Dissed, dismissed, and shut down, D.C.’s public hospital is back in the spotlight.
Theodore Gordon, chief operating officer for the D.C. Department of Health, wants to make one thing clear: “There is no more D.C. General,” he says. The institution that served for 195 years as Washington’s major source of care for indigent patients and settled at a site in Southeast Washington in 1846 no longer exists. It officially ceased operations on June 25.
You might not know that from watching the news, however.
Following the deaths of two postal workers from inhalation anthrax, Department of Health Director Dr. Ivan C.A. Walks held an Oct. 22 press conference in front of the old hospital and urged postal workers to “immediately come here to D.C. General to receive prophylactic medication and be evaluated.”
The next day, Walks reiterated the call: “We, again, are asking for, immediately, people to be brought or to come to D.C. General to receive the medication they need so we can help keep them safe and protect the public health.”
Suddenly, the hospital that even the poor and destitute tried to avoidby the end, more than 90 percent of D.C. Medicaid patients were seeking treatment elsewhereis the epicenter of the nation’s public-health response to a series of bioterror incidents.
Call it the revenge of D.C. General.
Over at the old hospital building, a woman directing District mail handlers who’ve answered Walks’ call barks, “Brown door on your right” to anyone who looks lost.
She’s not talking about the building’s front entrance, where patients still pick up prescriptions at the pharmacy and a plaque honoring former hospital Director John A. Fairman still hangs “in recognition of excellent service.” And she’s not talking about the emergency entrance, because there are no longer trauma services at the facility.
The “brown door” is a side door that patients use to get to Greater Southeast Community Hospital’s Ambulatory Care Clinic on one of the upper floors of the old D.C. General building. Greater Southeast has taken control of the remaining operations at the former hospital, but, because none of those involve inpatients, the facility is no longer even technically a hospital. The big sign on its front that once read “D.C.G.H.” and “D.C. General Hospital” now reflects that change. It now reads “D.C.G.” and “D.C. General.” It looks lopsided, as if the “H” had just fallen off.
Once inside the door, patients are directed to the left, where a volunteer hands out forms to be filled out. Since anthrax spores were found at multiple locations throughout the city on Oct. 26, the ring of individuals thought to be at risk has been expanded to include anyone who handles a large volume of mail at any of 4,000 different government and private offices. A man in the waiting room who works at the Bureau of Labor Statisticswhich receives massive deliveries of survey resultssays that the entire federal agency has been sent in to receive preventive treatment with the antibiotic ciprofloxacin.
“We’ll take anyone who comes,” says a female U.S. Postal Service employee, handing out the forms.
Not everyone who has come to D.C. General in recent days has received that warm welcome. Some postal workers workers from the Friendship Station office, where traces of anthrax were found this week, were bused to D.C. General on Tuesday but then turned away without receiving medication. Walks has apologized for the miscommunication and assured the workers that the Health Department would bring the medications to them instead. “There clearly was a problem down there,” he said at a press conference that afternoon.
Those patients not turned away fill out the paperwork as they wait in chairs placed along one side of a long hallway. Every few minutes, groups of five are taken from the front of the line and everyone moves up a few chairs. Forms are collected by a mix of staffers from the D.C. Department of Health and the U.S. Public Health Service. Some 200 people are staffing the center, says Gordon50 from the federal agency and the rest from the local one.
The irony of having the nation’s first public-health response to a bioterrorist event taking place at the recently shuttered D.C. General is not lost on those staffing the antibiotic-distribution center. “They didn’t think it was necessary to keep it open, but in a crisis situation, it’s what they fall back on,” says one Department of Health employee pulled from her regular disease-prevention duties to work at D.C. General.
Nor is it lost on those who fought long and hard to keep the hospital open. “The sad irony of what we’ve been facing with this national tragedy is that it highlights how much we need this hospital and how much we need a public hospital,” says Ward 7 D.C. Kevin Chavous. “We should never have closed it.”
Over in “Briefing Room 2″formerly the Patient Waiting Rooman employee of St. Elizabeths Hospital tells a room full of anxious mail handlers about the infection in question. “Good afternoon,” he says. “My name is Melvin Williams, and I’m here to talk to you today about anthrax.”
Williams, a doctor, takes the assembled through a brief, informative presentation on the four kinds of anthrax infectionsinhaled, cutaneous (skin), intestinal, and oropharyngeal (throat)and how infections can be treated. “Anthrax is very treatable,” he says. “It’s a wimpy germ.”
Department of Mental Health counselor Alvin Hinkle, who normally works with troubled teens, follows up with a short speech on responding to terror and how to calm down. “Burn incense, maybe take a relaxing bath,” he recommends.
After the briefing, patients are shuttled over to an adjoining room to get their medications. There are two lines: “express prescriptions”dispensed below a sign that says “Code Blue Equipment”and regular. Patients reporting any flulike or other symptoms must take the regular, longer line, where they to talk to a pharmacist or, depending on the severity of symptoms, an on-site doctor.
The worried visitors then wait in line for a turn at one of eight dispensing stations staffed by pharmacists sporting the neat beige uniforms of the U.S. Public Health Service. Other pharmacists wear the service’s dress uniforms: white shirts with little gold-and-black epaulets. Seated at two rows of desks, four to a row, they look like a cross between naval ensigns and bank clerks.
From start to finish, the process takes about 45 minutes, says Gordon.
“The patients have been very cooperative and very nice,” says pharmacist Samuel Wu, whose day job is as project manager in the Food and Drug Administration’s Center for Drug Evaluation Research. “They’ve been very patient patients.”
More than 13,000 people have received antibiotics at D.C. General since the center opened, on Oct. 22.
The National Disaster Medical System is on the scene. So is the Commissioned Corps Readiness Force of the U.S. Public Health Service, an elite wing of the surgeon general’s medical troops. The Centers for Disease Control have been providing advice. The American Red Cross, the Salvation Army, and the Hotel and Restaurant Association have been providing food and drinks to the center’s workers and patients alike. And the U.S. Postal Service has been providing support services and transportation for its workers.
But the command and control of the shop have been in the hands of the D.C. Department of Health. “It was a huge effort of manpower to make this happen,” says Jack Pannell, an aide to Walks. “And it still is.”
Gordon and Department of Health Deputy Director Larry Siegel split the command responsibilities for the center. And D.C. General is just one of the facilities identified by the Health Department to be pulled into use in the event of an attack. Gordon says he “can’t disclose” the others, but contingency planning for future attacks is ongoing.
As for D.C. General, “The grounds are perfect,” said Walks at a press conference. “They’ve got a lot of space. You can get a lot of people there….There’s a facility that has proven it can handle a large number of people.”
In short, if a facility such as D.C. General didn’t exist in this latest public-health panic, the Department of Health would have had to invent it. Luckily, it’s still there to recycle. CP