Long wait outside emergency room

Esmin Green had been committed, without her consent, to the Kings County Hospital psychiatric E.R. in Brooklyn, New York. She was left sitting on a chair and waiting for a hospital bed for more than 24 hours.

Then, at 5:32 a.m. June 19, she toppled from the chair and fell face-down to the floor. No medical staff attended to her, no security staff was concerned with her lying prone on the floor. Finally, about one hour later, a nurse kicked her so she would wake. Esmin would not wake; she was dead.

The medical examiner found that Esmin died from pulmonary embolism, caused by blood clots that developed in her legs and traveled to the lungs. This happens when blood stays in the legs for such long periods sitting in one spot that it eventually coagulates. Esmin, drugged and sedated, had sat too long in the chair – 24 hours – unattended.

But for a surveillance video that was shown weeks after the event, the death of Esmin Green in the hospital would have been ignored. The E.R. camera took in everything that was happening to the 49-year-old mother, but no other response from the hospital was forthcoming — none particularly from the staff. Esmin had been ignored by the medical professionals in life; she was also ignored even in death.

Esmin’s case was hardly unique. About one year before, Edith Rodriguez died under similar circumstances, bleeding to death on the floor of the Martin Luther King Hospital E.R. in Los Angeles. They were both classified as mental patients.

And it may have been for that reason they were ignored … like so many other emotionally disabled Americans. According to one psychiatrist, many medical professionals become indifferent once they have classified a person as a mental patient. This is particularly true when the person is involuntarily committed to hospital. Anything that happens to the person is simply dismissed and blamed on the mental condition.

Or, it could have been pure profit motive.

Hospitals have increasingly resorted to boarding inpatients in their E.R.s, resulting in overcrowding. When a patient in the E.R. needs to be admitted but there are no available inpatient beds, the stay in the E.R. is extended although the initial E.R. work has long been completed. As patients stay longer in E.R., new patients coming in also have to wait longer in the queue to see a physician.

Hospitals may give low priority to E.R. patients for inpatient beds, even if some are available. One reason is that direct admissions and transfer patients are more profitable, since they often have private medical insurance and require expensive procedures. Another reason is that patients who go to E.R. often are uninsured, or have only Medicaid, and may not need the high-profit procedures.

What can consumers do?

Hospitals should be held responsible for the waiting times of E.R. patients to get beds. They have mounted a strong lobby against this accountability. Consumers can pressure the federal Medicaid Services (which pays the bills) or the hospital-accreditation organization to require hospitals to track and remove E.R. boarding.

Consumers can also write their congressmen to conduct hearings on the matter. Let the U.S. Congress require hospitals to set a maximum time patients stay in E.R. (in England, the regulation is that 98 percent of E.R. patients must not exceed 4 hours stay).

Consumers can try (before the need arises) to identify those E.R.s in their community where waiting times are not so long. This will have to be done by asking friends and family, since hospitals will never reveal their waiting times.