How S.F. medics revived baby at park from diagnosed fentanyl overdose: ‘It was very much a close call’

All Robert Kuzma knew at first was that bystanders were conducting CPR on a child in cardiac arrest at Moscone Park.

It was Nov. 29, just before 3 p.m., when the paramedic rescue captain headed in his red San Francisco Fire Department sport utility vehicle to the park in the Marina.

When he arrived, he saw 10-month-old Senna Matkovic in the back of an ambulance. The child was already hooked up to an IV, an EKG heart monitor and a bag valve mask, an apparatus to help someone breathe, Kuzma said.

But the baby still wasn’t breathing.

Kuzma checked to make sure the child hadn’t choked on something, wasn’t having an allergic reaction or hadn’t had any recent illnesses that could affect breathing. He learned that the child had been playing, then became lethargic and stopped breathing — and he saw the baby’s constricted pupils.

From his three decades of experience, he knew those can be indicators of an opioid overdose. So he and other paramedics calculated how much of the overdose-reversing medication Narcan to give the boy based on his weight. Another paramedic then administered it through the IV.

Senna immediately blinked his eyes, started crying and breathing again, Kuzma said, indicating to him that the boy had suffered an overdose. Naloxone — the technical name for the Narcan brand drug — only has an effect on someone with opioids in their system, according to the National Institute on Drug Abuse.

“A complete turnaround,” Kuzma said Wednesday in describing the baby from inside Station 31 in the Richmond District, where he is based. “The father was able to come into the ambulance and hold his son, a wonderful moment.”

Kuzma’s account adds more details to the viral story of Senna, which the Chronicle first reported two months ago, including confirming some details that the Fire Department declined to verify at the time of the incident. The ambulance transported the boy to California Pacific Medical Center’s pediatric hospital on Van Ness Avenue and doctors diagnosed Senna with a fentanyl overdose, according to a hospital record provided to The Chronicle by the family.

But how, when and where Senna was exposed to fentanyl, as the hospital concluded, remains a mystery. Neither Kuzma nor Senna’s family knows.

Police spoke to the family and searched the park, but did not find any drugs or paraphernalia there later that day. They did not search the baby’s stroller, other possessions or home, the family said. The department is still investigating and a spokesperson said this week they had no updates on the case and no arrests have been made.

The story caused both alarm and skepticism, given that child opioid overdoses are rare and can be fatal. California documented six deaths of children 5 and younger related to fentanyl poisoning in 2021. A national study reported that 12 of 25 cases of accidental fentanyl ingestion for kids up to age 18 studied from 2004 to 2013 were fatal.

There is no comprehensive data in San Francisco on pediatric overdose reversals. Kuzma, who has worked with the city since 1990, first with the health department, then the Fire Department, remembers reversing only one pediatric overdose of a baby in the early 1990s that possibly occurred through breast milk transmission.

Medical and drug experts told The Chronicle that if children are exposed to fentanyl, it’s usually at home and has in some cases led to the arrest of a caregiver. They were not aware of another case in a public park. They stressed exposure would have had to be in an infinitesimal amount for the baby to survive.

While questions remain, Senna is now alive, healthy and just celebrated his first birthday with his twin brother. The family met on Sunday with Kuzma and other first responders, who Senna’s mother called “forever our heroes,” to thank them.

“Here is a family that was intact and could have been broken,” Kuzma said. “It was very much a close call.”

Kuzma said it appears Senna did overdose because of his response to the treatment, but didn’t have information about whether the drug was fentanyl, since Narcan has the same impact on any opioid.

He said he did not talk with the nanny about what Senna was doing before the baby stopped breathing, and also did not look at the overall area to see whether there were any drugs, paraphernalia or people using nearby. When the ambulance left for the hospital, he took off immediately to respond to another cardiac arrest that also turned out to be an overdose.

Senna’s father, Ivan Matkovic, previously told The Chronicle that he had no reason to believe his nanny or anyone else at the park had fentanyl or gave it to the child. Matkovic said his nanny told him she kept the boys in the stroller the whole time they traveled from their home nearby to the park, arriving less than an hour before the overdose.

The nanny declined to be interviewed by The Chronicle, but told NBC the boy was playing in the grass when she noticed him starting to lose consciousness and stop breathing. She twice called Matkovic, who was working at home, as well as 911, and started doing CPR.

The Fire Department said it was dispatched to the scene at 2:56 p.m. and arrived within two minutes. Matkovic arrived in time to observe paramedics administer Narcan.

Matkovic shared an after-visit summary report from the hospital, which The Chronicle agreed not to post online to protect the family’s privacy. The summary states the diagnosis as “accidental fentanyl overdose, initial encounter” followed by “respiratory arrest.” The document states the hospital completed lab tests including a “drug monitoring, fentanyl screen, urine” and screening for other drugs.

The record, printed at 10:56 p.m. on Nov. 29, states the baby was observed for “more than 6 hours since Narcan was given and is breathing well. The fentanyl should be out of his system. He is safe to go home.” The record had “Epic” printed in the corner with the same logo as the records company used by the hospital system.

Matkovic said he was shocked by the diagnosis, which he posted about on Nextdoor to warn other parents. The family left the hospital around midnight, he said.

Questions have been raised by some online about the accuracy of the diagnosis. The family said it didn’t obtain a full toxicology report with results of the fentanyl urine test and chose not to authorize the hospital to release reports or speak about the case to protect their son’s medical privacy. Sutter Health could only confirm that patients do receive after-visit summaries.

Urine drug screenings have only a 1% to 2% chance of giving the wrong result, Keith Humphreys, a drug policy expert at Stanford, told The Chronicle. It is also almost impossible for Narcan to give a false positive on a drug test, Dr. Noah Simons, a pediatrician in the Marina affiliated with California Pacific Medical Center, previously said.

San Francisco police spokesperson Robert Rueca, who said officers were dispatched to a local hospital at 10:16 p.m. on Nov. 29, confirmed the child was exposed to fentanyl, but said he was not able to confirm whether the child’s medical emergency was the result of fentanyl.

Matkovic said his son has no other known medical conditions.

Skeptics online have pointed to a story that Matkovic’s brother had a rare congenital heart defect that prevents enough freshly oxygenated blood from reaching an infant’s arteries, making them turn blue. Matkovic confirmed his brother’s diagnosis, but said that because of family history, he had his sons tested for the condition at birth and they didn’t have it.

Humphreys questioned how a toddler could ingest any amount of fentanyl and survive. Perhaps the child could have licked a pill, he said, but the exposure would have to be infinitesimal. A baby overdosing on fentanyl would pass out and could possibly die within 15 minutes of exposure, although CPR could slow that process, he said.

The timeline of exposure and the nanny’s 911 call is not clear. The Department of Emergency Management declined to release records without the family’s consent because of patient privacy laws, and Matkovic said the family did not want to release any more medical records.

Police previously reported that they heard from the child’s parent at the hospital that the boy had a medical emergency at the park with a babysitter around 2:30 p.m. Matkovic said 2:30 p.m. Wednesday was a general time, but not specifically when it all happened.

Matkovic said his nanny called him twice when the incident occurred, but could not provide exact times two months later. He previously said he arrived around 10 minutes after the calls, when paramedics were already there.

It’s not clear when the investigation will conclude or whether it will answer some of the lingering questions about the incident.

Kuzma, as a first responder, said he is grateful for the attention on the fentanyl crisis ravaging the city.

“It’s been a rough couple of years,” he said.

Mallory Moench is a San Francisco Chronicle staff writer. Email: mallory.moench@sfchronicle.com