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Recommendations for Improving New York

Presbyterians Emergency Department and


Strengthening the Hospitals Ties to the
Community

1/14/2015

Office of State Senator Adriano Espaillat


Office of Councilman Ydanis Rodriguez

Table of Contents
I.
II.
III.

IV.

Introduction
A tale of two hospitals
Recommendations
a. Increase staffing
b. Improve space & patient privacy
c. Improve access to urgent care centers
d. Improve communication with local stakeholders
e. Foster inclusive partnerships with healthcare professionals in the
community
f. Investigate billing practices
g. Work in partnership with the community
Conclusion

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Introduction
On December 10, 2014, New York State Senator Adriano Espaillat and other elected officials gathered
healthcare professionals, policy analysts, Upper Manhattan residents, and community leaders to discuss the
quality of care provided by New York-Presbyterians Emergency Department. The community hearing
was called in response to reports of overcrowding, a lack of patient privacy and wait times that are double
the national average. The hearing provided a platform for members of the community to share their
thoughts, concerns, and experiences and to discuss possible solutions for moving forward.
This community hearing was just the beginning of
an effort to create a more inclusive and responsive
community hospital. We need to make sure our
community has a hospital everyone can rely on,
regardless of who they are or how much money they
have, because that is where people go when they
need help the most, said Senator Espaillat. New
York-Presbyterian is a world- renowned facility
and a major healthcare asset. However, testimony
demonstrated that the Emergency Department
requires more resources to provide our community
with the care it needs. With 5% of ER visitors
leaving before they can even receive treatment, it is
clear that our needs are not being met.
New York-Presbyterians emergency rooms wait
times are double the national average. Even
adjusted for the crowded conditions typical of urban
emergency rooms, which often serve underinsured
populations, New York-Presbyterians wait times
exceed those of hospitals in similar areas.
During the testimony several themes emerged,
including most importantly the need for:

Increased staffing levels for doctors, nurses,


and allied health Professionals to reduce
patient wait times.

Additional space to improve patient privacy so people do not have to discuss personal medical data in
crowded waiting rooms.

Additional beds to allow patients to receive sensitive medical treatment out of public view.

With completion of a new emergency room three or more years away, there is an immediate need to increase
resources allocated to the hospitals emergency department. The hospital should also promote alternatives for
non-urgent care to alleviate the volume of patients seeking treatment in the ER.

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Improved communication with the community is essential for ensuring New York-Presbyterians long-term
ability to meet the needs of its patients. While representation of New York-Presbyterian at the community hearing
would have aided our fact-finding, suggestions on how to foster a continued two-way dialogue between the
hospital and Upper Manhattan residents are included below.
Thank you to all who submitted testimony, and to the Malcolm X & Dr. Betty Shabazz Memorial & Educational
Center for providing space for the community hearing.

A Tale of Two Hospitals


New York-Presbyterian is an excellent medical facility
providing world-class care, and has been ranked for
several years by U.S. News & World Report as New York
Citys #1 hospital. The hospital has made a significant
investment to attract an international clientele, offering
enhanced services for those who are willing and able to
pay for them. According to its own website, New YorkPresbyterian offers semi-private, private, and luxury
rooms and suites for our patients. Our recently renovated
luxury accommodations and suites feature amenities such
as flat screen televisions, complimentary Wi-Fi access,
DVD players, and satellite television with numerous language options. Some suites also offer sleeper sofas for
overnight guests and beautiful, panoramic views of the East or Hudson Rivers. Patients staying in our luxury
rooms and suites will also receive complimentary high tea service in the afternoon In addition to the standard
meal service included in your hospital stay, your Regional Coordinator can arrange meals of your choice prepared
by the Hospital's chef. A full-service restaurant is also available for patients and family members in the McKeen
Pavilion. Our Regional Coordinators can recommend and arrange hotels or furnished apartments where patients
and their family members will feel comfortable. During a patient's hospital stay, they can also arrange for family
members to stay at one of the Hospital's on-campus hotels.
This is in stark contrast to the conditions in of the
Emergency Department, which includes crowding,
lack of privacy, and the surrounding chaos of medical
treatment wherever one turns.

