Lack of Basic Care Leads to Death at Brooklyn Hospital

On June 18, 49-year-old Esmin Green was admitted to the Kings County Hospital Center psychiatric ward.  After waiting to be seen for 24 hours, she fell to the floor, began to convulse and then passed out.  Two security guards and one doctor walked into the waiting room, looked at her and then walked away.  After one hour, a nurse finally came over, kicked Ms. Green, and then proceeded to get a stretcher.  Shortly afterwards, Ms. Green was pronounced dead.  The entire incident was documented on a security camera, and is now on YouTube, thanks to the Associated Press.

Hospital officials said they fired three of the workers and suspended another three, the New York Times reported on July 7.  However, it is clear that Ms. Greene's death is far from an isolated incident at Kings County Hospital.  The New York Civil Liberties Union, in conjunction with Mental Hygiene Legal Service and the law firm of Kirkland & Ellis LLP, filed suit against the New York City Health and Hospitals Corporation (the agency that runs Kings County Hospital) in May 2007.  The plaintiffs claimed that patients at the hospital's psychiatric facilities were subject to conditions of squalor and filth, as well as abuse by hospital employees.  A summary of the case can be found on the NYCLU website.

The evidence displayed in the lawsuit shows that Ms. Green's death is not solely the fault of the hospital employees who watched her die. The conditions in the hospital, particularly the psychiatric ward, and the treatment of the patients are the responsibility of the city agency that runs the hospital.  It was not until over one year into the litigation, and after Ms. Green's death, that the city finally agreed to adopt a series of basic stop-gap measures, including:

* That every patient be checked every 15 minutes.
  • That there be no more than 25 patients at any time in the psychiatric emergency ward.
  • That detailed records on the ward be turned over every week to the advocates involved in the lawsuit.
  • And that the advocates be active participants in the search for a new deputy executive director and emergency room director for Kings County Hospital's Behavioral Health department.

It is shocking that it took a lawsuit and the very public death of a woman to get New York City to agree to such basic levels of care for mental health patients.  Donna Lieberman, executive director of the NYCLU, said:
What's happening in Kings County Hospital is an affront to human dignity...In 2008 in New York City, nobody should be subjected to this kind of treatment. It should not take the death of a patient to get the city to make changes that everyone knows are long overdue.

What is even more distressing about Ms. Green's death and the allegations of gross negligence of patients at Kings County Hospital is that many residents in Central Brooklyn do not have access to other hospitals.  This is mainly due to the fact that the predominantly black, low-income areas of Central Brooklyn, particularly the neighborhoods Bedford-Stuyvesant, Brownsville, Canarsie, Crown Heights, East New York, and Flatbush have seen numerous hospital closures in the last few years.

The Opportunity Agenda has documented these hospital closures on its website Health Care That Works.  Since 1985, Central Brooklyn has seen five local hospitals close their doors.  Because of these closures, people in these minority communities have been forced to rely on Kings County Hospital even more.  Local residents also begged the city to keep local clinics open - their requests can be seen in a video on The Opportunity Agenda's YouTube channel.  At the same time all of these facilities were closing, allegations of mistreatment at Kings County were surfacing.

The fact that people of color have inferior access to health care in New York contributes greatly to the health disparities in the city.  The Opportunity Agenda report Dangerous and Unlawful: Why Our Health Care System Is Failing New Yorkers and How to Fix It documents how areas with high concentrations of African Americans, Hispanics and Asian Americans are more likely to have shortages of primary care physicians than predominantly white communities are.  The distribution of hospitals and other health care services has a significant discriminatory effect on these communities of color - their health care access is simply inadequate.

Ms. Green's death should do more than signify the need for improvement of existing hospitals like Kings County.  It should also remind us that many people in New York, and across the country, lack basic primary care and access to emergency services.  Changing this reality needs to be a part of health care reform discussions.  If it isn't, we will continue to see needless deaths like Ms. Green's occur.

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Health Blog Roundup

Last Thursday, the American Medical Association issued an official apology for its past racism toward African American patients and physicians.  Along with the apology were the findings of a study conducted by the Commission to End Health Care Disparities, a group that the AMA and the National Medical Association (an organization representing black physicians) co-chair.  The study has found that between 1846 and the 1960s, the AMA's past transgressions included:

substandard care for black patients or segregated them to black hospitals; a lack of support for black physicians and for the Civil Rights Act; and exclusion of blacks from medical schools, hospital staffs and residency programs.

The apology can be found here, and the study is available in the online version of the Journal of the American Medical Association. To learn more about the work of the Commission to End Health Care Disparities, go to the AMA website.

