12-24 hour waits, patient walkouts plague N.Y. city’s EDs

News investigation finds that Syracuse hospital emergency departments have wait times high above the national average

September 28, 2023 08:38 AM

By James T. Mulder
syracuse.com

SYRACUSE, N.Y. — Michael Carapella expected to get care quickly last summer when he went to St. Joseph’s Hospital emergency room with chest pain.

Just eight days before, St. Joe’s doctors had propped open Carapella’s right coronary artery with two stents after he suffered a heart attack. He was scheduled for open heart surgery in late September to fix the other clogged artery.

Instead of quick care, the 67-year-old man and his wife had to hunker down for more than 12 hours in the ER waiting room alongside people who were coughing, bleeding, vomiting or appeared drunk.

Finally, around midnight, Carapella was moved to St. Joe’s cardiac unit where three more stents were inserted into his left artery.

“I pray every day that we will never have to return to the emergency room,” said Beatrice Smith, Carapella’s wife.

Syracuse hospital ERs are in crisis. They’ve become parking lots of sorts for patients.

Thousands of emergency patients here waited for hours last year before giving up and leaving without being treated.

Others who needed to be admitted waited even longer – sometimes days – on gurneys or in hallways because no beds were available for them elsewhere in the hospital.

The overcrowded waiting rooms and hallways get filthy. Neither the medical staff nor the janitors can keep up. The waits are so long, some patients sleep on ER waiting room floors. Others are stuck in wheelchairs for hours, according to dozens of families who shared their experiences with syracuse.com | The Post-Standard.

These emergency room horrors are happening nationwide. But here, it’s far worse, syracuse.com found.

It took 10 hours for the average patient to get care last year at Syracuse’s busiest ER at Upstate University Hospital downtown. That’s about three times worse than the national average.

The waits were so long that about 16% of Upstate’s ER patients walked out before they could get care. The national rate is about 3%.

About 55 people a day, or 10% of patients, walked out of Syracuse’s four ERs last year without being treated, a syracuse.com analysis found.

Most walked out of Upstate University Hospital, the region’s trauma center. There, 1 out of every 6 ER patients left before being seen. That comes close to matching the hardest-hit hospitals in the nation, according to an expert tracking the ER crisis.

Those who wait often find little dignity.

These stranded patients occupy ER beds or are relegated to gurneys or recliner chairs in hallways for hours or days until beds open up on hospital floors. While they are in limbo, these patients have little privacy.

One patient with a broken leg who spent more than 24 hours on a gurney in an Upstate ER hallway in December told syracuse.com he had to urinate in a plastic bottle while visitors and other non-medical personnel passed by.

Healthcare leaders acknowledge the profound problem, a glaring symptom of a hospital system that’s been broken by a severe shortage of nurses and other staff. The harried ER doctors and nurses caring for patients are often overwhelmed.

Worst of all, the gridlock can be dangerous and even deadly for patients.

That limbo between the ER and moving to a regular hospital room – called “boarding” among health care providers – should not exceed four hours, according to accreditation guidelines.

But at St. Joe’s the average boarding time last year was 21 hours – nearly triple the national average among comparable hospitals, syracuse.com found. Upstate University Hospital’s average boarding time was 12 hours, nearly twice as long as the U.S. average.

Those are the ones who got care. In Syracuse last year, more than 20,000 people who arrived at Syracuse ERs with a medical emergency finally gave up and left without being treated by a doctor or other health provider.

Most of those patients – 17,312 – walked out of Upstate’s ERs in downtown Syracuse and at Community Hospital on Onondaga Hill.

“Those numbers are horrific,” said Dr. William Paolo, Upstate’s head of emergency medicine. “They indicate the emergency department system is failing to be available for the people that need it.”

About 5%, or 2,633, of ER patients at St. Joe’s and about 1%, or 512, at Crouse also left without being seen last year.

To shed more light on the crisis, syracuse.com asked readers to share details of their recent ER experiences. Forty-six readers responded.

Some described the ERs as chaotic, MASH-like combat medical units operating in disaster mode. A few said they got in and out of ERs at Upstate, St. Joe’s and Crouse relatively quickly and got excellent care.

One woman said she watched the sun rise and set while sitting in a wheelchair in an ER waiting room for 18 hours.

Desperation and worry in the waiting room

ERs triage incoming patients, a process designed to determine the severity of their condition. The sickest patients are supposed to be seen first, even if other patients with less serious problems have been waiting longer.

Average ER patient stays were nearly 10 hours at Upstate downtown, 7 hours at Upstate Community Hospital, 6 hours at St. Joe’s and 3 ½ hours at Crouse. Those are all higher than the average national ER stay – 3 hours and 22 minutes.

Of course, some patients’ ER visits lasted much longer.

Jason Good was shocked and scared when an urgent care center doctor told him last summer to go to Upstate’s downtown ER immediately because he might have appendicitis.

“I was really worried,” said Good, 43, of Fayetteville.

Good arrived at the Upstate ER at about 5 p.m. Aug. 20 and waited about 16 hours before a doctor and nurse took care of him.

