As a lifelong liver transplant patient, Kelsey M. knows her body the way a navigator knows ocean currents. 

Through frequent blood draws, she tracks a panel of enzymes to see whether the organ is functioning or close to failure. So when results came back in early December — each reading higher than any since she received the transplant as a baby 35 years ago — she knew she needed immediate care. 

The symptoms were telling enough. She couldn’t keep food or water down. She was doubling over in pain. Someone on her UCSF transplant team told her to go to the emergency department at Parnassus. Her records were there, her specialists walked those floors. 

She packed the essentials: enzyme-replacement pills to help her eat, a phone charger, a change of clothes, an N95 mask.

Four hours later, she was in a bed and hospital gown, fluids flowing through a port in her chest. But she was in a shared room, with only a curtain separating her from someone on a breathing machine, battling an apparent respiratory illness.

What might have been uncomfortable to other patients posed a grave threat to Kelsey. Since she was only months old when she got a new liver, she was too young for live vaccines before the surgery and too immunocompromised after to ever receive them. 

When the man on the other side of the curtain started coughing, she stepped out of the room. 

“A nurse said, ‘You can’t be here in the hallway,’ and I said, ‘I can’t be in the room with this guy.’”

The nurse brought her a chair, saying there were no beds and the hospital was full. A transfer to another facility was the only option. A doctor told her she could die if she left; she felt she could die if she didn’t. 

“I was too scared to stay,” Kelsey said. 

Against medical advice, she walked out. 

Kelsey, who asked to withhold her surname, is a medical anomaly. 

As an infant transplant patient who came off anti-rejection drugs at 16, she’s rare living proof that the immune system can accept a new organ without medication. That made her valuable to researchers. A UCSF-led clinical trial (opens in new tab) recruited her last year to try to understand why. 

At the Parnassus emergency department, though, she’s one of thousands each year who walk out before being evaluated or treated by a licensed provider.

UCSF Health officials have maintained that the problems at its flagship emergency department aren’t unique to Parnassus. To a degree, that’s true (opens in new tab). A 2023 study in the Journal of the American Medical Association documented a decade of statewide deterioration: numbers of emergency visits rising, emergency rooms closing, severe cases surging.

Still, Parnassus stands apart on several measures. As a quaternary referral center (opens in new tab), the facility exists to treat patients too sick or complex for anywhere else, operating as the last stop for the rarest, most complicated cases. 

However, publicly reported data show that emergency room patients in Parnassus are increasingly likely to wait longer for care, or to simply walk out without seeing a doctor, compared with other hospitals in San Francisco. Patient complaints at the hospital are five times higher than the state average. 

State records analyzed by The Standard show that the Parnassus emergency department logged the highest walkout rate in San Francisco last year: 5.6% of patients left without seeing a licensed physician. In 2025, 2,243 people left, up 4.6% from 1,872 in 2024, while patient volume continued to hover around 40,000 annual visits. 

Source: California Department of Health Care Access, CMS. 2025 data preliminary. *St. Francis Memorial and St. Mary's SF are now part of UCSF Health, operating as UCSF Health Saint Francis and UCSF Health Stanyan Hospital respectively

A few miles southeast of the hilltop campus, Zuckerberg San Francisco General Hospital runs the busiest emergency department in the city. It’s the city’s only Level I trauma center, a hospital of last resort for the most acute cases, and a safety net facility for patients without insurance or primary care.

But after more than a decade of struggling with the highest walkout rates in the city, driven by a surge in drug-related admissions, SF General managed to turn things around. It slashed walkout rates from 7.6% to 3% between 2024 and 2025  — even as emergency visits grew from roughly 61,000 to 64,000.

In other words, SF General, with nearly 50% more patients and a fraction of the budget, has improved. Parnassus, with a growing surplus, expanded systemwide capacity, and steady demand, got worse. 

A longer comparison is difficult because both hospitals failed to report their walkout data to the state several times over the past decade. 

Source: California Department of Health Care Access. National average ≈ 2% (CMS). 2025 data preliminary

One problem at Parnassus is a lack of space. Patients waiting to be put into inpatient care routinely take up emergency beds because there’s no room elsewhere. That means the emergency department, which for many is a front door to the rest of the hospital system, is often clogged up exactly when people need it most. 

The so-called boarding crisis, in which admitted patients take up emergency beds because there’s no room elsewhere, is a nationwide problem that requires a long-term solution. To that end, UCSF is building new facilities as part of a $4.3 billion expansion (opens in new tab) that will increase emergency capacity at Parnassus by more than 70%. But completion is a few years away.

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Those billions are visible in the cranes that tower over the existing emergency department — a yellowed exterior that patients and clinicians say mirrors the neglect inside.

