TO THE THOUSANDS of residents who can recall all too vividly the terrible conditions at D.C. General Hospital only three years ago, the hospital today is a vastly different and better place. Still, because it is a public hospital -- with all the demands for services and money that this role entails -- it is far from being a health-care haven. These findings, coupled with dramatic examples of both the failures and successes at this city's hospital of last resort, have been expertly examined and set forth this week in a five-part series by Susan Okie, a physician who is medical writer for The Washington Post.
Much of what she describes, as well as many of the accompanying scenes photographed for the series by Fred Sweets, are depressing to those who do not have to seek the services of a public hospital. Yet some of D.C. General's roughest critics in the 1970s -- including several who joined in a suit to force improvements at the hospital -- now report that the care delivered there today compares quite favorably with most city hospitals in the country.
D.C. General's legal mandate -- unlike its budget -- is enormous: to treat all District residents, whether or not they can pay. This means accepting alcoholics, abandoned elderly people and anybody else without medical coverage -- a total of more than 200,000 patients a year. It also means operating the busiest emergency room -- more than 86,000 cases in a recent year. Add to this a medical talent pool that includes both the best and worst doctors and nurses, the financial strains that every arm of the District government is feeling, a civil service system that can complicate decisions of even the most sensitive management, and shortages of specialists and nurses.
At least now -- unlike in the years before the lawsuit, when mismanagement and inertia were the city-hallmarks -- D.C. General's shortcomings are officially recognized as important challenges. The hospital management, shifted out from under the old and awful Department of Human Resources to an 11-member citizen commission, is given high marks, as are Medical Director Stanford Roman and Executive Director Robert Johnson. The effort at this point is to end five years of court monitoring and achieve lasting accreditation.
Gilbert Hahn, chairman of the hospital commission, says the suit forced improvements but thinks the court's supervision isn't necessary anyomore. But U.S. District Court Judge Barrington D. Parker, whose orders paved the way for the changes, wants more proof that the hospital can keep good records and improve its nursing and its intensive care units. Agreement on these matters shouldn't be that difficult to work out, since all parties share the same general concerns.
D.C. General still needs more management independence, such as the ability to manage its own finances, establish more flexible personnel rules and negotiate contracts without the red tape and overhead that come with dealing through city hall's departments. With the closing of clinics and other neighborhood services, the role of D.C. General is all the more important -- and the efforts of its concerned managers deserve public and understanding and support.