Syracuse, NY – The baby boy came into Upstate University Hospital’s emergency room screaming and struggling to breathe.
“A very sick baby coming in,” the intercom crackled. He needed to get to the fourth-floor children’s ER, five minutes away.
A nurse rushed him toward the elevator, past areas packed with sick adults. More patients lined the hallways.
Then the baby stopped crying. He stopped breathing. His face began turning purple. “Oh, I can’t look,” his mother said.
Out of time, the staff changed course. They wheeled him back through the maze of patients, into an adult trauma space. Two adults needing urgent care had to be moved to make room.
The baby’s distress – and the obstacle course to get help – unfolded in the ER on a routine Friday afternoon in February witnessed by syracuse.com. It’s a scenario that plays out frequently at the region’s top trauma center, officials said.
Upstate University Hospital’s leaders are seeking hundreds of millions in taxpayer money for a bigger adult emergency room and other upgrades. If built, it would be the most expensive project in the 60-year-old hospital’s history. The project would also allow the children’s ER to be moved downstairs, with direct access to ambulances.
There’s no question that Upstate’s ER staff offers the most advanced care for the region’s sickest. But it often does so at the expense of the dignity of some patients.
Because the ER is so overcrowded and outdated, stabilized patients languish on hallway gurneys or slumped over chairs for hours. In extreme cases, they wait days for attention in the ER or a room upstairs.
Thousands just leave without being seen. Last year, 1 in 7 patients left the adult ER without getting care.
The way nurses pivoted in seconds to help the baby is a testament to the skill needed to work at Central New York’s only Level 1 trauma center. But it’s also an indictment of the physical conditions at the region’s most important ER, where urgent cases come – by car, ambulance and helicopter — from across 14 counties.
So far, Gov. Kathy Hochul has budgeted $200 million this year for the ER project, less than half of what Upstate leaders say they need. Still, that would be the single largest capital investment in the public teaching hospital’s history, Upstate Medical University President Dr. Mantosh Dewan said.
Upstate’s chief emergency doctor, William Paolo, called the current 30,000-square-foot facility too outdated and too poorly laid out to serve the region’s urgent cases.
“It’s as bad as it gets,” Paolo said.
Unacceptable conditions
Upstate’s adult ER is overwhelmed every day, routinely treating three times more patients than it has permanent beds. The hallways are cluttered and chaotic, with patients and their families crowded on top of each other.
Handcuffed prisoners and their guards share hallway space with elderly too weak to stay awake and drug users detoxing under the glare of fluorescent lights. Ambulances queue up in the entrance bays, sometimes waiting for hours to offload their patients and return to service.
Angry or mentally unstable patients routinely lose control in such a high-stress environment. One smashed a Plexiglas window recently with a staff member directly behind it. Another took out their revenge on the metal detector.
“It’s terrifying,” said Michelle Zoanetti, the hospital’s emergency department nursing director.
There are 31 adult beds in rooms beyond the waiting area. Yet 80 to 90 people are receiving care at once during the peak around 4 p.m. daily, hospital officials say. The rest are forced to take a spot along a hallway.
In Upstate’s ER, days are filled with judgment calls and chain reactions.
The sickest, like the baby boy, are always first in line. Everyone else gets treated in order of severity. Minor injuries come last. Seven thousand people walked away last year before getting help.
“If you twist your ankle, you may never be seen,” Dewan said.
To get the baby into a trauma room, two adults were shoehorned into other patient bays. That pushed others into the hallway, the parking lot for stabilized patients.
The wait along an Upstate hallway can sometimes be measured in days. The wait for ER patients to get a bed elsewhere in the hospital is averaging 17 hours a day, hospital CEO Dr. Robert Corona said. It’s roughly three hours in the average U.S. hospital, according to the latest federal data.
Overcrowding has become so routine that the hallways are equipped with call bells.
Zoanetti, who started working in the ER a dozen years ago, can’t recall the last time the adult ER had an open patient bay.
Each shift spends half the time managing the cramped space: rearranging patients in and out of rooms and hallways in what Zoanetti likened to a grim game of Tetris.
About 50 people staff Upstate’s adult ER at any given time. That’s 12 doctors, 20 registered nurses and more than a dozen support staff. There are 180 total dedicated adult ER staff.
Most of their 50,000 patients last year came in with typical problems. But 4,500 were sent to Upstate under dire circumstances. Those patients get their own special team of providers.
These Level 1 trauma patients come from as far away as the Adirondacks and the Southern Tier. The ER saw 12 trauma patients a day in 2024, up 18% from the year before.
The team consists of a dozen trauma doctors, nurses, technicians and support staff, who are on stand-by 24 hours a day. That includes a neurosurgeon, cardiologist, orthopedic surgeon and general trauma surgeon. A backup team of trauma doctors is also available, in case of more than one trauma patient at a time.
For the most urgent patients, any delay in care is a problem. Navigating a cluttered ER or rushing a baby to the fourth floor costs precious seconds.
“We are a time-based specialty,” Paolo said.
Ultimately, the lack of space prevents doctors from providing timely and adequate care, said Corona, the hospital CEO.
