Eric Goulet must have walked in and out of the D.C. Council chambers 20 times during the final legislative meeting of 2018. Clutched in his hand was the future of the District’s healthcare system for generations to come—or at least a piece of it.

With each trip to and from the Council chambers, the director for the Committee on Health carried another tweak to the newest legislation Councilmember Vince Gray was pushing to hasten the construction of a desperately needed, $325 million hospital east of the Anacostia River.

Ultimately, the Council passed Gray’s bill, along with an amendment introduced by Councilmember Elissa Silverman, 10-2. And in doing so councilmembers cleared a major legislative hurdle and avoided derailing the deal for now.

On the way to a consensus, a chaotic scene unfolded in front of a full house that included students from Howard University College of Medicine and employees at the United Medical Center (UMC), which the new hospital would likely replace. Lawmakers wheeled and dealed from the Council dais and behind closed doors up until the very last minute of the last day of the year to pass legislation. Leading up to the final vote, councilmembers asked questions about the hastily assembled legislation, apparently unsure of what they were about to vote on.

The final deal still contains the waiver for the so-called “certificate of need,” an analysis that tells lawmakers and the public if a medical facility is needed. The waiver applies to the new hospital in Ward 8 as well as a proposed 200-bed addition to the George Washington University Hospital in Foggy Bottom. But the bill now also contains watered down versions of previous assurances for Howard University and the labor unions representing workers at UMC.

The bill also starts the clock for the District to help Howard University find a new academic affiliation for its medical school. If that doesn’t happen by June of 2019, the deal likely implodes.

In recent months, the city has been working a tentative deal with Universal Health Services, Inc. (UHS), a national hospital management company, and GW Hospital, to collaborate on the new hospital. Negotiations with GW Hospital fell apart in early December, but the Council may bring them back to the table given yesterday’s vote.

Gray, for whom this effort has become a legacy issue, says he is satisfied with the outcome.

Just hours before the bill passed, Gray was considering postponing the vote as his staff negotiated the last changes.

“I’m happy we can move forward,” he said after the final gavel, as if he didn’t just sit through a grueling eight hours of sausage making. “I would be happier if we didn’t have any barriers at all associated with this, but something this complicated, there’s always going to be something.”

Others are not as pleased.

Councilmember Jack Evans, who has been an outspoken opponent of Gray’s push to waive the study of need typically required to open a medical facility, made a final plea from the dais and offered a warning. Evans represents Ward 2, where GW’s Foggy Bottom hospital would expand. Many of his constituents are against the expansion.

“I’ve seen bad law get made this way,” he said. “And this is how you make bad law.”

Evans and Chairman Phil Mendelson were the two no votes.

Silverman, her salt and pepper hair a bit disheveled after the final vote, summed up the long, confusing process in two words: “A shitshow.”

Though she too is pleased to see progress on a new hospital, Silverman was forced to make some concessions on the protections she had successfully put in place for unionized workers. Under Silverman’s previous addition to the legislation, the new hospital would have been required to honor UMC employees’ collective bargaining agreements. Now, a weaker amendment only requires the new hospital to hire half of UMC’s employees.

Under the new legislation, UHS would not be required to honor collective bargaining agreements. However, under Silverman’s new amendment, any UMC workers who are not hired are entitled to an explanation from UHS based on their qualifications, Silverman says.

“There’s not going to be quality care for Ward 8 residents, that’s what just got passed today,” says Yahnae Barner, vice president of 1199 SEIU, which represents some UMC workers. “There’s not going to be quality union jobs, and there’s not going to be quality healthcare. It seems like the councilmembers are OK with that.”

Councilmember Trayon White also made concessions to the amendment he successfully passed Dec. 4. This amendment mandated an academic partnership between Howard University and UHS, which would allow Howard’s medical students to train in the new hospital. The final version, passed yesterday, makes the waiver of the study of need contingent on Howard University finding a new academic affiliation, but it does not require that affiliation be with UHS.

Although councilmembers seemed confident that Howard University officials approved of the compromise, the dean of the College of Medicine, Dr. Hugh Mighty, was striking a different tone last Sunday, when Goulet announced an early version of Gray’s compromise.

After a public forum on the hospital proposal at the Union Temple Baptist Church Sunday evening, Mighty strongly expressed his desire for his students to work in the new Ward 8 hospital. “I’m going to put it bluntly to you standing out here,” Mighty told LL on the steps of Union Temple in Ward 8. “This is the neighborhood. It’s one thing to say you’ll find Howard affiliation agreements elsewhere, but the practicality of that in this District where you have three other medical schools is unlikely in existing hospitals.”

White indicated that UHS would not support these changes either, but said, “at some point we have to do something about it, and not take the dictatorship coming our way.”

This article has been updated to include information about the cost of the hospital and about GW Hospital’s Foggy Bottom location.