An Abomination

Below is a video of a psychiatric patient dying on the floor of a New York City hospital. Over the course of many hours she ignored by two security guards, but what isn’t shown here is that she is also kicked by a nurse (apparently to detect if the patient was alive) and neglected by a physician.

The mentally ill are often talked-down to and generally are treated as second-class citizens. During my graduate training I had some experience in psychiatric wards and the patients were often ignored or infantilized by the medical staff. This phenomenon was empirically demonstrated in 1973 by D. L. Rosenhan, whose study had people pretending to be patients in a psychiatric hospital. They approached staff members with questions like “Could you tell me when I will be eligible for grounds privileges?” or “When will my case be presented at Grand Rounds?” 71% of the time the psychiatrists (these are doctors, mind you) simply looked away and walked past. Only 4% of the time did they stop to talk to the people.
35-year-old studies are often not valid to highlight current psychological principles. After watching this video, however, the results seem more relevant than ever. If people want to make the argument that patients can be very demanding and need boundaries and limits, that’s all well and good. However, the fact remains that this woman died at the very hospital where she was being treated, and multiple members of the staff watched it and did nothing.
To say that this disgusts me is an understatement. I bash shrinks all the time for being neurotic and weird and elitist and all sorts of other negative shit. I didn’t know I should consider some of them to be soulless as well.
It’s no secret that many staff workers at psychiatric hospitals are both overworked and underpaid, which often is an underlying cause of poor interpersonal contact and the delivery of therapeutic services. But what occurred in this video is simply inexcusable. And so the staff is fired according to news report. That’s it? Does this “doctor” get to keep his license? If so I hope he ends up treating the very people who decided that he can continue to practice medicine.
I don’t see a silver lining in this, save for the fact that perhaps people will give some more thought to the idea that the mentally ill are just as significant as the rest of us. But if this is what it takes to make people think, then I’m embarrassed to be part of the mental health community.

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34 Responses to “An Abomination”

  1. Rosie says:

    I saw this video a few days ago and it deeply disturbed me as well. However, having worked on a medical floor at a hospital for many years, I wish I could say I was more surprised. It is not just the mentally ill who do not receive adequate attention in hospitals. Many of my fellow nursing assistants and nurses were so busy that they did not bother to check on patients who appeared to be sleeping, even if that patient was supposed to be having their vital signs measured every 15 minutes. Needless to say “sleeping” and “dead” look quite the same if you’re not looking closely. This behavior, whether you want to blame it on the laziness of the staff or the cheapness of the administrator, is inexcusable.

  2. Tina says:

    “It’s no secret that many staff workers at psychiatric hospitals are both overworked and underpaid, which often is an underlying cause of poor interpersonal contact and the delivery of therapeutic services.”
    That may be true but this, IMO, is in a totally different realm of neglect. This isn’t just about doing your job. It’s about basic human compassion. You see a woman laying on the floor and, from what Iv’e read, writhing and screaming, and then she gets very still and quiet and you can’t even go over to check if she’s ok? That has nothing to do with being a “good” or “bad” nurse/doctor. That boils down to being a very cold hearted human, regardless of what profession you’re in.

  3. Blah blah blah says:

    Is it lonely up on your soap-boxes Tina and Rosie?
    I’m certain that self-righteous assholes like you two likely would have treated that patient even worse.
    We don’t know that patient’s history and the behaviour that may have caused the staff to disregard it.
    Get over yourselves!

  4. Wayland says:

    Wow man.

  5. Dee says:

    If you do a bit of extra reading on this case you would find out that it appears that at least one member of the staff tried to cover up aspects of the incident, showing that they knew they had made a grossly huge mistake in not checking to see why the patient had stopped writhing about on the floor for almost an hour. Perhaps before you go calling someone a self-righteous asshole you would be best off doing a bit of extra research. Here’s a link for CNN if you’d like to read further. http://www.cnn.com/2008/US/07/01/hospital.death.ap/index.html
    Dr. Rob Note: So a person needs to not only be negligent but also a criminal by doctoring notes and covering it up in order for me to call him or her out? You apparently have a higher tolerance for horrific behavior than me. If the people involved had come clean and confessed what they did I might have a somewhat different take on your point. But what they did after realizing they made a “grossly huge mistake” was not based out of guilt but fear of getting caught.