It is also worth noting that a number of doctors were opposed to the AMA's discriminatory policies in the 1960s.  A group of physicians picketed the AMA convention in Atlantic City in 1963 in order to call attention to the AMA's racist acts.  Among these physicians was Dr. Robert Smith, a leader of the Medical Committee for Human Rights in Mississippi (MCHR).  The MCHR grew out of the Medical Committee for Civil Rights, and organized a number of volunteers to come down to Mississippi to provide care to black patients who were not being treated in their communities:

Though MCHR volunteers were not licensed to practice professionally in Mississippi, they could offer emergency first-aid anywhere and anytime to civil rights workers, community activists, and summer volunteers. Working without pay, they cared for wounded protesters and victims of police and Klan violence, assisted the ill, visited jailed demonstrators, and provided a medical presence in Black communities, some of which had never seen a doctor. They established and staffed health information and pre-natal programs in many Black communities. Appalled at the separate and unequal care provided to Blacks by Mississippi's segregated system, they soon involved themselves in political struggles to open up and improve Mississippi's health care system for all.

The Health Care Blog has a posting that discusses My Health Direct, the web-based solution to overcrowding in emergency departments.  The idea of My Health Direct is for hospitals to use an online appointment system to re-route their Medicaid and uninsured patients to community and safety-net clinics.  According to the blog posting, the program has been successful in increasing patients' access to primary care and improving the quality of care and treatment outcomes for those patients:
More than 12,000 health appointments have been made with the vast majority of these appointments for patients who are uninsured or enrolled in a Medicaid managed care plan. These appointments were made for patients who either presented for care with a non-emergent condition, or needed follow-up care in a primary care setting.

A utilization review of My Health Directs impact demonstrated that more than 92% of patients who received an appointment did not present to the ED again. Patients who obtained appointments were more than 4 times more likely to actually attend their appointment compared to previous referral efforts from the ED. Lastly, there was a 25% reduction in repeat non-emergent visits of those patients assisted by My Health Direct.


A recent Health Beat blog posting titled "The Realities of Rural Medicine" discusses the unequal access to health care for people who live in rural areas.  The study on rural health care, conducted by the Center for Studying Health System Change, found that both patients and doctors feel significant strain in living in communities that do not have enough primary care options.

The Washington Post is reporting that Los Angeles City Councilwoman Jan Perry is trying to limit the prevalence of fast food restaurants in South Central Los Angeles by placing a moratorium on new fast food locations in the area.  Perry is a representative for District 9, an overwhelmingly African American and Latino constituency that has significant health disparities in comparison to the wealthier West L.A. area:

Perry quoted research showing that although 16 percent of restaurants in prosperous West L.A. serve fast food, they account for 45 percent in South L.A. Experts see an obvious link to a health department study that found that 29 percent of South-Central children are obese, compared with 23 percent county-wide.

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Thursday Immigration Blog Roundup

*    Detention Watch Network has created a new interactive map that is now accessible on their website.  The map is a comprehensive tracking system that allows users to view the locations of detention centers, community organizations, ICE offices and immigration courts across the United States.

*    A T Don Hutto Blog posting discusses the recent American Immigration Lawyers Association position paper on alternatives to detention for immigrants.  The paper, which argues that the Department of Homeland Security should shift its focus from raids and electronic monitoring of immigrant populations to community-based, non-restrictive measures, can be accessed here.

*    Some updates on recent ICE raids: a posting on Standing FIRM links to a New York Times report that two Agriprocessor employers have been arrested.  Their arrests were connected to last month's ICE raid in Postville, Iowa; they were the first non "rank and file" workers to be targeted. Scott Frotman, a spokesman for the United Food and Commercial Workers Union, pointed out that the arrest of these supervisors does not show the full extent of the company's violations of workers rights:

What about the allegations of worker abuse? Does anyone really believe that these low-level supervisors acted alone without the knowledge, or even the direction, of the Rubashkins and other senior management?

In addition, the same Times story is reporting that last week five senior managers at Action Rags USA were arrested.  Their arrests are connected to the ICE raid on the Houston Plant in late June.

*    In response to these recent government crackdowns on employers of illegal immigrants, business owners have begun to speak out in opposition to tough anti-immigration measures.  A July 6 article that appeared in the New York Times claims that employers have begun fighting the government policies in state and local courts:

Business groups have resisted measures that would revoke the licenses of employers of illegal immigrants. They are proposing alternatives that would revise federal rules for verifying the identity documents of new hires and would expand programs to bring legal immigrant laborers.

