Staffing crisis forces Syracuse hospitals to turn away thousands

SYRACUSE — William “Bucky” Smith languished in an Oswego Hospital bed for 42 days this summer, waiting to be transferred to a bigger hospital with specialists who could replace his infected pacemaker.

St. Joseph’s in Syracuse, where Smith previously had heart valve surgery and a pacemaker implant, refused to take him. Its beds were full.

Oswego Hospital tried to send the 75-year-old man from Mexico, N.Y., to hospitals in Westchester County, 279 miles away, and Albany, 174 miles away. But no beds were available.

Finally, on Aug. 31, Oswego Hospital found Smith a bed at Ellis Hospital in Schenectady, a 130-mile ambulance ride.

Smith, a retired Nine Mile Point nuclear plant worker, was shocked by the long wait.

“I feel like I slipped through the cracks,” he said.

Syracuse’s three hospitals are turning away thousands of patients like Smith who need specialized care that is unavailable in smaller outlying hospitals. Many of them are being shipped to hospitals hundreds of miles away.

Those long-distance ambulance trips are just one symptom of the ongoing severe shortage of medical staff at Syracuse hospitals.

There are not enough nurses to care for patients like Smith — and thousands of other Central New Yorkers. Fewer nurses mean fewer beds.

Syracuse has lost one out of every five hospital beds since the COVID-19 pandemic began.

The total number of staffed beds at Syracuse hospitals dropped from about 1,229 in March 2020 at the start of the pandemic to 999 on Sept. 22. That’s a decline of 230, or nearly 20%.

Central New York’s hospitals have a lower rate of available beds than anywhere else in the state, according to state data.

In recent weeks, only 7% of staffed beds were available at Syracuse’s three hospitals — far less than the statewide average of 21%.

The lack of nurses and open beds is wreaking havoc on Syracuse’s health care system. People wait hours for care in the city’s four emergency rooms. The ERs are temporarily closing their doors to ambulances more often than ever. Some patients who need non-emergency care such as hernia repair or weight-loss surgery encounter delays.

And thousands of patients in outlying hospitals who need specialized care are being shipped to Buffalo, Westchester County or even Pennsylvania because there’s not enough room here.

Upstate, Syracuse’s biggest hospital system, expects to turn away about 8,500 transfer patients this year, the most ever.

“This is like a slow-moving natural disaster, and it’s going to last longer than any of us really want,” said Dr. William Paolo, Upstate’s head of emergency medicine.

The bottleneck affects all patients who rely on the city’s hospitals whether they live in Syracuse or outlying areas of Central and Northern New York.

Many transfer patients being turned away by Syracuse hospitals are rural residents who tend to be in worse health and are more likely to die.

Any delays in care can make them sicker and more costly to treat, said Shannon Monnat, a Syracuse University rural sociologist and population health expert.

“This is terrifying and an example of the complete failure of the U.S. health care system,” Monnat said.

Upstate needs 600 more nurses

The hospital staffing shortage got worse during the COVID-19 pandemic when many workers quit or retired after getting burned out. Hospitals also had to fire some workers who refused to get state-mandated Covid-19 vaccinations.

Even though the pandemic has eased, the staffing shortage persists.

The nursing shortage is not unique to Central New York. It’s affecting hospitals and nursing homes across the state and nationwide.

Here, the shortage is most severe at Upstate, Syracuse’s biggest and most critical hospital system that serves a 19-county region.

Upstate has more than 1,000 job openings, about 600 of them for nurses. Upstate’s total employment is 6,219.

That means about 15% of Upstate’s jobs are vacant.

It is so short-handed the federal government sent two disaster medical assistance teams of doctors, nurses and other staff to Upstate in January to help out in its ER and other areas of the hospital.

About 17% of registered nurse and employed doctor positions at hospitals across Upstate New York are vacant, according to a recent survey by the Iroquois Healthcare Association, a hospital trade group.

Longer ER waits for all

The fallout from the staffed bed shortage is most conspicuous in overcrowded Syracuse hospital emergency rooms.

“We’re seeing angrier patients who are waiting longer than ever,” said Paolo of Upstate.

The city’s ERs frequently are temporarily closing their doors at record levels to patients arriving by ambulance. The hospitals don’t have enough staffed beds available upstairs for those who need to be admitted.

Because Upstate is the region’s level 1 trauma center, it never turns away trauma patients such as car crash victims. It also does not refuse stroke patients, burn patients or pediatric patients. And all ERs will take walk-in patients, no matter how jammed their beds are.

But when a Syracuse hospital temporarily closes its doors to ambulance patients, a process known as “diversion,” ambulances take them to another ER in the city that’s not full.

When all the ERs are full and go on diversion simultaneously, which happens frequently, most ambulance patients are distributed among the city’s four ERs on a round-robin basis.

Each of the city’s ERs averaged 22 hours of diversion a day during July. That means each of the four were fully open to all ambulance patients just two hours a day.

The four ERs combined were on diversion 14,656 hours from January through August, according to the Hospital Executive Council, a Syracuse hospital planning agency.

That’s 2½ times more diversion than occurred during the same period of 2021 and 6 ½ times more than during the same period in 2019 before the pandemic.

The amount of ambulance diversion at Syracuse hospitals has declined over the past two weeks.

911 calls and long road trips

Small rural ambulance services are struggling to meet the growing demand to transport patients long distances and simultaneously respond to local 911 calls.

They also are wrestling with staff shortages of their own.

Some critically ill Oswego patients destined for distant hospitals are flown by Mercy Flight or LifeNet.

But that’s not always an option because of weather conditions, said Joseph Provost of Menter Ambulance which serves Oswego County.

Menter recently bought a new ambulance designed for long-haul trips.

