000 in 2023 from fewer than 50,000 people in 1980 — costing billions in taxes while few prisoners have access to any form of drug treatment.

Drug courts, which were meant to divert defendants into treatment, largely failed at providing treatment to those who truly needed it, and filled up limited spaces with court-mandated patients who did not always need the care, according to research by Physicians for Human Rights.

Mayor London Breed said at Friday’s news conference that the operation in San Francisco differs from the war on drugs of the 1980s, because back then, “everything was about arrest, lock people up.” Now, she said, the city provides “extremely generous” social services.

Nevertheless, the Public Defender’s Office has seen increased prosecutions for low-level drug sales, which are “filling up our jails,” Kim said. And defendants are often subsistence drug dealers, meaning they sell drugs to fund their own addictions.

District Attorney’s Aggressive Tactics

Andi Gernaey is harm reduction director of the St. James Infirmary. Gernaey leads a team that travels by van to the Mission District to distribute hygiene kits, harm reduction supplies, food and other necessities.

Gernaey said the crackdown is in keeping with “draconian” measures from law enforcement that have been seen since Brooke Jenkins took over as San Francisco’s district attorney, including installing barriers along certain streets in the Mission to disrupt sex work.

“A lot of time they just use it as an excuse to harass people and search people and detain people, and then they end up not filing formal charges because they’re more like nuisance charges than what holds up in court,” Gernaey said.

Not knowing what’s planned for the stepped-up enforcement is causing anxiety among the team members, who worry that officers will not understand what they are doing there. Gernaey said they advised the team to be wary.

“If we are approached by police or military,” Gernaey told the workers, “just like, don’t say anything, say you’ll get your supervisor, and then I’ll talk with them because we’re allowed to do what we’re doing.”

Sean Duryee, commissioner of the California Highway Patrol, said at Friday’s conference that his officers would be patrolling and executing arrests. He did not disclose the number of officers involved in the operation but said that 75 officers are currently assigned to San Francisco with nine more arriving in June.

Jenkins said the operation would help combat the “human trafficking defense.” She said suspects often speciously claim to have been forced into selling drugs under threats to them or their families.

“I am very excited at the prospect of having additional resources to be able to dispel the notion that people are not here dealing drugs of their own accord, because that is clearly what is happening,” Jenkins said.

Kim said that as an attorney at the Public Defender’s Office, she had heard “horrific” firsthand accounts from people arrested for dealing drugs, some as young as 17, who had witnessed gang violence in Central America and knew what MS-13 was capable of.

“Brooke Jenkins could deny all she wants, but two of her attorneys lost cases last year where the juries heard their stories,” Kim said. “One of them, they had to pay coyotes to come over here to escape violence, and they were under threat of death, forced to sell drugs. And the juries believed the defense. I’m not saying it’s every single case, but it happens more often than people might know.”

This article is part of a series on San Francisco’s overdose crisis and prevention efforts, underwritten by a California Health Equity Fellowship grant from the Annenberg Center for Health Journalism at the University of Southern California.

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These tragedies were disproportionately suffered by marginalized groups. The biggest increase in deaths occurred among those who lacked housing. People listed as having “no fixed address” accounted for 61 overdose deaths in the first quarter, up from 26 during the same period in 2022. Black residents accounted for 33% of fatal overdoses in the first quarter this year, despite representing only 5% of the city’s population.

Addiction experts say the recent increase in overdose deaths could be linked to the closure of the Tenderloin Linkage Center, a temporary facility that operated in United Nations Plaza from January to December 2022 to help drug users and people without housing access supportive services.

Gary McCoy is vice president of policy and public affairs for HealthRight 360, the organization that ran health services for the Tenderloin site. The center also became an unofficial overdose prevention center, and McCoy connects the rise in overdoses to its closure.

“When TLC was open, and we had a safe place for folks to go, the numbers went down,” McCoy said. “So yeah, it’s pretty telling data.”

Department of Public Health statistics showed that from January to November 2022, the center received 100,000 visits and reversed 300 overdoses. Despite those results, the city shut down the site a month earlier than planned in part due to complaints from business owners and residents who said that drug use and dealing increased after the center opened.

City officials planned to open more supervised consumption sites as part of San Francisco’s 2022 overdose prevention plan, but City Attorney David Chiu advised against this since state and federal laws prohibit them.

Five days after the medical examiner’s report was released, Gov. Gavin Newsom made an unannounced tour of the Tenderloin with state Attorney General Rob Bonta. In a video posted online Wednesday, Twitter user JJ Smith approached Newsom as he strode down Ellis Street, asking him what he was doing about the fentanyl crisis.

“That’s why we’re here. You tell me what to do,” Newsom said as he continued walking.

The health department did not address questions about a link between the closure of the Tenderloin Center and a rise in deaths. Instead it emailed a response pointing to measures the city is taking to address the overdose crisis, including distributing more than 5,000 kits of the overdose reversal drug naloxone and the recent opening of a 70-bed residential facility at Treasure Island for people transitioning out of treatment programs.

State legislators passed a bill last June that would have allowed supervised consumption sites in San Francisco, Oakland and Los Angeles, but Newsom vetoed it in August, saying he would not back such a move “without strong, engaged local leadership and well-documented, vetted, and thoughtful operational and sustainability plans.”

Alex Kral, an epidemiologist with independent research institute RTI International who has been studying harm reduction programs and supervised consumption sites for more than 30 years, called Newsom’s decision “disappointing.” In recent years, Kral provided expert testimony on their effectiveness in public hearings at City Hall and in Sacramento. 

“A couple of years before that, when he was campaigning, he said he would sign such a law,” Kral said. “And then he went back on it. And, you know, that was really a shame. And it’s really set us back.”

Kral said he provided San Francisco’s heath department with results of his study of the Tenderloin Center, which showed that it did not increase public drug use or the prevalence of discarded paraphernalia, but that it did reduce drug-related emergency department visits.

Nevertheless, Mayor London Breed expressed disappointment in the Tenderloin Center because fewer than 1% of its clients were provided opportunities to enter treatment.

