By DAVID CARUSO
Associated Press

NEW YORK - City hospital officials are promising an overhaul at a Brooklyn psychiatric ward where a woman collapsed on the floor after waiting nearly a day to be seen and lay dying for another hour before getting medical attention.

Video from a surveillance camera recorded the patient's agonizing death at Kings County Hospital on June 19.

Esmin Green, 49, had been waiting in the emergency room for nearly 24 hours when she toppled from her chair at 5:32 a.m. and lay writhing, face down on the floor.

Her collapse barely caused a ripple. Other patients waiting feet away didn't react. Security guards and a member of the hospital's staff appeared to notice her prone body at least three times, but made no visible attempt to see if she needed help.

In one case, a guard didn't even leave his chair, rolling it around a corner to stare at the body, then rolling away a few moments later.

Green, who had been involuntarily committed the previous morning and had waited fruitlessly overnight for a bed, stopped moving about a half hour after she collapsed. She was already dead when someone on the medical staff finally knelt down at her side.

The New York City Health and Hospitals Corp., which runs the hospital, said six people have been fired as a result of the incident, including security personnel and members of the medical staff.

A review also raised the possibility that someone might have tried to cover up the circumstances of the death. Green's medical records contained notations indicating that she was up and about during the time in which the video shows her dying on the floor.

"We are all shocked and distressed by this situation," HHC's president, Alan Aviles, said in a statement. "We express our deep regrets to the patient's family and will ensure a thorough investigation to answer any questions that remain."

Details of the death were disclosed by the hospital on June 20, but the case largely remained unnoticed until the video became public.

The psychiatric unit at Kings County Hospital had already been a subject of complaints by advocates for the mentally ill.

A state agency, the New York State Mental Hygiene Legal Service, filed a lawsuit a year ago, calling the psychiatric center "a chamber of filth, decay, indifference and danger."

Patients, the suit said, "are subjected to overcrowded and squalid conditions often accompanied by physical abuse and unnecessary and punitive injections of mind-altering drugs."

"From the moment a person steps through the doors," it added, "she is stripped of her freedom and dignity and literally forced to fight for the essentials of life."

The suit was especially critical of the hospital's emergency ward, saying it is so poorly staffed that patients are often marooned there for days while they wait to be evaluated.

Sometimes the unit runs out of chairs, according to the lawsuit, forcing people to hunker down on foam mats or on the waiting-room floor. The suit also claims that bathrooms are filthy and fly-ridden, and patients who complain too loudly are sometimes handcuffed, beaten or injected with psychotropic drugs.

The office of the city's medical examiner said it was still trying to determine why Green died. She had been brought to the hospital suffering from agitation and psychosis, city officials said.