Unions representing resident physicians and nurses at the Parnassus emergency department say there’s a staffing crisis — and not due to a lack of resources. From 2023 to 2025, UCSF Health swung from a $116 million deficit to an $809 million surplus (opens in new tab) — even as it bought two hospitals, slashed emergency nursing shifts nearly in half, and left 200 nursing positions unfilled systemwide.

Suresh Gunasekaran — who became CEO of UCSF Health about a year before it bought St. Francis and St. Mary’s hospitals — framed the acquisition in an open letter (opens in new tab) as a solution to one of the biggest challenges: “limited capacity to serve patients who seek our care.” The 500 additional beds, he wrote, would tide UCSF over until the new Parnassus Heights campus gets built.

Yet three years later, the Parnassus emergency department —  the entryway to the UCSF system for many of those patients — remains a chokepoint. 

When Dr. SatKartar Khalsa walks through the Parnassus emergency department on a shift with scores of people in the waiting room, they see things that make no sense. Empty rooms. Unoccupied beds. Idle equipment. 

The emergency medicine resident and regional vice president of the Committee of Interns and Residents — the nation’s largest union of doctors-in-training — said that’s because of a dramatic staffing shortfall. A department that once assigned 19 nurses per shift has operated with as few as 11 since last year. Because California law requires hospitals to maintain a ratio of one nurse for every four emergency patients, the staffing cuts mean people are left waiting even when there’s technically enough room to put 50 of them on beds and gurneys. 

The nursing shortage also means patients don’t get medications in time. Khalsa and their colleagues evaluate patients and figure out what tests need to be ordered, but only nurses can administer medicine.

“It’s morally distressing,” Khalsa said. “I’ve taken care of many patients who’ve been waiting for their medications for up to 12 or 13 hours. It’s heartbreaking to see them in pain, or to see people who have complex diseases coming to what is regarded as one of the best hospitals in the country, only to end up lying on the waiting room floor.”

For patients who make it past triage, the experience often doesn’t improve. They end up in hallways, in curtained areas, and in other spaces not designed for the conversations that follow.

Dr. Gloria Tavera, a second-year gastroenterology fellow at UCSF, said she routinely discusses sensitive health issues with patients in the open waiting room. “I have to ask them about their bowel habits, their poop, maybe about stool incontinence in front of all these other people,” she said. “There’s no sense of privacy or dignity in that situation.”

Jaclyn Oppedisano, a researcher and clinical nurse at UCSF, said she witnessed an end-of-life conversation that took place in a hallway. “Family, patient, multiple doctors at the bedside, discussing the end of life, next few hours or days in a busy place with people screaming, floor-cleaners going by, and dinner trays being put out,” she said. 

A nurse at Parnassus responsible for coordinating assignments and supervising staff said the sharp drop-off in nurses available during each shift is due to a “demand staffing model” implemented by hospital leaders as an efficiency measure. 

The system uses historical patient counts to determine future staffing. However, it fails to take into account the number of people forced to receive care in waiting rooms and hallways.

“You could have 50 or 60 patients in the waiting room, which I have seen, and that still doesn’t change the number of nurses we’re budgeted for,” said the nurse, who asked to remain anonymous because of potential retaliation. 

In perhaps the most damning indictment: Not one Parnassus emergency clinician interviewed by The Standard said they would send a family member or loved one to their own emergency department.

UCSF didn’t respond to detailed requests for comment. 

But hospital officials have publicly denied claims of personnel shortages, telling Mission Local (opens in new tab) in mid-May that the emergency department is “appropriately staffed.” Officials said a plan to “align staffing with patient demand” would launch this month. Sources at the hospital say they are still waiting for implementation.

Andrew McLester couldn’t have walked out if he tried. 

The 49-year-old Outer Sunset resident showed up to the Parnassus emergency department one afternoon in March after a surfing accident left a deep gash behind his left knee. The fin of his board had pushed the neoprene of his wetsuit a half inch into his flesh. Nurses immediately put him on morphine and placed him on a gurney in a hallway.

For six hours, he lay there as doctors and nurses stopped to look. “Have you seen this wound?” he recalled them saying to one another. “Wow, you have to see this.”

He kept waiting for someone to tell him what was happening. Occasionally, nurses let him know that they were looking for the right person to treat him.

At midnight — eight hours after he arrived — a surgeon walked over and said, “I’m going to stitch you up and get you outta here.” Right there in the hallway, in what McLester described as dim light, the doctor sewed 28 sutures in a mesh pattern. McLester was discharged at 2 a.m.

“It was the gnarliest experience of my life,” he said.

Thirteen days later, the wound began to discolor. He went to his UCSF primary care physician, who was uncertain how to remove the meshed sutures and had to consult a specialist by text. The wound worsened. Antibiotics were prescribed. A few mornings later, McLester woke up unable to walk, his leg turning dark purple. He went back to the emergency department.

