New Hospital's Likely Prognosis: Taxpayer Bailout

The closing of the city's public hospital in 2001 did create longer drives for ambulances that serve the poorer eastern part of town. But despite some hysterical political rhetoric, geography is not an issue except in the most desperate emergencies. In fact, D.C. General's old emergency room remains in operation, though it cannot handle the most severe emergencies.

What many doctors say the city needs is a full-service, free-standing ER at the old D.C. General site. Such facilities thrive in the suburbs, including Inova's Emergency Care Centers in Reston and Fairfax, and Fort Washington Medical Center in Prince George's County.

The closing of D.C. General enraged many Washingtonians, as much because of what it seemed to say about government's attitude toward the poor as because of any lost medical care. After all, few would argue that D.C. General provided top-notch service. But the place did serve a purpose: "D.C. General picked off a disproportionate number of very difficult cases socially," including disruptive patients, says Dr. Mark Smith, chairman of emergency medicine at the Hospital Center.

The crunch at ERs around town stems in good part from having to take cases that used to go to D.C. General, where the staff was accustomed to dealing with drug abuse and emotional dysfunction.

But the Howard-D.C. proposal commits the hospital to donate only a fraction of its care -- about 3 percent of operating costs -- to those who have no means to pay for services.

The hospital Mayor Tony Williams proposes to leave along with a baseball stadium as his legacy gifts to Washington is not a medical solution, but a political salve and a real estate deal.

Next week: Who wants the hospital and why.

E-mail:marcfisher@washpost.com