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Recommendations
Increase staffing
A root cause of the long wait times at New York-Presbyterian Hospital is poor staffing levels. From January 1,
2013 to November 30, 2014, there were 320 Protests of Assignments signed on to by over 1,100 nurses, over two
thirds of which were due to inadequate staffing or caseload was too high. An increase in the number of
doctors, nurses, lab technicians, and other healthcare professionals attending to the needs of patients in the
emergency room would reduce wait times and the number of patients leaving the New York-Presbyterians
emergency rooms without receiving care, both of which are twice as high as national averages.i
[A] woman whose husband said she
While the hospital has made some adjustments in how it utilizes its
was pregnant and bleeding, sat in the
staff in the ER, including placing a staff member at the front door,
ER for 2.5 hours with no one dealing
more must be done. We have no doubt as to the dedication and
with her. David Tossir, NYP ER patient
abilities
of
the
After having been in the emergency
nurses, and doctors,
room from 10pm to 4am I decided to risk
and additional healthcare workers who strive to ensure the wellmy chances at another hospital and
being of the Upper Manhattan community. But their numbers are
informed the nurse of my leaving, and
not adequate to meet community demand.
only then was the doctor finally called in
Nurses at New York-Presbyterian Hospital repeatedly have
to see me and assess my injuries, six
complained about the
On any given day, we are assigned
hours after my arrival at the ER. At that
staffing shortfall in its
eight to ten patients or more at a
time the blood on my wound had dried
emergency rooms.
time. On Mondays, our busiest
on my face, and my eye was painfully
Yasmin
Bahar
day, it is difficult for us to see
swollen. Angel Medina, regarding a June
(Registered Nurse at
2014 visit to the Allen Pavilion ER, where he
beyond the line of patients,
sought treatment for a bleeding wound.
sometimes looped around the
New Yorkfacility, creating backlog of needs
Presbyterian Hospitals Pediatric ER; NYSNA member) testified, The
that can seem very daunting.
reality is that we are called upon in every shift, every day, to care for
Whats easy to see, however, it is a
more patients than should be assigned by professional standards. In
situation that is out of hand and
acute cases- the most ill children -- caseloads should not exceed four;
worsening. Dawn Minerv,
there should be three...but everyday RNs are handling more than four
Registered Nurse in NYPs Adult ER
acute cases at our pediatric ER.
Whenever we go to ER, I
always say we need to bring a
pillow, a blanket, breakfast,
lunch, and dinner because we
get there at a certain time and
are still there seven or eight
hours later. - Carmen Rosa
Perez, NYP ER patient

The New York State Nurses Association have compiled 320 protests of
assignment dating from January 1, 2013 to November 30, 2014, signed by
more than 1,100 registered nurses. Anthony Ciampa, a registered nurse at
New York-Presbyterian Hospital, testified that there are more than 300
documents from the emergency room. Three hundred documents: instances
where we believe patient care might be compromised... More than 85% of
these protests of assignments, the detailed record indicates that there is a
staffing shortfall: not enough nurses to handle the patient load.

Even as nurses staffing levels are inadequate to support patient need, there arent enough techs to support the
physicians and nurses. A big part of the reason patients spend hours in the ER is because when RN or Dr.
collects their samples (blood, urine stool nasal swabs) the specimens get sent to the lab. You can have 100 RNs
and Drs. in the ER but with a short-staffed lab the patients are going to sit for hours until the [doctor] gets back
the results and can determine what to do with the patient next, one laboratory technician testified.

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Improve Space & Patient Privacy


On a regular basis, there is not enough space in New YorkWe are so overcrowded that we are
Presbyterians emergency room to serve patients presenting for
examining people in chairs! So
treatment. While the number of people utilizing emergency
overwhelmed with patients that sensitive
services has steadily increased, the hospital has continued to
matters -the things about which patients
reduce the number of beds in the Emergency Department. The
seek and should have privacy-- are hard
result is a cramped environment where patients are not afforded
to discuss. There are stretchers in
even a modicum of privacy or dignity; treatment being provided in
corridors all the time, sometimes in the
public hallways; and patients, many of them elderly, waiting 30
path of equipment. Nora Murphy
hours or more for a bed. This does not meet our standard of
(Registered Nurse at Allen Hospital with 30 years
fairness or decency -- a decency which the people in this
of experience)
neighborhood deserve, said Councilmember Mark Levine, whose
District, located just south of New York-Presbyterian, is home to many of its patients.
A needle was left in my arm with no
explanation except that it was needed. I
began to wonder if they thought I was a
visitor and not a patient. Jay Mazur,
regarding his experience at New YorkPresbyterian Hospitals ER, where he reported
staying for more than 10 hours for kidney stones.

