Every day of the week, it is the county's crisis center.Nearly 60,000 patients a year trek in and out of the emergency room of Prince George's General Hospital and Medical Center seeking help for ailments that range from sprained ankles to heart attacks.
No other emergency room in Prince George's County deals with as broad a range of problems in as large a volume. The Southern Maryland Hospital Center, with the second busiest emergency room, sees only half as many patients.
"We handle everything from shock trauma to common colds," said Dr. Dennis Frank, a resident physician. "For some people we are the family doctors."
"A lot of the indigent patients we treat come here because they are turned away by private hospitals which don't want to lose money," added Prince George's Hospital Commission Chairman Dr. Claire Christman.
The emergency room in Cheverly has one other characteristic that sets it apart from other hospital emergency rooms in Prince George's County: Nearly half of the patients never pay their bills.
In addition, nearly a quarter of the patients using the alcohol detoxification unit and the psychiatric services fail to pay their debts.
According to hospital officials, many who don't pay fall into the working poor category -- those not affluent enough to pay bills without badly straining their resources but not poor enough to qualify for Medicaid.
This record of bad debts plus the need for heavy county subsidies to the hospitals in recent years have led to an agreement between County Executive Lawrence J. Hogan and the County Council that the hospitals should be run by a private, nonprofit corporation. In the just-concluded state legislative session, however, a bill to give the county authority to reorganize the hospitals failed because of a technicality.
Sponsors hope to reintroduce the bill as an emergency resolution in the Maryland legislature next year, allowing it to take effect immediately if it is passed. In the meantime, county officials will lay the groundwork for the changeover.
Although legislation that created the county hospital system in the 1940s requires it to accept some charity cases, many county leaders view the unusually high bad debt ratios as signs of an ailing management system.
They note the county government last year had to give the Prince George's General Hospital nearly $2.5 million to subsidize losses in its emergency room, and in the detoxification, psychiatric, obstetrics and family practices units.
Another $1.5 million went to the county's other two public hospital facilities -- the Bowie Ambulatory Care Center and the Greater Laurel-Beltsville Hospital.
In total, the Prince George's County government spent $5.8 million in fiscal 1979 to subsidize the three public hospitals. However, heavy subsidization has not always been the rule. Until 1973, Prince George's General had been able to pay its own way for the most part.
With the construction of the facilities in Bowie and Laurel, however, the county had to contribute substantially more to help the hospitals with capital construction and start-up costs. In addition, the number of indigents using the hospitals rose steadily during the mid- to late 1970s. In the days before TRIM, the tax-limiting charter amendment, and under the Winfield Kelly administration, county government bore the brunt of the new costs without much complaint.
Now Hogan has launched a campaign to get the county government out of the hospital business in the hope of freeing funds badly needed in the county's TRIM-restricted budget. The council reaction was not especially favorable and a Hogan-appointed task force recommended a private, nonprofit corporation be set up to manage the hospitals.
Now the council and Hogan have agreed to support the proposal for nonprofit management corporation. From all accounts, sentiment for the change is prompted by more than financial concern. Many top county officials believe the present system has resulted in bureaucratic horrors that even its creators would condemn.
"The county government has no business trying to run a large and complex hospital system like this," said Irv Smith, health adviser to Hogan. "Not only does the county not know how to run the system but it's putting a lead weight around the shoulders of the people who do."
As an example, Smith said a leaky roof in the coronary care section of Prince George's General Hospital went unrepaired for six months last year. He said while the work request went through several layers of bureaucracy, patients were moved from one end of the coronary care section to the other.
Of the system, one administrator at Prince George's General noted, "It takes 20 signatures to get a box of pencils around here."
Hospital administrators say almost any decision dealing with purchasing, finances, personnel and data processing has to go through several levels of bureaucracy before it can be made final.
A request may go through as many as five in-boxes -- those of the hospital executive director, the hospital board of directors, the executive officer of the county hospital commission, the hospital commission, a county government department and in some cases even the county executive.
Taking into account that boards and commissions sometimes have as many as 11 members, it is conceivable that 20 people would have to give their approval to have a leaky roof repaired.
"It's not the commissions and boards that are causing the problems," said Christman. "The problems occur once the decisions get to the county level. The hospitals are being kicked around like a political football. There won't be any real solutions to the problems until the decision-making process is depoliticized."
Opponents of the present system say the trouble began when the architects of the 1970 county charter placed the hospitals in a government department.
When that happened, many of the personnel, financial and other kinds of decisions previously made in Cheverly by hospital adminstrators and the local board of directors, were transferred to government officials in Upper Marlboro.
As the hospital system grew during the late 1970s with the addition of the Greater Laurel-Beltsville Hospital and the Bowie Ambulatory Center, county politicians decided they needed a "superboard" to coordinate the work of the three hospitals governed by individual boards of directors.
Thus the County Council in 1975 created a hospital commission to oversee the facilities.
"We also wanted to make sure that community needs were figured into the process," said council member Ann Lombardi. "The only way we could do that was to appoint a citizens' group to make sure the community's voice was heard."
Lombardi, the only council member to vote against a resolution supporting Hogan's plan to reorganize the hospitals into a private nonprofit authority, said she is worried such action would raise rates for everyone, and threaten indigent and community service programs.
Smith calls the talk of problems in funding the indigent care program a "red herring" issue.
"If a person is truly indigent, the county will still take care of them," he said.
However, both Smith and Lombardi admit that no one knows what the fate of the community health programs will be.
Harry W. Penn, chief administrator of Prince George's General for 23 years until his retirement in 1972, said he would support the leasing of the hospitals to a private corporation, but precautions should be taken to ensure the continued funding of community programs.
"The county needs to review programs like the rape crisis center to see if the community wants them," said Penn. "Those that it wants to keep, it should be willing to finance. The hospitals were the product of community effort and their chief objective, no matter how they are organized should be to take care of community needs."