The opinion of the court was delivered by: PARKER
This proceeding is concerned with one aspect of the failure of the District of Columbia Government to deliver adequate health services to its residents. The plaintiffs are two local senior citizens organizations and several area residents. They seek declaratory and injunctive relief alleging that inadequate treatment and facilities are afforded at the principal City-operated health and medical facility -- The District of Columbia General Hospital (D.C. General). The defendants are the Mayor of the District of Columbia; the Director of the District of Columbia Department of Human Resources (DHR); and the Director of the Community Health and Hospital Administration and part-time acting Executive Director of D.C. General. The Department of Human Resources is charged with the delivery of health services for the City and D.C. General is a component within the Department of Human Resources.
The matter was heard at a full and complete hearing held on July 23, 24, 28 and 29, 1975. At that time the Court received the testimony of plaintiffs' witnesses,
who were thoroughly familiar with conditions at the facility by reason of their present or past working experience at D.C. General. The defendants offered only the testimony of the Director of DHR and the acting Executive Director of the hospital.
The testimony and evidence presented focused on only eight areas of services at D.C. General: medical records, the radiology department, emergency room, nursing department, pharmacy, infection control, laboratory and general maintenance. On the basis of the record the Court concludes that in those areas, the mission of the defendants to provide adequate services has failed; that the facilities fall far short of recognized and acceptable standards in this community; that relief is long overdue and that the defendants should be enjoined to undertake appropriate corrective action.
In reaching this decision the Court has considered not only the testimony of the witnesses, but also voluminous documentary evidence submitted by the parties. Plaintiffs submitted statistical data concerning the staffing levels of D.C. General compared with other hospitals in the area, including Cafritz Memorial Hospital, Georgetown University Hospital, George Washington University Medical Center and the Washington Hospital Center.
This comparative staffing study was compiled by one of the attorneys for plaintiffs, who is not qualified as an expert in either statistics or hospital staffing and administration. For that reason, the Court did not rely on that study in making its factual determinations. Plaintiffs have also submitted various reports and studies by governmental agencies which have been more helpful to the Court. These include the DHR's own evaluation of the staffing situation at D.C. General, contained in the Health and Medical Care Administration's 1972 Task Force Report (HMCA Report).
More recent studies of D.C. General include a survey conducted under the auspices of the Department of Health, Education and Welfare completed November 1, 1974 (HEW Report),
and a June 1975 research report authored by the Municipal Research Bureau, Inc.
The Court also considered certain in-hospital documents, including minutes of committee and department meetings,
memoranda, letters and minutes concerning problems in the renal dialysis unit,
and documentation concerning deficiencies in the Hospital's Infection Control Program.
Defendants' Duty to Provide Adequate Medical Care
Defendants' legal duty to provide D.C. General Hospital patients with comprehensive medical care in accordance with accepted medical standards in the community is clearly mandated. Organization Order No. 141
directs the Hospital to provide "comprehensive hospital care and treatment including inpatient services, outpatient services and emergency room treatment." Only recently in a case involving medical standards at D.C. General, Judge Waddy of this Court wrote that "D.C. General [is] required by law to provide comprehensive medical care for indigent residents of the District of Columbia."
This duty to provide adequate care "is measured by the degree of care, skill and diligence customarily exercised by hospitals generally in the community."
Nor does the argument that the failure to carry out this obligation may stem from budgetary or political restraints preclude this Court's concern and action. Our Court of Appeals clearly rejected that reasoning in a case involving D.C. General's duty to provide abortions to its indigent patients:
Even if the city's or hospital's resources are seriously overburdened, the court cannot for that reason refuse to inquire into an allegation of illegal conduct. The hospital may be unable to fulfill its obligation to provide medical care for indigents without affirmative action by the legislative or executive branch, appropriating or reallocating funds for that purpose. But that is no reason for the court to refrain from declaring that the obligation exists even though persons beyond the reach of the court prevent its discharge.
The record developed in this proceeding clearly shows that services and facilities at D.C. General, especially with regard to medical records, the radiology department, emergency room, nursing department, pharmacy, infection control, laboratory, and general maintenance are so deficient as to make it impossible to provide an acceptable level of health and medical care. The Court's factual findings with regard to each of these problem areas will be discussed in turn.
The critical shortage of personnel in the Medical Records Department and the problems stemming from it were noted as early as 1972. At that time an HMCA Task Force Report documented an annual misplacement rate for medical charts of 150-200 and transcription backlogs extending to 1966.
The HEW Survey also found that patient records were not being completed within 15 days following discharge, in violation of federal regulations.
The recent testimony before the Court demonstrated not only that the problem still remains but that only feeble efforts, if any, have been initiated to remedy the situation. The Hospital concedes that the situation cannot be improved until vacancies are filled in the Medical Records Department.
The gravity of the records situation has generated a more serious problem in that it has frustrated the efforts of the medical staff to render in a reasonable time an appropriate diagnosis and treatment of patients. The evidence showed that at least one department resorted to setting up its own record system, thus duplicating tasks which should be performed by the Medical Records staff. The supervisor of the acute inpatient renal dialysis unit
testified that his unit maintained its own records because of the inadequacies of the regular medical records system. He felt this step was justified because without up-to-date and complete records, any therapy plan devised would entail the risk of unnecessary repetition of tests or treatment procedures. The chief of Georgetown University Medical School's Cardiology Department at D.C. General, testified that in his opinion the medical records are unsatisfactory because the information is not organized in one place. The head of the out-patient clinic stated that inadequate records make it necessary for some out-patients to make two trips to the hospital in order for the physician to make a proper determination of what medication the patient had been receiving and what should be prescribed.
The acting Executive Director of D.C. General, conceded that the maintenance of medical records was a critical problem, but was of the opinion that the problem could be solved by reducing the patient ...