The Desperate Misinformation From Prop. D's Opponents

The Desperate Misinformation From Prop. D's Opponents
by Patrick Monette-Shaw


San Francisco's leading gay and lesbian newspaper's pro-and-con op-ed pieces about Prop. D last week are instructive for all San Franciscans.

Robert Haaland, a political operative on SEIU 790's payroll; Susan Mizner, a lawyer who serves at the pleasure of the Mayor as Executive Director of the Mayor's Office of Disability; and Health Commissioner Jim Illig, who is also a Newsom political appointee, have it completely wrong ["Proposition D: Trojan Horse," Bay Area Reporter, May 25]. Prop. D is not a "trojan horse," and their "con" guest editorial is - in a word - conning readers with misinformation; each author must know this.

Make no mistake: When the Department of Public Health, under Mitch Katz's so-called leadership, issues "estimates," there are many clinicians who do not believe his data, or DPH's "guesses." Readers should follow their lead, and discount both DPH's and SEIU 790's misinformation about Prop. D concerning Laguna Honda Hospital on the June 6 ballot.

When Katz wrote to the Department of Elections on March 2, he "estimated" 300 patients with Alzheimer's, dementia, or AIDS would face discharge due to aggressive behaviors. But Prop. D is not about patients exhibiting "aggression," it's about patients who pose a "danger" to self or others. The two terms are not synonymous; Mizner and Katz, if not Haaland and Illig, must know this. "Aggressive" is clinically quite different from "dangerous." In scientific literature, "aggression" is a catch-all phrase, including behaviors that do not pose danger to others.

Eleven days later, Laguna Honda's Executive Director, John Kanaley, produced an after-the-fact memo to Katz dated March 13, belatedly documenting Katz's "estimates." The data Kanaley presented (available on the http://www.PropositionD.org web site), clearly shows that of the 320 patients identified by LHH's Medical staff as clinically assessed for "aggression," only 23 (7.2%) have AIDS. But Haaland and Illig have chosen to play the "AIDS card," falsely claiming to B.A.R. readers that of the 300 patients facing discharge, "many," or a majority, are AIDS patients. Seven percent is not "many," and certainly not a majority. In fact, 211 (66%) of the 320 Kanaley claimed were aggressive are dementia patients; Prop. D explicitly states that dementia patients will continue to be served at LHH, as they always have. The remainder (131, or 41%) are those with psychiatric disorders who must have a co-existing need for skilled nursing care, or they wouldn't have been admitted; they too, under Prop. D will continue being served at LHH, because Prop. D is not about "aggression," it's about those posing danger, which went unmeasured by LHH's Medical staff.

Moreover, a second assessment performed by LHH's Nursing staff found that only 317 patients displayed "aggressive" behavior. Of those, only 9 AIDS patients (not 23), representing just 2.8% (not 7.2%), were assessed as "aggressive" by Nursing; similarly Nursing found just 154 dementia patients (not 211), representing 48.6% of the Nursing sample (not 66%). A reasonable person has to wonder why there was such a disparity between the Medical staff assessment results and those from Nursing. Were the two disciplines assessing the same patients? And why did both measure "aggression," rather than "dangerousness"?

Importantly, the Alzheimer's Association of Northern California/Northern Nevada has noted that Kanaley omitted from his memo to Katz several important conclusions of an Indiana Alzheimer's study Kanaley had quoted. Rather than Kanaley's claim that aggression occurs in 60% of Alzheimer's patients' home settings, he omitted mentioning the Indiana study found only 5% of Alzheimer's patients had displayed "physically abusive behavior" (which is also not the same as "danger" or "harm"), and that an undocumented, but even smaller, percentage (apparently less than 3%) had caused harm to others.

Therefore, downward adjusting the claim (that 320 LHH residents face discharge, which SEIU and the No-on-D folks have embraced in order to con) from 60% to (at most) 3% would result in only 15 potential discharges, not 320. It is thought that actual harm was less than 1%, which might potentially affect a total of 5 patients, not 320.

Once again, City Controller Ed Harrington appears to be mistaken by a factor of 64. Since Prop. D is not about aggression, but rather "danger," rather than costing $27 million annually (at $84,375 for each of 320 residents), even if Prop. D affected 5 patients who might pose a danger to others, more likely it would cost, at most, $421,875 annually - if it would cost anything at all, since the cost to the City of sending non-ambulatory elderly and disabled patients to out-of-county facilities that is currently occurring has not been released by the City or factored in. And City administrators know this. What was Harrington thinking when he used Katz's $27 million inflated hysteria for the voter guide's "Controller's Statement" based on Kanaley's belated and incorrect 60%-of-Alzheimer's-patients-are-aggressive rate? Can't Harrington or Dr. Katz do basic math?

