San Francisco General Hospital Goes to the Dogs

Hospitals are typically filled with sick adults, crying babies, anxious families murmuring amongst themselves, and nurses and doctors hurrying between patients. Yet, amongst humans, a visitor to Zuckerberg San Francisco General hospital (ZSFG) might encounter something furrier: a dog. 

Allowing animals into medical facilities is a complex issue, governed by a web of laws, regulations, and hospital-specific policies. In the United States, there are roughly a half-million service dogs, a population that may be growing at upwards of 10 percent a year. A service animal is a dog or miniature horse trained to assist individuals with disabilities by performing specific tasks, such as alerting a diabetic to blood sugar changes, reminding someone with depression to take medication, or detecting and responding to seizures. 

In addition, an American Psychiatric Association survey found that there are a couple hundred thousand emotional support animals (ESAs) nationwide, with a 50 percent increase in ESA registrations over the past five years.

An exploding population of service and emotional support animals is acting to change attitudes and create new challenges related to the role creatures can play in stressful environments, including at health care facilities.

According to the Americans with Disabilities Act (ADA), service animals must be permitted in Title II and III sites, which include government-run and public facilities, such as universities, hospitals and open spaces. Moreover, ADA doesn’t require animal companions to show certification, nor are businesses/facilities allowed to request documentation regarding the dog’s service/support abilities.

California law provides psychiatric service dogs with the same public access rights as service dogs. These animals are trained to assist individuals with mental disabilities through tasks like gentle wakeups and pressure therapy by using body weight. 

ESAs have more limited access rights; public spaces like hospitals are not legally required to accommodate them. However, at ZSFG patients are allowed to have pets for emotional support, even if they’re not service animals. According to the Department of Public Health Media Desk, ZSFG visitors and patients can bring service and support animals into facilities, as long as they don’t pose a safety threat. 

“The emergency department (ED) was established in 2016,” said Christopher Colwell, Chief of Emergency Medicine at Zuckerberg SFGH and Trauma Center. “We changed over from the cement building to the new one that gave us more individual rooms and freedom to accommodate animals in the ED. We make every effort to accommodate any request that our patients make while maintaining safety of patient staff and other patients. In most cases, we’re dealing with dogs, and we’ve had other animals requested as well.”

Colwell, who has been at ZSFG since June 2016, has “… noticed animals accompanying patients far more often, certainly several times a month, maybe more.” 

Robotic dogs and cats attend dementia patients in SFGH’s Acute Care for the Elders unit. 

“I’ve seen fantastic results from dog therapy,” commented Colwell. “The way patients light up, including those that don’t relate well to human beings, almost always relate well to animals. Twenty-five to 30 years ago it was almost a never event and at the time, there was no accommodation for it really. Overall, with the added flexibility, the added accommodations have been a real benefit for everyone, although not problem-free.”

The presence of animals in hospitals inevitably raises safety, logistical, and individual preference concerns. Some people are afraid of dogs. There’s a risk of zoonotic infections. A recent study noted the potential for therapy animals to transmit hospital-associated pathogens. 

“It’s a mess,” said one person familiar with SFGH’s animal-friendly policy, who preferred to remain anonymous. They and others pointed to the hospital’s lack of structure and capacity to manage dogs, concerns about cleanliness, as well as spillover obligations forced on an already stressed workforce.

As many as one out of three Americans are allergic to animals. Pet sensitivities can trigger or worsen asthma symptoms. People who have a severe allergic reaction to a dog encounter, or even the lingering presence of animal dander, including potential anaphylaxis, may need an immediate injection of epinephrine.

However, studies have also identified benefits from accommodating creatures: decreased depression in cancer patients and reduced physiological stress among healthcare professionals. 

“Occasionally with aggressive dogs, we ask that they be removed,” recounted Colwell. “We’ve also had two situations where the dog was involved in an accident and either injured and/or killed, and at the same time the person is injured/ill,” recounted Colwell. “So, there’ve been cases where the dog was brought in despite being killed by accident. We’re not approved to either treat or maintain bodies of animals and that has concerns regarding accreditation as a human facility to manage animals. We were able to find a room that was separate from anybody else and animal control ultimately was able to come in and take possession of the body.” 

Other Bay Area hospitals take a more restrictive approach. 

“Personal pets and other animals are generally prohibited in UCSF buildings, including UCSF leased space,” Elizabeth Fernandez, University of California, San Francisco senior public information representative, emphasized. “However, the ADA, California Code and United States Fair Housing Act contain provisions regarding service animals and assistance animals that ensure facilities and services are fully accessible to people with disabilities. Thus, university policies, practices, and procedures permit the presence of service and assistance animals used by employees, students, and members of the public with disabilities as mentioned in Policy 335 of the California Department of State Hospitals.”

“As a general rule, we do not allow pets or emotional support animals in the emergency department or hospital for safety/liability reasons,” Sarah Foad, Director of Patient Experience at Stanford Health, affirmed. “However, we make exceptions for end-of-life circumstances if the patient is admitted to the hospital. We allow service animals in accordance with ADA when it is safe for them and our patient population.”

There have been incidents of owners who don’t have people to take care of their “…pets in the ED,” recalled Foad. “It is a very challenging situation, as we aim to prioritize the safety of the patient and the animal. We have a veterinarian on call, whom we consult with, then our process is to safely relocate the animal until the patient is able to care for them again. Oftentimes, this means asking Santa Clara County Animal Services to collect and house the pet temporarily.”

“Our agency is able to help with taking in animals from patients being admitted to the hospital if there is no family, friend, neighbor, or others to take the pet in,” said Deb Campbell, media relations for San Francisco Animal Care and Control. “We will hold the pet up to 14 days in our ‘custody’, but always encourage pet owners/guardians to try and make other arrangements for care as quickly as they can. We charge daily keep fees. We’re frequently at capacity for animals to care for; overcrowding is a nationwide problem. We’ve seen increases in the amount of ‘custody’ animals that we take in because of an owner/guardian being hospitalized or incarcerated.” 

“In most cases we’re able to sort this out on an individual level with the patients. If they are staying for at least 24 hours, in most cases a family member or friend comes to help take care of the dog,” mentioned Colwell. “Although we’ve had occasional occurrences when the patient can’t find someone to take care of the dog, so we the staff at the ED take the dog out. That’s not ideal, obviously, taking staff away from other patients, but people volunteer to do it during their break. We worry about the safety of patients’ health, so we try to accommodate their requests to bring in pets. In one case a patient had to stay longer in the ED than they would otherwise, but we figured out how to accommodate it. We try to offer the best support to every patient, and we recognize the importance of the support of animals, so we try to accommodate as best we can while maintaining safety.”