More than 10,000 emergency room visits a year would be shifted to private hospitals from the D.C. General campus, under a proposal by District officials that is provoking outrage among hospital executives.
The emergency room, which never stopped operating after D.C. General Hospital ended inpatient services in 2001, currently handles non-life-threatening emergencies, but it would become a 24-hour urgent-care center with fewer capabilities.
Officials of the city's hospitals said the plan would push them to the brink of a crisis. They said they already strain to care for ER patients, who often face long waits because of a lack of critical-care beds, a national nurse shortage and the closing of D.C. General's inpatient functions. They blasted Mayor Anthony A. Williams (D) for not discussing the plan with them at a crucial moment in the development of the city's health care system.
"The impact on other hospitals, in terms of patient care capacity and finance, is overwhelming," said Sister Carol Keehan, chief executive of Providence Hospital in Northeast Washington. "The city is playing that down, and we're going to get in trouble playing that down. It's a crisis point for everybody who uses a D.C. hospital -- not just the poor."
The plan, which City Administrator John A. Koskinen said was necessary for Greater Southeast Community Hospital to emerge from bankruptcy, will be presented to U.S. Bankruptcy Judge S. Martin Teel Jr. on Jan. 21. Greater Southeast leads a private network of health care providers that replaced the city's public hospital 19 months ago.
The D.C. General emergency room, which is run by Greater Southeast, now receives about 860 patients a month suffering from what are deemed legitimate emergencies, including many who arrive by ambulance.
But Greater Southeast, forced to seek bankruptcy court protection in Washington after its lender did in Ohio, needs to cut costs to stay open. Under the plan, ambulances would stop delivering patients to D.C. General. Urgent-care staff members would see walk-in patients with minor complaints -- colds, fevers, allergic reactions, minor wounds, fractures, sprains, scrapes, rashes, miscellaneous pains and ear infections. An ambulance would be stationed there to take patients with serious conditions to hospitals.
The plan also would eliminate six of 21 outpatient specialty clinics in the same building; patients who have gone to those clinics for treatment would be referred elsewhere. Doctors said some patients would not switch because of confusion or unwillingness to see other physicians. Clinics marked for closing specialize in allergies, audiology, pulmonology (respiratory system), nephrology (kidneys), renal dialysis and rheumatology.
But the emergency room plan is what executives from private hospitals fear because their facilities have seen emergency room demand surge in recent years.
When D.C. General Hospital was closed and replaced by the private network, the plan called for a new trauma center at Greater Southeast. That never happened. Then, in November, Greater Southeast and its parent company filed for bankruptcy protection.
Nevertheless, Daniel P. McLean, chief executive of George Washington University Hospital, said the city should not take such action without consulting hospital leaders.
"I don't think that we really ought to be making a whole lot of independent changes without a good overall game plan on where we're going and what we'll have at the end of the day," McLean said. "When the system breaks, it's going to take a whole lot of money and time to rebuild it."
Koskinen said the restructuring was necessary to help Greater Southeast emerge from bankruptcy court protection. He said the plan would cut the District's direct support of the outpatient facility at D.C. General from $10 million to $8 million a year under its contract with Greater Southeast.
Greater Southeast officials said they lost an additional $8 million a year supporting the outpatient center at levels in effect when D.C. General was still a city-run hospital. That is no longer supportable with the firm under the control of the bankruptcy court and a demanding group of creditors.
If Greater Southeast does not survive, an even larger health care crisis could develop, officials said, because the entire eastern half of the city would be without a hospital other than Providence.
Koskinen said the conversion of the emergency room to an urgent-care facility would draw non-emergency patients back to D.C. General. "The D.C. General ER is not handling life-threatening stuff, and it's still staffed round-the-clock with doctors who say that, particularly in the evening, patients need urgent care," Koskinen said.
An urgent-care facility, he said, "would take pressure off other ERs."
The plan was written under deadline pressure by city officials, Greater Southeast executives and health care activists.
Patients of the targeted clinics who learned yesterday about the changes were not pleased.
Medicare patient Pauline Buckner, 69, has been fighting chronic obstructive pulmonary disease since 1986 and visits the pulmonology clinic at the D.C. General campus monthly. "I know I could go anywhere with my [Medicare] credential, but I prefer coming here," said Buckner, who lives in Southeast. "If D.C. General doesn't know what's wrong with you, no one knows. That's why I'm here. They're professional and deal with it all the time."
Ella Mae Knight, 74, visits the D.C. General nephrology clinic about 10 times a year for care of kidney problems. She said she would reluctantly seek medical help elsewhere. "I just like to come here," she said. "I've come here just about all my life."