In medical parlance, Code Blue generally refers to a patient in cardiopulmonary arrest, requiring a team of health care providers to rush to the specific location and begin immediate resuscitative efforts. With an estimated 47 million people in the USA without health care insurance, public hospital emergency rooms are usually the place where these folks go when they require health care. For one victim of what may be criminal neglect, the end came much too soon.
On June 19, 2008 a tragic and unnecessary death occurred in the emergency room (ER) of New York City's Kings County Hospital psychiatric ward.
Surveillance video shows how patient Esmin Green, 49, collapsed and fell to the floor at 5:32 AM while waiting in the ER. For the next hour, a number of hospital staff members noticed her lying on the floor but did nothing. Security guards saw her on the floor and did nothing. Over an hour later, at 6:35 AM, another patient brought a nurse to the area. And what was the first thing that nurse, that health 'care' provider, did? Kicked Green with her foot to see if she would respond. She did not respond. She was dead. Oh yeah, Green had already been waiting in the ER for 24 hours when she collapsed. Disgusting. Unforgivable.
Kings County Hospital is a public, not private, facility. It is part of the New York City Health and Hospitals Corporation, the largest municipal hospital and health care system in the country. Why was Esmin ignored in her time of greatest need?
1) Could there possibly be a difference in the quality of care provided at a public not-for-profit hospital versus a private one? If so, why? My answer is yes - because public hospitals must accept all incoming patients regardless of ability to pay, insurance, or immigration status, a patient-to-staff ratio that is too high is created. The answer is MONEY. The USA is the only industrialized nation in the world that does not guarantee health care as a right of citizenship. What we have is a patchwork quilt type of system, where those that can afford it have one level of care, and those that can't afford it go to hospital ERs for care that does not always qualify as an emergency. This overloads ERs, so that even those with health plans sometimes get delayed in getting ER care. The immediate solution is either universal health care coverage, or increased funding to public hospitals so appropriate staffing levels can be maintained. The long term solution is for all Americans to get jobs where employers provide affordable health care coverage.
2) Are employees of public hospitals less qualified? Can't say for sure. The psychiatric ward at Kings County certainly has too many unqualified employees. How many unqualified workers is too many? One.
3) Are there any standard operating procedures that govern the monitoring of ER patients? If so, what are they, and why were they not followed? I was unable to locate specific procedures that would have applied to the ER in question. However, in addition to the Hippocratic Oath, the American Medical Association has developed The Declaration of Professional Responsibility, which I reproduce here:
We, the members of the world community of physicians, solemnly commit ourselves to:
I. Respect human life and the dignity of every individual.
II. Refrain from supporting or committing crimes against humanity and condemn all such acts.
III. Treat the sick and injured with competence and compassion and without prejudice.
IV. Apply our knowledge and skills when needed, though doing so may put us at risk.
V. Protect the privacy and confidentiality of those for whom we care and breach that confidence only when keeping it would seriously threaten their health and safety or that of others.
VI. Work freely with colleagues to discover, develop, and promote advances in medicine and public health that ameliorate suffering and contribute to human well-being.
VII. Educate the public and polity about present and future threats to the health of humanity.
VIII. Advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.
IX. Teach and mentor those who follow us for they are the future of our caring profession. We make these promises solemnly, freely, and upon our personal and professional honor.
If these standards had been followed, Esmin would probably be alive today.
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45 comments:
You have gone from bitter and angry to outraged. You are just going to have to decide. Do I read a little Hillary Clintonism in this tirade and the call for dare I say it good "Universal Health Care"?
I am going to provide this little tidbit of news I read in the newspaper for whatever. Perhaps you missed this while watching fair and balanced FOX TV: The New York City medical examiner says a woman who died unnoticed on a Brooklyn hospital floor was killed by blood clots caused by a long period of physical inactivity.
And since you brought up socialized medicine I would like to point out the country of Great Britian. Its most well known and important citizens can't get the help they need as noted in this article:
The British paper The Daily Telegraph reports that 61-year-old Rolling Stones guitarist Ron Wood who has long battled alcohol and drug addiction:
- is back on the sauce;
- has left Jo, his wife of 23 years with whom he has four kids;
- has shacked up with an 18-year-old Russian waitress at his home in Ireland.
