"The large number of people who visit D.C. General but do not require hospitalization shows that many of the hospital's patients are using the emergency room as their primary care provider, which is both an expensive and ineffective way to provide health care. Emergency rooms don't provide the care people need to live healthier lives."
-- Mayor Anthony A. Williams,
March 25, 2001
THE MAYOR'S position on hospitals was sound in 2001, when he moved to close D.C. General, and it remains so today. The District's health problem is not a lack of hospitals or access to trauma centers. At least, no reputable study backs up such a claim. The problem is a lack of primary care and access to specialty services that can keep people out of hospitals and away from emergency rooms. Providing early and preventive care and treatment of chronic illnesses -- especially for the city's uninsured poor residents -- would use the city's scarce resources better than opening an unneeded hospital.
However, that well-thought-out policy now stands to be reversed by the mayor and Howard University, who propose to build a National Capital Medical Center, a $400 million, 250-bed, "state-of-the-art" complex with top-level trauma care and other sophisticated services on the grounds of the former D.C. General. Amazingly, the mayor also wants to bypass the city's "certificate of need" process, which is supposed to compare proposals like this one with set standards to ensure the facility is needed and the huge expenditure warranted. If ever there were a time for the public to demand a fair and independent review of a public project, it is for this expensive new hospital.
It is already clear from the long delays in providing details on the venture that the mayor and Howard have yet to work out the specifics on financing, governance and costs. Howard, we learned this week, has yet to decide how it will manage and operate its Georgia Avenue hospital along with a new facility. Neither has it determined the kind of facility that will remain on the school's campus. Likewise, Howard officials were not in a position to discuss financing arrangements, including how the university plans to fund the hospital's expected operating deficits in its first three years. That question is germane because city taxpayers could be left holding the bag if the university cannot cover greater-than-expected deficits.
Many of the assumptions and assertions in the proposal -- such as who will use the facility, occupancy rates and surgeries to be performed -- require independent examination by public health and health policy experts rather than by politicians. Absent from the discussion, too, is any mention of the future of the struggling Greater Southeast Community Hospital and what the loss of that facility could mean to medically isolated communities east of the Anacostia River.
The proposed hospital is being pushed for political reasons, as Alice Rivlin of the Brookings Institution recently observed. City residents deserve more from the mayor and members of the D.C. council, who surely know better. Before sending a proposal to the council, the mayor owes it to the city -- and himself -- to commission an independent review by outside experts and planners to determine whether a new hospital is, indeed, necessary.