In December 2021, Breed declared a “state of emergency” authorizing a crackdown on drugs in the Tenderloin. A few months leading up to the linkage center’s closure, police began leaning into a more punitive approach, which Breed lauded in a recent blog post, noting statistics showed that from Oct. 1, 2022, to April 6, 2023, police made 379 arrests for drug possession or sale in the Tenderloin.

But McCoy said the subsequent rise in overdose deaths shows that cracking down on possession is not an effective method for reducing drug use or the harm it causes.

“We’ve increased enforcement, police officers have been arresting and citing people for using drugs and having paraphernalia, the district attorney has increased her punitive efforts,” McCoy said. “And the rates of cases charged for people who use drugs, and our numbers, are going up.”

Furthermore, he said, focusing on the number of people who enter treatment is not an accurate measure of success.

“It takes consistent contact and communication to have those conversations,” he said. “It’s not overnight, although it could be sometimes, but it’s often not.”

During the last days the center was open, people who had been placed in housing and received services returned to express their gratitude.

“They were coming in on the last day, and bringing us flowers and thank you cards,” McCoy said. “It was very emotional.” He said some of those who received assistance were, “upset that what had helped them is no longer going to exist for other people.”

Former client Adriel Cota said the center helped by giving him clean drug consumption supplies. Staff were on hand to reverse overdoses should the need arise. But Cota said he was acutely aware of the perception caused by all the medical emergency activity at the center.

“I know there were a lot of ODs here,” he said. “Paramedics were here almost on the daily but, you know, that’s kind of what this was for. Out of all the ODs I know, everyone survived.”

Cota, who does not have housing, said the center provided him with services that were unavailable elsewhere, were located far away or limited access to once or twice a week.

“Here, every day they had food,” Cota said. “If you would take a shower, they’d wash your clothes, and before you go, get out of the shower, your clothes will be ready. Now, I’ll have to figure it out as best as I can.”

This article is part of a series on San Francisco’s overdose crisis and prevention efforts, underwritten by a California Health Equity Fellowship grant from the Annenberg Center for Health Journalism at the University of Southern California.

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It’s been four months since a viral video exposed the violent court-ordered removal of two Santa Cruz children from their father’s family home. The disturbing scene prompted protests on courthouse steps demanding “justice for Maya and Sebastian” and “free Maya and Sebastian,” as well as calls for action by local elected officials. But the children have yet to return.

Maya, 15, and Sebastian, 11, told a family court therapist that they were being sexually abused by their mother. They were removed from their father’s custody in October after their family court judge ruled that the children were lying and that their father was the actual child abuser because he manipulated them into making the false allegations. The judge also ordered the children into a program that would convince them to recant their allegations and reunite with their mother. Their father, Justin Laing, is unable to comment due to a gag order.

Disbelieving a child’s allegation of abuse based on the notion that the other parent brainwashed them into lying is a hotly debated legal tactic called parental alienation.

A growing chorus of international media coverage, medical groups and judicial bodies are expressing doubts over the validity of this legal defense tactic and of its practitioners.

It appears to let many abusers off the hook, according to Joan Meier, a professor of clinical law and director of the National Family Violence Law Center at the George Washington University Law School. She pointed to a 2004 study indicating that between 50% and 73% of child sexual abuse allegations during custody litigation are considered likely valid by custody evaluators and child welfare personnel. But courts on average find only 2% of child abuse claims valid.

“So, you can see by this comparison that it is extremely likely that many, many sexually abused children are being sent to their sexual abuser by courts,” Meier said. 

Despite the controversy, family courts routinely rely on parental alienation testimony.  

Survivor turns advocate

Twenty-year-old Ally Toyos — who recently changed her name from Cable — said years of abuse were added to her life when parental alienation proponent Robert Evans testified that she and her sister had been brainwashed into lying about their father’s alleged sexual, physical and emotional abuse. She was 13 and her sister was 11 when they first made the allegations of abuse.

“He actually called in to testify from Florida,” Toyos said. “And I had never met him. My mom had never met him.”

The judge determined that her mother’s brainwashing constituted psychological abuse. So, three years after they made their initial allegations, the girls were placed in their father’s custody where Toyos said his abuse persisted until they were able to leave when they each turned 18.

Today, Toyos belongs to a Bay Area organization called Center for Judicial Excellence, which fights harmful family court decisions. As previously reported in the Public Press, the group’s efforts to mandate education for judges and court personnel to better assess allegations of child abuse have been unsuccessful so far, thanks in part to resistance from the California Judicial Council, which represents judges and other judiciary branch staff.

Dubious origins

Parental alienation was conceived in the mid-1980s by Richard Gardner, an unpaid, part-time clinical professor of child psychiatry at Columbia University. He claimed without evidence that vindictive mothers psychologically abuse their children by brainwashing them into lying in 90% of cases where fathers are accused of sexual abuse. He diagnosed it as a psychological syndrome — a finding that never made it into the Diagnostic and Statistical Manual of Mental Disorders and was roundly rejected by the psychiatric community. Nevertheless, Gardner was a prolific expert witness in child custody cases, testifying in roughly 400 cases in 25 states — the vast majority of which advocated putting children in the custody of the parent that they claimed abused them.

A 1996 American Academy of Child and Adolescent Psychiatry journal article stated that Gardner’s book, “Protocols for the Sex-Abuse Evaluation,” was “a recipe for finding allegations of sexual abuse false, under the guise of clinical and scientific objectivity. One suspects it will be a bestseller among defence attorneys.”

Legal approach in dispute

Toronto-based lawyer Brian Ludmer regularly relies on parental alienation theory in his law practice in Canada and is called upon to act as a strategic advisor on parental alienation in cases across North America. When a child abuse accusation arises, he files a counter claim on his client’s behalf and brings in parental alienation experts to testify that the accusations are due to the other parent’s psychological abuse and manipulation of their child. He said he’s never had a client whose child abuse allegations were “substantiated as true.”

He said he believes that parents routinely psychologically abuse children by manipulating them into making false allegations of abuse. But the prevalence of sexual abuse within the family unit is another matter.

“This is so rare,” he said. “How many are so sick that they would abuse their own children rather than somebody else’s children, right? Because genetically, we have a protective instinct for own children.”