Another of the City's dirty secrets is that in order to solve a $510,000 problem with discharges from San Francisco General Hospital, the City began budgeting in the current fiscal year an additional $600,000 for increased security personnel at LHH, and another $600,000 for additional psychosocial programs, totaling $1.2 million. In the next fiscal year beginning July 2006, the City is proposing to add another $1.7 million in increased staffing as part of the plan-of-correction to "fix" the problems with recent state citations concerning dangerous and violent patient-on-patient altercations at LHH. That's an on-going $2.9 million cost annually to fix what is either a $421,875 or a $510,000 problem with dangerous admissions to LHH.

Why would 9 of our 11 Board of Supervisors have signed on as supporters of the No-on-D campaign, falsely claiming - as they do in their voter guide argument - that Prop. D will cost $27 million, when at best it would be only $421,875? The Supervsiors are the ones who have approved the on-going annual $2.9 million expenditures for safety-related problems at LHH related to the admission of "dangerous" patients. For all Ed Harrington and the Supervisor's know (and may well have known at the time Harrington wrote the voter guide's Controller's statement), any costs associated with Prop. D may be cost neutral ... and may actually save the City money.

Katz claimed on March 2 that the largest group facing discharge would be Alzheimer's patients, and "AIDS and dementia and/or behavioral problems" patients (not dementia or behavioral patients, but AIDS patients also having either dementia or behavior problems), persons with psychiatric disorders, and those with traumatic brain injuries. However, there is nothing in Kanaley's analysis to Katz 11 days later about patients with traumatic brain injuries, making that claim dubious. For good measure, despite not being in either Katz's letter or Kanaley's memo, the Mayor tossed in Parkinson's patients into the mix, and Haaland tossed in HIV patients for added measure. Even while Haaland decries "misleading facts," the No-on-D committee is doing that themselves.

It's like a bad game of telephone tag, where each person creatively tacks on something new to their misleading con job, in order to frighten and mislead voters. By the end of the telephone tag, misinformation has reached mythic proportions of misinformation. New categories of patients are being added daily to the No-on-D's list of those "facing discharge," completely falsely and unethically, including a new bizarre claim just last week that Prop. D's language actually prohibits (which is patently untrue) admitting people with substance abuse or alcoholism to LHH. Just how low are No-on-D opponents going to sink misleading and conning voters, and unethically alarming residents of LHH? To defeat Prop. D, why are the No-on-D committee succumbing to outright lies?

But it's not just voters being frightened. During a recent Laguna Honda Clarendon Hall resident's council meeting, LHH residents were reportedly told by an LHH administrator that if Prop. D passes, 300 patients face discharge. Employees are required to limit their statements about ballot measures to "accurate, fair, and impartial presentation of relevant facts" and to make a balanced presentation. Employees who work directly with the residents also have an ethical obligation not to use their position to influence or alarm residents. Clarendon Hall residents at that meeting report fair balance about the actual language in Prop. D was not presented and was not impartial, because it appeared to be taking a particular position against the ballot measure.

Similarly, Katz's claim on March 2 that people with advanced Alzheimer's or those with AIDS-related dementia would not be admitted to LHH in the future is not only inaccurate, unfair, and partial, it does not provide balanced presentation of fact, and appears designed to interfere with, not aid, a voter's ability to evaluate the measure, because Prop. D specifically provides that patients with dementia can continue to be admitted, because people with traumatic brain injuries will still be admitted to the physical rehabilitation program, and because Prop. D does not preclude admitting someone having a secondary psychiatric diagnosis provided they have a primary medical diagnosis requiring skilled nursing care. In this regard, Katz did not submit a balanced presentation of facts to either the Elections Department or to the City Controller.

Then there's the lie that Prop. D would change LHH's admission criteria. This is completely false; Prop. D merely seeks to enforce LHH's existing admission policy. Illig, Mizner, and Haaland each know that Prop. D uses the same language as in LHH's current admission policy, which has long prohibited admitting patients with mental illnesses "requiring ... active psychiatric intervention" who can't be adequately cared for; those with primary psychiatric diagnoses, but without coexisting dementia; and those with unmanageable behavior endangering others. Mizner, Illig, and Katz in particular, all know LHH's admission policy is completely legal and is modeled on existing laws governing nursing homes. They each know that Prop. D also does not change any admission or exclusion criteria currently in place at LHH.

Haaland cites Protection and Advocacy, Inc.'s so-called "analysis" of Prop. D as violating federal and state housing and antidiscrimination laws; if that were true, PAI could have already tried to stop what they misperceive as "discrimination"; they have not, since their claim is specious and since Prop. D uses the same language as LHH's current admission policy.

PAI's main claim, the one most emphasized by Prop. D opponents, is that Prop. D unlawfully discriminates against people with psychiatric disabilities. This has been mischaracterized as excluding all persons with psychiatric conditions. But in fact, Laguna Honda has long had many residents who - in addition to the primary medical conditions for which they require 24-hour skilled nursing care - have stable secondary psychiatric illnesses, and who don't endanger others. These patients would continue to be admitted to Laguna Honda under Prop. D. Surely PAI and Mizner know that current regulations governing skilled nursing facilities prohibit the admission of patients with primary psychiatric disorders to nursing homes. As lawyers, they must know it is against the law to admit patients who have psychiatric disorders but who do not have sufficient medical needs requiring 24-hour skilled nursing care. And they must know Prop. D isn't introducing anything new in this regard.

