Rescind the Social Worker Layoffs at Zuckerberg San Francisco General

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Dear Dr. Susan Ehrlich and Mr. Glen Mcclintock,

I, Leslie Suen, an Internal Medicine resident physician at Zuckerberg San Francisco General Hospital, am writing to voice my concerns about the recent layoffs of within the Social Services Division at ZSFGH, specifically the letting go of a number of social workers who I believe to be an invaluable asset to our care teams.

We as medical providers understand that our patients at ZSFGH are complex socially and medically, and a multidisciplinary approach is essential and paramount to delivering safe and high quality care. Being discharged from the hospital is a high risk event for all patients, and having a safe discharge plan is necessary to ensure patient safety. However, I am writing to say that planning for safe discharges and delivering high patient care is not feasible at ZSFG without a robust social work presence. We cannot plan for safe discharge plans without safe placement options. We cannot plan for safe discharges without approval from insurance. We cannot plan for safe discharges without setting up outpatient services like Home Health or IHSS. We cannot plan for safe discharges without coordinating transportation. These are all services that are completed by a consistent social work presence, and to claim we can cut our social work staff and still provide high quality care is unreasonable and unrealistic.

During March of this year, I was the senior resident on one of the inpatient medicine teams that did not have a consistent social worker and had a new covering social worker every day. Our team had one of the highest censuses in the hospital because of this lack of continuity. Most memorably, my team had a patient that we cared for for thirty consecutive days with no acute medical hospital needs. However, because he was actively suicidal, he could not be discharged safely, but only to an accepting psychiatric facility. The fact that he had out of county insurance only complicated matters further. Each day, we had to explain to the new and overwhelmed social worker our patient’s story, what their needs were, and where they could go. There was never a record of what work had been done by the prior social workers, so each day, our new social worker had to call every psychiatric facility, only to be rejected and to restart this process with another social worker the day after. It was truly a Sisyphean task, and our team had at least four or five patients with similar stories. Because of the lack of continuity with our social work team, hospital stays for our patients were prolonged by at least several days if not weeks, incurring thousands of dollars of unnecessary cost, exposed our patients to the risks associated with prolonged hospitalization, and prevented our patients from safely returning to the community.

I strongly believe that since these layoffs have occurred, the quality of care for patients has and will continue to suffer tremendously. Their hospital stays will be longer, their discharge plans will be less safe, and their risk of returning for readmission or suffering adverse events outside of the hospital will increase tremendously. If City Hall and the administration of ZSFGH truly believes in the mission of care that this hospital is built on, I hope that they will reconsider and reinstate the positions of our crucial social workers.

Leslie Suen, MD and the Undersigned Providers

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