July 2, 2008
Video of Dying Mental Patient Being Ignored Spurs Changes at Brooklyn Hospital
By ANEMONA HARTOCOLLIS, NY TIMES

New York City’s Health and Hospitals Corporation agreed on Tuesday to increase the monitoring of patients at a public psychiatric ward in Brooklyn. The agreement came after a videotape surfaced showing a patient collapsing onto a floor after waiting nearly 24 hours to be seen, and lying there for about an hour while hospital workers did nothing for her. The patient soon died.

The agency agreed to the stepped-up monitoring to settle a lawsuit filed by the New York Civil Liberties Union and others. The lawsuit, filed a year ago in federal court in Brooklyn, accuses the public hospital, Kings County Hospital Center, of keeping psychiatric patients in filthy conditions, systematically neglecting them and drugging them into submission.

“That it took somebody keeling over and dying, and it being captured on videotape, for the city to come to the table in a meaningful way is unconscionable,” Donna Lieberman, executive director of the civil liberties union, said at a news conference in Lower Manhattan. The proposed settlement was reported by The Daily News on Saturday.

The patient, Esmin Elizabeth Green, 49, died at Kings County on June 19. Neighbors said on Tuesday that Ms. Green, who had worked at a day care center and as a caretaker for the elderly, had suffered some kind of nervous breakdown. She was 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.

She waited nearly 24 hours in the so-called G Building, the psychiatric emergency room, because there was a shortage of psychiatric beds, hospital corporation officials said.

There are four video cameras running in the emergency room, Ms. Lieberman said. City lawyers gave the video to the civil liberties union a few days ago as part of the routine exchange of evidence in the court case, and the civil liberties union released it on Tuesday.

The cameras captured Ms. Green sliding off her chair at 5:32 a.m. on June 19, almost 24 hours after she was admitted.

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. A staff member in a yellow jacket can be seen prodding Ms. Green with her foot.

Staff members rushed in with a gurney and an oxygen tank to try to revive Ms. Green an hour after she collapsed, but it was too late, according to the civil liberties union. Yet her patient record says that Ms. Green got up and went to the bathroom at 6 a.m., nearly half an hour after she collapsed, and that she “was sitting quietly in the waiting area” at 6:20 a.m., when the video shows her lying on the floor.

Under the court agreement, the hospital will be required to have no more than 25 patients in the emergency room at any time, and to check on them every 15 minutes. The checks are supposed to be documented in a signed, sworn log. The hospital also agreed to reduce typical waiting times to 10 to 13 hours within four months.

Hospital officials said that on June 20, the day after Ms. Green died, the hospital took action against staff members responsible for her. The director of psychiatry, the doctor on duty and the director of security at Kings County were fired, said Ana Marengo, a spokeswoman for the Health and Hospitals Corporation. She said two nurses and a security guard had been suspended pending union-mandated hearings.

Alan D. Aviles, president of the Health and Hospitals Corporation, released a written statement on Tuesday expressing shock over the circumstances of Ms. Green’s death and promising improvements.

A spokeswoman for the city medical examiner said the cause of death was under investigation.

Friends said Ms. Green grew up in Kensington, Jamaica, and had six children living there, the youngest 14. She was active in the Jesus Is Lord Church, a Seventh Day Church of God, in the Canarsie section of Brooklyn.

Ms. Green lived above the church for about three years, and moved out about a year ago, said Marlene Sterling, a friend who still lives above the church. Ms. Sterling said that Ms. Green began having anxiety attacks in January and had been to the hospital several times since for psychiatric care.

Ms. Sterling and Dorrette Henry, who also lives above the church, said they had last seen Ms. Green, who loved to sing gospel music, two or three weeks ago at the church, where Ms. Green frequently ran children’s activities.

“She was always singing,” Ms. Sterling recalled, adding that the last time she heard her, Ms. Green was singing a song based on a biblical verse: “It’s not by might, it’s not by power, but by my spirit, said the Lord, this mountain shall be removed.”

David Giambusso contributed reporting.

