Howard: A hos­pi­tal’s tur­moil

Wrong­ful-death cases, long ER waits and vi­o­la­tions show de­cline

The Washington Post Sunday - - FRONT PAGE - BY CHERYL W. THOMP­SON

When Howard Uni­ver­sity Hos­pi­tal opened its doors as Freed­men’s in North­west D.C. in 1862, it stood out for the med­i­cal care it of­fered freed slaves and be­came an in­cu­ba­tor for some of the coun­try’s bright­est African Amer­i­can physi­cians.

But over the past decade, the once-grand hos­pi­tal that was the go-to place for the city’s mid­dle-class black pa­tients has been be­set by fi­nan­cial trou­bles, empty beds and an ex­o­dus of re­spected physi­cians and ad­min­is­tra­tors, many of whom said they are fed up with the way it is run. The fa­cil­ity has faced lay­offs, ac­cred­i­ta­tion is­sues, and sex­ual ha­rass­ment and dis­crim­i­na­tion law­suits, and it has paid out at least $27 mil­lion in mal­prac­tice or wrong­ful-death set­tle­ments since 2007, a Wash­ing­ton Post ex­am­i­na­tion has found.

The Post re­viewed more than 675 med­i­cal mal­prac­tice and wrong­ful-death law­suits filed since 2006 in­volv­ing six D.C. hos­pi­tals:

Howard Uni­ver­sity, Ge­orge Wash­ing­ton Uni­ver­sity, MedS­tar Ge­orge­town Uni­ver­sity, Prov­i­dence and Si­b­ley Me­mo­rial hos­pi­tals and MedS­tar Wash­ing­ton Hos­pi­tal Cen­ter. Of that group, Howard had the high­est rate of death law­suits per bed.

The $27 mil­lion paid out by Howard rep­re­sents just 22 of the 82 cases filed against the hos­pi­tal and tracked by The Post; the terms of most of the set­tle­ments were not made pub­lic.

The Post also found that Howard Uni­ver­sity Hos­pi­tal has fre­quently been cited by the Dis­trict for vi­o­lat­ing the hos­pi­tal’s own poli­cies, as well as lo­cal and fed­eral laws. City health reg­u­la­tors have doc­u­mented dozens of prob­lems, in­clud­ing lit­tle over­sight of med­i­cal res­i­dents, in­op­er­a­ble emer­gency room equip­ment, sloppy record-keep­ing and a lax nurs­ing staff.

“Howard has had a lot of in­sta­bil­ity in lead­er­ship, par­tic­u­larly at the hos­pi­tal, which has made it dif­fi­cult to have a sus­tain­able strat­egy,” said Chile­dum Ahaghotu, the hos­pi­tal’s for­mer chief of urol­ogy and a Howard alum­nus who re­signed in 2015. He now is vice pres­i­dent of med­i­cal af­fairs at MedS­tar South­ern Mary­land Hos­pi­tal Cen­ter. “Ac­count­abil­ity is an is­sue.”

It is very dif­fi­cult to com­pare one hos­pi­tal to an­other or even rate in­di­vid­ual fa­cil­i­ties be­cause there are few re­quire­ments for hos­pi­tals to re­port their data to gov­ern­ment agen­cies. But the law­suits, other pub­licly avail­able doc­u­ments and more than three dozen in­ter­views with pa­tients, doc­tors, nurses, ad­min­is­tra­tors and oth­ers show a hos­pi­tal that is strug­gling.

Howard of­fi­cials hired Cal­i­for­nia-based Pal­adin Health­care in Oc­to­ber 2014 to over­see its dayto-day man­age­ment and try to turn things around. The hos­pi­tal posted a $58 mil­lion loss in fis­cal 2014; the loss was $19 mil­lion in 2015, ac­cord­ing to fig­ures pro­vided by the uni­ver­sity.

Michael Rem­bis, the chief ex­ec­u­tive of­fi­cer of Pal­adin Health­care Man­age­ment, did not re­turn three calls seek­ing com­ment.

“It’s go­ing through a chal­leng­ing time right now, and I think they’re try­ing to fig­ure out the next step,” said Orit­set­se­maye Otubu, a fam­ily medicine physi­cian who left the hos­pi­tal in June after five years “to pur­sue other in­ter­ests.” She said her pa­tients of­ten com­plained about not be­ing able to make ap­point­ments be­cause no one an­swered the hos­pi­tal phones.

