A Hospital Stands Accused

By Claudia Wallis

The scriptwriters of Quincy could not have conceived a more compelling medical drama. The country's most famous pop artist dies in a prestigious big- city hospital after a rather routine gallbladder operation. The state health department investigates and finds the hospital guilty of a range of "deficiencies," in both preparing the patient for surgery and providing follow-up care. The city's chief medical examiner fails to pinpoint the cause of death and refers the case to the district attorney for possible criminal investigation. Meanwhile the hospital cries foul, complaining that the allegations are "uniformly incorrect." It acknowledges guilt of only minor procedural lapses in supervising nurses, none of which contributed to the artist's death.

Such was the hullabaloo last week surrounding the death of Andy Warhol at New York Hospital, an institution almost as well known for its celebrity patients (John F. Kennedy, Bob Hope, the Shah of Iran) as for its skilled surgical staff. The scandal was the second in just four weeks to engulf the medical center. In March the hospital admitted to having provided inadequate care for 18-year-old Libby Zion, the daughter of Sidney Zion, a locally prominent journalist-lawyer. She died March 5, 1984, less than eight hours after being admitted with a high fever and earache. A grand jury charged that hospital staffers gave her the wrong medication and woefully neglected her care.

The hospital, which at first vehemently denied the charges, finally owned up and agreed to pay New York State $13,000 in fines, review the credentials of its entire medical staff and report to the state on any other deaths occurring within 24 hours of admission. A malpractice suit by Zion's parents is still pending. But in the Warhol case, the hospital pleads innocent. "We have done many terrible things in the past," says Dr. David Thompson, the institution's director. "This is not one of them."

Certain facts in the case are not in dispute. Warhol, 58, underwent surgery at the hospital on Feb. 21. At 4:30 the next morning, his private nurse, Min Cho, made note of his increasing pallor, but it was not until 5:45, when he was "unresponsive" and turning blue, that she summoned the hospital's cardiac-arrest team. He was pronounced dead at 6:31 a.m., of an unexplained heart arrhythmia, or abnormal heartbeat.

According to the state, the hospital did not thoroughly evaluate Warhol before surgery, may have missed a possible allergy to the antibiotics he was given, and may have allowed him to become overhydrated. It also charged that Cho should have sought help sooner and faulted the hospital for not supervising her properly.

New York Hospital officials were indignant because the state released its report without first giving them the opportunity to comment. "This is not the proper way to do business," fumed Thompson. "People read the health department's report in the newspapers and think it is gospel. It is, in fact, a poorly investigated, erroneous account of what happened." In a hastily prepared but detailed 35-page reply, the institution defended its pre-surgery evaluation of Warhol and said the artist was neither allergic to the antibiotic nor overhydrated. It did admit that staff nurses should have visited his room more frequently, and has disciplined the individuals involved.

The hospital has barred Nurse Cho from further work there, though it praised her record of service over the past eleven years. Cho's lawyer, Arthur Blitz, complained last week that his client is being used as a "scapegoat." Said he: "The hiring of a private-duty nurse does not relieve the hospital of its own responsibilities."

Some doctors at the hospital privately admit that cost-cutting efforts, nursing-staff shortages and overworked, overtired interns may be compromising care at their institution. Hospitals around the U.S. may be "trimming their staffs too far down," says Dr. Dennis O'Leary, president of the Chicago-based Joint Commission on Accreditation of Hospitals. O'Leary suggests that the ongoing war between the "money people and the clinical people" at hospitals struggling to contain costs may be taking a toll on quality.

Whether these factors played a role in Warhol's death remains uncertain. Indeed, despite a continuing investigation by Manhattan's district attorney, chances are no one will ever know precisely why Warhol died. Unexpected arrhythmias sometimes strike after surgery, and medical scientists admit that the cause remains a mystery.

With reporting by Beth Austin/Chicago and Raji Samghabadi/New York