District to Use Tobacco Funds On Health Care

By Susan Levine
Washington Post Staff Writer
Wednesday, December 20, 2006

The D.C. Council unanimously approved a historic investment in the city's health care, voting yesterday to spend $245 million to construct major clinical facilities, strengthen emergency services and develop programs that reduce the toll of such diseases as diabetes and cancer.

The money, available through the District's portion of a 1998 national settlement between states and tobacco companies, will be directed primarily toward communities on the city's east side, where health problems are most acute and health providers most scarce.

But how and where $196 million of the total will be spent awaits a comprehensive assessment due early next year from the independent Rand Corp. After nearly three years of tortuous and often divisive public debate, which ended when Mayor Anthony A. Williams (D) pulled out of a plan to build a hospital with Howard University, the Rand study will decide what will best serve the city's complex needs.

"Let's do this dispassionately and not politically," said council member Vincent C. Gray (D-Ward 7), the chairman-elect. Had the discussion started with such a study after the closure of D.C. General Hospital in 2001, he agreed, health care in the District probably would have made far more progress by now.

"This is an unprecedented opportunity," Gray said.

The legislation approved by the council represents a sharp change in direction, targeting major capital dollars to communities more than institutions. At the same time, it is part of an evolution in focus, a significant commitment to lowering rates of chronic disease that are among the worst in the country.

It also is the first time the District has used its tobacco settlement funds specifically for health programs.

Rand will consider the potential of ambulatory health centers, particularly in Wards 7 and 8, as well as a task force's recommendation last summer that a sophisticated "healthplex," with 24-hour services, be built on the grounds of the former D.C. General Hospital in Southeast. The council agreed that any money for such construction or emergency care improvements must be awarded through competitive bidding.

"There's been a lot of strife associated with this journey," said David Catania (I-At Large), the council's Health Committee chairman and the key architect of the legislation. "We're going to get it right this time."

The Community Health Care Financing Fund allocates $116 million for new health-care facilities and reserves "up to $80 million" to upgrade hospital emergency departments. An earlier version of the bill identified Howard University Hospital and Greater Southeast Community Hospital as the two recipients; though their names were dropped from the final language, they remain the likely beneficiaries.

Also dropped from the legislation, with little discussion yesterday, was a provision requiring Greater Southeast to acquire nonprofit status before it could receive any money. A Prince George's County businessman is negotiating to buy the hospital.

Officials at neither facility responded this week to questions about the condition or needs of their emergency departments.

The balance of the fund will go for chronic disease prevention and management. Though that $40 million pales by comparison, the impact could be just as big: $20 million for cancer control, $10 million for initiatives to help people stop smoking and $10 million to target such problems as asthma and hypertension.

"These are hugely important dollars," Catania said.

The D.C. Cancer Consortium, charged with implementing programs to reverse the high incidence of that disease, already is at work. In a city where it is not uncommon for advanced malignancies to be diagnosed in hospital emergency rooms, a top priority is access to care.

"This doesn't begin to reduce cancer," Executive Director Susan Butler said. "This just reduces the human misery. . . . It reduces mortality."

The consortium hopes to develop a citywide "patient navigator system" that would guide a resident, regardless of insurance status, to immediate and appropriate services. All cancer centers in the District are cooperating in this effort, Butler said, to minimize duplication so that resources go farther.

"What we're going to set out to do is to try to coordinate these things," she explained. "I don't mean to make it sound easy. It's not. But it's the only thing that will work."

Early detection is equally critical, and the consortium will use part of the $20 million on public awareness campaigns and screenings. "We need the community to understand they have the right to be screened and a right to get care," Butler said.

Rand faces one large and immediate challenge. The District's health data still have gaping holes that must be identified and filled before an assessment can be completed.

"There are a lot of places where there are deep pockets of no information," said Nicole Lurie, the physician and senior scientist who will lead the study. "There's almost no data in the city on children's health needs, where they go for care, and almost nothing on mental health."

Rand will evaluate health needs specifically for Wards 7 and 8 and assess emergency services citywide. It also will analyze the capital and operating costs of whatever clinics or health centers it considers in its recommendations.

The fund allocates $1.5 million to buy ambulances and $6 million to establish a regional health information exchange program with a secure patient database for use by doctors, health providers and hospitals in the District. The Rand study will cost $1.5 million.