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It took courage for the Public Guardian to file suit. Hopefully, the public will learn the full extent of the scandal. The timing couldn’t be worse for LHHs struggle to survive.

City’s Public Guardian Sues Laguna Honda

••••••• May 2023 •••••••

The City’s Public Guardian and Public Conservator are suing the City on behalf of patients who were abused at Laguna Honda Hospital (LHH) between 2016 and 2019. Subpoenas are flowing.

Remarkably, this lawsuit embodies an internecine conflict. While operating under the authority of the SF Superior Court, the City’s Human Services Agency oversees the  Public Guardian and the Public Conservator (plaintiffs). Previously, they worked amicably with Laguna Honda, where many patients are cognitively impaired, lack family support, and are unable to manage their affairs.

The Lawsuit

The lawsuit was filed in San Francisco Superior Court (Case CGC-21-592296) in May 2021, and amended that October. It was preceded by a Claim against the City in February, 2020 “regarding privacy breach, abuse and neglect.” Like virtually all such claims, it went nowhere. So the plaintiffs retained the law firm Cotchett, Pitre & McCarthy to sue. The trial date is May 30th, 2023 in Department 206.

Plaintiff’s lawyers took the case on a contingency basis, meaning they only get paid if they win. This arrangement imposes no direct legal costs upon taxpayers. However, two more law firms were brought in to assist the lead firm, including elder abuse litigators and personal injury specialists. This legion will jack up legal costs - if the City loses. Then, there are indirect costs - the fees for City Attorneys defending the case.

Plaintiffs represent 17 current and deceased LHH patients who “suffered verbal, mental and physical abuse and/or privacy violations at the hands of (LHH) employees.” All are or were conserved, incapable of protecting their own rights (assigned a Conservator because they cannot manage their affairs). However, “Request for Dismissal” filings were made for six of the patients (four of whom had died), leaving 11 claiming damages.

This lawsuit mirrors a Class Action suit, Johnson v. CCSF (CPF-20-517064), filed in March 2020. Centered on allegations that LHH staff improperly accessed Johnson’s medical information and “took explicit photographs of his genital and anal areas," it also covers "130 or more similarly situated persons.” Bogged down in legal wrangling, this case has yet to go to trial.

A "Culture of Abuse"

The lawsuit refers to the invasion of privacy, sexual harassment and drugging of 23 patients from 2016 through 2019, as documented by California Department of Public Health inspectors in June/July 2019. The Westside Observer covered the scandal, including five patients who were drugged and overdosed by staff using pilfered methadone and sedatives, five who were sexually taunted, and two physically assaulted. Nursing staff photographed them on personal cell phones, without consent. Those photos were shared for laughs. Later, LHH found that 130 patients had experienced privacy violations. Six rogue nursing employees were fired. CEO Mivic Hirose, Chief Nursing Officer Madonna Valencia, and Quality Management Director Regina Gomez were replaced. However, Hirose parachuted into a lucrative job at SF General Hospital.

The preamble to the lawsuit denounces a “culture of abuse”;
Defendants neglected and/or abused and/or invaded the privacy of each of the Plaintiffs. The extent of the misconduct shocks the conscience and includes gagging one of the Plaintiffs with a towel, taking a photograph of a female resident with her shirt pulled up and her breasts exposed, taking photographs of patients in distress, taking a photograph of a resident balled up on the ground, taking one or more photographs of a male Plaintiff’s scrotum, among other things. Defendants also recorded Plaintiffs’ private health information and took photographs for a non-medical purpose, then disseminated the images and information for non-medical purposes, exposing Plaintiffs to intentional embarrassment, shame and ridicule. The evidence illustrates a culture of abuse at Laguna Honda Hospital.”

“Defendants’ managing agents and employees acted negligently… by failing to ensure that Laguna Honda Hospital maintained an adequate number of staff members, or to ensure that the staff were adequately trained to supervise, maintain and protect Plaintiffs and other Laguna Honda Hospital patients. Defendants also failed to adequately supervise Laguna Honda Hospital staff, by failing to monitor the shortcomings and the sub-standard level of care provided to Plaintiffs and other patients. Defendants’ negligence and failure to monitor their staff members, resulted in poor outcomes, severe damages to Plaintiffs and others, as well as multiple Statements of Deficiencies and/or Citations issued by the California Department of Public Health, and multiple claims and/or lawsuits filed against Defendant.”

Righteous Indignation

The outrage, seething in the harsh language throughout the lawsuit, was also incited by LHH’s egregious disrespect toward the Public Guardians. In most of the cases, LHH provided phone notifications of nondescript "breaches of privacy." Much later - up to 5 months later, the Guardians were sent formal letters; “But no information about what specifically happened was provided.” Alarmingly, some of these letters were dated February 2020, but sent in August. At best, these formal letters merely informed the patients’ Guardians that; “…staff had taken a recording of a patient on a personal device without her consent.”

The long delays between LHH’s writing and mailing of these important letters, smacks of withholding vital information from court-appointed patient representatives – or cover-up. The holdups and omissions were consistent with the furtive management style of LHH’s former CEO, Mivic Hirose, and her enablers. Only later did the Public Guardians learn the appalling details of the abuses inflicted upon their clients. They had been kept in the dark.


