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Hospital ERs overflowing
Health director: D.C. General closing may not be the cause
(Published June 18, 2001)
By JULIE BELLAMY
The cityís health director acknowledges complaints of emergency room overcrowding at local hospitals but is questioning whether the planned closure of D.C. General Hospital at the end of this month is the cause, as some critics of the cityís health-care privatization plan have charged.
"Hospitals are complaining that they have too many patients and that their emergency rooms are overloaded because of the changes at D.C. General," Dr. Ivan Walks said. "But overall, things are going smoothly at D.C. General Hospital."
According to the D.C. Hospital Association, which represents all of the cityís public and private hospitals, local hospitals were reporting an increased number of patient visits before city officials began a transition on May 1 that is expected to dismantle D.C. Generalís inpatient hospital services by June 25 and replace them with a network of private health-care services for the cityís poor and uninsured residents. D.C. General stopped admitting patients on June 15.
A study analyzing demographic data about hospital patients that is expected to be completed next week should tell hospital officials whether the increase in hospital visits is because of the changes at D.C. General or part of a nationwide trend of increases, Walks said.
Meanwhile, as the transition toward privatized services progresses, critics have continued almost daily protests against the presidentially appointed financial control boardís decision that abolished the cityís public health care system over the objections of a unanimous D.C. City Council. The control board imposed a contract, backed by Mayor Anthony A. Williams, on May 1 that turns over responsibility for indigent health care services to Greater Southeast Community Hospital and a network of health care subcontractors. A federal court ruling is still pending on a challenge to the contractís legality.
City health officials said patients may still seek 24-hour emergency help at D.C. General, but persons needing care for life-threatening or other serious ailments now will be transferred by ambulance to other local hospitals in the D.C. Alliance Healthcare Network, under terms of the contract with Greater Southeast. Inpatient services -- including adult medicine, OB-GYN, pediatric, maternal, infant, newborn, surgery and post-operative care -- will no longer be offered at D.C. General.
Over the past couple of weeks D.C. General has been preparing for the transition by sending many patients to Greater Southeast hospital, officials said. There are currently only 40 patient beds at D.C. General, a number that has been going down for weeks, from 125 in mid-April, according to Dr. Larry Siegel, senior deputy director for medical affairs at the D.C. Department of Health. By the end of the transition, only one or two patients are expected to remain, he said.
For many local hospitals, the transition of D.C. General means more patients and crowded emergency rooms. Emergency room visits at Washington Hospital Center have increased by 22 patients a day since the contract was signed, said Leroy Tillman, the hospitalís director of media relations.
Before May 1, Washington Hospital Center averaged 165 emergency room patients a day. Now, the hospital is averaging 187. In recent weeks, Washington Hospital Center has had as many as 210 patients a day, said Tillman.
At least one suburban hospital has noticed an increase in its patients since D.C. General started phasing out its services. Bob Howell, spokesman for Prince Georgeís County General Hospital, said that since the beginning of May, 10 more people per day arriving in D.C. ambulances visit the emergency room, and one or two more people come into the hospital each day for general care. The suburban Maryland hospital is now the nearest hospital for many D.C. residents of Ward 7. Greater Southeast, located on the Maryland border near the Districtís southernmost tip, is the only hospital operating east of the Anacostia River in the District.
There have been scattered recent reports that ambulances have occasionally been lined up waiting to deliver their patients to emergency rooms in the District due to overcrowded conditions. A spokesman for the D.C. Fire and Emergency Medical Services Department said his department regularly compiles statistics on ambulance runs, but he declined to provide them to The Common Denominator, referring a reporter instead to the health department. The health department provided statistics only for May 1-12, the first 12 days during which the privatization plan for D.C. General and its community clinics was put in place.
D.C. Health Director Walks said the city is looking to focus more on primary care, as other cities have done, to solve patientsí health problems before they merit an emergency room visit.
D.C. General will continue to have a "full-service emergency room," Walks said, but depending on the severity of a patientís ailment, they may by transported by ambulance to another care facility. Two on-site ambulances will serve patients needing care at a trauma level one center. "Itís the same way as anywhere. If a person is badly hurt, they should go to the nearest place that can take care of them," Walks said.
Outpatient clinic services will also continue at D.C. General including HIV/AIDS, dialysis and specialty and primary care clinics. A board-certified emergency room physician will also be present at all times at D.C. Generalís emergency room as soon as the hospitalís transition to a private facility is complete, Walks said.
The clinical care at D.C. General is still good, and people needing emergency care can still go to D.C. General, said Walks.
"When people ask me what they should do, I am not telling people to do anything different. You can still go to D.C. General to take care of most of your health needs," Walks said.
Mayor Anthony A. Williams recently established an oversight commission of local health care officials and others to track how well the privatization plan is working. The commission plans to meet for the first time in two weeks.
Copyright 2001, The Common Denominator