When he got to the ER there were at least 20 people in the waiting room, some of whom had been waiting 10 hours.

Good said that once he got to see an ER doctor and nurse, the care was fantastic.

Tests showed he did not have appendicitis. It turned out he had a parasite infection that can be caused by contaminated water.

Abigail Grovine was unhappy with her experience at Upstate’s downtown ER on Feb. 4, 2022.

Grovine, 34, of North Syracuse, got dehydrated after a severe migraine headache left her vomiting for about 20 hours.

She called an ambulance. When Grovine arrived at about 1 p.m., she was taken to the ER waiting room that she said was filled with about 30 patients.

Grovine said she lay on a bench in the waiting room. Several times she had to cover her head with a blanket and vomit in a bag because the restrooms were occupied by other patients, she said.

“It was the worst experience I ever had,” Grovine said.

Her husband came to the ER and kept giving her sips of Gatorade. After waiting 10 hours, Grovine left and went home.

Leaving ERs without being seen can be deadly

Dr. Alex Janke, an emergency medicine doctor and Yale medical school researcher, said leaving ERs without being seen can be dangerous and deadly.

That’s because patients often don’t know how seriously ill they are, he said.

Parents who take a child with a bellyache to the ER, for example, may leave after a long wait if the child isn’t running a fever, according to Janke. But that decision can prove disastrous if it turns out the kid has appendicitis, he said.

The same holds true for a woman whose potentially ectopic pregnancy goes undiagnosed because she left an ER after waiting 12 hours, he said.

Paolo of Upstate calls the large number of people leaving his hospital’s ERs without receiving care “a drastic cause for concern.”

He said emergency room staff are trained to determine what is and is not an emergency,

“We want everybody to be able to be seen,” he said.

Blood on the floor. Bathroom disgusting.

Some readers complained about dirty conditions at Syracuse ERs.

They reported seeing blood splattered and dirty tissues on the floors and in the bathrooms in Upstate’s ERs downtown and at Community Hospital.

A patient provided this description of St. Joe’s ER after a recent visit:

“Waiting room filthy. Garbage all over. Discarded masks. Soiled blankets. Bathroom disgusting.”

Here’s how another patient described Upstate’s downtown ER:

“It is an awful environment. Quite sad. Dirty. Smells. Blood on the floor. Despite the conditions, staff were wonderful and warm.”

Dr. Philip Falcone, St. Joe’s chief medical officer, said the hospital has a janitorial crew dedicated to keeping the ER clean.

“Sometimes you have bad days when it’s extremely busy,” Falcone said. “You may see the level of cleanliness is not as high as you’d like it to be.”

Upstate spokesman Darryl Geddes said Upstate is committed to providing patients a clean and safe environment but acknowledged the volume of patients makes that challenging.

A 3-day stay in the emergency room

Michael O’Brien, 57, of Houston was visiting relatives in Oswego when he started having a hard time breathing.

He went to the ER at St. Joe’s at about 7 p.m. Oct. 8 and didn’t leave for three days.

O’Brien was given oxygen and told to take a seat in the waiting room where he languished for 24 hours.

He then spent most of the next two days in a recliner in an ER hallway waiting for a hospital bed that never became available.

O’Brien said he was shocked by the number of patients waiting for beds who were lying on gurneys in the ER’s hallways.

He said it reminded him of photos he saw during the height of the Covid pandemic: patients crammed into New York City hospitals.

O’Brien said there was no privacy, and it was difficult for patients who needed attention to get the attention of nurses. He said the staff was overwhelmed.

“You heard every conversation that was going on,” he said. “There was a guy across from me having a heart attack. And there was a woman who tried to get out of bed and pull all her IVs out.”

O’Brien was diagnosed with a lung infection and treated with steroids. After three days, he left the ER, he said.

David King of Tully spent more than 24 hours on a gurney in the hallway of Upstate’s ER after he slipped on ice and broke his leg Dec. 21.

King said he got great care, but the hallway accommodations left a lot to be desired.

King said he had to relieve himself in a plastic container under a bed sheet while a parade of visitors, contractors wearing hard hats and other non-medical personnel walked by.

“It was a little demoralizing,” King said.

King was shocked when he got his hospital bill that showed Upstate charged him for a semi-private room during the 24 hours he spent on a gurney in the ER hallway.

He filed a complaint, but Upstate refused to reduce the charge.

“While we apologize that a semiprivate room was not readily available, we have been assured that this did not alter the services rendered during your stay, or the resulting charges,” Upstate’s office of patient relations told King in a letter.

Boarding patients in ERs leads to mistakes in care

The Joint Commission, a hospital accreditation agency, says boarding of admitted patients in ERs should not exceed four hours because of patient safety risks.

The four-hour threshold is merely a guideline. Hospitals are not penalized for boarding patients longer than four hours.

Average ER boarding times at Syracuse hospitals last year were 21 hours at St. Joe’s, 12 hours at Upstate and four hours at Crouse.

The federal government does not track ER boarding time data.

