In April 2022, federal regulators decertified Laguna Honda Hospital in San Francisco following inspections from 2021-2022. The decertification ended Medicare and Medicaid payments, requiring closure of the hospital and the transfer of approximately 700 medically fragile patients. Patient transfers began in June 2022, at which time, the San Francisco Marin Medical Society (SFMMS) and California Medical Association (CMA) requested a meeting with the Centers for Medicare & Medicaid Services (CMS) to express concern for the health and safety of the patients undergoing transfer, and the effects such transfers would have on our communities and care systems. In the days that followed, four patients died following transfer. Last week, following outcry from the San Francisco Board of Supervisors and numerous community stakeholders, interim CEO of Laguna Honda Hospital Roland Pickens announced, in agreement with regulators, that transfers would be paused. This is a positive development and we thank those responsible for it. Several outstanding questions remain, including the duration of the pause; the status of Medicare and Medicaid payments to Laguna Honda Hospital during the pause; and the status of the demand by the United States Health and Human Services Department for Laguna Honda to cut 120 beds to comply with new federal rules. SFMMS is alarmed and concerned for the health and safety of the patients of Laguna Honda Hospital, and because transfers, if permitted to resume, would cascade throughout the delicate healthcare ecosystem of San Francisco and surrounding counties. “The transfer of vulnerable patients out of Laguna Honda Hospital is a case of the cure being worse than the disease. We would like to see the pause in transfer of patients extended indefinitely and for Medicare and Medicaid payments to resume,” said SFMMS President Michael Schrader, MD. “Our health care systems and emergency medicine departments in San Francisco, already contending with overlapping crises of COVID, opioid abuse, and a recently declared public health emergency due to monkeypox, cannot sustain the loss of those beds.” SFMMS is eager to work with CMS to resolve these issues, alongside other concerned stakeholders in our community, including the Alameda Contra-Costa Medical Association; the San Mateo County Medical Association; the California Medical Association; and the San Francisco-Marin Section of the Hospital Council. SFMMS remains committed to collaborating with community partners to advance long-term solutions to the cycling of complex patients through emergency medicine departments and social support services. Laguna Honda Hospital is seeking recertification by September 13th, 2022. SFMMS will continue to monitor and communicate with Laguna Honda Hospital; the San Francisco Department of Public Health, which operates the hospital; CMS; and our community partners. The welfare of some of our most vulnerable residents is at stake.