D. C. General Hospital took another step this week toward regaining its accreditation with the appointment of a full-time medical director.
Dr. standford Roman, currently the director of ambulatory care at Boston City Hospital, is expected to take over the post of medical director at Washington's trouble-plagued public acute care hospital on July 1.
His appointment ends a three-year period in which D. C. General's medical staff has been under the direction of part-time or "acting" medical directors.
The appointment of Roman comes at a propitious moment: The survey team from the Joint Commission on the Accreditation of Hospitals has spent the past three days at D. C. General prior to deciding on yet another of the institution's requests for reaccreditation.
The hospital lost its accreditation in 1975, and lost three appeals of the commission's decision. While loss of accreditation does not prevent a hospital from operating, it does reflect on the level of care the constitution provides its patients.
Among the commission's chief complaints about D.C. General were sloppy medical record keeping, sloppy record keeping in the pharmacy area, physical safety code violations and staff shortages in numerous departments.
Many of those violations have been fully or partially eliminated, and conditions at the hospital have improved to the point where Margaret Kohn, the attorney who represented the plaintiffs in a successful class action suit against the hospital, told survey team she no longer opposses the hospital regaining its accreditation.
"There have been improvements at the hospital in various areas and I have in the past urged them not to accredit or reaccredit the hospital," Kohn said. She told the surveyors, "but I think it's important for them to reconsider the impact of nonaccreditation.
Kohn said she feels the loss of accreditation was in part responsible for increases in the institution's capital budget, and the severing of ties between the hospital and the city's Department of Human Resources.
Last fall, D. C. General was taken out from under the wing of DHR and placed under the control of an 11-member commission which is responsible for the operation of the hospital.
Commission chairman Gilbert Hahn said this week that he believes the hospital "deserves" and will receive reaccreditation. Hahn said he feels the survey team members were favorably impressed with what they saw at the hospital and Hahn praised Kohn's statement to the survey team as "very fair."
Roman comes to D. C. General with a background in running hospital programs at similar institutions. Boston City Hospital, which is the principal teaching hospital for Boston University Medical School - where Roman is the assitant dean for student affairs - serves a population very similar to that served by D.C. General.
Last year, said Roman in a telephone interview, there were about 100,000 visits to Boston City's emergency room and about 194,000 visits to its outpatient clinics. Both censuses are similar to those at D.C. General, as is the fact that both hospitals serve a patient population that depends almost exclusively on Medicaid for its health care. About two-thirds of Boston City's patients are black, said Roman, while D.C. General has an almost 100 percent black clientele.
Before serving at Boston City Roman, a graduate of Columbia University's College of Physicians and Surgeons, ran a rural clinic in North Carolina and was associate director of outpatient services at New York's Harlem Hospital, another large facility serving a poor, black, urban patient population.
Roman, a believer in the role of public hospitals in health care delivery, said he believes "all public hospitals are sort of at a point where they have to assess and reassess their goals and objectives in the long term.
"I think they have a role in the delivery of care, mainly because many of them have the type of facilities many private hospitals can't, or won't, provide," including acute psychiatric care and intensive social service functions.
Roman said he views the medical director as one who "provides medical leadership" and works with the hospital administration in setting long-term goals for the institution.
"I also think it's a role that requires a lot of interpretation between the administration, in the strict sense, and the medical staff. I think that a lot of the dificulties that do occur in an institution are a failure to really communicate what is a medical care need into an administrative decision."