Settlement Secures Major Reforms at Brooklyn Hospital Where Patient Died on Waiting Room Floor

A settlement agreement and court order signed today by a federal judge establishes a framework for the systemic reform of Kings County Hospital Center’s (KCHC) psychiatric facilities, where staff ignored a Brooklyn woman in June 2008 as she suffered and died on the emergency room floor.

The New York Civil Liberties Union (NYCLU), Mental Hygiene Legal Service (MHLS) and Kirkland & Ellis LLP filed a civil rights lawsuit against KCHC and the New York Health and Hospital Corporation (HHC) in 2007. Shortly after the lawsuit was filed, the United States Department of Justice began its own investigation of KCHC’s psychiatric facilities.

Under the terms of the settlement, the NYCLU, MHLS and Kirkland & Ellis will partner with the U.S. Department of Justice to closely monitor the hospital for the next five years to ensure that it is fulfilling its obligations to protect the New Yorkers it serves. The court also approved a separate settlement involving the U.S. Department of Justice.

“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,” NYCLU Executive Director Donna Lieberman said. “But we are mindful that ending the culture of indifference that has plagued this hospital is a massive undertaking. This settlement is just a start. The real test is what happens over time. Over the course of this litigation, HHC has put in place a hospital leadership that is capable of doing the right thing. This settlement will allow us to monitor them and the hospital at every step to ensure that reforms are executed, conditions improve and patients receive the best possible care.”

The NYCLU, Mental Hygiene Legal Service, and Kirkland & Ellis LLP sued the KCHC in federal court in May 2007 after investigators found unsanitary, inhumane and dangerous conditions in the public hospital’s psychiatric ward. The complaint described the hospital’s psychiatric emergency room and inpatient unit as “a chamber of filth, decay, indifference and danger,” and sought an end to pervasive neglect and abusive treatment in the hospital’s psychiatric facilities.

The lawsuit – Sidney Hirschfeld, Director of Mental Hygiene Legal Service, Second Judicial Department v. New York City Health and Hospitals Corp., et al. – triggered an investigation by the U.S. Department of Justice (DOJ), which issued a report last year calling conditions at the hospital’s psychiatric ward “highly dangerous” and requiring “immediate attention.” The report concluded that the hospital regularly fails “to properly assess, diagnose, supervise, monitor and treat its mental health patients.”

Conditions at KCHC drew national attention in July of 2008 after the NYCLU, Mental Hygiene Legal Service, and Kirkland & Ellis released security camera footage of Esmin Green, a 49-year-old Brooklyn woman, dying on the waiting room floor of the hospital’s psychiatric emergency room. The footage, acquired through the lawsuit, showed hospital staff ignoring Green as she writhed on the floor. Green had been in the waiting room for more than 24 hours.

Following release of the video, a federal court ordered the city to initiate emergency reforms at the hospital, including requirements that every patient be checked every 15 minutes, that there be no more than 25 patients at any time in the psychiatric emergency ward, and that detailed records on the ward be turned over every week to the advocates involved in the lawsuit. Today’s settlement and consent judgment represent much broader reforms.

The settlement agreement is part of the advocates’ lawsuit while the consent judgment concerns a lawsuit the DOJ filed today against New York City. The advocates and DOJ collaborated in negotiating both documents.

“The court’s approval of the reform and monitoring mandates contained in the settlement agreement is the beginning of the process. The hardest work lies ahead,” said Rob Cohen, a partner at Kirkland & Ellis. “We will continue our work with the same vigilance with which we pursued the lawsuit. In this regard, we very much look forward to partnering with the Justice Department, which will play a critical role in ensuring that this settlement agreement produces real and lasting reform.”

Under the terms of the settlement and consent judgment, the hospital agreed to develop and implement a wide series reforms to provide the best standard of care. The reforms include:

• Ensuring patients in the psychiatric emergency room receive timely assessments and care, and prevent overcrowding in the psychiatric emergency room. Stays in the psychiatric emergency room must not exceed the state mandate of 24 hours.
• Preventing the use of restraints on patients except as a last resort when the patient is an immediate threat to himself or others, and reducing the use of emergency psychotropic medications.
• Instituting appropriate discharge planning to place patients into the least restrictive setting possible that provides the support they need. This will prevent patients continually cycling through the hospital.
• Promoting staff accountability, protecting whistleblowers and facilitating reporting of patient grievances.
• Compiling accurate data on the treatment, flow and disposition of patients in the psychiatric emergency room and inpatient units, which must be delivered to plaintiffs periodically.

“We now have a blueprint for improving the standard of care at the psychiatric facilities and protecting patients’ rights,” said Beth Haroules, NYCLU senior staff attorney. “While we’re confident the hospital’s staff is capable of implementing these reforms, it is our job over the next five years to make sure they do so.”

A six-member team of outside experts provided by the advocates and DOJ will have access to the hospital’s buildings and facilities, records, staff, contractors and patients. The experts will report to the advocates and DOJ every three months. Also, the hospital must provide the advocates with copies of incident reports twice a week, including incidents of patient or staff member violence, and acts or omissions by staff that put patients at risk of serious harm.

“Incidents of violence at KCHC used to be accepted as a way of life. That we will get regular reports of these and other incidents is a major step forward in seeking to convert the KCHC psychiatric emergency room and inpatient units into safe, humane and therapeutic environments,” said Dennis Feld, MHLS deputy director of Special Litigation and Appeals. “It also supplies a transparency where administration and direct care staff will be held fully accountable whenever harm befalls a patient whether at the hands of staff or other patients.”

The monitoring will last for at least five years. It can be extended if the advocates and DOJ determine the hospital has not made sufficient progress.