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Hospital Shutdown Scenario Stirs Fears
Experts See Ripples Beyond Pr. George's

By Rosalind S. Helderman and Nelson Hernandez
Washington Post Staff Writers
Thursday, April 12, 2007

Extended emergency room waits, longer response times for ambulances, thousands of displaced health-care workers and undermined rape prosecutions -- all are consequences industry experts and others warn could result from closure of the financially ailing Prince George's hospital system.

County leaders said yesterday that they are continuing to work to save the system, even as state officials and regional health workers said they were drafting contingency plans in the event those efforts fail.

"It's a huge health system, and obviously any disruption would have the potential really to cause health-care chaos across the region," said Gregg A. Pane, director of the D.C. Department of Health. "We're taking this very seriously."

The board of directors of Dimensions Healthcare System, which manages the county system, will meet Monday to consider bankruptcy or closure.

G.T. Dunlop Ecker, chief executive and president of Dimensions, has said he will recommend the latter.

The crisis comes after discussions between state and local leaders over a massive funding plan to save the system collapsed Monday, the last day of the Maryland legislative session. Gov. Martin O'Malley (D) has put aside $20 million to fund the "orderly closure" of the hospital over several months. He has said it can be prevented only by County Executive Jack B. Johnson (D) and the County Council. Johnson spokesman John Erzen said talks are "ongoing."

"We all understand the need to move quickly," Erzen said.

State Secretary of Health and Mental Hygiene John M. Colmers said he is convening working panels to draw up plans for the closure and the relocation of five groups of patients: trauma, maternity, psychiatry, long-term care and others.

The emergency rooms of neighboring hospitals, particularly trauma centers that treat severely injured patients, are likely to be the worst and most immediately affected. The trauma unit at Prince George's Hospital Center in Cheverly, the largest of three hospitals in the county system, treats 3,500 patients each year.

Shutdown of the Cheverly center, along with Laurel Regional Hospital and the Bowie Health Campus, could further strain the web of emergency rooms across Maryland. The three Prince George's hospitals handle a combined 122,000 emergency cases a year, making their emergency rooms among the busiest in the state.

Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, said closure could effect patients as far away as Western and Southern Maryland.

For example, a man hurt in an auto accident in Largo might be sent to Suburban Hospital in Bethesda instead of Prince George's Hospital Center. That would mean that an elderly patient hurt in a fall in northern Montgomery County, who today might go to Suburban, could be sent to Washington County Hospital in Hagerstown. In addition, patients in northern Charles County may be flown as far north as Baltimore.

This juggling act will become increasingly precarious as emergency rooms grow more crowded. Most hospitals in the metropolitan region are operating at or near capacity.

"We just recently peaked out on the flu respiratory season," Bass said. "We didn't have a lot of surge capacity."

When a hospital can't accept any more patients, it declares a yellow alert. The Prince George's hospitals that may close are often on yellow alert: Prince George's Hospital Center declared 24 yellow alerts last month; Laurel Regional had 22 alerts; and Bowie declared nine.

Suburban, which had one yellow alert for an hour last month, may be more able to handle the influx, but other hospitals that would pick up the slack are already stressed. Doctors Community Hospital in Lanham and Washington Adventist Hospital in Takoma Park each had 20 yellow alerts last month.

At other nearby hospitals, "instead of a two- to four-hour wait, there would be a six- to 10- to 12-hour wait," said George Bone, a member of the Dimensions board of directors.

Many low-income patients who arrive at the Prince George's Hospital Center rely on the county's public transportation, Ecker said. They may find it difficult to take buses to hospitals much farther away and call for ambulances instead, extending response times for emergency service departments. Ambulances also would often have to travel much further, causing paramedics to take longer for every call, said James Keary, a spokesman for the county government.

Prince George's Hospital Center also hosts the county's only sexual assault center, where specially trained staff perform forensic exams on victims of assault in the county, preparing evidence for trials. State's Attorney Glenn F. Ivey said closure of the unit, where 250 such exams are performed annually, would require a new center to be established. Such a scenario, he said, could "jeopardize rape prosecutions" during the transition.

For workers, the system's closure could mean losing jobs held for decades. Some could find jobs elsewhere amid a worker shortage in the field, but they could need additional training and might have to work far from home. Many have concerns about their retirement benefits.

"I'm in a state of shock, to be honest," said David Goldman, a doctor who has been part of the system for 38 years. "It affects so many lives. The citizens of this county are going to die because they don't have a place to go."

Staff writer Ovetta Wiggins contributed to this report.

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