Details emerge in death of infant
Woman had visited hospital before her stillbirth at tent site
A homeless San Francisco woman who had a stillbirth in a portable bathroom at a citysanctioned tent site outside City Hall was treated at a hospital the previous evening and was back at the site by the morning, records show. People close to her said she told them afterward that her full-term pregnancy was not detected.
The woman told authorities at the site after she gave birth that she had not known she was pregnant, according to the city medical examiner’s report on the incident last year. The organization running the site, a person who helped the woman at the site and her neighbor at the site said they also didn’t know.
A cleaning crew found the infant inside the toilet of a portable restroom at the site in Civic Center around noon on Jan. 7, 2022. The 9-pound boy died from complications of funisitis, an inflammation of the umbilical cord, with pneumonia, according to the Office of the Chief Medical Examiner. The baby’s body contained multiple drugs, including fentanyl, cocaine and methamphetamine.
The incident occurred at a pandemic-era homeless shelter where people lived in tents and received food, bathroom access and security services, in a parking lot visible from the City Hall office of Mayor London Breed. Urban Alchemy, a nonprofit organization with millions of dollars in city contracts, ran the site, which was open from May 2020 to June 2022.
In an effort to understand what happened, over the past month The Chronicle obtained public records from the medical examiner and the police and
homelessness departments, and interviewed authorities as well as people who lived with and helped the woman at the site.
While the incident highlights the stark toll of the city’s homelessness and drug crises, and raises questions about whether more could have been done to prevent the death, much remains unknown about the treatment offered to or accepted by the woman at the hospital.
The Chronicle couldn’t locate the woman, and people who knew her at the site said they were no longer in contact with her. It’s not known whether the woman’s partner, who also lived at the site, knew of the pregnancy before the stillbirth. In the police report, an officer wrote that, after being dispatched to the scene, he overheard her partner “spontaneously state that he was distraught and that the child was supposed to be (a) boy.”
Public records reviewed by The Chronicle do not say which hospital the woman went to, what kind of care she was offered and what she received in the end. No city agency appears to be currently investigating the episode, after police closed a homicide investigation. The woman, whose name was redacted from reports, was not accused of a crime. Urban Alchemy said it conducted an internal policy review to minimize the possibility of similar incidents in the future.
“It’s a real tragedy that occurred,” Breed said in an interview Tuesday. “Our goal is to try and get people the help and the support they need, but we also can’t force people into treatment or any other services that we might have available.”
In an interview, a tent-site resident said the woman told him she didn’t receive testing or treatment for pregnancy at a hospital the night before the incident. Another person who helped individuals at the site told The Chronicle they heard a similar account from a member of the care team that treated the woman after the birth and expressed concern about the care provided.
An ambulance arrived to take the woman to a hospital at 7:08 p.m. on Jan. 6, the night before she gave birth, according to a homelessness department report on the incident. Spokespeople for multiple hospitals near the site said they couldn’t comment on whether a patient was in their care because of patient privacy laws.
Adam Husarik, who lived at the site for two years and was the woman’s neighbor, said he saw the woman return from the hospital.
He said the woman and her partner, who shared her tent, told him after the stillbirth that she had gone to the hospital the night before because she was in a lot of pain. According to Husarik’s account, staff at the hospital gave the woman treatment for constipation, but didn’t test for pregnancy and released her. Husarik said the woman’s partner was upset that the hospital didn’t detect her pregnancy.
Husarik and Avalon Attinasi, another former resident of the tent site, said they worried the woman did not receive adequate care before the stillbirth because she was unhoused and used drugs.
“The big responsibility falls on the doctors or the health professionals that woman had seen prior to having her stillbirth,” said Attinasi, who also previously used drugs and had her own pregnancy at the site that she didn’t discover for five months. “The stigma of homelessness and addiction is really strong, and it’s really sad. She needed help.”
Dr. Maria Raven, chief of emergency medicine at UCSF Medical Center, said pregnancy tests are commonly given in emergency rooms, though asking a woman of reproductive age whether she might be pregnant or testing her would depend on the situation and symptoms. Raven, who was unfamiliar with the tent-site case, said that in her hospital, patients sign consent forms during registration that permit blood work and other tests.
Patients are then informed of these tests, including pregnancy tests, and their results, if they are conducted. A person can refuse treatment even after signing. If a person doesn’t want to be tested or is found to be pregnant but doesn’t want further care, there’s not much a provider can do, Raven said, as patients have the right to refuse care.
