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July 31, 2008

The Kings County ER Incident

I recently saw a Kings County video online. (Emergency Room Death Sparks Outrage) A Kings County Hospital Center surveillance camera caught a patient writhing on the floor while other patients and staffers ignored her.

Esman Green, a 49-year-old Jamaican woman and patient at the Kings County Hospital Center in Brooklyn, died last month, unattended and seemingly ignored, on the floor of the Kings County psychiatric emergency room, according to officials.  The video shows Green slumping out of her chair and going into convulsions as workers and fellow patients walked by her, doing nothing. How could no one do nothing? Is this hospital care? What happened to morality?  Green had been in the King’s County psychiatric ward waiting area for over 24 hours.  She was later pronounced dead.

It is now reported that hospital workers falsified the time of the incident on Green's medical records. Meanwhile, federal and city investigators are considering possible criminal charges and the staff involved were suspended or fired. A Civil Rights Suit is now in being filed.

Are we so cynical about patient care that ignorance is now accepted? Do we no longer have time to check on a patient? Was this preventable? Where was the staff? Any staff? Where is the pride in helping a human being today? Isn’t that the bottom line of nursing?  Your comments, please...

July 31, 2008 in Beka | Permalink


I have been a registered nurse for 2-1/2 years now. My robust, gun-ho attitude has been battered and bruised by the stress of putting my heart and soul into my work daily, and still not doing enough. I have seen nurses who find the time to surf the internet and text half the day, yet still report they did everything on time. Then I see other nurses who run around actually DOING things for patients, then stay late trying to report all those little things they have to document doing, or else, legally, it was never done. Some say actions speak louder than words. They don't always. Unless there's a witness to atest. If that camera hadn't been rolling, it would have been the nurse's word against the wordless patient. I've witnessed nurses skipping rounds, sacrificing a quick look-in for a personal attendance. But I've also witnessed action - a tender touch, an extra visit, a caring talk, a life saving maneuver, or a shield from a fall, etc. that sometimes never goes noticed by words or witnesses. But someone is ALWAYS watching... whether you're on camera... or not. there's always that person that comes to the desk right when some snide remark is said... about THEIR family member. Always an auditor who goes by and sees you giving a whole dose instead of the half... always, eyes at your back, over your shoulder, peering into your heart. So if you have lost your patience with your patients, if you have been desensitized by falure, abuse, acting, pretense, overworking, lack of sleep, anything, remember... the eyes are there, staring through the camera, seeing. so if your compassion or patience has run out... maybe you can inspire paranoia in yourself enough to spark a compassionate act, if not from your heart, then at least for your self-preservation. For, whatever appeals to you, it is a human's life in YOUR hands. In the end, to God, if not anyone else, ACTIONS speak louder than WORDS ANY DAY! For me though... I cannot ever see myself reacting, or allowing anyone around me to react, like those people did thay horrific day. In every patient, I see my mother, my grandfather, my husband, my friend.... even myself. Over worked, underpaid, Under staffed, over whelmed, it matters not. Do what you promised to do no matter what. First, do no harm. by omission, negligence, or incorrect action. forget yesterday. a hundred tantrums, a hundred cries of "wolf!" may see one true last cry. Compose yourself like you are always being watched, for the patients sake! Because anyway... You probably are. And no matter what, at the end of the day, you document and say of your actions or observations... what, in actuality you did or didn't do... will be seen by who matters MOST.