Howard Uni­ver­sity Pres­i­dent Wayne A.I. Fred­er­ick, a physi­cian who also over­sees the hos­pi­tal, said at a news brief­ing in the fall that the med­i­cal fa­cil­ity has made “sig­nif­i­cant strides in achiev­ing our fi­nan­cial and op­er­a­tional sta­bil­ity.” Of­fi­cials an­nounced that the hos­pi­tal had a $4.3 mil­lion sur­plus at the end of June, the first time since 2012.

“We rec­og­nize we have a lot more to do,” Fred­er­ick said.

The sur­plus came a month after of­fi­cials an­nounced they were re­duc­ing the hos­pi­tal’s work­force by 110 em­ploy­ees. Hos­pi­tal of­fi­cials now say the sur­plus is $21 mil­lion, even though op­er­at­ing rev­enue has re­mained about the same.

Fred­er­ick has raised the idea of sell­ing the hos­pi­tal, which has been a fi­nan­cial drain on the uni­ver­sity, and said at the brief­ing that Pal­adin Health­care could be “a po­ten­tial owner.”

Fred­er­ick de­clined six in­ter­view re­quests from The Post, which then emailed him a se­ries of spe­cific ques­tions about its find­ings. He de­clined to an­swer those ques­tions and in­stead re­leased fi­nan­cial data and a state­ment on the hos­pi­tal’s back­ground, not­ing its “com­mit­ment to high stan­dards and qual­ity pa­tient care.”

For­mer Howard Uni­ver­sity pres­i­dent H. Patrick Swygert said the hos­pi­tal con­tin­ues to be an im­por­tant part­ner for the med­i­cal school and D.C. res­i­dents.

“It’s been a ma­jor re­source for the com­mu­nity for a very long time,” said Swygert, who headed the in­sti­tu­tion from 1995 to 2008. He de­clined to dis­cuss the cur­rent sta­tus of the hos­pi­tal, say­ing he’s “been away too long.”

‘A bro­ken sys­tem’

Robert L. DeWitty Jr. al­ways thought he would re­tire from Howard Uni­ver­sity Hos­pi­tal. The cancer sur­geon’s re­la­tion­ship with the hos­pi­tal be­gan in 1968 when he ar­rived as a med­i­cal stu­dent. He re­mained there through his sur­gi­cal res­i­dency and was on staff for more than 30 years un­til Au­gust 2015, when he sev­ered his ties, cit­ing “an un­healthy en­vi­ron­ment.”

DeWitty said the prob­lems start “at the high­est level of man­age­ment.” “I de­cided in­stead of spend­ing the rest of my days be­ing in an en­vi­ron­ment that was un­healthy, I would leave and go to an­other hos­pi­tal.”

DeWitty, who now prac­tices at Prov­i­dence Hos­pi­tal in North­east Wash­ing­ton, said Howard has been on a rapid de­cline for years, prompted in part by the 2001 shut­ter­ing of the city’s only pub­lic hos­pi­tal, D.C. Gen­eral.

“When it closed, we be­came the city hos­pi­tal — un­of­fi­cially,” he said. “Pa­tients have to go some­where, and they may be dis­cour­aged from show­ing up at cer­tain places.”

DeWitty de­scribed Howard Uni­ver­sity Hos­pi­tal as the “sec­ond D.C. Gen­eral” be­cause it be­came the place where many of the city’s poor­est res­i­dents would go for health care, which con­trib­uted to the hos­pi­tal’s fi­nan­cial trou­bles.

“I think it prob­a­bly did play a role,” DeWitty said. “It was a com­bi­na­tion of things that made us more fi­nan­cially strapped than I think we should have been.”

The hos­pi­tal also is poorly run, with staff of­ten tak­ing a year or more to bill pa­tients, he said. Fred­er­ick ac­knowl­edged at the fall news con­fer­ence that billing has been an is­sue, and hos­pi­tal of­fi­cials at­trib­uted the hos­pi­tal’s fi­nan­cial dif­fi­cul­ties in part to a de­cline in in­pa­tient ad­mis­sions.

