United Medical Center in Southeast Washington is the District’s only public hospital. (Salwan Georges/The Washington Post)

The District's top health regulator first warned leaders of the city's only public hospital about serious problems in its obstetrics ward in March, five months before she took the extraordinary step of shutting down the facility's nursery and delivery rooms, hospital managers and city health-care officials said Friday.

The disclosure during a public hearing by the D.C. Council's Health Committee is likely to intensify questions about lapses in patient care at United Medical Center, the District-owned hospital that caters to the impoverished neighborhoods east of the Anacostia River.

It shows that even with abundant time to remedy the problems, hospital managers were unable to bring the obstetrics ward up to the minimum safety standards necessary to avoid the closure, which has put the long-troubled hospital in renewed financial jeopardy and left two wards of the city without a place for women to give birth.

The six-hour hearing, led by D.C. Council member and Health Committee Chairman Vincent C. Gray (D-Ward 7), marked the first public airing of concerns about regulators' abrupt shutdown of UMC's obstetrics ward Aug. 7. It comes amid growing public concern about conditions at the hospital, which since 2016 has been run by a consulting firm led by campaign donors to Mayor Muriel E. Bowser (D).

Health officials have declined to discuss their reasons for closing the nursery and delivery rooms, saying their investigation of problems at the now-shuttered facility is pending. Last month, The Washington Post obtained a letter from D.C. Department of Health Director LaQuandra Nesbitt to hospital chief executive Luis Hernandez describing dangerous medical errors that led her to shut down the obstetrics ward.

Among them were a failure to take routine steps to prevent a newborn from contracting HIV and failure to properly monitor or treat a pregnant woman with potentially fatal blood-pressure problems.

But the Aug. 7 letter's description of those incidents was incomplete, since it did not describe what ultimately happened to the patients subject to the hospital staff's mistakes.

D.C. Health Care Finance Department Director Wayne Turnage said during his testimony Friday that Nesbitt had called him to discuss troubling findings about care for pregnant mothers and newborns shortly before a retreat and meeting of the hospital board in March.

"She was very emotional, very upset, and she said she was coming to the board to speak," Turnage said. "She believed that the standard of care that was to be expected was simply not there." At the meeting, Turnage said, "she gave the board a pretty good tongue-lashing."

It is not clear what steps the hospital took to try to improve conditions in the following five months before Nesbitt closed the obstetrics unit.

UMC executive David Boucrée — one of three hospital managers employed full time by the consulting firm Veritas of Washington — said that the hospital sent a letter to Nesbitt in the spring responding to her concerns but that he was unaware of what it said.

Nesbitt gave a conflicting account, saying after the hearing that she had never received such a letter.

It is also unclear when the obstetrics ward might reopen. Boucrée testified Friday that he thought it unlikely it would restart within 90 days, as some had initially hoped.

"My gut tells me we'll probably end up asking for an extension," Boucrée said.

During Friday's hearing, city and hospital officials repeatedly refused to talk about the specific problems that led to the closure of the nursery and delivery rooms, saying they did not want to run afoul of laws protecting patient privacy.

Their deflections eventually prompted an exasperated response from Gray.

"The operation is owned by the District of Columbia. There's a board that's been appointed by the District of Columbia. How can you all sit there and say we don't have a right to know?" Gray said. "We do have a right to know."

Turnage and Boucrée also said Friday that UMC's financial picture has grown bleaker over the past six weeks.

Boucrée said that admissions at the hospital have dropped off, a decline he attributed to negative publicity for the hospital after the closing of the obstetrics ward.

Since then, The Post also has reported on the allegations of a family who said they did not learn of a relative's death in the UMC nursing home until a week after the fact, as well as the failures of the consulting firm managing the hospital to meet many of the goals laid out for it by the city.

Turnage said Friday that while he did not anticipate the hospital would need a taxpayer subsidy as it closes out the current fiscal year, the declining revenue might mean that it would have to slash next year's budget. He said the city should have a clearer picture of UMC's financial situation by next week.

When testimony ended Friday, Gray did not formally adjourn the hearing, instead recessing it with a promise to bring hospital officials back for more questioning in the near future.

He said afterward that he was frustrated so little information about the problems in the obstetrics ward had come to light. "There are too many unanswered questions," he said.