Obviously, public health care can fail the rich and poor alike.
I wish I had an 18-year-old Russian waitress at my home in Ireland; if I had a home in Ireland.
Also, your comment of "If these standards would have been followed Esmin would be alive today." Sorry, but your emotional conjecture has no basis in fact. Get Reeeeeeeeeeeal Man!!!!
Alright, concerning my second comment, you did use the qualifier "probably" so I will give you that much. And if the dog would not have stopped to take a shit he "probably" would have caught the rabbit!!!!
Okay, I must admit that I'm scratching my head on this one.
You wrote a 732 word article explaining in great detail how "public" or government run facilities provide inferior care, even border on malpractice and, in this particular case, are down-right negligent... then in the same breath recommend that we hand over the entire nations health care system to these same bozos.
Oh boy, where do I sign up? If they can't run their existing hospitals, why on Earth would we want to give them the whole shootin' match?
The solution can be found in the free markets which nurture innovation and competition. Free markets drive prices down... government involvement drives prices up.
The typical government solution of "let's throw more money at it" has *never* worked.
wayne in pa - The autopsy revealed that Esmin was killed by pulmonary thromboemboli (blood clots that form in the legs and travel through the bloodstream to the lungs).
The medical examiner said the clots were due to deep venous thrombosis of her lower extremities due to physical inactivity, This is the same condition that airline passengers on long flights are warned about. They are advised to walk the aisles as a way of preventing this type of clot formation. As noted, she had already been sitting in the room for 24 hours when she collapsed at 5:32 AM. At 6:02 AM she began twitching on the floor. Had she been treated in a timely manner, perhaps this tragedy would have been avoided.
Your example using millionaire Ron Wood of how universal health care doesn't work is comical at best and cruel at worst.
Your revealing comment, "And if the dog would not have stopped to take a shit he "probably" would have caught the rabbit!!!!," does deserve damnation as it was a statement directed at my comment, "If (The Hippocratic Oath and Declaration of Professional Responsibility) had been followed, Esmin would probably be alive today." Your comment disgusts me.
bfoxy - I don't think there are any reliable statistics on the questions you raise. My gut feeling is that, in general, people are essentially good. I therefore hope that the number of folks opting out of health care, thereby endangering both themselves and their families, in order to waste their money on crap, is limited.
Ken - The article included suggestions of how the current overtaxed public health care system could be fixed. If understaffing or training are major causes of the problem exemplified by Esmin's death, then the solution would be more staff or revamping the training of staff. And that takes money.
Free markets often drive down prices. However, in the health care field, the free market resulted in the creation of Health Maintenance Organizations (HMO), profit-driven entities that sometimes refused to authorize tests, operations, treatments, or specialist referrals because their profit margins would be adversely affected.
Abuses like these tarnish the free market approach when it comes to this area of health care, and result in demands by the public for government intervention.
Only because the free markets had to compete with such entities as "Medicare. Since the government is "non-profit", it doesn't care what the prices are. Medicare has a built in user base, and authorizes, or is willing to pay, high prices.
When a doctor checks the "what's allowed" price listing of Medicare, and they see that the stupid government is WILLING to pay $2000 for a a $200 procedure... What do you think they will charge. Hmmmm $2000 perhaps?
Then the HMOs were created in an attempt to capitalize on this unfair imbalance. The government is "supposed" to avoid competition with the free markets. As soon as they did, it drove the prices through the roof.
If the government was NOT in the business of healthcare, then the competition between providers would keep the costs in check. Unfortunately, the government doesn't play by the same rules.
Until your comment, I did not know that a category of HMOs for Medicare recipients even existed. Thank you for this information.
I was referring to HMOs that private employers choose to provide health care coverage to their current employees in place of traditional plans, not Medicare HMOs for people who qualify for Medicare.
Although some HMOs to which I refer are non-profit, many more are for-profit. This would be fine provided their profits increased as a result of ethical competition, like providing such excellent care to members that more and more companies chose those HMOs. However, many abuses have occurred because some HMOs reward case managers for keeping the HMOs' costs down, without being too particular about how it's done. This has resulted in denying many patients necessary tests and treatments.
