Johanna Wangerin, the hospital said, was well enough to go home, and home was where she wanted to be, she kept telling everyone.
So Monday afternoon, an ambulance crew arranged for by the Greater Southeast Community Hospital transported Wangerin to her Suitland garden apartment, carried her upstairs to her second floor residence and then left.
Wangerin's homecoming, which normally would be cause for celebration, instead has precipitated a controversy over whether she should have been discharged at all.
For Wangerin is, at 90 years old, unable to care for herself, lives alone on a small fixed income, and has no more Medicare hospital benefits to pay for hospital care. She has a broken hip and cannot walk, has a catheter attached to her body to drain her bladder, is hard of hearing, and has no family nearby to help her.
Her situation, according to her social worker and hospital officials, is an indictment of the area's inability to care for the aged and infirm and society's lack of interest in meeting the needs of the elderly who may not need hospital care but cannot care for themselves.
"The crisis in health care today is aftercare," said John Leis, the hospital's director of social services.
Dr. Jay Shapiro, the hospital's medical director, said the Johanna Wangerin case was all tied in with such health planning issues as "utilization review," "discharge planning" and something called "PSRO," which stands for Professional Standards Review Organizations, the group that decides when a patient's Medicare benefits run out.
The form letter informing her that her benefits were exhausted was sent to Wangerin's Suitland garden apartment while she was still in the hospital. In it, hospital administrator Dunlop Ecker wrote that it was "my duty to inform you that the Utilization Review Committee has found in your case further acute hospitalization is unwarranted . . .
"Converage for your hospital bill . . . will cease in 72 hours," the letter dated March 6, said. "Should you remain in the hospital beyond March 10, payment for further hospitalization will be your responsibility."
"Wangerin was told she could appeal the decision "within two months of this letter."
The discharge, which came a week date, followed a letter from the hospital that was sent to her nephew in New Jersey. It noted that Wangerin cannot remain here, unfortunately."
"The last thing we're going to be accused of is dumping a patient," Shapiro said yesterday. Greater South-east, he noted, now carries 21 elderly patients who cannot afford to pay any money. It costs the hospital $160,000 a year, he said.
Th Wangerin case ras been the subject of "considerable discussion" at the hospital's regular discharge planning conference last Thursday, Shapiro said. "The bottom line is the lady wanted to go home and is happy to be home. She wanted to be in familiar surroundings. That makes a lot of sense."
The hospital, Shapiro said, had 'put the wheels in motion" to get Wangerin the services she needed at home. "My understanding is she's doing fine," he said.
But she wasn't doing fine, according to Debbie Jeffries, her social worker, and Dr. Joseph Thibadeau, her regular family physician who said, "I don't know who's to blame. Someone should have picked up the ball and put her somewhere other than here."
The long-term solution, everyone agreed, was for Wangerin, described as a proud, stubborn woman of Dutch birth, to go to a nursing home that provided the kind of middle-level care she needs.
In the meantime, however, two elderly women friends were in and out of the apartment, doing what they could but it was not enough, according to Thibadeau. "She can't survive here," he said.
Wangerin lay in her bedroom, her March 25, 1918, marrige certificate o none wall and her late husband's World War I naval commission on another. "God has him. Now I wish He's take me," she said. "That's the only place I'd be satisfied again. I long to see him. I long to see him."Thibadeau arranged, instead, for Wangerin to be admitted to the emergency room of Prince George's General Hospital. The ambulance came and the county rescut crew carried the woman downstairs. Outside, a gaggle of children had gathered to watch. "Goodbye, have a happy trip." one of them said as the Ambulance, siren wailing drove away.