The teach­ing hos­pi­tal has strug­gled re­peat­edly to main­tain sev­eral of its res­i­dency pro­grams. The Chicago-based Ac­cred­i­ta­tion Coun­cil for Grad­u­ate Med­i­cal Ed­u­ca­tion has with­drawn the ac­cred­i­ta­tion of res­i­dency pro­grams at Howard more of­ten than at any other D.C. hos­pi­tal in the last 15 years, records show.

Howard has lost ac­cred­i­ta­tion for five train­ing pro­grams since 2002, the coun­cil’s data­base shows. Ge­orge Wash­ing­ton Hos­pi­tal, MedS­tar Ge­orge­town and MedS­tar Wash­ing­ton Hos­pi­tal Cen­ter have lost ac­cred­i­ta­tion for one pro­gram in the same time pe­riod.

The Howard pro­grams that have lost ac­cred­i­ta­tion are emer­gency medicine, pe­di­atrics, urol­ogy, ra­di­a­tion on­col­ogy and di­ag­nos­tic ra­di­ol­ogy. None of the five pro­grams have been reac­cred­ited, ac­cord­ing to records. The ACGME with­drawals typ­i­cally oc­cur after re­peated warn­ings, ac­cord­ing to Emily Vasil­iou, a spokes­woman for the ac­cred­i­ta­tion coun­cil.

“We’ve lost a lot of pro­grams,” DeWitty said. “And a lot of schol­ar­ships, too, be­cause of that.”

Vasil­iou said hos­pi­tals can­not use pub­lic money to em­ploy res­i­dents from pro­grams that aren’t ac­cred­ited.

Jul­lette M. Saussy, the for­mer med­i­cal di­rec­tor of D.C.’s Fire and Emer­gency Med­i­cal Ser­vices Depart­ment, said the hos­pi­tal’s prob­lems are wide­spread, from empty beds to a trou­bled emer­gency room.

“I know they’re hav­ing a hell of a time in the ER and hav­ing a hell of a time staffing it,” said Saussy, who re­signed from her D.C. po­si­tion in Fe­bru­ary 2016. “It’s bro­ken sys­tem at Howard.”

Wayne Moore, an­other for­mer med­i­cal di­rec­tor of D.C. Fire and EMS, said he con­sid­ered the hos­pi­tal a “dump­ing ground” dur­ing his ten­ure.

“Cer­tainly for the drunks and home­less and the un­de­sir­ables,” said Moore, who also worked in Howard Uni­ver­sity Hos­pi­tal’s emer­gency room be­fore leav­ing in 1999.

Moore said the fa­cil­ity has a his­tory of “bad care and long waits in the emer­gency room,” and it wasn’t un­usual for pa­tients to be left in the hall­ways or on gur­neys.

David Rosen­baum was one of a them.

Rosen­baum ar­rived as a John Doe at Howard’s emer­gency room in Jan­uary 2006 after be­ing found on the street with­out iden­ti­fi­ca­tion. A para­medic told a nurse he was drunk. Hos­pi­tal work­ers failed to per­form ba­sic as­sess­ments that could have in­di­cated the se­ri­ous­ness of his in­juries, ac­cord­ing to a D.C. in­spec­tor gen­eral’s re­port. He lay on a gur­ney for sev­eral hours be­fore any­one took him to the op­er­at­ing room, records show. He died less than 48 hours after ar­riv­ing at the emer­gency room.

Rosen­baum was a long­time New York Times re­porter who had been mugged while tak­ing an after-din­ner stroll in his Friend­ship Heights neigh­bor­hood. His death sparked na­tional out­rage and sul­lied the hos­pi­tal’s rep­u­ta­tion. His fam­ily sued the city and the hos­pi­tal, de­mand­ing that of­fi­cials take steps to en­sure noth­ing like that hap­pened again.

The in­ci­dent was sup­posed to be a turn­ing point for the city’s emer­gency med­i­cal ser­vices and for Howard Uni­ver­sity Hos­pi­tal. But at least for the hos­pi­tal, it wasn’t.

