As nurses and doctors worked to resuscitate a man passed out on the linoleum floor of the UCSF Parnassus Medical Center waiting room, the words of a patient waiting to be seen pierced through: “We’re all going to die here.”
The man who fainted had come to the hospital, located between Mt. Sutro and Golden Gate Park, in the fall of 2025 after losing consciousness. It’s one of U.S. News’ 20 best hospitals in the nation. He thought he was in good hands.
A nurse evaluated him when he first arrived at the emergency room, according to multiple eyewitness accounts shared with Mission Local. He then waited for hours to be seen. When he finally stood up to tell the receptionist he was feeling worse, he fainted again. The doctors did not have a bed or room for him, so they treated him right there on the ground.
About two months ago, an elderly woman arrived at the same ER with a pulmonary embolism — a life-threatening blood clot in her lung — according to two providers. There were no rooms. She lay in a bed in the ER hallway for three days.
“She had no nurse assigned at first,” said one of her providers, who like others in this piece requested anonymity to discuss hospital matters. “She had urinary incontinence and had no privacy to be cleaned up in the middle of the hallway.”
These cases are not the only ones. Nine UCSF Parnassus emergency room providers told Mission Local that patients are suffering — and in some cases, dying — because the UCSF Parnassus ER does not have enough nurses or beds to monitor and treat everyone in a timely manner.
Over the last three years, staffing has been cut — but UCSF has begun running a surplus. The conditions, according to providers, have resulted in multiple preventable patient deaths.
“Because we don’t have enough staff, we don’t have the ability to monitor all our patients. We have found people literally dead in gurneys,” one provider said. “These are people who came into the ED [emergency department] walking and talking, and then basically have a cardiac arrest.”
These issues can happen at any ER, but the conditions at Parnassus are dire enough that providers are speaking out.
“The thing that’s been horrifying for us is that these patients have decompensated in front of us, and they have had preventable outcomes, including death, because they’re not being monitored,” the same provider said.
“UCSF Health takes every concern about patient safety seriously,” a spokesperson for the health system shared in a written statement sent to Mission Local. “We cannot comment on individual patient cases, but any report of patient harm is reviewed through our quality and safety processes so we can identify what happened, take appropriate action and make improvements.”
As for concerns about insufficient staffing, “the Parnassus ED is appropriately staffed,” the statement read.
Nurses, doctors have long complained about ER staffing
The problems at Parnassus are not new. Three years ago, 125 nurses signed a petition demanding that UCSF improve its ER staffing. One described “injustices and horrors” occurring as a result of understaffing to the San Francisco Standard at the time.
Providers tell Mission Local the situation has since deteriorated. There is a nursing shortage, but also a “boarding” crisis, where patients ready for admission take up ER rooms because the hospital lacks open inpatient rooms upstairs. Both have combined to wreak havoc on the emergency department, the doctors and nurses said, causing dangerously long wait times and overcrowding.
The residents’ union is now petitioning UCSF. It’s gathered more than 1,000 signatures in support of three demands: hire more nurses, add more nurses to each shift and let the emergency department call in additional staff when needed.
The union delivered its petition on March 31 and asked to meet with hospital leadership. It said it has yet to hear back.
In an interview with Mission Local, Dr. Jahan Fahimi, the emergency department’s executive medical director, acknowledged staffing and boarding issues at times impact patient safety.
But he said these problems are impacting all hospitals, and he believes many of the problems are outside of UCSF’s control, like a limited amount of space available to treat patients in the ER and a shortage of new workers entering healthcare.
He described the ER as “well staffed” for responding to emergency cases, but stretched thin because of the lack of open beds.
“There will certainly be periods of time where we are understaffed, we are behind. Have I experienced patient safety concerns or adverse events, substantial wait times that I would consider to be too long and inappropriate? Yeah, of course. Regularly,” Fahimi said. Still, he added, it’s “not unique by any stretch. Most EDs experience some version of this.”
He went on to call morale in the ER “worse than it’s ever been” because of overcrowding, an increased frequency of violence against healthcare workers and more demand for acute emergency care as the cost of health insurance continues to rise. He praised doctors, nurses, techs and all staff for doing “phenomenal” work in extreme circumstances.
“I am usually proud to serve those patients coming to us in their most challenging moments, but that has not been the case in recent years,” wrote Dr. Rosny Daniel, who has spent the last 12 years as a UCSF emergency physician, in a statement that was read aloud by a colleague at a recent rally held in front of the Parnassus hospital’s main entrance.
“I spend the majority of my shift apologizing to patients, trying to cheer up and inspire burnt-out trainees, dealing with my own burnout and moral injury from treating patients in chairs, hallways, supply closets,” the statement continued. “We can no longer pretend that our emergency department is a safe or healthy place for our patients or staff.”
