- The Washington Times - Saturday, September 1, 2007

A Rockville hospital is at risk of losing Medicare funding following the death of a malnourished man and a state review that found problems with the feeding of other patients.

State investigations of Adventist Rehabilitation Hospital of Maryland this year found some patients were not receiving diets ordered by their doctors, lapses that could have exacerbated their health problems.

In the case of the man who died, state investigators concluded that his severe malnutrition went largely undocumented and untreated until it was too late, placing additional pressure on his already precarious health. Julian Frazier, 29, died in December.

In August, state health officials notified Adventist that it had 90 days to make changes before losing Medicare payments. The relatively rare step can be a blow to hospitals, many of which rely on the federal funds to help cover costs.

Copies of the state reports from the May and July inspections of the hospital were obtained by the Associated Press.



The hospital, part of the Rockville-based Adventist HealthCare system, has 77 beds at facilities in Rockville and Takoma Park, as well as smaller outpatient centers.

Aisha Bivens, the hospital’s quality-management director, characterized Mr. Frazier’s death as an isolated case and said patients at the facility are not at risk.

“We do realize we could have coordinated our care better. We didn’t meet the high standards that we expect of ourselves,” Miss Bivens said.

Mr. Frazier, who grew up in the Washington area, was a high school math teacher in Brandenton, Fla. In April 2006, he suffered a case of pancreatitis, an illness in which the pancreas releases digestive enzymes into the rest of the body, damaging organs.

Mr. Frazier nearly died and lost the ability to walk, according to his mother, Jean Clancy. He was airlifted from Florida to Mrs. Clancy’s home in Santa Barbara, Calif., where he began a long, slow recovery.

In November, Mrs. Clancy said Mr. Frazier felt well enough to visit his father, James Frizzell, in Maryland. Soon after he arrived, Mr. Frizzell, a Frederick, Md., gastroenterologist, concluded his son needed further treatment.

According to the state health report issued in May, Mr. Frazier was admitted to Adventist on Nov. 16 after a short stay in an acute care hospital. He was 75 pounds below his normal weight, and doctors at the acute center said the plan was “to let him eat as much as possible.”

But state inspectors could find little documentation about his nutritional state after his admission to Adventist.

“There is no indication in the medical record that his nutritional status was seen as a problem” until shortly before his death, the May report concludes.

On Dec. 5, a gastroenterologist who saw Mr. Frazier reported that he was profoundly malnourished and his body was swollen. On Dec. 7, he was sent to the emergency room at Shady Grove Adventist, in the same medical complex as the rehabilitation hospital.

About four hours later, he died of cardiac arrest.

The state report does not specifically identify a cause of death, and Mr. Frazier was already seriously ill when he entered Adventist. But it concludes the hospital did not intervene even though he “was at a severe and unrelenting risk of starvation.”

Mr. Frazier’s mother was much blunter.

“They saw that he was sick. They saw he was dying. They did nothing,” Mrs. Clancy said. “He would have been better lying in the street.”

Mrs. Clancy, a nurse practitioner, reviewed her son’s medical files and contacted the state.

Following the May visit and report on Mr. Frazier’s death, the state made an unannounced follow-up visit on July 18-19, when it found other problems with patient diets. That review prompted the Medicare warning letter.

Miss Bivens said Adventist would submit a plan of correction for the problems, and predicted the hospital will not lose its Medicare payments. State officials will visit again to assess the changes.

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