District might get back in hospital business to keep United Medical Center alive

By Mike DeBonis
Washington Post Staff Writer
Friday, July 9, 2010

In District politics this election season, it's hard to find consensus on much of anything.

But closing the only city hospital east of the Anacostia River? That ranks somewhere between eliminating snow plowing and tossing grandmothers in the street on the list of political no-gos in this town.

At a candidates' forum held in May by Ward 8 Democrats, every last contender expressed support for using city money to keep the ward's United Medical Center open.

That's not campaign rhetoric: There is not an elected official in town willing to venture that the long-troubled hospital should disappear.

"We can't let the hospital close, that's a given," said D.C. Council member Jack Evans (D-Ward 2), the fiscal hawk who has rarely found a city expenditure he couldn't question.

The ubiquity of that sentiment now means that the District might, by noon Friday, once again be in the hospital business, fewer than 10 years after it thought it was out for good. After the failure of Specialty Hospitals of America to bring UMC into the black, an auction has been set, and the city doesn't expect any bidders.

Saving the hospital -- which opened in 1966 as the nonprofit Cafritz Memorial Hospital before becoming Greater Southeast Community Hospital in the '70s -- has been the subject of a three-year crusade by D.C. Council member David A. Catania (I-At Large), chairman of the health committee. It was Catania, with the support of Mayor Adrian M. Fenty (D) and others, who engineered a $79 million plan to save an on-the-brink Greater Southeast in 2007, and it is Catania who is now the prime architect of the city's reentry into charity health care.

It's a tough pill for Catania to swallow; from his committee perch, he's overseen wide-scale privatization of city health services -- from drug and alcohol detoxification to care for the mentally ill. A UMC takeover would represent the most significant deprivatization since the control board disbanded.

There is no happy example of a local government smiling its way through the hospital business. Just across the District line in Cheverly, Prince George's Hospital Center has been on the brink of failure for years -- surviving on a string of ad-hoc fixes by county and state officials. And then there's D.C. General Hospital -- a sprawling charity hospital that became a fiscal black hole for the city, swallowing tens of millions a year in taxpayer funds before Mayor Anthony A. Williams (D) pulled the plug on inpatient care in 2001.

It is the specter of another D.C. General that has some worried -- including Evans and Chief Financial Officer Natwar M. Gandhi.

Gandhi counseled against the original Greater Southeast deal in 2008, and when the council moved last month to create a nonprofit entity to potentially run the hospital, he again sounded the alarm. He said that "it is likely that the District will have to continue to subsidize the hospital," -- up to $15 million per year.

Catania, who has sparred on and off with Gandhi for years, calls the estimates "wholesale exaggerations." At most, he said, it will cost taxpayers $5 million a year. He anticipates that within three years, the city will be able to exit.

"This is not D.C. General," Catania said. "We are not advertising United Medical Center as the charity hospital. . . . It's a smaller operation, and it's a more limited operation." The city has invested about $40 million in the hospital's physical plant -- which can be seen in a new facade and a children's emergency room to open later this summer. Catania expects that tweaks to Medicaid reimbursement rates and new efforts to bring in patients will keep it from dipping too far into the red, if at all.

But it's not just the politicians who are invested in keeping UMC alive and well. Owners of the city's six other full-service hospitals would consider the facility's closing a "disaster," said Robert Malson, president of the D.C. Hospital Association.

They're afraid of a flood of poor and uninsured residents that could strain their own precarious bottom lines.

"Keeping this hospital open provides a core public service," Malson said. "It has to be compared to police, fire and other services."

UMC is treating people like Eugene Thompson, 70, who was found homeless and near death this winter near First Street and Florida Avenue NW. His feet gangrenous, Thompson was taken to UMC, where he has been treated in the hospital's state-of-the-art Advanced Wound Care Center, equipped with brand-new hyperbaric chambers to treat ill-healing wounds caused by, among other maladies, diabetes -- the scourge of Ward 8.

That reality has Catania ready to suspend his faith in free enterprise. "There are times when the market fails you," he said Wednesday. "The market is not begging to take over a safety-net hospital that has a track record of financial problems."

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