After half a decade of declining admissions, D.C. General Hospital now is so crowded that patients occasionally have been kept lying on stretchers in hallways up to four hours waiting for rooms to become available.
Officials of the city's only public general hospital, who as recently as six months ago complained that private hospitals in the city were dumping their poor patients there, now want to see if those same private hospitals can take D.C. General patients.
No one is sure what has caused the current problem, but the lack of nursing home beds in the District of Columbia, renovation at D.C. General, and a seasonal increase in hospital admissions all have contributed.
"We've been affected by the inability of D.C. Village and Glendale to accept more long-term patients," said Dr. Stanford Roman, medical director of D.C. General.
The hospital, which under the best of circumstances usually has about 100 beds occupied by long-term patients who belong in nursing homes, now has 127 of these patients.
Because renovation work under way has reduced the number of beds in the hospital to 537, down from 645 a year ago, 24 percent of the hospital's beds now are taken up by patients who do not belong in the hospital.
"In the long-term, we've got to do something about the long-term care patients," said hospital executive director Robert Johnson. "I've asked [the city's Department of Human Resources] to take a look to see if there's any way they can take up to 50 long-term patients."
Although there are some sections of D.C. General that still can take patients easily -- pediatrics and obstetrics usually are about 60-to-70 percent full -- those beds have limited use, since men cannot be placed in a maternity ward and adults cannot be placed in a pediatrics area.
However, the hospitals' two main units, which handle surgical and general medical patients, now have a 96-to-100 percent occupancy, rate, which means that, in many cases, a patient must leave before a new patient can be admitted.
"We have a daily average of 15 discharges,' said Roman," and although the majority occur in the morning hours, between 10 and 12, some patients can't leave until later in the day," leaving new patients waiting for beds.
Patients admitted through the hospital's busy emergency room now are routinely waiting "a couple of hours for a bed," said Roman, and "occasionally I'Ve been called at home about people who have been there three and four hours."
This is one of the peak seasons for hospital admissions, Roman said, and several hospitals in the city are functioning at close to capacity. Many people put off operations until after their vacations, he said, and many physicians delay surgery for the same reason.
Because of the bed shortage at D.C. General, the hospital is postponing surgery that is not needed immediately, Roman said.
The crowded conditions have not proved a financial windfall.
The 127 patients that belong in nursing homes have been a financial drain on the hospital, according to officials.
Because those patients do not need general hospital care, their insurance coverage -- be it Medicare, Medicaid, private insurance -- stops, and D.C. General is unable to collect the average of $38,000 a day it normally would receive for the use of those 127 beds.
This crunch comes at a time when D.C. General has been improving its financial situation dramatically, collecting close to $26 million this fiscal year compared with about $16 million last year.
Last October, the hospital switched to a computer billing system, and for the first time began trying to determine which patients had insurance coverage, and to collect those insurance payments.