Patients have suffered unnecessary discomfort by revealing


intimate, personal medical information in the middle of a
crowded emergency room, within earshot of many others. This
lack of privacy also makes patients hesitant to share such
information, potentially leading to improper care provided. While
federal privacy laws allow communications as required for
quick, effective, and high quality health care that may result in
incidental disclosures, it is questionable whether the hospital is
taking the reasonable precautions federal regulations require to
prevent such situations from becoming the status quo.

While the new facility will provide a


significant increase in the number of beds
and available space for New YorkPresbyterians emergency department, our
communities cannot wait years for these
overarching issues to begin to be addressed.
Immediate steps must be taken to address
overcrowding.

There are stretchers in


corridors
all
the
time,
sometimes in the path of
equipment.

ER space was so congested


that any efficiencies were
negated and there was no way to
pass a fire inspection. David
Tossir, community resident

Improve Access to Urgent Care Centers


According to NYP, over a 16 year period, the annual number of ER visits has
soared from 50,000 to 80,000. While many patients ailments do not require
emergency care and could be better served by healthcare professionals in a
different setting, a lack of access and patients unfamiliarity with such options are
hindrances to the appropriate use of such resources. Increasing outreach efforts
(including better signage), having 24/7 urgent care centers, and opening such
centers throughout the community would significantly reduce the use of an
overcrowded emergency room.

Urgent care centers are part of the solution, but New York-Presbyterian only has
one in Upper Manhattan, and there is minimal knowledge in the community of the
services it provides, in part due to poor signage.
There is a growing demand for urgent care centers, but it is not being met by New York-Presbyterian. As a result,
two urgent care centers, including one by Mount Sinai hospital, have opened in Washington Heights and Inwood.
Even though a substantial portion of the community is uninsured and many of those who are insured are covered
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by Medicare and Medicaid rather than private insurance, there clearly is a market for these services. It seems odd
that New York-Presbyterian would not have capitalized on this opportunity, and has failed to expand into its own
catchment area to meet the needs of its own consumer market.
There is no communication between
ER physicians and primary doctors.
Even when they know who the doctors
are, we seldom get a call to tell us about
the progress of our patients. A local
physician testifying that the ER at New YorkPresbyterian Hospital does not communicate well
with patients primary care physicians.

Improve communication with local stakeholders


Communication between doctors, patients, and New YorkPresbyterian must improve. As one doctor testified, primary care
physicians are often not receiving notification when a patient visits
the New York-Presbyterian emergency department, while such
contact is standard practice at other hospitals in Manhattan.

While New York-Presbyterian has put the onus on patients


primary care doctors to inform them of the proper instances to use
the emergency room, there is little evidence of the hospital taking responsibility to better inform the community.
With thousands of doctors affiliated with New York-Presbyterian, the hospital has the ability to address its
concerns.
The extent of community input at New York-Presbyterian has ebbed and flowed over the years. In the 1970s,
community activism led to the creation of an ambulatory care network (ACN), improved cultural sensitivity
measures including translation services, and the formation of a Community Health Advisory Council with two
dedicated staff members. While these initiatives met the needs of patients at that time, there currently are no
dedicated staff members to support the advisory council. "There has been a lack of public dialogue between the
hospital and the community members who utilize these services," Sen. Espaillat said. As a result, there have been
insufficient means of communication to ensure the hospital is meeting the needs of its patients in the community
in the 21st century.
Foster Inclusive Partnerships with Healthcare Professionals in the Community
With New York State is accepting applications for its Delivery System Reform Incentive Program (DSRIP),
which will allocate up to $6.42 billion in efforts to redesign Medicaid funding and improve health outcomes, New
York-Presbyterian has the opportunity to make major changes. Presuming New York-Presbyterians application is
granted, we hope the hospital will utilize this new funding appropriately to work with all key community partners,
including independent physician associations, to reduce utilization of the emergency room when care can be
sufficiently provided elsewhere. The image of an island in the community has only been furthered by the
shutting out of local organizations from potential shared opportunities," said Councilmember Ydanis Rodriguez,
who represents the district in which the hospital is located and many of its patients reside.
Investigate billing practices
Healthcare professionals have raised serious concerns over the billing practices in the emergency room at New
York-Presbyterian hospital. These range from being billed for seeing a doctor when such services were not
provided, to excessive charges for minimal services provided. A letter has been written to New York City
Comptroller Scott Stringer and New York State Comptroller Thomas DiNapoli requesting further investigation.
Work in Partnership with the Community to Create
New York-Presbyterian is a not-for-profit institution that generated $4.3 billion in revenue in 2013. It has the
resources to embark on initiatives that would both improve the health of the community and the hospitals bottom
line, and understands the public health concerns specific to Upper Manhattan, but could do improve its efforts to
meet the communitys needs.
In 2006, New York-Presbyterian commissioned a Community Health Needs Assessment by Columbia University
professors. It found a significant number of residents in these communities are Eligible for Public Health
Insurance but Not Enrolled (EPHINE), and in 2008 created a three-year plan to facilitate access.ii By the end
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of 2011, with one in three Washington Heights and Inwood residents lacking continuous health insurance at the
time,iii New York-Presbyterian was able to enroll a total of 334 people into Medicaid, with no mention of
additional enrollees in subsequent years.iv
Increasing Medicaid enrollment would improve access to local physicians while reducing the use of emergency
room for the provision of primary care while increasing peoples ability to pay for services provided in the
emergency room. Even so, New York-Presbyterian has not matched this opportunity with aggressive patient
enrollment into available insurance coverage.

