Re: the proposed closing of D.C. General Hospital (Loose Lips 2/23):

Drawing on my position as a physician and board member of the Public Benefit Corp., which oversees D.C. General Hospital, as well as my background as a medical director for a four-hospital system in Northern Virginia and my master’s degree in health policy from Georgetown, I contend that the mayor and control board’s plan will not improve either care or access to care. It appears to be designed simply to control costs and to force more uninsured patients into private hospitals. The proposal under final negotiation is an “insurance-plan” scheme that would use constraints on eligibility, on access to inpatient care, and on utilization of services to limit what the city will pay for care of the uninsured. The scheme would remove all inpatient services from D.C. General—which, located by RFK Stadium, is ideally located to serve Capitol Hill and both the northeast and southeast quadrants of the city. The plan calls for the “shifting” of services to the for-profit Greater Southeast Hospital, located on the D.C.-Maryland border at the southernmost part of the city. However, most former D.C. General patients would simply migrate to the closer emergency rooms of Washington Hospital Center, Providence Hospital, George Washington University Hospital, and Howard University Hospital. Patients who presented to the free-standing emergency or clinic services to be retained at the D.C. General site would have to be transported by ambulance to surrounding hospitals for any needed surgery or hospitalization. Although touted to promote primary care, the mayor’s scheme would do so at the expense of inpatient care and in a manner that would needlessly shift costs to already financially fragile private hospitals.

The local community’s outcry has been echoed by a medical and hospital community that has consistently opposed the mayor’s plan as clinically unsound. A Feb. 6 Medical Society of the District of Columbia press release reviewing the mayor’s efforts states that “the plan to eliminate or downsize acute care beds at DC General will, in fact, cause harm to patients…” A March 1 D.C. Hospital Association press release cites concerns over the greater potential for overcrowded hospital intensive-care units and for worsening delays in already overcrowded emergency departments. No medical, hospital, or public health organization will endorse the plan—so shouldn’t we take the time to time develop an alternative that addresses everyone’s clinical and access-to-care concerns?

Nobody believes that D.C. General should simply continue as it has been currently run. Clearly, new facilities and major reforms are needed. With 52,000 emergency-department visits, 98,000 clinic visits, and 9,000 admissions annually, the hospital plays a vital clinical role in the city. More than 5,000 patients choose PBC physicians as their own primary-care providers. With hospital accreditation scores of 92 percent in 1997 and 94 percent in 2000, the staff is clearly persevering under what D.C. Council Chair Linda Cropp acknowledges has been an “underbudgeted” mandate—with a $45 million annual subsidy being used to support about $70 million in uncompensated care.

Most of the financial problems of the PBC resulted from poor support from District agencies and poor financial/billing systems.

Isn’t it time for the mayor, the D.C. Council, and the control board to listen to the community and work out a compromise that truly addresses the needs of patients in a manner that is acceptable to the local and the health-care professional communities?

PBC Board