Palo Alto to review Stanford’s plans to add more hospital beds

Citing surging demand in emergency room visits, Stanford Health Care is asking the city of Palo Alto for permission to add 70 beds in its hospital buildings, raising the maximum total to 670, according to an application that the hospital system submitted last month.

The proposal, which is now being reviewed by the city’s Department of Planning and Development Services, comes at what has already been a period of rapid growth and transformation for the university’s hospital system. In 2011, Stanford signed a development agreement with the city of Palo Alto for an expansion plan known as Project Renewal. The $5 billion project entailed adding 1.3 million square feet of development, which included construction of a new hospital, an expansion of Lucile Packard Children’s Hospital and renovations to existing hospitals and clinics. The City Council approved the plan after four years of negotiations with Stanford, a process that included 97 public hearings.

The expansion plan continues to unfold. In November 2019, Stanford opened its new 824,000-square-foot hospital at 500 Pasteur Drive, which includes 368 single-patient rooms, 20 operating rooms, a trauma center, five gardens and a meditation room. The following year, it launched a major remodel and expansion of its existing hospital at 300 Pasteur Drive, a project that includes seismic upgrades, two four-story additions, the doubling of post-surgery bays from 36 to 72, the renovation of nursing towers and creation of an inpatient psychiatric unit.

The university emphasized at the time that outside the in-patient psychiatry unit, all patient rooms would be single occupancy. But the demand for emergency services spiked during the Covid-19 pandemic and Stanford reacted by bringing back the hospital spaces that it had just decommissioned for renovation, according to the application. Stanford also brought back the beds that were taken out from rooms that were previously classified as “doubles” but that became private as part of the project, wrote Molly Swenson, Stanford’s land use director, in a letter accompanying the plans.

Over the past four years, the university has seen a growing share of its patients come in through the Emergency Department. Before, admissions from the Emergency Department made up 47% of total admissions. Today it’s more than 60%, Swenson wrote.

“At times, due to the increased demand coming from the ED, SHC must deny transfer requests—including strokes, tumors, and medical emergencies—that have few other options in this area,” Swenson wrote. “This also reduces the capacity available for treating local high acuity patients in such areas as cardiac surgery, cancer, and transplants—services that SHC is uniquely positioned to provide.”

Visits to the emergency department have increased substantially beyond the volumes that Stanford had anticipated at the time that it was getting its expansion project approved. The number of annual visits went up from 48,744 in 2009 to 75,391 in 2023, she wrote. She attributes this to numerous factors outside Stanford’s control, including the downgrading of the Regional Medical Center in San Jose, financial struggles of community hospitals, labor actions and staffing shortages at nearby hospitals, and a lack of post-acute facilities in the Bay Area, which results in longer hospital stays.

Since the onset of the pandemic, the university has been relying on waivers from the state to expand its capacity and bring back decommissioned beds. When the public health emergency formally ended, the hospitals obtained approval from the state Department of Public Health to continue to use these provisions and retain its beds, according to Swenson.

Now, Stanford is asking the city for a permit to add 70 beds to its various hospital buildings so that it would no longer have to rely on state provisions. The change would raise the maximum number of beds at Stanford hospital facilities from 600 to 670. This will be done by recommissioning the “semi-private” beds to its hospital license, turning private rooms at 300 Pasteur Drive into shared rooms, project plans show.

Swenson wrote that Stanford’s request to increase its licensed bed count is intended to “enable a continuation of the same level of care at the same capacity level available today” as the hospitals work to achieve a state deadline to make its facilities seismically safe by Jan. 1, 2030. She wrote that the hospitals have also boosted incremental capacity by creating a program for transferring patients to its community hospital in Pleasanton, scheduling more outpatient surgeries in network locations and operating an inpatient unit at Sequoia Hospital in Redwood City.

Meghan Horrigan-Taylor, the city’s chief communication officer, said that city staff is now evaluating the project and the existing adopted Stanford Hospital environmental impact report to confirm next steps, including project review and process for approval.

This story originally appeared in Palo Alto Weekly. Gennady Sheyner covers local and regional politics, housing, transportation and other topics for the Palo Alto Weekly, Palo Alto Online and their sister publications.