Southeast Carries On Despite Shortages
Hospital Staffers Lauded for Loyalty

By Susan Levine
Washington Post Staff Writer
Sunday, July 8, 2007

The doctors and nurses who for decades have staffed Greater Southeast Community Hospital remember when theirs was a premier institution, a source of pride and an anchor for Ward 8 and the neighborhoods beyond.

Those memories hit hard as they pull into its unkempt parking lot off Southern Avenue and see what exists today: a facility close to crisis, with such severe cuts and neglected problems that regulators say patient care and safety have been jeopardized.

"It's really difficult to look back," physician Victor Nelson acknowledges. "It's painful."

Today, the District hospital's obstetrical nurses plead for crib sheets for their babies. The operating room is dark and silent every other weekday. X-ray machines and IV pumps are pushed to the side for lack of repair, and patients are shipped out for routine tests such as bone scans.

Greater Southeast's crisis stems from years of paltry capital investment, swelling numbers of uninsured patients, changes in health care reimbursement and particularly, according to many people, bad management by an absentee landlord. Most believe the crunch would have come sooner and harder if not for the hospital's workers. At a recent hearing, the chairman of the D.C. Council's health committee singled out their dedication in his otherwise scathing remarks about Greater Southeast's corporate owner.

"The people who are left now are mission driven," declared David A. Catania (I-At Large).

That commitment is not just to patients and the community. Again and again, the employees talk about allegiance to one another, about not abandoning colleagues after all they've endured collectively. "It's like family," explained Thomas Tobias, an anesthesia technician with 30 years' tenure there.

Yet the deteriorating physical and fiscal conditions have taken a toll on everyone. There is little new and nothing fancy at Greater Southeast. It has 110 beds, a quarter of the number it once filled. Entire wings -- even an entire floor -- are locked and mothballed. Patient rooms have been converted for storage or cannibalized for fixtures.

"You make do with what you have," a nurse said matter-of-factly last week. Some of Tobias's equipment had been in use at D.C. General Hospital before it was shut down. "You bring it over, parts are missing," he noted.

Not surprisingly, given the harsh spotlight -- and the near-universal condemnation of parent company Envision Hospital Corp. -- once-loyal patients have defected. Their loss has exacerbated the money woes, with the hemorrhaging approaching $800,000 a month.

"I don't see those faces anymore," Tobias said. In the hospital's largely deserted cafeteria, his voice sounded pained. "It's not because they're so healthy. They're scared to come here."

Greater Southeast dates to 1966. Built with private and public funds on federally donated land, it opened as the nonprofit Cafritz Memorial Hospital and for a long time was one of the region's busiest medical centers. The changing demographics and economics of its immediate community presented an increasing challenge, but the steep downward spiral didn't start until the late 1990s.

The past five years have been arguably the toughest and most uncertain in the hospital's history.

In 2002, the company that had bought Greater Southeast out of bankruptcy several years earlier itself declared bankruptcy. In 2003, the hospital lost its national accreditation for several months over serious care issues, including blood transfusion errors and poor screening of workers and physicians. Some District regulators, alarmed by six patient deaths they deemed preventable, recommended that the facility be forced to close.

In 2005, the first of repeated rounds of layoffs began. By January, the medical staff was warning city officials of a potentially dangerous environment because of Envision's administration. Based on regulators' subsequent inspections, the doctors weren't far off.

With every new calamity, Chris Groover and her fellow nurses have told themselves, "We can't go any lower. It can't get any worse."

They were wrong.

"I haven't seen anything positive happen," said Groover, who has been swaddling newborns at Greater Southeast for two decades. She has watched its census of tiny patients dwindle to single digits -- once upon a time, 35 cribs were regularly filled -- and the unit threatened with closure. Down the hall, virtually the only remains of the defunct pediatric ward are characters from "Winnie the Pooh" and "The Jungle Book" that decorate one wall.

"We've learned to deal and still give the best care," Groover said Friday. She was catching up on paperwork, having sent home the nursery's sole occupant a few hours earlier. The quiet made it easier to reminisce about a time when she and other nurses didn't have to beg for the tools to do their jobs, much less bring in their own WD-40 to oil the hinges of recalcitrant doors.

Back then, "I was so proud to say I worked at Greater Southeast." She wants to feel that way again. "This is home. I still love this place."

But the past and present, as described by Nelson, the head of obstetrics and gynecology, are painfully different. How to attract doctors? And how to regain the public's confidence? Ward 8 is coming back, with more new home construction than anywhere in the city and development it has not seen for years. Greater Southeast, the city's sole hospital east of the Anacostia River, seems an isolated holdout.

"There is a need for a massive influx of money," Nelson said.

Superficially, the building does not show as poorly as its battered image. Its lobby is plain but neat. Its aged floors have a respectable shine. Keeping up even minimal appearances is a daunting task, however. Cleaning and maintenance crews face as many issues as almost every other department.

"We have a ton of equipment that never gets fixed," Calvin Lucas said. Back in 2000, the housekeeping worker had more than a half-dozen buffer machines at his disposal. Last month, the number was two. Not that many people were left to handle them. Their ranks also have been slashed.

"We're at a bare minimum," he said. It is a touchy point; in their latest report, regulators blamed inadequate staffing for their finding that the hospital was not being maintained "in a safe or sanitary manner." Lucas disagrees, but not vehemently. "It's a daily challenge," he conceded.

The man responsible for holding Greater Southeast together is an unassuming, soft-spoken physician, a hematologist by specialty, who arrived from North Carolina six years ago to take care of family business in the area. Cyril Allen was going to stay six months, but after he worked part of that time at the ambulatory care clinic that Greater Southeast was running at the former D.C. General, one thing led to another. Last fall, he was named chief executive -- the third since 2004.

Allen doesn't make excuses for the facility's problems or ownership. Still, he suggests that some of the censure is unfair. "It hurts when you hear it," he said. Good care is being delivered: "Patients here actually do get better."

An unlikely supporter as Quincey Gamble of the 1199 Service Employees International Union, which represents 275 Greater Southeast employees, is glad Allen is in place. Without him, Gamble said, the hospital's troubles would be much worse: "It's probably one of the most difficult working situations I've seen in some time."

Yet few expect it to be resolved until Envision leaves town. The company has been negotiating a contract with a Prince George's County businessman, though the numerous missed deadlines have city officials frustrated to the point of disbelief.

Greater Southeast employees hold on to hope.

"We really want the hospital to improve and survive and get back to the way it used to be," said fifth-floor nurse Tracy Willett, who has spent her entire career here. "We didn't put all these years into it for nothing."