July 1, 2008 -- Even pared down to a few minutes, the hour-long surveillance video is disturbing.
At 5:32 a.m. June 19, a woman in a hospital gown in the waiting area of the psychiatric emergency room of a New York City hospital topples first to her knees before collapsing on her face.
A full hour passes. Other people stream in and out of the waiting room, including hospital security guards. The woman writes something on the ground before going completely still. Finally, someone takes notice and alerts the staff. But by then, at 6:36 a.m., the woman is already dead.
The woman, 49-year-old Esmin Green, died on the floor of the waiting room at the Kings County Hospital Center Psychiatric Emergency Department. Her exact cause of death has not been released.
The native of Jamaica, who had been waiting for a bed when she collapsed, had been involuntarily admitted the previous day for "agitation and psychosis," according to the City Health and Hospital Corp., which acknowledged June 20 that Green had been left unattended on the ground for an hour.
Alan Aviles, the president of the Health and Hospital Corp., had already announced that six hospital employees, including staff members who oversee patient care and security, face disciplinary action for their lack of response. Two of the employees were fired, while four unionized staff members must go through termination proceedings.
The hospital, in the Brooklyn borough of New York City, may have a much bigger problem on its hands. In May, Kings County Hospital was targeted in a federal lawsuit by three organizations that described hospital conditions as "inhumane." Attorneys for the plaintiff released the footage of Green's death Monday night to illustrate in brutal detail some of the allegations made in the suit.
The Mental Hygiene Legal Service, New York Civil Liberties Union and Kirland & Ellis LLP filed the lawsuit after an investigation at the hospital "showed that Kings County psychiatric facilities are overcrowded and often dangerously unsanitary and that patients -- including children and the physically disabled -- are routinely ignored and abused," according to the groups' May 3 release announcing the suit.
The groups claim that alleged mistreatment of patients at the hospital is a violation of the federal Americans With Disabilities Act as well as several New York State provisions that guarantee the delivery of mental health services in a safe and sanitary manner.
Aviles is named as one of the lead defendants in the 36-page suit, which specifically cites five patients, all with some type of disability, who allege "abusive and neglectful" treatment at Kings County.
One patient, L.D., claimed that she was laughed at when she asked to call her family and was placed in a bed with soiled sheets. Another patient, identified as J.P., said that she had to sleep sitting up in a wheelchair after she got up in the night to use the bathroom and returned to find another patient in her bed.
The New York Daily News reported that in addition to the neglect in Green's case, staff members entered false information into her medical chart during the hour in which she lay on the ground to cover up the lack of treatment.
At 6 a.m. on the morning of her death, according to the Daily News, Green's medical chart reportedly listed the patient as "awake, up and about, went to the bathroom." Green had been in the same spot on the ground for more than a half-hour. At 6:08 a.m., she stopped moving, according to the footage. But her chart described her at 6:20 a.m. as "sitting quietly in the waiting room." In reality, she may have already been dead.
Ana Marengo, a spokeswoman for the Health and Hospital Corp., would not address the exact entries in Green's medical chart, but did say, "There appears to be some discrepancies" that have been forwarded, along with the entire case, to various New York City investigative departments.
"It is clear that some of our employees failed to act based on our compassionate standards of care," administrators wrote in a statement last night that followed the video's release.
Hospital administrators outlined a series of improvements already made to the Kings County psychiatric program, including the addition of staff and expanding space to cope with overcrowding. They pledged a series of improvements, including the appointment of an "interim administrator" who will report directly to Aviles, and a guarantee that patients in the psychiatric emergency unit will be checked on every 15 minutes.
In June, USA Today reported that nearly 80 percent of hospitals said that mentally ill patients sometimes wait up to four hours or more for emergency care, citing a study by the American College of Emergency Physicians that surveyed 328 emergency medical directors.
Physicians blamed the delayed care on shrinking budgets that have prompted many hospitals to either consolidate mental health services or shut them down completely. Since 2000, the number of psychiatric beds has dropped 12 percent, according to the medical organization's statistics.