Here's a situation that should make anyone with an aging parent or vulnerable family member pay attention.

A San Francisco family recently discovered their loved one — a dementia patient with a language barrier — had been transferred from UCSF's emergency department to a different campus without anyone bothering to inform the family, let alone get consent. When the family finally tracked down where their relative had been moved, the receiving hospital staff seemed fuzzy on the patient's case history, communication was poor, and the overall level of care felt like a downgrade.

Sounds alarming, right? Turns out, it's completely standard.

As one local RN put it plainly: "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."

Multiple healthcare workers confirmed that UCSF now routinely shuffles patients between its Parnassus, Stanyan, and Hyde campuses based on bed availability, insurance, and case complexity. Patients can wait three or more days for a bed at Parnassus, so getting placed at a satellite campus is often considered a win — even if nobody tells your family about it.

Another SF resident familiar with the system was even more blunt: "Unless you're the patient's power of attorney or you have conservatorship, I don't think they really need to notify anyone. The hospital is full of older patients with dementia — can you imagine if they had to track everyone's family member down for every little thing?"

Well... yes, actually, we can imagine that. And we think it's not an unreasonable expectation when you're moving a cognitively impaired person who literally cannot advocate for themselves.

Let's be clear: we're not arguing hospitals should grind to a halt seeking permission for every bed reassignment. Triage exists for a reason, and ERs need to keep beds open. That's sensible resource management. But there's a canyon-sized gap between "we don't need legal consent" and "we don't even need to pick up the phone."

The real takeaway here isn't that UCSF did something illegal. It's that the system has normalized a level of bureaucratic indifference toward vulnerable patients that should make us uncomfortable. If your family member has dementia, a language barrier, or any condition that limits their ability to self-advocate, you need to establish medical power of attorney now — not after a crisis. Without it, you're essentially invisible to the system.

Government-adjacent institutions love to talk about equity and patient-centered care. A courtesy phone call would be a good place to start.