Conclusion
New York-Presbyterian Hospital is a premier facility for numerous medical specialties. However, there is a tale
of two hospitals. Conditions in the emergency room accessed by local community members remains poor. There
is overcrowding, not enough staff and a lack of privacy. The recommendations above, based on the testimony of a
wide array of stakeholders, will dramatically improve the state of Presbyterians Emergency Department. By
improving communications with local stakeholder and increasing involvement in the community New-York
Presbyterian Hospital will be better equipped to address both the current and future concerns of Upper Manhattan
residents.
Summary of Recommendations:
o Increase staffing By improving the patient to staff ratio, wait times can be lowered, and the
quality of care will improve significantly.
o

Improve space & patient privacy Providing patients with additional private space to discuss
sensitive matters and information will prevent having these conversations in public spaces.

Improve access to urgent care centers Ensure urgent care centers and the services they
provide are accessible and well known throughout the community. Opening additional urgent
care centers and increasing hours of operation can provide better utilization of these health care
resources.

Improve communication with local stakeholders The hospital should have strong
communication between the doctors whose patients they treat, and with the community whose
healthcare needs they are trying to meet. Community activism lead to previous improvements at
New York-Presbyterian, such as adequate translation services, a continuing public dialogue is
necessary to meet the communitys 21st century needs.

Foster inclusive partnerships with healthcare professionals in the community The Delivery
System Reform Incentive Program (DSRIP) is an opportunity for New York-Presbyterian to
improve health outcomes. However, this can only be accomplished by including all key
stakeholders.

Investigate billing practices Ensure people are only being billed for the services they receive
while in the emergency room. Any miss-billing can cause financial hardship.

Work in partnership with the community- It is vital that a community resource as important as
New York Presbyterian has a strong connection with the community and that there is an
accessible conduit available to community members and other stakeholders to voice their
concerns.
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TESTIMONY
FROM 12/10/14 HEARING
on
CONDITIONS IN THE EMERGENCY DEPARTMENT
AT NEW YORK-PRESBYTERIAN HOSPITAL

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Senator Adriano Espaillat Opening Remarks


Public Hearing on New York-Presbyterian Hospital ER Conditions
December 10th, 2014
Good morning, and thank you for being here.
Were gathered across the street from New York-Presbyterian, an undeniably world class facility, and a major
asset for Upper Manhattan. Inside, hospital staff are leading the way in multiple specialties pioneering advanced
techniques that will benefit the entire world.
But local residents are experiencing something radically different: if New Yorkers recognized that our home had
become a tale of two cities, then we must acknowledge that New York-Presbyterians treatment has become a
tale of two hospitals.
This tale includes an E.R. overflowing with patients with wait times more than twice the national average and
higher than equivalent facilities in underserved areas. This problem is so pronounced that 5% of ER visitors leave
before they can even receive treatment.
It includes reoccurring complaints that patients have been asked to detail private medical history in crowded,
public, and invasive settings. And many visitors have been uncomfortable discussing their conditions or
immigration status out in the open.
It includes frustration from partners and advocates in our community doctors treating low-income and
immigrant patients, whose patients report horror stories. Or community organizations who hoped to partner with
New York-Presbyterian on federal initiatives like reducing hospital readmission rates but have been shut out
shared opportunities.
And it includes healthcare professionals who have devoted their careers to helping others, but often feel hindered
in doing so. They have complained to me about questionable billing techniques they are pressured to use,
deprioritizing patients based on insurance, and basic issues like access to critical equipment.
Compared to the patients seen by specialists in the hospital, the community members visiting the emergency room
are low-income Blacks and Latinos. They are more likely to rely on Medicaid for insurance; many are ineligible
for their insurance because of their immigration status.
Of course the ER is less profitable than other parts of the hospital. But that doesnt mean we can accept unsafe
conditions.
This is not meant to be an attack on New York-Presbyterian but there has been a lack of public dialogue
between the hospital and the community members who utilize these services.
Yesterday at a closed-door meeting with New York-Presbyterian and stakeholders, one attendee movingly spoke
of a recent experience at the hospitals emergency room in which a family member did not receive timely