Her Name Was Esmin Green
LINK

Esmin Green sang gospel music at church. Esmin Green was a mother with six children. Esmin Green was a black woman who died on the floor of one of New York City’s public hospitals while waiting for psychiatric care and being ignored.

No, it’s not the first time somebody has died waiting for treatment in a hospital emergency department, but it should serve as a wake-up call for those not paying attention. Esmin Green collapsed on the floor after waiting almost a full day to be seen. Nobody noticed for half an hour, and that person just walked away. Another staff member, instead of bending down and saying, “Ma’am, ma’am,” instead of talking to her or touching her like she was a human being, prodded her with a foot.

Her patient record contains absolute falsehoods, documentation that she went to the bathroom, that she was sitting quietly, when videotape clearly shows that she was already collapsed on the floor.

Part of the Kings County Hospital Center’s response strategy will be to check in on patients more frequently and document those checks. How well can such documentation be trusted when documentation on Esmin Green contained outright lies?

How many people weren’t satisfied by reading accounts of this event, and just had to watch the video themselves out of morbid curiosity, not out of compassion for Esmin Green?

The public reaction hasn’t always been any better than Kings County’s care in this case. I have seen comments asking where her family was, asking why she didn’t just leave, why other people who were not healthcare providers and were also waiting for psychiatric care didn’t help her - comments that put the blame on her and everyone but the responsible system and parties for dying on the floor, alone. Reports say that Esmin Green was involuntarily admitted in the first place - the hospital determined that she was in need of care, and should not leave without receiving it, they just hadn’t provided any. Frankly, how much of an asshole do you have to be to say that someone waiting in an emergency department for psychiatric care should have been the one to control the situation? How much of an asshole do you have to be to see video of someone dying on the floor in a public area and being ignored and to not see that something went seriously wrong with the people and system who were supposed to be providing her with care?

What if Esmin Green wasn’t a poor woman? A black woman? A woman with mental health problems? A woman who needed to use the public hospitals, which should not be providing substandard care just because they serve poor/black/mentally ill people? If I asked you, “Where do you think this is more likely to happen - the private hospital in a good part of town, or the public hospital that takes everybody?” what would you say? And why would that answer ever be appropriate? Is this the best we can do for our fellow Americans? Or is it just the best we’re willing to do?

Ask yourself: If you're white, male Mayor or city council members or university president collapsed on the floor of a hospital, would he have been ignored? Would poking him with a shoe have been an adequate assessment technique? Or would a team of people have swooped in to save the day (and the life)? Would our hypothetical person of privilege have waited for care for nearly a day in the first place, and if not, is that an appropriate way to dole out healthcare? Yes, the healthcare system is broken. But it’s a hell of a lot more broken for some people than for others.

Important Related Posts:
More information from the New York ACLU

Published by the New York Civil Liberties Union (http://www.nyclu.org)
Federal Civil Rights Lawsuit Challenges Squalid Conditions at Brooklyn Hospital

May 3, 2007 -- The New York Civil Liberties Union, Mental Hygiene Legal Service, Second Judicial Department (MHLS), and Kirkland & Ellis LLP today filed a lawsuit in federal court in Brooklyn on behalf of thousands of New Yorkers who have been and continue to be subjected to inhumane conditions at Brooklyn's Kings County Hospital Center.

The lawsuit seeks to bring an end to abusive and negligent treatment of patients at the Kings County Hospital Center's psychiatric facilities. An extensive investigation recently conducted by MHLS, in conjunction with the NYCLU and Kirkland & Ellis, showed that Kings County's psychiatric facilities are overcrowded and often dangerously unsanitary and that patients -- including children and the physically disabled -- are routinely ignored and abused.

"The pattern of neglect and abuse at Kings County Hospital Center is an affront to human dignity," said NYCLU Executive Director Donna Lieberman. "The New Yorkers most in need of our care and support are being denied their basic rights by the very institutions entrusted to protect these individuals."

