Shortly before dawn on March 6, an elderly man with no fixed address and no medical insurance was taken to the emergency room at Capitol Hill Hospital. Initial examinations indicated that the man possibly had suffered a heart attack.
But, the man was not admitted to Capitol Hill Hospital. Instead, he was transferred to D. C. General Hospital, even though there was "a risk of sudden death during the transfer," one specialist at D. C. General said later. The man "should not have been subjected to those risks," the specialist said.
"Transferring such patients is medically dangerous and shows poor medical judgment," the specialist, a staff cardiologist, wrote in a letter on file at D.C. General.
On any given day, an average of two patients are transferred to D.C. General by one or more of the city's 12 private hospitals that provide emergency medical care.
Very few of the transfers are life-threatening but, officials at D.C. General and other hospitals say, few if any of the patients are transferred for medical reasons.
Rather, nine out of 10 of those patients are sent to the city's only public hospital because they have no health insurance and therefore are unable to pay private hospital bills.
In a recent 13-month period, 713 patients were transferred to D.C. General from the private hospitals in the city. Thirty percent of those patients came from Capitol Hill Hospital, according to records at D.C. General.
According to Dr. Stanford Roman, medical director at D.C. General, about 25 to 30 of the patients transferred each year are at risk of dying during the transfer.
"You're dealing with factors of luck and the grace of God," Roman said.
"We feel that part of our mission is that we will take patients who have a need for... hospital admission but who do not have insurance," Roman said.
"Our problems lie with the ability of the transferring to be done objectively," Roman said, "and not to base it on the patient's insurance coverage."
Capital Hill Hospital officials refused to discuss the case described by the cardiologist, other than to confirm that the man was treated in the hospital's emergency room.
However, before he was informed about the man's case, Fred Hubbard, the hospital's director of planning and operation said, "This hospital cannot exist having everybody in a no-pay category, and doesn't pretend to... But we do admit a lot of patients where there is a medical necessity. We would not transfer a patient where it would endanger his health."
In the 13 months begining Jan. 1, 1978, and ending Jan. 31, 90 percent of the 216 patients Capital Hill transferred to D.C. General were persons with no medical insurance, according to D.C. General records.
According to Hubbard, Capitol Hill provided free care to 136 patients between July 1977 and July 1978.
George Washington University Medical Center accounted for 25 percent -- or 183 -- of the transfers to D.C. General in 1978 and January 1979. Ninety-five percent of those patients had no insurance, according to D.C. General records.
Dennis O'Leary, GW's medical director, said his institution only transfers about 2 percent of the 900 uninsured patients seen in the emergency room every month.
"These figures suggest that we're carrying at least a substantial portion of our self-pay burden in the District," said O'Leary. "I'm not saying we're perfect, but it's not bad."