BROOKLYN, N.Y. – City hospital officials agreed in court Tuesday to implement reforms at a psychiatric ward where surveillance footage captured a woman falling from her chair, writhing on the floor and dying as workers failed to help for more than an hour.
Esmin Green, 49, had been waiting in the emergency room at the city-owned Kings County Hospital Center for nearly 24 hours when she toppled from her seat at 5:32 a.m. on June 19, falling face down on the floor.
She was dead by 6:35, when someone on the medical staff, flagged down by a person in the waiting room, finally approached, nudged Green with her foot, and gently prodded her shoulder, as if to wake her. The staffer then left and returned with someone wearing a white lab coat who examined her and summoned help.
Until the staffer's appearance, Green's collapse barely caused a ripple. Other patients waiting a few feet away didn't react. Security guards and a member of the Brooklyn hospital's staff appeared to notice her prone body at least three times but made no visible attempt to see if she needed help.
One guard didn't even leave his chair, rolling it around a corner to stare at the body, then rolling away a few moments later.
Green, a Jamaican-born woman who had been involuntarily committed the previous morning and had waited overnight for a bed, stopped moving about half an hour after she collapsed.
The New York City Health and Hospitals Corporation, which runs the hospital, said six people have been fired as a result of the incident, including security personnel and members of the medical staff.
The psychiatric unit at Kings County Hospital had already been a subject of complaints by advocates for the mentally ill.
The Department of Justice began investigating allegations of patient mistreatment this spring.
A state agency, the New York State Mental Hygiene Legal Service, and the New York Civil Liberties Union filed a lawsuit a year ago, calling the psychiatric center "a chamber of filth, decay, indifference and danger."
Both sides in the dispute went before a federal judge Tuesday to jointly file papers in which the hospital system agreed to a series of reforms. Under the agreement, patients in the waiting room will now be checked every 15 minutes.
Over the next four months, the hospital will attempt to shorten the median waiting time to around 10 hours. A judge is scheduled to sign off on the agreement Wednesday.
The tape of the incident has also been turned over to prosecutors.
Green's medical records raised the possibility that someone might have tried to cover up the circumstances of the death.
One notation said that at 6 a.m., she was "awake, up and about" and had just used the restroom. Another said that at 6:20 a.m., she was sitting quietly in the waiting room, and had a normal blood pressure. During both of those times, Green was either in her death throes or already dead.
Mayor Michael Bloomberg said he was disgusted by the tape, and that the actions of the hospital staff were unacceptable.
"I think what they said is, 'Oh well, people sleep on the floor all the time, and I didn't pay any attention,"' he said. "They shouldn't be sleeping on the floor ... and you should pay attention."
HHC's president, Alan Aviles, said in a statement that he was shocked and distressed by the situation and promised a thorough investigation.
Details of the death were disclosed by the hospital on June 20, but the case largely remained unnoticed until the video became public.
According to the lawsuit, patients at the hospital, "are subjected to overcrowded and squalid conditions often accompanied by physical abuse and unnecessary and punitive injections of mind-altering drugs."
"From the moment a person steps through the doors," it added, "she is stripped of her freedom and dignity and literally forced to fight for the essentials of life."
The suit was especially critical of the hospital's emergency ward, saying it is so poorly staffed that patients are often marooned there for days while they wait to be evaluated.
Sometimes the unit runs out of chairs, according to the lawsuit, forcing people to wait on foam mats or on the waiting room floor. The suit also claims that bathrooms are filthy and filled with flies, and that patients who complain too loudly are sometimes handcuffed, beaten or injected with psychotropic drugs.
Robert Cohen, a Manhattan attorney who is representing the legal service for free, said those changes should only be a start for the beleaguered hospital.
"This woman did not die because there are a few bad apples on the staff," he said. "There is a culture of indifference to patients."
The office of the city's medical examiner said it was still trying to determine why Green died. She had been brought to the hospital suffering from agitation and psychosis, city officials said.
The city has agreed to fly her body home to her family in Jamaica for burial.