Health care: July 2008 Archives
Esmin Green, whose June 19 death in the waiting room of Brooklyn's Kings County Hospital psych ward was caught on videotape, died of pulmonary embolism. The medical examiner's conclusion was reported by the New York Daily News last weekend. According to the paper, Green may have been sitting for 20 hours, after receiving a "mild sedative," while waiting for psychiatric admission to the facility.
Although it is not known how long Green may have experienced deep vein thrombosis, the source of her embolism, earlier medical attention may have alerted physicians to its presence, resulting in appropriate medical intervention. The paper reports that, because Green's death is being classified as due to natural causes, there will be no homicide charges.
The apology comes more than 40 years after AMA delegates denounced policies at state and local medical societies dating to the 1800s that barred blacks. For decades, AMA delegates resisted efforts to get them to speak out forcefully against discrimination or to condemn the smaller medical groups that historically have had a big role in shaping AMA policy.
The AMA's apology is evidently intended to foster greater minority representation among physicians. African Americans currently represent approximately 13% of the US population but less than 3% of the nation's 1 million doctors or medical students.
It's an unfortunate and open secret that nurses, most of whom are women, bear the brunt of on-the-job verbal and physical abuse―the latter either threatened or real. The source can be mentally compromised patients, as described in yesterday's NYT article ("Nurses Step Up Efforts to Protect Against Attacks"); but I've also seen senior physicians (typically male) exploit the entrenched hierarchy in medicine by intimidating all sorts of subordinate healthcare staff with their vitriolic tantrums.
Having left clinical medicine several years ago and any OR experience even further behind me, I can only hope that the abuse I witnessed in male-dominated specialities of yore remains a vaguely amusing memory. Okay, I'm talking specifically about the collective behavior of the 100% male Duke Surgery Department of the 1980s under the leadership of David C. Sabiston, Jr, MD, in which quaking, incredulous medical students (without naming names) witnessed an attending surgeon throw a resected organ at a flabbergasted scrub nurse or fling instruments with such force that they become fragmented, ricocheting missles.
Let's hope that behavior no longer remains a model of abuse for physicians in training. Okay?
Update: On point and on cue, the Joint Commission released an alert today requiring that all accredited hospitals create a code of conduct that defines acceptable and unacceptable behaviors and...establish a formal process for managing unacceptable behavior," beginning January 1, 2009.
HT for update: WSJ Health Blog
By now, pretty much everyone has seen the June 19 videotape of Esmin Green, 49, dying on the waiting room floor of Brooklyn's Kings County psychiatric facility, aka G Building, while others―including security guards―saw the prostrate woman and did nothing. Until it was too late.
But reports of inhumane psychiatric care at Kings County Hospital (dubbed "Killer County" by online wags) are nothing new. A search of the NYT archives reveals that repeated and gross deficiencies in treatment existed there at least as far back as the 1960s. On a least 2 occasions, the facility lost its accreditation status, according to the paper. The remarkably dubious history of the public facility, culminating in Green's death, suggests that blame could go as high up as possible, arguably to city hall.
Last year, the Mental Hygiene Legal Service (MHLS) and the NY Civil Liberties Union, on behalf of patients, filed suit against the NYC Health and Hospital Corporation (HHC) and others, alleging that the Kings County facility is a "chamber of filth, decay, indifference, and danger where individuals...are subjected to overcrowded and squalid conditions often accompanied by physical abuse and punitive injections of mind-altering drugs." The plaintiffs cite lack of basic sanitation and laundry services, inadequate food, no wheelchair accessibility, vermin infestation, and neglect alternating with verbal or physical abuse from healthcare staff and security personnel.
The HHC, the largest city hospital and healthcare system in the United States, comprises more than a dozen hospitals, including Kings County, in the city's 5 boroughs. The HHC Chairperson, Charlynn Goins, along with HHC President and CEO, Alan D. Aviles, are named defendants in the lawsuit. Goins and Aviles, both lawyers, were appointed to their positions by Mayor Bloomberg in 2004 and 2005, respectively. Yesterday, Aviles provided a written statement to news sources on the death of Green: "We are shocked and distressed by this situation. It is clear that some of our employees failed to act based on our compassionate standards of care."
The suit also names the following defendants, at least 2 of whom are longstanding employees of Kings County:
- Jean G. Leon, RN, Executive Director, Kings County Hospital: Leon, a native of Trinidad, has evidently held her position for at least 13 years (see 2005's "10 years of inspired leadership"). A PR-type video on YouTube featuring Leon was posted April 2008.
- Kathie T. Rones, MD, MPH, Medical Director, Kings County Hospital: Rones, a 1980 graduate of the Brown University School of Medicine and a board-certified internist, has held her position since 1996. She received a tribute for her services from the NY House of Representatives on April 3, 2006.
- David K. Dailey, MD, Chief of Psychiatry, Kings County Hospital: According to the NY State Department of Health, Dailey is a 1981 graduate of the Loyola University Chicago, Stritch School of Medicine and has been licensed in the state since 1998.
- Joseph A. Charlot, MD, Comprehensive Psychiatric Emergency Program, Kings County Hospital: Charlot received his medical degree in 1968 from the State University of Haiti and has had a NY medical license since 1979.
- Ellen B. Tabor, MD, Medical Director, Adult Psychiatric Inpatient Services, Kings County Hospital: Tabor is a 1983 graduate of the Rush University School of Medicine in Chicago. She has held a NY medical license since 1990.
- Jacqueline Purser, Captain, Hospital Police
- Oswald David (or David Oswald), Assistant Director of Nursing/Product Line Manager, Comprehensive Psychiatric Emergency Program, Kings County Hospital
- Elsa P. Bush, Associate Executive Director of Nursing, Kings County Hospital
According to today's NYT, the hospital fired the director of psychiatry, the doctor on duty, and the director of security at Kings County on June 20, the day after Green died. It is not clear if the "director of psychiatry" refers to Dailey, Charlot, Tabor, or someone else. According to Esmin Green's medical records, provided by the NYCLU, a "Dr. Estes" was on duty at the time of her death. Two nurses and one security guard were also "suspended pending union-mandated hearings."
The NY Daily News provides earlier coverage and more background on Esmin Green and Kings County:
June 27 "Shocking death on Kings County Hospital psych ward stirs reform call"
June 22 "Video shows staff ignored patient later found dead"
June 21 "Patient dies waiting for bed at Kings County Hospital"
June 21 "Video shows Brooklyn hospital staff ignore patient later found dead"
May 17 "US Attorney probes claims of patient abuse at Brooklyn psych ward"
In addition to a Federal investigation of civil rights violations at Kings County, the latest reports indicate that criminal charges are being considered in the case of Green's death.
07/03/08 update: The NY Daily News reports that Pierre R. Arty, MD, the head of psychiatry at Kings County, was 1 of 6 people fired after Esmin Green's death. The others included Kenneth Jones, the hospital's director of security, and the 2 security guards (not 1, as previously reported) seen in the waiting-room videotape.