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The city’s cure for D.C. General’s illness was to pull the plug. But the new D.C. HealthCare Alliance shows many of the same symptoms.

Around 4 p.m. one Wednesday in December, Ronald Spencer affixes his name on the emergency-room log at Greater Southeast Community Hospital. The 45-year-old reports that he’s suffering from chest pains and shortness of breath.

Spencer didn’t arrive by ambulance to the hospital at 1310 Southern Ave. SE, on the eastern edge of Ward 8, where grassless garden apartments, newly constructed town-house developments, and roaming Prince George’s County police cruisers make the border between city and suburb almost indistinguishable. Like the majority of patients in Greater Southeast’s ER this afternoon, Spencer walked in on his own.

And, like an estimated 81,000 of his fellow District of Columbia residents, Spencer has no health insurance to pay for his visit. Unemployed for nearly five years and in recovery from narcotics addiction for a little under one, he says that he supports his two teenage sons with a $355 monthly check from the government and additional help from his family. He brags that he hasn’t seen a doctor since he injured his Achilles’ tendon in the early ’80s, but his wife and another son died from heart-related illnesses in 1994 and 1995, respectively, so Spencer decided to take these warning signs seriously. He doesn’t know how he’ll finance his trip to the ER, which might include a chest X-ray and an electrocardiogram totaling a few hundred dollars.

“I have to take care of my sons, put food on the table, pay the bills…Then maybe I’ll send [the hospital] $25 or so,” he shrugs.

Yet instead of a disapproving head shake or a menacing finger wag at the registration desk, Spencer gets politely directed across the hall to a small room, where he signs up for something called the D.C. HealthCare Alliance. He’s informed that his enrollment in this plan entitles him to free medical services for 30 days, and if he meets three criteria—residency in D.C., annual earnings up to 200 percent of the federal poverty level, and no other health insurance—the coverage will extend to six months, subject to renewal thereafter. Spencer will pay nothing. He receives no other information at this time save a pink carbon copy of his Alliance application, which he’s instructed to use as proof of insurance until his enrollment packet arrives in the mail.

Spencer says he chose Greater Southeast’s ER simply because it was the closest to his house. He had no idea, in other words, that he’d land in the District’s newly rewoven health-care safety net.

This past spring, the D.C. financial control board—with Mayor Anthony A. Williams’ wholehearted endorsement and over the D.C. Council’s unanimous objection—pulled the plug on the taxpayer-funded Public Benefit Corp. (PBC), which managed D.C. General Hospital, at 19th Street and Massachusetts Avenue SE, and eight community health centers. Until last June, the PBC and its flagship hospital provided de facto universal health care to those with no other medical alternative. Most ended up at D.C. General’s ER, which treated urgent and nonurgent maladies alike—from gunshot wounds to ear infections to fallout from all kinds of drunken mishaps. In fiscal year 2000, for example, 31,720 of D.C. General’s 52,000 ER visits were made by uninsured patients.

D.C. General was beloved and mythologized, particularly by the city’s African-American community. It also hemorrhaged money. In its last three years of operation, the PBC overspent its budget by $109 million. More often newsworthy for political scandal than medical achievement, the PBC never lived up to its mission to deliver competent, comprehensive, cost-effective health care to a population sorely in need.

So in one of its last and most significant acts, the control board followed a municipal trend and decided to put the city’s public health infrastructure on the market. It attracted only two bidders. In April, the control board signed a contract worth up to $90 million a year with a group led by Greater Southeast, which eventually called itself the D.C. HealthCare Alliance. Alliance partners include Greater Southeast, D.C. Chartered Health Plan, Unity Health Care, the Children’s National Medical Center, and George Washington University Hospital.

D.C. General Hospital is no more. Its inpatient services shut down in June, and its outpatient clinics and its ER became part of Greater Southeast. The PBC-run community health centers became managed by Unity Health Care in July. In place of the public hospital’s free-for-all, the Alliance instituted an HMO-style health plan targeted to uninsured D.C. residents earning up to twice the poverty level—which means $17,180 for a single adult or $29,260 for a family of three.

