D.C. General Hospital, the financially stressed public facility that never turns anyone away, has begun an unprecedented television ad campaign that casts the hospital as something more than a place where poor people can get patched up after being shot or stabbed.

The two 30-second spots--which will run during health-care programs on cable NewsChannel 8 through January--emphasize a range of health-care services offered by D.C. General and reflect the hospital's determination to create a marketable identity in the face of increasing threats to its future.

Once a mammoth facility with more than 1,000 beds in use, D.C. General has seen demand for its services shrivel, and its capacity has been cut to 250 beds. D.C. officials periodically have suggested shutting the costly facility and shifting charity patients to private hospitals, which also have seen dramatic declines in business as health plans steer their members away from hospital care.

In the spring, D.C. Mayor Anthony A. Williams (D) offered a plan that would have sliced guaranteed city funding of D.C. General and provided insurance coverage to thousands of low-income residents--giving them treatment options besides the public hospital.

D.C. General and its supporters beat back that plan, largely by emphasizing the hospital's history as a safety net for the city's estimated 80,000 uninsured residents, most of whom are low-income African Americans.

Racial pride is a key element in the hospital's new ads, which are targeted at black women and remind them that D.C. General always has cared for their families--even when no one else would. As images of black health professionals and patients fade in and out, a male vocalist sings the message in an up-tempo jingle:

Imagine a world where health care's Denied,

If you couldn't get it as hard as you Tried.

Well it wasn't that long ago that

Was the case,

But you always could depend on Being seen at our place.

Try to imagine a world without us,

Try to imagine a world without us,

Try to imagine a world without us


The Public Benefit Corp., which runs the hospital, nine community clinics and nursing programs at 147 D.C. public schools, spent $36,000 to produce and broadcast the ads--a modest investment by industry standards. They have been airing since July.

The effort could lead to a larger campaign that might include spots on WJLA-TV (Channel 7), the local station most watched by the District's black community, said PBC marketing development officer Leo Alexander.

The two commercials trumpet the PBC as an agency that does far more than provide a trauma center for victims of urban violence, offering primary care, prenatal care and dental services, among other things, across the city.

"The impression is, if you get shot or stabbed, go to D.C. General because they have the best trauma surgeons in town--but after that, go someplace else," said PBC Vice Chairman Julius Hobson Jr. "We have to change that. We want them to see that the PBC is a full-service entity [providing] excellent care. The only way you can convince people of that is to advertise."

Officials hope the messages impress the District's poorest residents, many of whom are enrolling in private health maintenance organizations hired by Medicaid. The PBC hopes to create its own HMO soon.

With Williams continuing to push his plan to extend Medicaid coverage to most D.C. residents who lack health insurance, the number of Medicaid HMO members could surge in the next few years.

For newly insured patients, coverage would bring greater freedom to choose doctors and hospitals, and the PBC will have to compete for those patients or continue to face an uncertain future. Years of deficits have been halted, but the hospital still relies on D.C. taxpayers for about $50 million in subsidies each year.

The need to compete represents one of the biggest changes in the way the public hospital has operated since Congress appropriated $6,000 to open an alms house for charity health care in 1806, a forerunner of D.C. General.

John A. Fairman, the PBC's chief executive and spokesman in one of the ads, said the advertising responds to the mayor's insistence that Fairman's agency become competitive.

"It doesn't help us to stay at home and be typecast inappropriately by some and let that be the last word as to who we are," Fairman said.

Williams spokeswoman Peggy Armstrong said the mayor was happy to learn about the commercials.

"He is pleased to see them reach out to people," she said. "He called upon them to be more competitive, to provide more primary health care and to reach out to people to let them know what is available from the hospital--especially services that go beyond the emergency room."

For 15 years, private hospitals across the nation have used advertising to promote their services, but only recently have public hospitals followed suit.

The New York City Health and Hospitals Corp. apparently is the most active, spending about $5 million this year to promote 11 hospitals, five long-term care facilities, six clinics and an HMO.

"It was somewhat unheard of for public hospitals to be using taxpayer money to promote the services and the providers of the facility," said Jane D. Zimmerman, a senior vice president at the New York agency. "But managed-care market forces have sent shock waves through the health-care industry."

With Medicaid recipients being shifted to HMOs and private hospitals suddenly competing to care for them, public hospitals had to act, Zimmerman said. She began a campaign that includes television, radio and transit advertising.

"The criticism we hear most frequently" about the ads, she said, "is that we're not doing enough."