Urban Alchemy said staff called an ambulance for the woman on Jan. 6, after she complained of serious leg pain. She later returned to the site on her own and, per protocol, staff asked if she was OK, according to the organization. She said yes and didn’t indicate that she needed extra care, the nonprofit said.
Urban Alchemy’s policy was not to house pregnant women at the site because other providers were better equipped to serve them. The nonprofit’s chief of government and community affairs, Kirkpatrick Tyler, said it wasn’t informed of the pregnancy by the resident or her partner during intake, nor were there any noticeable signs that she was pregnant.
“This incident was a devastating tragedy, and our leadership and team are deeply saddened,” he said in a statement.
Tyler said that when the nonprofit became aware of the stillbirth, staff connected the woman with emergency medical care and notified authorities.
A homelessness department spokesperson, Emily Cohen, said in an email that she was deeply saddened to hear of the tragedy when it happened last year. She said privacy rules prohibited the department from going into detail about the woman, but officials “appreciate the professional manner with which our provider partner, Urban Alchemy, handled the situation.”
According to the medical examiner’s report, the woman who gave birth told authorities she’d had two previous pregnancies that were aborted in the first trimester. The woman said she was a chronic opiate and methamphetamine user and that, because of her drug use, she didn’t get her period for over two years and was unaware of her pregnancy.
The person who helped individuals at the site said they had known the woman and her partner since October 2021. This person said the woman was “incredibly sweet and soft-spoken” with “not a bad bone in her body.” The person did not know that the woman, who was heavyset, was pregnant.
The health department offers resources to pregnant people, including a special team that serves those who are also homeless, addicted to drugs, mentally ill, incarcerated or the victims of domestic violence. While the tent site offered voluntary medical services, the person who helped others at the site said there would be no reason for providers to ask a woman if she were pregnant unless they were giving care that could be detrimental to a pregnant person.
According to the medical examiner’s report, the woman said she felt constipated and had cramps on the morning of Jan. 7 before she went to the portable bathroom and “shot up” to assist her bowel movement. She said she thought she had passed stools, and wasn’t aware she had a stillbirth, since she didn’t hear crying or feel movement.
The stillborn baby was discovered by two employees of the portable restroom company. They told police that an unknown woman had been in the bathroom for more than an hour, and that they had knocked on the door to tell her they needed to clean it, according to the police report.
When the woman left, she was wearing only a black sweater, with her lower body wrapped in a blanket, and she was bleeding and left the immediate area in a wheelchair, one employee told police.
One of the cleaners soon noticed what he initially thought was a doll in the toilet. Staff removed the baby, wrapped him in a blanket on the ground and called 911 just after noon, records show.
Police and paramedics found the woman in her tent. The responding officer wrote in his report that he had encountered the woman hundreds of times dating back to 2010 and recognized her partner.
The woman initially refused medical attention, according to the homelessness department report. Husarik said the woman was scared after the incident, but eventually did return to a hospital.
When she was discharged, she moved into a shelter-in-place hotel, set up to temporarily house medically vulnerable homeless people, he said. That hotel permanently closed in December.
Attinasi, who lived at the site from its opening until the spring of 2021, said it’s understandable if the woman was overwhelmed by her situation. Attinasi recalled that she didn’t realize she was pregnant herself for five months because she hadn’t had her period for a year. It was only after she noticed sudden weight gain and volatile emotions that she took an over-the-counter pregnancy test.
Even after confirming the pregnancy at a hospital, she said she didn’t feel comfortable telling the tent-site staff immediately and thought she could handle it on her own.
When she became visibly pregnant, she said staff approached her. An Urban Alchemy worker told Attinasi that she could help prioritize her for housing if she had a proof-ofpregnancy document — which turned out to be challenging.
She eventually obtained proof from a doctor at a methadone clinic she visited for outpatient drug treatment, and within days moved into a family shelter with her partner. Three months later, her daughter was born.
Cohen, of the homelessness department, said it offers immediate shelter access for pregnant people, and that proof of pregnancy is not a barrier to entry. The city can serve 404 people in family shelters and transitional housing and provides 1,111 supportive housing units for families, with more on the way.
Attinasi said staff should be more proactive in asking about or addressing possible pregnancies. She also encouraged women in the same situation to speak out.
“That’s the hardest thing, in these really vulnerable circumstances, to say, ‘I need help,’ ” she said. “Because a lot of times, you’re going to be like, ‘I’m a grown woman, I’m going to be a mother now, I need to be able to take care of this on my own,’ but a lot of times, we’re in circumstances generally that are over our head, and we do need help.”