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.
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