  6. Amber says:

    I second Wayland. Wow.
    And I’m saddened and sickened by this video.

  7. Anonymous says:

    So, BlahX3, you think the disregard for this woman was justified? You think it’s acceptable that no one bothered to check on her, for “over an hour”, and let her lay on the floor? You can call me self-righteous, if that’s what you see. But, I couldn’t sit there (as a medical professional OR simply as a bystander) and watch this woman lay on the floor and not at least ask if she needed help or, I dunno, check for a pulse, at the very least.
    Guilty conscience that you think this type of treatment is ok?

  8. Maggy says:

    I don’t even know what to say about this DocRob. It’s just awful that NO ONE helped her. I can’t understand how ANYONE can do that. It’s a measure of our human nature when we can become completely desensitized to someone writhing and screaming in pain. Just…I echo the wow.

  9. Unfunny Pun says:

    I think what blahblahblah is saying is that it’s unfair to judge the nurses because the woman who died might have deserved it, because it’s just fine and dandy to leave a person to die because she might have been unpleasant.

  10. Giganto! says:

    Guys, blahx3 is probably trolling. Don’t get that upset by it.
    I think stuff like this does need some introspection from everyone, though, and a some level of understanding.
    I don’t think anyone can deny that’s it’s unfortunate and disgusting that this happened; that a woman died a death that could have been preventable with some level of attention, especially in a hospital.
    I think it does show a level of detachment, and one can possibly use this woman as an example of how the mentally ill are held in low regard and shown disrespect, even among those that are supposed to assist them in fitting in with society more.
    There’s probably a part of everybody that likes to think of themselves as better than someone else. A lot of groups have suffered from this, and the mentally ill across the board are getting the treatment today. There’s a sneaking suspicion that somehow, if they just TRIED A LITTLE HARDER, they’d make it. But that’s not true. Somethings are inevitably bigger than any individual can handle, and the thought of that is horrifying, so the belief that trying hard enough is a fix exists.
    How many times have you guys heard someone say that someone with a more “minor” disorder just needs to buck up? That the kid with ADD needs disciple, the OCD guy needs to chill out, the depressed person needs to buck up, and the autistic guy needs to consider other people’s feelings? I know I’ve heard people say these before, and I’m sure others have as well.
    That being said, I don’t know how I’d react in the situation the nurses and guards were in, simply because I wasn’t there, I haven’t experienced it. Maybe they’re not good people, but they’re probably not pits of evil. Every time I hear a story about how onlookers do nothing, I wonder how many people I know that would definitely, 100%, do something, and if I could say that I would be the one that bravely steps up and does what needs to be done.
    And, if I have the audacity to say that I would, I remind myself that the onlookers that did nothing, if you asked them the day before, would probably say the same thing.

  11. Tina says:

    “I think stuff like this does need some introspection from everyone, though, and a some level of understanding.”
    I could very easily have some understanding if the woman died sitting in a chair, or laying in bed, or on a couch, etc. However, she was laying on the floor, for “over an hour” and no one checked on her. Was this hospital policy to allow patients to just lay on the floor, face down, for hours at a time? Even if no one cared enough to render assistance, you’d think someone would have thought “Hey, she can’t just lay around on the floor like that. Someone’s gonna trip and hurt themselves”.
    I think that’s the part what boggles my mind. The woman is mentally ill. From the news reports I’ve heard, I’m assuming she was either an admitted patient or known to the facility (I’m not quite clear on whether this happened at an inpatient facility or ER). Regardless of how mentally ill she was, for over an hour, no one approached her and mentioned that maybe laying on the floor wasn’t the best place for her. If they had, maybe they’d have noticed she wasn’t breathing or, possibly, noticed that something was actually physically wrong with her.
    As for “stepping in” when you see something “odd” happening, I’ve actually been in the situation before. Nothing as dramatic as this but other situations. Kids (and pets) left alone in cars. An elderly man who fell and hit his head while waiting for an elevator. People broke down on the side of the road. Again, all relatively minor situations but I like to think I would respond the same in a more serious situation. I certainly hope I wouldn’t continue about my business while someone died at my feet.