Law­suits over care

Solomon J. Oko­roh was known at Clas­sic Cab Com­pany in D.C. for pick­ing up ev­ery fare. He needed the money to help pro­vide for his wife and their five chil­dren, one of whom was a stu­dent at Howard Uni­ver­sity and played on its bas­ket­ball team.

Shortly be­fore 3 a.m. on June 4, 2013, Oko­roh picked up two young men in Adams Mor­gan in North­west Wash­ing­ton. Min­utes after climb­ing into Oko­roh’s taxi, one of them shot him in a botched rob­bery. Three un­der­cover D.C. po­lice of­fi­cers heard a gun­shot and a revving car en­gine. Then, Oko­roh’s Ford Ex­plorer taxi whizzed by and shots were fired in­side the SUV again be­fore it crashed.

Both sus­pects fled; paramedics found Oko­roh bleed­ing heav­ily from his shoul­der, court records show. They took him to Howard Uni­ver­sity Hos­pi­tal for treat­ment.

Oko­roh lay unat­tended on a gur­ney for 70 min­utes be­cause there was no bed avail­able, and nurses were un­able to take his blood pres­sure be­cause of a “ma­chine mal­func­tion,” his fam­ily al­leged in a law­suit filed in 2015. When Oko­roh was moved to a bed, his neck was “ex­tremely swollen” and he was “twist­ing and turn­ing,” ac­cord­ing to the law­suit. It was only after Oko­roh was un­able to breathe that the med­i­cal team re­al­ized he had been shot twice. Oko­roh, 59, died within min­utes.

His wife, Pa­tience, de­scribed what hap­pened to her hus­band as “hor­ri­ble.” The law­suit was dis­missed in De­cem­ber after she de­cided that the mat­ter was “go­ing on too long,” ac­cord­ing to her at­tor­ney, C. Jude Iweanoge.

“It was putting too much pres­sure on her and her fam­ily,” Iweanoge said. “She didn’t want her chil­dren to re­live this.”

Oko­roh said drop­ping the law­suit gave her “a lit­tle peace.”

Fred­er­ick de­clined to com­ment, but the hos­pi­tal re­leased a state­ment say­ing that “Howard Uni­ver­sity does not dis­cuss spe­cific is­sues re­gard­ing in­di­vid­u­als who re­ceive health care ser­vices at Howard Uni­ver­sity Hos­pi­tal.”

D.C. taxi driver Mo­hammed Nur was used to mak­ing runs to pick up fares from Howard Uni­ver­sity Hos­pi­tal.

But this swel­ter­ing July 2012 evening was dif­fer­ent.

When Nur pulled up in front of the hos­pi­tal at 7:45, Pa­tri­cia Moore was wait­ing in a wheel­chair, ac­com­pa­nied by a hos­pi­tal staffer. The 61-year-old Moore, who suf­fered from asthma and

“I thought it had high stan­dards. I was so, so sur­prised. You al­ways feel like peo­ple are in good hands at a hos­pi­tal.” Kath­leen Moore, whose sis­ter was sent home by taxi, with­out shoes and clad only in a hos­pi­tal gown, after be­ing di­ag­nosed with fluid around the heart. She col­lapsed and died the next day at the hos­pi­tal.

other ail­ments, had come to the emer­gency room four days be­fore com­plain­ing of short­ness of breath. Doc­tors di­ag­nosed her with fluid around the heart, records show.

“I said, ‘What’s go­ing on?’ ” Nur re­called in an in­ter­view. “She was alert but very, very weak. I don’t know why they re­leased her.”

Moore, un­able to walk unas­sisted, was helped into the cab for the 10-minute ride home to Wah Luck House, an as­sisted-liv­ing hous­ing com­plex in nearby Chi­na­town. Lasan Bald­win, a home health aide who worked for other ten­ants in the build­ing, said a hos­pi­tal so­cial worker called her, say­ing they needed some­one to be there when Moore came home.

“I don’t know why they called me,” Bald­win said in an in­ter­view. “She has fam­ily.”

Bald­win said she was stunned when she saw Moore, the mother of one grown son.

“She didn’t have no shoes on and she was in a hos­pi­tal gown — her whole butt was out,” Bald­win re­called in an in­ter­view. “I told the cab­driver, ‘They sent her home like this?’ ”

Nur said he had never seen any­thing like it in his 20 years of driv­ing a cab.

