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Remetter Freeman is 89 years and 2 months old, and she’s been in D.C. for all but three of those months. She can’t be quite as involved in community affairs as she used to be—she only makes it to ANC meetings “sometimes” now—but she’s still a presence, sharp as ever.
A couple weeks back, Freeman woke up with a nasty stomach virus and called her doctor. He told her that she needed to go to the emergency room. So she did what she always does in situations like this: She had one of her sons take her to Doctors Community Hospital way up in Lanham.
She’s lived in Ward 7 for over 60 years, and when her blood pressure is too high or she has some other emergency, Maryland has long been where she goes. There aren’t really other options. If her sons aren’t available to drive her, she calls a private ambulance since the District ambulances don’t go up there. Her brother-in-law used to go to Providence Hospital in Ward 5, but “Providence never had any room. You just wait and wait. I wouldn’t take anyone to Providence.” Thankfully, she’s has insurance that will cover her in Lanham, where she says there are only ever a few people waiting and there’s “no one pushing you around.”
“It is a bit far,” she says, “but if you don’t have a choice, what do you do?”
This lack of options east of the river has been the status quo for decades, but that’s about to change. In February, the Department of Health gave MBI Health Services the final regulatory approval to open an urgent care center a five minute walk from Freeman’s house on Grant Street NE, near the Minnesota Ave. Metro stop. It will be the first urgent care center east of the river.
Once the center opens, it will be a 24/7 site for any acute problem that doesn’t truly require a trip to the emergency room. Advocates have long been fighting to build a proper health care system in Wards 7 and 8, and they say this is a major step forward, long overdue.
Currently, the health system east of the river is broken into two parts: the United Medical Center hospital, and a scattering of primary care clinics, like those operated by Unity Health Care. Unity CEO Vincent Keane says that to increase health care access, Unity takes walk-in appointments and keeps its clinics open late and on weekends. However, he emphasizes, this only works for more minor problems. Urgent care facilities are necessary because they have the equipment and expertise to handle routine emergencies like broken bones and wounds that requires sutures. If a child wakes up in the middle of the night with a high fever, or if someone thinks, “I have a terrible headache. It could be a migraine or it could be a tumor,” Keane says an urgent care is the appropriate place.
MBI hopes to finish building out its center by November of this year. As far as their doctors are concerned, it couldn’t open soon enough. MBI is currently one of the District’s largest providers of mental health treatment, with clinics scattered across the east side of the city. MBI CEO Marie Morilus-Black says that “at least once a week, sometimes more, we have to call an ambulance for one of our patients because their [blood] pressure is so high as to be at a stroke level.” She wants to send them to an urgent care rather than to the ER, but there aren’t any east of the river. So she decided to start her own.
She made that decision about two years ago. The process of getting regulatory approval has been long and arduous. It took roughly a year for MBI to put together their application for the Certificate of Need, a months-long regulatory process that evaluates whether a proposed health facility is needed in a particular area. Then, once they submitted their application last spring, it took almost another year for the Department of Health to actually finalize the approval. Only then could they start the necessary renovations. (MBI says that while the process was certainly burdensome, they “understand the oversight and think it’s needed.” Ward 7 Councilmember Vince Gray, however, is a little less patient: “The health disparities that exist in the city are too pronounced for us to have any time to waste. Two years is much too long.”)
But this is one victory in a much larger struggle, and MBI didn’t do it alone. ANC 7D chair Sherice Muhammad has been intimately involved in the process of getting MBI approved by the city, and she is part of a band of ANC commissioners she says are “working hard to improve the system” in Ward 7 and east of the river. It’s a massive, desperately needed task. “We have a myriad of health issues throughout the ward, and it’s a travesty that we don’t have a health system that is ward-based,” she says. Many in Ward 7, which has no hospital of its own, currently go to Providence, and when that shuts down in April, “Where are they going to go? That’s going to add to the famine of our health system. Now, with one less provider, we need to double down.”
Right now, without alternatives for urgent treatment, the weight of supporting that health system falls on the sagging shoulders of United Medical Center. Because they don’t see other viable options, people who don’t truly need to be in the ER often still end up in the UMC emergency room.
Since emergency room visits are much more expensive than just about any alternative, this is a major waste of resources, both for patients and for the District government, which often ends up footing much of the bill.
It also majorly drives up wait times. At the UMC ER, spending 12 or 13 hours in the waiting room is not uncommon.
This in turn makes it so that, for many, going in to UMC is a last resort—or not an option at all. “I don’t go to UMC. Let’s be clear about that,” says Regina Pixley, a longtime activist in Congress Heights and newly elected ANC 8C commissioner. Between the wait times and the reputation of the overburdened, scandal-plagued hospital, she says, “If I cut up my finger badly, I’m going to wrap it up and wait until I can go somewhere reputable.” Instead of going to UMC, says Pixley, when people have health problems, “a lot of people just deal with it. They try home remedies.”
ANC 7F chair Tyrell Holcomb, who lives on Minnesota Avenue NE, says, “If something comes up and I need urgent care, I go to Inova [in Fairfax] or the urgent care in Alexandria. We’re looking at a 20, 25 minute drive.” It was worse before he had a car, taking two or three buses as a kid to get treatment. He emphasizes that this distance affects people’s health: The long trip is something “people make the decision to do or not do, based on access.” Friends of his often wait a few days to get care until they can get a ride somewhere like Inova; others forgo treatment entirely. When that happens, health outcomes can get worse.
Furthermore, when people always take their health problems to the emergency room or to distant urgent care centers, it creates issues down the line. Neither of those places can make the connection to primary care physicians closer to home, so people often don’t get follow-up treatment. It’s a cycle that keeps people from seeing physicians for more routine matters, leaving them to wait to get care until their problems become acute.
Knowing how important it is for urgent cares to then connect their patients to regular physicians, MBI also applied for regulatory approval to open up a walk-in primary care clinic, which would be connected to their urgent care. This application, however, was denied. “We don’t understand that. Primary and urgent go hand in hand,” says Muhammad, who fought to push MBI’s applications along. “The community is depending on you—you have to be able to provide both.”
Unity’s Keane echoes that urgent care doctors and nurses must connect their patients to primary care for follow-up. “You might ask, ‘Why haven’t we done it?’” he says. “We’d love to do urgent care. But as a nonprofit, we just don’t have the capital to start it up.” Opening an urgent care center requires a large investment to build out the space and buy expensive equipment like X-ray machines—on the order of a million dollars up front. While Unity is positioned to provide the care, they would need help from the city. “If we had subsidies to start it up, we’d be able to staff and run it.” (Morilus-Black says that MBI is funding its new urgent care center through a combination of loans and reinvested profits.)
Pixley is appalled by what she sees as a lack of investment by the city in a proper health care system east of the river. “[The District] could’ve put money into anything they wanted to, with the money they give developers,” she argues. “They could’ve already opened an urgent care.” Pointing to the millions of dollars Mayor Muriel Bowser put toward building the Wizards practice facility in Ward 8, she thinks the arena demonstrates the Mayor’s priorities. “We didn’t need that,” she says. “They chose entertainment over health care. Over saving people’s lives.”