Who Killed Mrs. Jones?

ON SEPTEMBER 10, Patricia Jones, 63, of Washington D.C. complained to her children of chest pains and shortness of breath. One of her daughters brought her to D.C. General Emergency Room, where she was asked to sit in the waiting area. Three hours later, she collapsed in front of the receptionist's desk with a blood clot in her lung, less than 50 feet from advanced resuscitation equipment. After 30 minutes of intensive treatment, physicians declared her dead.

To some, the case of Patricia Jones is a textbook study of medical malpractice. After all, how could any competent physician or nurse allow a woman with the symptoms of a life-threatening condition to wait for three hours? Lawyers across the city tripped over one another to file suit against the hospital. The news media converged on D.C. General, demanding answers.

But the case isn't as simple as it seems. What killed Patricia Jones was more than an error in medical judgement; it was a system of care that forced her into an overburdened and underfunded emergency room, stocked with inadequate supplies and staffed by professionals pushed to the limit hour after hour, day after day. Patricia Jones was killed by her lack of access to private health care--the health care that most Harvard students take for granted.

EACH Saturday this summer, I worked the day shift in the Emergency Care Center at D.C. General. I assisted the medical staff during trauma emergencies, wheeled patients to x-rays and stocked supplies in the walk-in clinic. After two months in the emergency room, what surprises me most about the case of Patricia Jones is that it doesn't happen more often.

D.C. General is to emergency care what a soup kitchen is to dining--the emphasis, by necessity, is on treating as many patients as quickly and decently as possible. According to city records, more than 220 people received care at the D.C. General emergency room every day last year--more than three times the number at the second-busiest hospital.

What makes D.C. General so popular? The answer is simple and telling: it is the only hospital in the city that guarantees treatment regardless of ability to pay. In addition to a steady stream of desparately ill patients, D.C. General serves a regular group of homeless (who often just need a place to stay), mentally ill (some of whom must be restrained in a corner room) and drug abusers (who are known to attack the health staff).

The D.C. General emergency room also provides care to inmates from the D.C. Correctional Facility and from jails as far away as Lorton, Virginia.

The patients who can't afford private care go to D.C. General. The patients other hospitals are loathe to take--for example, intravenous drug users with AIDS--go to D.C. General. On a routine basis, these hospitals ship indigent patients, often, some of their sickest, to D.C. General.

To cope with these challenges, the emergency room is understaffed, under-funded and understocked. Once, during a "Code Blue" emergency resuscitation. the heartbeat monitoring machine ran out of paper. Another day, I tried to help as nurses searched for a valve to open an oxygen tank needed by a patient. The next week, I was sent to other parts of the hospital to track down scarce gauze and urinals.

Three times I saw the frustration on the head nurse's face when she checked the work sheet and saw that too few nurses and health assistants were assigned for Saturday night--the shift when four gunshot wounds and two stabbings is par for the course.

"Why do I do it?" a nurse rhetorically asked. "Because if I don't, who will?"

PATRICIA Jones' vote may have counted as much as that of every other citizen of the District, but her health did not. In a society that distributes life-prolonging care on an ability-to-pay basis, we have, in essence, decided that some people deserve to live more than others.

District Police officers, for example, have written in their contract that they will never be taken to D.C. General in the case of a trauma emergency. If an officer and an innocent bystander get shot, the officer is helicoptered to a high-tech facility in Virginia, and the city resident goes to D.C. General.

The Washington Redskins also refuse to be taken to D.C. General--the hospital just one block away from RFK stadium. When Joe Theisman broke his leg on Monday Night Football, he was air-lifted far away from the predominantly poor and Black patients at D.C. General to an isolated hospital in the suburbs. A fan injured in the stands that same night went you-know-where.

"What kind of message does that send?" asked a health aide. "Does Joe Theisman think we're not good enough?"

WHAT killed Patricia Jones was much more than medical neglect. The doctors and nurses I observed at D.C. General worked in the worst of circumstances with the sickest patients, but they did so with the most dedication and courage of any group that I have ever observed. Ironically, that group will likely get blamed for the one occasion when they failed to perform a superhuman feat.

The real lesson of Patricia Jones is not about D.C. General, or about doctors, or even about hospitals. It is about whether we will continue to allow the free market to mis-allocate health care. It is about whether politicans will allow 38 million Americans to remain uninsured and vulnerable to financial ruin in the event of an accident or illness.

It is about whether Americans will demand a health care system as equitable as Austria's or West Germany's, or whether we will remain the only industrial nation save South Africa that doesn't guarantee health care as a right of citizenship. Other countries, such as Canada, provide equivalent care to all their citizens at roughly two-thirds of the cost of care in America.

Solving the health care crisis in this country won't be simple. But we don't lack the ability to develop lasting solutions.

What we lack are the people willing to demand them.