Kings County Hospital's psychiatric emergency program, source of many medical horror stories, is under lawsuit again after staff negligence led to the death of a patient.

Esmin Green, a 49 year old Canarsie resident, died on the floor of the psychiatric waiting room in plain view of a security guard and several patients on June 19. A surveillance video released by the NYCLU shows the woman collapsing to the floor at 5:32 AM after waiting for treatment for almost 24 hours. She was admitted involuntarily for “agitation” and “psychosis,” according to the hospital.

 

 

As seen on the surveillance footage, the woman laid twitching right in front of a security guard observation window. At 5:53, a guard walked into the room, looked in Green’s general direction for a little while and walked out. Green stopped moving at around 6:07 and the hospital staff only checked on her half an hour later, when a patient summoned an employee. The employee can be seen prodding Green’s unresponsive body with his foot before sending for a gurney.

The death provoked a furor, not only because of the apparent act of neglect, but also because of the NYCLU statement that Green’s hospital records were subsequently falsified. The records claim that at 6 AM, Green was "awake, up and about, went to the bathroom" and at 6:20 AM, she was “sitting quietly in waiting room.” All the while, the patient laid on the floor.

"I saw the film and I was horrified," Mayor Bloomberg was quoted as saying. "That's too nice a word. I was disgusted.”

The event sparked an investigation into the Kings County psychiatric emergency department by law enforcement and medical oversight officials. The Health and Hospitals Corporation which is in charge of Kings County hospital declined to comment on any specifics about the case except that six employees were terminated and several others are suspended, pending termination.

"We are all shocked and distressed by this situation. What our investigation so far determined violates the basic principles of the compassionate healthcare practiced every day here at Kings County and across our public hospital system," said Dr. Alan D. Aviles, HHC President. He went on to enumerate a list of reforms that would be made to the psychiatric emergency program, including additional staffing, expanded crisis prevention training, shortening patient wait time, checking on the patients every 15 minutes and the installation of a new interim administrator.

 

These changes have been on delay for over a year, ever since the Mental Hygiene Legal Service, an agency that oversees due process in mental health facilities in New York State filed a lawsuit against the Kings County psychiatric emergency program on May 3, 2007. According to MHLS lawyer Dennis Feld, the organization's on site watchers routinely made complaints and kept receiving unfulfilled promises by the psychiatric emergency program throughout the years 2004, 2005 and 2006.

 

"There is a culture of indifference to the rights of these [patients]," Feld said. "I would even say... a culture of arrogance as if they didn't deserve any better. There was no public scrutiny. This continued without any oversight."

 

The MHLS report described the conditions in the psychiatric emergency room as "a chamber of filth, decay, indifference and danger." Some of the complaints included bloody, lice-infested linens, overmedication and abuse of inpatients and a lack of toiletry. Patients routinely having to sleep on plastic chairs and the floor which was covered in urine, feces and blood. Complainers were often injected with drugs to pacify them.

 

Kings County Hospital services many low-income communities around it, including Bedford-Stuyvesant, Brownsville, Canarsie, Crown Heights, East New York and Flatbush. Many patients tend to be black or Caribbean.

 

"It is unconscionable that here - in the world's greatest city, in the world's richest country - people who need help are subjected to such appalling conditions by the very institution that should be caring for them," said Rob Cohen, a partner in the New York offices of Kirkland & Ellis, one of the companies participating in the lawsuit.

 

The legal action soon brought the case to the attention of the Department of Justice. Following that, Feld said, sanitary conditions improved somewhat. However, as evidenced by Green's death, the improvements did not go far enough. Now, Kings County's psychiatric emergency program is the target of a second lawsuit by the MHLS and NYCLU in order to push through the promised changes under court order. The preliminary injunction is due to arrive tomorrow.

 

According to the NYCLU, defendants have agreed to arrange to have the woman’s remains transported to her nation of origin.