It was the control board’s final mandate to put the bad old days of D.C. behind. Gone would be the legendary waits in D.C. General’s ER, PBC-salaried doctors double-dipping at their private practices, and political grandstanding at patient expense. The Alliance promised to deliver a more accountable, integrated, patient-driven health-care system that would make city residents healthier—and the city’s financial books, as well.

The decision met with much controversy, from political rallies to pray-ins at the mayor’s office to one woman’s personal sit-in next to the hospital grounds.

It’s important to remember, of course, that the PBC had been put in place only five years earlier with the same mandate as the Alliance: “The mission of the PBC was ‘to be a community-oriented leader in the delivery of comprehensive, high quality cost-effective, and timely medical care, with a special community commitment to ensuring care for the District of Columbia’s underserved and indigent,’” the control board noted in its request for proposals for the health-care contract. Members of the federally appointed board were aware of a time-honored District tradition: to tear down one system with much hoopla only to replace it with another that acts remarkably similarly.

The Alliance aspires to change the way D.C.’s ill and impoverished get health care, by giving patients primary-care physicians instead of interminable waits in the ER. It promises to deliver more health care for less cost. It says it will be efficient and accountable. Those are all good things. But in another five years, will the District experience deja vu all over again? So far, the Alliance has hardly demonstrated efficiency and accountability. Many patients are confused by the system, and the number of uninsured seeking treatment at area ERs has increased. Reports of how the system has been used and how many taxpayer dollars have been spent have been incomplete.

Meanwhile, the new health-care system’s overseers have been mostly silent during the transition. A mayorally appointed commission charged with oversight, for example, has met only three times in six months and has already changed its chairperson.

The stakes of reinventing this part of government are greater than those of, say, overhauling the Department of Motor Vehicles—a fact driven home when you look at the crying babies, wheelchaired seniors, and others waiting for care at Greater Southeast this particular Wednesday afternoon. Spencer grabs a seat across from a young man slumped over, right hand pressing a handkerchief over a swollen right eye. A few patients watch the AccentHealth TV show for holiday cooking tips, most opt for Judge Judy on another TV, and some—like the three women huddled in the back corner—use their coats as blankets and grab some sleep.

Spencer ends up taking in the entire prime-time lineup before he asks why his name hasn’t been called. Did he leave the building? No, he answers. Was he in the bathroom for too long? How long is too long?, he wants to know. Around 10:20 p.m., he walks out of Greater Southeast’s ER. After more than six hours, Spencer has yet to see a doctor. Although Greater Southeast reports that under 3 percent of its ER patients wait more than six hours—the national average is 6 percent—some of those in the waiting room when Spencer arrived are still sitting there when he leaves. He checks his pocket for the pink sheet of paper. “I guess I’ll try again tomorrow,” he says, before ambling home.

It’s clear that the District has purchased at least one thing from the Alliance for its $90 million, which it already owns in abundance: bureaucracy.

The city’s health-care contract allocates nearly $60 million for nonspecific health services and roughly $9 million to cover administrative costs in its first year. The remaining $20 million funds such things as nurses in D.C. public schools, health care for inmates, and pharmaceuticals. According to the Office of the Chief Financial Officer, $23.2 million was dispersed to D.C. HealthCare Alliance contractors from June 1 to Nov. 29, 2001: Greater Southeast collected $12.3 million; the Children’s National Medical Center, $4 million; D.C. Chartered Health Plan, $3.5 million; and Unity Health Care, $3.4 million.

The quantity and quality of services that the city has bought, however, remain elusive. It’s interesting to note that Unity, the contractor providing the bulk of primary care—touted by the mayor as the cornerstone of the privatized system—received the least amount of dough. “There has been no public information on costs and utilization of the Alliance contract,” D.C. Primary Care Association Executive Director Sharon A. Baskerville testified before the D.C. Council on Dec. 10. The association works on behalf of the city’s medically underserved to improve preventative- and primary-care options. “We have no real numbers nor do we know much about current spending,” she added.