If those HMOs cannot survive and thrive in a capitalist free market untainted by such greed and corruption, then they deserve to go out of business.
Sorry, bfoxy, I was composing my response to ken when your comment arrived. I appreciate your insight into why young people, especially those who are single or childless I would imagine, opt out of their employer's health care coverage. Their parents should have enlightened them on the potential financial disaster awaiting anyone without coverage, but we all know that parents aren't perfect, and sometimes children don't listen.
Do they also opt out of contributing to IRAs or 401Ks for the same reason?
Would some kind of 'How to survive in the real world' class in the senior year of high school and college help?
I see we're both suffering a bit of insomnia and you've posted another comment. I agree that your topic deserves full attention and would best be discussed as a separate Friday Bitter Analysis. Thanks for the suggestion.
Well, not only are you bitter, angry, and outraged, I have even managed to disgust you. What is the record for inciting negative emotions in your psychological make-up????
I believe I said "died of blood clots"? So was it necessary to go on and on using fancy schmancy words to say what I had already said in plain english???
The "dog 'probably' would have caught the rabbit" was in reference to your noting that if the "H" oath and the Declaration guidelines had been followed by the health care professionals the person would "probably" be alive today. You must be GOD to be able to make that leap of foresight. I think I said this in my second comment. You must have been too emotionally charged up and missed that point, twice.
Ron Wood may be a millionaire, but he resides in a Universal Health Care environment. Rich or poor the system can be an equal opportunity failure.
And I still wish I had an 18 year old Russian waitress at my home in Ireland. If I had a home in Ireland.
Sorry to jump in the middle of the fray, but one must defend ones honor! (not really sorry)
First, I must say that I'm liking Wayne in pa. :)
Second, I find it interesting that this woman died of a cause other than the ailment that she arrived in the ER for.
Did the article happen to mention what her so-called "emergency" was that she sat there for 24 hours.
Even some of the lowliest minimum wage jobs offer medical insurance. Work at McDonalds and have the option for coverage. It's not like you have to try very hard to "move up" to a job that will offer insurance.
A lot of people opt out because they'd rather have the extra $50 on their paycheck. It's not a tragedy... it's a choice!
wayne in pa
Yes, you did say that "...a woman...was killed by blood clots..." My interpretation of your mentioning the ultimate cause of death was that the neglect she suffered did not contribute to her death. My response showed how those types of clots possibly were connected to Esmin being neglected for over 24 hours, as they were the same type of clots that can develop in airline passengers on long flights.
I still feel that your phrase, "And if the dog would not have stopped to take a shit he "probably" would have caught the rabbit!!!!" was a poor choice, but I regret, and apologize for, my response that your comment disgusted me. It was my response that was a very poor choice.
I had written that "If (The Hippocratic Oath and Declaration of Professional Responsibility) had been followed, Esmin would probably be alive today." You responded that I must be God to have made such a "...leap of foresight."
Please re-read these points from the Declaration that are in support of my leap of foresight:
I. Respect human life and the dignity of every individual.
III. Treat the sick and injured with competence and compassion and without prejudice.
IV. Apply our knowledge and skills when needed, though doing so may put us at risk.
Here are the points in the Oath that are relevant to Esmin's situation:
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
ken - You stated, "... I find it interesting that this woman died of a cause other than the ailment that she arrived in the ER for." Then you ask, "Did the article happen to mention what her so-called "emergency" was that she sat there for 24 hours.[sic]" Either you know what caused her ER visit (your first sentence quoted above), or you don't (your second sentence quoted above).
Why did you refer to her ER appearance as her "... so-called 'emergency'..." Is there some reason to question the legitimacy of her being there?
I could find no confirmable data about Esmin's medical and psychiatric history. The evidence we do have is the video showing her collapsing and then having convulsions.
Wait just a minute. I'm getting a little tired of the straw-man tactics in twisting my posts.
My questions were not an "either-or" situation.
According to your article, she died of blood-clots due to sitting for 24 hours. That is obviously NOT the ailment that she arrived for. The clots formed WHILE she was there.
So, again, she arrived for what? I'm suggesting that whatever it was, was not life threatening since what killed her was the STAY in the waiting room and NOT the original ailment.
