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July 15, 2009

Criminal Inquiry Begins in Waiting-Room Death


A criminal investigation has begun into the death of a patient on a waiting room floor at a city-run psychiatric hospital in Brooklyn last year, the Brooklyn district attorney said on Tuesday.

The district attorney, Charles J. Hynes, said that a grand jury had begun an inquiry into the death of Esmin Green, 49, who died early on June 19, 2008, about 24 hours after arriving by ambulance at Kings County Hospital Center’s psychiatric emergency room, where doctors said she was schizophrenic and ordered her to be involuntarily committed.

According to hospital protocol, Ms. Green should have been given a medical examination before she was admitted.

Instead, she was left in the waiting room, where she eventually collapsed on the floor and died of a blood clot the next morning.

The case became a symbol of callous treatment of psychiatric patients after the New York Civil Liberties Union and other lawyers released a security video that showed Ms. Green writhing and lying on the floor while workers ignored her.

Last month, the city’s Department of Investigation issued a report that could become a template for the grand jury investigation. It named three doctors and three nurses or nurse’s aides, saying that they were complicit either in the neglect of the patient or in a cover-up over a period of four shifts.

Although the medical examiner found that Ms. Green had died of a blood clot, ruling out homicide, it is possible that the grand jury could consider lesser charges related to her death or to the falsification of hospital records. A spokesman for Mr. Hynes declined to say what charges might be considered.

The city report said that contrary to protocol, Bernardita Cabildo, the head nurse for the midnight to 8 a.m. shift on June 18, did not add Ms. Green to the “24-Hour Observation Sheet” that lists incoming patients.

Dr. Rashed Abedin told investigators, according to the report, that he had made three unsuccessful attempts to examine Ms. Green during the next shift, between 8 a.m. and 5 p.m.; he said she was uncooperative.

But investigators found that Dr. Abedin’s account was contradicted by the surveillance video and by written notes.

The city found that two other doctors, Dr. Dimitru Magardician and Dr. David Estes, who ultimately pronounced her dead, made no effort to examine Ms. Green during a third shift, and that during the fourth, Ms. Green had no contact with any doctors and little contact with nursing staff until she died at 6:35 a.m.

The city found that a senior nurse, Aida Gonzalo, made three false entries in Ms. Green’s medical records, making it appear that she had been in normal condition 45 minutes before she was discovered on the floor. A nursing aide, Royal Easton, was found to have made false entries indicating that he had checked on Ms. Green and found that she was sleeping, when in fact Mr. Easton was on a break.

There were so few patients in the waiting room during the night that the two nurses, Ms. Gonzalo and Ms. Cabildo, were taking a break at the time Ms. Green collapsed about 5:30 a.m., the report said.

Ana Marengo, a spokeswoman for the city’s Health and Hospitals Corporation, said the agency would be “fully supportive” of the investigation. She said that the three doctors and one nurse, Ms. Cabildo, were still working at the hospital.

Calls on Tuesday afternoon to the doctors at the hospital and at their homes were not immediately returned. Ms. Cabildo, reached at the hospital, declined to comment. Ms. Gonzalo did not respond to a message left on her home phone. Mr. Easton has been reassigned outside Kings County hospital, and has been recommended for firing pending disciplinary hearings, Ms. Marengo said. A woman who answered the phone at his home said he would have no comment.

Sanford Rubenstein, a lawyer for the Green family, said Ms. Green’s children were pleased that the grand jury was investigating. “The family wants anyone who committed a criminal act to be held accountable and liable criminally,” Mr. Rubenstein said Tuesday.