That’s surprising, particularly given the criticism of the PBC’s haphazard approach to billing and record-keeping. The control board underscored the importance of financial accountability in its contract with the Alliance: “The contractor shall supply data to the Authority,” the contract unequivocally states, “…to measure the cost, utilization, and types of services being provided.”

Plus, the District constructed a system of checks and balances to make sure that monitoring of the contract would happen. The D.C. Department of Health—which became the city’s contracting agent when the control board shuttered in September—created a new office called the Health Care Safety Net Administration to review the data, monitor contract compliance, and ensure accountability. The D.C. Council’s Committee on Human Services would provide legislative-branch supervision. And the mayor created a new commission to provide oversight, as well.

On June 7, Williams appointed 38 people to the Health Services Reform Commission. The commission includes an eclectic assortment of government officials, business and labor leaders, and health-care professionals. Populated by some of the District’s loudest noisemakers—including members such as Metropolitan Washington AFL-CIO President Joslyn Williams and Ward 6 Councilmember Sharon Ambrose, who had squared off against the mayor on the closing of D.C. General—the commission promised to be an active and aggressive overseer of the Alliance. Yet after convening meetings twice, mostly for orientation purposes in the summer, commission Chair Bailus Walker Jr. resigned in September. While his seat stayed vacant for three months—crucial months in the Alliance’s embryonic period—the commission remained dormant.

“I have not been in touch with anybody for months,” admitted commission member Paul Offner, a Georgetown University professor and the District’s former commissioner of health care finance, in late November.

“I’ve received no information whatsoever,” echoed commission member Nancy McCall, a former PBC board member and vice president of Health Economics Research Inc. “I think enough time has elapsed that we should have some data that should be useful.”

“To this point, we have been unable to get reports,” announced fellow commission member Baskerville.

The commission met for a third time on Dec. 12, when the mayor appointed Eugene Kinlow as chair. Kinlow’s prior act of public service had been as a member of the control board, which has raised the eyebrows of some commission members: “How eager will he be to criticize something that he helped create?” asks one member, who wishes to remain anonymous.

Minutes after his swearing-in, Kinlow witnessed the many layers of health-care oversight in action. Commission members were distributed packets of information, which included various enrollment, cost, and utilization figures on the Alliance. Alliance representatives in attendance expressed surprise, claiming that the numbers did not match information they had submitted to the Health Department. (The Health Care Safety Net Administration also went rudderless for months, after its director, Shauna Spencer, resigned in the fall. Spencer did not return requests for comment.) The packets were quickly collected. D.C. Department of Health Director Dr. Ivan C.A. Walks then proceeded to walk his staff into an adjacent room and dress them down, according to witnesses.

In fact, information-gathering on the Alliance seems like a shell game. Greater Southeast handed responsibility for Alliance enrollment, utilization reporting, and data collection to D.C. Chartered Health Plan, an HMO that provides health care primarily to D.C. residents on Medicaid. “We are looking forward to participating in the data collection process outlined for this program that will ultimately allow for a high total of accountability,” testified Chartered Chief Operating Officer Karen Dale at a June 22 D.C. Council hearing on the Alliance.

Through December, though, the Alliance’s mandatory monitoring reports offered very little insight into how—and how many of—the program’s enrollees were using its services. Take the Monthly Monitoring Report for September 2001: The table of contents of the 13-page submission promises to contain 15 different reports. Yet some sections, including “Type of Clinic Encounters—By Clinic”—which was supposed to record how many patients visited Greater Southeast, D.C. General, and the Unity clinics for various kinds of care—are completely blank. A note at the bottom reads: “NO INFORMATION PROVIDED—data from claim data insufficient to provide reliable information.” Other listed sections, including “Complaints—Number and Type,” do not even appear among the pages.

Other reports provide information on services provided by Greater Southeast yet remain incomplete in terms of enrollment and clinic numbers.

Chartered denies that the lack of information constitutes a failure to comply with the contract. When asked about the Alliance’s incomplete monitoring reports, both Chartered and Alliance representatives point their fingers back at the city’s Department of Health. “We’ve given them the information,” explained Dale in an early-December interview with the Washington City Paper. “We have submitted the numbers of people being seen and to the best of our knowledge our utilizations….When we have preliminary claim information, we have given it with the disclaimer that we can’t use this data alone, because it’s not sufficient.”