Investigators found that patients at Kings County's psychiatric facilities are confined in hospital wards whose floors are often covered with urine, feces and blood. Patients frequently sleep in plastic chairs and on the floor -- sometimes for days on end. Patients are given soiled linens, if any, and frequently go without showers and clean clothes. If a patient complains about these conditions or asks for basic necessities, she runs the risk of being punished with a forcible injection of psychotropic drugs. Patients who use wheelchairs must choose between using the facility's only accessible bathroom, which has no lock on the door; using a commode, which is rarely emptied; or dragging themselves across a filth-covered floor in an attempt to use a non-accessible toilet in privacy.

"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. "This lawsuit will improve the lives and treatment of the thousands of New Yorkers who pass through the psychiatric facilities at Kings County."

The lawsuit, Hirschfeld v. HHC, asserts claims under the Due Process Clause of the U.S. Constitution, the Americans with Disabilities Act, the Rehabilitation Act and several provisions of the New York State Mental Hygiene Law and Public Health Law, as well as the New York State Constitution. The lawsuit demands that Kings County Hospital Center provide mental health treatment in the safe and sanitary manner that is required by the law and to which all people are entitled.

"MHLS's legislative mandate is to oversee the care and treatment of individuals who are admitted to psychiatric facilities," said Dennis Feld, Deputy Director of Special Litigation and Appeals at MHLS. "After years of negotiating with Kings County, it became apparent that the only way to ensure that patients at this hospital would receive treatment that was skillfully, safely and humanely administered, with full respect for the patients' dignity and personal integrity, was through civil rights litigation."

Sidney Hirschfeld, the director of MHLS, is the plaintiff in the case and is acting on behalf of the constituents.

Read statements from constituents represented in this action.

Read the full complaint.
Source URL:
http://www.nyclu.org/node/964

Mental Hygiene Legal Services v. NYC HHC (Challenge to Squalid Conditions, Abuse at Brooklyn's Kings County Hospital Center)
E.D.N.Y, Index No. 07 cv 1819 (direct)

This case involves the squalid conditions of confinement and abusive and negligent treatment of patients at Brooklyn’s Kings County Hospital Center (KCHC).

An extensive investigation recently conducted by Mental Hygiene Legal Services (MHLS), in conjunction with the NYCLU and Kirkland & Ellis, showed that Kings County's psychiatric facilities are overcrowded and often dangerously unsanitary and that patients -- including children and the physically disabled -- are routinely ignored and abused. Investigators found that patients at Kings County's psychiatric facilities are confined in hospital wards whose floors are often covered with urine, feces and blood. Patients frequently sleep in plastic chairs and on the floor -- sometimes for days on end. Patients are given soiled linens, if any, and frequently go without showers and clean clothes. If a patient complains about these conditions or asks for basic necessities, she runs the risk of being punished with a forcible injection of psychotropic drugs. Patients who use wheelchairs must choose between using the facility's only accessible bathroom, which has no lock on the door; using a commode, which is rarely emptied; or dragging themselves across a filth-covered floor in an attempt to use a non-accessible toilet in privacy. Defendants in the lawsuit, the Board of the New York City Health and Hospitals Corporation, were made aware of the horrific conditions at KCHC and failed to remedy them.

On May 2, 2007, the NYCLU, in conjunction with MHLS Second Judicial Department and Kirkland & Ellis LLP, filed a complaint on behalf of Sidney Hirschfeld, the director of MHLS, in its representational capacity on behalf of all of its constituents – all patients who have been treated at KCHC. Among other things, the complaint alleges that the patients were subjected to unhealthy conditions, illegal staff use of restraints and injections, neglect and lack of proper services. The plaintiffs claim that the defendants’ actions violated the Due Process Clause of the U.S. Constitution, the Americans with Disabilities Act, the Rehabilitation Act, and several provisions of New York State Mental Hygiene Law, Public Health Law and the New York State Constitution. The complaint requests the District Court to issue a permanent injunction compelling defendants to remedy the gross deficiencies and to comply with the law. The defendants’ answer is due on July 13, 2007. The initial case conference with Magistrate Judge Matsumoto is scheduled for Aug. 28, 2007.

