When James E. Grace, 29, sought help at Providence Hospital after he had been stabbed in the chest, he was sent home after 3 hours and 45 minutes in the emergency room with a prescription for an antibiotic and instructions to see a private doctor later, according to a $1.7 million lawsuit filed against the hospital.
Grace died of his stab wound three days after he initally sought treatment. His mother, Betty Grace, claims in her court complaint that the hospital and its staff delayed treating and admitting her son because he did not have the ability to pay for his care. A hospital official and its attorney deny that Grace's financial status influenced the way he was treated, which they defended.
Grace, an unemployed carpetlayer, went to Providence Hospital's emergency room on July 29 and told staff members there he had been stabbed in the chest, according to the complaint filed in D.C. Superior Court on behalf of Grace's estate and his next of kin. The complaint contends that he returned to the hospital 50 hours after he was sent home because of difficulty breathing and chest pains. He was given a second X-ray and electrocardiogram and admitted to the hospital. Eight and a half hours later, his condition worsening, a city ambulance was summoned to transfer him to Washington Hospital Center, the complaint states. Shortly after arrival, he suffered cardiac arrest and underwent emergency surgery.
He died seven hours later.
The lawsuit alleges that the Providence Hospital staff determined that part of the knife blade remained in his chest. Surgery was not performed until Grace was transferred to the Washington Hospital Center where surgeons removed a half-inch fragment of a blade from his chest, the complaint asserts.
The lawsuit reaches further than a usual malpractice suit by charging that the hospital failed to provide medical services because the patient lacked health insurance. The issue of access to health care by indigent patients has assumed new importance at hospitals locally, and across the country, as the number of uninsured patients continues to increase. Providence, like most hospitals in the District, provides a greater amount of free care than it is obligated to under either federal or city regulations.
The complaint also claims that the hospital staff did not tell Grace the seriousness of his condition so that he could seek treatment elsewhere. The lawsuit claims that the hospital did not tell Grace that its emergency services were "inadequate and deficient and that its attending surgical staff was not adequately organized and maintained in order to provide necessary therapeutic services to trauma patients . . . ."
James A. Welch, an attorney for Providence Hospital, said the hospital does not agree with the charges and said there were no delays in Grace's treatment. "When his condition reached a certain point, they felt he had to be transferred," Welch said.
Dr. Dennis Hannon, director of Primary Care Physicians, a Hyattsville corporation that is hired by Providence to staff its emergency room, said Grace's lack of insurance had no bearing on his treatment.
"The insurance-payer status had nothing to do with it," said Hannon. "It was a medical decision that resulted in the patient not being admitted initially. We see hundreds and hundreds and hundreds of patients without insurance . . . ."
In addition to the hospital, the lawsuit names Dr. Alberto Nunez, a chest surgeon and member of the hospital's attending staff who was called in to see the patient during Grace's second visit to the hospital. The complaint asserts that Nunez was aware of Grace's condition, but "failed and refused" to take care of him.
Nunez said the lawsuit is "completely without foundation, 100 percent. The way it's written in the lawsuit looks very different than what happened." He declined to elaborate, but added, "There were several other physicians. I was only a consultant."
His attorney, Brian Shevlin, said "Dr. Nunez was called in in the afternoon. The patient was stable. Dr. Nunez looked at him later on when the patient deteriorated." Shevlin said Nunez decided to perform surgery, but "there was not the instrumentation necessary to crack the chest." So, a decision was made to transfer the patient, Shevlin said.
Hannon did not comment on Shevlin's statement that the hospital lacked certain equipment.
According to Grace's medical records, on July 29 he spent nearly four hours in Providence's emergency room for treatment of the knife wound before being sent home at 6:45 a.m. with a diagnosis of pneumonia. He was given a prescription for an antibiotic and instructions to call a private internist for an office visit.