Posted by: Shaddow | Sep 6, 2011 10:25:35 PM

Working as a psychiatric nurse for over 25 years, I have worked in every field of nursing at one time or another....I resigned for a number of years as I have an autistic son, who needed my care and guidance to meet and exceed what he is capable of. When he reached the point of driving, and could get back and forth on his own and excelled in school...I was getting antsy to return to nursing. Now, I am a seasoned nurse and graduated from a Catholic Nursing School. The pts. care and needs were a top priority and I have always used my skills for physical care and psychiatric care. I returned to work in 2005 on a psychiatric unit, which had many ill pts. with physical illnesses as well as psychiatric diagnosis. I was efficient with all aspects of the care of the pt. I was not liked very much because when a pt. had physical complaints and I would do what I could for the pt. I was over and over again told that I was interferring with the care of the other staff (nurses) patients. And they did not like that. I
eventually was terminated/resigned an option, as I was
accused of alienating staff by bringing to their attention physical ills of their pts. or even talking to them.......Where was the teamwork??? There was none and my supervisors, which were 3 at the time, did nothing to resolve a hostile environment.I was horseplaying in the break room and this was reported to the supervisor. I was terminated, appealed it and got my job back, put on 3 mos. probation and 6 days before my probation was up, I was suspended for being accused of making a racist remark,which a staff member (CNA) said I said, but no one witnessed this so I was permitted to return to work.
I am not a racist and did not say the remark she accused me of.
The day I returned to work after the suspension was lifted, I went around to all staff and apologized if I had stepped on their toes and to please come to me and let me know if you have complaints and I will resolve them, as I was not getting support from our new
Manager. The next day I came into work, I once again was suspended for embarrassing the same CNA, this time
staff lied and said they had a witness and so I was terminated at this time. Since Feb of this year, I have
been working in a hostile environment on night shift and evening shift. People don't like me, I was told, because I am pro active about taking care of patients.
And staff does not want me to even talk to their pts. or anyhting......
What would you do?? Termination twice in two months is alot of stress and pressure.....my health was being effected? I was even granted FMLA, for depression and anxiety affecting my BP and causing Tachycardia.
So I have not had the strength to appeal again.....
Has anyone out there experienced working with staff that just wants to do psychiatric nursing, ignoring the physical needs and hating you because you are skilled and a valued nurse??? My manager told me this, but still did not resolve or tell me what the complaints were.
There was lack of empathy, especially towards pts. that
were frequesnt visitors to the Psych. unit. Where have the nurses gone from the nursing schools who were taught pt. care......its not at this domain on the unit I worked. Not on nights or evenings, but there are a few good nurses left, but not enough to fight the politics or have the guts to have helped me or stood up against the management. But lots of backstabbers...
I live in Winston Salem and it is one of the two
huge domains there. I cannot say the name, they are likely to sue me....
Please send some comments to me or suggestions.....

Posted by: Angel Mercy | Aug 29, 2008 8:58:59 PM

I am an ER nurse in Brooklyn, not too far from King's Co. Hospital where this happened. I started my nursing career almost 15 years ago in the South and began nursing in NYC in 1998. While I am ashamed to say it, I am not surprised this happened in NYC. NYC brings out the best and the worst in people and in this case, the worst. The attitudes in most ERs (psych and medical)is more jaded than I can even begin to describe. Is it right? Of course not! Are there reasons, yes; are they "right"? No. Most RNs in ERs in NYC have anywhere from 10-16 patients each; those included ICU patients, intubated patients, post-code/resussitation patients, psych and med/surg, and tele patients. You have no help. There may be 2 or 3 "PCTs (pt. care technicians)" assigned to the whole ER (which they will stuff about 100 people in when there are beds for 50) but they are never to be found. You are spit on, hit, called every profanity in the book, have things thrown at you....I could go on. Does this excuse the total lack of care shown by all disciplines that passes this woman while she lay on the floor? Absolutely not. Perhaps she was a "frequent flyer", of which we have many in NYC. Perhaps this was often observed behaviour and, wrongly so, assumed to be her "usual routine". Doesn't matter; it takes 2 seconds for ANYONE - security, housekeeping, nursing, whomever - to check and see if she is at least BREATHING!! My point, I suppose, is to paint a picture life in the ERs in NYC. Given the working conditions management at EVERY hospital I've worked in in NYC (about 5 or 6) forces staff in every department to work under, it is no wonder that they become jaded, dispirited and nonchalant to the point than a human life is put in jeopardy. And this case, folks, is just ONE that happened to get caught on camera. You don't want to hear about all the ones that don't. And if you report issues to the unions that almost all NYC hospitals have, you're wasting your ink and paper. In October or November my current assignment ends and I will be leaving the ERs of NYC. These are not the mindsets I choose to be around, not the nursing I practice or will be forced to practice. Only when the rest of the states follow CA and impose FINANCIAL penalites on hospitials who put patients (and nurses' licenses!) at risk will things MAYBE begin to change.

Posted by: kimberlee | Aug 29, 2008 6:32:24 PM

I wouldn't disagree with any comments here. Added to what's been said, how about the legality of this? Whether you lack compassion, empathy, drive, intellect or any of the traits mentioned, it's illegal to hold a professional license and fail to deliver adequate care.

I do agree that you cannot (obviously) legislate professional conduct. I too have to say the answer lies in refusing to tolerate nurses who put up red flags. We should all verbalize when we seen inappropriate behaviors of any kind from fellow-nurses. Each situation might be different. Whether those behaviors are discussed directly with the offender, a supervisor, or other member of administration shouldn't matter, as long as efforts are made.

