The proposal to build a National Capital Medical Center on the grounds of the old D.C. General Hospital should not be allowed to bypass the normally required vetting process known as a certificate-of-need review.

The District and 35 states, including Maryland and Virginia, use this process, which employs experts to review proposals and solicit comments from the affected community to determine which projects should be approved as submitted, which should be modified and which should be rejected. The certificate of need is designed to hold down costs by ensuring that projects are needed, have adequate financing and management plans, and relate favorably to existing services. The statute also includes an appeals process.

Many of the District's health care providers and citizen groups had expected to review the mayor's detailed plan for the medical complex after its scheduled release (now postponed) at the first of this month. The city administrator previously had advised Mayor Anthony A. Williams to introduce legislation asking the D.C. Council for authority to build the 250-bed, $400 million hospital without a certificate of need ["D.C. May Shortcut Hospital Review; Williams Wants Only the Council to Decide on Proposed Facility," Metro, Sept. 17]. The D.C. Hospital Association has an interest in this project because the provision of hospital care to the uninsured and underinsured in Washington is a joint venture of the District and its hospitals. Private hospitals provide more than $167 million in uncompensated care annually in a partnership that requires collaboration and coordination.

Williams retained a consulting firm to analyze aspects of the proposed project, and the firm's report, released in April, contained the pros and cons of five possible models for the new medical center and described capital and operating costs.

A number of council members who have announced that they are running (or considering running) for mayor or council chair have decreed that they can review the proposal "on its merits" without the need for a certificate-of-need review. Other council members have indicated that they will oppose the tactic. Given the absence of the Department of Health from the debate, it is hard not to conclude that the city's involvement in the new hospital complex is more about politics than health.

If the city is going to invest taxpayer money in a National Capital Medical Center, intense public scrutiny is warranted. The public should demand that the certificate-of-need process not be bypassed -- particularly in an atmosphere already charged with election-year posturing and pandering.

-- Robert A. Malson

is president of the District of Columbia Hospital Association.