“It was sad,” he said. “I told the aide to take care of her.”

Bald­win said she sat Moore in a chair in the lobby and went to her ninth-floor apart­ment to re­trieve her in­haler and walker. She re­turned min­utes later to find Moore slumped in the chair.

Bald­win called 911, and paramedics took Moore back to Howard, where she died the next day.

“Ev­ery time I think about what hap­pened to Miss Pa­tri­cia, I want to cry,” Bald­win said, adding that she used to bring McDon­ald’s ham­burg­ers to Moore and a friend, a Catholic nun, who of­ten vis­ited her.

Moore’s son sued Howard Uni­ver­sity Hos­pi­tal, which set­tled the case in 2015 for an undis­closed amount. Hos­pi­tal of­fi­cials de­clined to dis­cuss the mat­ter.

Moore’s younger sis­ter, Kath­leen, said she was ap­palled to learn that the hos­pi­tal sent her home alone, un­able to walk, still ail­ing and scant­ily clad.

“For the sake of hu­man de­cency, why any­body al­lowed that to hap­pen is mind-bog­gling,” Kath­leen Moore said. “It was just aw­ful.”

Moore said she re­grets al­low­ing her sis­ter to go to Howard.

“When I heard she was taken there, I thought it had high stan­dards,” Moore said. “I was so, so sur­prised. You al­ways feel like peo­ple are in good hands at a hos­pi­tal.”

As­sess­ments are tricky

Mea­sur­ing a hos­pi­tal is com­plex be­cause there are few pub­lic met­rics, ac­cord­ing to health pol­icy and pa­tient safety ex­perts.

“It’s very dif­fi­cult to come up with com­pre­hen­sive mea­sures of qual­ity,” said Martin Makary, a sur­geon who teaches health pol­icy at the Johns Hop­kins Bloomberg School of Pub­lic Health. “That’s what ev­ery­one wants, but we have to do it care­fully. We don’t want to pun­ish doc­tors who take on high-risk qual­ity.”

Some pa­tients con­sider be­ing sat­is­fied with their doc­tor a good met­ric, Makary said. But it’s not, be­cause “it doesn’t tell you if the doc­tor pre­scribes too much medicine or whether they have a lot of ex­pe­ri­ence,” he said.

Hos­pi­tal in­fec­tion and read­mis­sion rates also may be good mea­sures of qual­ity, but they are not com­pre­hen­sive, Makary said.

Te­jal Gandhi, a physi­cian and chief ex­ec­u­tive of­fi­cer of the Na­tional Pa­tient Safety Foun­da­tion, agreed that it is dif­fi­cult — but not im­pos­si­ble — for the pub­lic to find data to mea­sure a hos­pi­tal’s qual­ity.

“It’s not that we don’t want to have good met­rics,” said Gandhi, an as­so­ciate pro­fes­sor at Har­vard Med­i­cal School. “It is chal­leng­ing and la­bor-in­ten­sive to have good, ro­bust met­rics.”

The fed­eral gov­ern­ment rates a va­ri­ety of as­pects in health care, in­clud­ing read­mis­sion and death rates, and time­li­ness and ef­fec­tive­ness of care. Data from the Cen­ters for Medi­care and Med­i­caid Ser­vices, which com­pares hos­pi­tals across the coun­try, found that Howard Uni­ver­sity Hos­pi­tal per­formed worse than other hos­pi­tals in some key cat­e­gories.

For in­stance, the av­er­age wait time for a pa­tient vis­it­ing Howard’s emer­gency depart­ment be­fore be­ing seen by a health-care pro­fes­sional was 113 min­utes, com­pared with 27 min­utes na­tion­ally and 79 min­utes at other high-vol­ume D.C. hos­pi­tals that serve roughly 40,000 to 60,000 pa­tients per year, ac­cord­ing to data re­leased in De­cem­ber, the most re­cent avail­able.

While Howard Uni­ver­sity Hos­pi­tal was worse than the na­tional av­er­age for the amount of time pa­tients stayed in the emer­gency room be­fore be­ing ad­mit­ted — 415 min­utes, com­pared with 295 min­utes na­tion­ally — it fared bet­ter than other high-vol­ume Dis­trict hos­pi­tals, which av­er­aged 464 min­utes, the data showed.