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But a recent study by Janke, the Yale doctor, found the nation’s median ER boarding time was 6.58 hours in 2020 and 2021 at hospitals where more than 85% of inpatient beds were occupied. Syracuse’s hospitals are even fuller than that, state data shows.

That’s why the boarding time at St. Joe’s, for example, is nearly 3 times longer than the national average.

“My read is that SUNY Upstate and St Joseph’s are among the harder-hit hospitals,” Janke said.

Boarding is not a new problem in ERs, but it has gotten much worse in recent years as the Covid pandemic exacerbated the nursing shortage.

Patients boarded in ERs for long periods of time are more likely to be given the wrong medications and experience delays in care, diagnostic errors and other problems, according to Janke.

Upstate’s Paolo agreed. “An emergency department bed should only be a temporary way station,” he said.

Upstate’s downtown ER has 40 beds intended for incoming emergency patients. It’s not unusual for 25 to 30 of those beds to be occupied by boarders.

St Joe’s ER has 54 beds. On any given day there can be 40 to 60 boarders in the ER waiting for a hospital room, Dr. Falcone said.

Upstate and St. Joe’s have been operating at 100% occupancy lately. That means boarding patients must wait for other patients to leave before moving upstairs.

“We see a lot of patients coming through our doors, and we care for all of them as best we can,” Falcone said. “But we can’t always get people out of the emergency department and into a bed in the hospital as quickly as we’d like to.”

The American College of Emergency Physicians and other doctors’ groups recently asked President Joe Biden to address the ER boarding problem. In a letter, the doctors’ groups called ER boarding a public health emergency.

“Our nation’s safety net is on the verge of breaking beyond repair,” the doctors said in the letter.

A former nurse’s ‘dangerous and neglectful’ ER visit

Kathleen Phillips, 81, of Manlius, went to the ER at St. Joe’s on Aug. 26 after she fell at home and was unable to get up on her own.

Phillips, a retired nurse who used to teach in St. Joe’s nursing school, said before the fall she experienced frequent bouts of stomach pain and diarrhea, weight loss, weakness and dizziness for several weeks.

A friend who lives with Phillips drove her to St. Joe’s and used a wheelchair to get her into the ER at about 6 a.m.

Phillips said the care she got there was “dangerous and neglectful.”

About 10 minutes after Phillips arrived, a triage nurse took Phillips’ vital signs which showed she had a fever, low blood pressure and a fast heart rate.

Staff also conducted some diagnostic tests, then sent Phillips back to the waiting room.

Phillips said she was offered ice water once during the day by a chaplain.

She got so uncomfortable sitting in the waiting room she lay on the floor on top of a blanket.

Staff got her off the floor, put her in a wheelchair and moved her into an alcove near the ER nurses’ station where she was later put on a gurney at about 6 p.m.

Phillips said she almost fell off the gurney because no one raised the side bedrail.

Phillips said she was transferred by ambulance to Upstate Community Hospital at about 1 a.m. because St. Joe’s staff determined she needed an upper endoscopy test no one was available to perform at St. Joe’s.

Phillips said the staff at Community quickly determined her biggest problem was a bad infection bordering on sepsis that was not picked up in testing done at St. Joe’s. Staff at Community put her on intravenous antibiotics until she was well enough to go home Aug. 30.

“As miserable as I was I ended up OK,” Phillips said. “I’m a lot more concerned about everybody else, the other little old ladies like me who are not going to get the care they need.”

People sleeping on ER waiting room floor, coughing and crying

Alexandra Merante loved the care she got at St. Joe’s ER but hated the waiting room.

Merante, 34, of Syracuse, went to the ER after shattering her left shoulder in an electric scooter crash in Armory Square.

She sat in the ER waiting room from 10:30 p.m. until 7 a.m. The waiting room was packed with very sick people and some homeless folks she regularly sees in downtown Syracuse.

“People were sleeping on the floor, coughing and crying,” Merante said. “It was really heartbreaking.”

She couldn’t sleep because of the pain and the commotion going on in the waiting room.

“You had to stay alert in case there was any violence and you had to get out of there quickly,” she said.

Things dramatically improved for Merante when it was her turn to leave the waiting room and get care from the ER doctors and nurses. They gave her pain medication and referred her to orthopedic doctors for outpatient surgery.

“They were so gentle and kind,” Merante said. “I went from being treated like a criminal to being treated like a queen.”

A doctor’s plea for an ER patient with chest pain

As Michael Carapella sat in St. Joe’s ER waiting room worrying about having another heart attack he talked by phone several times with his regular cardiologist.

Carapella, of DeWitt, said his cardiologist kept asking if he had been seen yet or moved to a room.

He said his doctor finally called the ER staff about 11 p.m. and pleaded with them to see his patient.

Shortly after that call Carapella said he was taken into the ER treatment area for testing, then moved to the cardiac unit in about 45 minutes.

Carapella said once he got into a room the care by doctors and other staff was good.

The silver lining to Carapella’s harrowing day came when he learned the three stents they put into his left artery eliminated the need for his scheduled bypass surgery.

Beatrice Smith, Carapella’s wife, is still miffed he had to wait so long.

“For God’s sake, he had just had a heart attack,” she said.