But U.S. Department of Justice data shows that half of predators committing sexual assault against kids younger than 6 are family members.

Los Angeles-based child forensic psychiatrist Catherine Barrett said focusing on the child rather than the alleged sexual abuser plays into the hands of abusive parents who claim parental alienation as a distraction to derail proceedings.

“We have a child that has been abused that has now become a pawn of the courts,” Barrett said.

Studies sow doubt

Several international studies have also generated significant uncertainty around the theory. One recent study disputed the idea that bad-mouthing one parent promotes alienation toward the other at all. In fact, it will probably backfire against the disparaging parent. The study revealed that when alienation does occur, it’s more likely due to upsetting behavior by the rejected parent like substance use, uncontrolled mental illness and child abuse.

The theory’s validity is also undermined by being unequally applied between men and women. Meier’s 2019 study revealed that when a mother alleges child abuse and the father counter claims parental alienation, the chances of her losing custody virtually doubles. When fathers allege that mothers are abusive, they are not dismissed as readily when mothers counter claim alienation.

The United Nations Human Rights Office of the High Commissioner has taken notice of this and is investigating the trend. The office announced a call for feedback by Dec. 15, 2022, on custody cases involving violence against women and children with a special focus on parental alienation.

Read the three other articles and listen to the “Civic” podcasts associated with this series:

Part one: “Coercive Control Victims Face Skeptical Judges, Court Transcripts Show”

Part two: “When Judges Dismiss Claims of Domestic Abuse, Children Can Die”

Part four: “Children’s Violent Removal From Santa Cruz Home Raises Calls to End Reunification Camps”

CORRECTION 2/24/23: Ally Toyos was 13 and her sister was 11 when they first alleged that their father had abused them. This story has been updated to clarify the timing of that event. Three years later, he was granted full custody of the girls until they became adults at 18.

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Against this backdrop and with extreme weather events on the rise, physician-researchers like Dr. Andrew Chang, an attending physician specializing in cardiology at the Veterans Affairs Palo Alto Health Care System and postdoctoral research fellow at the Stanford Cardiovascular Institute, are investigating how the biological mechanisms of aging and a warming world will affect the health of older adults.

In 2022, Chang and his colleagues examined medical literature to study the intricate and nuanced ways that climate change-fueled disasters and other environmental factors influence the cardiovascular health of older people. They summarized their findings in the journal Current Cardiology Reports. In an interview with the San Francisco Public Press, Chang shared some of the concerns expressed by older patients during environmental disasters like wildfires, and explained the challenges researchers often face while gathering data on this subject.

Below are excerpts from the interview, which have been edited for length and clarity.

What was the motivation for you and your colleagues to embark on researching the health impacts of climate change specifically on older adults?

In the immediate phase, the group of people who most suffers from the effects of climate change are our older adults and some of our senior citizens, and the reason for that is sort of twofold. First is, there are pretty unique biological changes that happen to the human body with aging, which actually increase the susceptibility to environmental factors. And the second thing is, there are social factors as well which make older adults less resilient against some of these events. So not surprisingly, if you look at the casualty rates from both natural disasters, as well as long-term exposures to things like air pollution, disproportionately, it is older adults who are dying from some of these conditions or developing conditions or suffering from the effects of these things. I think, very quickly, it became clear to us that the study of climate change’s effects on human health disproportionately involves the health of our older adults.

Wildfires are an ongoing concern here in the Bay Area as well as across the state. And your article explored the relationships between climate change and wildfires and cardiovascular risk for older people. Could you explain how they are linked?

The biggest thing is that older adults don’t have the same barrier functions that younger adults and younger people do. And what I mean by that is that most of the injury that happens from wildfire smoke is from inhalation. So, you breathe in particles, and particulate matter we know is highly inflammatory, and it enters your body. It enters the circulation through the tiny blood vessels called capillaries that are inside of your lungs. Older adults don’t have barrier functions at those blood vessels that are as robust as younger adults. So, you kind of have more of a leaky effect, where more of those toxins are absorbed. And then they enter into the bloodstream. 

Now, not only are more toxins coming in, there’s underlying susceptibility. There’s just the normal process of aging that causes us to have reduced lung capacity. If you imagine that we’re already starting out with reduced lung capacity as an older adult, then losing even more of that is more dangerous. Similarly, just due to normal aging processes, the heart muscle becomes stiffer, the arteries are less elastic. So, any of these toxic effects basically become magnified. 

And then on top of all of that, of course, older adults are more likely to have preexisting cardiopulmonary diseases — things like heart failure or high blood pressure or diabetes — and all of those things work additively or multiplicatively in terms of your injury from air pollution exposure.

Were there any other particularly startling or surprising findings that you came across as you were doing this research?

I was really surprised how so many of the deaths that are attributable to heat waves or heat events were actually cardiac rather than things coded as heat stroke or heat exhaustion. Because, I guess in my head, it had seemed that the actual exposure to the heat itself was probably going to be the biggest determinant of injury. As a clinical cardiologist, it kind of reinforced to me that heat-related injury for older adults is a cardiac problem.

Were there any challenges that you and your team experienced as you were working on this paper? Did you run into any hurdles in finding data about how climate change will affect the elderly population?

The paper that you’re referencing is … our synthesis of what the entirety of the literature looks like. In terms of data, our group also does a lot of primary research using primary sources of data. In general, in those situations, there are some challenges. One of them is that a lot of exposures tend to be gradual, over long periods of time. Things like air pollution, for example, we know climate change makes air pollution worse. But everyone experiences some amount of air pollution at baseline. So, there’s a challenge of studying something that’s sort of insidious, and occurring over a long period of time, in terms of things like air pollution. 

On the flip side, studying things like wildfires or extreme heat events, which are very intense, very short exposures. Part of that is also challenging because it’s hard to gather data in the moment. When there is a natural disaster, say like a wildfire, the priority on the ground really is to evacuate people. It’s to make sure that they’re being safe, that they’re being cared for. And a lot of research ends up happening retrospectively, trying to kind of go back and cobble together what exactly happened. So, you start to lose some of that individual granularity. 