PAI further claims Prop. D illegally discriminates because it would exclude "[P]ersons who pose a danger to themselves or to others, or who pose a threat to the maintenance of a safe environment at Laguna Honda." This claim ignores the fact that only persons with disabilities are protected by disability rights laws from discrimination on the basis of disability; "dangerousness," in and of itself, is not a disability. It also ignores CA Code 5150, which is designed to protect all patients from those who are dangerous.

LHH's admission policy, per state law, has also long excluded those who pose a danger to others; Mizner, Katz, and Illig must know this. Mizner, a civil rights lawyer with the Office of the Mayor, could already have embroiled the City in costly lawsuits, but she has not done so, possibly because she must know this PAI claim lack any merit. If she believed it true that excluding patients posing a danger to others was discriminatory, she would have sought to shut down LHH completely on just this single issue a long time ago. She hasn't for good reason: She knows this to be untrue.

Regrettably, Haaland asserts Prop. D got on the ballot because Residential Builders Association president Joe O'Donoghue financed Prop. D so the RBA could build private healthcare facilities on public land. This both ignores that the RBA is not interested in building healthcare facilities, and that building and operating them are financially unviable. It also ignores a grassroots effort placed Prop. D on the ballot.

While Haaland laments that Prop. D is trying to change zoning laws, he neglects to mention that Prop. D seeks to zone one "special use district" on one parcel - LHH's current property. Instead, he has asserted 1,600 public parcels in San Francisco are subject to an RBA "land grab," which is utter nonsense. This is yet another myth, with no basis in reality. Almost all of the "public" space he points to on a silly San Francisco map is not at all "public" in this context. Much of it is federal land (e.g., the Presidio and the Golden Gate National Recreation Area), which cannot be taken for any reason. The Presidio land is owned by a special trust with its own set of stringent controls; it isn't subject to City control. Coastal areas are subject to separate controls by federal and/or state agencies. More still is designated "Public Open Space," which also cannot be used for anything else. That leaves some City buildings and schools. Haaland falsely asserts the City could convert recently closed elementary schools into nursing facilities, but he fails to acknowledge that State law requires that any closed school buildings can only be re-opened as schools. He also ignores a City law that requires any City buildings declared "excess property" must first be converted into housing for the homeless, not into nursing facilities.

And while Haaland takes a swipe at a "slick" Yes-on-D campaign mailer, he neglects to mention that the "No-on-D" campaign issued a slick mailer of its own, presenting misleading information, including a photo of an LHH patient that appears to have been digitally altered to remove a tribal tattoo from their forehead to make them more palatably sympathetic. At least one patient in the No-on-D mailer is thought to be too cognitively impaired to have consented to use of their photo. Others used in the No-on-D mailer appear to require 24-hour care, and are the very types of patients Prop. D seeks to protect.

Interestingly, SEIU 790 and SEIU-UHW have climbed into bed with the Committee on Jobs, SPUR, and the Chamber of Commerce in opposing Prop. D, using the public relations firm Barnes Mosher Whitehurst Lauter & Partners. I have to wonder how rank-and-file SEIU members feel about their unions having climbed into bed with the very forces opposing SEIU's City jobs? After all, Illig is working hand-in-glove with Haaland; both the City (Illig) and the Unions (Haaland) are actively engaged in opening the LHH replacement facility staffed with non-profit, not City, employees, and both are engaged in "culture change" at LHH to prepare City employees to be able to work anywhere in the City (rather than at Laguna Honda) providing so-called "community-based" care. Are union members paying dues willing to have Haaland help outsource their jobs to non-profit and for-profit agencies, and not tell them that's what he is up to as a political huckster?

Mayor Newsom's plan is to get the City out of the long-term care, skilled nursing business. He's behind the plan to eliminate 420 beds from the LHH replacement project, and to do so, the City is actively working with Haaland, SEIU, and Illig, all of whom are already involved with discharging 420 patients from LHH. They just want to blame already-planned discharges on Prop. D to divert public attention from what they are currently working to accomplish and to later have an excuse ready to confuse the public that the 420-bed closure was the fault of Prop. D.

Meanwhile, the SEIU unions are misleading their members that if Prop. D passes, it will lead to the loss of even more union jobs than the jobs that will be lost if the 420 beds aren't built.

I'm ashamed, but not surprised, that my union has sunk to despicably new lows misleading its members.

Voters who want to preserve Laguna Honda as the sanctuary it has historically been for elderly and disabled San Franciscans should ignore the con job Haaland and Illig espouse, and should vote "Yes on D"!

Patrick Monette-Shaw
Immediate Past President
Laguna Honda Ancillary Professionals Chapter, SEIU Local 790