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Deplorable Conditions at Kings County Hospital Center

Jul 7, 2008 | Parker Waichman Alonso LLP

Last month, Esman Green, a 49-year-old Jamaican woman and patient at Brooklyn’s Kings County Hospital Center (KCHC) was allowed writhe on the floor of its psychiatric emergency ward for a full hour before a nurse realized Green was in distress; by then, Green had died.  This medical malpractice occurred while that unit’s attending psychiatrist and two security guards were in the vicinity.  Based on surveillance footage obtained by the New York Civil Liberties Union (NYCLU), Green appeared to be ignored and unattended while hospital workers and other patients in the same room, did nothing.  Green had been in the KCHC psychiatric ward waiting area for over 24 hours.

Apparently, the KCHC is so typically jammed with patients that the sight of a woman stumbling, writhing, collapsing, and dying was not cause for concern.  Patients often wait hours, days even, with many spending the night sleeping in chairs or on the floor.

Doctors are still trying to determine a cause of death.  Meanwhile, federal and city investigators are considering possible criminal charges and Health and Hospitals Services suspended and fired six hospital employees, and the city agreed to reduce overcrowding and trim the time patients spend in the unit.  Hospital administrators also promised to improve conditions in the unit, which had been condemned in a pending lawsuit that claimed KCHC long waits could be cruel; patients had limited access to linens, gowns, or soap; showers were filthy; and there were few places to sleep.  One patient able to get a bed complained someone stole her spot when she got up to use the bathroom; another said his wallet was robbed while he slept in a busy hallway.  A 54-year-old man—days after open heart surgery—said he had to curl up on the floor of a reception area, where he was kept awake by fighting between patients and guards.

Experts say ERs have become a psychiatric “dumping grounds.”  A survey by American College of Emergency Physicians (AECP) released last month revealed of hundreds of U.S. hospitals, 79 percent reported routinely “boarding” psychiatric patients in waiting rooms:  One-third reported stays averaged eight hours; six percent reported average waits of over 24 hours.  “We try to find a place to put them, unfortunately, sometimes the only thing we can do is restrain them, or medicate them,” said Dr. David Mendelson, an emergency physician in Dallas who wrote the ACEP.  “There’s no place to put them in the community, so we literally hold onto them,” said Dr. Michael Cohen, director of the emergency psychiatric unit at Stony Brook University Medical Center on Long Island.  “Optimally, you don’t want a patient sitting in the emergency room for any length of time,” said Dr. Bruce Schwartz, the director of clinical psychiatry at Montefiore Medical Center, in the Bronx.

In Austin, Texas, hospital officials have complained that a county decision to reduce patients sent to a state psychiatric hospital has those mentally ill patients waiting in their ERs. 
In Massachusetts, parents have complained about days-long ER waits for children needing pediatric psychiatric placement and California health officials have long complained about overcrowding in psychiatric ERs.