The av­er­age time that pa­tients who came to Howard Uni­ver­sity Hos­pi­tal’s emer­gency depart­ment with bro­ken bones waited be­fore be­ing ad­min­is­tered pain med­i­ca­tion was 101 min­utes, nearly 40 min­utes longer than other D.C. hos­pi­tals. Na­tion­ally, pa­tients waited 52 min­utes.

The fed­eral gov­ern­ment in 2015 be­gan award­ing star rat­ings based on pa­tient ap­praisals. The rat­ings are based on pa­tient ex­pe­ri­ences with med­i­cal pro­fes­sion­als, in­clud­ing com­mu­ni­ca­tion and whether they would rec­om­mend a hos­pi­tal. Ac­cord­ing to the most re­cent rat­ings on Medi­care’s web­site, Howard Uni­ver­sity, Ge­orge Wash­ing­ton Uni­ver­sity, Prov­i­dence and MedS­tar Ge­orge­town Uni­ver­sity hos­pi­tals got one star out of five. MedS­tar Wash­ing­ton Hos­pi­tal Cen­ter got two stars, while Si­b­ley Me­mo­rial was rated a three-star hos­pi­tal.

In­spec­tors cite prob­lems

The D.C. Health Reg­u­la­tion and Li­cens­ing Ad­min­is­tra­tion in­spec­tor en­tered the Neona­tal In­ten­sive Care Unit at Howard Uni­ver­sity Hos­pi­tal at 2:55 p.m. on July 22, 2015, and counted six frag­ile new­borns. She looked around for a nurse but saw none, even though three are as­signed to the unit.

After walk­ing the length of the nurs­ery, she found an em­ployee “around a cor­ner where s/he could not ob­serve the pa­tients and was out of di­rect vi­sion of any­one en­ter­ing the nurs­ery,” ac­cord­ing to a health depart­ment in­spec­tion re­port ob­tained un­der the Dis­trict’s Free­dom of In­for­ma­tion Act. The nurse was on her cell­phone, and the in­spec­tor cited the hos­pi­tal for “fail­ing to pro­vide a safe en­vi­ron­ment” for in­fants in the NICU, a vi­o­la­tion of the D.C. Nurse Prac­tice Act.

It is one of dozens of de­fi­cien­cies found at the hos­pi­tal over the past decade by city health reg­u­la­tors who are sup­posed to re­view D.C. hos­pi­tals an­nu­ally for com­pli­ance with ev­ery­thing from laws to de­liv­ery of pa­tient care. The in­spec­tions show lax over­sight at Howard.

“If we find any­thing egre­gious, we make sure it’s taken care of be­fore we leave the hos­pi­tal,” said Sharon Lewis, se­nior deputy di­rec­tor with the D.C. Depart­ment of Health’s Health Reg­u­la­tion and Li­cens­ing Ad­min­is­tra­tion.

The agency typ­i­cally doesn’t do pe­ri­odic re­views to de­ter­mine whether a hos­pi­tal has cor­rected the de­fi­ciency, Lewis said. In­stead, it checks back the next year dur­ing the an­nual re­view.

A com­plaint filed in July 2015 al­leged that Howard Uni­ver­sity Hos­pi­tal al­lowed a res­i­dent fel­low to prac­tice medicine with­out a li­cense for a year, a vi­o­la­tion of D.C. law. A health depart­ment re­view sub­stan­ti­ated the al­le­ga­tion. That re­view also found that 10 of the hos­pi­tal’s 26 med­i­cal fel­lows “lacked doc­u­mented ev­i­dence” that they took the re­quired CPR classes.

An in­spec­tion of Howard Uni­ver­sity Hos­pi­tal last March found var­i­ous prob­lems: an in­op­er­a­ble de­fib­ril­la­tor in the emer­gency room and a lack of doc­u­men­ta­tion show­ing that med­i­cal staff had the re­quired bi­en­nial tu­ber­cu­lo­sis screen­ing and/or phys­i­cal health exam “in ac­cor­dance with es­tab­lished Dis­trict of Columbia Mu­nic­i­pal Reg­u­la­tions for Hos­pi­tals.”