“I just find that unacceptable,” he said.
‘It’s not OK. It’s not OK’
Upstate officials point to the lack of dignity that surfaced in every corner of the ER.
Patients have to share intimate details with providers out in the open or behind thin curtains in shared rooms. Only 10 of the ER’s permanent 31 beds are in private rooms. That leaves 21 others with roommates and dozens more along hallway walls.
“You see these patients lining the hallway, with their business out in front of everyone,” Zoanetti said. “It’s just devastating.”
Some patients wait in chairs because there isn’t room for enough beds. Dewan noted one elderly woman slouched over, her underclothes exposed.
“If that was my mom, I’d be upset,” Dewan said. “It’s not OK. It’s not OK.”
He also noted the little details that get lost in the daily ER scramble. He saw bed railings that weren’t raised. What if someone rolled out of bed?
“Those little things worry me,” he said. “You can see the chaos.”
What does Upstate want?
Upstate leadership says there’s not enough space in the hospital for a bigger ER. Instead, Upstate Medical University officials are proposing building an annex across East Adams Street from the current space. An old academic tower there would be demolished.
It’s unclear what the new annex would look like, how big it would be or how much it would cost. The first $50 million will be dedicated to assessing exactly what Upstate needs, Dewan said.
Top of the wish list: Upstate would need to triple its adult ER beds to accommodate its traffic. Individual rooms with doors would restore dignity and comfort, Paolo said.
The current ER also has only one triage room – the place where thousands of walk-in patients each year are initially assessed. Having multiple triage rooms would speed up the process, Paolo said.
Same goes for the ER’s only negative-pressure room. That’s used to treat severe respiratory illness, such as Covid. The community needs multiple rooms, Paolo said.
There are four trauma beds in the current ER, where Upstate brings in emergencies from across a region of more than 1 million people. Two had to be cleared out to make way for the baby who couldn’t make it upstairs.
Ideally, Upstate might have up to 10 trauma beds in separate rooms. Modern hospital design allows such rooms to be used for trauma or general patient care, depending on need, Paolo said.
Moving the adult ER into a new building would also allow the pediatric ER to move downstairs. That would allow doctors to treat children right off ambulances. There would be no more rides to the fourth floor, like when the baby stopped breathing.
The new adult ER annex would also, ideally, have separate ambulance entrances. There would be one for trauma patients and another for everyone else.
The hospital has been sounding the alarm on its ER for more than a decade. But plans and proposals have come and gone, with little changing.
The last big reorganization came upon the opening of the Golisano Children’s Hospital in 2009. The pediatric ER was relocated from a corner of the adult ER up to the 4th floor, where the pediatric ward had been before.
Where do things stand?
Just before Christmas 2024, Central New York’s state delegation signed a bi-partisan letter in support of Upstate’s request for $450 million to build a new adult ER in an annex that would also include more operating rooms for ER patients and a new burn center.
The 10 legislators cited the fact that Upstate’s sister hospital in Brooklyn requested $450 million as part of a plan to transform the long-struggling safety-net institution. It’s too early to know if $450 million is enough for Upstate’s ER project, but it seemed only fair.
Hochul’s budget proposal set aside $450 million for Downstate, but only $200 million for Upstate. However, the governor toured Upstate’s ER in late January and left open the idea that Upstate could get more money during budget negotiations.
Nothing will be built this year. It will take several years for Upstate to study, design and build any new hospital annex, hospital officials said.
While hoping for more, Dewan noted that Hochul’s proposed $200 million is already the most for an Upstate project since the hospital opened in 1965. (The Golisano Children’s Hospital tower cost $150 million in 2009.)
“It’s a huge deal,” Dewan said. “We’re very grateful.”
‘It rattles me every time’
Staffers save lives in Upstate’s ER every day, despite the building’s bad layout.
“When you are having your worst day, we can do anything,” Paolo said. “We have great teams who are doing amazing jobs. As ever, it’s the space that lets us down.”
When the baby couldn’t make it upstairs, a team of pediatricians and nurses rushed down the elevators to meet the infant. Equipment came downstairs, too.
In a race against the clock, two dozen doctors, nurses and technicians crowded around the child in a trauma bay. He’d suffer brain damage after two minutes without breathing, Corona said.
The mother sat crumpled in a hallway chair. There was nowhere else to wait. Two staffers sat on the floor to comfort her. Cold air blew in from the ambulance doors as more patients came in.
Soon, the baby’s cries pierced the ER. The chief nurse was relieved: The baby could be stabilized from there.
He was moved upstairs to the Golisano Children’s Hospital, where he was treated and eventually able to go home.
Afterward, Dewan marveled at the staff’s composure. Staff rushing down from the 4th floor had even offered a quick “excuse me” as they passed.
“It rattles me every time when I come,” said Dewan, a trained psychiatrist. “But they are so calm, courteous and professional.”
Two hours after the baby’s arrival, his trauma room was clear. A worker remade the bed.
It was a brief lull until the next patient.
Staff writer Douglass Dowty can be reached at ddowty@syracuse.com or (315) 470-6070.
