D.C. Hospital in Critical Condition, City Officials Told

Staffing and supply shortages at Greater Southeast Community Hospital have become so acute this year that city officials have ordered patients transferred and doctors have turned to other facilities to get medications.

Early this month, nearly two dozen nurses walked off the job because they had not been paid after the hospital failed to pay their contract agency. Without enough nurses on duty, the emergency room closed for the weekend.

The grim state of conditions emerged during testimony yesterday before the D.C. health committee. It was the most detailed and distressing accounting to date of the deterioration of Greater Southeast, the city's only hospital east of the Anacostia River. Most days, it has 100 to 110 patients, less than a quarter of its capacity.

It needs more than $16 million in new or replacement equipment, according to one inventory, including basics such as anesthesia machines, blood pressure monitors and a portable defibrillator. After several years of repeated layoffs, it lacks adequate technicians, social workers, clinical supervisors and many of the medical specialists critical to hospitals.

"Enough is enough," committee Chairman David A. Catania (I-At Large) said, asking the city health department to begin a comprehensive analysis of Greater Southeast's status and warning its corporate owner that improvements would be required, and soon.

"I regret one thing -- that I let this go on too long," he said.

Catania also questioned billing practices of the former Doctors Community Healthcare Corp., which changed its name this spring to Envision Hospital Corp. The Arizona-based for-profit company once owned a second hospital in the District, then known as Hadley Memorial Hospital, before selling it last year. Catania cited fees Greater Southeast charged its sister hospital that were substantially more than what another local facility now bills it.

Among them was a stool culture, currently costing $3.30; Greater Southeast billed Hadley $235. The costs often were reimbursed by Medicaid, and Catania has asked the city's Medicaid administrator to investigate.

"There certainly is a great disparity," said Paul Tuft, Envision's board chairman, who offered minimal defense of Envision's eight years of ownership.

During often sharp questioning, Catania told Tuft that he would seek to have the city reinstate a $10.5 million debt that Greater Southeast had owed the District. The city forgave the debt in January 2006 under an agreement signed by former city administrator Robert C. Bobb, but the settlement apparently was not reviewed by the attorney general, as Catania contends was required.

Bobb said yesterday that he didn't remember the issue, "not at all. That is news to me. I would never do something like that without the blessing of the mayor," he said.

For months, Envision Hospital Corp. has been negotiating Greater Southeast's sale to Prince George's County businessman Carl Jones. But Jones has not filed the certificate of need required before a purchase and has not found anyone to run the hospital. Neither he nor his attorney could be reached this week for comment.

Greater Southeast, which is licensed for 494 beds, continues to lose $500,000 to $800,000 a month. Broken equipment languishes for want of money for repairs. On some floors, patients cannot be put on ventilators because the air outlets don't work. The emergency department diverts ambulances because too few doctors are available to handle cases. Until the city intervened in January, administrators planned to end labor and delivery services.

"It's been difficult to assess [the hospital's] status from one day to the next," said Robert Maruca, head of the city's Medical Assistance Administration.

At great risk are patients in the city's 20-bed acute mental health unit, which is at Greater Southeast. The outside psychiatric group that provides care there is another vendor that has not been paid and has warned it will pull out.

For the moment, the city has few alternatives but to continue working with Envision and trying to shore up the once-respected community hospital. Should the sale to Jones fall through, the effort to sell the institution will begin again.

Staff writer David Nakamura contributed to this report.