Death In An Emergency Room: A Symptom That The Public Health 'Care' System Is In Code Blue Status

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.