A Nov. 5 Metro article about a proposed hospital for Southeast Washington gave an incorrect title for Robert A. Malson of the District of Columbia Hospital Association. He is the association's president. (Published 11/8/04)

What began one year ago as discussion of a new 110-bed hospital in Southeast Washington has grown into negotiations for a medical complex with up to 300 beds, the highest-level trauma care and groundbreaking research, prompting plenty of questions about such sweeping ambition.

The National Capital Medical Center, on the grounds of the former D.C. General Hospital at Massachusetts Avenue and 19th Street SE, would be an unusual partnership between the city and Howard University. It would make amends for what many people still consider Mayor Anthony A. Williams's grievous closure of D.C. General, which left one of the District's neediest communities without emergency room services and shifted a huge burden of indigent care to facilities across the city.

Yet the project's expanded scope has been kept largely out of the public spotlight. Its possible cost and funding remain unknown, though public money would pay for much of the construction. Despite the repercussions for local health care, not until a meeting Tuesday with city Administrator Robert C. Bobb were officials at other medical facilities brought into the discussion.

"There is major concern," said Joan Phillips, chief executive officer of Greater Southeast Community Hospital.

The one-page "vision statement" that Bobb handed Phillips and her counterparts at other hospitals describes a "world-class, high-quality, comprehensive academic medical center serving the national capital region and beyond." Its breadth would encompass prevention and wellness programs, as well as "centers of excellence" in such specialties as oncology and orthopedics. As the first new hospital undertaken in Washington since the 2001 terrorist attacks, it would be built for a full response to any homeland security disaster.

Loaded with superlatives, the synopsis makes clear how different this facility would be from its long-stigmatized predecessor.

"There's a lot in the vision statement, and I don't think that ought to be minimized," said Robert A. Malson, executive director of the District of Columbia Hospital Association. But he said his members need "hard-core data" to evaluate the proposal's viability and impact, especially on the provision of primary care to uninsured residents.

"The hospitals would like to meet with Howard as soon as possible to review its financial analysis and . . . projections," Malson said.

Howard forwarded operating and capital estimates to the city this week. Bobb said last night that the numbers are being evaluated and that the other institutions would be kept posted and their opinions solicited. "We had to establish our relationship [first] with Howard," he said.

The city administrator recently characterized the talks as moving past economic feasibility studies into "a very critical stage with respect to financing and financial options." The city has retained a health care facilities planning firm as adviser and is working to determine the valuation of the nine acres that would be turned over to Howard through a 99-year lease.

University spokeswoman Jennifer James-Pryor referred all questions to Bobb's office because "the city has the lead on this."

Williams and the now-dormant financial control board shuttered D.C. General in 2001 despite opposition from the D.C. Council, the District's other hospitals and a major swath of the community. The move, which Williams blamed on the facility's repeated fiscal problems and mismanagement, ended nearly two centuries of care there.

The intent was to provide more services for less money by redirecting city dollars to private medical providers and a network of community clinics. The sprawling red-brick institution was largely abandoned, save for the sections that were converted into a small urgent care center and some outpatient clinics and offices.

Within 18 months, other hospitals were complaining of emergency rooms overwhelmed by former D.C. General patients. And then Greater Southeast, one of those most affected, lost its accreditation as its parent company struggled through bankruptcy.

While standing firm that the city would never again build or run a "poor person's hospital," Williams announced last fall that he would support construction of a facility on the site of D.C. General.

In a memo of understanding that the city and Howard signed in the spring, the parties specified that the university would build, own and operate the National Capital Medical Center. According to the just-released vision statement, Howard would do so by creating a governing corporation "with an independent board of directors for the NCMC and Howard University Hospital."

That implies, but does not guarantee, that Howard would maintain its current 482-bed hospital on Georgia Avenue NW -- a prime concern for numerous hospitals, though they also are concerned about the university's ability to effectively run two large facilities.

But CEOs like Phillips focus first on the question of how an initial 110-bed proposal more than doubled in size and scope over the past year and where already scarce dollars will be found to pay for it. A price tag point of comparison is Virginia Hospital Center in Arlington, which weeks ago opened a new-from-the-ground-up hospital of 334 beds. Its cost: $150 million.

Jim Caldas, president of Washington Hospital Center, said he realizes that the District aims to avoid the mistakes of the past. D.C. General required huge subsidies and still had financial problems; its successor, officials hope, would attract paying patients from across the region to balance out those without means.

Still, Caldas argued, "the crying need" in the city's southeast quadrant is for a community hospital and a better network of primary care, not a major medical teaching center. He said he would have made that point earlier if he had been given the opportunity.

"This has not been the sort of open process to date we would have liked," he said.

Staff writer Lori Montgomery contributed to this report.