The District and Howard University want to build a new hospital on the D.C. General campus. This is a bad idea. If that plan goes through, the new hospital and Greater Southeast Community Hospital both could find themselves with too few patients to be financially viable. Alternately, a new facility on the D.C. General campus could lure away so many Greater Southeast patients that Greater Southeast would fold, leaving the District with no hospital east of the Anacostia.

To avoid the damage to our health care system that would result, a hospital should be built east of the Anacostia to replace the antiquated Greater Southeast. The underutilized campus of St. Elizabeths would be an excellent site.

During the past decade hospital closures and downsizing took 1,200 staffed beds -- 30 percent of the beds in the city -- out of service. Inpatient days declined 31 percent during the same period. Private hospitals provided fewer patient days in 2002, even after closure of D.C. General, than they did five years earlier. Demand is anticipated to decline further as managed care presses for shorter hospital stays.

D.C. General and Greater Southeast experienced even greater declines than the citywide averages. D.C. General's average daily census fell by nearly 50 percent in the years before its closure. Greater Southeast had a 25 percent drop in admissions and a 33 percent drop in patient days during the five years prior to its first bankruptcy in 1999. By the time D.C. General closed, Greater Southeast had nearly enough excess capacity to absorb all of D.C. General's remaining patients.

But, as was the case at D.C. General, the physical plant at Greater Southeast has become an impediment to delivering efficient, good quality care. In a 1998 report the hospital's systems and physical design were found to be seriously out of date; the report stressed that "doing nothing at this point could be fatal." That was six years ago. Since then, the infrastructure has worsened, and the facility is involved in a second bankruptcy.

The average age of Greater Southeast's plant is 28 years, while the average age for community hospitals nationally is 8.4 years. Greater Southeast is in need of a $47 million overhaul.

Given the physical inadequacies of Greater Southeast, its less than optimal location and its operational shortcomings, a better choice than modernizing would be to build a facility on or near the St. Elizabeths campus to be run by Howard University or another nonprofit health care provider with a proven commitment to the District. Mechanisms exist to finance such a facility largely through federal programs.

In recent years, the District has made tremendous progress in increasing access to care for low- and moderate-income residents while improving the environment for its health care providers. The city's uninsured rate has gone from 19.2 percent in 1998 to 9 percent last year. Yet despite this progress, the primary care infrastructure still needs investment. And although average operating margins at private District hospitals have improved during the past five years, they remain less than adequate to support a stable hospital sector.

The District is in a strong position to make a modified hospital plan happen. Nonprofit providers have shown an interest in such an initiative. Now the city should act to ensure access to good hospital services for all its residents.

-- Doneg McDonough

co-authored a Service Employees

International Union report that identifies

mechanisms to reestablish a stable community hospital east of the Anacostia River.