RESIDENTS AND BUSINESSES in every quadrant of the District should devote some time to familiarizing themselves with the joint project of the D.C. government and Howard University to build a $400 million, 250-bed hospital on grounds D.C. General Hospital once occupied. Costs of the new hospital will be borne by the city -- as will the consequences of failure -- should this unprecedented venture not live up to supporters' expectations. The issue is not whether residents who are likely to be served by the proposed National Capital Medical Center should have convenient access to the highest quality health care services. They, of course, should. But D.C. residents who will end up carrying much of the financial freight for a new hospital must decide, through their elected representatives, whether this proposed use of public money is the most effective way to improve the health status of people most in need of medical services.
In an earlier editorial, we raised questions that we believe have a direct bearing on the wisdom and feasibility of the hospital. Today we raise additional issues that we hope city legislators and other key stakeholders, including the mayor and leaders of Howard University, will explore fully with the D.C. Council before a final decision is reached on the project in the fall.
A key question is how Howard University will manage and sustain its current hospital and the new one as a two-campus health care system, as indicated in the proposal. A consultant's report, which the city commissioned, projects huge deficits if Howard University Hospital is kept open along with a new hospital.
The consultant's findings raise a number of concerns that should be addressed, such as:
* How does Howard University plan to fund the new hospital's expected operating deficits in its first three years?
* If the deficits are greater than expected, how does Howard intend to cover them?
* What assumptions has the university made regarding the range of financial risks it might encounter?
* If those risks or the deficits are greater than expected, what will be the university's exit strategy?
* Why do Howard's trustees want to increase the university's exposure to the challenges of hospital economics when most university boards -- e.g., George Washington University, Georgetown University -- are divesting their hospitals?
* Given the huge projected costs for a new hospital, what is the university's strategy to recruit and pay for its physicians and staff, especially in light of a national shortage of skilled workers?
The D.C.-Howard proposal also contains a number of assumptions that cannot be taken for granted. Council members should want to know the basis for the university and the city assuming that:
* The new hospital will perform 22 times more surgeries annually (15,000) than Howard University Hospital currently performs annually (673).
* Moving Howard Hospital's trauma center to the new hospital will improve the overall patient mix and the economics of the center.
These questions -- in addition to central issues such as the need for responsible city leaders to rationalize expensive and duplicative health services and the capacity of both the city and the university to find money for the new hospital -- ought to occupy the minds of D.C. taxpayers and everyone concerned about access to quality and cost-effective health care in the nation's capital. Sound medical decisions and fiscal responsibility ought to trump expediency.