Reforms at NYC hospital where patient died in waiting room announced as part of consent decree

Settlement calls for 5-year watch of NYC hospital

NEW YORK — A Brooklyn hospital where a patient died in a waiting room will undergo improvements mandated by a consent decree and five years of court monitoring to end years of neglect and overcrowded and unsanitary conditions, advocates for the mentally ill who had filed a lawsuit said Friday.

The settlement and court order called for monitoring by the U.S. Department of Justice and the advocates to end what their 2007 lawsuit had described as “a chamber of filth, decay, indifference and danger” at Kings County Hospital Center in Brooklyn.

The dangers stirred public outrage after 49-year-old Esmin Green in June 2008 was ignored by hospital staff for nearly 24 hours before she collapsed from a blood clot and died on an emergency room floor. She had been diagnosed with schizophrenia.

“The systemic reform outlined in this settlement should ensure that another tragedy, like the one that claimed Esmin Green’s life, never happens at this hospital again,” said Donna Lieberman, executive director of the New York Civil Liberties Union.

“This settlement is just a start. The real test is what happens over time,” she said in a statement.

The NYCLU, along with the U.S. Department of Justice, city agencies and lawyers in the case, will monitor the hospital to ensure reforms are occurring on schedule, the NYCLU said in a release. The agreement pertains to the hospital’s behavioral health units, its psychiatric emergency program and its extended observation unit.

U.S. District Judge Kiyo A. Matsumoto signed the consent decree Thursday.

Many of the improvements it mandates are routine procedures designed to ensure that the facility is clean, food is not spoiled and patients are treated properly.

Some are designed to ensure patients are treated properly in the most stressful circumstances. For instance, it requires that a patient in restraints is re-informed at least every half hour about how behavior must be improved to be released from restrictive intervention.

The decree also permits a nurse to end restraints without waiting for a doctor to consent.

Many of the improvements outlined in the consent decree have yet to be designed. One section calls for the hospital to “develop, implement and maintain an updated and comprehensive set of psychiatric practice guidelines, including but not limited to administration of medications.”

But some rules put in place ensure immediate improvement, including a provision requiring that new patients receive a psychiatric evaluation within 24 hours that includes a psychiatric history, a complete mental status exam, admission diagnoses and the ordering of any lab tests.

Last year, the Justice Department called conditions at the hospital’s psychiatric ward “disturbing” and “highly dangerous” and said they required “immediate attention.”

It said violence among patients and sexual abuse occurred at the hospital where staff failed to properly assess, diagnose, supervise, monitor, and treat its mental health patients.

Even before Friday’s consent decree, the president of the New York City Health and Hospitals Corporation, which runs the hospital, had announced “radical changes,” saying a new $153 million psychiatric center would include increased mental health staffing and a reduction of average time patients spend undergoing evaluation in the psychiatric emergency room from 27 hours to just over nine hours.

In a release, the city cited numerous improvements to the hospital that were already in place. It said more than 360 new doctors, nurses, psychologists, social workers and other staff have been hired since the lawsuit was filed.

It said it has also installed a new system of evaluating new patients that ensures the average number of patients in the psychiatric emergency room does not exceed 25 patients, half the number that sometimes existed in the past. And it said it has agreed not to place patients in seclusion.

“We are pleased to bring this litigation to a conclusion and look forward to continuing our work to fully implement sweeping and radical changes for the better in the delivery of behavioral healthcare at Kings County Hospital,” said HHC President Alan D. Aviles.