LHH was forced to admit dangerous patients from SFGH, for whom it could not provide safe and adequate care. One set a fire that ruined a 30-bed ward. Others got into altercations, did drugs, and intimidated elderly residents and staff. New administrators, imported from SFGH, plundered the Patient Gift Fund to supply lavish perks for managers and staff. ”

Causes of Action

The lawsuit cites seven Causes of Action, simplified below;

  1. Elder Abuse and Neglect
  2. Defendants were reckless, in that they knew it was highly probable that Plaintiffs would suffer harm if Defendants permitted Laguna Honda Hospital’s culture of abuse to thrive and failed to provide adequate means of identifying and reporting instances of abuse when they occurred.”

    Defendants engaged in despicable conduct, in that they knowingly disregarded the rights and safety of Plaintiff and other patients, and repeatedly failed to provide them with a basic level of protection and confidentiality.”

    Defendants’ actions were part of a pattern and practice at Laguna Honda Hospital of abusing and neglecting dependent patients.”

  3. Negligence
  4. “Defendants’ negligence, carelessness, recklessness, and unlawfulness was a substantial factor in causing Plaintiffs to suffer tremendous physical, emotional, and economic harm, as well as other damages to be proven at the time of trial.”

  5. Violation of Medical Confidentiality
  6. Defendants obtained medical information and identifying information concerning patients, including Plaintiffs. Defendant then misused and/or negligently disclosed this medical information, without valid authorization, and then used these disclosures for purposes of entertainment and facilitation of a culture of abuse at Laguna Honda Hospital.”

  7. Violation of California Health and Safety Code
  8. Defendants failed to establish and implement proper administrative procedures and protocols to protect privacy of Plaintiffs’ medical information…”

    “Defendants also failed to report the unauthorized access to or disclosure of Plaintiffs’ private medical information within the statutorily required fifteen-day period… As a result, Plaintiffs are entitled to a statutory penalty of one hundred dollars ($100) per day that the unlawful access, use, or disclosure was not reported.”

  9. Violation of Patient’s Bill of Rights
  10. Plaintiffs bring this cause of action to redress the pervasive and intentional failure of Defendants to provide sufficient nursing care for elderly and disabled patients at Laguna Honda Hospital…. Instead of complying with California’s minimum nurse staffing statutes, Defendants engaged in an unlawful pattern and practice of understaffing…”
    Defendants: (1) failed to employ an adequate number of qualified personnel to carry out all the functions of the facility; (2) Defendants also failed to protect Plaintiffs’ right to be free from mental and physical abuse; as well as (3) Plaintiffs’ right to be treated with consideration, respect and full recognition of dignity and individuality; and (4) Plaintiffs’ right to a safe, clean, comfortable, and homelike environment. The acts and omissions alleged above constitute violations of patients’ rights…”

  11. Invasion of Privacy
  12. “…Defendants’ staff took photographs and/or videos of Plaintiffs, as well as photographs of their private medical information without their consent. Defendants then negligently made public disclosures of Plaintiffs’ private information when they disseminated these photographs and/or videos to other persons not privileged to receive this information. These intrusions and disclosures would be highly offensive or objectionable to a reasonable person.”

  13. Disability Discrimination
  14. Defendants…have violated the Unruh Act by denying persons with disabilities the full and equal access to the accommodations, advantages, facilities, privileges or services offered by Defendants. Defendants also have failed to operate their services on a nondiscriminatory basis; by failing to ensure there was an adequate number of staff members to provide Plaintiffs and other disabled persons with the care, supervision and protection they required.”

    Additional accusations may emerge. For instance, in October 2020, the Plaintiffs filed a wrongful death Claim regarding a patient who died that September with; “unprescribed methadone in her system.” In another case, the LHH doctor “refused to sign the death certificate, stating that ‘her death may be related to past instances where patients were administered methadone’." The Public Guardian did not receive autopsy results until four months later.

Prayer for Relief

The relief sought includes,

  1. Compensatory damages with maximum interest rates.
  2. Attorneys’ fees and reasonable costs of suit;
  3. Reimbursement for Conservators who pursued the elder abuse claims. 4) Double damages per Probate Code § 859; 5) $1,000 for each release of confidential information; 6) Statutory damages and injunctive relief for the pre-death suffering of deceased Plaintiffs.

Fraying of City Family

There was a time when airing dirty linen or challenging wrongdoing was suppressed. How did this embarrassing lawsuit get past Human Services Agency gatekeepers and City Hall brass? The City Family may be losing cohesion and loyalty. Still, it took courage and determination for the good people in the Public Guardian and Conservator offices to file suit. If the case goes to trial, the public will learn the full extent of the scandal, how it was handled - and cloaked. The timing couldn’t be worse, given Laguna Honda’s grueling struggle to reverse its decertification by the Centers for Medicare and Medicaid Services.

Flow Project Karma

The 2004 DPH Flow Project gave birth to the “culture of abuse” described above. That’s when the rights and well-being of LHH patients were dismissed and subordinated to the needs of SF General Hospital (SFGH). LHH was forced to admit dangerous patients from SFGH, for whom it could not provide safe and adequate care. One set a fire that ruined a 30-bed ward. Others got into altercations, did drugs, and intimidated elderly residents and staff. New administrators, imported from SFGH, plundered the Patient Gift Fund to supply lavish perks for managers and staff. Recently, LHH’s own consultants issued a Root Cause Analysis, documenting many patient care deficiencies, management incompetence, and deformed policies designed to align with SFGH. The degradations described in this lawsuit arose from a milieu, cultivated since 2004, that devalues empathy as well as patient rights and dignity.  

Dr. Maria Rivero and Dr. Derek Kerr were senior physicians at Laguna Honda Hospital where they repeatedly exposed wrongdoing. Both are local San Francisco residents. Contact Derek

May 2023

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