Attorneys involved in this case include Beth Haroules.
Source URL:
http://www.nyclu.org/node/1067
Links:
[1] http://www.nyclu.org/pdfs/KCHC_constituent_statements.pdf
[2] http://www.nyclu.org/pdfs/KCHC_complaint.pdf

Esmin Green…Yes, She Mattered - Womanist Musings
Esmin Green - Dies B/c She Does Not Count - WOC PhD

US: Mentally ill woman left to die in hospital waiting room
By Peter Daniels, 5 July 2008
LINK

A videotape aired on national television showing a patient dying in the waiting room of the Kings County Medical Center in Brooklyn last month has provoked a wave of revulsion.

Esmin Green, 49 years old, was taken to the psychiatric wing of the massive public hospital in New York City’s most populous borough on June 18. She was apparently having some form of mental breakdown. Ms. Green was left almost 24 hours in the psychiatric emergency room because there was no bed available.

Video cameras in the emergency room later showed the woman sliding off a chair at 5:32 a.m. the next morning, nearly a day after she had arrived. At first Ms. Green writhed on the floor, and then lay face down. For the next hour, a security guard and other staff members ignored her. At last one employee attempted to arouse the patient with her foot. Finally, an hour after she had fallen, an unsuccessful attempt was made to revive Ms. Green. A Jamaican-born immigrant, she worked at a day care center and was the mother of six children, the youngest 14 years old, all still living in Jamaica.

What brought this death in the emergency room to public notice was that it was captured on tape and also that the New York Civil Liberties Union had joined in a lawsuit against the public hospital a year ago, accusing the authorities of exactly the sort of behavior documented on the video. The suit charges not only that psychiatric patients are neglected at Kings County, but that they are kept in filthy surroundings and drugged in order to keep them more manageable.

The video was turned over to the Civil Liberties Union in connection with the ongoing court case, and that is how the graphic illustration of conditions at the hospital became public knowledge, shown on television and on the Internet.

The airing of the videotape has been followed by a predictable flurry of official reactions. Alan Aviles, the president of the city’s Health and Hospitals Corporation, issued a letter on July 1 to all hospital staff, expressing his “sorrow and shame,” and announcing that the HHC had now agreed, in connection with the NYCLU lawsuit, to increase monitoring of patients in the hospital’s Comprehensive Psychiatric Emergency Program. Patients awaiting admission will now be checked every 15 minutes and the hospital pledges to reduce waiting time to between 10 and 13 hours within the next four months.

Donna Lieberman, executive director of the NYCLU, declared: “That it took somebody keeling over and dying, and it being captured on videotape, for the city to come to the table in a meaningful way is unconscionable.”

Aviles also reported that six employees, including those who had ignored the patient, a nurse who falsified the patient’s medical chart after her death in an apparent attempt to cover up for gross negligence, and two senior psychiatric managers, had been fired.

It is not surprising that the entire focus of the official response remains on punishment for those with immediate responsibility, along with a few minor procedural changes. It has also been reported that federal and city authorities are considering criminal charges in connection with the death of Ms. Green.

This horrifying incident calls for more than outrage, however. This death begs for careful consideration of what it reveals about the health care system and more broadly about life in New York City and society at large.

The response of New York Mayor Michael Bloomberg was perhaps unintentionally revealing in this regard. After declaring that he was “disgusted,” the mayor said to reporters, “I can’t explain what happened there. Does it say anything about our society? ‘I hope not’ is the basic answer.”

Of course Bloomberg knows the answer is yes, but he chooses to say “hope not” as a way of communicating concern without delving any more deeply into the significance of the incident, much less proposing any systemic changes in response. It is Bloomberg and the whole political and financial establishment who are responsible for the conditions at Kings County.

When a half dozen employees, who stand out in no particular way, are involved in something like this, the endemic character of the problem should be apparent to anyone. A lengthy investigation should not be necessary to discover understaffing and underfunding, low pay and inadequate training, all contributing to a demoralized workforce in which feelings of empathy or consideration for the patients with whom they work has declined or evaporated completely.