The vehicle is equipped with a portable ventilator, extra oxygen and a specialized stretcher. Four Menter paramedics assigned to these trips have received extra critical care training.

Madison County emergency medical service providers don’t have enough staff to keep up with local calls, never mind long distance transfers, said Jenna Rosky, Madison County’s EMS coordinator.

“When you put long-distance transfers on top of that, it’s taking a toll on our system,” Rosky said.

‘I worry they’re getting insufficient care’

Traveling out of town is inconvenient for patients.

The patients feel isolated from friends and family while they battle serious conditions. Long-distance transfers are a hassle for patients’ families.

“It’s taking a toll on them, even more so than the patients, because they have to drive so far to see their loved ones and talk to their doctors,” said Jenna Rosky, Madison County’s emergency services coordinator.

Upstate turned away nearly 6,000 transfers in 2021, about three times more than in 2019 before the pandemic began. This year Upstate expects to turn away about 8,500. Crouse and St. Joe’s refused to say how many transfers they have turned away.

Dr. Robert Corona, CEO of Upstate, Syracuse’s biggest hospital system, is concerned about patients who are turned away.

“We really try to take everybody we possibly can,” Corona said. “But sometimes they get stuck in these small hospitals that don’t have same level of trained specialists that we do. I worry they’re getting insufficient care.”

Small outlying hospitals don’t have as many physician specialists as they used to, said Tom Dennison, a retired Syracuse University professor and health care expert.

That’s why they need to send more patients who need specialized care to larger hospitals in Syracuse, he said.

“There’s just a constellation of things coming home to haunt us,” Dennison said.

Statewide hunt for a hospital bed

When Oswego Hospital is unable to get patients transferred to Syracuse it often sends them far afield to hospitals in Buffalo, Cooperstown, Binghamton, Albany, Schenectady and even Westchester Medical Center in Valhalla.

Dr. Duane Tull, Oswego’s chief medical officer, said his hospital’s case managers regularly call other hospitals around the state to see if they have beds. They also sometimes call the state Health Department for help, but even the state cannot always quickly find an available bed, he said.

Over the past year Oneida Hospital has sent some patients to Westchester County, Ulster County and Sayre, Pa.

Kevin Prosser, an Oneida spokesman, said the hospital has arranged more helicopter medical transfers over the past year for patients too unstable for long ambulance rides.

Westchester Medical Center in Valhalla has been getting an average of 60 patient transfers a month from Central and Northern New York hospitals since November. It accepts about 10,000 patient transfers annually from hospitals outside of its territory.

There are no quick fixes for the gridlock at Syracuse hospitals, experts say.

Upstate recently reorganized the ER at its hospital near downtown to speed up care for patients with minor health problems and get them out the door quicker.

The hospital also is working to keep patients out of its ER by making sure they have primary care doctors in the community to provide routine care.

During the pandemic the state Health Department created a “surge and flex” program to help coordinate care among hospitals with limited bed capacity. That program helps some of the small hospitals in Central and Northern New York find hospitals across the state that will accept transfers patients who need higher levels of care.

Gov. Kathleen C. Hochul has pledged to increase the state’s health-care workforce by 20% over the next five years.

The state budget approved earlier this year included $1.2 billion for health care worker bonuses, $3.9 billion to help struggling hospitals and $2.5 million to repay students loans for nurses who agree to work in underserved areas for at least three years to address the state’s nursing shortage.

“The bottom line is we need a lot more health care providers,” said Monnat of SU. “But we also need to do a better job of preventing the types of diseases that lead to premature death.”

‘I felt like a prisoner’

William “Bucky” Smith’s problems began when he developed an infection following surgery June 7 at Oswego Hospital to remove a bladder tumor.

He was prescribed antibiotic pills, but they did not clear up the infection which spread to Smith’s knees. His knee pain got so bad he had trouble standing.

He was admitted to Oswego Hospital on July 21, where he got knee surgery to address the infection.

A sonogram showed the infection had spread to the wires of his pacemaker. Oswego couldn’t replace Smith’s pacemaker. It wanted to transfer Smith to St. Joe’s, which specializes in cardiac care, but the Syracuse hospital did not have a bed available.

In the meantime, Oswego put Smith on intravenous antibiotics to stabilize his condition. Doing that, perversely, made it harder to transfer him. That’s because the sickest patients awaiting transfers get top priority.

Dr. Duane Tull, Oswego’s chief medical officer, said some hospitals in other parts of the state agreed to take Smith, but then canceled their offers after sicker patients arrived in their ERs.

“It was very frustrating for our staff and also for Mr. Smith and his family as this continuously happened as these hospitals had to prioritize patients based on their severity of illness,” Tull said.

Smith’s wife, Nancy, said it was frustrating to see her husband get his hopes up, then have them dashed.

St. Joe’s refused to discuss Smith’s case or explain why it would not take him.

“While we strive to accept all transfers in need of a higher level of care, there are some rare instances where complicating factors preclude us from doing so,” Meredith Price, St. Joe’s senior vice president, said in a prepared statement.

Doctors at Ellis Hospital discovered one of Smith’s heart valves also was infected. He underwent open heart surgery Sept. 7 to get that valve replaced.

They were going to replace the pacemaker, but discovered after taking it out Smith’s heart rate was stable and he no longer needed it.

Smith is now getting critical care rehabilitation at a rehab hospital next door to Ellis. His wife has visited him regularly because she’s staying with a friend who lives close by. Many other transferred patients recuperate far from home with few visitors, experts say.

He was scheduled to go home Friday after being hospitalized more than two months.

Smith said he got good care in Oswego Hospital, but being stranded there for 42 days was exasperating.

“I felt like a prisoner,” he said.