The administration of D.C. Mayor Anthony A. Williams (D) wants to bypass the independent review of a $400 million medical complex the District would build with Howard University and instead send the proposal directly to the D.C. Council for approval.
Removing the National Capital Medical Center from the usual regulatory process would exempt it from the D.C. code requirement that an applicant demonstrate "a public need for the new service or expenditure." That need is measured by health analysts against set criteria and standards and must conform to the District's Comprehensive Health Plan.
While hospital closures or ownership changes in the city have circumvented the certificate-of-need requirement on rare occasions, there apparently is no precedent for doing so on a new hospital.
Several council members said this week that they would be inclined to grant the exemption and give themselves sole authority to decide whether the joint venture should go forward. Numerous members already have voiced strong support for the project, though specifics of its cost and funding remain unknown.
Oct. 1 is Williams's self-imposed deadline for releasing those details, as well as the date by which Howard University officials are expected to reveal their complete plans and financing. City Administrator Robert C. Bobb has managed the project from the moment Williams announced it nearly two years ago, and it was Bobb who recently disclosed the plan to have the council alone take up the matter.
Gina Lagomarsino, a senior policy adviser in Bobb's office, said this week that the administration thinks public hearings before the council and members' own analysis would be adequate review and risk fewer delays. "Once the council votes on the project, it seems redundant to take it back through the [certificate-of-need] process," she said.
Council member Jim Graham (D-Ward 1) said he finds merit in the move: "Ordinarily I would say, 'Let's have as apolitical a review as possible,' but here I think the issues have to be before us." One way or another, he added, "let's get on with it."
But the president of the D.C. Hospital Association, which voted this spring to endorse the far less costly alternative of an ambulatory care center, said that bypassing outside oversight would be "a public disgrace" that could result in higher hospital costs and duplicative services. "Doing so signals there are serious flaws in the current plan," Robert Malson said.
The National Capital Medical Center, which would be built on the grounds of the former D.C. General Hospital at Massachusetts Avenue and 19th Street SE, is being touted as a 250-bed, state-of-the-art teaching and research complex that would bring top-level trauma care and other sophisticated hospital services to a part of the District where all are lacking.
As discussed to date, the city would pay $300 million toward half of the construction cost, plus other expenses. Howard, however, would own and run the facility.
The project already has provoked intense reaction, with backers insisting that medical needs and inequities demand its construction and opponents countering that the District's greatest health failings trace to chronic illnesses that must be addressed through primary care. Detractors also question whether the facility can survive without ongoing public subsidy and whether Howard can run it while maintaining its Howard University Hospital on Georgia Avenue NW.
Numerous D.C. civic groups have voted their support -- the project is sure to become a central issue in next year's elections -- but few public health or policy experts have offered endorsements.
"What we need most in this city is to keep people out of the hospital," said Alice M. Rivlin of the Brookings Institution. "You can reduce the need for hospital and ER care. . . . I think that should be the first priority."
Rivlin has dealt with similar emotional issues in the past; her tenure on the city's financial control board included the 2001 closure of D.C. General, which the immediate community bitterly fought. But she is skeptical of the justifications for the National Capital Medical Center and its unintended consequences, such as the possible closure of Howard University Hospital or the struggling Greater Southeast Community Hospital. She is even skeptical of the proposed location. Why not put it east of the Anacostia River, she suggested, where the community is every bit as isolated medically?
"It is a very political issue right now," she said. "I think it's almost entirely political."