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services, and they walked out to obtain care elsewhere. When the discussion shifts from abstractions to personal
anecdotes, the urgency of the situation becomes readily apparent.
This hearing today provides an opportunity for members of our Upper Manhattan community to openly discuss
issues and experiences that many have been unable to speak out on, and I thank everyone testifying for their
courage.
The testimony heard today is just the beginning of an effort to create a more inclusive and responsive community
hospital that everyone will benefit from. The problems and solutions heard today will be used to compile a report
on how to improve conditions, enhance collaboration between New York-Presbyterian, elected officials,
community members, and additional stakeholders, and result in a local hospital that this community can rely on
without reservation
Testimony by Council Member Ydanis Rodriguez-District 10
As the 6th best hospital in our nation, and #1 hospital in both New York state and metropolitan area according to
US News, New York-Presbyterian Hospital obviously has high expectations. Over 100,000 patients come from
around the nation and world to receive the renowned medical care from one of our nations best facilities, ranking
in the top 10 in 10 specialties according to the US News and World Report Rankings. Recently, the first hotel in
Northern Manhattan began construction near the hospital to serve those waiting for surgery and their families. The
level of service surgery patients have received is renowned. However, the surrounding community has expressed
serious concerns about not receiving the same level of service. We have received reports of differential treatment;
one hospital serves the elite from around the world with incredible amenities, and another heavily underserving
the surrounding community.
Each year the emergency room at Columbia Presbyterian receives over 275,000 visits. These patients, some with
critical undiagnosed diseases and issues, are then subject to wait times twice the national average. Long waittimes only further exacerbate an already crowded hospital leading to incredibly uncomfortable conditions for
those seeking treatment. Although the emergency room does not provide the hospital with large profit margins, it
must be heavily invested in so that the hospital does not remain an island in the community. Our community
deserves top-tier service from a top-tier hospital, and will not settle for anything less. That will require that New
York-Presbyterian Hospital invest heavily in improving and expanding the services offered in order to better
address the needs of the surrounding community.
We call for increased transparency in dealings with patients as well as local organizations and advocacy groups.
We must have as much transparency as possible to end these practices so that our communities can gain the
medical priority they rightly deserve as patients, regardless of insurance status. The image of an island in the
community has only been furthered by the shutting out of local organizations from potential shared opportunities.
I call upon the hospital to instead reach out to any and all local organizations to partner with, not only to give
funding but also to create and expand much need programming and services for our communities.
In conclusion, though the hospital has provided many economic benefits to the community, it has not provided the
quality of service expected from a hospital of its tier. The communities of Northern Manhattan deserve the best
quality treatment from one of the best hospitals in our nation.
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Testimony by Council Member Mark Levine-District 7


There are presidents and prime ministers who come to seek care from Columbia Presbyterian. This is a hospital
that serves people not just from around New York City, not just from around the U.S., but globally.
This is the ultimate, world-class healthcare institution. But it is also a neighborhood health institution. This isnt
like the Upper East Side, where you have great hospitals every few blocks; this is it for us. Were 200 miles away
from other hospitals in Manhattan. This is our first option for medical care. We depend on this hospital, but the
hospital that we here in the neighborhood experience is not the same one that presidents [receive] and prime to
support people who have limitless resources at their disposal to pay for their health care.
But for the average person, someone who may be relying on government insurance, may not even have insurance,
they are experiencing something very different: an emergency room where the waits are long, I think the average
is 3.5 hours, where often people have no privacy and are forced to share medical information in public in front of
others, where something so frustrating that, as the senator mentioned, that they get up and leave. And this is
unacceptable. This does not meet our standard of fairness or decency -- a decency which the people in this
neighborhood deserve.
So today is about listening and learning to all the voices of the people who work and receive services in this
emergency so that we can document in a public way what the challenges are, and hopefully that will lead us to
solutions.

