Officials of Capitol Hill Hospital said yesterday that they have called in a two-man team from the American College of Emergency Physicians to survey and recommend improvements in the hospital's trouble-plagued emergency room.
The announcement came as Mayor Marion Barry said the city's Emergency Medical Services Advisory Committee is considering a recommendation that city ambulances no longer transport patients to the hospital's emergency room. In the last five months, three patients reportedly have died a short time after being discharged from the emergency room there.
Yesterday, a news report disclosed that a 52-year-old, critically ill pneumonia patient suffered cardiac arrest and became comatose minutes after being transferred out of Capitol Hill's emergency room to another hosptial. He died six weeks later without regaining consciousness.
Last month, a 28-year-old auto accident victim, Howard Smith, was reported to have died of massive internal injuries 55 minutes after being discharged as basically sound by Capitol Hill.
Last Saturday, the case came to light of a 75-year-old man pronounced "sound as a dollar" by Capitol Hill last Thanksgiving only to be admitted to D.C. General the following morning from acute dehydration and a Bowel obstruction. Eight days later he was dead of complications from gall bladder gangrene.
The deaths, and attention they have drawn to Capitol Hill, are causing local hospital administrators and medical personnel to question what is happening at Capitol Hill and how that hospital's troubles may affect the District's entire hospital community.
Capitol Hill Hospital is not a major teaching insitution with a medical staff engaged in research. Rather, it is a private, 250-bed, nonprofit institution whose executive director Ray V. Terry described in 1976 as a "meat and potatoes type hospital that delivers good, basic, health care."
At the time Terry made the commement, Capitol Hill was the object of a battle between Congress, which wanted to give its neighborhood hospital a special $4 million appropriation, and then President Ford, who was trying - successfully - to block what he viewed as a special interest grant
Ford's blocking of the appropriation came a month after the hospital changed its name to Capitol Hill as part of a program of renovation, expansion and image improvement.
The hospital, located at 700 Constitution Ave. NE, was previously called Rogers Memorial Hospital, and in an earlier incarnation was known as Casualty Hospital.
In each of the last five fiscal years, according to an auditor's report, the hospital treated a declining number of patients and operated at a substantial loss. Hospital officials estimated that this year they are losing about $70,000 a month.
Because of the hospital's financial situation, said Capitol Hill officials, they feel compelled to limit the free care they give and do so by transferring nonpaying patients to D.C. General Hospital, the city's public hospital.
James McCallum, assistant administrator of Capitol Hill, said in an interview Thursday that Benny Butler, the penumonia victim, "Wouldn't have" been transferred to D.C. General had he had Medicaid coverage, which pays on a cost-of-treatment basis.
Following the first news reports of Howard Smith's death and a published report that 30 percent of all transfers to D.C. General in a recent 13-month period came from Capitol Hill, Barry called an unusual meeting of the city's private hospital administrators.
At that meeting in his conference room, Barry told the hospital directors that the city woudl use its licensing power, and its power to grant and discontinue tax-free status, to ensure that all hospitals did their fair share to care for the poor. Poor patients, said Barry, should not be transferred around the city because they are poor.
But it is not simply the care of the poor that has drawn attention to Capitol Hill. Rather, it is the quality of care itself.
Every hospital has its horror stories, some of which make newspaper headlines and most of which remain items of gossip in physicians' lounges and nursing stations.
Rarely, however, do the stories come so quickly, one right after the other.
"The first reaction here was it can't be true," said one local hospital official. "But then came the second and then the third."
"I think that in any hospital there may be individual cases that aren't handled as well as one might desire or expect," said Dr. Stanford Roman, medical director of D.C. General, whose own hospital has come in for some harsh criticism over the years.
"From a statistical point of view, you can't say that if you find three cases that aren't handled as well as they could be that the whole program is no good," said Roman, cbut these three cases were very tragic."
Capitol Hill officials agree with Roman.
"We're talking about three cases out of about 9,000 cases" treated during the same time period, said Dr. Keith Manley, director of medical education at Capitol Hill.
"Three in four months is three too many," said Manley, "We can't say if we can keep deaths down to 10 percent that's okay.
"[But] I would sort of wager that most hospitals would, with certain invaluable sources [feeling stories to the press] and with the sort of public interest" being shown Capitol Hill, chave skeletons in the closet which would come to life . . ."
Capitol Hill has difficulty recruiting first-rate physicians for its emergency room, said Manley, because it has to compete with such teaching hospitals as Georgetown, George Washington and Howard. "There's no question they'll get first in the draft," he said.
Of the 16 physicians who work in Capitol Hills' emergency room, 13 are graduates of foreign medical schools.
According to D.C. General's Roman, having such a high proportion of foreign doctors - about half of D.C. General's emergency room physicians are foreign - can cause difficulties because "it's important in an emergency room setting to have people familiar with the language and cultural aspects of the patients that come in.
"It's an area of the hospital that has an intense emotional overlay," said Roman. "Certain innuendos, certain speech aspects, can be vital in assessing a medical problem."
". . . We pick lower in the draft than Georgetown," said Manley. "Man for man, you would find more qualified people in the bigger places.
"The irony, if you will, of this sudden rash of things that has come to light," he said, "is that we have been making some modest advances" despite finanical problems. Other doctors, however, say some basic principles are at stake at Capitol Hill.
"Emergency medicine isn't hockey," said one local physician. "In this game you either play in big leagues or you get out of the business."