A federal judge who ruled four years ago that D.C. General Hospital's quality of care was "well below any acceptable level" was asked again yesterday to step in and immediately correct continuing alleged problems in health care there.
The attorneys who originally obtained the court order from U.S. District Judge Barrington D. Parker told the judge yesterday that the city was delaying its compliance with his earlier orders to upgrade care at the hospital.
Citing five specific areas of problems at the city-owned hospital which serves a large segment of the city's poor, the attorneys said a court order is again needed "to achieve the necessary improvements" there.
Parker ruled in 1975 that the Center for Law and Social Policy had presented in its suit "overwhelming and uncontroverted evidence" about the poor quality of care at the 700-bed hospital, which is operated by a quasi-public board. He ordered the city to take immediate action to fill 100 staff vacancies there, and said budgetary restrictions presented no acceptable excuse.
The suit presented at the time a novel legal theory that city hospitals must provide a level of medical care equal to that of comparably sized private hospitals in the same city.
Witnesses at the time told of ceilings collapsing in patient rooms, sloppy record-keeping about patients, doctors performing tasks that nurses should do, patients dying after the page system failed to work and the appropriate doctor could not be summoned, and malfunctioning heart machines that caused patients to suffer electric shocks.
Since then, the city has had to file monthly reports with the court about its attempts to meet Parker's order.
Margaret A. Kohn, an attorney with the Center for Law and Social Policy, termed the city's progress "slow and uneven." She said that the city had conceded as recently as May of this year that it was not yet fully complying with the 1975 order.
Since then, however, there have been numerous attempts to negotiate an end to the suit. Those negotiations have been unsuccessful, Kohn said in an affidavit filed in court yesterday.
The attorneys listed five areas of continuing concern at the hospital:
Medical records -- The attorneys said that only half of the patients' records can be retrieved when needed and that many records are not filed.
Nursing -- The attorneys again said that there are not enough nurses in certain areas, and want specific staffing quotas set. They also asked that the court monitor the hospital's attempts to hire and retain nurses.
Radiology -- Patients sent to the radiology unit are not returned to their rooms promptly, the attorneys said, and some have to wait an hour or more.
Emergency room -- The attorneys asked for specific time limits to be set on the length of time patients must wait for treatment. They also asked that patients be released within a specified time limit.
Pharmacy -- The attorneys said that "there is no excuse for further delays" in implementing a new drug control procedure at the hospital, and that new deadlines should be set within which to fill prescriptions.
At this point, the plaintiffs are not asking that the city or the corporation running the hospital be held in contempt of previous court orders. Instead, they are asking for new court orders to focus on the specific areas of their concern and eliminate other areas that are in compliance.
In asking for the order, Kohn said, "The time has clearly come when immediate action is warranted. In large part these problems have been reportedly identified, supposedly addressed, and yet still remain unresolved four years after the court directed the defendants to take action."
At the time of Parker's original order, the hospital was operated by the city's Department of Human Resources. Since that time, the hospital has been under the control of a quasi-public commission appointed by the mayor and city council.
Gilbert Hahn Jr., chairman of that commission, disputed the allegations and said that D.C. General has become a "first class facility" whose public reputation lags behind its present quality.
Although there was probably good reason for the original lawsuit, Hahn said, the Center "ought to step out now and let the commission, which has operated the hospital successfully, run it."
He asserted that the best judge of the hospital's quality is the national board of experts that has renewed the hospital's accreditation.