Testimony by Sabino Perez


My name is Sabino Perez, I live in the Bronx and I came to share my experience in the emergency room at
Columbia Presbyterian. On February 2nd, 2014, I had an accident at my jobsite, picking up demolition debris. I
arrived in the emergency room at 9:30am, at 9:45am I was seen in triage, and at 10:15am I was admitted into the
hospital. At 10:00am and at 10:15am, I asked the nurses for a checkup and something for the pain, but they
completely ignored me. At 10:30am they told me that they could neither give me anything nor do anything until
the eye specialist came to see me. At this point, my eye was swollen and it hurt very much; my iris broke.
Although I asked for medicine for my eye, no one spoke to me, nor did they check on me. All of the nurses
ignored me; they were writing documents at the computer terminals and didnt even glance at me. A while later, I
asked one of the nurses supervisors to give me something for the pain, but the gentleman said I had to wait for a
doctor, and that no one ever died from an eye injury.
An EMT who was in the ER told me that it would be better if I went to Saint Luke's Hospital instead because at
Presbyterian, they wouldnt be seeing me for a while.
Throughout the entire time we were there, we never saw a nurse pay any attention to me, nor take my vitals, nor
ask me about the pain or the accident.
At 11:00am I asked for something for the pain, but to no avail. At 11:45am I left because I didnt receive any type
of attention during my wait. They only said to wait and that nobody could see me at the moment because they
were filling out some documents.
I left and went to Queens to search for a private doctor. When I arrived at the clinic and met with the doctor, she
told me that I had developed an infection from the sliver of wood that I had lodged in my eye. The doctor gave me
a note so that I could go to the Eye and Ear Infirmary. There, I was quickly treated; I was given an MRI shortly
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after arriving and I was treated as one should. In the wake of the accident and the poor medical attention I
received, I lost vision in my right eye.
----------------------------------------------------------------------------------------------------------------------------------------------------------My nombre es Sabino Perez, vivo en el Bronx y vine a compartir mi historia en la sala de emergencias del New
York-Presbyterian. El 2 de febrero de 2014 tuve un accidente en mi lugar de trabajo, recogiendo basura de
demolicin. Llegu a emergencias a las 9:30 am, a las 9:45 am me vieron en triage y a las 10:15am me entraron
dentro. A las 10:00 am y a las 10:15 am le perdi a las enfermeras que me revisaran y que me dieran algo para el
dolor, pero me ignoraban completamente. A las 10:30 am me dijeron que no podan darme nada ni hacer nada
hasta que llegara el especialista de los ojos a verme. En ese entonces tena el ojo muy hinchado y me dola
mucho. El iris se me rompio. Aunque peda medicina para el ojo, nadie me hablaba ni me chequeaba. Todo las
enfermeras me ignoraban, escriban papeles en el espacio con computadoras, ni siquiera me miraba. Ms tarde le
pregunt a unos de los supervisores de las enfermeras que me dieran algo para el dolor, pero el seor me dijo que
tena que esperar por el doctor, que nadie se mora de un golpe al ojo.
Un EMT que estaba en la sala me dijo que era mejor que me fuera al Hospital San Lucas porque en el
Presbyterian no me iban a ver por ahora.
Nunca vimos una enfermera darme atencin y tomar mis signos vitales o preguntarme sobre el dolor o el
accidente durante el tiempo que estuvimos all.
A las 11:00am ped algo para el dolor pero nada de nada. 11:45am, me march porque no recibi ningun tipo de
atencin durante mi espera. Solo me decia que esperara y que nadie me poda ver porque estaban llenando unos
papeles.
Me march y me dirig a Queens y busque a un doctor privado. Cuando llegan a la clnica, a ver la doctora
privada. La doctora dice que se me desarroll una infeccin por la estilla de madera que tena incrustada en el
ojo. La doctora me di una nota para que fuera al Hospital Ear and Eye Infirmary. All fu tratado rpidamente,
me hicieron un MRI a poco tiempo de llegar al hospital y me atendieron como se debe. A raz del accidente y la
pobre atencin mdica recibida, perd la visin en mi ojo derecho.
Testimony by Francisco W. Matos
Estoy testificando sobre el trato recibido por mi madre Josefa E. Encarnacin (MRN: 201 3524 en New YorkPresbyterian Hospital) en la sala de emergencias del New York-Presbyterian, La razn de haber ido al hospital
fue las observaciones que hice, como ameneca con mi madre de noche y la homeattendant la acompaaba de dia,
que ella tenia 3 das sin orinar. El miercoles yo llame a la enfermera del plan mdico de ella y la enfermera me
dijo que no me preocupara, que iba a visitar a mi madre para ver su estado. Mi madre estaba hinchada en sus
piernas y tenia ciertas erupciones en la parte interior de las piernas y la parte lateral del cuello, eso mostraba que
el cuerpo no estaba eliminando todas esas excreciones. Entonces, yo observaba que a mi madre no le daba fiebre
pero cuando vino la enfermera, fue directamente en la parte trasera y le puso un termometro y tenia 101 grados de
temperatura y procedi a llamar inmediatamente al hospital para que mi madre fuera ingresada.
El 31 de julio de 2013 a las 5:30 pm fue ingresada al saln de emergencia, se le tomaron sus respectivos
examenes rutinarios de presin y temperatura e inmediatamente fue trasladada al rea D de emergencias. Yo
considere unas 2 o tres horas mas tarde, mi madre iba a ser trasladada al Mailman Hospital, pero la enfermera me
habia dicho que no habia camas vacantes. Pase toda la noche hasta el otro dia, al lado de mi madre junto a la
home attendant de ella en el Area D. Llega la maana, considere que en ese lapso de la maana iba a ser traslada,
no fue asi, llega la hora de la tarde y mi madre segua en la misma posicin. Luego llega la noche, y yo me
levanto para decrile a una supervisora de la sala de emergencia que me iba a quejar porque eran demasiadas horas
de no recibir atencin y mi madre era una persona muy mayor y nunca habia durado tantas horas para ser
atendidos. Despues de 30 horas de espera la subieron a un cuarto al Mailman.