In addition there is the prevalent stigma attaching to mental illness, in which chronically ill and often “difficult” patients are shunted aside, treated with contempt or in some cases viciously abused.

Although conditions may be most severe for psychiatric patients who are unable to care for themselves, the crisis at Kings County is part of a broader, nearly universal state of affairs in urban public health. As a general rule, the poorer the population, the worse the services. The demoralization of the workforce translates, not all the time but all too often, into substandard care and occasionally abuse.

Nor is this problem confined to health care. The prevalent atmosphere is the law of the jungle, in which empathy is considered something quaint. Even in the wealthiest country in the world—especially in the wealthiest country, under conditions of growing inequality, poverty and social tension—life is cheap, the values reflected by reality television are increasingly encouraged, and ignoring or trampling on others is not considered anything special.

Social polarization permeates every aspect of life. The super-wealthy have their own private “concierge” health care and every imaginable luxury at their command. The growing numbers of the poor, like Ms. Green, are shunted aside and thrown literally onto the scrap heap. And the great majority of the population in the middle faces loss of jobs and joining the 47 million Americans without health benefits, only a step away from destitution and treatment similar to that suffered by Esmin Green.

Biography of HHC President Alan D. Aviles
Alan D. Aviles is the President and Chief Executive Officer of the New York City Health and Hospitals Corporation (HHC), the largest municipal healthcare system in the nation. Mr. Aviles was appointed by New York City Mayor Michael R. Bloomberg in February 2005 to lead the 39,000 employees of this $6 billion corporation, which includes 11 acute care facilities, four nursing homes, six large diagnostic and treatment centers, more than 80 community-based clinics, a large home care agency, and a Medicaid managed care plan with more than 300,000 enrollees. Last year, HHC facilities served 1.3 million New Yorkers that reflect the diversity of this global city – including nearly 400,000 uninsured.

Under Mr. Aviles’ leadership, the city’s public healthcare system, while remaining steadfast in its mission to provide quality care to all who come through the doors regardless of their ability to pay, is also experiencing a dynamic transformation. Highlighted by a $1.3 billion capital program to rebuild and modernize its aging infrastructure, today’s HHC is securing a national reputation for quality medical care and leadership in patient-centered initiatives.

To achieve a vision for HHC focused on increasingly safe, efficient, effective and patient-centered care, Mr. Aviles is leading efforts to better manage chronic diseases like diabetes and asthma, address healthcare disparities by increasing access, invest capital dollars strategically, and use cutting-edge technology to enhance efficiency, quality and patient safety. This activist agenda drives New York City’s public healthcare facilities toward state-of-the-art treatment and sustained competitiveness in a tumultuous healthcare environment.

Mr. Aviles’ experience in public service dates back to the late 1970s. Before entering the healthcare field, Mr. Aviles spent his career fighting for social justice as a lawyer and former Assistant Attorney General. His longstanding involvement in civil rights litigation includes a groundbreaking 1982 lawsuit that challenged discrimination against HIV/AIDS patients, and later litigation that led the United States Supreme Court to compel a major skilled trade apprenticeship program to open its doors to qualified minority candidates for the first time. During the past twelve years he has served in several leadership roles within HHC. Before his appointment as President/CEO, Mr. Aviles served as HHC’s General Counsel. He also previously led one of HHC’s seven regional healthcare networks.

Mr. Aviles’ engagement as a healthcare leader extends beyond the HHC system. He serves on the Boards of a number of organizations, including the Greater New York Hospital Association, the Healthcare Association of New York State, the Primary Care Development Corporation, and Public Health Solutions (formerly MHRA). He also is a member of the Regional Policy Council of the American Hospital Association, the Advisory Council of the New York State Health Foundation and the United Hospital Fund Health Policy Forum.

Mr. Aviles, 57, is a native of the Bronx and lives in Brooklyn, New York. In 2007, Alan Aviles was named as a recipient of Modern Healthcare magazine’s CEO IT Achievement Award, and as one of Modern Healthcare’s 100 Most Powerful People in Healthcare, for the second consecutive year.