You can gather much more granular data. For example, some of my colleagues are putting air sensors in people’s homes and looking forward to future wildfire seasons to see how much does that impact their health outcomes. The challenge on that side is also that’s very granular data that tends to be kind of hard and expensive to do on a large scale. 

And are you currently doing any research?

I’ll speak more generally, just because these studies are ongoing. But some of the questions that we’re interested in generally are: What were the effects of specific wildfire seasons on emergency room visits? Did emergency room visits for certain types of conditions — say, asthma attacks, heart attacks, strokes — change before and after specific wildfire events? 

Other things we’re looking at are things like subclinical markers. What I mean by subclinical markers is: Is there an early detection system for injuries to the organs from these insidious, prolonged exposures? To give you an example, I look at ultrasound data of the heart in older adults — people over 65 — to look at over the course of five years or so of air pollution exposure. Are there subtle findings like subtle changes that happen to the way the heart moves? The way the heart muscle moves that may mean worse things are down the line? Can we identify these things early on? Can we identify people who are at risk for worse things like heart failure down the line from air pollution exposure? So that’s another thing that I’m interested in. 

In your clinical practice here in the Bay Area, do conversations about climate change come up with your older patients who have cardiovascular diseases?

The climate change issue that I field the most questions about are usually during wildfire seasons. I think part of that has to do with the visibility of it. When it looks like “Blade Runner” outside, the skies look pretty apocalyptic. I think it’s pretty clear to everybody: If you’ve ever tried to go jogging during a bad air quality day, it’s quite apparent that your heart and lungs are not happy with what’s going on. And I have to say most of our patients are also aware of that. I think that’s less of a thought during the extreme heat, because most people don’t immediately connect extreme heat events with heart disease, but I will definitely say I get a lot of questions from patients during wildfire season asking: What does this mean for me? What are the dangers to me? And most importantly, what should I do?

How can healthcare professionals help older people understand the risks of climate change?

We do know that unfortunately, older adults are less mobile and less able to evacuate in times of climate crises. I think one of the saddest statistics I’ve ever heard is that during Hurricane Katrina, over half of the people who died were over the age of 75. That really speaks to the fact that emergency planning has to be done in advance for older adults.  

I know a few of the environmental agencies do in general recommend that people at higher risk for harm from these situations have a disaster response plan. And having these types of disaster management plans is something that we can and should be talking about with our patients, particularly those who live in parts of the country with seasonal emergencies like hurricanes or wildfires or extreme heat waves. I think, as of now, that’s probably something that we as clinicians should be talking about with our older and vulnerable patients that we probably aren’t doing.

While older adults overall are vulnerable to climate change threats, your paper mentioned how those experiencing poverty and structural racism are at greater risk. Could you say more about this?

People who are at a lower socioeconomic status are almost always at higher risk. Part of that has to do with the fact that a lot of current solutions that have to deal with these things involve money, things like air conditioning for heat, and the fact that people who have money and means are more likely to afford higher quality care, so they are less likely to have developed some of these risk factors even if they are the same age as somebody who may be poor. 

In terms of racial, ethnic breakdowns, we’re increasingly recognizing that certain policies, for example, redlining, have marginalized certain groups of people such as African Americans to unfortunately live in parts of cities and communities that may be exposed to higher rates of air pollution — for example, near highways or industrial areas. And as you can imagine, having a higher baseline underlying rate of air pollution exposure means you’re more likely to be injured when there’s a spike in it from something like a wildfire. 

Anything else you wish to add?

I think, moving forward, we shouldn’t take a paternalistic attitude. There are a lot of things that older adults can also offer in the fight against both climate change and climate change-mediated disasters. There’s a certain resilience that you gain from life experiences. 

Also, older adults, a lot of them have this transgenerational thinking, this ability to imagine and advocate for a world for future generations — for their children, for their grandchildren, for their great grandchildren. That, I think, is really powerful. And in many societies, like First Nations societies, elders are quite respected and are important decision makers. Anything that we do in terms of policy, we need to make sure that older adults are equal partners in the decision making, and that we try to leverage their specialized skill sets or their strengths or their worldviews in order to craft our responses to these things, because we’d be surprised at a lot of the strength and resilience that we’ll find from our elders.

This Q&A, the first in a series of stories on the health impacts of climate change on older adults, was produced with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Archstone Foundation.

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On average in the U.S., more than 1 in 3 women, and 1 in 4 men, will experience physical violence, rape or stalking by an intimate partner, according to the National Domestic Violence Hotline. Nevertheless, when victims turn to family court for protection from their abusers, they often face skeptical judges. And that’s especially true when the abuse doesn’t leave a mark.

That’s what San Francisco Public Press reporter Viji Sundaram found through her reporting on a new movement to protect victims of what experts call coercive control. (See: “Coercive Control: Abuse That Leaves No Marks.”)

“He kept telling her, ‘How can I believe this?’” Sundaram said of one judge’s reaction to a victim’s request for a temporary restraining order to keep her partner away from her. “Just because a woman is staying within an abusive situation, it doesn’t mean she is not abused. And that is what the judge did not seem to understand.”

In San Francisco, the Department on the Status of Women reported in 2019 that crisis hotlines and 911 got more than 15,700 domestic violence-related calls over the previous year. 

And it only got worse during the pandemic. Lockdowns limited victims’ ability to safely contact the outside world for help. The isolation increases the opportunity for abuse, aggression and coercion. 

A study by the National Commission on COVID-19 and criminal justice shows that domestic violence cases in the U.S. increased by over 8% following lockdown orders in 2020.

That spike also hit San Francisco, according to an organization that assists domestic abuse survivors called Women Organized to Make Abuse Nonexistent, or W.O.M.A.N. Inc. The group reported that in 2020, its San Francisco crisis hotline got 11,000 calls and its Domestic Violence Information Referral Center website had 125,000 hits.

At a San Francisco Board of Supervisors public hearing in May 2020, Beverly Upton, the San Francisco Domestic Violence Consortium director, described the escalating problem of domestic violence in the early days of the pandemic lockdown in March 2020: “The first couple of weeks, we saw W.O.M.A.N. Inc’s numbers alone go up 130%,” Upton said. “So that was, you know, quite alarming.” 

