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January 8, 2010

Deal Made to Monitor Brooklyn Hospital


New York City, the Justice Department and lawyers representing mentally ill patients at Kings County Hospital Center in Brooklyn, where a 49-year-old woman died in 2008 while waiting for treatment, said on Thursday that they had reached an agreement allowing a federal judge to monitor conditions at the hospital.

In a 45-minute conference call on Thursday with Judge Kiyo A. Matsumoto of Federal District Court in Brooklyn, lawyers for the city, the federal government and the patients confirmed that they had agreed on a consent decree that would require changes at the hospital and a timeline for enacting them. The conference call was broadcast in the courtroom.

The judge indicated that she was prepared to sign the agreement, even as she expressed some reservations, saying that some parts seemed “vague” and “ill defined.”

The proposed settlement comes after two and a half years of bitter litigation over conditions at the hospital. The lawsuit, filed in May 2007, called the psychiatric unit of Kings County, a city-run hospital, a “chamber of filth, decay, indifference and danger.”

It was filed by the Mental Hygiene Legal Service, the New York Civil Liberties Union and the law firm Kirkland & Ellis on behalf of all mentally ill patients receiving psychiatric services at the hospital.

The suit gained momentum in June 2008, when Esmin Green, a Jamaican immigrant who had worked as a caretaker for children and the elderly, died about 24 hours after arriving by ambulance at the psychiatric emergency room, where doctors said she was schizophrenic and ordered that she be committed.

She was left in the waiting room, where she eventually collapsed and died because of blood clots that began in her legs and traveled to her lungs, according to the medical examiner.

A surveillance video released by the civil liberties union showed Ms. Green lying on the floor for more than an hour. During that time, a guard went in to check on her by wheeling his chair across the floor while still sitting in it, and another staff member prodded her with a foot.

Notes in Ms. Green’s medical chart claimed that she had been sitting quietly or had been in the bathroom at times when the surveillance video showed that she had been lying on the floor, according to subsequent investigations.

Shortly after the lawsuit was filed, the Justice Department opened an independent investigation.

Last February, a scathing report by the department looked beyond Ms. Green’s death and documented a pattern of sexual and other violent assaults among patients in the psychiatric unit. Investigators found the unit to be a nightmarish place, where suicidal behavior was left untreated, patients sexually abused one another, and the emphasis was on subduing patients through drugs and physical restraints, rather than on giving them individualized treatment.

Last May, the city agreed to pay $2 million to Ms. Green’s family.

When the lawsuit was filed in 2007, Alan D. Aviles, president of the city’s Health and Hospitals Corporation, called the allegations “grossly inaccurate, irresponsible and an affront to the dedicated and caring staff of Kings County Hospital Center.”

But the agency reacted to the federal report immediately and with contrition, firing the top managers of the psychiatric unit, adding medical workers and retraining the staff, including security guards, who are responsible for screening patients brought to the psychiatric emergency room. The city also unveiled a new $153 million psychiatric building.

Judge Matsumoto could modify the agreement before signing it, lawyers said, and indeed, during the conference call on Thursday, the judge expressed concerns about what she saw as somewhat flabby language.

She noted that the settlement called for the hospital to meet “generally accepted standards” for psychiatric diagnoses, a goal that seemed to underwhelm the judge, who said it was “obvious.”

Judge Matsumoto criticized another section that called for mental health treatment plans to be assessed and revised “when appropriate.”

“O.K.,” the judge said tartly. “How do we decide?”

She pushed the parties to submit progress reports to the court sooner and more frequently than they had envisioned.

Judge Matsumoto would function as the enforcement agent for the decree and would have the power to hold the city in contempt or impose other penalties if the decree’s provisions were violated. The decree was not made public on Thursday because the judge had not signed it as of the close of business, and the lawyers declined to comment on specifics outside court.

At the hearing, lawyers for the city contended that the Health and Hospitals Corporation had enacted many of the changes envisioned in the decree, and the lawyers for the patients did not dispute that contention.

Under questioning from the judge, the plaintiffs’ lawyers said there had been only “minor” problems at the psychiatric unit since last summer, and credited the reorganization.

“There is a fundamental sense from the top administrative levels that there needs to be accountability at all levels, and that’s a welcome change,” Beth Haroules, a lawyer for the New York Civil Liberties Union and co-counsel for the plaintiffs, told the court.