This is a horrible thing, and it will have a very negative impact on the nursing profession.

Posted by: Kathleen | Aug 28, 2008 7:06:03 PM

There are too many MENTALLY imbalanced entering nursing to help others,when they need to get off their psych meds and take personal responsibility for their life and not enter the ranks of nursing, where all too often they bring with them their mental imbalances and are quick to yell discrimination when their flaky irresponsible choices again reap as they have invested.

Get well before you think of entering nursing...you do those of us whom are accountable, to our own mental and physical health, no favor. Neither are you therapeutic to the ailing patient whom comes to the hospital for professional Therapeutic interventions.

Posted by: Arthur | Aug 12, 2008 6:21:03 PM

You become a nurse with education, but you also need the heart of compassion to go with it. If I saw anyone lying on the floor anywhere, I would find it my "prime directive" to see why they were there and if they needed CPR or other medical care, including mental health care. I am an RN in corrections, and our officers wouldn't let someone be in the situation that poor woman was in without calling for one of us to check her. So many of you who have written before me have expressed my own thoughts.

Another article in this group that came to me was about the lack of nurses and what things prompted people to become a nurse. I've decided to offer my services to the closest high school as a speaker about the occupation of nursing. While there,one of my goals will be to educate any who listen to find out if they are speaking to an RN when they are getting care. Society does need to understand who they are receiving care from. May I challenge you to also offer yourself to the closest high school in your neighborhood?


Posted by: annettepn | Aug 12, 2008 1:22:55 PM

Our society is prejudiced against those with pyschiatric diagnoses. There is a huge stigma-even within the health care professions. I am an NP with Bipolar disorder and have been hospitalized in the past and viewed first hand the negative attitudes toward the mentally ill. I once was in a ER as a staff nurse and the nurse in report was talking about a patient who had tried to commit suicide saying "she should have done it right". I immediately volunteered to take the patient. I tried to care for her as if I was caring for my own loved own in this situation.
I understand there are flaws in the system-including no beds for those who really need inpatient care, particularly the most vulnerable-the uninsured patient who has little resources. As nurses we must be the voice for those with psychiatric disorders and advocate for increased services.

Posted by: Debbie | Aug 12, 2008 1:16:59 PM

While walking along a residential street, I noticed a pile of newspapers at the front door of a house. Having had the experience of stopping the paper on vacation only to find a pile of them on the porch when I returned, I gathered the papers and took them to the back of the house. I noticed the mailbox was overflowing. I looked in at the back porch and noticed a loaf of bread that was unopened and stale. No one answered the door. I went to all the neighbors' homes and no one answered my knocking. I then contacted the police and they found a woman lying in the hallway where she had fallen five days previously. She was still alive and awake and was taken to the hospital where she recovered.

This is just an example of responding and caring for one another. It is unimaginable to me that something so awful could happen at a health care facility or any where else for that matter; but,it does happen.

We, as health care providers, are called to minister. If it is just a job and not a profession, it is time to leave. The thing that keeps me going after so many years is that most of my colleagues and I minister and answer the call, no matter the consequences. I am a nurse.

Posted by: Lin Miller, RN | Aug 11, 2008 12:03:28 PM

Just of Note -
In the news today - Kaiser Permanente has settled with the two cases from last year in which two homeless individuals where dropped off on the streets in LA, one being a paraplegic.


Posted by: beka | Aug 7, 2008 1:24:46 PM

I am a nurse of some 35 years, working in Melbourne, Australia. I trained in the hospital trained system, and have witnessed the college training which was implemented in the early 80's. Today in 2008, we have not moved on in our professinalism, but educationally we seem to be better. However, nurses are born and very few are made. Our attrition rates are high, our standards of care is falling, we have shortages of nurses in every sector of nursing and many of our younger nurses don't want to do the hard work. Nursing is an intensely pratical profession, which requires hard work, dedication, caring and the smarts. Without those attributes we have failure in our profession and a lowering in the standard of care. I am nearing the end of my career, having gone back to clinical nursing where I started. I like to believe that I can still deliver the high standard of care that I started out with and to which my patients are entitled. As my daughter nears the end of her final year at school, and wants to be a nurse, I know that she will be imbued with the attributes that make a "good nurse".