The form of domestic abuse called coercive control can be harder to detect than physical violence. Behaviors like isolating a spouse from friends and family, depriving them of basic needs, spying on them, sexual coercion, intimidation, repeatedly degrading and humiliating them — these are all examples of coercive control. 

But the lack of physical evidence often pushes domestic abuse into a gray zone that even survivors sometimes fail to grasp, according to Sundaram.

“In fact, one woman told me when I was going to interview her, ‘You know, I wish he had hit me. Then I would have had a good reason to leave him,’” Sundaram said.

Coercive control is no less ruinous for victims than physical violence, according to Evan Stark, the man who pioneered the concept. A sociologist, forensic social worker and award-winning author of “Coercive Control: The Entrapment of Women in Personal Life,” Stark said his research found that around 25% of abusive relationships involve violence that’s either nonexistent or below the radar — meaning they don’t result in serious injury or hospitalization. But abuse that does exist is equally harmful.

Stark’s work focuses on the cumulative effects of this treatment: “What I call the death by 1,000 cuts — the push and shove, the grab, something that wouldn’t impress a judge, wouldn’t impress a police officer, but whose cumulative weight was such that it could lead to a feeling of being imprisoned.”

Despite such research, according to the domestic violence and sexual assault prevention organization No More, 65% of domestic abuse survivors who come forward report no one helping them when they do. They report that law enforcement treats domestic abuse as a “domestic dispute” rather than an act of escalating violence.

In January 2020, California Gov. Gavin Newsom signed a law that integrated coercive control into the state’s Domestic Violence Prevention Act. Senate Bill 1141 expanded the Family Code to allow the abusive behavior to be used as evidence in family court hearings. It was meant to empower survivors trying to protect themselves and their children during appeals for restraining orders and child custody. But getting family court judges to embrace the new legislation has been slow going.

A 2019 study by Joan Meier, a law professor and director of the National Family Law Violence Center at George Washington University, shows an apparent “systemic gender bias against women” in U.S. family courts. Her study found that women often grapple with the high cost of legal help and are penalized by courts that favor fathers. 

One woman using the name Sarah to protect herself from her abusive ex-spouse and father of her two children said she’s been fighting that bias in court for two years.

During her 10-year relationship, Sarah was subjected to threats of violence, absolute control over every aspect of her life, and destruction of property during bursts of rage. Three incidents that involved police even led to the temporary confiscation of his firearms. Their children also endured his volatile need for control. In one incident he physically overpowered their 4-year-old son, pinning him down to a bed by his neck.

Sarah applied for a restraining order in family court. As court transcripts show, the judge said he didn’t believe her testimony.

“The court finds that there are credibility issues that causes the court to doubt as to whether or not abuse as defined by the Domestic Violence Prevention Act has occurred,” the judge said. “The court will deny the request for a domestic violence restraining order.”

The ruling left Sarah dumbfounded.

“Even though, you know, I’ve never damaged property, cell phones, laptops, doors, etc., the judge just found me not credible, which I thought was shocking,” Sarah said. “And it was almost as if he didn’t care. He really didn’t care to look at the facts. He didn’t care to look at the history.”

The post Coercive Control Victims Face Skeptical Judges, Court Transcripts Show appeared first on San Francisco Public Press.

Foghorns sounding on the Golden Gate Bridge signal that San Francisco’s “natural air conditioning” is rolling in, keeping San Francisco cool. During summer, the fog prevents triple-digit heat in the East Bay from roasting the city’s homes and businesses.

That pattern is changing. Since the 1970s, San Francisco’s average temperature has increased by 2 degrees Fahrenheit. Now, city leaders are developing new strategies to keep people safe, with infrastructure designed for much cooler weather. The question is whether San Francisco is ready for the next deadly heat wave.

During the summer, chilly waters off the Northern California coast create a cool marine layer that is pulled inland like a blanket by the warmer air in the East Bay. On the other side of that weather pattern, an upper ridge of high pressure usually indicates where temperatures will be hottest.

On Labor Day 2017, the cool marine layer never reached San Francisco, and temperatures predicted to be in the upper 80s, soared to a record-breaking 106.

National Weather Service Meteorologist Brian Garcia said his agency didn’t see it coming — prediction models were off.

“It looked like the peak of that ridge was going to set up over the East Bay,” he said. “We were looking at temperatures upwards of 115 for Livermore.”

The ridge ended up 30 miles to the west — right on top of San Francisco. Any possible ocean breezes were blocked by a wall of high-pressure air.

The extreme heat took the lives of three elderly San Franciscans and three more people on the Peninsula. Most died alone in overheated buildings. None of them had called 911. Dozens of other people in San Francisco were taken to hospitals with serious heat-related illnesses, overwhelming local emergency medical services.

Threat Starts at Lower Temperature in SF

Most San Franciscans live without air conditioning. The 2020 Census found that in the metro area that includes San Francisco, Oakland and Berkeley, only 47% of households had air conditioning. That percentage is certainly lower in San Francisco, which is typically cooler than the East Bay. 

Adrienne Bechelli, deputy director of San Francisco’s Department of Emergency Management, said people in the city are at higher risk with even moderate heat.

“Our thresholds in San Francisco are much lower than in other comparable cities nationwide, or even in other neighboring counties, because a lot of homes don’t have air conditioning in our work or commercial spaces,” she said. “So, our spectrum starts with pre-planning — depending on the incident — in the high 70s, but usually low 80s.”

Bechelli said setting heat protocols in motion starts with the forecast.

“A couple of days out, when we get that spot report from the National Weather Service, we will hold various levels of meetings with our key city partners, as well as other community stakeholders,” she said. “That would include policy-level meetings, as well as operational coordination meetings.”

Agencies participating in such meetings include the Department of Public Health, the Human Services Agency, the Department of Homelessness and Supportive Housing and the Recreation and Parks Department, as well as the police, fire and sheriff’s departments. Elected leaders and representatives from the San Francisco Municipal Transportation Agency and the San Francisco Unified School District would also take part.

While the Department of Emergency Management coordinates the effort, no one person in San Francisco makes the decision as to which level of response is appropriate.

