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Health plan cuts ICU
Proposal eliminates 25 of cityís scarcest beds
(Published March 12, 2001)
By KATHRYN SINZINGER
In the midst of a "critical shortage" of intensive care beds at the Districtís hospitals, the contract under negotiation to privatize the cityís public health care services would eliminate 25 of the 27 ICU beds currently operated at D.C. General Hospital.
Control board spokesman Glenn Dixon confirmed March 9 that the ICU beds would be replaced with "telemetry beds" in a contract under which Greater Southeast Community Hospital is expected to soon take over the Public Benefit Corp.ís responsibility for treating an estimated 65,000-80,000 poor and uninsured patients. Greater Southeastís proposal adds two ICU beds to the 18 the hospital currently is licensed to operate.
"Telemetry beds" are medical/surgical beds Ė the licensed class that includes most hospital beds Ė that are "able to monitor patientsí heart rate," according to D.C. Department of Health spokeswoman Vera Jackson.
"The reason why D.C. General had so many ICU beds was because they didnít have any telemetry beds," Dixon said.
Officials at the District of Columbia Hospital Association, which represents all of the Districtís hospitals, expressed shock that the new contract would equate the cardiac care offered to patients in telemetry beds with an intensive care unit. Intensive care unit beds usually provide at least 1:1 staffing and are equipped to monitor all of a patientís vital signs.
"We are talking about a very critical part of all hospital services," said Joan Lewis, the hospital associationís senior vice president. "A telemetry bed does not make up for an ICU bed. ICU beds are super high-techÖ.itís not the same."
Lewis said elimination of already scarce ICU beds would exacerbate a serious problem of emergency room overcrowding that has existed in the District for the past six to eight months. The problem often requires ambulances to be re-routed between hospitals when overwhelmed emergency rooms temporarily close while critically ill patients await the availability of an ICU bed, she said.
"Virtually every hospital in town has had this problem," Lewis said.
While few details have been made public about how the proposed contracting-out of public health care services would function, officials have said the plan includes closing the Trauma 1 level emergency room at D.C. General on the eastern edge of Capitol Hill. Critics of the plan say that would leave the entire eastern portion of the city without nearby access to the highest level of medical care in critical emergency situations.
Dr. Howard A. Freed, who heads D.C. Generalís emergency room staff, recently complained in an internal memo that the cityís private hospitals may be skirting federal law in that they "strongly and very effectively resist" the transfer of uninsured patients from the public hospitalís emergency room to an available ICU bed at their facilities.
"Surrounding hospitals are required by [the federal Emergency Medical Treatment and Labor Act] to accept DCGH patients in transfer when, in an emergency, we are unable to provide medical services that a patient needs and the other hospital is able to provide them," Freed wrote in a Feb. 13 memo to D.C. General Chief Executive Officer Michael Barch.
"In reality, the other hospitals in our area (except Childrenís) [National Medical Center] do not Ďrefuseí to accept such patients, butÖhave put up a variety of practical impediments and administrative barriers to such transfers," Freed wrote in the memo, a copy of which was obtained by The Common Denominator.
Freedís memo cited as "so typical of how the system works" an example of his needing to make 17 telephone calls over the course of nine hours on Feb. 11 to get a 54-year-old patient with a dysfunctional liver transferred from D.C. Generalís overcrowded emergency room to an available ICU bed at Greater Southeast Community Hospital.
Freed included a chart summarizing each call, naming the personnel at Greater Southeast with whom he spoke. According to the chart, an ambulance summoned to transfer the patient had to be sent away empty at one point when Greater Southeast personnel agreed to accept the patient but wouldnít designate which location at the hospital would accept the patient.
When provided with a copy of Freedís chart and asked for comment, Greater Southeast spokeswoman Donna Lewis Johnson said the hospital had no comment.
With funding for D.C. General and the rest of the Public Benefit Corp. due to run out by mid-March, PBC Chairman Julius W. Hobson Jr. on March 6 sent a request for "urgent interim financing" to control board Chairman Alice M. Rivlin, Mayor Anthony A. Williams, Council Chairman Linda W. Cropp and Chief Financial Officer Natwar Gandhi.
"Even assuming an instantaneous transition schedule, funding for the PBC will likely expire before replacement services will be available," Hobson wrote. PBC is requesting "transitional funds sufficient to cover the current level of service provision through at least June 30" while final arrangements are worked out with the intended contractor for public health services, the letter said.
"Our paramount concern is patient care," Hobson wrote.
"Hospital beds, particularly intensive care beds, are in critical shortage," he said, citing the flu season as intensifying the problem. "Emergency rooms are operating at capacity, thus forcing ambulance rerouting. Without proper care, patients for whom the District has a legal obligation, pursuant to the PBC Act, to provide care will suffer and some will likely die."
Hobson also requested a "date certain" for the proposed contract to replace the PBCís services so that the PBC may provide its employees with proper legal notice if their jobs are to be eliminated. He also requested clarification of whether the PBC Board of Directorsí "authority for policy and management decisions transfers to the contractor, or some other entity" upon execution of the contract.