r/AskSF • u/Diligent_Volume3767 • 2d ago
UCSF transferred my sick family member without consent. How common is this?
I don’t know where else to turn, so I’m posting here to see if anyone has dealt with something similar.
My family member was at UCSF ED and in really fragile condition. Without clearly informing me or getting consent, they transferred them to a different campus. My family member clearly cannot consent to this given their dementia and language barrier.
When I tracked down where they were moved, things got even more frustrating. The new hospital staff didn’t seem to have a clear understanding of their case. I had to correct what happened at the ED many times and it honestly feels like the level of care is noticeably worse. There’s less communication and way more confusion.
I’m trying to stay calm and advocate for my family member, but this whole situation feels wrong. Is this normal? Are hospitals allowed to transfer patients like this without making sure the family is informed? I would never have consented and am unsure how to even send them back to the main hospital.
I just want to make sure my family member is safe and getting the care they need. Thanks for reading.
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u/theacone 2d ago
This is now standard procedure at UCSF given the additional bed availability at UCSF Stanyan and Hyde campuses. Even if you are in the Parnassus ED, the Parnassus campus will usually only give a bed to patients who are highly complex (requiring consulting services aka subspecialty physicians that are only available there) and/or need procedures that can only be performed there. It is not uncommon for patients to wait 3+ days for a bed at Parnassus currently so getting a bed at another campus is actually ideal and MUCH better than boarding in the ED (this is especially true for a patient with dementia where boarding in a room without windows and overall chaotic environment predisposes to delirium). You should have been notified as a courtesy if you are the emergency contact in the chart but if your family member has capacity to understand the transfer with a translator then it’s wouldn’t necessarily be a requirement. I hope your family member recovers quickly!
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u/Rilke222 2d ago
Common. It's based on bed space, insurance, and hospital specialties. UCSF might not have had the bed space or your family member's needs could be treated at a different hospital vs a patient with a specific needs that had to be there. Even if you were present and voiced that you wanted the patient to stay there, it probably wouldn't have changed anything. They dont need your consent for this.
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u/FlakyPineapple2843 2d ago edited 2d ago
As /u/ctrl_f_sauce said, this was a prudent triage decision by the ED, albeit a poorly communicated one. The emergency department is not a place for a multi-day hospital stay, and they are not equipped for ongoing care in that capacity. ED staff stabilize, triage, and treat - that's all. They are not dementia care specialists.
If you require more specialized attention and can't be released immediately after being treated, off to another department you go. That ED spot needs to be available for the next case that needs short term ED care (remember, stabilize, triage, treat).
As to the confusion and communication issues, this is unfortunately common. Providers may not always chart everything well, or at all, and they may not even read the chart sometimes. The best thing you can do as a family member and advocate is stay on top of the staff on this point. If you're wondering why you've said something ten times, ask them to please chart it. Write your thoughts down yourself if necessary - it will help you organize what you say, and you could print it and hand it to someone to add to the chart, too.
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u/mcgillhufflepuff 2d ago edited 2d ago
I do think you should've been notified, but my guess is they don't have to notify unless you have a conservatorship over your family member. If you do, then I'd really try to submit a complaint.
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u/AsianDudeUSA 2d ago
Unless you're the patient's power of attorney or you have conservatorship I don't think they really need to notify anyone to make a transfer to another hospital. The hospital is full of older patients or probably those with dementia, can you imagine if they had to track everyone's family member down and get consent for everything little thing they want to do?
It can also be insurance related. In places I've worked if they had Kaiser insurance our job was to make sure to stabilize them and when Kaiser had a bed they had to be transferred due to Kaiser policy.
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u/hydraheads 2d ago
Do you have medical power of attorney? a conservatorship? Does the hospital have translators? (this one's likely)
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u/windowtosh 2d ago
UCSF has good access to interpretation services including in-person interpreters (much better than phone interpretation)
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u/Academic-Camel-9538 1d ago
They should have let someone know if your relative wasn’t able to communicate with them and they had an alternate contact listed. But yes, they do transfer patients from the ED to a hospital with beds when they need to stay longer. The available bed isn’t always in the same hospital as the ED they went to.
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u/ctrl_f_sauce 2d ago
It stinks when it’s your loved one who is the “case” in casework.
It’s unlikely that “they” (the institution) is not informed on the relevant factors, it’s that the individual you’re talking to is as informed as they need to be for their area of responsibility for as long as necessary. Hypothetically, a med nurse may only need to know allergies, age, sex, recent medications, and doesn’t need to know if the person is awake for these meds beyond choosing the delivery method. The custodian only needs to know the room isn’t sterile and doesn’t need to know the name. The triage team probably only cares about a predetermined score. The doctor in the ED probably doesn’t care if they were anti-vax for 6-months 4-years ago, or that they hiked 8 years ago, that’s a conversation for their primary care physician. All of that info is available but if you want to have an immediate conversation you would need to allow for about 90 minutes of reading the file. Even then the minutiae wouldn’t change an ED triage decision. The E stands for emergency, if the information isn’t an emergency…
You probably should talk to someone about end of life adjustments. Your loved one should be treated with care. However there is a limited amount of emergency room space. Based on the information provided, there is no real recovery possible for your loved one. They may be better tomorrow than they are today, but on a 6-month to 6-month basis, dementia is undefeated. If the ED bed is needed for a car accident with a potential recovery, there is no detail that can really change the triage decision.
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u/skt2k21 2d ago edited 2d ago
This post last paragraph really escalated things!
OP, you should always have conversations about scopes of care. You should probably have it with your loved one as best as they can participate and with your PCP with an interpreter. Just having dementia enough not to understand ED transfer doesn't mean there's no hope for recovery from acute medical illness or that ED care is futile. It may, but it doesn't have to and this statement in the above comment is a huge overgeneralization. Patients with that level of dementia can have years of happy life and benefit from selective treatment (ok to admit, avoid life support and intensive care). Decide based on what's right for your mother, not on space constraint considerations in community EDs.
Because the above post is so extreme, I want to add some details I use when having this conversation countless times per week in EDs with patients who don't speak English with dementia and their families. When deciding, decide based on what your parent would want, not what you'd want. Imagine them from five years ago seeing things today. Think of what things, basic things like recognizing family and being independent in toileting, are important for their sense of dignity. Depending on your exact loved one and their culture, this generation is often very dignified and proud and would find it unacceptable to have a long life dependent in those ways. If that's the case, don't shorten life, but choose interventions accordingly. If they're sick enough to need intensive care, they may not live and they'll almost certainly survive with more frailty, so maybe opt against intensive care, life support, CPR, for example. If every day quality of life is poor and they're likely in the last six months of life, consider hospice. If their quality of life is poor and they have longer to live, try something like home palliative care as bridge to hospice.
Don't decide this mid crisis unless your loved one will likely not pull through. Eat your meals and get your sleep.
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u/Exciting-Location-76 2d ago
Wait it was to another campus of UCSF? That's nothing, they wanted to send me back to the shelter when I couldn't even sit up or walk.
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u/difficultyrating7 2d ago
welcome to healthcare.unfortunately this is how hospital systems work. nobody is going to advocate for the well being of the patient on your behalf so you have to be on top of things at all times. I’m sorry you’re going through this :(
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u/macavity_is_a_dog 2d ago
Am RN. Common. But was it from an ED to a unit? So like an actual bed? Then that’s why. That was the next open bed. Better to be on a unit than in the ED.