"They were waiting for someone to drive in and read the X-ray," the patient's mother said she was told by hospital staff about the wait. "I told the doctor and he told the doctor he was stabbed," said Mrs. Grace, who said that her son changed his bloodied shirt before going to the hospital. "She the doctor told me he had a touch of pneumonia . . . . She assured me it was just a flesh wound." Mrs. Grace said she repeatedly showed doctors where her son had been stabbed.
Dr. Hannon agreed with the allegation in the court complaint that part of the knife remained in Grace's chest. "It was, but believe it or not, the treatment was justified by extenuating circumstances."
He noted that "the patient himself diminished the fact of the stab wound. It's almost as if he denied it. And he had pneumonia."
"It seems on the surface to be very cut and dried in retrospect," Hannon said, "but prospectively, it wasn't." He added, "It looks horrible. It's not as horrible as it looks."
Mrs. Grace and her niece supported Grace as he walked out of the emergency room. He spent the next day and a half at his mother's house and his apartment. "I waited for the drug store to open, but the pills didn't help," she said. Grace continued to have severe chest pains. "My sister made him a pot of vegetable soup," Grace said, and her niece reported that he could not lie down without pain.
She said that early the following morning, Grace began sweating profusely and gasping for breath. He telephoned his mother for help. She and her niece dressed him and drove him back to Providence, the closest hospital to his mother's home in Northeast Washington.
According to the court complaint, he entered the emergency room about 9 a.m. on July 31, again was X-rayed and was given another electrocardiogram. By about noon, he was admitted to the intensive care unit, according to his medical records.
"He was just sweating compulsively," said his mother. "Finally at 7 p.m. they paged me because his temperature was dropping. They just had him laying in the room monitoring him."
A city rescue squad was summoned and almost 12 hours after he arrived at Providence a second time, he was transferred to the Washington Hospital Center, according to the court complaint.
Doctors at the second hospital operated on Grace and removed part of the knife blade, stuck in his sternum, according to the complaint.
The immediate cause of Grace's death was "stab wound of chest," according to his death certificate. D.C. police have classified the death a homicide and are investigating who stabbed him during a card game.
"It's inexcusable that Providence failed to admit Mr. Grace on Sunday and when he returned Tuesday, the hospital failed to remove the metal substance," said Edward Greensfelder Jr., the lawyer handling the lawsuit for Grace's mother.
The complaint contends that Grace's death was caused by what it alleged was a policy by Providence Hospital of not admitting or providing treatment to patients if they are unable to demonstrate that they can pay. Welsh, the hospital's attorney, said there is "absolutely no policy" of denying services to the indigent.
Grace's medical records at Providence include the typed notation "self-pay," which had been circled by hospital personnel.
Hannon said hospital staff circles the typed notation "self-pay" when a patient says he has insurance, but that he doesn't have an identification card or memory of the policy number. The hospital then contacts the patient later for a policy number. When a patient has no insurance, the hospital staff types the notation "self-pay" but does not circle it, Hannon said.
Grace's mother said her son had not had health insurance since 1971, when he worked as a maintenance man at the National Institutes of Health. "I told them he don't have any insurance," she said. "I told them I just called my sister and she would try to bring in some money. She [the admitting clerk] asked me how much, that they would have to have something on it. She went back and asked a supervisor what to do about it."
Hannon said Grace "apparently told us that he did have insurance . That's why it's circled. In 12 to 15 percent of the cases, the information we get is erroneous."
Mrs. Grace said of her only child, "I believe if he had insurance he wouldn't be dead now." Mrs. Grace's husband died in 1967. She has one grandchild, James' 3-year-old son Chris who lives with his mother. CAPTION: Picture 1, Betty Grace, in her $1.7 million lawsuit, claims that Providence Hospital delayed admitting and treating her son James for a stab wound because he couldn't pay. By Dudley M. Moore -- The Washington Post; Picture 2, James E. Grace and his son, Chris, in a family photograph.