The District recently announced that it would delay its final proposal for a National Capital Medical Center on the campus of the former D.C. General Hospital. A staff member in City Administrator Robert C. Bobb's office said, "We think it's best to take that extra couple of weeks and get things right."
I agree. But to get things right, the city needs a new approach.
The city's argument for the new medical complex revolves around proximity, not health. Because many residents in the eastern part of the city live farther from a medical center than do many residents in the west, the theory is that Washington needs another medical center in the eastern part of the city. While appealing on its surface, this argument is thin justification for another medical center, given that all D.C. residents already live close to at least one of nine acute-care hospitals, all of which include emergency rooms and five of which have top-level trauma centers. That proximity has not improved their health, however. The District still suffers from terrible rates of disease and premature death.
The new medical complex would include a 250-bed hospital, a trauma center and an emergency room. It would be owned and operated by Howard University, but it would cost the District several hundred million dollars in start-up funds and probably require large operating subsidies. The hospital is not intended primarily for poor, uninsured Washingtonians; most of its patients are expected to have health insurance.
The city argues that fairness demands the medical center be built, but fairness actually demands the opposite. In Washington, life expectancy for black women is five years less than for Americans in general (71.6 years versus 76.7 years), and life expectancy for black men is nearly 20 years less (57.5 years versus 76.7 years). Fairness in life expectancy should trump fairness in proximity.
The city also has not shown that the District needs another medical center. Washington is well above the national average in terms of trauma centers, ER visits and hospital beds per capita. The city's own consultant, Stroudwater Associates, has found that the center could threaten Howard University Hospital and Greater Southeast Community Hospital and that it might even force them to close.
Chronic diseases such as asthma, HIV, high blood pressure, diabetes and obesity cause most serious illness in Washington. These diseases are best treated by family doctors and outpatient specialists, such as cardiologists. Unfortunately, good, accessible outpatient medical care is just what many D.C. residents lack. As a result, people with chronic diseases often become sick enough to need an emergency room or hospital stay.
Since D.C. General closed, the city has insured more than 40,000 people through its Healthcare Alliance. As Mayor Anthony A. Williams has said, the alliance has increased outpatient care, decreased emergency room use and lowered the rate of "avoidable hospitalization."
Washingtonians concerned about health should hope that the delay in the National Capital Medical Center proposal represents a decision to begin a planning process that takes a hard look at why D.C. residents become sick and addresses those causes. Health policy experts who have not embraced the medical center might step forward if the city showed it were serious about becoming a healthier place.
We soon will see if it is.
-- Eric Rosenthal
is a pediatrician who lives and works in the District.