The administrator of Capitol Hill Hospital said yesterday that he is "gravely distressed" by the death of a man 55 minutes after the man was ordered to leave the hospital's emergency room. But the administrator, Ray V. Terry, defended the treatment given the man by his hospital's staff.
"All of us are distressed," Terry said of the death earlier this month of Howard B. Smith, a 28-year-old security guard.
"A man died and we don't know why," said Terry, who broke a weeklong silence by hospital officials.
The hospital's version of the Smith case, as related by Terry, differs in several ways from that of the police. According to the hospital version, Smith was taken to Capitol Hill Hospital in a D.C. fire department ambulance at about 11 p.m. on March 2 after an accident in which Smith was the driver of an auto that was struck by another auto.
Hospital officials say Smith was treated and then discharged -- "not thrown out," in Terry's words. According to the hospital, Smith was in good enough shape to walk out under his own power and carrying two shopping bags.
Police investigators say officers were called to the hospital about three hours after Smith was brought there and that the officers were asked to evict Smith. According to the police, Smith did not want to leave and was in obvious pain.
Police say that two officers took Smith to his home, where he collapsed going up the walk. When an ambulance failed to respond promptly, the officers took Smith to D.C. General Hospital, where he was dead on arrival.
In an interview yesterday, Dr. Brian Blackbourne, the District of Columbia's chief deputy medical examiner, said, "I can say categorically the injuries [Smith] sustained, were sustained in the automobile accident." A nationally known expert on trauma inflicted by automobile accidents, Blackbourne said that he compared Smith's injuries to the damage done to Smith's car and the two match perfectly.
According to Blackbourne, Smith suffered from 10 rib fractures, a lacerated liver, and a lacerated adrenal gland, and about one-third of his blood supply had bled into his abdominal cavity.
The Smith case and disclosures that 30 percent of the 713 patients transferred to D.C. General Hospital last year came from Capitol Hill, have prompted investigations by a congressional Barry, a local hospital association and the city's health planning agency.
Hospital administrator Terry, defending his staff, said that Smith's "vital signs were all taken. They were all normal. His blood pressure was 130 over 80. His skin was dry."
Terry said: "There's 55 minutes of that man's life that is unaccounted for. He left in the company of two policemen. We asked the police to remove him from the emergency department because he was creating such problems with his conduct."
Experts in trauma say that a person of Smith's age could maintain such a blood pressure despite several hours of slow internal bleeding. They say that the two key bits of evidence in such a case would be the patient's pulse rate and his "hematocrit" level -- the percentage of red cells in his blood. The hospital has not made that data public.
According to Terry, hospital staff members "had some difficulty trying to get [Smith] ready to leave. One of the policemen went into the room and closed the door. When he came back out he was heard to say, 'he won't give us any problem now.'"
Smith then "walked out carrying two shopping bags," Terry said. "The personnel say he slammed the door. The police escorted him or took him to his home. We have no idea what happened to that man after he slammed the door. Absolutely none."
According to medical examiner Blackbourne, Smith did not suffer any injuries at the hospital or after leaving the hospital. He had only one "very subtle bruise" on his body, and that bruise, on the right chest, was caused by the auto accident, Blackbourne said. "He could not have sustained that kind of injury falling," he said. "He was not beaten."