On average, San Francisco has three days a year over 90 degrees. By comparison, San Jose sees 16.

San Jose Deputy City Manager Kip Harkness is the person who makes decisions about heat emergencies when San Jose’s Emergency Operations Center is activated during an extended heat wave.

“We believe that it’s important to have the authority to act at the appropriate and lowest level possible,” he said.

In most situations, San Jose agencies independently decide to do things like open cooling centers, Harkness said.

“Now, it’s just standard protocol,” he said. “If it got longer or larger, we’d pull everybody together. And we’d work through what additional resources were needed to support the people in the field.”

San Francisco’s response system can’t be set in motion by one official, Bechelli said.

“We do so much pre-planning, where we have all of these specific thresholds and triggers where all the city departments responsible during extreme heat know what that threshold or trigger is,” she said. “The Department of Emergency Management holds that authority to ask other city departments to activate their extreme heat operations protocols at a lower threshold.”

Keeping Track of Heat

When San Francisco officials found themselves scrambling on Labor Day in 2017 to deal with an unexpected, deadly heatwave, many were asking why the forecast was off by 20 degrees.

Garcia, the National Weather Service meteorologist, said the problem was one of scale.

“When we look at models, typically they are in 3-kilometer, 12-kilometer or larger grid boxes,” he said. “And around here, in 3 kilometers, you can go from sea level to 5,000 feet up Mount Tam, and it’s a completely different climate regime.”

Garcia said the system has improved over the last five years, and now the models are based less on a precise forecast and more on probabilities.

“So, instead of saying, hey, it’s going to be 85 degrees in the city, we’ll be able to say the probability of it being 85 degrees in the city is 90%. The probability of it being 105 in the city is 5%,” he said.

Since 2017, the National Weather Service office in Monterey has been reaching out proactively to local municipalities as soon as it sees the threat of rising heat.

Cooling Near You

In the past, San Francisco would open cooling centers and encourage people to travel to them to get out of the heat. That proved a challenge for some seniors, disabled people and families who had to leave their neighborhoods to find a place to cool down. 

Bechelli said the city now offers three categories of weather relief centers.

“The first are overall public locations, things like shopping malls, museums, local parks, local swimming pools, locations that are accessible year-round to the public,” she said. The second category includes city-operated facilities, such as libraries and community buildings. The third category includes sites that people use in their neighborhoods, such as YMCAs, senior and community centers and homeless shelters. The Department of Emergency Management coordinates with all those groups and tries to get the word out to people who need to use them.

When heat and wildfire smoke came to the city during the COVID-19 pandemic, some people avoided leaving hot houses to go to weather relief centers. Bechelli said that fears about COVID-19 and smoke could put people with underlying health risks in serious danger.

“Extreme heat is much more serious than extreme smoke for most people,” she said.

That’s also true when sheltering at home. Opening a window to bring in cooler, but smoky air is less dangerous than being shut up in a hot room for long periods of time.

Bechelli said she is confident the city is focused on managing increasing numbers of heat waves as the climate warms.

“As emergency managers, we do everything in our power to try to stay out ahead of the hazards that impact our communities,” she said. “We always have areas for improvement, we always are looking for specific corrective actions that we can implement to make our citywide response even better. But I definitely feel confident that we are better established to respond to an extreme heat event now than we were in 2017.”

Heat Safety How to stay safe in the heat: Stay somewhere cool Drink plenty of water Wear light clothing and hats Take a shower Close blinds during the day, open blinds at night Avoid: • Being outside between 10 a.m. and 4 p.m. (when it is the hottest) • Strenuous activity • Eating or drinking sugar, alcohol, caffeine and high-protein foods Drink water and cool down right away if you: Feel tired, weak or dizzy Have a headache or muscle cramps Are sweating heavily Faint Look pale You may be experiencing heat exhaustion, which can become heat stroke if not addressed promptly. Get immediate medical attention if someone: Has difficulty breathing, a headache or nausea Has a fever (body temperature of 103 F or higher) Has red, hot, dry skin without sweating Is confused, delirious or hallucinating Is dizzy, unconscious or unresponsive They may be experiencing heat stroke, which can be deadly. Call 911 if someone is having a medical emergency. From SF72.org

The post Cool San Francisco Could Get Walloped by Next Heat Wave, but City Says It’s Ready appeared first on San Francisco Public Press.

UPDATE 7/29/2022 — The federal government has agreed to allow Laguna Honda Hospital to stop discharging and transferring all patients out of its facility, according to a statement issued by Mayor London Breed on July 28. The announcement came two days after the San Francisco Board of Supervisors unanimously approved a resolution urging the U.S. secretary of Health and Human Services to suspend an order by the Centers for Medicare and Medicaid Services to move all patients out of the hospital. A separate resolution asked Gov. Gavin Newsom and the state health director to stop the transfers. Both resolutions expressed concern that relocating vulnerable patients would cause harm. Federal regulators had previously said they would require Laguna Honda administrators to relocate all patients before they would allow the hospital to apply for recertification needed to receive continued federal funding. Four of the patients recently transferred from Laguna Honda Hospital died soon after being displaced.

Administrators are overhauling policies and procedures to regain federal funding that is set to expire following the issuance of multiple damning inspection reports at Laguna Honda Hospital. They have until Sept. 13 to implement changes, which include a requirement to transfer or discharge all patients, before they can apply for recertification from the Centers for Medicare and Medicaid Services — which has the authority to restore funding for patient services. But administrators say they’re struggling to fulfill the centers’ mandate to move out all patients by the looming deadline.

Laguna Honda has room to house more than 700 patients (although as of July 18, occupancy is at 613) and accounts for 34% of all skilled nursing facility beds available in San Francisco. And the hospital’s interim CEO, Roland Pickens, said finding other suitable beds, ones that come with the same level of medical care, has proven to be a near-impossible task. Part of the challenge is finding beds for two distinct populations: those who are typically older and need high-level nursing home care, and those who are not usually elderly but require long-term treatment for psychiatric needs, behavioral disorders and substance abuse problems.