November 9, 2007
Suit by Civil Liberties Group Presses State on Legal Services for the Indigent
By ANTHONY RAMIREZ, NY TIMES

On a hapless morning this summer, James Adams, a 44-year-old day laborer, found himself at the Rite-Aid drug store on Salina Street in Syracuse.

What happened then is in dispute. The police said he tried to steal, among other things, a container of Johnson & Johnson baby oil gel. Mr. Adams said they arrested the wrong man.

What happened later is not in dispute. For the 100 days since he was arrested on July 31, Mr. Adams has been in the Onondaga County jail. He cannot pay his $2,500 bail, and he faces at least three and a half years in prison if he is convicted.

Mr. Adams contends that his lawyer has been no help. He will not return Mr. Adams’s calls, failed to show up at one hearing and did not fight when prosecutors charged Mr. Adams with a felony, he said. Reached for comment, Donald E. Kelly, a lawyer appointed by the court to represent Mr. Adams, denied those charges and said he had provided a vigorous defense.

For years, New York State has been criticized for failing to comply with Gideon v. Wainwright, the landmark 1963 decision by the United States Supreme Court that required states to provide meaningful legal representation to poor defendants.

Yesterday, in an effort to goad a new governor and a cautious State Legislature to abide by the decision, the New York Civil Liberties Union filed a class-action lawsuit against New York State in State Supreme Court in Albany.

The suit is on behalf of 20 indigent defendants who, the Civil Liberties Union claims, were effectively denied the right to counsel. The defendants include Mr. Adams.

The suit charges that inadequate funding, poor oversight and lack of statewide standards deny New Yorkers accused of crimes their right to competent representation at all stages of the judicial process.

Donna Lieberman, executive director of the Civil Liberties Union, told reporters yesterday, “Every day throughout the state, people accused of crimes are deprived of justice because they are poor.”

Gary Stein, a lawyer with Schulte Roth & Zabel, pro bono counsel in the suit, added, “No more studies, no more delay. It is time to act.”

Jeffrey Gordon, a spokesman for Gov. Eliot Spitzer, said the administration had not yet reviewed the complaint but that the governor was concerned about representation for indigent defendants.

In June 2006, Chief Judge Judith S. Kaye of New York cited a crisis in the way county governments and New York City were providing legal aid in criminal cases and advocated an overhaul of legal representation for the poor. Judge Kaye cited a judicial commission report that recommended that a permanent state commission be created to take over the responsibility of representation from counties and other local authorities. Such a takeover would require approval from the Legislature.

But Mr. Gordon said a legislative solution would not be possible until the litigation was resolved, helping to clarify constitutional issues.

“So in terms of problem-solving,” he said, “it’s a step backwards.”

The commission report cited such problems as overburdened defenders — who in one county averaged 1,000 misdemeanors and 175 felony cases in a year — and “grossly inadequate” financing.

The state, the report said, lacks standards to define what it means to provide an adequate legal defense and has no means to enforce such standards.

But if Mr. Adams’s case is any indication, defining adequacy will be difficult.

In a telephone interview from his office in Syracuse, Mr. Kelly said he was fully qualified to defend Mr. Adams, since “95 percent of my practice is criminal defense work.” He may have asked for an adjournment in a proceeding, but “never was I unaccounted for in a court appearance,” as Mr. Adams has claimed, he said.

It is true that Mr. Kelly has never visited Mr. Adams in jail. But, Mr. Kelly said, “He has given me everything I need in order to defend the case at this juncture.”

Mr. Adams’s case is complicated by an extensive criminal history, which includes seven felony convictions. If he is convicted on the Rite-Aid charge of felony burglary, he could be sentenced, as a “persistent felony offender,” to life in prison.

Mr. Kelly has filed a motion to dismiss the felony charge. But, he said, the Civil Liberties Union is “only alleging half the facts and not taking into account that Mr. Adams is a career criminal.”

Nicholas Confessore contributed reporting.