  12. Dr. Rob says:

    I may not have been clear: my main point of contention is with the physician. By the time this went to post I couldn’t find the longer video that I had originally seen, but in it a doctor walks into the room, sees the woman lying on the floor, and then walks away. This is a DOCTOR, working in an emergency room, who simply walks away from a patient. His job, whether he cares at that moment or not, is to help this person. This is independent of what any of us would do as bystanders who are not physicians (which as you know I am not). I don’t give a flying fuck if this patient has a history of curling up on the floor to get attention. If you are a physician you do your Goddamn job and check to see if she is hurt or ill. I understand that none of us can predict what we would do in any given situation and that ER work is stressful and that patients are demanding, but if you’re going to carry the title of Doctor and all of the prestige and responsibility that goes with that you damn well better make sure every person on your shift has a fucking pulse.

  13. Giganto! says:

    Dr. Rob, you are correct and I should have been more clear myself, professionals do need to have a standard, and this is clearly at the very least a breach of ethics for a member of the field. My point is simply that while I’m comfortable calling this a breach of ethics, I’m less so with a personal moral judgment.
    I have personally seen the bystander effect, and I’ve seen enough reports of it that I’m not comfortable with moral implications strictly because a sin that’s committed so commonly needs to be thought about and carefully considered.
    Ethics are almost universally much more clear cut. As a therapist, you have an ethical obligation not to reveal personal information about a client. A lawyer would have an ethical obligation to defend a client to the best of his ability, and a physician has an ethical obligation to protect the well being of a patient to the best of his or her ability. On this I agree whole heartedly, and I apologize for my lack of clarity on this point.
    I’m also glad that you, as a member of the mental health care field, are being vocal, and not standing on the sidelines. Enforcement of ethics is best suited to those within the field, and calling bullshit on breaches is an important part of the enforcement.

  14. Lizza says:

    That is incredibly, horrifically sad. How could the guards and the nurses and doctors who saw her NOT check on her? Like you said Dr. Rob, it is their job. No matter what, they need to check patients. I can’t even put into words how angry this makes me; it’s so sad to think that someone could see this woman, lying there on the floor, and not do anything.

  15. Jason says:

    Unfortunately, this isn’t just a phenomenon localized to psychiatric care.. It’s extended to every aspect of life. We as human beings have become lazy, and videos like above are just a symptom of it. And you can’t make a claim that this was anything BUT laziness presenting itself. We’re all to blame. I’m not saying I’m any better, I’m lazy myself. And it’s only going to get worse. For everybody.

  16. Jackmo says:

    wow, a bit of a darker post then usual Dr Robo (I haven’t seen the video cause it won’t play at work but I take your word that it was pretty bad).
    Sorry to hear that bro, I hope you’re able to use your writing to make a difference.

  17. Joe says:

    As tragic as this one death is, I’ve heard worse. When my dad did his dental residency at a state psychiatric institution in Delaware, it was still common practice for the nurses to pester the doctors into signing off on lobotomies for patients a la One Flew Over the Cuckoo’s Nest. No joke. And often within 48 hours of admission to the institution. And this was the ’70’s, not the 40’s or 50’s.
    As tragic as one death is, an institutionalized practice of carving up many peoples’ brains is worse in my opinion. People have grown to accept the idea that psychiatric institutions in large hospitals are really holding pens for poor mentally ill people and that there really is not best case scenario for them.
    A lot of that stems from a distrust of the medical and psychiatric profession that is justifiable. Anyone who had relatives institutionalized before 1980 and especially before Thorazine could be used to at least keep patients docile and compliant knows that this is the case.
    No matter how much the profession has changed in the past 30 years or so, there is still a public perception that psychiatric medicine is pseudo-science and that perception leads to complacency in the public and also to really dangerous charlatans like Scientologists gaining traction with their beliefs and starving people to death in Florida.

  18. J says:

    Well, we didn’t see the video with the Doctor, but I would agree that this man needs his license taken away immediately. Now.
    I feel there is a growing detachment in people with our deepening love and necessity for electronics. But that argument is for passerby accidents and such.
    In this case, it’s a controlled environment and the people there should be held accountable for not doing their jobs…..taking care of people.

