Credit: Darrow Montgomery

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The George Washington University Hospital has the District over a barrel. And the D.C. Council is thinking of giving away one of the city’s biggest bargaining chips.

Last week, the Council gave initial approval for a bill that sweetens the deal for GW to operate a new hospital to be built in Ward 8. It would serve an area that desperately needs one, with about 150,000 people living in about 20 square miles, and virtually no specialty care services. The bill waives the project’s Certificate of Need, a months-long regulatory process that evaluates whether a proposed health facility is, well, needed. The Bowser administration backs this bill.

The city chose GW to run the new hospital in August, and the new waiver would naturally accelerate the opening of a 150-bed hospital on the St. Elizabeths campus. 

But the deal comes with a significant and controversial caveat: That same waiver would apply to GW’s existing operation at its Foggy Bottom hospital. The university says it needs 270 more beds there to finance the Ward 8 hospital, stat—or the whole deal is off. 

That’s riled up some activists and councilmembers, who liken GW’s bargaining tactics to “blackmail.”

Critics argue that moving forward without a Certificate of Need could push the District’s health care inequities further out of whack, adding a significant number of beds in Foggy Bottom, and with no public study of the need there. Supporters say that the dire health care situation in Southeast D.C. is a crisis in need of an immediate solution. 

In the middle stands Ward 7 Councilmember Vince Gray, who is casting for a legislative triumph to cement his record. The Council’s 10-2 initial approval of his bill is a step toward establishing a health care system in wards 7 and 8 that he tried to build during his one-and-done term as mayor.

“Had I still been the mayor, this hospital would have been finished next year,” Gray says.

He’s now rolling the dice on an issue that could establish his legacy either as the man who built a health care system east of the Anacostia River, or the one who gave one medical corporation an inordinate amount of power in shaping health care for the whole city.

“There’s got to be a sense of urgency about this,” Gray says. “People are dying, moms don’t have a place to have their babies. It’s completely unacceptable.”

***

When you ask Vince Gray “what happened with the new hospital after you lost the mayoral election?” he’ll correct you. Four years after voters traded Gray for Mayor Muriel Bowser, the defeat still stings the 76-year-old lawmaker.

He didn’t lose, Gray will tell you; the election was stolen from him—and along with it the momentum to build a new hospital east of the Anacostia River.

Currently, the United Medical Center is the only hospital located in Ward 8. And it’s crumbling. The District purchased UMC in 2010 at a foreclosure auction. By 2014, as problems with the public hospital mounted, then-Mayor Gray had set aside $336 million in his proposed budget for fiscal year 2015 to build a replacement. 

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But Gray lost the election after his mayoralty was tainted by a shadow campaign in 2010 that involved upward of $660,000 in off-the-books spending and ended with guilty felony pleas from six people connected to his campaign. Then-U.S. Attorney Ronald Machen ended the investigation in 2015 without charging Gray. But Gray believes his 2014 re-election campaign was doomed by the specter of criminal charges that never materialized. 

Bowser rode the shadow campaign scandal to victory, and her administration and the Council shredded Gray’s hospital plans.

In a 2014 letter to Council Chairman Phil Mendelson, Gray criticized the Committee on Health’s decision to cut money he’d set aside for the new hospital as “inexplicabl[e]” and “arbitrary.”

“Make no mistake, any councilmember who votes to cut funding from this project is voting to deny the residents of wards 7 and 8 access to a nearby hospital,” Gray wrote.

Yvette Alexander, the former Ward 7 councilmember, who chaired the health committee at the time, tells LL that the funds were never attached to any concrete plans, nor was an agreement with a hospital operator in place. So they decided to address more immediate needs.

In the meantime, UMC has been haunted by mismanagement, layoffs, and deaths that Gray believes were potentially avoidable. In late 2017, the D.C. Department of Health decided to permanently close UMC’s maternity unit, leaving women east of the Anacostia River without access to obstetrics care.

Since his return to elected office, Gray has been sharp in his criticisms of Bowser’s tenure. Yet with the ball rolling on a new hospital to be built in Ward 8, Gray is more tepid in his rebuke, declining to name names.

“I think whoever was making decisions at that stage concluded that there was not going to be a new hospital, and we’ll just keep moving along,” he says.

And whose decision was that?

“I guess the current administration,” he says with a grin.

***

At a health committee hearing on Oct. 26, Ward 2 Councilmember Jack Evans asked Kimberly Russo, CEO of the George Washington University Hospital, if she had been in discussions with the District about the regulatory waiver. 

