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Advocates and clinicians warn medication oversight gaps and missed appointments impede care
Summary
Public Defender Service and clinicians described missed specialty appointments, lack of ophthalmology coverage, fragmented clinical records and pharmacy systems, and raised concerns about monitoring (including lithium levels) and medication governance; hospital said pharmacy is licensed and that clinical review processes and committees exist.
Lawyers from the Public Defender Service and clinical staff described cases where patients lacked timely access to medical exams, eyeglasses and specialty care, and where some long-stay geriatric clients are at the wrong level of care. Antoinette Quander Clemons, medical clinic coordinator, said the clinic historically ran with a single staff member coordinating hundreds of outside consultations and that transport and escort reductions have caused frequent missed appointments and backlogs.
Tamara Butler, a pharmacy data technician, testified to historic Pyxis/host integration problems and a history of system-driven medication errors; she recommended moving pharmacy informatics under an independent technical governance model for auditability. DBH and hospital leaders said the pharmacy is licensed and regularly surveyed, adverse medication events are reviewed by a pharmacy-and-therapeutics committee, and the hospital will provide adverse-medication statistics the committee requested.
Committee requests: disaggregated data on missed appointments by cause (transportation or staffing), a list of pending outside consultations, and pharmacy adverse-event counts and monthly trends. Hospital agreed to provide those data and to route allegations requiring regulatory review to DC Health or the Inspector General.