  19. Borderline Betty says:

    I think many practices at hospitals, in general, border on the awful. But still, even given that, it’s shocking and awful that this woman died, lying on a (Hospital)!!! floor, while no one bothered to help her. I doubt this would have happened to her if she had money and were at a better hospital. Could it have Still happened, even at a wealthy hospital? It’s certainly possible, but a good deal less likely. It’s clear (to me, at least) that it’s not Only that Esmin Green was in a bad way, mentally. It’s also that she was very poor. And yes, her death is obscene on All levels. No debate, there. Had there been no video of her death, (easily viewed via the Internet), this certainly would have been covered up.

  20. Blah blah blah says:

    Oh boy, now the self-righteous assholes are joined by people who think they are qualified to judge doctors based on youtube videos.
    Fuck-ups in hospitals lead to deaths…this is news?
    Gee a mental patient doing something fucked up gets ignored, and maybe dismissed as routine…you’re right, hang the doctor and all the staff!
    How dare they dedicate their careers/lives to helping people in the most intense profession on the planet, with people dieing in horrible ways every day and have the nerve to be imperfect!
    IF ONLY THE HOSPITAL WERE STAFFED BY BITCHY PEOPLE ON A BLOG’S COMMENT PAGE THIS TRAGEDY COULD HAVE BEEN AVERTED!

  21. Maggy says:

    Blah blah blah good thing you’re not a fucking doctor!! And if you are hope you go put your head in an oven because it is a doctor’s JOB, a nurse’s JOB, to care for a patient whether they are belligerent, idiotic, poor, rich, handsome, old, young, ugly, stupid, or a genius!! I don’t see a weapon on this poor woman so there was absolutely no reason that they should not have helped her.
    People die in horrible ways everyday, yes, but the fact is that this person was there for help at a hospital and no one helped her. I don’t see how you don’t see what an abomination that is. It’s people like you that really make me think how far GONE humanity really is.
    I hope you are getting psychiatric help for your complete deadpan lack of empathy.

  22. Raeann says:

    Dr Rob, I agree with your opinion on the hospital staff. On the morning radio show I listen to them hosts was going on and on about how everyone in that room should be held accountable for her murder, and I have to disagree with that? Is that wrong? Recently I was in the ER for a non-psychiatric problem, and avoided engaging on any level with any of the other patients, especially the ones obviously there for psychiatric care. When I am having an emergency, all I am thinking about is me. It’s not exactly the place for strangers to show other strangers empathy. The doctors behaved completely reprehensibly, but what do you think about the others?

  23. Dee says:

    I have a question for Blah blah blah, What do you think of the efforts of one of the staff members doctoring paperwork to try and cover up what really happened?
    It was reported that someone changed the paper work to say that she had been checked on and was up moving around the time of her death. She obviously wasn’t moving, so someone either checked on her and lied, or never bothered and lied. Do you have a defense for this?