If you insist on rephrasing my posts to suit your own needs, I'll have to refrain from joining the discussions.
P.S.
Sorry for the harsh words, but you've engaged in straw-man tactics pretty consistently.
Pssst... it's not an honorable form of debate. (hint-hint-nudge-nudge)
http://en.wikipedia.org/wiki/Straw_man
You asked: "Is there some reason to question the legitimacy of her being there?"
Why, yes, I'm glad you asked...
"Emergency" is *usually* defined as something that is immediately life-threatening. Whatever it was, she survived it for at least 24 hours... doesn't sound like it meets the criteria of "emergency".
Bitten by a deadly snake? Allergic reaction and her tongue was swollen causing a breathing obstruction? Bleeding to death from a severed limb? Cardiac arrest? A gunshot wound? You know, the kinds of things that RATIONAL people would call an emergency...
It certainly seems that she arrived for something other than an emergency since she sat untreated for 24 hours and didn't die from "it" whatever "it" was.
So, yes, there is plenty of reason to question her legitimacy for being there.
Hmm. Never looked at it that way.
The fact is Esmin was there. The fact is she was neglected. The fact is she died. Had hospital staff done their jobs, she may still be alive today.
That is the basis for my post, and my outrage.
That is indeed deplorable. The doctor should lose his license to practice and half the staff should be fired. I never questioned that.
But I live in a world where two wrongs do not make a right.
Excusing the abuse of ERs because "I don't have insurance" is the equivalent of:
I don't have a steady girlfriend, so I should be excused for rape.
Or, I don't have a good paying job, so I should be excused from robbing banks.
It was wrong what the hospital did. But it was *probably* also wrong for that person to be there in the first place.
BTW: what will stop small business from eliminating their healthcare options once "universal healthcare" is in place? Why should a business cover its employees when the government will do it for free?
Universal Healthcare will be a Massive burden on the government's pocketbook, and the people will end up will inferior care, like in other solialized health countries.
Did we even get a reason that she showed up to begin with?
Thinker, the hospital staff may have been doing their jobs by taking more serious cases first. I don't believe we even know why she was there in the first place. And once again you imply that if the hospital staff had done their jobs this person "may" be alive today. Maybe, maybe not. This person may have already had these blodclots before this timeframe.
It has got to be tough work being employed in an ER in a public hosptial and I don't envy any of those folks. And I can imagine that there are major staffing shortages also. Tough on the workers, tough on the people hoping for swift and effective treatment. Sad instances like this bring all this to the forefront. It's what we have become, and it's scary.
wayne in pa - Why she was there pales in comparison to how she was treated. The video evidence shows a human being in distress being ignored by a hospital staff who, in your words, "... may have been doing their jobs by taking more serious cases first."
Triage is always in use in an ER. Since we don't have access to the hospital's records of ER admittance that day, we have to rely on those who do have such access, and who are more qualified than you or me to pass judgment on the staff involved.
I urge you to check the site below and read what Alan Aviles, the president of New York City's Health and Hospitals Corporation (which operates Kings County Hospital), said on this incident. You'll see, amongst other abuses by the staff, that one of the nurses even falsified Esmin's chart with the notation that the nurse had checked on her and that the patient was ambulatory and apparently fine. At that time, Esmin was lying face down on the floor.
http://newsblogs.chicagotribune.com/triage/2008/07/esmin-greens-de.html
The video evidence shows a human being in distress being ignored by a hospital staff...
At the time any hospital staff is on camera looking into the waiting room, there is no sign of distress. There is only a scene of a customer possibly "sleeping" on the floor.
Have you ever been to an ER in the wee hours of the morning? It's not unusual at all to see people lying motionless all over the place. I myself have slept in an ER. I don't need a nurse shaking me awake every 5 minutes saying, "Oh my god, are you alive!"
You are trying to suggest that those staffers walked in and saw a woman in obvious distress and ignored her. Don't play up the drama please.
