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D.C. General cutbacks portend ER ‘disaster’
City’s trauma needs go unmet now, private hospitals warn
(Published August 28, 2000)
By OSCAR ABEYTA
The radical downgrading of services at D.C. General Hospital proposed by its governing board could severely hamper the ability of other hospitals in the city to deliver emergency care to residents and could lead to the closure of other trauma centers in the District, the president of the city’s hospital association warns.
"The nation’s capital has more need for emergency room services at trauma Level I than we frequently have room for in the city," D.C. Hospital Association President Robert Malson told The Common Denominator. "If you take D.C. General out of the mix it would be a disaster."
The Public Benefit Corp. (PBC), which oversees D.C. General and the city’s eight public health clinics, voted Aug. 25 to downgrade the hospital’s emergency room from a Level I trauma center, eliminating most emergency services that would treat seriously injured automobile accident victims or life-threatening injuries like gunshot wounds.
Malson said any major change to the services provided by D.C. General’s trauma center would be felt throughout the city. Malson said most hospitals’ emergency rooms lose money and asking them to absorb more uninsured patients would negatively affect emergency care for all D.C. residents.
"What you might get is a domino effect of other hospitals closing their emergency rooms in response," Malson said.
The PBC board also voted to eliminate most in-patient care at the hospital and replace it with an "emergency access center." The new center would be able to treat only patients who could be discharged or transferred to another hospital within 24 hours of admission. The restructuring of D.C. General will mean the loss of 550 hospital jobs, probably starting as soon as Oct. 1.
Malson said representatives from the hospital association’s 17 member hospitals met with PBC Chairman Julius Hobson in July and expressed their concerns about any proposed closure or downgrading of D.C. General’s trauma center. The association also sent letters to House and Senate members detailing their concerns. As part of the city’s fiscal 2001 budget, Congress is considering a ban on use of local government funds as a line of credit to cover cash-flow problems at D.C. General – something the PBC has needed to rely on to stay afloat.
"Private acute care hospitals are able to absorb only some of the services provided at the PBC," the association’s letters state. "Private acute care hospitals are not able to absorb such services as adult trauma care…The private hospitals believe that the PBC should continue to provide these acute adult medicine services. It is important to note that any reduction in emergency services at D.C. General Hospital would be disruptive to all of the other crowded/overcrowded emergency rooms."
According to audited figures provided by the hospital association, D.C. General absorbs almost 40 percent of the cost of treating the District’s uninsured patients, totaling about $80 million worth of medical services for which it is not compensated. D.C. Department of Health figures show that half of all patients treated by D.C. General Hospital and the city’s clinics are uninsured.
A spokeswoman for Mayor Anthony A. Williams said the administration has put together a contingency plan for the total closure of D.C. General if the PBC board recommends that as an option.
"The system that the mayor wants to put in place is one that expands health care coverage and options to District residents," said Lydia Sermons, the mayor’s director of communications. She would not say whether the mayor is committed to keeping the public hospital open.
Private hospitals in at least one other city have not fared well after the closure of their city’s public hospitals. After Detroit and surrounding Wayne County, Mich., closed their public hospitals in the early- to mid-1980s, the city’s remaining hospitals saw an increase in uninsured patients at a time when insurance companies and Medicare were paying out less for claims, according to Vernice Anthony, who was director of public health for Wayne County at the time.
"The safety net is extremely frayed without some level of government addressing the needs of the uninsured," Anthony said.
She said that in the past two years, two of the city’s nonprofit "safety net" hospitals have closed because of budget problems, making it more difficult for the remaining hospitals to deliver care to the city’s uninsured population.
"There still is over-bedding," she said, referring to an excess of unused hospital beds in the city, "but the load at emergency rooms has increased. Also, demand for primary care for uninsured patients at the city’s clinics has increased. The waiting list is as long as three months at some clinics."
Besides D.C. General, at least four other hospitals in the District have faced financial crises in recent years — Greater Southeast Community Hospital, Georgetown University Medical Center, George Washington University Medical Center and Columbia Hospital for Women.
A spokesman for the PBC said the board has received a study of its health clinics conducted by the U.S. Department of Health and Human Services and could make a decision regarding the future of the clinics as soon as Sept. 1.