NEW YORK -- City hospital officials said they were shocked by surveillance footage showing a woman falling from her chair, writhing on the floor and dying as workers failed to help for more than an hour.

Esmin Green, 49, had been waiting in the emergency room for nearly 24 hours when she toppled from her seat June 19 at 5:32 a.m. She fell facedown on the floor.

She was dead by 6:35, when someone on the medical staff finally approached, nudged Green with her foot and gently prodded her shoulder, as if to wake her. The staffer then left and returned with someone wearing a white lab coat who examined her and summoned help.

Until the staffer's appearance, Green's collapse barely caused a ripple. Other patients waiting a few feet away didn't react. 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 help.

One guard didn't even leave his chair. He rolled it around a corner to stare at Green and rolled away moments later.

The New York City Health and Hospitals Corporation, 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.

Green's medical records raised the possibility that someone might have tried to cover up the circumstances of the death. They 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."