Dale further explained that claims take several months to process—which means a time lag in obtaining accurate information on what services were performed and how much they cost.

Yet Chartered has received poor marks for its record-keeping before. In its recent appraisal of local HMOs, the Delmarva Foundation for Medical Care gave Chartered an 83 percent score, only 4 percentage points above a failing grade. The assessment flunked the HMO on six criteria, including systematic processes, quality assurance documentation, and adequate resources. Another HMO rating outfit, Weiss Ratings Inc., graded Chartered at C- in its most recent review. “[U]nless you are comfortable with a certain amount of risk,” reads Weiss’ Oct. 18 report, “we believe you should consider this company for new insurance purchases only if you have no better option.”

“Rest assured we have submitted [the Department of Health] information,” argues Dale. “I would not want anyone to believe that after this much time of operation we have not submitted information.”

“We have a very positive story,” adds Ana Raley, chair of Greater Southeast. The Alliance had enrolled 18,475 eligible D.C. residents out of more than 24,000 applications as of Dec. 4. Some applicants qualified for other government programs, such as Medicaid, which is 70 percent federally funded. And according to Unity Health Care Chief Executive Officer Vincent Keane, Alliance patients have made more than 8,000 visits to community health centers since July. Unity has arranged for walk-in hours at the clinics, so those with urgent health concerns can seek treatment there instead of trekking to an ER.

So why doesn’t the Department of Health want to help the Alliance tell that story? “I can’t help you with that,” Dale responds. “You might want to ask them.”

Fight night at 13 1/2 Street NW: The D.C. Council’s Committee on Human Services’ public oversight hearing on the D.C. HealthCare Alliance hadn’t yet begun, and it was practically standing-room-only in Wilson Building Room 412. The crowd included Alliance representatives, doctors and nonprofit clinic directors, and more than a few spectators who believed this afternoon’s proceedings might feature more braggadocio—and bloodletting—than Lennox Lewis vs. Mike Tyson.

One week earlier, on Dec. 10, Ward 8 Councilmember and committee Chair Sandy Allen had delivered a knockout punch to Walks when she refused to let the Department of Health and Alliance contractors tell their health-care success story to her committee. Allen waved two three-ring binders in the air, explaining that fellow committee member David Catania had requested information about the Alliance from the Department of Health with a due date of Nov. 30. Walks delivered the department’s voluminous response—more than 400 double-sided pages—to Allen on Sunday, Dec. 9, at 2 p.m., less than 24 hours before the Monday hearing.

Allen viewed the late response as a deliberate strategy to keep the council in the dark. “I’m outraged that you would even put me in that position with my colleagues,” she scolded the director. Allen announced that she would reschedule government and Alliance witnesses for the following Monday. Walks sat at the witness table in disbelief, as Allen repeatedly ignored his requests to speak.

She then proceeded to call other witnesses.

Walks—who became a national celebrity during the recent anthrax scare, appearing cool and collected on Nightline and CNN—became so enraged that he had to be physically restrained by his staff. He stormed out of the council chambers moments later. Allen made her message succinct: Walks and his boss couldn’t hide behind control-board fiats anymore.

What remained to be seen was whether the council would let bygones be bygones, as well. “We’ve lost the battle on D.C. General,” Allen proclaimed in her Dec. 17 opening statement, “but we’re going to win the war on quality health care in the District of Columbia!” It was clear that Allen and her colleagues considered Walks and the Alliance as the Axis in this war, not the Allies. Catania harped on the new health-care safety net’s finances, arguing that the privatized system had come up short in its promise to provide more care for less dollars. “I’m struck by how little this contract and this reality resemble,” argued Catania at one point. “We were promised a 34 percent increase in health care with a 25 percent reduction in cost.”