“I did not expect this waiver or request this expedited timeline,” she said, then assured Evans one more time. “I did not.”

Amid discussions over the proposal, District officials told GW that the hospital needed to seek the waiver through the D.C. Council.

Gray ultimately introduced the bill to waive the requirement in September. Russo supports the waiver, telling Evans a Certificate of Need is “very tedious.”

Interim Deputy Mayor for Health and Human Services Wayne Turnage says that he is also supportive of the Council’s exemption.

How the city came to pick George Washington is another story. The city enlisted health care consultants Huron for $996,000 in May 2017 to search for a new operator. The firm approached top area hospitals to solicit proposals, eventually turning up two top bids for the city: the George Washington University and a joint bid from Howard University and Sibley Memorial Hospital, run by Johns Hopkins, according to a person with knowledge of the proposals.

The city sought an operator with a reputable name, one that could attract patients from all wards. George Washington fit the bill.

“To be frank, the differences in the quality of the proposal were striking,” said a District official involved in the negotiations, speaking on background. “GW had an extensive proposal,” while the joint bid was “thin” and “demanded more of the city and offered little in return.”

A team of District officials—led by the office of City Administrator Rashad Young—received the bids last spring and reviewed them throughout the summer.

Russo testified that the hospital would not be able to financially support running the Ward 8 hospital without expanding its Foggy Bottom facility. Despite co-introducing the four-page bill, Evans—who admits he did not fully read it initially— calls the move to sidestep the Certificate of Need “unprecedented.” But he knows why George Washington wants it.

“These are the money-making beds,” he says, pointing out that the GW University Hospital is a subsidiary of a Fortune 500 company, Universal Health Services. “So, it’s a windfall for this hospital, for this corporation, to get those 270 beds.” 

The Council has already approved over $325 million to build the new facility. Gray’s plan also includes urgent care and ambulatory facilities in wards 7 and 8. The Bowser administration plans to finalize and deliver its agreement with GW to the Council early next year. The hospital is on schedule to open by 2023, but Gray wants it by the end of 2021.

***

When it came time for the initial discussion to waive the Certificate of Need for the new hospital facilities, councilmembers generally landed in one of two camps.

On one side, stood councilmembers Evans and Elissa Silverman and Chairman Mendelson. No other ward pol wanted to oppose a project outside their ward, a council staffer noted, and few at-large members want to be seen as against building a hospital in a health desert—even if they oppose the waiver for Foggy Bottom. 

Silverman points to the 2017 Health Systems Plan released by the Department of Health, which shows gaps in specialty services “particularly for low-income residents,” many of whom live in wards 7 and 8. She supported failed amendments to the bill that would have removed the Foggy Bottom waiver, but ultimately voted in favor of the whole bill. 

“GW has every right to negotiate to its benefit, but the District needs to negotiate for the public good, and this should raise red flags for us,” Silverman says. “Why does GW want to avoid the proper analysis and public input? This process would ask them to give us clear and convincing evidence that the proposed hospital in Ward 8 and the expansion in Ward 2 meets not only the health needs of residents, but is accessible, high quality, and has continuity and coordination of care.”

She also points out the irony that the Council is trying to enforce a Certificate of Need to slow the imminent closure of Providence Hospital in Northeast, but is waiving it for GW.

“This inconsistency makes us look silly,” she says.

On the other side of the debate are Gray and Ward 8 Councilmember Trayon White, who say the abysmal state of health care in their wards is a crisis that has festered for too long. Essentially, human lives must trump bureaucracy.

“Just now, at 5:56 p.m., in the 1800 block of Alabama Avenue Southeast, there was someone shot,” White said from the dais Nov. 13. “Now that person has to travel from Alabama Avenue to Northwest or to [Prince George’s] County … to get treatment, and the reality is the more we wait, the more people … are losing their lives … because we are letting the bureaucracy of what happens down here get in the way.” 

For all his support of the new hospitals, Gray tells LL that he has so far been excluded from negotiations between GW hospital and the administration, though he has promised fellow councilmembers he will hold a health committee hearing  to evaluate the final proposal. (Though by then, the deal will have been finalized, and it’s unlikely any changes will be made.)

“I think anything of this magnitude with this great of a need, if it’s accomplished, it’s going to be a legacy item,” says Jimmie Williams, chair of Ward 7 Democrats. “Just because it’s a major item that the community needs.” 

Gray, for his part, says he’s focused on solving the health care problem, not his legacy.

“It’s one of the reasons I came back: To focus on these issues and get a solution to them,” he says. “It didn’t seem to me we were moving in the right direction at all.”