(Lee Powell/The Washington Post)

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 day-to-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, center, discusses a plan to improve Howard University Hospital at a news conference in September. (Marvin Joseph/The Washington Post)

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.”

[Is this Howard University’s tipping point?]

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 a 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 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



Howard University Hospital in Washington. (Marvin Joseph/The Washington Post)

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 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. Ford-Jackson is a supervisory health licensing specialist for the D.C. Department of Health.



Shelly Ford-Jackson stands on the porch of her home in Landover, Md. She filed a complaint against the hospital, questioning the quality of the care her grandmother received. (Marvin Joseph/The Washington Post)

“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 anti-

embolism 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.

Julio Palma Sr. (Family photo)

“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.



Bertalisa Sagastume weeps as she recalls the story of what happened to her husband, Julio Palma Sr. (Marvin Joseph/The Washington Post)

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.”

Alice Crites and Joanne Zalatoris contributed to this report.