Hospital Crises Could Buckle Area Network

In fact, the city alternately has cracked down on Greater Southeast, ignored it or tried to place public programs there -- for inmates, addicts and psychiatric cases. Political considerations have sometimes motivated officials' actions.

In Prince George's, a key issue has become the state's unique "all-payor system" that sets rates for every operation and hospital service and compensates for those without insurance. With the highest rate of unpaid care in Maryland last year -- 14.5 percent of patients -- Prince George's Hospital Center is a primary beneficiary. It also receives $19 million annually in direct subsidies from a state fund to help with the uninsured.

Dimensions Chief Executive G.T. Dunlop Ecker contends that the state system has fallen behind. An institution is reimbursed for direct expenses but not for physicians' fees. Dimensions spends nearly $12 million a year to keep crucial hospital units staffed with doctors 24 hours a day. Without that drain, it could almost break even.

In 2005, a special county-state committee concluded that Prince George's Hospital Center and the other county facilities had "suffered from a long period of poor management" under Dimensions, losing cash through inefficient hospital staffing, a bloated and ineffective leadership team and expensive consultants whose recommendations for improvement were rarely followed. The panel urged the county to sever its tie and set up a new source of government revenue to support hospital operations.

There has been no action on either front. And twice since March, Dimensions has claimed it was weeks away from running out of money.

Depending on the outcome of the court hearing this week -- Ecker and the board are trying to force another rescue with county dollars, on top of $50 million since 2003 -- the board could vote for bankruptcy or total shutdown. County Executive Jack B. Johnson (D), who has a long history of political fighting over the hospital, blames mismanagement for the system's latest losses.

For each hospital, the future remains uncertain. Both have been up for sale but attracted few suitors. Fifty percent of their patient base continues to be uninsured or dependent on Medicaid or another publicly subsidized program for health coverage.

"It's a hard sell because of community perceptions, physician perceptions," explained Bruce Siegel, a health-care policy expert and professor at George Washington University's school of public health. He sees a change in ownership as vital for both, as well as tough management decisions and an infusion of money. Even then, nothing is guaranteed.

Rebuilding a hospital can take years, Siegel said. Most of the time, "the strong get stronger, the weak get weaker."

Staff writer Lisa Rein contributed to this report.