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Cuando llegamos al Mailman pude darme cuenta de que habian varias camas vacias en el piso, porque estuve
observando cuarto por cuarto. En ningun momento vi que le pusieron una sonda para tratar de ver si sus orines
pudieran salir. Para mi fue muy dolorosa esa experiencia. No le estaba llegando a los pulmones suficiente
oxigeno y por consiguiente a su sangre no estaba lo suficientemente oxigenasa. La doctora me explico esa
situacin y me aconsejaron que le iban administrar morfina para aliviale el dolor. Me arrepiento de haber
aceptado que mi madre ya en sus ultimas permaneciera en el Mailman, porque si la hubiera trasladado a Calvary
Hospice, su estadia en Calvary quizas le hubiera prolongado su vida, sin embargo ella falleci en el hospital
Mailman a raz de esta ultima hospitalizacin.
Francisco Matos
12/16/2014
Rita McKee
Thank you, Senator Espaillat, for holding this hearing and for pushing our hospitals to be the BEST they can, to
serve the people of New York City in general, and Upper Manhattan in particular. I appreciate the opportunity to
express my own experience with New York-Presbyterian Hospitals Emergency Department.
On August 27, 2013 my 63rd birthday I briefly lost consciousness and fell on my face,
cutting my upper lip and hitting my forehead hard enough to raise a large lump. Since I was scheduled for
gallbladder surgery within 2 weeks, and I had just eaten a great homemade birthday breakfast of bacon, eggs, and
toast something I hadnt eaten in months because of a strict diet I suspected I had (as my surgeon later
confirmed) suffered a severe gallbladder attack, triggering a vasovagal reaction and causing me to faint. My
partner called 911.
The EMTs were terrific. At my partners insistence, and at the urging of the EMTs, I agreed to be taken to the
NYPH ER by ambulance. Based on a visit two years previously to the ER of a much smaller hospital in
Northampton, Massachusetts for an unrelated medical issue, I figured I would be in and out in a couple of hours
unless something were really wrong. A few tests... bloodwork, maybe a neurological exam or a head xray...
treatment for the facial cut... and Id be out of there, in plenty of time for a birthday celebration. Two hours.
Three, if the ER was really busy.
After my initial arrival on a gurney, and a 5 minute conversation with what I found out later was a supervising
physician, I was ushered to a single chair against the wall in a large, open room a chair my partner and I would
share for the next nearly 8 hours.
From that chair, I had a good view of the entire ER: to my left, I could see into an open,
Ushaped area in which at least a dozen people sat at computer screens. (I later learned
these were residents, doing paperwork.) In front of me, stretching from about where the
doctors were sitting over to the wall, were nurses cubicles. They were mostly empty, and the few people sitting
there were also at computer screens. Beyond that nurses area was a line of sometimes curtained, sometimes open,
beds on which lay a variety of patients. One of these yelled for much of our stay; when I asked about him, I was
told he was a regular, awaiting mental evaluation.
Very little personal interaction happened with either nurses or doctors, though when they happened, they were all
personable, pleasant individuals. Mostly, they sat at their computer terminals, in full view of everyone awaiting
attention. If I hadnt taken the initiative, repeatedly approaching residents and nurses to ask when I would be seen,
there would have been even less interaction; we were left on our own about 90% of the time we were in the ER,
sharing that lone chair in full view of everyone in that large, open room.

