The Woman Who Died in the Waiting Room

Esmin Elizabeth green fell out of her chair in the waiting room of Brooklyn's largest psychiatric hospital nearly an hour before anyone realized she was in trouble. For 20 minutes, she writhed and twisted between two chairs under the watchful eye of a security camera whose footage would later be broadcast across the country, spurring a public outcry. Two security guards and two other staff members passed through the room and glanced at the 49-year-old woman, without bothering to check her vital signs or help her up. The sight of patients like Green, wearing a urine-stained hospital gown and lying face down on the floor, was hardly uncommon in the psychiatric emergency room of Kings County Hospital Center. Neither was the fact that by the time she collapsed, she had been waiting almost 24 hours for a bed. At that moment Green was in line with 32 other patients, some of whom had been waiting just as long, if not longer.

In fact, the hospital's psychiatric unit, also known as the G Building, was notorious for being both overcrowded and indifferent to its patients. A lawsuit filed in 2007 by the New York Civil Liberties Union charged staff members with beating and handcuffing patients and injecting them with psychoactive drugs when they complained. And the Commission for Quality of Care, a state agency, found that instead of trying to locate available psychiatric beds at other area hospitals when the facility reached capacity—as required by state law—G Building employees had falsified documents to hide a persistent overcrowding problem. Last year Alan Aviles, president of the Health and Hospitals Corp. (HHC), which oversees Kings County, called the NYCLU allegations "grossly inaccurate, irresponsible and an affront to the dedicated and caring staff." Hospital leaders insisted that the facility's troubles stemmed from space constraints, not staffing issues, and promised that a new building still under construction would help alleviate that problem. In an e-mail to NEWSWEEK, the embattled hospital says it has made "significant reforms" since then, and promises more changes are coming. But any such improvements will come too late for Green. Nearly 40 minutes after she stopped moving, a nurse walked over and lightly kicked her. By then, she was already dead. Last week the city's medical examiner cited blood clots in her legs as the official cause.

As disturbing as the circumstances of Esmin Green's death were, they should not have come as a surprise. Public hospitals across the country have struggled to provide acute psychiatric care to the poor and uninsured since the early 1960s, when large mental hospitals began closing their doors en masse. Rather than lock them away in cold, uncaring institutions, the thinking went, the mentally ill should be offered a place in society. But with insufficient outpatient services and a dearth of community-based support, the least fortunate of them have ended up in already overtaxed emergency rooms. They are the poor, the uninsured and the undocumented. Many of them suffer from chronic conditions that could potentially be treated with medication and regular counseling, luxuries most of them cannot afford. With just 50,000 inpatient psychiatric beds for tens of millions of people across the country, the mentally ill typically wait twice as long for treatment as other patient populations do. "It's like landing airplanes at O'Hare airport," says Ken Duckworth, medical director of the National Alliance on Mental Illness. "For psychiatric patients in particular, every day is the Wednesday before Thanksgiving at O'Hare. There is just no place for them to go."

On June 18, as Green waited for help, the American College of Emergency Physicians released a nationwide survey of emergency-room directors. More than 80 percent of them said psychiatric patients should be placed in dedicated emergency psychiatric facilities, like the ones New York established in the late 1980s. The G Building at Kings County, where Green died, was the city's largest such facility. But if her story tells us anything, it's that isolating psychiatric patients from everyone else will not solve the problem. In New York, at least, this approach seems only to have fostered an environment conducive to abuse and neglect.

Green came from a rural village near St. Catherine, Jamaica, in 2000, and made her home among Brooklyn's Caribbean diaspora and the Jesus Is Lord Sabbath Day Adventist Church, where she sang, prayed and sometimes lived. The eldest of 12 children and a mother of six, Green assumed the role of matriarch when she was just 20, after her own mother died. In Jamaica, she had been a shrewd businesswoman, establishing a successful dress shop, a wholesale fishing business and a small import company over the course of a decade. Family and friends remember her as outspoken, vivacious and generous to a fault, with a voice that could wake the dead and a love for church and children that surpassed all else. "She was the light to us," says her eldest daughter, Trecia, who is suing the hospital and the city for $25 million. "She had a strength that drew everyone to her."

In Brooklyn, Green struggled with poverty and bouts of depression that friends say were triggered by a profound home-sickness.Having left her own children, including a 6-year-old son, in Jamaica, she immersed herself in the church's youth programs, where she ran activities and led prayer sessions, and area day-care centers, where she worked on and off over the years. Without a green card, a permanent job or any health insurance, Green relied on her pastor, Marilyn Johnson, and a patchwork of friends to see her through dark times. But a fierce pride compelled her to hide her illness from most of, them, so that even after she died, only a handful knew the full extent of her suffering.