*    A story that appeared in Sunday's San Francisco Chronicle discusses the positive results of the city's 1989 immigration sanctuary law.  The law bars local officials, including police officers, from questioning residents about their immigration status.  The Chronicle also points out that San Francisco is not alone in enacting sanctuary measures:

San Francisco is among scores of cities in California and around the country with sanctuary laws, according to the National Immigration Law Center. Several states also have such policies.

A recent posting on The State of Opportunity also called attention to a California superior court decision upholding the Los Angeles Police Department's of neither arresting people based on their immigration status nor asking about one's immigration status during interviews.

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Lifting up the 4th of July

Fireworks on the 4th of July always make me cry. I'm not affraid to say it. There's something about it, all the senses are activated as an idea--what once was the dream of a few revolutionaires--plays itself out in vivid colors and exsplosive bursts right before you.

This year, my wife and I planted ourselves on the stone path between Pier 17 and Pier 11, right in front of one of the Macy's barges, lucking out that this year they decided to move them further down the East River, making the end of Wall Street a perfect location to watch the fireworks. What made the event more impressive was the rich diversity that surrounded us, reminding me why New York City is such a special place to experience the 4th of July.

For many of the families around us, America was as new as it was for Abigail Adams and her family, as she watched the cannon balls fly over Boston Harbor while her husband was away. Opportunity and freedom were new on the horizon, like the flash of powder ignited in the distance seconds before the sky explodes with life. Hearing families share their excitement in Korean, Russian, French, Spanish and Mandarin seemed fitting, as we all huddled along the Manhattan shoreline between the Brooklyn Bridge and the Statue of liberty. The 4th of July is full of traditions, and I think I've found a new place to celebrate for years to come.

Another great thing I gravitated toward this weekend was the new web site, 1,000 Voices Archive a project of the Creative Council. This web site is a perfect mirror into the american experience, presenting videos of Americans who have been touched by communities. It's a wonderful snapshot into the diversity of our nation, both in ethnicity and experience. Strongly recommend it for those looking to continue celebrating this holiday weekend. It gives a real feel of America and has a bunch of engaging tools that allow us to become involved in the America that is more than ideas and fire works.

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Thursday Immigration Blog Roundup

*     The Kentucky Post has reported on the status of the case where the federal government prosecuted a landlord for renting apartments to illegal immigrants.  The jury found in favor of the defendant, whom the Puerto Rican Legal Defense Fund represented, and agreed with his argument that he did not intentionally harbor undocumented immigrants.  Immigration News Daily also reported on the case and claimed:

The case is thought to be the first time that the government has prosecuted a landlord merely for renting to illegal immigrants.

*    The DMI Blog posting titled, "Immigration Raids Tend to Spare Employers," questions why employers are so rarely arrested during ICE raids:
Even though Department of Homeland Security talks big about cracking down on employers who hire undocumented immigrants, federal officials explain that is easier to prove that an immigrant is here illegally than it is to build a case against the employer.

According to ICE, that it is tougher to build a criminal case proving that an employer knowingly hired an undocumented than to prove that an immigrant is here illegally.


The ICE policy of not arresting employers is somewhat ironic in the context of many federal government methods of enforcing immigration laws, and represents a striking contrast to the government's decision to prosecute the landlord in Kentucky.

*    In the past weeks, there have been a number of YouTube videos showing the effects of the ICE raid on Postville, Iowa.  One video, shown in a New America Media posting, depicts the struggles that families in the community are having in the aftermath of the raid.

*    Standing FIRM has posted a video clip of a story on the June 28 protest in Houston, Texas.  The protest was a response to the recent ICE raid on a plant called Action Rags USA.  Another Standing FIRM posting offers numerous details about the raid:

...agents arrested 166 of the 186 employees. ICE released 73 people who had medical problems or were sole care providers. Another 20 were released by cause they either were here legally or were born here... [Of] the remain[ing] 73 who are detained, 70 of them are women, so only 3 of them are men.

*    Citizen Orange has posted a hilarious YouTube video, courtesy of "Capitol Hill Gangsta." Capital Hill Gangsta (aka Ray William Johnson, a college student in New York and YouTube video commentator) uses the video to dispel a number of myths about immigrants in the United States.

*    According to Monday's New York Sun, New York City Mayor Bloomberg has reinforced his pro-immigration stance by claiming that America is "committing mass suicide" by restricting immigration into the country.  According to The Sun, Bloomberg said:

There are people around the world who want to come and create here and add jobs and excitement and innovation, and we're keeping them in Canada and in Europe and Asia and not letting them here...

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