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About two hours after my arrival, I was given a chest xray; about 4 hours in, I was given an EKG. Bloodwork was
taken at some point, though I was never told results. About six hours in, a sonogram of my gallbladder was done
administered by a resident who was demonstrating the use of the machine to two students. The resident attempted
to convince me to have gallbladder surgery immediately, but I declined, since I had surgery already scheduled. By
the way, this was evidently not an official examination; it was never billed for, in any event.
And just before we left a resident used superglue on my upper lip, which was by then quite swollen. No
neurological exam, or head xray, or MRI, was ever done. I may or may not have suffered a concussion. I will
never know, even after 8 hours and $2272.16 of services including $442.12 for the superglue fix.
I am convinced that, had the ER been run more efficiently if more than one supervising
physician been working; if the residents and nurses had been interacting with patients, rather than doing
paperwork we would have been out of there within my initial estimated time.
As it was, being on public display during this entire ordeal was humiliating; sharing a single hard chair for nearly
8 hours was uncomfortable; discussing my questions and concerns in a public setting in earshot of other patients
and staff was embarrassing; and not getting answers about my own health was unacceptable. By the time I left at
minimum I should have known the results of bloodwork, and I should have known whether I had a concussion.
The most reassuring interaction I had that long, long day came from my gastroenterologist, whom I called while I
was sitting around waiting to be seen by a physician in person.
After this experience, I dont know how I will feel if I ever again have to be taken to the ER at New YorkPresbyterian Hospital. I hope, as I have recently read, that the hospital is serious about expanding its ER facility
but I also hope the hospital takes a look at its ER practices to see how they can be improved for all patients, both
critical and noncritical.
Thank you for your kind attention.
Julissa Lorenzo
Espero todo vaya bien. Te escribo porque estuve mirando un reportaje en las noticias, donde Espaillat denuncia el
maltrato que los pacientes viven en el hospital Presbiteriano. Me da gusto que ste tema se haya llevado a los
medios de comunicacin, puesto que es realmente una situacin bastante denigrante la que se vive all. Me atrevo
a relatarlo de esta manera porque visit esa sala de urgencias y la de la sucursal que tiene el mismo hospital en la
calle 232 y fue verdaderamente absurdo el trato y el mal servicio que se recibe en ambos lugares.
A consecuencia de esta experiencia que viv y todos los rumores que se escuchan al respecto, me interesa
cooperar del modo que sea para que se preste atencin seria al asunto. Si necesitan historias que contar para
apoyar la causa del reporte, por favor djame saber . Con gusto me encantara contar la experiencia que vivi mi
prima y un amigo, a los que acompa a dicha sala de urgencias. Mi prima est dispuesta a cooperar si necesitan
apoyo. Mi madre siempre dice que prefiere morir antes de ser ingresada a esa sala especficamente. Y creme,
ahora entiendo a qu se refiere. Es un completo caos lo que se vive all.
Si les interesa nuestro testimonio o necesitan algunas que otras firmas para llevar el tema a las autoridades de
investigacin correspondientes, cuenten conmigo. Slo avsenme.

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Citations

CMS Hospital Compare: http://www.medicare.gov/hospitalcompare


New York-Presbyterian Hospital's 2008 Community Service Plan, http://www.nyp.org/pdf/communityserviceplan2008.pdf
iii
NYC Department of Mental Health and Hygiene: Community Profile,
http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-301.pdf
iv
New York-Presbyterian Hospital's 2013 Community Service Plan, http://www.nyp.org/pdf/communityserviceplan2013.pdf
ii

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