San Francisco’s health department created an online dashboard to show the progress of patient transfers. It shows that Laguna Honda staff are making about 1,500 calls a week searching for open beds. According to the dashboard, as of July 18, 40 patients have been transferred to skilled nursing facilities, and 16 were discharged, three of them to homeless shelters.

The requirement that Laguna Honda move out all patients before seeking recertification is leading some to foresee disaster for patients, their families and for a city already beset by homelessness.

“There’s no way — it’s unthinkable to try to relocate over 700 residents,” said Valoria Russell-Benson, who has worked as a nurse at Laguna Honda for 27 years. “A relocation or to close down Laguna Honda would end up in homelessness for a lot of our residents.”

The Centers for Medicare and Medicaid Services declined an interview request, but in an unsigned statement, wrote that ending a Medicare and Medicaid provider agreement was a last resort. The agency has agreed to continue funding patient care until Sept. 13 as the hospital works toward recertification.

Two consulting firms — Health Management Associates and the Health Services Advisory Group — are helping by conducting mock inspections, according to Dr. Derek Kerr, who worked at the hospital for 10 years. Following his involvement in a successful whistleblower case against the hospital, he became an investigative reporter for the Westside Observer — an online news publication covering San Francisco’s western neighborhoods — and has inside knowledge on activities at Laguna Honda. And full disclosure, he has also donated to the Public Press.

Kerr said the first mock inspection happened in June, and Laguna Honda is correcting deficiencies identified then. San Francisco General Hospital Quality Management staffers have been brought in as well, along with more nurses and more sheriff’s patrols, safety searches and visitor screenings. And narcotic analyzers will check patients when they return to the hospital after brief, permitted excursions.

These measures are meant to address the problem of illicit drug use in the hospital and the presence of contraband among patients. Kerr contends that these problems arose when the Department of Public Health made admissions policy changes in 2004 and introduced a younger population of men — some of them with substance abuse issues.

He said the elderly patients who formerly made up most of the hospital’s population cannot thrive in a “fortified institution” with drug scans, increased police presence and nurses searching patients for contraband.

“Those kinds of constraints are diametrically opposed to what nursing home care should be for elderly patients. They need a completely different model,” he said. “The risk is that you transform the hospital into a carceral complex in order to manage an antisocial subset. So that’s the problem. It might deform the hospital.”

According to a report presented by Pickens, Laguna Honda’s interim CEO, at a San Francisco Health Commission meeting July 19, a second mock survey will occur in August, and in September, the hospital will apply for recertification. If Laguna Honda passes an initial inspection, the Centers for Medicare and Medicaid Services will return 90 to 120 days later for a final review. If it passes that test, Laguna Honda could be in the clear by January 2023.

The post Laguna Honda Hospital Has to Self-Destruct to Survive appeared first on San Francisco Public Press.

More than one month after statewide eviction protections expired on June 30, less than 4% of rent relief funds requested by San Francisco households remain unprocessed, with 55% of funds paid out. 

Over 20,600 San Francisco households had asked for almost $340 million in rent and utility assistance from both state and local COVID-19 rent relief programs as of the week of July 11, government figures show. The amount requested declined 9% between April 11 and July 11 as the state continued to weed out ineligible applications. The state stopped accepting applications on March 31, more than a year after it opened a financial aid program to cover housing debt incurred by tenants due to pandemic hardship. 

Households whose applications have been approved can stay an eviction even if they have not received payment yet; however, those with applications under review or pending applicant information — a category that applies to 1,154 applicants in San Francisco — are vulnerable to eviction.  

California passed legislation to ensure all eligible households who applied by the March 31 deadline will receive funding. Recent budget proposals would earmark additional money for rent relief. 

The following figures include San Francisco residents’ requests from California’s COVID-19 Rent Relief Program and San Francisco’s original Emergency Rental Assistance Program, which stopped taking applications in September 2021. It does not include requests from the city’s newest rent relief program, which began accepting applications April 1. 

Over $140 million in rent and utilities requested from the state program by San Franciscans had been denied as of the week of July 11. Almost 1,000 San Francisco applicants appealed their denials. 

On July 7, an Alameda County Superior Court judge barred the state from denying any more pending applications or any appeals of denials that occurred in the previous 30 days until a hearing is held to determine if applicants’ rights to due process were violated in the application review process. 

In 2021, California received $5.2 billion for emergency rental assistance funds from the federal government. The state has since acquired nearly one out of every three dollars of federal reallocations of unused funds from other states, for a total of $198 million.  

Tenants who had previously applied to the program and were awaiting rent relief were protected from eviction through June 30 for rent due between April 2020 and April 2022 under AB 2179. Under the same bill, local eviction protections passed unanimously by the Board of Supervisors in March were voided until July 1, but have since taken effect.  

In response to the state’s move to cease accepting applications, the city reopened its own rent relief program for tenants who are seeking funds for rent debt accumulated in April and beyond. So far, it has distributed close to $4.3 million in funds to 713 of the 4,415 households that have applied, and residents who need help are encouraged to apply. 

In its previous rent relief program, San Francisco assisted over 3,200 applicants with $22.8 million in relief. An additional $243,878 in requests from 53 households are yet to be processed. 

The statewide eviction moratorium, protecting tenants who could not pay rent because of COVID-19 hardship, was originally scheduled to end Jan. 31, 2021, but lawmakers extended it twice. Following the moratorium’s final end date, Sept. 30, San Francisco tenants became vulnerable to eviction for nonpayment of rent if they had not paid at least 25% of the rents due in the preceding 13 months, as well as October’s rent. 

However, California lawmakers did create some protections for renters who were unable to pay back rent after the moratorium expired. Tenants who applied to the state’s rent relief program before the deadline and were waiting on relief were protected from eviction through March 2022. State lawmakers in late March extended those protections through June 30. 

Even though they may have been barred from evicting some tenants, starting in November 2021, landlords could sue tenants to obtain unpaid rent that was due from March 2020 through September 2021. If a landlord pursues the debt in small claims court, they and the tenant must represent themselves in the courtroom. 

Are you facing eviction? Call the Eviction Defense Collaborative at (415) 659-9184 or send an email to legal@evictiondefense.org as soon as possible. The organization advises that tenants respond within five days of being served with court papers to avoid the risk of a default judgment against them.

