Capitol Hill Hospital will be under continuing review by city health officials for the next 90 days to determine whether its emergency room shouls continue in operation.
The hospital was notified yesterday that its emergency room license has been reduced "to provisional status" as a result of a city investigation into the death of a man who died of internal injuries 55 minutes after he was discharged March 3 from Capitol Hill.
A letter sent to the hospital yesterday by Sarah B. Glindmeyer, chief of the division of licensing, certification and consultation services of the city's Department of Human Resources, asserted:
"It is the professional opinion of the [inspection] team that the emergency room staff made an error in discharging the patient. With the observations given, Bizarre behavior, restlessness and patient's complaint of plain, the patient should have remained in the emergency room wilth closer monitoring than the record indicated."
The patient, Howard B. Smith, pronounced dead at D.C. General Hospital, where District police took him after they were asked to remove him from Capitol Hill.
According to D.C. Chief Deputy Medical Examiner Dr. Brian Black-bourne, Smith had 10 rib fractures, a lacerated liver. a lcerated adrenal gland and about two quarts of blood in his abdomen, all injuries suffered in a car accident.
According to Pat McShea, chief of the city's hospital inspection service, members of her staff will make unannounced visits to Capitol Hill during the next 90 days to determine whether the hospital's misdiagnosis of Smith as having only three rib fractures is part of a pattern, or was an isolated incident.
The hospital is in no danger of losing its license to operate an emergency room if the Smith case was an isolated one, said McShea. However, if inspectors determine that a pattern exists, the hospital could lose its authority to operate an emergency room, she said.
Capitol Hill administrator, Ray V. Terry, said yesterday he considers the DRH findings "a reasonable assessment of the situation. They made a couple of recommendations, and one has already been implemented -- the taking of thr vital signs more often."
"Given what we know now about the Smith case, he would have been better off in a shock trauma unit," said Terry. "You may rest assured the emergency sevices department is going to be undergoing very careful review and reorganization as needed, and I hope you use the entire phrase, as needed," Terry added.
According to the medical records, Smith's vital signs were taken only twice during the four hours he was at Capitol Hill, and his blood count was taken only once.
According to McShea, the vital signs should have been taken every half hour, "or, if they were very busy, at least once an hour."
According to an expert in the treatment of trauma victims, the vital signs contained in Smith's medical record do not indicate he was in shock during the time he was in the hospital.
However, according to the record, Smith's white blood cell count was almost twice normal, a sign, said the expert, that "is suspicious and is consistent with someone who has abdominal trauma... When you have something like a reptured liver or spleen, you get a high white count."
The medical record also indicates that about three hours after entering the hospital, Smith began to demand water repeatedly, which is consistent with someone beginning to go into shock, said the expert, a surgeon.
The record also shows that Smith was "on stretcher on corridor yelling for pain medication "at 1 a.m. and was not given the medication until 1:55 a.m.
The records also indicate that Smith was acting in a bizarre fashion, repeatedly attempting to take off his trousers and yelling. This, say DHR officials, should have alerted hospital staff that something was amiss with Smith, who had been treated in the hospital previously and behaved in a more rational manner.