  24. Someone who kind of knows what they're talking about says:

    Wow, it is extremely evident that most of you have never worked in a medical situation, let alone one involving the mentally ill. It’s very easy for people outside of any profession to criticize the actions of those in it, but they hardly ever think about the actual situation.
    Think about this: you’ve been working in a hospital (as a nurse, a guard, a tech, it doesn’t matter) for a 10 years, dealing with the same antics over and over and over again. At first, you spring to help everyone out, going out of your way to make everyone comfortable, but slowly this starts to drain on you. You realize that some people are just there to get attention, to get drugs, to take advantage of you and your co-workers and the system in general. This is not a great number of people, but they keep coming back. You start disregarding their requests, coming up with some excuse because you’re tired of being their errand-boy (it’s not what you thought the medical profession was all about). The problem here is that one of these times, the complaint is going to be real, and if something happens you’re going to have to suffer the consequences.
    I’m a medic myself, and I’ve encountered my fair share of “frequent flyers,” people who call complaining of vague things like stomach pain or difficulty breathing. They call 911 constantly, 5-7 times a week, to be taken to the hospital. It gets hard to have sympathy for them, even if they do have real problems, because of their obvious abuse of your time, especially when you hear other, more important, real calls go out with delayed response times because the system is busy (partly because of your “buddy” in the back). It’s hard not to show up, and just go through the motions, getting them to the hospital as quick as possible so you can off-load them on the nurses who feel exactly the same way about them. It’s hard, but one day that stomach pain might be real and might have real consequences, and if you slip up, you can’t use the their past as a defense. Should the fear of litigation be the only reason you care for certain people? As a society that teaches everyone about the boy who cried wolf, how do we just disregard this timeless fable when it comes to real life?
    It’s very easy to think about events occurring in a vacuum, outside of the precipitating factors. I think it’s very easy to blame medical workers when you see one isolated incident of accidental neglect. Dealing with the certain patients (the kind that don’t need help, but want attention or, more aggravatingly, drugs) can be very trying. And I’m not saying they don’t need help. because they do, but they won’t get it because they don’t want the kind of help they actually need. Dealing with the mentally ill is even harder, and I admire those who truly enjoy working with them, as they are very needy and often difficult to deal with (for various, individual reasons). This is the reason they often get such substandard care, because those who work with them can very easily get burnt out by it. It’s nobodies fault, it’s a structural deficiency within the system (though I see no good solution to it either).
    Before everybody goes pointing fingers, think about all this (as a few above have). Maybe this lady brought such a situation upon herself. Maybe the real culprit is whoever didn’t realize this lady needed to be institutionalized, instead of having her repeatedly visit an emergency department where there is not really anybody qualified to deal with mental illness! The ED is a place of generalized knowledge where you then get funneled to the appropriate location. Certain, immediate things can get done there, but not the long-term treatment needed by mental illness. There are bigger problems at play here than the mistakes made by the unfortunate people in this video, who will be pilloried for an inadvertent mistake (and we don’t see what they’re doing off camera) yet receive no praise for all the people they’ve tried to help throughout the years. How typical of blame-game modern America.

  25. Someone who kind of knows what they're talking about says:

    And to clear any confusion about the previous post, I am not saying that what they did was right. Just that there is probably a bigger picture to what took place there that is not (and could not possibly be) captured by a video camera of the single event.

  26. Jolene says:

    I was utterly sickened when I saw this video. Poor woman. It amazes me how the general public has got to the point of ignorance. I seen a similar video about a guy who was hit by a car. There must have been a dozen people around and they all stood there and gawked instead of helping the poor man or at least hold his hand til help came.
    I’m a person who suffers from depression and have for about 20yrs now. Speaking about how mental health caretakers treat patients, I had my own experience once. I admitted myself because I was feeling very depressed and suicidal. They held me for 24hrs by the next day, I was waiting to be released when I coincidentally saw my therapist. I walked up to the counter and told one of the receptionists that I saw my doctor and that I would like to speak to her. The gal looked at me and said “There is no one here by that name. You just go sit yourself down, ok?”.. just looking at me like I was a totally crazy. Few minutes go by and my therapist [who WAS there] walked up to me.
    I just felt very un-comfortable and being that I only have depression, I was treated like I had every mental disorder combined. It was awful not to mention the fact that my cousin was murdered in the same facility by another patient. Great staff they had there!
    Anyhow, thats my story but, thanks for sharing yours. It is good to see from a therapists perspective and to know that not all of you agree with the way some patients are treated. It is bad enough that we have a mental stigma from the general public but, to be treated that way from people who are in the line of buisness to take care of you, is the worst.

  27. J says:

    This is totally unacceptable. It is akin to a policeman on patrol just driving by a holdup because the store is in a bad part of town and often gets held up, a firemen just ignoring a 911 call because it’s out in the country, and hey, they’re playing scrabble, or a lifeguard not saving someone because they look like a strong swimmer, and everyone knows to swim sideways to a riptide.
    Another life-saving profession not doing their job would enrage everyone, so why are doctors special?

  28. Borderline Betty says:

    “Someone…” wrote: “Maybe the real culprit is whoever didn’t realize this lady needed to be institutionalized, instead of having her repeatedly visit an emergency department where there is not really anybody qualified to deal with mental illness!”
    Instutionalization wouldn’t have saved her, either. No: she was EXACTLY where she needed to be. But no one gave a damn about her health or anything else. The reasons, as you say, could be myriad, but, essentially, that’s what this boils down to. No one gave a damn.

