Leaders at the District's only public hospital were planning to close the facility's nursery and delivery rooms before those units were shut down by District regulators because of safety problems, according to confidential documents obtained by The Washington Post.
The documents show that the consultants running the hospital prepared a proposal to close United Medical Center's obstetrics ward, citing its drain on hospital finances and concerns about the quality of care for patients. The proposal was emailed Aug. 6 to LaRuby May, the hospital board chairwoman appointed by Mayor Muriel E. Bowser (D).
The previously undisclosed plans shed new light on the closure of the ward, which left a wide portion of the nation's capital east of the Anacostia River without a hospital for women to give birth and receive prenatal care. The decision surprised and upset maternal-health advocates and community activists in Southeast Washington, where infant mortality is more than double the national rate.
LaQuandra S. Nesbitt, director of the D.C. Department of Health, ordered the hospital to close its obstetrics unit Aug. 7, citing medical errors including the failure to adequately protect a newborn from contracting HIV and the treatment of a pregnant woman who died — and whose brain-dead newborn died days later — after spending about six hours in the emergency department without proper monitoring.
In December, after leaving the nursery and delivery rooms inactive for more than four months, the hospital board voted to permanently close them.
Former employees of the unit have told The Washington Post that plans were already in the works to eliminate obstetric services before regulators acted. They say that for months, hospital managers had not devoted adequate staff or resources to the nursery and delivery rooms, creating conditions that potentially put patients at risk.
In previous statements and public testimony before the D.C. Council, hospital officials have said they were caught off guard by regulators' shutdown of the nursery and delivery rooms and suggested that it was possible the facilities would reopen.
However, in an email sent the day before Nesbitt formally notified hospital leaders of the closure, David Boucree — who worked for the consulting firm running the hospital — sent May a board resolution to close the obstetrics unit as well as a transition plan for smoothly eliminating the service and an explanatory "executive summary" highlighting the unit's declining number of deliveries and spiking liability costs.
"The steady decline in volume and the correlation between volumes and quality outcomes of care, coupled with the reality that providing for the liability coverage for this high-risk specialty has increased over 200 percent in the last five years, require that [the] Board of Directors . . . take action regarding the quality of care regarding the availability of our existing maternity services," the summary says.
It continues: "Additionally, and arguably most importantly, several recent events related to quality patient care has necessitated hospital leaders and the Board of Directors to take action regarding the continuation of these services."
The accompanying board resolution states that "it is necessary to immediately suspend all services currently provided obstetric patients" at UMC.
In addition to May, Boucree's email was sent to two outside attorneys for the hospital and several other officials with the consulting firm Veritas of Washington, which has managed the hospital since 2016. They were Corbett Price, the company's executive chairman; Chrystie Boucree, the firm's owner, Price's wife and David Boucree's cousin; and Luis Hernandez, a Veritas employee and UMC's chief executive.
It is unclear how long the plans outlined in the email and documents had been pending, what became of the proposed board resolution or what "recent events" involving patients the summary referred to. Board members never publicly discussed the plans before regulators shut down obstetric services.
Health department spokesman Tom Lalley said Nesbitt did not communicate to any hospital officials or board members that a closure of the obstetrics unit was imminent or urge them to close the ward voluntarily.
Through a spokesman, May declined to comment on the documents.
"United Medical Center does not have a comment because this is privileged and confidential information, and the property of United Medical Center only," hospital board secretary Mike Austin said in an email responding to questions submitted to May.
Veritas declined to comment through a spokeswoman. In November, the D.C. Council voted not to extend the consulting firm's $300,000-per-month contract, citing concerns about patient safety and allegations of mismanagement.
The consultants are expected to leave the hospital by the end of this month.
David Boucree no longer works at the firm, spokeswoman Jennifer Devlin said.
D.C. Council member and health committee chairman Vincent C. Gray (D-Ward 7) said the documents shared among Veritas consultants and May called into question statements that hospital officials made at a September public hearing on the closing of UMC's nursery and delivery rooms.
At that hearing, Boucree did not mention independent plans by the hospital to eliminate those services and said regulators' closure of the obstetrics ward took him by surprise.
"You didn't know something was coming?" Gray asked.
"No, I did not," Boucree said.
"It's pretty obvious that they were very disingenuous with us," Gray said last week. "At the very least, they did not reveal that they already had had internal discussions about shutting down the obstetrics services."
Gray is planning a public roundtable on UMC on Tuesday and said he is expanding his review of the hospital and may seek subpoenas. "We will get to the bottom of this," he said in a statement issued Friday.
Wala Blegay, a staff attorney at the D.C. Nurses Association, said members of the union suspected that plans to close the obstetrics ward were already in motion.
However, Blegay said, human-resources officials at the hospital assured her that was not happening and that after the shutdown, hospital managers told her in meetings that the situation had been forced on them.
"They said it was not their fault it closed but it was because of the Department of Health," Blegay said.