Yellow Post-it notes sticking out of his binders, Catania had spent his week studying. He rattled through various statistics, including the number of inpatient and outpatient visits the Alliance had provided. “Madame Chair, we’ve received exactly 18.8 percent of what we were promised!” he proclaimed.

“It means everyone’s lives have been put at risk!” Catania continued.

Catania cited ER temporary closures as an example. According to the D.C. Fire and Emergency Medical Services Department, emergency-room closures, or “blackouts,” have increased since the Alliance, especially at Greater Southeast, George Washington, and Howard University Hospitals—as well as at Prince George’s Hospital Center. For example, in August 2000, Howard diverted ambulances from its emergency department for a total of seven hours. In August 2001, the blackout time was 216.5 hours—an accumulated total of nine days. Greater Southeast’s diversions in August 2000 totaled 32 hours; in August 2001, they added up to 240.5.

“We knew when this was proposed that this would endanger people,” Catania warned the audience. “We are going to get one-third less care—not one-third more—for the same amount of money.”

Ward 7 Councilmember Kevin Chavous eventually strolled up to the dais, eyeing the crowd. Walks had not made his appearance in the chambers yet. The director, Allen had explained at the beginning of the hearing, had spent the morning testifying on Capitol Hill. Allen asked her colleague for an opening remark. “I want to make sure Dr. Walks is here when I make my statement,” Chavous replied.

Chavous then meandered in and out of the chamber, as Catania pointedly jabbed witnesses. All Alliance contractors got a taste, especially Unity’s Vincent Keane, who oversees the primary care that Catania seemed so concerned about.

Catania also attacked Chartered’s Dale, noting that a contract modification had altered the way the city pays Alliance contractors: Instead of the initial claims-based system, the city doled out lump-sum payments for the first six months of the contract. That meant that Greater Southeast received $2 million per month for health-care services, no matter how many ER visits or surgeries were performed on Alliance patients. “How much have we paid Greater Southeast?” Catania asked Dale at one point.

“Technically, I’m not in claims,” Dale responded.

“Ms. Dale, who is in charge of the numbers?” Catania countered.

Three hours into the hearing, Walks finally approached the microphone. “Each year we were spending more and getting less,” he read from prepared testimony. “The ongoing poor health of our neighbors…mandated a change. In order to avoid that change, those who could not manufacture a plan manufactured and marketed fear. They enjoyed the support of radical fringe groups….They predicted doom and death. Their predictions were wrong.”

Catania and Chavous huddled; “those” clearly meant them.

“Today, Dr. Walks, are citizens getting 30 percent more health care for less cost?” Chavous asked, putting a question mark on a common refrain of the mayor’s.

“The answer is no,” Chavous cut off Walks, before the health director could answer. “Today, they’re not.”

Chavous then launched into a story recycled from the previous hearing, about an ambulance ride with a Langston Terrace resident suffering an asthma attack. The ride, Chavous claimed, took over half an hour. “You’re going to tell me that that citizen didn’t suffer?” Chavous asks.

“Mr. Chavous,” Walks huffed, “I think it was traumatic for you to experience that.”

Chavous didn’t laugh at the comment. “We all know how to connect dots. We connect ours; you connect yours,” he told the health director. “I’ve ridden on ambulances; I know the mayor hasn’t.”

While Chavous was thus making his mayoral intentions known, Catania remained in pursuit of something else for the time being. “You cannot tell me—if you are the brains of the outfit—you cannot tell me how much you’ve billed the city? How am I supposed to have more confidence in you than the PBC?” Catania asked Greater Southeast Chief Executive Officer K. Singh Taneja, who was sitting at the table with Walks. “I remember the PBC being faulted for not reconciling its billing!”

Catania had connected his own dots. “There is no institutional oversight of this contract,” he thundered toward the end of the hearing. “This is Camp Run-Amok: The Sequel!”

Alliance providers willingly admit that not everyone’s thrilled with the District’s new approach to delivering health care—especially those who live in the suburbs. One of the three basic qualifications for free medical care is D.C. residence. “A lot of people that were being treated at D.C. General were from out of state,” explains Greater Southeast’s Raley. “We weeded out a lot of people that were from Maryland and Virginia.”

