-- Irma Evans' bad memories of Detroit's Sinai-Grace Hospital were enough for her to drive several miles to see a doctor rather than willingly go there.

The Detroiter's nearly 20-year-old recollections of the west-side hospital included overcrowded and noisy rooms, a rushed and rude staff, and hallways that smelled of urine.

"The last time I was here, I said, 'I'm never going back there,'" said Evans, 77, who lives in the tree-lined neighborhoods that surround the Detroit Medical Center hospital, where some of the city's poorest residents live within blocks of some of the city's finest homes.

Sinai-Grace is in the midst of an unlikely turnaround. In a place where gunshot victims regularly hobble through the front door and many of the city's poorest go for care, a mix of back-to-the-basics improvements and unconventional approaches are fueling change.

For years, Sinai-Grace's reputation was one of two- to three-hour waits in the emergency room, often-surly service and dank rooms. Private rooms were hard to come by, and the ER often got so crowded that patients laid in gurneys in the halls.

"It used to be that if you were sick and you were headed to Sinai-Grace, that was not going to be a pleasant experience," said Conrad Mallett Jr., a former state Supreme Court chief justice who was tapped in 2004 to help steer the turnaround.

Count Evans among the converted. Earlier this month, she sat smiling in a hospital bed at Sinai-Grace, fresh out of a procedure to clear her clogged arteries.

Mallett has launched effective advertising campaigns. He regularly visits senior citizen homes, personally trying to convince folks they won't regret going to the hospital. If a patient comes from hours away, the hospital will pay to put them up in a hotel.

And Mallett is pouring money into cosmetic surgery programs that draw in cash-paying patients and help offset the high cost of caring for the uninsured. The hospital earlier this year ran a $7.99 special on facial peels. More than 750 people signed up.

"People say, 'Conrad, do you really want to be known as the liposuction hospital?'" he said. "I say, 'Sure. It's a service that people want provided.'"

More patients are coming to the hospital's emergency room, by choice as well as necessity. Emergency room volume is expected to hit 87,708 this year, up from 61,664 in 2002.

Patents are coming from around the state -- often paying thousands of dollars in cash -- to receive a rare knee replacement surgery there. About 440 are expected this year for the procedure.

"It's all attitudinal," said Adam Jablonowski, executive director of the Wayne County Medical Society, about changes at Sinai-Grace. Jablonowski visited there recently and was surprised to be given directions and greeted warmly. "It's such a change."

Situated amid Detroit's densest residential population and surrounded by three expressways, Sinai-Grace sees more patients suffering from heart disease and more automobile crash and violent crime victims than most any other hospital in the city. Its system is one strained by tough cases, a lack of money and confusion from the merger years earlier.

The emergency room came first. Simple adjustments, such as taking patient information at the bedside with mobile computers, helped drastically cut down the wait time in the ER. Sinai-Grace managed to pull off the DMC's 29-minute guarantee for fast emergency rooms service.

On a recent day, Mallett did one of his daily walkthroughs of the hospital. Nurses stopped for a joke, a chat or the occasional hug. A patient's family in the cancer ward, angry with the care he was receiving, vented their frustrations on Mallett.

Later, he stopped by the computer screen in the emergency room that ticks down the minutes patients are waiting to be admitted. A doctor hovered by the screen, waiting to grab the next patient in line.

"When it comes to hospitals, you have one time" to win over patients, Mallett said. "We had our one time, and people were concerned with what they saw. Now we feel like we're getting a second chance."

Challenges still remain at Sinai-Grace. Facilities are still dated at a time when hospitals in the city and suburbs are spending millions on the newest technology. The DMC is spending $4 million on a cardiac care center for Sinai-Grace.

The hospital is still operating in the red, posting an $8 million loss through September, according to the Michigan Hospital Finance Authority. That's compared to an $18 million loss in the last months of 2003 alone.

"The feeling has been that if you want first-class service, go to Oakland County," said Mike Duggan, DMC president and CEO. "Re-establishing Sinai-Grace as an outstanding hospital is an important part of changing that."

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