THE RECENT STORY concerning patient misery and sweltering conditions in the aging D.C. General Hospital underscores the necessity of reforms in the city's health care system. The District's key safety net providers -- D.C. General, Greater Southeast Community Hospital and Howard University Hospital -- simply cannot continue business as usual and expect to survive financially, let alone serve as effective safety nets.

The three hospitals can legitimately claim to provide substantial uncompensated care to the city's medically underserved population. Each hospital also has an active emergency room, heavily used outpatient services and a reputation for being community-oriented. But D.C. General, Greater Southeast and Howard University hospitals are also part of a health care system that has an excess of inpatient acute care services, many duplicative and expensive administrative and clinical services, and an overall structure that lends itself to misuse of scarce resources.

The mayor and the D.C. financial control board have correctly decided that the time has come to fundamentally redo the manner in which health care gets delivered in the city. They have urged the three hospitals to discuss how to consolidate and rationalize health care delivery among themselves. Talks among Howard, Greater Southeast and D.C. General have occurred. They agree that efficiencies of scale are to be realized if the three hospitals can integrate their operations.

But thus far, despite encouragement from the mayor and the control board, small-minded provincialism seems to be preventing the three hospitals from reaching a meeting of the minds. Each hospital apparently regards itself as the logical nucleus of a future integrated health care system. That attitude, should it prevail, could bring talks to an impasse.

The situation calls for political leadership. The mayor and the control board are already in the picture. The D.C. Council can play a constructive role, too, provided more members are willing to tackle the issue of future health care delivery in the District with an open mind.