Uninsured Help Sap Finances Of Hospital

Md. Facilities Need Millions, Dimension Says

Derrick Washington, 30, who was uninsured at the time he was treated at Prince George's Hospital Center after a car accident, recovers at his Aunt Loretta Washington's home. (By James M. Thresher -- The Washington Post)

When an ambulance brought Derrick Washington to the Prince George's Hospital Center emergency room in Cheverly on an early morning in September, doctors and nurses had no idea whether he had health insurance to cover the cost of his care.

They did not know that he had been released from prison three months earlier, that he was a resident of the District and that he had been injured in a car accident in the county.

They did not even know his name, referring to him as John Doe until police found his cellphone in the back of his mangled car hours later and dialed through its contact list looking for family members.

All they knew was that the man's feet had been severed and that he was on the verge of bleeding to death. And so, like thousands of others who arrive sick and injured at the financially ailing hospital each year, he was treated.

Like half of the 180,000 patients who are cared for in the county's health system, Washington, 30, did not have insurance. Although he has since been enrolled in Medicaid, some of his bills might never be repaid. The problem for the hospital is that it has as many patients like Washington as it does fully insured patients whose bills are paid.

The result is a hospital caught in an endless cycle: Its reputation for crowded, antiquated and low-tech facilities is so widespread that it cannot attract the insured customers whose regular payments could be used to fund improvements that would attract more patients like them.

"They were already $250,000 into it before they even knew he was out of the dark," said his aunt, Loretta Washington, 47, who recalled the events and estimated Washington's five-week hospital stay cost double that. "Who knew that he would even live?"

Studies have shown that 57 percent of Prince George's residents, including many middle-class professionals who have private health insurance, leave the county for care. Hospital system executives think that enticing more of them to the three county-owned facilities would make caring for uninsured patients such as Washington economically viable.

Executives of Dimensions Healthcare System, the nonprofit company that runs the county-owned hospital center and hospitals in Bowie and Laurel, think the situation has become so critical that it would take a $100 million infusion to upgrade its hospitals to begin attracting more paying patients.

Without the improvements, hospital leaders think the system will always bleed cash, risking a closure that health officials agree would be a disaster for the region, sending thousands of poor and needy patients such as Washington to other facilities.

"The fix has not been applied because the fix is going to involve big numbers," said Dimensions chief executive G.T. Dunlop Ecker, the system's fourth top leader in the past five years.

After weeks of negotiations, the county gave Dimensions $5 million last week, the latest in a series of periodic government bailouts, this one intended to last through next month. Intense negotiations are underway in Prince George's and Annapolis to find a way to stop the hemorrhaging for good.