In 10 of 26 cases — nearly 40 per­cent — Howard Uni­ver­sity Hos­pi­tal staff failed to doc­u­ment whether pain-re­liev­ing drugs and other con­trolled sub­stances were given to pa­tients as or­dered or given in a timely man­ner. In some in­stances, the drugs — Per­co­cet, OxyCon­tin, mor­phine and oth­ers — were re­moved from the au­to­matic dis­pens­ing ma­chine with no record that they were ad­min­is­tered, ac­cord­ing to the in­spec­tion re­port. Sim­i­lar de­fi­cien­cies were found in 2015 and 2014, records show. In one case, 11 of 13 doses of pain med­i­ca­tion were given to a pa­tient more than an hour late.

In an­other in­stance, a physi­cian wrote an or­der for an ad­dict to restart methadone with­out spe­cific direc­tions. There was no in­di­ca­tion that the doc­tor was reg­is­tered with the Drug En­force­ment Ad­min­is­tra­tion or that the pa­tient was in a treat­ment cen­ter as re­quired by fed­eral law.

Howard Uni­ver­sity Hos­pi­tal came un­der scru­tiny in 2007, after in­spec­tors found the re­mains of 25 new­borns and fe­tuses in its morgue, some of which had been there for sev­eral years.

Am­pu­ta­tions

The city’s health depart­ment also has cited Howard Uni­ver­sity Hos­pi­tal sev­eral times for fail­ing to pro­vide proper care and treat­ment for pa­tients with di­a­betes, records show.

When Frances Barnes, a re­tired postal worker, was ad­mit­ted on Aug. 22, 2008, for a pos­si­ble stroke, her fam­ily felt con­fi­dent that Howard’s med­i­cal team would make her bet­ter. The hos­pi­tal des­ig­nated the 80-year-old Barnes, a di­a­betic, a high-risk pa­tient and laid out a plan: She would be seen by a nu­tri­tion­ist, have a soft care bed, be turned ev­ery two hours and have a weekly skin assess­ment. They or­dered anti-em­bolism stock­ings to help her cir­cu­la­tion, with or­ders from the doc­tor to re­move them “at least once per shift” for at least 30 min­utes, ac­cord­ing to records.

But health depart­ment doc­u­ments show that the nurses failed to re­move the stock­ings for three days at a time on three sep­a­rate oc­ca­sions, and they didn’t doc­u­ment prob­lems with Barnes’s feet dur­ing the weekly skin assess­ment. It was only after Barnes’s fam­ily en­tered her hos­pi­tal room and no­ticed “an ex­tremely foul smell” that they learned of the sores, re­called San­dra Ford, one of Barnes’s eight chil­dren.

“I took her sock off and there the sores were on her foot,” Ford said. “They were big and black. I was shocked.”

The sores spread so fast that doc­tors had to am­pu­tate Barnes’s leg be­low the knee, Ford said.

Barnes’s grand­daugh­ter, Shelly Ford-Jack­son, filed a com­plaint against the hos­pi­tal, ques­tion­ing the qual­ity of Barnes’s care. FordJack­son is a su­per­vi­sory health li­cens­ing spe­cial­ist for the D.C. Depart­ment of Health.

“I kept a jour­nal and noted ev­ery­thing that was go­ing on,” she said. “I saw so many things that were done in­ap­pro­pri­ately.”

The health depart­ment found that the hos­pi­tal’s nurs­ing staff “failed to fol­low the stan­dard of care” in treat­ing Barnes, city records show.

“Fi­nal anal­y­sis de­ter­mined that a vi­o­la­tion of law was found and a de­fi­ciency was cited,” ac­cord­ing to a health depart­ment let­ter to the fam­ily.

The hos­pi­tal agreed to de­vise a plan of cor­rec­tion that in­cluded de­vel­op­ing writ­ten guide­lines on man­ag­ing pa­tients with antiem­bolism stock­ings and ran­dom mon­i­tor­ing of those pa­tients three times a week for 90 days.

Barnes died on Feb. 2, 2009. Her fam­ily sued Howard Uni­ver­sity Hos­pi­tal the fol­low­ing year and set­tled the case in 2011 for an undis­closed amount, court records show.

