By James T. Mulder
syracuse.com
SYRACUSE, N.Y. 鈥� Michael Carapella expected to get care quickly last summer when he went to St. Joseph鈥檚 Hospital emergency room with chest pain.
Just eight days before, St. Joe鈥檚 doctors had propped open Carapella鈥檚 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鈥檚 cardiac unit where three more stents were inserted into his left artery.
鈥淚 pray every day that we will never have to return to the emergency room,鈥� said Beatrice Smith, Carapella鈥檚 wife.
are in crisis. They鈥檝e 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 鈥� sometimes days 鈥� 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 | The Post-Standard.
These emergency room horrors are happening nationwide. But here, it鈥檚 far worse, found.
It took 10 hours for the average patient to get care last year at Syracuse鈥檚 busiest ER at Upstate University Hospital downtown. That鈥檚 about three times worse than the national average.
The waits were so long that about 16% of Upstate鈥檚 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鈥檚 four ERs last year without being treated, a analysis found.
Most walked out of Upstate University Hospital, the region鈥檚 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 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鈥檚 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 鈥� called 鈥渂oarding鈥� among health care providers 鈥� should not exceed four hours, according to accreditation guidelines.
But at St. Joe鈥檚 the average boarding time last year was 21 hours 鈥� nearly triple the national average among comparable hospitals, found. Upstate University Hospital鈥檚 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 鈥� 17,312 鈥� walked out of Upstate鈥檚 ERs in downtown Syracuse and at Community Hospital on Onondaga Hill.
鈥淭hose numbers are horrific,鈥� said Dr. William Paolo, Upstate鈥檚 head of emergency medicine. 鈥淭hey indicate the emergency department system is failing to be available for the people that need it.鈥�
About 5%, or 2,633, of ER patients at St. Joe鈥檚 and about 1%, or 512, at Crouse also left without being seen last year.
To shed more light on the crisis, 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鈥檚 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鈥檚 and 3 陆 hours at Crouse. Those are all higher than the average national ER stay 鈥� 3 hours and 22 minutes.
Of course, some patients鈥� 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鈥檚 downtown ER immediately because he might have appendicitis.
鈥淚 was really worried,鈥� 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鈥檚 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.
鈥淚t was the worst experience I ever had,鈥� 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鈥檚 because patients often don鈥檛 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鈥檛 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鈥檚 ERs without receiving care 鈥渁 drastic cause for concern.鈥�
He said emergency room staff are trained to determine what is and is not an emergency,
鈥淲e want everybody to be able to be seen,鈥� 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鈥檚 ERs downtown and at Community Hospital.
A patient provided this description of St. Joe鈥檚 ER after a recent visit:
鈥淲aiting room filthy. Garbage all over. Discarded masks. Soiled blankets. Bathroom disgusting.鈥�
Here鈥檚 how another patient described Upstate鈥檚 downtown ER:
鈥淚t is an awful environment. Quite sad. Dirty. Smells. Blood on the floor. Despite the conditions, staff were wonderful and warm.鈥�
Dr. Philip Falcone, St. Joe鈥檚 chief medical officer, said the hospital has a janitorial crew dedicated to keeping the ER clean.
鈥淪ometimes you have bad days when it鈥檚 extremely busy,鈥� Falcone said. 鈥淵ou may see the level of cleanliness is not as high as you鈥檇 like it to be.鈥�
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鈥橞rien, 57, of Houston was visiting relatives in Oswego when he started having a hard time breathing.
He went to the ER at St. Joe鈥檚 at about 7 p.m. Oct. 8 and didn鈥檛 leave for three days.
O鈥橞rien 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鈥橞rien said he was shocked by the number of patients waiting for beds who were lying on gurneys in the ER鈥檚 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鈥橞rien 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.
鈥淵ou heard every conversation that was going on,鈥� he said. 鈥淭here 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.鈥�
O鈥橞rien 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鈥檚 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.
鈥淚t was a little demoralizing,鈥� 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.
鈥淲hile 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,鈥� Upstate鈥檚 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鈥檚, 12 hours at Upstate and four hours at Crouse.
The federal government does not track ER boarding time data.
Steve Wirth and Doug Wolfberg join host Rob Lawrence to discuss strategies for overcoming hospital bed delays
But a recent study by Janke, the Yale doctor, found the nation鈥檚 median ER boarding time was 6.58 hours in 2020 and 2021 at hospitals where more than 85% of inpatient beds were occupied. Syracuse鈥檚 hospitals are even fuller than that, state data shows.
That鈥檚 why the boarding time at St. Joe鈥檚, for example, is nearly 3 times longer than the national average.
鈥淢y read is that SUNY Upstate and St Joseph鈥檚 are among the harder-hit hospitals,鈥� 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鈥檚 Paolo agreed. 鈥淎n emergency department bed should only be a temporary way station,鈥� he said.
Upstate鈥檚 downtown ER has 40 beds intended for incoming emergency patients. It鈥檚 not unusual for 25 to 30 of those beds to be occupied by boarders.
St Joe鈥檚 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鈥檚 have been operating at 100% occupancy lately. That means boarding patients must wait for other patients to leave before moving upstairs.
鈥淲e see a lot of patients coming through our doors, and we care for all of them as best we can,鈥� Falcone said. 鈥淏ut we can鈥檛 always get people out of the emergency department and into a bed in the hospital as quickly as we鈥檇 like to.鈥�
The American College of Emergency Physicians and other doctors鈥� groups recently asked President Joe Biden to address the ER boarding problem. In a , the doctors鈥� groups called ER boarding a public health emergency.
鈥淥ur nation鈥檚 safety net is on the verge of breaking beyond repair,鈥� the doctors said in the letter.
A former nurse鈥檚 鈥榙angerous and neglectful鈥� ER visit
Kathleen Phillips, 81, of Manlius, went to the ER at St. Joe鈥檚 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鈥檚 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鈥檚 and used a wheelchair to get her into the ER at about 6 a.m.
Phillips said the care she got there was 鈥渄angerous and neglectful.鈥�
About 10 minutes after Phillips arrived, a triage nurse took Phillips鈥� 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鈥� 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鈥檚 staff determined she needed an upper endoscopy test no one was available to perform at St. Joe鈥檚.
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鈥檚. Staff at Community put her on intravenous antibiotics until she was well enough to go home Aug. 30.
鈥淎s miserable as I was I ended up OK,鈥� Phillips said. 鈥淚鈥檓 a lot more concerned about everybody else, the other little old ladies like me who are not going to get the care they need.鈥�
People sleeping on ER waiting room floor, coughing and crying
Alexandra Merante loved the care she got at St. Joe鈥檚 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.
鈥淧eople were sleeping on the floor, coughing and crying,鈥� Merante said. 鈥淚t was really heartbreaking.鈥�
She couldn鈥檛 sleep because of the pain and the commotion going on in the waiting room.
鈥淵ou had to stay alert in case there was any violence and you had to get out of there quickly,鈥� 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.
鈥淭hey were so gentle and kind,鈥� Merante said. 鈥淚 went from being treated like a criminal to being treated like a queen.鈥�
A doctor鈥檚 plea for an ER patient with chest pain
As Michael Carapella sat in St. Joe鈥檚 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鈥檚 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鈥檚 wife, is still miffed he had to wait so long.
鈥淔or God鈥檚 sake, he had just had a heart attack,鈥� she said.
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