Associated Press story on MSNBC:

Experts say the case of Esmin Green, whose death in a Brooklyn hospital waiting room was caught on security video, is an extreme symptom of a national crisis facing patients with mental illness. Green (at left in 2007 photo) had been waiting more than 24 hours when she toppled out of her chair and lay writhing on the floor in view of hospital staff until she died, unattended, an hour later.

Emergency rooms, they say, have become all-purpose dumping grounds for the mentally ill, with patients routinely marooned a day or more while health care workers try to find someone to care for them.

A survey of hundreds of U.S. hospitals released last month by the American College of Emergency Physicians found that 79 percent reported that they routinely “boarded” psychiatric patients in their waiting rooms for at least some period of time because of the unavailability of immediate services.

Average routine waiting times were reported to range from eight hours to more than 24 hours.

(CNN photo)

See also:

• Mental patient dies, ignored, in hospital waiting room
• Children with mental illness endure long hospital waits
• A psychiatrist examines Esmin Green’s tragedy — Chicago Tribune
  
• Woman who died on hospital floor called ‘beautiful person’ — CNN

From the New York Times, Newsday:

A surveillance camera at a public psychiatric hospital in Brooklyn has recorded the death of a patient who collapsed onto the floor after waiting 24 hours to be seen. Forty-nine-year-old Esmin Elizabeth Green died after laying on the floor for about an hour while hospital staff members looked at her and walked on. One staff member prodded Green with her foot. An elapsed time video of the last hour of Green’s life is here.

Since the video has surfaced, New York City’s Health and Hospitals Corporation has agreed to increase the monitoring of patients at the King’s County Hospital Center psychiatric ward. The agreement is part of the settlement of a lawsuit, filed by the ACLU, that accused the hospital of keeping psychiatric patients in filthy conditions, systematically neglecting them, and drugging them into submission.

Criminal charges are also being considered.

From The Boston Globe:

In the past few weeks, parents and advocates in Massachusetts report that at least a dozen children and teens with mental illness - threatening violence to themselves or others - have waited up to a week in hospital emergency rooms or medical wards waiting for psychiatric beds. Other children have been turned away from treatment.

Among factors contributing to the problem are: the impact of increasing economic stress on children, lack of coordination in the mental health system, and insurance constraints on hospitalization.

Gail Rowell of Reading said that her 18-year-old daughter, Kelly, waited a full week in Merrimack Valley Hospital’s emergency room in March. Kelly has been diagnosed with bipolar disorder and developmental disabilities and has been hospitalized 18 times since she was 9 years old. But this wait “was at least double or triple what we’d seen before,” Rowell said.

Children with difficult or multiple diagnoses are often especially hard to place. But “when you’ve got a kid in the emergency room for a week, that’s just wrong,” Rowell said. “It’s outrageous.”

From The Associated Press:

Patient websites enable those with a range of critical and chronic illnesses to provide progress reports and receive support — all without having to repeat details in exhausting phone calls. Medical professionals praise the online tools for addressing the “emotional needs” of patients.

Free online services like CaringBridge and Carepages offer user-friendly formats that allow people to quickly set up sites to share medical and personal news. CaringBridge is supported primarily by donations from users, as well as sponsor fees from hospitals. CarePages also has arrangements with hospitals and sells advertisements.

On both sites, patients and family members share information about treatment and recovery from illnesses, accidents, or other medical crises. “We just think it’s made a huge difference for families,” Alan Goldbloom, president and CEO of Children’s Hospitals and Clinics of Minnesota, says of CaringBridge.

Letter to governor: Georgia let problems fester as patients suffered and some died

By Alan Judd and Andy Miller in the Atlanta Journal-Constitution

An “unabated” failure to correct dangerous conditions at the state mental hospital in Atlanta has caused preventable deaths, injuries and illnesses for patients, federal investigators have found.

In a blistering 65-page letter to Gov. Sonny Perdue, the U.S. Justice Department detailed “critically deficient” conditions at Georgia Regional Hospital/Atlanta. Investigators have inspected two other state hospitals, finding comparable problems, and plan to visit another next week.

Continually failing to address hospital fatalities and violence, the letter said, caused similar deaths to multiply and left patients vulnerable to sexual assaults and other attacks.

… “We have concluded,” the letter added, “that numerous conditions and practices at [Georgia Regional] violate the constitutional and statutory rights of its residents.”

The inquiry’s findings echo a 2007 series of articles in the Journal-Constitution, “A Hidden Shame,” in which the newspaper reported that at least 136 patients died under suspicious circumstances in seven state hospitals from 2002 through late 2007.

From the New York Times:

A retirement community affiliated with Dartmouth Medical School in New Hampshire has become a laboratory for the ’slow medicine’ movement, allowing patients to put on the brakes when considering care that may have high risks and limited rewards for elderly people.

… it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.

Slow medicine, which shares with hospice care the goal of comfort rather than cure, is increasingly available in nursing homes, but for those living at home or in assisted living, a medical scare usually prompts a call to 911, with little opportunity to choose otherwise.

The movement is not without controversy.

Many in their 80s and 90s — and their boomer children — want to pull out all the stops to stay alive, and doctors get paid for doing a procedure, not discussing whether it should be done. The costliest patients — the elderly with chronic illnesses — are the only group with universal health coverage under Medicare, leading to huge federal expenditures that experts agree are unsustainable as boomers age.

(more…)

An analysis by the Dallas Morning News of state personnel records finds that 72 employees from Texas’ 10 state mental hospitals have been fired in the last three years over allegations of physical abuse, including brutal beatings and sexual abuse. Hundreds more were terminated for other violations, from sleeping on the job to over-medicating mentally ill patients.

State officials say there will always be some reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic.

The state’s juvenile prisons, group homes for the disabled, and state schools for people with mental disabilities all came under fire last year for reports of widespread physical and sexual abuse. The state psychiatric hospitals, like other systems for vulnerable Texans, are chronically starved for cash, advocates of more state funding say, and services at the local level can’t keep up.

“You get what you pay for,” said Rep. Garnet Coleman, D-Houston, who has bipolar disorder. “When you financially dumb something down, you make services cheap, something’s got to give. Unfortunately, it usually ends up being a mentally ill or disabled Texan.”

See earlier posts here and here.