  29. Maggy says:

    To Someone who kinda doesn’t know what they’re talking about…my parents both work as nurses in hospitals and sure they get their share of those types of frequent flyer patients, but they found this to be absolutely disgusting. I could never ever ever see my mother or my father turning their back on someone like that. And this is much more than “accidental neglect.” You obviously have missed the fact that she was screaming in pain and lying on the floor for hours. It doesn’t and shouldn’t matter not in the slightest that she has done this many times before. (Which is not known) Who cares? It’s called do your damn job. You disgust me. I think, instead of thinking that everyone is crazy for feeling sorry about a situation involving a poor mentally ill woman who wasn’t helped, you should think about what YOU do at the hospital and maybe work harder to better yourself and to not just “brush off” the mentally ill patients. I don’t see my parents going, “People just don’t understand how it is in the medical field. All those crazy people who call 6 and 7 times a day who cares about them?” Yeah my mom gets irritated sometimes, but she never fails to treat them with the utmost kindness and respect no matter how badly they treat her because it is her job.

  30. Dee says:

    Just to get everything straight, if you read the paper it will tell you the woman was actually admitted and waiting for a room as they were all filled. As an admitted patient it was the nurses and doctors responsiblity to check on her, if they had done that she may be alive today. I understand it can be very difficult working in that environment for a long time, as someone who one day hopes to work with people with mental illness i do not dilude myself into believing i will not make mistakes or get stressed however after having shown this video to people who have clocked the same hours in the same type of environment as these nurses and doctors i find them to be no less disgusted and more sympathetic towards the staff who were responsible for checking on her, even though they endure the same types of things day after day, year after year.

  31. Clay says:

    When will there be a new post?

  32. Same from above says:

    I never said that I thought this was okay. I said that it’s very easy to make a snap judgment based on a 2 minute clip, and of course anybody you ask is going to say this is horrible (I bet even the people in the video, were they shown another video with different people doing the same thing). My point is to not be self-righteous, to not say “string ’em up!” as a first response. I’m sure your mom has worked harder for some patients than others, and she’d be lying if she claimed otherwise. Ask her if she occasionally prioritizes the patients who are there working hard to recover, if she bends the rules for them a little bit because she feels sympathy for them and wants them to feel better. Look which patients get to make extra phone calls, extra visits, etc. It happens. To everyone. I’m not saying she should have been completely disregarded, but perhaps there is more going on. I know thinking beyond what a quick video clip shows is more than the average TV-watching Joe is capable of, but try it once in a while. I’m sorry that she died. I’m even more sorry that she wasn’t able to get the help she needed, and I’m sorry that these probably-overworked guards/doctors/nurses let her down. My point stems from the fact that so many people “disregarded” her: perhaps this was normal behavior, perhaps she always acted out to get attention, perhaps, perhaps, perhaps. The problem is that you don’t know what really happened, and neither do I. So do some research (as the last poster did) before you decide that you’re an expert on the matter.
    And please, anecdotal evidence is not evidence. “I asked these people and they said they thought it was bad too” does not amount to anything in rational discussion. To use a topic from this board, ask a closet pedophile what he thinks about somebody caught molesting a child, and he’ll proclaim to the world how terrible that person is, while saying to himself “better him than me” or “glad I didn’t get caught.” I’ve seen too many doctors too many places to believe that they don’t get tired of patients.

  33. Dr. Rob says:

    Same From Above: I’m not against your style of thinking and far too many people make snap decisions based on far too little information. But the fact remains that progress notes were altered to contradict what is on the video and there’s nothing in her record to suggest that this was attention-seeking behavior. And, even if there were, a doctor needs to make sure his patient remains alive. There has to be some accountability.

  34. Robin says:

    I really don’t know why people are shocked by this kind of behavior. Don’t we all walk past homeless people, who might as well be dead to us? Don’t we ignore the pet getting beaten to death by the next door neighbor?

    We’re constantly told to man up, don’t let things bother you, grow a pair, or just plain grow the hell up. Empathy is NOT a virtue in our culture. Unfortunately.