Anil Chopra can’t believe some of the things happening in his emergency departments’ waiting rooms.

Or triage areas.

They’re just too crowded.

It’s clear to him where the surge of people comes from.

“You just have to look outside your window,” says Chopra, head of emergency medicine at the University Health Network, which comprises four hospitals: Princess Margaret, Toronto Western, Toronto General and Toronto Rehab.

“Toronto has a great reputation as being a condo king in North-America,” he says.

Amidst the debate ignited by Deputy Mayor Doug Holyday over who should live in the city’s downtown core, Torontonians are wondering what services are available for the increasing number of people who do.

Chopra and other doctors and hospital administrators say the rate at which downtown Toronto’s density is increasing is outpacing the area hospitals’ capacity and infrastructure.

Both Toronto Western and Toronto General’s emergency departments have exceeded their capacities, with a combined total of more than 100,000 visits to the ER every year.

“We do things I wouldn’t have imagined,” says Chopra.

Nurses in his department started doing some therapies right in the triage area. Patients with IV drips are sitting in chairs — there aren’t enough beds. Chopra’s had to examine patients’ right in the waiting room, “knowing full well I’m in earshot of other people,” he says. “Otherwise, they will wait four more hours.”

He doesn’t like saying it, but they’re just trying to survive.

The city and province’s plans to curb urban sprawl have pushed development vertically with a multitude of condos sprouting up in the downtown core. While there are environmental and social benefits to building up, doctors say hospital infrastructure hasn’t been able to catch up. The emergency waiting rooms are getting as crowded as Toronto’s skyline.

“We’re seeing a 5 to 10 per cent increase (in emergency room patients) year after year after year,” says Chopra. “It seems to be endless.”

Planning for downtown urban growth can be challenging, says Sandeep Agrawal, professor of planning at Ryerson University. Usually, when planners prepare new subdivisions, they design and allocate services according to the planned density.

“Downtown, it’s a bit the other way around, where the population has increased multiple folds and hospitals have to keep up with that,” he says. “Obviously they were not designed initially to cater to that density.”

Agrawal is worried urban planners have forgotten their discipline’s original purpose which was to mitigate the spread of disease caused by living in close quarters.

“City planning as a profession has moved far from health planning agencies with relatively little or no contact with health and health planning agencies,” he writes in an email.

In downtown Toronto, the quarters are getting closer.

The city’s population grew by almost 112,000 residents, a rise of 4.5 per cent between 2006 and 2011. That’s more than five times the growth reported in the previous five-year period, according to Statistics Canada.

The city of Toronto’s website reports there are 132 high rises currently under construction. It’s the most out of any city in the world.

The Ministry of Infrastructure’s plan for Toronto is to increase the density of residents and jobs in downtown Toronto to a minimum of 400 per hectare by 2031. That figure is already at 708 jobs and residents per hectare in Toronto Centre, according to MPP Glen Murray’s office.

The downtown population boom has also put pressure on St. Michael’s Hospital.

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When its emergency department was built in 1983, it was designed to handle 45,000 patients a year.

Today, that department annually sees more than 70,000 patients.

That figure is growing alarmingly fast.

“We’ve been going up 5 to 8 per cent a year over the last five years,” says Doug Sinclair, St. Mike’s executive vice-president and chief medical officer.

He says there are likely other factors behind the rapid increase in the number of ER visits, but the increased downtown population is an important one.

“The vast majority of patients who come to St. Mike’s are from the downtown area . . . most of the emergency department visits are local. We’re presuming it’s had an effect,” he says.

It’s hard to beat the rush.

Since securing government approval for a hospital revitalization project which will include a new 17-storey patient care tower, they’ve had to revise the emergency department’s size and resources to fit the new volume of patients.

But it’s nearly impossible to really build for future projections.

“We can design it for the number we have now or guesstimate a few thousand more, but clearly the government never wants to build something too big,” says Sinclair.

Money is tight.

The Ministry of Infrastructure sets its density forecasts and communicates them to other relevant ministries, like the Ministry of Health. The two are responsible for funding and building hospitals in the province. The Ministry of Health changed its funding model from an across-the-board increase to funding hospitals based on the services they deliver. This should provide funding that better matches each hospital’s changing population and needs, according to Tori Gass, spokesperson for the Ministry of Health.

But emergency doctors like Chopra aren’t sure the new funding model or all the cost-saving strategies already in place will help them much.

“I’m not that optimistic,” he says.