City Administrator Robert C. Bobb made a lengthy pitch yesterday for the National Capital Medical Center, saying it would help the District remedy geographic inequities in hospital beds, prepare for future growth needs, anchor a community health network for east-side neighborhoods and disperse emergency facilities in the event of a major disaster.
"The NCMC will fill the gaping hole in the District's hospital map," Bobb testified during a day-long hearing on the 250-bed complex, which the city and Howard University want to build on the grounds of the former D.C. General Hospital.
But if the reactions of the half-dozen members of the D.C. Council's Health Committee are a gauge, top city and Howard officials have to fill in a lot of holes before Mayor Anthony A. Williams (D) asks for the critical vote this fall that would commit the District to spending $200 million on construction alone.
The joint project's cost is quadruple the initial estimate from less than two years ago, and questioners yesterday repeatedly asked what the public dollars were buying -- and how far they would go to treat the city's greatest health problem, the lack of primary and specialty care in a huge swath of the District.
"Why aren't we using $200 million to resuscitate our whole public health system?" asked Jim Graham (D-Ward 1), who said he could justify such spending on a new hospital only if its core mission included provision of care to uninsured and underinsured residents.
Even committee members who strongly supported the project said they wanted a commitment to a certain level of care for that significant portion of the population.
"What is in the plan's specifics to assure us?" pressed council Chairman Linda W. Cropp (D).
As put forth by Bobb and Howard University Senior Vice President Hassan Minor, the city would essentially donate nine acres along Independence Avenue and 20th Street SE, pay for site preparation and finance half the $400 million construction, a share that could top $300 million. Howard would own and operate the medical center, though a board governing the medical center and Howard University Hospital would include mayoral appointees.
"When you're asking for $300 million, it's not going to be easy," committee Chairman David A. Catania (I-At Large) warned, having given Minor and Bobb his own conditions for support.
The new facility would succeed D.C. General, which Williams closed in 2001 after years of physical decline and financial losses. He recently suggested that the city could provide some funding for specific programs or uninsured care, but he remains firm that the National Capital Medical Center would not receive annual operating subsidies from his government.
Given a consultant's conclusion that Howard could not run it without budget deficits if it kept open Howard University Hospital, the future of the university's Georgia Avenue institution also played prominently.
Minor told Cropp that when complete legal and financial agreements are presented to the council Oct. 1, as Williams has promised, the university would specify what medical and surgical services would move with Level 1 trauma care to the new site and what, and how many, beds would remain on Georgia Avenue.
Cropp proposed that the university turn its existing hospital into an ambulatory care center without beds, a facility at one point proposed for the D.C. General location. "My suggestion is just to switch," Cropp said, in part to mitigate the impact of a new medical center on the city's other hospitals "so we don't send them toppling over."
A decision on that also will be made before October, Bobb responded.
Comments from almost two dozen residents followed Bobb, Minor and a panel representing the District's hospital association, medical society and primary care association. Though some opposed the medical center, more spoke for it, some with vehemence that their communities deserve no less.
By the hearing's end late in the afternoon, Catania was looking ahead. By Oct. 1, he said, the project has to be "in a nice package with a bow on top. All questions answered, all details known."