Alliance providers point to that fact when explaining lower-than-expected utilization numbers, but not all those falling through the city’s safety net live in the mythical “Ward 9.” “D.C. General had a mandate to serve patients regardless of ability to pay. The Alliance serves folks below 200 percent of poverty,” notes Alliance for Fairness in Reforms to Medicaid Executive Director Pat Thompson, who also serves on the Health Services Reform Commission. “What happens to people who present who are above 200 percent of poverty?”

Or, as Catania put it at the Dec. 17 hearing: “If you make $8.27 an hour, you’re SOL.”

By law, hospitals must stabilize the condition of patients who appear on their doorsteps with medical emergencies. But statistics demonstrate an increase of uninsured patients showing up at area ERs with nonurgent maladies. The hospitals close to Wards 5, 6, and 7, where D.C. General drew the majority of its patients, have felt the most impact. “Folks are just voting with their feet,” says David Sparks, senior vice president for Providence Hospital, in Ward 5. Sparks notes that ER visits for self-pay patients increased 25 percent at Providence, inpatient self-pay admission skyrocketed up 130 percent, and outpatient visits grew 20 percent from May through July 2001.

That’s why area hospitals and the D.C. Hospital Association argued against the closure of D.C. General. They knew that many of those patients would end up at their door—without insurance or any other means to pay.

“I sent a letter in August to all the hospitals to join the Alliance,” counters Raley. “None of them joined.”

Other D.C. health-care providers have been more willing to work with the Alliance. According to the D.C. Primary Care Association, two-thirds of D.C.’s uninsured—or approximately 55,000 people, totaling nearly 200,000 visits per year—receive health care at the city’s 13 nonprofit clinics. “The broader goal of this Alliance is to create an integrated health-care system,” explains George Jones, executive director of Bread for the City.

In 2000, according to the city’s Nonprofit

Clinic Consortium, Bread for the City/Zacchaeus Free Clinic had 6,852 visits from 2,550 patients.

“You should look at the Alliance as a coordinator of care. It’s just not about dollars,” Raley agrees. “Our aim is to make sure care is very coordinated, that there’s communication among all providers.”

So far, that’s been difficult. In the initial contract with the Alliance, nonprofit clinics were expected to provide “maintenance of effort,” meaning that they would continue to provide a certain amount of free medical services for the indigent, despite the creation of the new municipally funded system: “All other providers in the District of Columbia, including program providers, will be expected to continue to provide at least their historical levels of charity care…during the term of the Agreement,” reads the contract.

That creates a two-tiered system, though, because the Alliance offers a much broader range of services, such as access to specialist care and prescription drugs. Some uninsured patients believed that they were forced to choose between the clinics, which had been their historical health-care provider and medical home, and the Alliance. The Alliance now allows nonprofit providers access to specialists in its network. But, clinic workers complain, specialist participation has been unreliable. And when specialists do see Alliance patients, confusion still ensues.

Dr. Gloria WilderBrathwaite, who runs Children’s Hospital’s mobile health programs, offers one of her young Alliance patients as an example.

WilderBrathwaite was the boy’s primary-care physician through the mobile clinic. But when she wanted to refer him to a cardiac specialist in the Alliance system, WilderBrathwaite found out that she couldn’t make the referral. Instead, her patient needed to go through the Alliance gatekeeper: a primary-care doctor at one of the six Alliance community clinics. The boy’s parents became unsure of whom they should turn to for health-care, WilderBrathwaite or the new doctor. “That confused the heck out of patients, because their nonprofit providers were their medical homes,” explains WilderBrathwaite. “It’s breaking continuity of care.”

In fact, some patients who have historically sought care at the nonprofit clinic So Others Might Eat wrote to the mayor asking that he let them remain patients at SOME.

Even when patients remain with the nonprofit clinics, doctors outside the Alliance have had trouble gaining access to tests and to information from the system’s specialists. “If there’s anything the Alliance needs to focus on…it’s the flow of care,” says Jones. “I think the reason we need to act fast is because it’s such a new system—its whole success is at stake right now. It really does hinge on responding to the early troubles.”

