It began with a slight change of gait.
“I put my foot on the floor, and it felt weird — like my brain wasn’t telling my foot what was happening,” Marisa recounted.
As a 63-year-old cancer survivor, she knew enough to err on the safe side. So, on her nurse’s advice to go to the hospital where she’d been treated by oncologists, she drove from her home in the East Bay over the Bay Bridge and through San Francisco to the emergency department at UCSF Parnassus in the Inner Sunset.
Then she waited, and waited, as her left leg grew weaker.
Seven hours passed before they moved her from the lobby to a bed with only a curtain separating her from the packed corridor. Night turned to morning. Thirteen hours.
By that point, “my balance is getting worse,” said Marisa, who asked to go by just her middle name for privacy. “I use one of those metal walkers, trying to move and up and down the hallway, thinking, ‘I’d better use it or lose it.’”
She talked to her spouse, who was at home with their two young daughters — they planned to visit once she got admitted. Marisa shuffled to a courtyard to breathe some fresh air. The numbness in her left leg spread to her right. After 28 hours, she was whisked away for an MRI.
By the end of Feb. 8, her second day in the emergency wing, she was immobilized in a hallway bustling with nurses rushing to tend to dozens of patients. She summoned the effort to stand, if only to prove that she could. It was the last time she ever did. A nurse guided her back to the bed and set an alarm to prevent her from trying to get up.
“I’m more trapped,” Marisa said, sobbing. “I’m more paralyzed, I’m trying to keep in contact with my community, and I’m laying there in this corridor with no results back from my fucking tests.”
Another day slipped by, until at 11 p.m. on Feb. 9, she was ushered into a spacious room of her own on the seventh floor.
Fifty-two hours after she walked into the ER, she was finally seen by a doctor. By then she could no longer walk at all.
Hurry up and wait
The problem of patients spending hours, even days, in the ER is hardly unique to UCSF but is especially remarkable for one of the nation’s most prestigious hospitals, in one of its wealthiest cities.
In California, emergency visits rose by 7.4% in the decade leading up to 2021, as the number of ERs fell by nearly 4%, according to a landmark 2023 study of state healthcare and federal census data. The study also found that high-severity visits in the state rose by 68%, while low-severity intakes fell by 63%.
The disparity between demand and capacity has only worsened in the years since. At UCSF, it has become a focal point in labor negotiations as thousands of workers strike to demand higher pay amid what they call a systemic staffing shortfall that endangers patients.
“Fifty hours is long, but not crazy-long compared to what I’ve seen,” said Kacie Cooke, a member of the University Professional and Technical Employees who has worked as a physician assistant at the UCSF emergency department for four years. “There are people who wait anywhere from 60 to 70 to 90 hours for an inpatient bed.”
That doesn’t mean they’re not getting care in the meantime, she added: Nurses, assistants, and residents initiate care, but it’s often not the level needed.
At a little more than four hours, UCSF’s emergency wait times exceed the national average of three hours and 18 minutes, according to the federal Centers for Medicare & Medicaid Services. The Parnassus ER has more than double the national average of patients leaving without seeing a doctor: thousands of the 60,000-plus people who visit each year depart without being treated.
UCSF’s average length of patient stay — in all departments — outpaces that of the state, shooting up by 40% in the past five years.
Despite heightened demand fueling staggering wait times, UCSF has cut ER staff in recent years, according to financial reports the hospital submitted to state regulators.
UCSF Health didn’t respond to requests for comment. A spokesperson for the statewide UC system’s Office of the President disputed union claims of short-staffing at UCSF and other campuses.
“There is no staffing crisis at UC,” Heather Hansen said in an email. Further, she added, headcounts at the UPTE and AFSCME unions are “increasing, separations are declining, and turnover is flattening.”
Labor organizers say that contradicts statements UC officials have made among themselves. At a 2023 Board of Regents meeting, UC CFO Nathan Brostrom described systemwide job vacancy rates as three times higher than prepandemic levels.
While UC leaders acknowledge difficulties hiring people at current pay rates, the number of senior executive leaders — CEOs, supervisors, and other high-ranking administrators — grew by more than 42%, state data show, while frontline staff expanded by just under 19%.
Perhaps nowhere in the UC system is the strain felt more acutely than in hospital emergency departments, which are taking longer to unload patients from ambulances, if they don’t turn them away entirely, and leaving people to wait longer in the ER.
“I think it’s a pretty systemic issue,” said Cooke, who has worked in hospitals in several states over her 15-plus-year career. “But we feel the effects of short-staffing in emergency departments the most because everything sort of trickles down to us. If inpatients aren’t discharged in a timely manner, then those beds don’t open up, so the ER just becomes this collection point.”
Some ERs more than others, as 48-year-old cancer scientist-turned-cancer patient Marie Lee came to find out after two recent visits: one with a seven-hour wait at Parnassus and another with virtually none at UCSF Health’s recently acquired St. Mary’s Hospital.
“Cancer patients are treated really, really well at UCSF. It’s just that common sense goes out the window in the ER,” she said. “If somebody comes in and says they’re a cancer patient or losing sensation in their limbs, from my knowledge of science, you know they’re immunocompromised and need immediate care.”
She calls St. Mary’s Hospital’s emergency wing “the best-kept-secret ER” in the city and worries that wait times might worsen now that it’s under the aegis of UCSF.
“They’re spending all this money on cancer care, but part of that includes emergency services — especially for patients when they first start chemo,” she said. “You can read all of the texts that say you’re going to get fatigued, get mouth sores, and feel all this discomfort, but sometimes it hits you really hard, and you have an infection, and you do end up in the ER. And when we do, we need help right away.”
‘I can’t dwell on it’
Seeing a neurologist sooner, rather than after a 52-hour wait, might not have prevented Marisa’s paralysis. But she couldn’t help but wonder.
“I can’t dwell on it,” she said.
Still, she’s hopeful, despite the prognosis that came weeks into her hospital stay: multiple myeloma. She beat the same cancer when it showed up in her plasma a few years ago, and though it “returned with a vengeance” in her spine and brain, she’s determined to recover again.
Though she feels it took longer than it should have to see a specialist after checking into the ER last month, she knows she’s in the right place, she says.
In her hospital room, alongside cards wishing her well and a whiteboard message exhorting her to be “a bad bitch,” are signs supporting striking UC workers.
“I’m thanking everybody — the doctors, the nurses, the people who mop the floor and take out the garbage, and the person who brings me coffee,” she said. “I want them to have hope, too.”