Two medical clinics run by Catholic Charities provided substandard care to poor immigrants in Maryland and the District, failing to promptly treat emergency cases, properly process and monitor critical lab tests, and reliably document serious errors, according to a lawsuit filed by a former clinic doctor.
The suit alleges that in one case a clinic in Silver Spring failed to adequately monitor a 32-year-old woman’s blood-thinning medication three years ago and that the oversight might have contributed to her death from internal bleeding.
The whistleblower lawsuit, filed Thursday in D.C. Superior Court, identifies the plaintiff, Charles Briggs, as the sole staff doctor at the clinic from March 2008 until Oct. 1, 2010, when he was fired.
Briggs, 66, says in the suit that he was fired in retaliation for raising concerns about patient care with supervisors who did little to address them. He was told by Catholic Charities that he “interfered with the smooth running of the Clinic,” the suit says. He wants his job back and $2 million in damages.
A spokesman for Catholic Charities strongly disputed the allegations in the lawsuit.
The clinics are part of the Spanish Catholic Center, which provides medical and social services in Maryland and the District to poor Latinos with no health insurance, many of whom speak little English.
The center operates under the umbrella of Catholic Charities of the Archdiocese of Washington. Its two medical clinics receive some federal, state and local government funds and private-sector grants, a Catholic Charities spokesman said. Last year, the Silver Spring and Northwest Washington medical clinics treated more than 5,000 patients, he said.
For those patients, “Catholic Charities was the place they trusted to go for quality health care,” said Alexis Ronickher, a lawyer with Katz, Marshall & Banks, which is representing Briggs. “. . .Instead of addressing the problems, Catholic Charities took the all too common approach of shooting the messenger.”
Marguerite Duane, medical director for the Spanish Catholic Center, said privacy concerns prevented her from discussing personnel issues or specific patients. The center’s mission is to provide the highest level of care to an underserved population, she said. Efforts to improve care are continuing, and medical care will get better when the Silver Spring clinic moves to a new facility in Wheaton on Monday, and when the Washington and Maryland clinics switch from paper charts to an electronic record system.
“Everything we do is about providing excellent care,” she said.
After reading an earlier, online version of this article, Catholic Charities spokesman Erik Salmi said in a statement Thursday: “While we have not been served with the complaint, we understand a lawsuit was filed today by a disgruntled former employee of the Spanish Catholic Center. We strongly dispute the information contained in the online edition of the Washington Post, and what we understand the allegations to be in the lawsuit. We will defend this matter vigorously.”
Salmi said the private, nonprofit Primary Care Coalition of Montgomery County closely monitors the Silver Spring clinic on behalf of the county’s health department. The clinic is among several clinics evaluated for their treatment of diabetes, hypertension and cancer screening.
On those measures, the Silver Spring clinic meets applicable standards, and the coalition is “happy with their performance,” said coalition spokeswoman Diane Briggs, who is no relation to the doctor. She said the coalition was not aware of the allegations in the lawsuit.
Briggs, who was in private practice for 33 years, was the only staff doctor at the Silver Spring clinic, the lawsuit says. The other staff members included one nurse practitioner and medical assistants; other doctors were volunteers. Briggs was temporary medical director of both clinics for nine months. Medical providers at the D.C. clinic told him that they had the same problems he identified at the Silver Spring clinic, the lawsuit says.
The lawsuit says medical care at the clinics did not meet the requisite standard. There was no policy or procedure, for example, for evaluating how sick “walk-in” patients were. In several cases, patients in critical condition were not seen by medical providers for hours, the lawsuit says.
In one incident, a walk-in patient, a 71-year-old man, arrived at the clinic Aug. 24, 2008, with symptoms of a “cardiac event,” and medical assistants failed to notify a medical provider or to direct him to an emergency room, according to the lawsuit.
In another case, in early 2010, the condition of a patient with cardiac-related symptoms deteriorated “so significantly” as she waited to see a doctor that “the Medical Assistants finally realized that immediate action was needed and called an ambulance,” the lawsuit says. At the next staff meeting, Briggs reiterated the need to establish a policy and procedure for triaging patients, but no corrective action was taken, the lawsuit said.
Duane said the 2008 case took place before she was hired, also in 2008. She said she could not recall the specifics of the 2010 case.
The clinics also lacked policies and procedures to govern processing and monitoring of lab tests and results, including Pap smears to detect cervical cancer and tests to monitor levels of blood-thinning medication, according to the lawsuit.
The outside laboratory that processed Pap smears repeatedly rejected specimens because slides were missing patient names or had improper paperwork, the lawsuit says.
The lawsuit also alleges that the clinic failed to properly supervise some patients who took blood thinners to prevent strokes and pulmonary embolisms. The degree to which clotting is being inhibited by those medications should be tested regularly to prevent excessive bleeding.
On several occasions, the clinic staff took too long to alert providers that patients had dangerously thin blood, the lawsuit says. In one case, there was a five-day delay. In other instances, Briggs found documents showing abnormal test results lying loose in the medical records room or in the reception area’s box for incoming mail.
The mishandled test results prompted Briggs to review the files of a woman on blood-thinning medication who had died, according to the lawsuit. He concluded that there had been “habitual poor Clinic follow-up” of lab tests “that may have resulted in the the patient having dangerously thin blood, a contributing cause of her death,” the lawsuit says.
The lawsuit says Briggs reported those and other problems to supervisors in e-mails, telephone calls and face-to-face meetings. He provided copies of the e-mails to The Washington Post.
In a Nov. 8, 2009, e-mail to the Rev. Mario Dorsonville, director of the Spanish Catholic Center, Briggs wrote that he had been pushing for implementation of policies and procedures for 14 months but that problems were not being addressed. The 32-year-old woman, he said, “died partially due to a failure of follow up of blood thinning medications.”
“Failure to address and correct clear deficiencies in patient care not only achieve the opposite effect of the mission of the Catholic Charities but also exposes the Catholic Charities and myself to medical liabilities,” he wrote.
After he complained to Duane about the lack of a written policy for handling lab results and offered to write one, she thanked him. “We still do need to have a written policy, so I appreciate your offer to help write them,” she wrote in a Nov. 12, 2009, e-mail.
Briggs eventually proposed a checklist of “red flag symptoms” that medical assistants could use to assess patients. That policy was not put in place until spring 2010, the lawsuit says.
A month before he was fired, Briggs said, he met with Dorsonville and another Catholic Charities executive to discuss the problems. Dorsonville cried and then asked that the parties “pray together about the problems,” the lawsuit says.