Nurses at the city’s main publicly funded hospital say they are troubled by a policy that effectively compels them, in some cases, to return methamphetamine and fentanyl to patients who are trapped in a revolving door of addiction and mental illness.
Hospital staff are required to return a patient’s personal property at discharge, even if it may contain the illicit drugs that landed them in the hospital. And ambiguous procedures around how to manage patients who arrive at the hospital with drugs are raising concerns among health care professionals who are increasingly carrying the burden of the city’s behavioral health crises.
Zuckerberg San Francisco General Hospital said that it asks patients to disclose if they have non-prescribed medications—but that it doesn't have the authority to search them "without lawful or statutory cause," according to a statement. Patients are “offered the option to dispose of any substances or substance use supplies with the hospital,” the hospital said.
“Zuckerberg San Francisco General Hospital (ZSFG) is a drug-free campus. We do not condone or tolerate the use of illegal drugs on our campus by anyone,” said the statement.
But some nurses said they often feel stuck between obliging the hospital’s "substance-use free zone” policy and rules that restrict them from confiscating a patient’s personal property.
Moreover, some raised questions about whether the hospital is placing undue burden on front-line medical staff as they care for patients using street drugs that have grown increasingly dangerous.
“We have these crazy lines in the sand. You're not allowed to smoke a cigarette anywhere on our campus, but I can't take away your fentanyl?” said Heather Bollinger, a longtime nurse at SF General. “If the institution really wants to support this harm-reduction model, and if that’s the priority, then how do we remove the nurse from the equation?”
Many nurses were afraid to speak publicly about the issue due to fear of retaliation.
“You have a really broad, unsafe situation and we’re not getting the support,” SF General surgical nurse Megan Green told The Standard. “So a lot of times people just quit.”
Some said they fear that if their patients were to overdose shortly after leaving the hospital, they could be sued for facilitating the death. On the other hand, they say, confiscating a patient’s drugs could sow distrust in the medical system.
Bollinger told The Standard she believes “there’s not a right or wrong answer to the problem,” but expressed frustration over how policies that come down from the hospital's upper management can have debilitating effects on front-line staff.
“Treating your patient like a presumptive criminal is not conducive to a therapeutic environment. I am someone who believes in the harm-reduction model,” Bollinger said. “But every time there’s a bad outcome, I’ve watched my colleagues get disciplined.”
Eighty-four people have died in SF General Hospital of fatal overdoses since Jan. 1, 2020, according to data obtained from the SF Chief Medical Examiner’s Office, though it's not clear how many—if not all—of those patients overdosed prior to arriving at the hospital.
In a statement, SF General Hospital said that overdoses are “extremely rare” on the premises.
But the description of General Hospital as a drug-free zone didn’t square with the accounts of nurses, who said they aren’t equipped with protocols for enforcing such a policy.
Nurses who spoke to The Standard said that they sometimes catch their clients using hard drugs while in the hospital, and that sometimes overdoses occur while staff is attending to other clients.
An incident last week in which a man used fentanyl inside of his hospital room resulted in some medical staff forming a task force to consider better procedures for dealing with drug use in the hospital.
“It’s silly and typical to just say, ‘Well, we tell people not to,’” Bollinger said. “When they do [use drugs], what happens then?”
Geoffrey Grier, executive director of the city’s Behavioral Health Commission, said that handling a patient’s illegal drugs shouldn’t fall under the purview of medical staff. Grier suggested that a third party, such as California Poison Control System, could come in to handle the drugs.
“Say, they give them their drugs back, and the person goes out OD’s and dies,” Grier said. “When the family comes along and sues the nurse for giving them their drugs. Who’s liable? Who’s paying for the court costs?”
Boone Callaway, an attorney who specializes in medical malpractice lawsuits, said that the idea of nurses having any role in handling illicit drugs didn’t make sense to him.
“It seems like a problem that would be so easy to avoid,” Callaway said. “I don’t know if that law has ever been clarified. […] But potentially there's an exposure to liability, why would they want to even get near it?”
Other experts aren't convinced that the issue has a quick fix.
Keith Humphreys, a Stanford professor who advised President Obama on drug control policy, said that there likely isn't a solution to this issue without first addressing the city’s inability to control the supply of drugs and provide treatment for those who are addicted.
“The solution to this is upstream,” Humphreys said. “It’s one of those things that happens when you have a drug crisis that’s out of control. It puts a lot of people in an impossible situation.”