Hos­pi­tal of­fi­cials de­clined to com­ment on the case.

Julio Palma Sr. went to Howard Uni­ver­sity Hos­pi­tal after sev­eral days of hav­ing a fever and vom­it­ing. The fa­ther of six, who em­i­grated from Gu­atemala City 20 years ear­lier, was be­ing taken for tests when a hos­pi­tal worker pushed Palma’s wheel­chair too close to the wall. Palma, a di­a­betic, wasn’t wear­ing shoes. His big toe was cut and bruised, but he didn’t no­tice be­cause di­a­betes of­ten robbed him of feel­ing in his ex­trem­i­ties.

“There was blood on his blan­ket,” Julio Palma Jr. re­called. “But he not feel when he hurt his foot.”

The younger Palma said he called the nurse twice, who promised to take care of it.

“No­body show up,” he said. “I was there for maybe an hour and a half. I call him [the el­der Palma] in the morn­ing and ask him if some­one show up and he said ‘no.’ ”

Nurses wrapped the in­jured foot in gauze and dis­charged Palma. When his wife and a daugh­ter cleaned him, they no­ticed that his big toe was black.

“They sent him home like that,” his daugh­ter Gisa said through an in­ter­preter.

Palma re­turned to the hos­pi­tal to see a spe­cial­ist, and “that’s when we got the bad news that they were go­ing to cut off his big toe,” his son said.

De­spite the am­pu­ta­tion, the wound didn’t heal, so they cut off a sec­ond toe three weeks later, ac­cord­ing to court records. See­ing no im­prove­ment, Palma went to an­other hos­pi­tal.

“The spe­cial­ist there said he had to cut higher be­cause there was an in­fec­tion,” his son said. “We never went back to Howard.”

Palma’s fam­ily said the am­pu­ta­tions changed his life. He could no longer drive. Or work. Or dance with his wife of more than 40 years. He sank into de­pres­sion.

“It was all be­cause of Howard,” Gisa said. “They could have pre­vented that.”

Hos­pi­tal of­fi­cials de­clined to com­ment on the case.

Palma and his wife, Ber­tal­isa Sa­gas­tume, sued the hos­pi­tal in fed­eral court in 2008 and set­tled for $90,000, ac­cord­ing to their chil­dren.

D.C. Fire and EMS Chief Gre­gory M. Dean said that he sym­pa­thizes with fam­i­lies who have “com­pelling sto­ries” about their ex­pe­ri­ences at Howard Uni­ver­sity Hos­pi­tal, but he said that the fa­cil­ity is sorely needed in the na­tion’s cap­i­tal.

“Howard is a teach­ing hos­pi­tal,” Dean said. “It’s an in­sti­tu­tion and an in­cred­i­ble part of the Dis­trict.”

“No­body show up. I was there for maybe an hour and a half. I call him in the morn­ing and ask him if some­one show up and he said ‘no.’ ” Julio Palma Jr., who said a Howard nurse promised to help his di­a­betic fa­ther, shown above, with a bloody foot wound but didn’t. Julio Palma Sr. and his wife, Ber­tal­isa Sa­gas­tume, sued the hos­pi­tal in 2008.

MARVIN JOSEPH/THE WASH­ING­TON POST

Shelly FordJack­son, a su­per­vi­sory health li­cens­ing spe­cial­ist for the D.C. Depart­ment of Health, filed a com­plaint over the care given to her grand­mother, a di­a­betic. “I saw so many things that were done in­ap­pro­pri­ately.”

PHOTOS BY MARVIN JOSEPH/THE WASH­ING­TON POST

Ber­tal­isa Sa­gas­tume’s hus­band, Julio Palma Sr., un­der­went two am­pu­ta­tions at Howard after a staffer rammed his wheel­chair into a door frame and he got gan­grene that went un­treated. The cou­ple sued the hos­pi­tal in 2008 and set­tled for $90,000. Palma even­tu­ally died.

Howard Uni­ver­sity Pres­i­dent Wayne A.I. Fred­er­ick dis­cusses a plan to im­prove Howard Uni­ver­sity Hos­pi­tal at a Septem­ber brief­ing. “We rec­og­nize we have a lot more to do,” he said.

FAM­ILY PHOTO

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