Posted by: Kate S | Aug 7, 2008 3:36:57 AM

As I coursed through a rigourous BSN program in the midwest, as a non-traditional student, I was appauled at the compromise I witnessed in both the students and the nursing faculty. I strove to keep my standard high, to embrace diligence, self-control, empathy, compassion, integrity of effort and performance. When in clinicals, to remember the patient I cared for was one made in the image of God, vulnerable, with issues, but deserving the very best care possible. I noted with great internal lamentation, the character of so many going into nursing today, grossly lacked moral and ethical fiber of the heart and mind. As they cheated from one assignment to another, it was obvious to me, this same compromise of integrity in the classroom would translate to the field. I was not wrong in this perception about many entering this profession, more for a thirst of money, to hunt for an MD husband and to seek power. To render compassionate service to the maimed, ill and disabled of this society was NOT the driving force for which they entered this profession;and in time it showed.

I observe so many nurses, especially on back shifts, sleeping,doing personal internet shopping, talking on cell phones, text messaging, surfing the web, e-mailing and a host of personal objectives, that is always at the expense of those patient's put to their charge. To expose this, to insist on integrity of performance, for the safety and welfare of these vulnerable patient's is to have a bullseye target on one's back.

Even today, the Whistle blower, is crucified. Too many medical institutions have enough money to halt most public knowledge of such sloppy, immoral and illegal behavior and they do. Today, medical institutions across America, employ many young, relatively new and inexperienced nurses to keep their staffing up. As more and more "boomers" exit this profession, more and more horror stories will emerge. The gold standard that once prevailed in nursing, is being replaced by a rusty counterfeit.

Too many in America today, in all professions, believe the pretense of something is as worthy as the pragmatic existance of the same. It is not!

With the advent of technological devices such as computers, cell phones, MP3 players and palm pilots; it has been my observation that especially on back shifts where the number of "brass" is vastly reduced, more and more nurses, opt to play on these devices for personal entertainment, at the expense of the routine and diligent bedside care of patients. I have witnessed routine checks, meant to prevent potential medical crisis, go unattended in actuality, though the charting reflects routine monitoring. That is illegal, that is unethical, that is reprobate nursing, but as this is brought to supervisory attention, too often it is swept under the rug, and the whistle blower becomes a victim of covert and overt slanderous attack.

Nurses are the irreplacable force of any medical system and when their integrity is compromised, so too is the whole of the system compromised. Patients are the ones that suffer today, yet so much goes unaddressed and undisciplined in the ranks of nursing because of the vast shortage which is ever increasing.

We as a society seem unwilling to reward, and protect the integrity of nursing so that the mentally imbalanced, the corner cutter, the power monger and the insatiably greedy stay out of our ranks.

Compassion, empathy, moral fiber cannot be legislated, no matter how earnest law makers try to control any of these factors. Integrity starts in one's heart, and unless one highly values the divine integrity of each and every human being, no matter his/her issues presenting, the sad presentation of patients being neglected, poorly cared for, or berateded for whatever reason, will prevail.

Nurses have a reputation for "eating their young." Some need to be eaten, but largely we need to nurture, and model empathy, professionalism, and moral integrity in how we nurse, how we interact with others, and how we live both in public and private.

"Sow a thought,
and you reap an act.
Sow an act,
and you reap a habit.
Sow a habit,
and you reap a character.
Sow a character,
and you reap a destiny."

Professional conduct and character cannot be divorced from personal conduct and character. The problem's of apathy, neglect, and abuse in the care that is rendered or not, has it's etiology with the substance of the heart.

It is impossible for any entity to effectively monitor and enforce integrity of performance in any profession, especially nursing. Many try, but the horror stories that keep surfacing, safe keep the evidence that only as one disciplines him/herself, at the heart level, with the integrity of truth and compassion for another, will the outworking of their actions, prove nobel and commendable.

We few band of Angels, in this nursing profession, with rightly anchored hearts, need to set the example, encourage the same and cease to cover for peers whom habitually give us bad publicity, because they were never in this profession to serve with integrity and compassion for the welfare and good of another.

It all starts with each one of us, doing what is right, one day at a time.

Posted by: PJ | Aug 6, 2008 6:37:51 PM

My husband and I are both Registered Nurses that are on a travel assignment in the northeast. We have worked down south and out west. Indeed, different hospitals do have their own culture of caring, and hold their employees to a suscribed standard. We both view our practices as a sacred trust and responsibility for another life. We strive to provide the best care we can, often under less than optimal conditions.
We often share with other nurses, different practices we've seen. This often encourages positive results. We need to advocate for the good of our profession and encourage accountability of those in our practice, administrators and in government in order to maintain the public's safety and trust.