In recent weeks, the Nonprofit Clinic Consortium has negotiated with the Alliance about becoming part of the Alliance system. Providers remain hopeful that the kinks will be worked out. “There’s real potential here,” asserts WilderBrathwaite, who serves on the Health Services Reform Commission. “That’s why I feel it’s so important that we don’t screw it up. The plan is a really good plan. If it’s carried out well, we could really change things.”

The Alliance bears more than a metaphysical resemblance to the PBC. It looks like the PBC physically: D.C.’s newly privatized health-care system inherited D.C. General’s ER, outpatient clinics, and neighborhood health centers. Alliance patients at the former D.C. General, in fact, seek treatment by walking through halls with empty gurneys, boxes of latex gloves, and abandoned computer equipment.

Many of the clinics are in need of repair, as well. The city has allocated $11.8 million to improving health-care facilities. The capital budget includes $1.4 million to build a new Anacostia Community Health Center. The current center occupies a temporary building with no windows.

But the city and the Alliance have yet to spend those funds.

Unity Health Care’s Keane says that changes will be made soon. “The PBC moved out Friday, July 13, and we moved in Monday, July 16,” he explains. “I don’t want to point fingers at anybody, but it was a mess….There were systemic problems that we had to undo, both from the patients’ perspective, not only about how they could access care, but in terms of inheriting unclean, unkempt clinics and health centers.”

One other expected change hasn’t been made. When the Alliance took over D.C. General, its ER ceased serving as a Level 1 trauma center. The Alliance announced that it would open a new Level 1 trauma center at Greater Southeast, which had closed its own trauma unit in 1987. The contract set an August deadline for Greater Southeast to open the trauma center. The contract also specified that Greater Southeast receive $116,627 per month for trauma services.

August has come and gone, and Greater Southeast still has no trauma center. In August, the hospital’s parent company, Doctors Community Healthcare Corp., even floated the idea of building a new hospital on the D.C. General campus. City leaders expressed surprise at that proposal, and also at Greater Southeast’s suggestion that it might not build its own trauma center after all.

“They’re reneging on their agreement to provide trauma,” says Vanessa Dixon of the Health Care Now Coalition, a union-backed group that fought the closing of D.C. General. “Trauma requires immediate treatment. You’ve got the greatest incidence of illness happening on the eastern half of the city—where there’s Greater Southeast and where there was D.C. General—and you’ve got more trauma, more severe cases of illness, and you’ve got to transport people from that part of the city to the other side of the city when minutes count. It makes no sense.”

In fact, a close reading of the Alliance contract reveals that Greater Southeast doesn’t have to open a trauma center at all.

Section 4.3.5 of the contract’s Exhibit A reads: “Contractor shall initiate Comparable Trauma Services at Greater Southeast Community Hospital no later than August 31, 2001, and maintain such Comparable Trauma Services for the duration of the Agreement…”

At which point there is a semicolon—”…;provided, however, that if Contractor is unable to initiate such Comparable Trauma Services at Greater Southeast Community Hospital by August 31, 2001, Contractor shall ensure the availability of such services through agreements with other providers within the District of Columbia.” The Alliance has contracted with George Washington University Hospital for trauma services .

D.C. has five Level 1 trauma centers; the city of San Francisco, by comparison, has only one. In fact, the need for another Level 1 trauma center is at issue. But Alliance officials don’t engage in that conversation. They defend themselves by attacking the standard of trauma care formerly available at D.C. General. “There is a fallacy out there that D.C. General had accredited Level 1 trauma care,” argues Raley. “They had Level 3 trauma.” Indeed, in 1999 the American College of Surgeons failed to give D.C. General Level 1 accreditation.

Alliance officials say they still plan on building that new trauma center on Southern Avenue SE. “Greater Southeast is committed to handling those patients that require trauma services,” says Raley. “We’re working on that.”

And Raley defends the quality of care available through the Alliance at Greater Southeast. “We’re comparable to the other emergency rooms,” argues Raley. “The only thing is that we’re being watched very, very closely.” CP