Kings County Hospital Submits To Consent Decree For Court Oversight In Green Case

In the hopes of averting what would otherwise be a massive lawsuit by civil liberties groups, Kings County Hospital in Brooklyn, NY, will submit to five years of court supervision to ensure that conditions improve at the facility. the consent decree is part of the fallout from the heinous death of Esmin Green who died in a psychiatric ward waiting area while hospital employees ignored her plight for almost an hour.

Under the court settlement, KCH has agreed to more reforms including: banning psychiatric ER stays beyond 24 hours; using restraints only when patients pose an imminent threat to themselves or to others; protecting whistleblowers; paying attention to patient grievances; making staff more accountable and preventing patients from continually cycling through the hospital by starting appropriate discharge planning.

Staff at KCH could face criminal charges for allegedly faking medical records and lying as they scrambled to cover up their apparent neglect of Green, who died of a blood clot, according to a devastating report by the city's Department of Investigation and law enforcement sources.

"The systematic 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," said Donna Lieberman, executive director of the New York Civil Liberties Union, which had sued KCH along with Mental Hygiene Legal Services and Kirkland & Ellis LLP.

The consent decree is an attempt to avoid further litigation and help bring the hospital into compliance with basic standards, though the standards are pretty much common sense - common sense and basic human decency that was sorely lacking throughout this entire episode on behalf of hospital employees. The City and the hospital had agreed to a $2 million settlement with Green's family.

More Fraud and Abuse Uncovered At Kings County Hospital

This is definitely a dangerous and disturbing trend. Kings County Hospital, one of the 11 HHC hospitals that are under fire for underreporting bad outcomes and repeatedly engaging in fraudulent activities and recordkeeping and which was previously under fire for its despicable handling of the Esmin Green incident, now faces a similar tale of woe from another mentally ill patient.

Records indicate that the patient was in fine shape while waiting for treatment. The truth is another matter altogether.

Day after day, the mentally retarded autistic 18-year-old - labeled in internal reports as Patient GB - lived inside the waiting room of the hospital's emergency room.

He was not officially registered as a patient, although staff members repeatedly wrote inrecords that he was okay.

"Every 15 minutes there's an entry stating he was there sitting in the waiting room . . . that he was fine," said a source familiar with the case.

One of those reassuring notations was entered into the records at the same time Patient GB was found in a bathroom, forced to perform oral sex on another patient.

The reassuring record was a lie.

When investigators checked what records existed for Patient GB, they discovered hospital employees had made numerous entries in logbooks that were contradicted by videos of the waiting room showing the teenager wasn't where they had claimed he was and nobody was checking on him.

After the state was notified, the boy's mother picked him up and brought him back home. The mother declined to discuss the incident.

People going to hospitals are doing so to receive care and respectful treatment for their ailments. This patient received none. You hope that when you go to a hospital, you are in a safe environment where you do not have to worry about being sexually assaulted.

That, sadly, is not the case here either.

This patient was abused by the lax security, the inattentive staff, and then the fraudulent coverup by staffers.

In other words, none of the lessons from the Esmin Green incident were internalized. The hospital continued to lie about the treatment of its patients - engaging in wholesale fraud and deception.

Then, there's the whole issue of overcrowding at the hospital, despite the fact that there are state laws prohibiting keeping patients in the emergency room for days at a time. All this points to an ongoing culture of insensitivity and inability to abide by state laws. Moreover, it is criminal the way that the hospital treats the mentally ill - those people who are most at risk of being abused by the system because they cannot speak for themselves.

It also shows that state oversight is lacking since the overcrowding issues would have been addressed long ago had anyone bothered to note.

Where is the accountability? The Daily News notes that the fraudulent recordkeeping would only be an issue every few months if a bad outcome occurred, but yet there's little evidence that anything changed in the culture at the hospital to end the practice altogether. If anything, it shows that there was a deeply ingrained culture of deception at the hospital that went up the chain of command to the highest levels despite claims that they would change how business is done at the hospital.

Clearly, nothing has been done to address the systemic failures at this hospital. Heads must roll both at the hospital and within the HHC for the massive coverup and fraudulent records.

Massive Fraud Uncovered at New York City Hospitals

I don't think I'm overstating matters in the headline. The City of New York operates 11 hospitals via the Health and Hospitals Corporation [ed: see the comments for clarification on relationship between NYC and the HHC]. They are: Bellevue, Coney Island, Elmhurst, Harlem, Jacobi, Kings County, Lincoln, Metropolitan, North Central Bronx, Queens and Woodhull.

Each and every one of those hospitals was found faking records, including coverups of medical malpractice and inadequate care.

A months-long probe found coverups at all 11 Health & Hospitals Corp. hospitals — the only option for millions of New Yorkers who cannot afford private medical centers.

From 2004 through September 2008, the state cited city hospitals 68 times for violating laws that require immediate reporting of "adverse events," records show.

Each hospital — Bellevue, Coney Island, Elmhurst, Harlem, Jacobi, Kings County, Lincoln, Metropolitan, North Central Bronx, Queens and Woodhull — had at least one citation.

The law requires all New York hospitals to quickly report all serious medical mishaps to the state.

"There's a tremendous lack of confidence in the reporting," said Arthur Levin, director of the Center for Medical Consumers. "It matters because it is a way to understand where the safety problems are. . . . This identifies what goes wrong and where."

Hidden incidents uncovered by The News — corroborated by dozens of interviews with doctors, patients, lawyers and families of victims — bordered on the Medieval.

Some incidents were simply not reported, while others were reported long after the fact, making investigation impossible. Some records were incomplete or even fictional.

* A stroke victim's leg had to be amputated after gangrene was left untreated. No report.
* An ill infant died after sitting, unexamined by a doctor in an ER for 24 hours. Confronted for not having enough doctors on duty, they produce a "corrected" report saying there was – a month after the fact.
* A mental patient hanged himself and, after several days, died. Though hospitals must report suicides, they report this one as an "unexpected death."
* Records were altered after medical students made mistakes and an infant died.
* Logs for a respirator were changed after staff failed to notice it wasn't turned on. The patient died.

The findings come a year after employees of Kings County Hospital tried to hide the death of 49-year-old Esmin Green. Hospital staff wrote in records that she was fine; a shocking video showed Green dead on the floor.

New York City has some of the best hospitals in the world, but these 11 aren't among them. The best hospitals are the private institutions such as Hospital for Special Surgery, Memorial Sloan Kettering, New York–Presbyterian Hospital, Weill Cornell, and Mount Sinai Medical Center.

This is the Obama health care in action. It's what the care will be in microcosm. Inadequate care, but access is provided.

Enforcement of existing regulations shows that several of the hospitals received no citations, despite racking up hundreds of violations. The oversight is completely lacking:

Since 1999, all New York hospitals have been required to self-report a long list of medical incidents to NYPORTS, which in turn analyzes the incidents and implements patient safety reform.

Sunday NYPORTS barely functions. The Statewide Council that oversees it hasn't met in more than two years. Though NYPORTS is supposed to release "annual" reports, the last one filed is dated 2004.

Levin, a consumer member of the NYPORTS Council, says he's watched the system "sort of gradually slide into total dysfunction."

While all hospitals have been underreporting bad outcomes for years on end, the HHC hospitals have underreported to a much greater degree: 34.8 incidents versus 45.5 for every 10,000 patients discharged.

The HHC will obfuscate that the HHC hospitals handle millions of admissions every year, 400,000 of which are uninsured, but that ignores the fundamental issue that they provide inadequate care to all those who come through their door. Insurance isn't the issue - the quality of care and the subsequent coverup of how inadequate that care is.