Posted by: Maria Bertolino | Aug 6, 2008 2:03:47 PM

Hi folks

This side of the pond, we are becoming aware that the NHS is very good at treating patients, but sometimes we do not care very well for them!

Which is the reason why I became a Nurse!


Adrian Jones RN

Posted by: adrian jones | Aug 6, 2008 10:20:43 AM

It is truly hard to believe that we all live in a country where the 'best' health care is, and yet what were the staff thinking? I've read the comments posted from seasoned veteran nurses. I'm a pretty new nurse, but just because your a nurse, doc, lawyer does not make you a good person. You can't place blame on just nurses for something this tragic. It's a domino effect, and it started with the moment she walked into the doors of the hospital--this should make us all more aware not to become jaded and insensitive.

Posted by: Karen W. | Aug 5, 2008 10:54:28 PM

The moral implications of this incident for all the health care professionals on duty are earthshaking. I've spent the last few years working with patients who have odd psychiatric behaviors as manifestations of their illness. As I get to know each one, my greatest fear is how they will be treated by others in a crisis, whether medical or some other emergency which sets their anxiety into high gear. The more I work with such people the more I see the bigotry and apathy that exist throughout our society for those who are mentally ill. I would have hoped that nurses could rise above that level.

Posted by: Joan Knape | Aug 5, 2008 9:20:40 PM

I was appalled when I read about this incident. I don't care how long you've been on duty or how burned out you are, it is totally inexcusable to treat another human being this way. I've worked in the same rural hospital for over thirty years, mostly in the ED. When I first started as a CNA at age 16, I saw first hand the kind of nurse I wanted to be. I've tried very hard to keep up that attitude and dedication. I have seen plenty of patients like the one Lee described. You always treat them like anyone else with the same symptoms because one of these times it will be a true heart attack/seizure/stroke. I agree with Jennifer that there are a lot of nurses out there giving the rest of us a bad reputation.

Posted by: April Tainter | Aug 5, 2008 6:49:11 PM

28 years ago, as a graduate nurse, I went to work in a rural (30 bed) hospital. I was fortunate enough to work in the ER quite often. At that time,there was a young man in the community who was mentally deranged and had frequent "seizures". The seizures weren't real, but he was an expert at imitating a seizure. Sometimes he would have 2 or 3 "seizures" a week. Someone would find Jimmy lying on the sidewalk at 2 AM and call the volunteer ambulance crew, who would go pick Jimmy up and bring him to the ER. The ER staff would do a full assessment, give him whatever treatment we could, and send him home feeling better. This routine was repeated countless times during my years at the hospital. I left that hospital 20 years ago. Recently I was visiting someone in that community and their scanner was on. A call went out for a man having seizures on the sidewalk on Main Street. Jimmy was still doing his thing! Out went the volunteers, off to the ER went Jimmy, to get the attention and treatment he unfailingly received throughout years and years. What else can I say? God help us all when the caring professions no longer care.

Posted by: Lee Peck | Aug 5, 2008 4:16:12 PM

Must the question be asked: What is the duty of a Nurse? The Patient should always come first. You should treat EVERY patient with the care they need and deserve, regardless of anything. How many people in this world actually have morals, ethics, integrity, empathy? That is the foundation of a nurse, yet I know many who go into the profession for the money, and to climb that ladder of education (CNA, LPN, RN, etc..). The higher they climb, the less physical work is required of you, yet you are payed a lot more.
I also believe that a patient who is a "regular", especially in a psyche unit, will be looked at as "crazy", of course that word should not be used, and they will be treated as if they simply want attention; essentially there is the probability they are ignored. I'm still going through Nursing School and I know that this is the profession for me. For all of the right reasons, and luckily the financial end is great. I love caring for patients. I've seen many nurses in action, or not, those of any rank. The brunt of patient care falls on those with the least education. I can say it's half and half as far as how the nurses treat their patients. Half do everything to the tee and are friendly with the patients, and the other half do the opposite, pretty much nothing, unless it's complaining.
It has turned my stomach to watch a group of healthcare professionals chatting around the nurses station while call bells ring endlessly. I, doing my clinicals, always feel compelled to answer those bells.
It's blatantly obvious during clinicals and even classroom, which students will be a true nurse, and which ones don't care for people. They lack the empathy. Many lack all of the key components and simply do not care!

Posted by: Jennifer Ball | Aug 1, 2008 6:55:50 PM

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