When D.C. police officers arrived at Capitol Hill Hospital at 3 a.m. on March 3, they were told that Howard B. Smith, 28, had been treated for three broken ribs and refused to leave the hospital. Smith, injured in a car accident almost five hours earlier, complained to police that he hurt all over.

Emergency room personnel said Smith would have to leave, so the police gave him a ride to his Southeast Washington home, where he collapsed as he walked up the front path. The police then put Smith in a patrol wagon and took him to D.C. General Hospital.

"Don't bother to stop here," they were told by the physician who met them at the door. "This guy's already dead."

According to Dr. Brian Blackbourne, the District's deputy medical examiner, Smith had 10 rib fractures, a lacerated liver, a lacerated adrenal gland and had bled about one-third of all his blood into his abdomen.

"In my experience it's a unique case where someone is treated in an (emergency medical) care facility and is released to die subsequently of a more serious injury," said Blackbourne who performed the autopsy on Smith.

According to Blackbourne, "He made complaints that he was still sick, and you have to listen to the patient. The patient usually knows what's going on. That's an old medical dictum: Listen to the patient. He was saying he was still hurting, and they thought he only had three rib fractures and didn't see the need to keep him in."

Capitol Hill Hospital officials refused to comment on the Smith case, other than to say Smith was treated in the hospital.

Trauma experts at two other Washington hospitals say it is standard procedure to test a patient like Smith for signs of internal bleeding. Rib fractures and continued complaints of general pain following a car accident, they said, indicate that such a test is necessary. It could not be learned what treatment Smith received at Capitol Hill Hospital.