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Ward 7 Councilmember Vince Gray’s legacy hinges on his ability to bring a new, equitable health care system to the residents of Southeast D.C. His newest plan to get it done has critics asking: At what cost?
In a series of proposals in the Fiscal Year 2020 budget, the D.C. Council’s Committee on Health, which Gray chairs, moved to cut the subsidy to the city’s only existing hospital in Southeast, the troubled United Medical Center. Gray is also pushing to accelerate the construction of a replacement community hospital on the St. Elizabeths campus—a goal he’s pursued since his time as mayor.
But with UMC still seeing patients, and no deal currently in place with George Washington University Hospital, the city’s preferred operator for the new facility, hospital workers are concerned for their jobs and say patients’ lives could be at risk.
Last week, the D.C. Council approved Gray’s proposal to cut UMC’s subsidy to $15 million per year. UMC would maintain its emergency department and its psychiatric unit; its board will have leeway to add more services as long as the costs don’t exceed a $15 million budget.
If the UMC board can’t present a budget within that limit, a control board would take over its finances. Under this plan, UMC would close for good by 2023.
Council Chairman Phil Mendelson supports the reduced subsidy and expects the control board will be activated at some point. “The hospital can’t just simply function with an expense account that is escalating without a corresponding increase in patient census,” he says.
Mayor Muriel Bowser’s proposed budget included a $40 million subsidy for UMC. In a memo on the Council’s cuts to her budget, Bowser writes that lawmakers can’t possibly know the full impact of a subsidy reduction on UMC, and calls Gray’s proposed cut “disappointing and impetuous.”
Roberta LeNoir, an emergency room nurse at UMC and president of the D.C. Nurses Association, says the severe cut will force UMC out of existence prematurely.
“At this point, I really don’t see how they plan on safely operating the hospital if they take that cut, if they lose all those employees,” LeNoir says. “If you take away all of those departments, then we’re like an island. Our ability to give services that we’re giving at this point would be greatly hampered.”
The Bowser administration also questions whether Gray’s proposed timeline for completion of a new hospital is realistic.
“One thing that Councilmember Gray did that we do not support is he proposed moving up the date of construction from 2023 to 2022,” says Deputy Mayor for Health and Human Services Wayne Turnage. “We don’t think that’s possible.”
Djawa Hall, an organizer for 1199 SEIU, which represents many UMC workers, lays the blame not only with Gray, but with the entire Council.
“This is Gray’s legacy,” Hall says. “The other councilmembers are scared to do anything that will be to the detriment of Vince Gray’s goal of bringing a hospital to the city since he was mayor. No one will challenge him because that would be killing his legacy, and that’s a problem.”
Gray was in Las Vegas for the International Council of Shopping Centers Convention at the time LL was reporting this story, and his staff said he was unavailable for questions.
But in a letter to the Council dated May 8, Gray defends the subsidy cut as a fiscally responsible decision for a hospital that’s bleeding money. In 2018, D.C. CFO Jeffrey DeWitt declared UMC functionally bankrupt, according to a Washington Post report.
Gray’s letter points to UMC’s falling patient volume and lays out his thinking for the rest of his plans.
Gray writes that “the most recent daily census reflected only 78 patients, while UMC has 850 staff positions.”
Although patient volumes have decreased since 2017 when its obstetrics unit closed, according to city data provided to City Paper, Gray’s letter paints a picture the D.C. Nurses Association calls a “grave mischaracterization.”
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In response, the DCNA sent their own letter to councilmembers clarifying that Gray’s numbers refer to only a fraction of the hospitals patients and boost the amount of employees by including non-clinical staff. Left out are the 200 to 300 patients who visit the emergency room on a daily basis, the 100 patients in the skilled nursing facility, and the 26 patients in the psychiatric unit. Included in the 850 staff positions are cafeteria workers, janitorial workers, human resources staff, and secretaries, the DCNA letter says.
Gray’s staff later clarified to LL that UMC’s 70 to 80 daily inpatients, when compared to the facility’s 210 operational beds, indicate the hospital’s poor health.
“If we are discussing utilization of the hospital, it is important that lawmakers have an accurate count of the patients visiting the hospital, which is between 400 to 500 patients per day,” writes Wala Blegay, an attorney for DCNA. The proposed subsidy cut triggered a notice from UMC chief executive Matthew Hamilton to its unions that layoffs could begin as soon as July.
“Not only do we need the equipment to evaluate people, but we use the ICU, the dialysis unit,” says LeNoir, the emergency room nurse. “We really, really needed our OB-GYN that nobody gave us back. We have people coming in here in labor and we don’t have an OB-GYN department. But with these cuts we won’t be able to offer services we do have.”
In late 2017, the UMC board voted to permanently close its obstetrics unit. Providence Hospital in Northeast closed earlier this year, and as a result, LeNoir says, UMC has seen an increase in patients.
“The residents have to do what I call hospital hopping because waits in the [emergency departments] are going from three days,” she says. “That’s the norm now. We’ve had incidents in the last week where we were unable to transfer out critically ill patients because there was nowhere to transfer them to.”
In his letter, Gray also suggests that some of the money he’s cut from UMC’s subsidy can be used to accelerate construction of the new Ward 8 hospital. Before the new hospital can be built, the city has to finish building a new men’s homeless shelter, then demolish the old shelter to make room for the hospital.
“We know there will be some [environmental] remediation there,” says Ward 1 Councilmember Brianne Nadeau, of the site for the new men’s shelter. “But we don’t know what it is or how bad it is. But if that takes longer than planned, then everything slides back.”
The shelter demolition is currently scheduled to begin in July of 2021. The Council approved a construction timeline for the new hospital with an expected completion date of December 2022.
As if Gray didn’t have enough on his plate, he and Ward 8 Councilmember Trayon White, whose constituents live closest to and stand to benefit most from the new facility, are in a stalemate over how the forthcoming hospital should be run.
White spoke against Gray’s proposed subsidy cut, saying during last week’s Committee of the Whole meeting that “we should not pull the plug because people are still living there. I’m concerned about this budget, and the manner in which the money was taken, and even the fact that we tried to close [the hospital] earlier than we need to without a new hospital being built.”
White also introduced an amendment that requires Howard University’s medical school to have some role in the future Ward 8 facility. The amendment had seven co-sponsors and passed despite objections from Gray.
“The effect of this amendment means that there will be no hospital deal,” Gray said. “Despite everyone’s best efforts this creates a dead end for us.”
White pushed a similar measure late last year, which Gray repealed in his committee as part of a larger bill, the “East End Health Equity Act.”
Gray said George Washington University’s exclusivity agreement with Universal Health Services, which owns GW Hospital, precludes any partnership with Howard University.
Before the Council gave initial approval for the $15.5 billion budget last week, Gray floated the idea of a legislative mechanism to provide Howard University’s medical school with up to $10 million in revenue for the next 30 years.
Mendelson says he facilitated a meeting with Gray and White last week but couldn’t broker a compromise.
“I can’t say that either councilmember felt their concerns were resolved,” Mendelson says. “Trayon White has some criticisms, and I’m not sure they went away. But I thought it was important for there to be a conversation.”
Given the level of support that White’s amendment had among the other lawmakers, Mendelson says it’s up to Gray as the chair of the health committee to find a solution for Howard University’s medical school.
The Council will vote on the budget for a second and final time Tuesday, May 28.