According to the medical records of the psychiatric emergency room at Kings County Hospital Center in Brooklyn, New York, a patient named Esmin Elizabeth Green, who had been brought to the hospital almost 24 hours earlier but had not yet been seen by a doctor, was sitting quietly in a chair. In fact, she was already dead. The hospital chart also says that she got up to walk to the bathroom when she was actually writhing on the floor. How do we know the truth? Because unlike most instances of medical malpractice, this apparent fiasco is captured on the hospitals own security surveillance videotape.
The cameras captured Ms. Green, 49, sliding off her chair at 5:32 a.m. on June 19th. About half an hour after she collapsed, the video shows a security guard walking in to look at her, then walking away again as she lies motionless. A security guard can be seen later on the video rolling his chair into the room, then rolling out again without doing anything to assist her. A staff member in a yellow jacket can be seen prodding Ms. Green with her foot.
City officials turned over the surveillance video to attorneys for the New York Civil Liberties Union (NYCLU) and to mental health advocates in connection with a civil-rights lawsuit filed a year ago over the way in which Kings County treated its psychiatric patients. As a result of the suit, the city, which runs Kings County, will increase its staffing and improve its procedures at the Kings County psychiatric emergency room.
This incident is apparently not the first or only one of its kind. The Brooklyn U.S. Attorneys Office initiated a criminal civil-rights investigation into Kings County Hospital Center earlier based on other complaints. Robert Nardoza, a spokesman for the Brooklyn U.S. Attorney’s Office, said the criminal civil-rights investigation will now also review Ms. Greens death.
Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness (NAMI), the nations largest grassroots organization dedicated to improving the lives of individuals and families affected by mental illnesses, said that it is a sad commentary that it took a tragedy of this nature to move New York City’s Health and Hospitals Corporation to immediately settle a lawsuit that was filed a year ago to improve conditions at the hospital. Mr. Fitzpatrick said also that state and federal authorities should take a close look not only at the circumstances of Ms. Greens death, but also systemic issues involving the hospital and potentially other parts of the city’s mental healthcare system. That includes staffing levels, training, and availability of hospital beds.
In 2008, the American College of Emergency Physicians (ACEP) released a survey that indicates emergency psychiatric care is ‘extremely limited’ and ‘getting worse.’ Over 60 percent of psychiatric patients needing admission to a hospital have to stay in the emergency department over 4 hours after a decision to admit them has been made. 33 percent wait over 8 hours; 6 percent over 24 hours. 62 percent of emergency department medical directors indicated there are no psychiatric services for patient care while patients are boarded prior to admission or transfer. 89 percent transfer psychiatric patients every week to other facilities due to unavailable psychiatric beds at their hospitals.
Ms. Green had been taken to the hospital by emergency medical service workers on June 18 suffering from agitation and psychosis, according to the Health and Hospitals Corporation, and was admitted involuntarily. Hospital corporation officials said she waited nearly 24 hours in the G Building, the psychiatric emergency room, because there was a shortage of psychiatric beds. Hospital officials said that on June 20, the day after Ms. Green died, the hospital took action against staff members responsible for her, firing the director of psychiatry, the doctor on duty and the director of security at Kings County. Two nurses and a security guard have been suspended pending union-mandated hearings.
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