I find it a tiny bit distasteful that this poor woman's tragic death is being used as a political vessel to sell the idea of "universal healthcare".
exploiting the dead to sell a platform... grrrrrr
Thinker, (and please live up to this moniker for just a second), I was not passing judgement on the staff, I was making a generalization concerning how health care in an ER at a public hospital in Brooklyn may not be the gold-plated standard we all wish it would be. I seem to recall that there was a Discovery or TLC program that profiled various hospital ERs and for some reason this one seems familiar. Noisy, chaotic, just general mayhem.
Yes, I know that Doctors take an oath and there are all these Declarations, but how about we deal in the real world for a moment.
Abuses, inattention, lack of compassion, all exist in the real world and like it or not will continue to exist. Overburdened systems, overworked and stressed out health care workers all combine to cause these situations. We allow some of the most psychotic people to wander the streets with a prescription in hand hoping these folks take their meds and stay out of trouble because we have closed all the mental health facilities that used to cater to them. "Too expensive to stay open" so say our bureaucrats, "Hard choices must be made." OK, so we've made the hard choices and this is what we have and like it or not we do not live in a classless society. We have the folks who have health care coverage who have a physician to go to when they don't feel well. And we have the rest of the world. AND GUESS WHAT??? The haves do not feel like paying for the have nots!!!
Let's say that sleeping in that room was a regular occurance. The surveillance camera should therefore have been monitored periodically. When the person checking the camera saw Esmin lying on the floor, he could run the tape back to see if she had positioned herself there, or had fallen. Had he seen the fall, he then would have had legitimate cause for notifying medical personnel.
In a place where it's *probably* common for people to sit and talk to themselves, park their shopping carts in the corner of the room, and maybe even occasionally take a crap on the sofa... it's nothing to see someone catching some Zzzz's on the floor.
My point was that you suggested that staffers saw a women "in distress"... Where? I missed that part of the video. I saw only two places of the video indicating distress, and a staffer was not present either time.
Oh, and if you think I'm exaggerating the typical clients... think again. I've been in the better VA hospitals, and you'd be shocked by what you see in waiting rooms.
A person sleeping face down on the floor is nothing, and unless the hospital has a policy against it, there would have been no reason to wake her.
Plus, even though it has been largely ignored in this discussion, the reason she arrived IS important and here's why:
There has been an accusation of neglect, suggesting that the woman required some kind of treatment that she was not receiving in a timely manner. But there is no mention in the article what that needed treatment was.
As far as we know, she arrived with a complaint that she'd like to have an alien implant removed from her nasal cavity. (Or some other minor ailment that did not realistically require treatment)
Maybe since they could not offer any treatment, they allowed her to stay in the waiting room rather than kick her back to the street.
Was that the case? I DON'T KNOW... but they are the kinds of questions to have answered before we judge others for neglect.
So, yes, it's important to know why she arrived.
It's amazing how buried the details of this story are, but after quite a bit of research, i found that:
"She was a probable homeless mental patient who had been waiting since the day before to be provided a bed."
So, now, the question is: Were there any beds available? And one that could be given to a patient with NO AILMENT.
Your profile, Thinker, describes you as a "seeker of truth", but it seems that you made your mind up on this without feeling the need to ask questions. Shame, shame.
Still, that staff is not the kind of people I'd want caring for me either.
Shame
The distress of the collapse to the floor and the convulsions, while not witnessed in person by the staff, was readily available on the video tape. Had there been periodic review of the surveillance camera with appropriate playback when, at one moment she was not on the floor and the next she sprawled face down on it, then a nurse or aide should have been informed.
I agree with bfoxy that an assumption that hospitals have someone monitoring cameras live should not be made.
Following Esmin's death, the reforms listed below were proposed by Kings County Hospital administration for the Psychiatric Emergency Program. #6 is a better solution than mandatory periodic camera checks.
(1) Additional staffing.
(2) Expanded crisis prevention training for staff, including managing of agitated patients.
(3) Expanded space to address overcrowding.
(4) Shorten patient wait time for treatment, release or placement to inpatient bed.
(5) The appointment of a new interim administrator who will report directly to (Health and Hospital Corporation President) Mr. Aviles.
(6) Patients in the psychiatric emergency unit will be checked every 15 minutes.
(7) A clinical staff person will be assigned this responsibility for each shift.
(8) Timely documentation of patient care and assessment.
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