Ten hours after a 76-year-old Washington man was pronounced "sound as a silver dollar" and discharged from Capitol Hill Hospital last November, he was admitted to another hospital for acute dehydration and a possible bowel obstruction.
Eight days later he was dead - of complications caused by gangrene of the gall bladder and tissues supporting his small intestine.
The case of John Henry Hall is the second death to come to light in recent weeks following a questionable discharge from Capitol Hill Hospital emergency room.
Last week, city inspectors reduced the status of that emergency room's license to "provisional," and put the hospital on warning that they would be inspecting operations there periodically for the next 90 days.
The city made the move after publication of news stories about the death of Howard B. Smith, a 28-year-old security guard discharged from the Capitol Hill emergency room March 3 with a diagnosis of three rib fractures. He died 55 minutes later of severe internal injuries.
City health officials have warned that if the care accorded Smith appears to the part of a pattern, the hospital could lose its emergency room license.
After the Hall case was brought to their attention by The Washington Post, officials of Capitol Hill Hospital said yesterday, they would conduct an internal investigation of the incident.
Dr. J. R. Young, the hospital's senior attending surgeon said, the decision to discharge Hall was "borderline."
Hall, a retired liquor store clerk, was taken to Capitol Hill Hospital by ambulance last Thanksgiving complaining "the arthritis" was hurting him. He was discharged within an hour and 10 minutes.
Halls, daugher, Marion Barr, said the physician on duty in the emergency room told her as they left, "Mrs. Barr, except for his arthritis, your father is sound as a silver dollar for a man of his age."
There is no mention of possible dehydration in Hall's emergency room record at Capitol Hill Hospital, nor is there any indication that any tests were performed on his blood or urine.
The "after-care instructions given to the patient" bear the handwritten notation, "patient needs home care. Call Capitol Hill Hospital Med(ical) clinic if continues to have pain."
Ten hours later, when Marion Barr took her father to D.C. General, "this guy was severely emaciated, malnourished and acutely dehydrated", said D.C. General Medical Director Dr. Stanford Roman.
A blood test given Hall at the time of his admission to D.C. General's emergency room showed the lvel of urea nitrogen in his blood was nearly 10 times that of a peson with normally functioning kidneys.
"That means his kidneys were failing, either because of kidney disease or because of dehydration," said Roman, who said, "if you or I stopped drinking Any fluids) for four or five days, our (urea nitrogen) isn't going to go up like that."
Roman said he would "be concerned" if a man in Hall's condition came into D.C. General's emergency room and was not given at least a blood work-up and a rinalysis.
He did say, however, that he doubts the 10-hour delay in Hall's hospitalization would have made any difference in the final outcome.
Young, senior attending surgeon at Capitol Hill hospital and the hospital's chief of staff from 1939 to 1977, said yesterday there was nothing in Capitol Hill's record, or D.C. General's admission record, "to indicate the man was seriously ill' except the urea nitrogen level.
"Looks like this gentleman was beginning to get sick when he came in (to Capitol Hill) and then got progressively sicker," said Young. "They appear to have given him good observation and care," at D.C. General, he said, after reviewing portion's of Hall's records provided to Capiol Hill officials by a reporter.
"This isn't a diagnosis department," he said of Capitol Hill's emergency room.
"In the average emergency room people complain about how long it takes to get test results," he said, when asked why no blood or urine tests were done on Hall at Capitol Hill.
Asked if Hall could have looked "sound" 10 hours prior to his admission to D.C. General, Young said, "I agree it doesn't sound right. . . but it can happen. . ." He said he thought Hall's case was handled at Capitol Hill "the way it would have been handled in any emergency room."
The decision not to admit Hall "is borderline, and that's as far as I go," said Young.
According to D.C. General's Roman, Hall's dehydration was so severe it had caused apparent changes in the tissue immediately beneath his skin. It is not possible, said Roman, that such acute dehydration could have occured in a 10-hour period.
Maion Barr said she called the ambulance tha took her father to the hospital after he told her he felt too ill to attend Thanksgiving dinnerat her home. Physicians at D.C. General later learned that Hall had not eaten in four days prior to his admission.
Barr said that when her father was brought out of the treatment area of Capitol Hill's emergency room, "his hat was still on his head, his coat was still buttoned up and his shoes were tied. He couldn't have done that," she said, adding that she believes her father was never even undressed during his examination.
Capitol Hill Hospital officials said Hall was properly examined.
"There's no way in the world my father could have gotten that sick in 24 hours," said Barr. "Where's the blood work? Where's the lab work? I can see it if they had done blood work or a urinalysis.
"Had I taken him home as they instructed, and left him at home as they instructed," Hall said, "he wouldn't have lasted 24 hours."