Hospital settles after waiting room death
Health and Hospital Corp., the parent company of Kings County Hospital in Brooklyn, NY, has settled a lawsuit filed by the family of a woman who died on a waiting room floor - but went unnoticed for more than an hour.
The family's attorney and the hospital's chief executive recently announced that they had reached a settlement of $2 million.
Alan Aviles, the president and CEO of Health and Hospital Corporation, said in a written statement that the company takes full responsibility for the death of 49-year-old Esmin Green. Aviles said in his statement that the company offers the family "a full apology." He also noted that the settlement "is not meant to put a value on a life and the loss of a loved one. That remains priceless."
Kings County Hospital was facing a $25 million lawsuit after staff failed to respond when a woman collapsed in the emergency department (ED) waiting room. Surveillance footage from a security camera was obtained by the media and played over and over again, showing the woman fall out of her chair, land face down, and then die there as hospital staff just looked at her without offering aid.
The incident happened on June 19, 2008. Video footage, shown widely in the media, shows Green, a mother of six, sitting in a waiting room in the hospital's psychiatric ED. She slides off the chair and lands face down on the floor, apparently convulsing. Green had been involuntarily admitted June 18, 2008, for "agitation and psychosis," according to the hospital.
An autopsy determined that Green died from pulmonary thromboembolism, according to Ellen Borakove, spokeswoman for the New York City medical examiner. The clots were the result of deep vein thrombosis, which had complicated Green's chronic paranoid schizophrenia, she explains.
The New York Civil Liberties Union (NYCLU), which released the surveillance camera video of the incident, claims Green had been waiting nearly 24 hours for treatment. She collapsed at 5:32 a.m. June 19, the NYCLU said, and stopped moving at 6:07 a.m. Workers at the hospital did nothing until 6:35 a.m., when the tape shows a hospital security guard approaching Green and nudging the woman with her foot but not immediately aiding her. Help was summoned three minutes later.
Seven people were fired or suspended immediately for their alleged involvement in the incident, according to a statement released by the hospital's parent organization. They were the chief of psychiatry, chief of security, a doctor, two nurses and two security guards, according to the New York City Health and Hospitals Corp., which oversaw Kings County Hospital at the time.
NYCLU also claims that hospital staff falsified Green's records to cover up the time she went without assistance.
"Contrary to what was recorded from four different angles by the hospital's video cameras, the patient's medical records say that at 6 a.m., she got up and went to the bathroom; and at 6:20 a.m. ,she was 'sitting quietly in waiting room' - more than 10 minutes since she last moved and 48 minutes after she fell to the floor," according to the NYCLU statement.
The incident should hold plenty of lessons for risk managers, says Barry Cobb, JD, a partner with the law firm of Yates McLamb in Raleigh, NC.
"Situations like this are a nightmare for risk managers, because the outcome is terrible and because - at least as the media portrayed the story - there seems to be no reasonable explanation for why no one intervened to assist this patient," he explains.
The first lesson risk managers can take away from this incident is the importance of training all staff, including security guards, waiting room receptionists, and anyone else who comes in contact with patients or families, on the importance of observing and reporting conditions of people on the premises to health care providers, Cobb says. When working around patients with mental health issues, it is easy to slip into believing all the patient's behavior is caused by their psychological issues, rather than a physical ailment.
"Where someone's actions or appearance are consistent with physical illness or injury, however, any employee observing that patient should consider it their job to inquire about the person's condition," he says. "They should then assist or report to health care staff if they are not reassured by the patient's response."
The second lesson concerns how to handle clear mistakes when they occur.
"Obviously, we'd like to prevent such incidents from occurring, but where those efforts fail, it is important to act quickly to determine whether there is any basis for defending the care provided by the hospital," he says. "If not, early, proactive communication with family members is critical to partially defusing a potentially explosive situation."
In the early days after the death of a loved one in a situation such as the Kings County Hospital case, family members want to be certain that they know what really happened and why, Cobb notes. Risk managers should keep that in mind when responding, no matter how real the worries about potential litigation.
"They are usually motivated more by a need to know than by a desire for compensation. Any hint of a cover-up or of not telling the whole truth both increases the anger of the family and potentially makes the incident more newsworthy," Cobb says. "Talking to them about what you do know, and being honest about what is still being investigated, helps to reassure them that the situation is being taken seriously."
Families often want reassurances that steps have been taken to prevent the same thing from happening to others. Cobb notes that they also usually want an acknowledgment of fault, and if one can be given early and sincerely, that shifts the focus of the conversation from "who is responsible" to "what do we need to do to make this right?"
Cobb's third point is that specific settlement discussions or offers of compensation should wait until the family is ready to talk about those issues. It is always difficult for family members to consider placing a value on the life of a loved one, but asking them to do so too early risks angering them more. Letting them set the timetable for discussions allows them to judge their own emotional states and prepare themselves for the conversation, he says.
"Damage control is a difficult and often thankless task. If it is properly done, however, it can help take some of the passion out of these types of tragic cases," Cobb says. "If risk managers have handled families appropriately, hospital attorneys are able to negotiate settlement from a better position and credibly argue to juries that any eventual lawsuit is about fair compensation from a contrite defendant, not about punishment of a faceless hospital who does not understand its responsibilities."
Source
For more information on the Kings County Hospital settlement, contact:
Barry Cobb, JD, Partner, Yates, McLamb & Weyher, LLP, Raleigh, NC. Telephone: (919) 719-6007. E-mail: [email protected].
Health and Hospital Corp., the parent company of Kings County Hospital in Brooklyn, NY, has settled a lawsuit filed by the family of a woman who died on a waiting room floor - but went unnoticed for more than an hour.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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