Even past waiting room, ‘you’re kind of in a parking lot’
When patients arrive at the Parnassus emergency room, they are supposed to have an initial triage assessment by a nurse in the waiting room.
When the ER is quiet, they are called to a back room for a more comprehensive assessment with a doctor. When it’s busy, some are assessed on a gurney or even on a chair in the hallway, once they’re lucky enough to get past the waiting room.
Across all 29 ER rooms at Parnassus, its 10 curtained areas for rapid treatment (each with a bed) and its hallway, the ER can accommodate a total of about 50 people in beds and gurneys when fully staffed.
But five providers said the number of nurses working each shift at the Parnassus ER is so low at times that, even when the waiting room is full, beds and rooms are closed off to comply with state law that limits the number of patients assigned to each nurse. California allows a maximum of four patients per ER nurse.
“Imagine our frustration when we see 10 beds that are open, where a patient could be and have a private space, but we don’t have enough staffing for them. We have the capacity to take care of more people,” one provider said.
Mission Local reviewed an ER staffing grid from March showing that as many as 14 ER beds that were fully staffed 24/7 until early 2025 were not staffed with nurses during certain hours recently, particularly in the early morning and overnight.
Two providers said internal UCSF documents show more than 200 nursing vacancies across the hospital. That has led to excessive wait times for patients not only to get into the ER, but also to receive treatment once inside.
“I’ve been to other ERs before, and once you’re out of the waiting room, you kind of expect care, and it very much felt like I was just in the secondary waiting room,” one patient said. Many patients idle in the curtained areas or hallways. “It’s a traffic jam back there. Even when you get past the waiting room, you’re kind of in a parking lot.”
Ten providers, including several who have spoken publicly at recent union rallies, said patients often wait 12 hours or more to receive prescribed drugs because there are not enough nurses to distribute medication. Three told Mission Local that doctors will send patients home with painkiller prescriptions because they will get their medicine faster at a pharmacy.
“We’ve had several cases where patients have seized in the ER that are 100 percent preventable. All the times are because of medication delays, and the delays result in them having a seizure,” one provider said.
The staffing issue is compounded by a hospital-wide shortage of beds. Often, rooms meant for emergency patients are taken by those who would otherwise be upstairs in an inpatient ward, five providers told Mission Local. That practice, called “boarding,” means the ER is often forced to function like an inpatient unit.
In fact, providers said, there are often no nurses assigned to incoming ER patients because so many rooms and hallway gurneys in the emergency department are taken by admitted patients waiting for a room upstairs.
“I’m shocked when I can see an ED patient in an actual room,” one provider said. “It’s very rare.”
According to experts, the boarding crisis at Parnassus is emblematic of a systemic deprioritization of emergency medical care in hospitals all over the country, driven by the bottom line. A 2025 report titled “Strategies for Sustaining Emergency Care in the United States” found insurers regularly underpay for emergency care, which has gotten evermore complex and expensive, causing hospitals to value their ERs less.
“They’re prioritizing lucrative surgeries or procedures, and giving the beds that are in the hospital to patients that are post-operative because those make more money,” Dr. Mahshid Abir, an emergency physician of 20 years who was the report’s lead author, said of hospital systems nationwide. “Because it’s a system, and all the pieces are connected to each other, that means people are going to wait longer, and yes, they’re going to die. I’ve seen that happen.”
But providers at UCSF Parnassus said problems there are far worse than other hospitals.
“We work all across the Bay, and there is no hospital that is as dysfunctional and morally distressing and unsafe as Parnassus,” one said.
Several said San Francisco General Hospital is better staffed and has a better system to move patients upstairs more quickly.
“The General feels like an actual functioning ED. We use all of the rooms available to us. We have enough nurses to see our acute cases. This week, there were moments where we literally had zero nurses to cover our ED patients at Parnassus. That is incomprehensible to the General,” one provider said.
Nurses at the General Hospital have sounded their own alarms about inadequate staffing in recent years, though not specifically about the ER. The San Francisco Chronicle reported on violence against nurses at the General and declines in employee satisfaction in April 2024. Social workers are also demanding more behavioral health staff in the wake of the December 2025 fatal stabbing of their colleague, Alberto Rangel.
Providers say UCSF fixes are Band-Aids
The residents’ union has staged multiple demonstrations protesting ER conditions and brought them up in recent contract talks. In response, UCSF created a “rapid treatment area,” a separate area next to the waiting room where nurses provide IV medication while patients wait for a bed (nurses can legally only give Tylenol to people in the waiting room).
Hospital leadership also announced the hiring of 10 new nurses. “At today’s Town Hall, we discussed several initiatives underway to address ED and waiting room boarding,” a March 10 email to providers stated. “Leadership at every level within UCSF Health is actively working on this issue.”
