San Francisco’s burn unit — one of the largest in Northern California, and the only dedicated center between San Jose and Sacramento — has quietly sent child patients to other hospitals since last fall, a practice that appears to fly in the face of an agreement with the state attorney general.
UCSF Health, which runs the burn unit, stopped rerouting patients this week, after The Standard began asking about it.
As a condition of taking over the Saint Francis Hospital Bothin Burn Center in a two-hospital acquisition last summer, UCSF Health promised Attorney General Rob Bonta it would keep the same level of staffing and patient care through 2034.
In addition to possibly violating that agreement, the move to send patients to other cities for care puts a burden on families that lack the resources to visit children during what can be months-long stays, front-line staff say.
Asked for comment last week, UCSF Health officials took days to respond and sent a statement only after resuming pediatric burn care.
“They said, basically, ‘We were put under pressure by a journalist,’” a source inside the hospital system told The Standard. “So the timing was definitely related to inquiries. … They well knew they were in violation and probably fearful of what would happen if that got out.”
UCSF Health apparently didn’t give staff advance notice.
“The Bothin Burn Center at UCSF Health Saint Francis Hospital has resumed inpatient admissions for pediatric burn patients under the age of 18,” UCSF Health System Chief Medical Officer Lukejohn Day announced in a memo sent to managers Tuesday at 2:09 p.m. “The Bothin Burn Center is now prepared to revert to previous protocols.”
In an email to The Standard the next morning, UCSF Health spokesperson Chad Burns confirmed the about-face, saying it followed “a temporary pause” on pediatric care at the Bothin Burn Center that began Oct. 30 after an assessment identified a need to “strengthen the infrastructure, capacity, and capabilities” of the program.
While the internal communique mentioned reverting “to previous protocols,” the media statement boasted about implementing “new protocols” as well as “training and staffing measures to support safe, high-quality care.”
The Santa Clara Valley Medical Center in San Jose, which houses the closest burn unit, learned about the decision a day after the pause took effect.
Dr. Clifford Sheckter, a burn surgeon at Valley Med, said his unit began taking a few children a week who would otherwise have gone to the Bothin Burn Center. The kids came from San Francisco, but also from Sonoma and Marin counties and other jurisdictions that usually rely on Bothin.
“We’ve been more than happy to provide their care,” Sheckter said in a phone call Tuesday, two hours after UCSF Health notified him about reinstating pediatric burn admissions.
Valley Med was able to handle the influx of patients.
“It wasn’t something that put us underwater,” Sheckter said, but the impact “was definitely noticeable.”
A source familiar with the situation says the suspension of pediatric burn care in San Francisco came after an accreditation survey identified deficiencies at the Bothin Burn Center, which treats 500 patients a year from its 16-bed unit in Saint Francis Hospital on Hyde Street.
The stoppage triggered a chain reaction across the city’s emergency response system. The San Francisco Emergency Medical Service Agency found out about UC Health’s decision to suspend on the day it went into effect — and learned of its reversal with just as little notice.
“As pediatric burn care is very specialized and limited in scale, with the two closest centers in Sacramento and San Jose, the San Francisco EMS Agency immediately notified local EMS agencies, ambulance providers, hospital, and dispatch partners throughout the region using emergency messaging systems,” a spokesperson for the agency told The Standard by email.
Instead of sending patients directly to the isolation unit at Bothin, burned children were routed to Zuckerberg San Francisco General Hospital for initial stabilization before being transported outside the city for specialized care.
Burn units are increasingly few and far between — especially those that focus on children. According to the American Burn Association, which compiles data from voluntary reporting by hospitals, the number of centers has dropped from more than 130 in 2004 to fewer than 100; the number of pediatric units is about a few dozen.
Because of lengthy hospital stays for many burn victims, the centers are expensive to run. “For every 1% of your body that’s burned, you stay in the hospital for one or more days,” Sheckter explained. “So if 70% of a patient’s body is burned, he’ll be in the hospital for 70 to 110 days. And that’s ICU-level care. … A big burn is going to require 20 to 25 operations, and those come with a lot of costs.”
The San Francisco Health Commission passed a resolution last year affirming that UCSF Health’s purchase of the city’s two oldest hospitals wouldn’t have a detrimental impact as long as it kept its promise to maintain services and staffing.
That same resolution calls for UCSF Health to come before the commission every six months through 2027 to keep the city apprised of how the acquisition is affecting patients. Officials are expected to address the pause in pediatric services at the burn center at an upcoming public hearing.
The attorney general declined to comment on the legality of the lapse.
“UCSF Health has confirmed that services are back online,” a spokesperson for Bonta’s office said. “Beyond that, we are unable to comment on, even to confirm or deny, a potential or ongoing investigation.”