DC General Crucial to the Health of the Community
by Vanessa Dixon

April 2001
Volume 38, No. 3

DC General, Washington, DC's public hospital, is the only hospital with the legal obligation to provide care for everyone who lives and works in DC. DC General, an essential part of the safety net -defined as the public hospital, teaching hospitals, clinics, and the Department of Health -is traditionally supported by the government to protect the health of the public.

Our city is fortunate to have in DC General a public hospital that provides excellent quality of care as noted by the accreditation agency, JCAHO, which awarded DC General a rating of 94% - well above the national average. And DC General is the third most efficient hospital in DC according to the DC Hospital Association.

In addition to DC General's unique capacity as the public hospital, it serves the significant role as one of only two hospitals in the eastern half of DC. Nine of the eleven hospitals in the city are located in the western section. DC General serves an expansive geographic area and large population that must continue to have timely access to quality health care. Without appropriate access to the services provided by DC General - particularly Level 1 Trauma (i.e., penetrating wounds) and in-patient services -- the eastern half of DC would become a healthcare wasteland.

Clearly, any plan to substantially reduce services at DC General will cause harm to patients. Evidence of this was provided by DC's chief health officer, Dr. Ivan Walks, who stated, "A couple of folks may exsanguinate [bleed to death] per five years on their way to the [Washington] Hospital Center...That's what we have to do." In fact, diverting patients from DC General to other hospitals already has resulted in loss of life. On February 9, 2001, a patient was taken to Greater Southeast, a hospital without Level 1 trauma, but had to be directed to DC General, the only hospital with Level 1 trauma in the eastern half of DC. Tragically, the patient died en route.

Notwithstanding the life and death impact to DC residents, Mayor Williams is moving full speed ahead with his plans to dismantle DC General.

The Mayor's proposal to dismantle DC General appears to be driven by a financial, bottom-line mentality that, however well intentioned, puts patients at risk. The deadline for dismantling DC General was scheduled in accordance with dire predictions that the City would face a $240 million deficit. However, as of the January 2001 audit, the feared deficit was revealed to be a $240 million surplus. Given this reevaluation, the predicted financial forecast should not drive the extraordinary actions that the Mayor and Control Board are exacting on District residents.

When the Mayor was unable to reach a consensus with the City Council which favors DC General remaining a full service hospital, city officials crafted a Request for Proposal (RFP) to pay a private company to offer the services provided by DC General. City officials selected a bid by Greater Southeast (a for-profit hospital). The Mayor and Control Board are negotiating an agreement to pay this private firm nearly $100 million per year to provide fewer services than offered at DC General, which was allotted only $45 million by the city for the same purpose.

In addition to the life and death consequences of dismantling DC General, there are serious concerns about the devastating impact on the private hospitals. Given the precarious financial situation of most private hospitals, they would be placed at enormous risk if the only safety net hospital -- DC General -- is dismantled. The Mayor's plan has the potential to strain every hospital in town. Quality of care would decline, and those with money would go out of the city for hospital services.

City-wide opposition to the Mayor's plans has been demonstrated by protests at the State of the District address, repeated disapproval expressed by some of the city's most influential ministers, and numerous demonstrations from health care advocacy organizations, care givers, and community activists.

The broad-based medical community supports DC General as the safety net hospital - the American Medical Association, Medical Society of DC, American Public Health Association, National Association of Public Hospitals, and the DC Nurses Association. The medical community warned that in-patient services must remain at DC General. The Mayor's plan ignores health care advocates.

On March 6, 2001, the City Council unanimously passed an Emergency Resolution that opposed the Mayor's plan to dismantle DC General, and it admonishes the Control Board to cease its intervention in this matter. The Mayor's proposal was criticized as poorly and hastily conceived, and the control board's intervention as a rebuke to home rule.

Council members also expressed concern about the finances of the parent company of Greater Southeast Hospital (Doctors Community Healthcare Corporation). Doctors is reported to be financially unstable, never has earned a profit, and is being investigated for fraudulent activity.

Notwithstanding the financial insolvency of Greater Southeast, and overwhelming opposition to the Mayor's plan from the medical community, clergy, DC residents and the City Council, Mayor Williams is moving full speed ahead with his plans to dismantle DC General.

The rising number of uninsured Americans - 100,000 in Washington, DC- makes it imperative for safety net institutions such as DC General to be preserved given the critical role of delivering health care to the uninsured and underinsured. In fact, most of the uninsured are not "deadbeats," but members of a working class family.

As demonstrated in other cities, a public hospital is the cheapest way to provide the greatest amount of care to the largest number of people. And the sizable geographic area served by DC General requires on-site services in the present location. Anything less is just plain dangerous.

We can afford to keep DC General open. The terms of the federal Appropriations Bill have been met, which allows access to $90 million allotted for DC General. Only the Mayor has the power to submit a supplemental bill to fund DC General. The city also could establish a "sin" tax on tobacco and alcohol, use the "Rainy Day" fund, and restore the $200 million reserve by reforming the "Tax Parity Act of 1999."

There is a plan that allows DC General to remain a full service hospital as recommended by the American Medical Association. The plan was developed by DC General's new CEO, Michael Barch, former CEO of GWU Hospital and Assistant Vice President at Johns Hopkins. The plan is called PBC2: Urban Health Campus on Capitol Hill, and it responsibly combines safety net providers with greatly improved primary care.

The Mayor must build an improved health care system, but not by tearing down an essential component of our safety net - DC General Hospital. For centuries, physicians have adhered to the oath, Primum non nocre - First, do no harm. It is against this standard that we must measure the Mayor's plan to dismantle DC General. We can do nothing less.

Vanessa Dixon, Health Care Now Coalition. the Coalition is composed of health care advocacy organizations, caregivers, community activists and labor united to save DC General Hospital. To get involved, call (202) 726-4479.