Is your landlord suing you to recover pandemic rent debt? Go here to read our guide on how small claims court works, and how to argue your side of the case.

The post San Francisco Rent Relief Tracker appeared first on San Francisco Public Press.

Nearly 700 live-in patients at Laguna Honda Hospital were thrown into chaos this spring after a series of damning inspections led the Centers for Medicare and Medicaid Services to pull funding and mandate a closure plan for the facility.

It’s a dire situation for residents of the skilled nursing facility who have specialized needs that make them hard to place elsewhere. Hospital administrators are scrambling to attain the recertification needed to continue to receive federal funding.

Two former Laguna Honda physicians say they have continued to warn city officials about this looming crisis after first flagging it 18 years ago. That’s when a Department of Public Health policy began admitting to Laguna Honda patients whose needs fell outside the scope of a typical nursing home for the elderly.

“This shutdown was predictable,” former Laguna Honda physician Dr. Teresa Palmer said at a San Francisco Board of Supervisors hearing on June 14. “Normally, a nursing home is filled with primarily women over 85. And now you have a nursing home, with predominantly men from 40 to 60. The city needs to provide funding and a place for people with substance use problems and conduct disorders.”

The path to decertification began in July 2021 when two patients nonfatally overdosed on fentanyl and methamphetamine. That instigated an inspection by the California Public Health Department. In documents obtained by the Public Press, the Centers for Medicare and Medicaid Services reported that the inspection revealed 13 of 37 sampled patients tested positive for illicit drugs, and 23 of those patients had contraband items, including drugs, syringes and other drug paraphernalia.

Hospital officials were given until April 14 to resolve all its violations while regulators continued to conduct periodic inspections. Follow-up surveys exposed other serious breaches. Among them was an incident in which a patient smoked fentanyl during a psychiatric appointment. And hospital staffers admitted that they were unable to control illicit drug use among patients. Regulators declared a state of immediate jeopardy in March. In April, the hospital resolved problems with drugs and contraband, but inspectors discovered other problems around hygiene. That led the federal centers to decertify the hospital and announce that it would pull its funding for patient care. Regulators subsequently gave the hospital a four-month cushion with funding to Sept. 13.

The San Francisco Department of Public Health owns and oversees Laguna Honda, and the city contributed $33 million to its $296 million budget last year. But according to its last annual report, about 99% of the hospital’s reimbursements for patient care came from Medicare and Medicaid — aka MediCal, which is covered by a combination of state and federal funds.

The city cannot cover the $15 million a month in federal money used to run the facility, but it is spending $5.6 million on two consultants with expertise in Centers for Medicare and Medicaid Services procedures to resolve the issues before applying for recertification and a commitment to continue funding past their September deadline.

Palmer, who was a geriatric physician at Laguna Honda from 1989 to 2004, said the current crisis could have been avoided if the city had heeded warnings issued 18 years ago when the Department of Public Health began intervening to change the hospital’s admissions policy.

In 2004, changes to the admissions policy were made in response to a city health department audit that found that some non-acute San Francisco General Hospital patients were in acute-care beds. Because they didn’t need acute care, Medicare didn’t cover their $1,300-per-day payments. The cost was being subsidized by the city at a rate of millions of dollars per year. The Department of Public Health corrected this mismanagement by transferring patients who didn’t require acute care to Laguna Honda. Among those patients were people with long term psychiatric needs, behavioral disorders, and substance abuse problems.

It was a practice called the “flow project,” according to Dr. Derek Kerr, who worked at the hospital for 10 years until he was fired in 2010 for blowing the whistle on an unrelated financial mismanagement case. He won a subsequent lawsuit for his improper dismissal and became an investigative reporter for the Westside Observer, a San Francisco news outlet. He takes a special interest in Laguna Honda. And full disclosure, he has also donated to the Public Press.

Kerr said that prior to the 2004 flow project, Laguna Honda had an admissions committee that would screen out patients “who are violent, who set fires, who were using drugs.” When the Department of Public Health took over those responsibilities, patients were admitted “regardless of behavioral issues,” he said. Staff was not equipped to care for patients with serious, long term psychiatric needs.

“So, that led to an upsurge in violence and drug use and intimidation,” Kerr said.

Ensuing complaints drew the attention of the state Occupational Safety and Health Administration and other regulatory agencies, he said, as well as protests by the medical staff, and a lawsuit was filed against the Department of Public Health. Then, in 2006, residents and former physicians proposed a ballot measure that would have prohibited admitting people with psychiatric or behavioral diagnoses, people who posed a threat to themselves or others, and people who needed short-term care. Opponents said the legislation was overly broad, and would have had unintended consequences, including discharging potentially hundreds of patients who badly needed treatment. Voters did not support the ballot measure. Nevertheless, new security and safety measures were adopted, and the flow project was officially reversed, but, Kerr said, patient admission practices didn’t change.

The Department of Public Health declined an interview request but emailed an unsigned statement that “the hospital takes all findings from or [sic] regulators very seriously and we are making immediate improvements to address concerns.”

During the June 14 Board of Supervisors meeting, newly appointed Laguna Honda CEO Roland Pickens said officials plan to address problems related to changing patient population by separating patients into two towers according to their health care needs. He said this would “minimize regulatory noncompliance as it relates to substance use and behavioral disorders.”

During the hearing, Supervisor Myrna Melgar, who represents Laguna Honda’s district, pushed bank on the notion that a certain segment of the population should not be admitted to the hospital.

“The cure is not to serve a different population,” she said. “It is to come up with systems that deal with a population that we have today. That is who we are, that is our values of San Francisco, that’s who we need to be. And we need to do more of it actually, not less.”

San Francisco is working toward adding hundreds of mental health and addiction treatment beds throughout the city. In the 2022-2023 budget, Mayor London Breed allocated $57.5 million to operate newly acquired behavioral health facilities totaling 360 beds.

Next, we’ll examine the hospital’s efforts to fulfill a Centers for Medicare and Medicaid Services directive of moving all patients out of the facility before applying for recertification in the fall. 

The post Laguna Honda Doctors Warned SF of Looming Crisis appeared first on San Francisco Public Press.