01 July 2008

Another Waiting Room Death

This one caught on video:


The staff apparently documented her up and around during the time that she lay dead on the floor. The report is a little unclear, but it sounds to me as if this took place in the ER's waiting room, involving a patient who had been committed for psychiatric reasons but was waiting for an inpatient bed.

While the angle the media will play on this is the indifference of the staff and other patients, the real story can be found here:

The psychiatric unit at Kings County Hospital had been a subject of complaints by advocates for the mentally ill.

A state agency, the New York State Mental Hygiene Legal Service, filed a lawsuit a year ago, calling the psychiatric center "a chamber of filth, decay, indifference and danger." [...]

The suit was especially critical of the hospital's emergency ward, saying it is so poorly staffed that patients are often marooned there for days while they wait to be evaluated. Sometimes, the unit runs out of chairs, according to the lawsuit, forcing people to wait on foam mats or on the waiting room floor.
ERs are overcrowded and underfunded. Psychiatric units are even worse off, and patients nationwide will languish in ERs for days waiting for psych beds, preventing more urgent patients from being seen. Nothing has changed since the Institute of Medicine published its report: Emergency Care at the Breaking Point. Expect to see more of these in the coming months and years. And expect to see the media gin up outrage at the callousness of the staff, missing entirely the larger public policy picture.

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UPDATE:

In defense of the staff -- many times I have seen patients dramatically and histrionically throw themselves to the floor, and moreover, if these patients were in truth supposed to sit in chairs for 24 hours while waiting for beds, I suspect that it may not have been uncommon for a patient to take a nap on the floor. So the presence of a patient supine on the ground may not have been as uncommon as you might think at first blush. Yes, I suspect that there was some inattention by the staff -- but I wonder whether it was negligent, or whether they were simply overworked and engaging in care for other patients? There's no way to know.

My point here is really that the problem is not bad care per se, but patients languishing in waiting room chairs for hours on end.

15 comments:

scalpel said...

I blame deinstitutionalization.

ccinnkeeper said...

That is shocking. Many years ago I did some volunteer work as an EMT on an ambulance in a part of Brooklyn served by King's County hospital. I brought several patients into their emergency room, although perhaps not the psychiatric one.

I remember the King's County ER being dingy, but that wasn't surprising considering it is a public hospital and in a terrible neighborhood, but I remember the nurses and doctors being pretty caring and getting our patients triaged fairly quickly, even the psych. patients. I guess things have changed for the worse there and I'm sad to hear it.

Albinoblackbear said...

That video gave me goosebumps, how horribly tragic. I agree that HC staff get unfairly blamed when these situations occur but I have to say there was some major FAFFING going on once she was in fact discovered.

I think this speaks to Whitecoats recent post about the exodus of ER staff lately...in these conditions our licenses have greater and greater risk of growing wings (along with our patients).

Nurse K said...

It's hard to tell where the staff are sitting in relation to this waiting room. I assume that if these people were being involuntarily committed that there was SOMEONE watching them in person (apparently no one was watching the camera)...

Creepy stuff, man.

shadowfax said...

I read that the patient's chair was in sight of the nursing desk, but I suppose that it you happened to miss the patient crumpling to the floor, and nobody said anything, the patient might not have been visible from the desk.

Nurse K said...

At 0:45 on that video, it looks like the patient in the lower left corner is protesting about why the patient on the floor is getting a cot and she isn't.

My hospital is nowhere near as bad as far as psych wait times, but it seems generally cruel to make these people wait against their will for 24 hours and not provide at least a cot or mat or something in the waiting room to sleep on. I'll bet everyone thought she was just a sound sleeper in that context.

jz said...

I agree with scalpel.


http://online.wsj.com/article/SB121297144756555917-email.html

jz said...

I especially agree with this quote from the WSJ article:

"As Supreme Court Justice Anthony Kennedy wrote in 1999: "It must be remembered that for the person with severe mental illness who has no treatment, the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our powers to describe."

Rogue Medic said...

This does raise a bunch of questions about what difference would have been made in the outcome if the patient had been admitted to a floor. Would that have changed anything?

What were the patient's vital signs? Was there anything there to suggest instability? Would this patient have been triaged to the ED for medical clearance prior to admission? Was this patient already medically cleared?

Remember that down time is meaningless - we do not know what the vital signs were for the patient at any time, except at the end they appear to be permanently stable.Was the patient perfusing adequately up until that point? Was the patient gradually deteriorating up until that point? Were the vital signs waxing and waning during that time? We have no idea. Making assumptions about the vital signs, based on the first set taken, is bad medicine.

In a video at MSNBC, one of the staff members in scrubs, comes out kicks the patient a couple of times in the ribs and leaves. With staff like that, how trustworthy are any of the vital signs?

ERP said...

Yup - hard to say how much fault the staff has. Perhaps she was well known to them and did this sort of thing all the time. I bet overwork and some degree of laziness/disconnect occurred and not overt "I see someone dying and don't give a shit".

Mark p.s. said...

edited video, original videos shows a nurse kicking the patient to see if they are faking being dead. At 6:35 am.
Better video at
http://video.wnbc.com/player/?id=271155
LINK

Surgeon in my dreams said...

If she had been anything other than a "psych" patient, such as a maternity patient, or perhaps an orthopedic patient, would she have been ignored.

I usually don't disagree with you but on this one I do. I think these staff members, for whatever reason, have developed a "who gives a shit" attitude when it comes to "crazy" patients.

Rogue Medic said...

Surgeon in my dreams,

This was apparently in a psychiatric waiting room. They do not deal with any OB/GYN or ortho patients. This is the chosen field of the people who work there.

Anonymous said...

I think these staff members, for whatever reason, have developed a "who gives a shit" attitude when it comes to "crazy" patients. (SIMD)

This is the chosen field of the people who work there.(Rogue Medic)

These two comments aren't mutually exclusive, unfortunately.

Anonymous said...

I can not side with the hospital at all in this case. Even if they truely believed the woman was taking a nap on the floor, they lied in reports and fudged the records after the woman died.

That in itself implies to me that they were in the wrong ... and they knew it.