The “Unavoidable” Death of Esmin Green

Esmin Green was “Disregarded, Disrespected, Discarded”: Powerful words from a congresswoman from New York, Rep. Yvette Clark in her eulogy during the wake held for Esmin Green, an immigrant from Jamaica, who died while waiting for medical care at Kings County Hospital Center in New York (Clark, 2008). And I guess that answers the first question: If Esmin Green received quality health care. For documentary evidence, the City of New York’s Department of Investigation (DOI) made a thorough investigation and had submitted a report detailing the “Circumstances Surrounding the Death of Esmin Green” (Hearn, 2009) In that comprehensive report, DOI stated that Ms. Green was never medically examined during the times that she was supposed to be cared for, and despite an earlier order by a doctor, no examination, no EKG and no blood work were done on Ms. Green, who spent almost a day at the emergency room until her death on June 18, 2008.  

As to the first premise of the same question, however, it would seem that Ms. Green received “quality health care” as far as her old 2007 medical record was concerned (Hearn, 2009) and on that fateful day when Dr. Thomas Kowacz examined her and issued written orders. It was Dr. Kowacz who, the report said, diagnosed Ms. Green as “psychotic and schizophrenic” and who ordered Ms. Green to be “involuntarily admitted to KCHC’s Inpatient Service” and who made written orders that Ms. Green receive full medical examination, blood work and an EKG (Hearn, 2009).  Be that as it may, Ms. Green’s fate may have been sealed when the nurses failed to follow the Comprehensive Psychiatric Emergency Program (CPEP) protocol to include Ms. Green’s name in the 24-Hour Observation Sheet for an hourly observation (Hearn, 2009).

ER “Strong Documentation Standards”

As provided in the DOI report, the particular incident involving Ms. Green indicated a dismal and total failure to observe proper documentation at Kings County Hospital Center…for at least one patient in the person of victim Esmin Green.  It should be noted that Kings County Hospital Center had a “first rate” reputation, especially when dealing with patients suffering from gunshot  wounds, and was once named the first Level 1 Trauma Center in the U.S.” by the New York City Health and Hospitals Corporation (Wikipedia, 2013).  But in the June 18, 2008 incident, KCHC failed miserably, as shown by the “doctored” or falsified documents by nurses, and even by medical doctors who claimed to have “examined” Ms. Green but did not as shown by the video.  The cover up showed that although KCHC may be a top-rated trauma center, the indifference towards people needing medical care was very glaring.  For all we know, more may have also died as a result of the staff’s negligence and dereliction of duties.   Perhaps, because they were “psychotics and schizophrenics” and were unable to express themselves properly.  Unfortunately, from the names of the nurses, who I believe may be Filipinos like me, I am scared for my life.  I thought we are compassionate, caring and hard workers.  And even if Ms. Green was from Brooklyn, though Jamaican, and is an “inner city” I hope that race was not a factor in her death...but I doubt that.

Clinic Was Responsible for Esmin Green’s Death

The mere fact that the hospital fired at least six of its staff, the DOI investigation showing cover up and for doctors to assert their Fifth Amendment to avoid self-incrimination clearly demonstrated the lack of proper hospital supervision in relation to their medical staff, and for this incident, even for their security personnel.  Which brings to mind this very obvious security measure: Video cameras are there for the security of safety of all people in the facility, which the security personnel ironically should be manning or at least be in charge of.  Not only are the medical staff perhaps criminally liable for Ms. Green’s death, the family of the victim has valid reasons to civilly charge the hospital and the City of New York (Fennell, 2008), as Ms. Green was a provider of six children, who may still be living today if not for the negligence  by the nurses, doctors and security personnel, some of whom as already mentioned lied and tried to cover up their misdeeds.  If we were to base our argument on Wikipedia’s article, which stated that the Kings County hospital has apparently “paid out more than 1/3 of all medical malpractice claims against the New York City Health and Hospitals Corporation (over $60 million)…has a very high amount of malpractice claims compared to other city hospitals (and) has been the most sued hospital of the city’s health care system” (Wikipedia, 2013), the more that the hospital is responsible for Ms. Green’s death, and perhaps for many others whose episodes were also fatal but not as controversial as Ms. Green’s death.

If EHR system were in place

For the purposes of our class, the death of Ms. Green could’ve have been avoided if only the medical staff at  Kings County Hospital Center were responsible enough to follow established  protocols, including monitoring and actually applying the ordered procedures, especially if aided by an electronic health record system that would’ve alerted the healthcare workers and even the security personnel.  As we’ve learned from our previous meetings, an electronic health record management would’ve begun as soon as when Ms. Green was picked up by the EMS personnel prior to arriving at the psychiatric emergency room of the KCHC.  From there, they would’ve known that since 2007, Ms. Green had been in and out of KCHC and was “diagnosed with psychosis and/or schizophrenia .” and was prescribed medications for these symptoms (Hearn, 2009).  Her records also indicated that Ms. Green was “non-compliant” with her medications in 2007 that could’ve alerted the staff on her behavior upon her arrival at the hospital on June 18, 2008. 

Moreover, Dr. Kowacz may have also found out Ms. Green’s wasn’t placed on the 24-Hour Observation Sheet even when she was deemed on the early morning of June 18, during the initial screening, that she was a “Priority 2-High Priority” patient (Hearn, 2009).  Regardless, Ms. Green’s fate seemed hopeless because she wasn’t monitored on an hourly basis and Dr. Kowacz’s written orders were not administered.  These incidents were aggravated by the fact that the assigned doctors later that day didn’t do the tasks that they were supposed to perform and by the insensitivity of the security personnel and other medical staff who could only manage to “nudge” Ms Green with their foot to find out how she was and did not perform CPR as required at that very moment (Associated Press, 2008). Again, for the purposes of this class, the monitoring alone could’ve saved Ms. Green’s life, which apparently all it needed was the administration of anticoagulation drugs to stop clots from forming (Associated Press, 2008). 

Bibliography

Associated Press. (2008, July 11). Esmin Green, who died on Brooklyn hospital floor, perished from sitting. Daily News .

Press, A. (Producer). (2008). Video Shows Woman Dying on NY Hospital Floor [Motion Picture]. USA: Associated Press.

ZYNCTV (Producer). (2008). Esmin Green Remembered (Woman left to die at Kings County Hospital) [Motion Picture]. USA: Youtube.

Fennell, A. (Producer), & Fennell, A. (Writer). (2008). Esmin Green Case [Motion Picture]. USA: NBC Universal/Comcast.

Hearn, C. R. (2009). DOI’s Investigation into the Circumstances Surrounding the Death of Esmin Green. New York: New York City Department of Investigation.

Wikipedia. (2013, October 29). Kings County Hospital Center. New York, New York, USA.