This time, an MRI, an ultrasound, and a CT scan revealed what had gone wrong: an infected pool of blood had gathered beneath the flesh, unable to drain. Two weeks after his original visit, he went into septic shock. He was rushed into surgery. 

Physicians reopened the wound, cleaned it, and installed drainage tubes. He was discharged three days later and told to pack the wound with wet gauze twice a day. 

The surgeon who performed the second operation told McLester what should have happened the first time. He had what surgeons call a “dirty wound” — a laceration driven by impact and contaminated by seawater, not a clean cut. A trauma specialist would have recognized it and left it open to drain for at least a week. That single judgment call, McLester was told, would probably have healed the wound in weeks rather than months. .

Instead, McLester spent more than 100 days recovering. He couldn’t work for much of that time, and as an independent wine wholesaler will feel the impact of that loss for a year or two to come.

In a grievance filed with UCSF patient relations, he made a point of not blaming the nurses or doctors. “I’ve never met a group of more caring and committed individuals than the nurses and staff at the ED Parnassus in all my life,” he wrote in his complaint letter. “They work so dang hard through so much insufficiency and higher-up malfeasance. Like me, they deserve better.”

After his persistence appealing a $150,000 bill — the cost of care tied to what he described as botched treatment — UCSF forgave the debt.

Walkout rates are one bellwether. Wait times tell a parallel story. 

According to the most recent data from the Centers for Medicare & Medicaid Services, the median time a patient spends in the Parnassus emergency department is four hours and 18 minutes. That’s nearly double the national median of two hours and 41 minutes, and the second-longest wait of any San Francisco hospital. Only SF General — which handles the most acute trauma cases and sees about 60% more patients a year than Parnassus — reports longer times, at five hours. 

Source: Centers for Medicare and Medicaid Services, 12-month period ending June 2025. ZSFG's longer time reflects its role as the city's only Level I trauma center. *St. Francis Memorial and St. Mary's SF are now part of UCSF Health, operating as UCSF Health Saint Francis and UCSF Health Stanyan Hospital respectively

As a caregiver to a few aging family members, Julie Mayer has spent a lot of time in emergency rooms. Her 91-year-old mother and 96-year-old uncle require frequent medical attention, and she splits her time between her home in San Francisco and their homes in Florida, where she manages their hospital visits. She has been to emergency departments in three Florida hospitals and to facilities across the Bay Area. 

Nothing prepared her for the night she spent at Parnassus.

It was a weeknight last month, and she was caring for another family member who had noticed a large black spot obscuring his peripheral vision on both sides. He had consulted a telehealth doctor, who suggested he might be having a stroke. He took an Uber to Parnassus because he assumed it was the best hospital in the city.

He arrived around 9 p.m. and was quickly triaged. That was the last efficient moment of the stay.

Over the next several hours, he was seen in a hallway or some liminal space. Hallways at the Parnassus emergency department are often crowded with patients in beds. However, many have not been officially admitted and have not yet received care from a licensed provider; they are simply too sick to wait with others.

As Mayer waited with her relative throughout the night, she saw people suffering. A man slumped unconscious across chairs, another vomited into a bag, a third puked up blood. A pregnant woman with abdominal bleeding got admitted pretty quickly, but a man with appendicitis kept getting sent back to the waiting room.

By 7 a.m., Mayer and her relative couldn’t take it anymore. When they told a doctor they were leaving, another came out to try to persuade them to stay. They left against medical advice. Results from tests taken at the ED didn’t post online until a day later. They included no analysis. 

“I don’t know what the problem is,” Mayer said. “In Florida, you check in, they send you to triage, and, pretty quickly, you get a room. You might wait, but not for all those hours, and at least you’re in a private space.”

Two days after leaving against medical advice, Kelsey was still in pain. 

She tried to manage it at home — soup, Boost shakes, mashed potatoes — but her liver panel readings weren’t improving. She still couldn’t keep down water. She was still doubling over. She decided to head back to Parnassus. Only this time, she knew better than to go during the emergency department’s rush hour. 

She had done the calculus before. Leave home at 1 a.m., arrive before the morning shift change turns the nursing stations into ghost towns. Never on a Friday. Never on a weekend. Never during the day. Make sure medications are administered before the handoff, or you may not see a nurse for an hour or more. 

This time, she was triaged in less than 30 minutes and quickly given Dilaudid for the pain and hydration through her chest port. Then she was transported by ambulance to another hospital, where she spent a week recovering in a private room. 

Just as she spent a lifetime studying her symptoms, she has spent several years figuring out how to survive the place that’s supposed to take care of her. And since she requires emergency care five to six times a year, she has become a reluctant expert. 

“I don’t really have a choice,” she said. “It would be nice if I didn’t have to know all of this.”