But union workers said more than 20 nurses took early retirement or resigned in the last year, so the 10 new hires are not enough to make up the deficit.
Fahimi, the Parnassus ER medical director, called the demand for more staff a “short-term solution” that fails to address the problem of space constraints. More nurses would alleviate some stress today, he said, but additional providers would still be assessing patients in the waiting room, in hallway chairs and in supply closets converted into treatment areas.
“The real long-term solution is, ‘Hey, we need this new hospital built,’ which is still four years away,” he said, referring to the $4.3 billion UCSF Health Helen Diller Hospital under construction on the Parnassus campus, which will increase the ER’s capacity by 71 percent.
According to a UCSF spokesperson, the hospital system has increased patient transfers to other sites to free up beds at Parnassus and reduced wait times by implementing the rapid treatment area. A “system-wide escalation plan” for “aligning staffing with patient demand” will be in place by June, they said.
Bottom-line is up
Suresh Gunasekaran became UCSF Health’s president and CEO in 2022. In the years since, the hospital has put restrictions on nurse overtime shifts and significantly cut the number of nurses working each shift, multiple providers told Mission Local. During that time, UCSF Health has also begun running a surplus.
Gunasekaran received his MBA from Southern Methodist University in 2014 after careers as an analyst for Gartner and IBM and as an associate vice president at the University of Texas Southwestern Medical Center.
Gunasekaran has hired a number of other executives with business backgrounds. One particular hire that has ruffled feathers among staff is Wendy Horton, who joined the C-suite as a senior vice president and the president of adult services in 2025.
Horton, who came to UCSF after a stint as the CEO of the University of Virginia Health’s University Medical Center, was recently named in a federal lawsuit accusing UVA Health leadership of a profit maximization scheme that included “fraudulent billing practices and falsification of medical records,” and resulted in two patient deaths.
UCSF did not respond to requests for comment on Gunasekaran’s approach to running the health system and the lawsuit naming Horton.
In Gunasekaran’s time as CEO, UCSF Health went from running a net loss of $116 million in fiscal year 2023 to a net income of $809 million in 2025, according to annual financial reports.
Between 2020 and 2025, operating revenue grew by 78 percent from $5 billion to $8.9 billion.
Part of that turnaround is tied to UCSF’s recent expansion. It acquired Saint Francis Memorial Hospital and St. Mary’s Medical Center from Dignity Health in 2024 for $100 million, giving the system more inpatient capacity. Total outpatient visits to UCSF facilities increased from about 2.5 million in 2022 to 3.4 million in 2025.
Those expansions added capacity and kept the boarding crisis from getting worse, Fahimi said.
But under Gunasekaran’s tenure, providers describe policy changes that have contributed to the problems in the emergency department.
According to five ER providers, managers must now approve nurse overtime shifts that were once under the purview of the ER’s lead nurse. Under the new rules, the number of nurses working emergency department shifts has fallen from 19 at all times to as low as 11.
Fahimi said he and supervising nurses can still call for additional staff but acknowledged problems remain. “Is it sufficient in every scenario? No. We don’t have an infinite backup system,” he said. “We have a reasonably practical one that doesn’t serve our needs every single day, unfortunately.”
In its own statement, UCSF told Mission Local that “overtime review and shift call-offs are standard management practices in health systems around the country and part of our work to operate more consistently and effectively across departments.”
‘This ED just doesn’t function’
Recent changes have not been enough for workers. Last month, several hospital unions held a press conference at the Parnassus main entrance.
One of the speakers, pharmacist Zlatan Coralic, told a crowd of several dozen that he frequently sees patients sitting in a chair right next to his desk in the ER, sometimes vomiting or bleeding in the open.
“After five years, I’m speaking up because I did everything I was asked. And there’s a clear message from the top down that your pain, your suffering, your preventable harm that occurs to the patients is just the cost of doing business,” Coralic said as he gestured to the nearby site of a new hospital building under construction. “Looking at that big crane right there, business is good.”
Ultimately, providers said the answer is simple: hire more nurses and free up beds upstairs for admitted patients so they don’t use ER beds. Until then, Dr. Abir, the author of the state of emergency medicine report, warned things will only get worse, especially as people lose Medicaid coverage from cuts in Trump’s One Big Beautiful Bill.
For now, on the ground, nurses and residents are reckoning with what they described as war zone medicine, where they somehow have to choose who should get care first.
“You carry that around with you. I don’t just leave the hospital and forget all the people who were waiting for eight hours and begging for help,” one provider said. “I remember those faces when I leave … There’s no way to leave feeling like you did a good job today, because you had to say no to many, many people.”
“Everyone’s kind of like, ‘Yep, it’s a disaster,’” another added. “This ED just doesn’t function.”