The District and Howard University unveiled preliminary financing details yesterday for the hospital complex they plan to build in Southeast Washington but -- nearly a month after their own deadline -- acknowledged to impatient council members that they still have no signed agreement or resolution on key issues.
During a hearing that revealed several council members' rising irritation over the protracted negotiations and lack of answers to their questions, the two parties promised to return by Jan. 1 with a completed deal that would lay out all the parameters of the proposed National Capital Medical Center. They now hope to break ground in 2007 on the project, which supporters maintain is crucial to increasing medical care in underserved neighborhoods on the city's east side.
"Virtually every deadline's been missed," said Vincent C. Gray (D-Ward 7), one of the center's main backers on the council. "Every day that elapses, this . . . begins to lose credibility."
"We need a little more specificity in regard to a whole lot of details," said Sharon Ambrose (D-Ward 6), who represents the community where the complex would be built.
The documents released yesterday show that construction of the 250-bed hospital at the heart of the project -- a top-level trauma facility on the site of the former D.C. General Hospital at 19th Street and Pennsylvania Avenue SE -- would cost just more than $400 million.
The city and Howard would be construction partners, but Howard would own and run the medical center and cover the multimillion-dollar operating deficits expected for at least three years.
The cost estimate had been considerably higher before plans for underground parking were modified and the hospital was shrunk in part by eliminating an atrium and retail space. Yet the figure remains significantly above the industry standard, as council Chairman Linda W. Cropp (D), another declared backer, pointed out. Neither Howard nor District officials have publicly broken down the total for the various medical programs. "It is still more than the [average] $1-million-per-bed cost," Cropp said.
The city has proposed to pay for its half of the construction with $100 million it is slated to get from the national tobacco settlement and another $100 million from an anticipated budget surplus in fiscal 2009. Additional funding could come from a federal program that offers subsidies to institutions investing in underserved areas, City Administrator Robert C. Bobb said.
The District's construction share would be capped at $201.5 million, according to the city's version of an exclusive rights agreement, though its investment would run at least $32 million more because of infrastructure improvements.
Howard plans to finance its share of the construction through federal tax-exempt revenue bonds, the same mechanism that the university's vice president, Hassan Minor, said numerous New York hospitals have used for capital endeavors. The university would pay the full cost of adjoining medical and research buildings, as well as all operating costs once it takes possession of the hospital.
The city's proposed rights agreement repeats Mayor Anthony A. Williams's edict that the District provide no annual operating subsidy to keep the hospital afloat.
The question of what the city would get for its dollars provoked the sharpest comments yesterday, with Gray and David A. Catania (I-At Large), chairman of the council's health committee, pressing to learn the extent of Howard's commitment to providing care to uninsured residents. When neither Bobb nor Minor could provide a dollar amount, Catania warned that the issue was a potential "deal breaker" for him, given "all the money we're going to give Howard."
"If there is not a benefit that meets my satisfaction," he said, "I will do everything I can to stop this train."
Catania bore down, clearly angry that Howard's trustees have yet to vote on the National Capital Medical Center despite the deadlines. "You have had two years to get your board together and answer these questions," he told Minor.
The university took more than three months to respond to the city's first proposal laying out the specifics of construction hiring, financing and responsibilities. And the document it returned apparently was vastly different. "I've seen that document," Catania said. "We could have a clownfest on it."
And Howard has yet to respond to a request Williams made early last month. Among other details, the mayor asked for a comparison of the proposed center's construction costs with those of George Washington University Hospital, completed several years ago.
The university's board is scheduled to meet next month to decide whether to support the project. Minor's comments suggested that the trustees' approval is not necessarily assured, especially given concerns over the amount of uncompensated care the hospital might be required to provide. "They don't want to agree to something that is doomed," he said.
Only yesterday did Howard itemize how the 250 beds would be divided among medical specialties or what services would be left at Howard University Hospital on Georgia Avenue NW. Obstetrics and gynecology would move to the new location, for example, as would pediatrics and all trauma care. Howard's existing hospital would lose nearly four dozen beds, and its intensive/critical care unit would be cut by nearly three-quarters.