Finger-Pointing Over 'John Doe'

This week I received a copy of the D.C. Health Department's report on Howard University Hospital's handling of a "John Doe," aka New York Times reporter David E. Rosenbaum, who was robbed and beaten on Jan. 6 and transported by the D.C. Fire and Emergency Medical Services Department to the hospital, where he died two days later from a massive head injury.

The investigation was ordered by Edward Reiskin, deputy mayor for public safety and justice, on Jan. 11. The next day, the Health Department conducted an unannounced investigation and a visit to the hospital, followed by additional visits during the month.

The Health Department's findings didn't cause wild cheering in the hospital's emergency department (ED). The report said:

· The patient care Form 151 that the ambulance's Emergency Medical Services technicians gave to the hospital revealed that an emergency medical technician (EMT) had assessed Rosenbaum's Glasgow Coma Score at 6, which correlated with findings suggestive of a severe brain injury, but that the ED triage nurse designated Rosenbaum as a Category 3 -- a lower priority.

· The ED triage nurse "failed to properly assess, evaluate and manage the clinical presentation of [Rosenbaum] in accordance with established ED triage protocols and patient care standards. The triage nurse also failed to perform a neurological assessment of [Rosenbaum] to determine his level of consciousness and possibility of brain injury."

· The triage nurse documented her record on Rosenbaum as follows: "Chief complaint: ETOH [alcohol]; patient was found lying in street. Patient awake and alert. Vomitus noted all over shirt. Positive ETOH smell." But in a subsequent face-to-face interview with a Health Department official, the triage nurse acknowledged that although it was written that [Rosenbaum] was "awake and alert," she said he "wasn't really moving," his eyes were closed, and the only responses elicited from him were "moanings." She stated further, the report said, that there were three or four other ambulances in the area waiting to be triaged and that she felt "overwhelmed."

· The ED charge nurse "failed to assess and evaluate" Rosenbaum's condition before assigning him to a hallway, where he was left unattended on a stretcher for one hour and 20 minutes, and she also "failed to alert and specifically delegate the nursing care of [Rosenbaum] to another ED nurse assigned to the area where [he] was placed."

· The physician "failed to perform a complete and comprehensive assessment on a 'John Doe' patient who was initially discovered to be 'lethargic' and responding only with facial grimacing to painfully applied stimuli."

The Health Department shared its findings with the federal Centers for Medicare and Medical Services and is weighing other options for holding the hospital accountable for what it did and did not do.

That was Tuesday. On Thursday, Howard fired back.

In a background paper sent to me by Howard University's senior vice president, Hassan Minor, the university hospital offered its defense and then lobbed a shot of its own.

First, contending that the emergency department was crowded on the night of Jan. 6, the university noted: