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Howard Hospital After Rosenbaum: Changed Enough?

On the night David Rosenbaum was attacked, taken by ambulance to Howard University Hospital and left on a stretcher in the hallway, the emergency room was "overwhelmed" and understaffed, the nurse in charge of the retired New York Times reporter dismissed him as "just an alcoholic," and the doctor who became alarmed at his condition had trouble getting anyone to help move the patient toward treatment, according to a firsthand account by a Howard physician.

A detailed look at how Howard's staff failed to save Rosenbaum on that night in 2006 emerges from a deposition that Dr. Aaisya Ansri-Lawal gave in the now-settled lawsuit that Rosenbaum's family filed against the hospital. I obtained a transcript of the deposition from a source who is not involved in the settlement.

When Ansri-Lawal noticed Rosenbaum in the hallway and asked why a man was lying in the hallway covered in his own vomit, the nurse replied that "she basically did not want to help me transfer the patient because she was busy doing other things," said Ansri-Lawal, who has since left Howard to open an urgent care center in Fort Washington. "You know, they were short-staffed. She said she wasn't able to transfer him right now, that he was just an alcoholic."

"Stunned" to find Rosenbaum in the hall in his desperate condition, the physician asked to see his chart. But there was no chart. An hour after Rosenbaum had been brought in -- by a D.C. ambulance crew that got lost on the way to help him, failed to properly diagnose his injuries and failed to take him to the closest ER, as the D.C. inspector general's report found -- no one had bothered to evaluate his condition, the deposition says. No one saw that he'd been bashed in the head with a pipe.

Once Ansri-Lawal saw the bump on Rosenbaum's head, the Howard ER finally moved into action, clearing a passage for him to breathe and calling in the trauma team. But it was too late. Rosenbaum died, his treatment became a scandal that led to changes at the top of the District's fire and emergency services department, his family sued the city and the hospital, and investigations and studies were launched.

While the Rosenbaum family dropped its suit against the city after Mayor Adrian Fenty agreed to implement all of a task force's recommendations for reform in the emergency medical system, the family made only a confidential settlement of its case against Howard.

So what has happened at the city's fourth largest hospital -- which handles more trauma cases than any other D.C. facility, since the Rosenbaum disaster?

The hospital has almost entirely new leadership -- new chief executive, nursing director, emergency room boss -- as well as some new physicians and nurses. "Some people have been transitioned out of here because there are clear expectations now," says Dr. Geoffrey Mountvarner, who took over the emergency department last summer and says he would now send his own five-year-old to Howard -- a vote of confidence he says not many on his staff were willing to cast a year ago.

"Was I satisfied with the quality of the nurses when I arrived? No," says Mountvarner, who grew up in Upper Marlboro and worked at the University of Maryland Hospital before returning to Howard, where he had done his residency. "We've assisted some of them in leaving and there are others who we will be assisting." (The Washington Post reported Friday that a senior nursing administrator at Howard has filed a lawsuit in D.C. Superior Court alleging that Mountvarner routinely subjected her to "unwelcome touching, sexual demands, vulgar and sexually explicit remarks" and other harassment last year. Mountvarner told The Post he would not comment on the lawsuit.)

Howard put its ER staff through training in customer service and the treatment of patients in an altered mental state. Mountvarner says Howard now assigns physicians or physicians' assistants to work alongside the triage nurse, trying to handle the least serious cases at the front door to prevent the hugely long waits that often plague inner-city ERs.

"We had these holes in our system that we were not aware of," Mountvarner says. "The effects of Rosenbaum are still being felt. There has been a cultural shift here. There should not be any minimizing of patients whether they are alcoholics or anyone. The fact that it was Mr. Rosenbaum -- that it was somebody famous and that helped expose the situation -- that's just the way it is when people are famous in our society. It showed that we can't let this happen again."

Questions about Howard's management have not disappeared in the city's medical community. A RAND study of the District's hospitals released this January found that on four national measures of emergency room care, Howard ranked last in the city in two categories (Greater Southeast was lowest-ranked in the other two.)

"The EMS people say the delivery of care at Howard is even worse," says Dr. David Milzman, an emergency medicine specialist who is research director at Washington Hospital Center. "Customer service training is not going to fix their problems. Delivering emergency care is not like serving churros at Disney."

Kenneth Hawkins, a nurse who is safety director at Washington Hospital Center and formerly worked at Howard's ER, says EMS crews have long used Howard as a hospital of last resort. "That hasn't changed," he says. "There's still a major staffing issue."

Marcus Rosenbaum, the late reporter's brother, would love to hear a good news story about Howard changing its ways. But he is reasonably skeptical: "The city was very receptive to reform. It was not at all that way with the hospital. They never said they were sorry. When we went to see the CEO of the hospital [before the family filed suit], he had one person with him -- not his lawyer, but his PR person. That sent us a powerful signal."

Since then, he said, the Rosenbaums have not heard from Howard. "Nothing," says Rosenbaum. "I really hope they can make it a good emergency room. Our experience was that I would never go there."

Mountvarner agrees that "Howard's emergency room is not a perfect ER yet." But, he says, "Howard is further along than it was a year ago. I won't stay here and not have it become a better place."

The 44,000 patients who arrive at Howard's ER each year deserve at least that much.

By Marc Fisher |  April 6, 2008; 8:13 AM ET
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Comments

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Not to say that this incident is not horrific, but I wonder how many people in the ER that day were legitimate patients. Our ED's are overrun with non-emergent patient complaints. These people divert resources in the form of techs, nursing staff, and money away from truly sick people. They are to blame as much as the ED charge nurse and EMS staff that so carelessly left this patient to die.

Posted by: Scrubs | April 6, 2008 11:06 AM

I am so angry about this. No person should be left to die for their race. But it has happened all too often. Remember Bessie Smith. Justice should be for all of us.

Posted by: Gary E. Masters | April 6, 2008 4:11 PM

The federal government is of two minds on health care. If you've got health insurance through your employer, then fine. Seek help anywhere. Otherwise, if you have no health insurance, you can sit and wait in an Emergency Department queue for hours or days. Hospitals are required to treat the poor. And may God help you if you are rich, unconscious, and end up in an Emergency Department that services mainly the poor. The priority of the plutocrats in charge of everything in our country is that health insurance companies and drug companies make obscene profits off the fringe benefits that employers offer many of their employees. The money that executives in those companies don't use to buy expensive homes and waterfront property and yachts goes to pay taxes to fund health care (such as it is) for the poor. It is like trying to win in a racecar that has its brakes on throughout the race. The false assumption is that we have in the U.S. the best healthcare system imaginable. And so, why would we want to change it? The reason is that it is wasteful and rewards people who don't contribute materially to health (except their own financial health and the financial health of investors). Trillions go to deteriorate the health of people who are termed our nation's enemies. One dime going to improve the health of a poor person, or to make the system work better, is a transfer payment from rich to poor. Baloney.

Posted by: BlueTwo1 | April 6, 2008 6:22 PM

how dare "dr". mountvarner/women chaser. how dare he act as if he is always clueless about what is going on in howard's er. how dare "dr". lawal try to place blame on the nurse. if you think about it, the response lawal states the nurse gave her does not even make sense. she was trying to save her own skin. regardless to whatever goes wrong with a pt, bottom line, the nurse somehow becomes the scapegoat. in order to care for the volume of pt's that come to howard's er, you need what howard does not have and that is staff. yes it was a terrible thing that happened to mr. rosenbaum. but why is howard being put on blast like this? unfortunately, similar situations have occurred at other hospitals in the metropolitan area.[and no one with a brain can deny that] nurses do not hire staff. so if there is not enough staff to care for the people, is it not just a matter of time before something goes awry when you have 1 nurse assigned to 8-9 pts? dr. mountvarner and lawal, stop blaming the nurses!!! its all about common sense.

Posted by: eyewitness | April 6, 2008 11:30 PM

The idea of teamwork and professionalism does not exist at HUH's ER environment.
Everyone in this dept. (tech., nurse, unit secretary, registration, transportation etc.) works as if they are not working with the same goal in mind: patient care. There are always staff shortages, which leaves those that are present overworked and stretched to their limit. The organization is horrendous. On any given day a patient or visitor can be directed, redirected, misdirected numerous times. The waiting area becomes so inundated with patients that it becomes a standing room wait area. Patients will wait upwards of 4+ hours without ever having a doctor, administrator or nurse update them on their condition or afford them a courtesy announcement explaining the long wait period. The solution or response to a patient's question(s) or concern(s) is shifted around so many times that patients become enraged. Staff members who have worked at the institution for years can be heard complaining about the salary difference that the travel nurses make and snippy remarks about how "they ain't gonna train nobody or they'll learn, no one showed me." Truthfully, JACCHO needs to be on site to help manage any new changes that will ever occur at HUH. It doesn't appear as if any real changes have taken place, only changes on a superficial level. You cannot put a bandage over a bullet wound and expect everything to be ok.

Posted by: frustrated... | April 7, 2008 1:27 AM

It is very interesting reading these comments..I am a RN in Philadelphia at a major University Hospital..It is devastating to witness any death in an Emergency room, let alone one that could have been prevented, not to mention the callous nature to which HUH responded in the tragin loss of Mr. Rosenbaum..Whis is classic of large hospitals, always covering up for the physicians, making everything hush hush.. and never taking resoponsiblilty, and the nurses are Totally expendable, a dime a dozen.. Staffing is always the major issue, we can not blame the nurses, when the CEO's do not provide ample budgeting for staffing, recruitment and retention, that is the bottom line, how can the big bosses actually think it can be done and constantly turn a deaf ear to the pions, until a sentinel event occurs, and now let us scurry to change policy and procedure, re educate the staff with new implementation and blah blah.hire consultants and such and so forth, get rid of the old bring in the new..See what that brought them, I guess the bid dogs shoulda been listening to the nurses before hiring Big Daddy, now more reorganizing and I see big staff turnovers now...It is so so sad that Hospital administrators are rather clueless to the real bottom line in patient care..Providing enough nurses to do the job..I can recall many nites in an inner city ER, with beds filled in the house, not enough floor nurses so the admitted patients have filled a third or so of your 40 or 50 beds, the waiting room is 4hrs deep, the doctors are not moving the patients, and the traumas are rolling in left and right!!! How can you possibly blame the bottom of the food chain when when the fat cats are sitting pretty at home, when you call them and tell them them you have to close the Er because your nurses are taking care of 8 and 10 patients..and you are told to do the best you can..We are not paid enough for the verbal abuse from patients, stressed out coworkers and idiot doctors overcompensating for their lack of knowledge and intimidated by you having more commonsense..Were is our glory?? no wonder the turnover in any Emergency room in any inner city suffers the same ills and woes, falling on the backs of the nurses... Jcaho should make more pop up visits everywhere I say and shake things up a bit, and make the fat cats wake up and smell the coffee...HIRE ENOUGH NURSES TO STAFF ERS TO SAVE PATIENTS LIVES...IS THIS NOT THE REAL BOTTOM LINE..

Posted by: Trauma RN | April 7, 2008 1:05 PM

It is true that the nurses are juggling as many 5-9 patients at a time, while the "attending" sits on an e.r. phone, or even better walks around with his/her own personal cell phone affixed to his/her ear talking about his/her personal life. There was something mentioned about have a Dr. or P.A. working alongside of the triage nurse to assist in diagnosing the patient level, but that is absurd, no such change has taken place. Yes there are frequent flyers, as they are called, people who come in to the e.r. everyday screaming at the top of their lungs because they are drunk and hungry, but the point isn't that you crack a joke at the expense of that person so your co-workers get a good chuckle in, I mean everyone is so worried about not created waves that they allow this type work condition to fester, while they get steamed-rolled into making up the slack for being a understaffed department. The same people that spit their wise cracks about how bad conditions are, are the same ones with their nose up "bid daddy's" you know what feeding his ego. Then everyone wants to sit around with a lost, puzzled huh on their face wondering why all the sexual over, under, in your face, I play along type of inappropriate lewdness happens...Even in house adminstrators have commented on the locker room mentality that exist...Change has to happen from the top, but that doesn't mean those working the frontlines have to sacrifice their own character...

Posted by: so true, so true | April 7, 2008 7:03 PM

Hopefully the good Dr. Mountvarner will be able to pry his mitts off of his staff long enough to impact some of the change he promises....

Posted by: former HUH staff | April 9, 2008 4:33 PM

How much confidence can the Howard University Hospital ER Staff have when the ER Director has been accused of sexual harrassment and is still "employed" while the person who brought forth the alligations has been placed on "administrative leave?"

In the real world, should at least the accused be placed on leave? I aquaint it to allowing the rapist to still work beside his victims. The tension is so thick in the ER when Mount Varner is around that you can cut it with a knife.

It doesn't bode well that his presence gives off an air of intimidation to the female staff. Nor does it look good that the hospital is not taking the alligations of the sexual harrassment seriously.

I guess it's going to take the hospital being sued for millions by several women to get the message across that such behavior is not to be tolerated. Change should occur at EVERY level at HUH.

Posted by: Anonymous | April 12, 2008 5:23 AM

That's right, blame the nurse. If I'm not mistaken, the EMS didn't get lost on that faithful night that Mr. Rosenbaum died, but the driver of the ambulance brought him to Howard because her home was closer in the area so that she could get medication for a toothache. There were at least two other hospitals that were much closer for Mr. Rosenbaum to receive treatment, why wasn't that addressed?

Howard's ER has been known as a dumping ground for intoxicating patients. If you check the stats of all the area ERs, you will find that HUH has more than 60%. Any given night there are at least 4 to 8 intoxicated persons at Howard compared to 4 or 5 a week in other area ERs. EMS has been quick to state "We bring all the drunks to Howard" on many occasions. If you don't believe me, have someone check the facts.

Too often ERs are overwhelmed with patients who use the 911 service for "getting something to eat" "needing a bandage" "I need somewhere to sleep" and other non-emergent services to the point where the ERs cannot provide service to those who are truly sick or have urgent concerns.

It is so easy for those behind the sidelines to critize those that are in the trenches doing the hard work. I agree there have been times when calls were made to administrators about crisis situations with large number of patients to be seen and not enough staff and to be told "do the best you can." Doing the best that we can would be if someone got off their lazy butts and would come in to help. Then when an adverse event occurs, they are quick to blame the nurses.

Very hard to respect an administration that does not provide the assistance when it's needed, but will place blame on those that are trying hard to make an impossible situation possible.

Posted by: Tothrew | April 12, 2008 6:11 AM

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