“If you go to GW, they treat you nice. But this hospital don’t treat you nice,” he said Monday outside the campus of UMC, the District’s only public hospital. “As long as I know they’re going to take good care of me, I don’t care how long it take me.”
Patients like Jones have given up on UMC in droves after a series of highly publicized medical failures, with many saying care is inadequate. The hospital’s revenue is cratering as a result. Last week, the D.C. Council stunned hospital leaders by refusing to increase the funding cap for UMC, instead saying that any additional infusion of money would trigger a new financial oversight board.
On Tuesday, Mayor Muriel E. Bowser (D) disbursed an additional $25 million, money that will allow the hospital to cover payroll this week and expenses for the rest of this fiscal year.
In a statement, Bowser acknowledged that the payment means UMC’s budget will be rewritten by an outside financial control board that will ensure the hospital lives within its means.
Staffers and patrons are bracing for huge, disruptive cuts to services — and debating whether those cuts amount to an overdue right-sizing for a flailing institution or a dangerous removal of vital health care in an underserved neighborhood.
“This isn’t about not having a hospital [in Ward 8]. In fact, we’re committed to having a hospital,” said council chairman Phil Mendelson (D), who voted against raising the hospital’s funding cap. “United Medical Center is undisciplined and thinks they have a limitless credit card.”
United Medical Center is in its final years, with a new hospital on the nearby St. Elizabeths campus set to replace it in 2023. According to Wayne Turnage, deputy mayor for health and human services, the 700-employee hospital has just 70 admitted patients on an average day. The emergency room is often crowded, however, and wait times are long, union representatives say. Minutes from a recent hospital board meeting quote an emergency-room employee who said some patients spend more than a day waiting for treatment.
Even before the coronavirus pandemic, which sent non-covid-19 admission rates plunging at hospitals across the city, UMC’s occupancy rate was about 30 percent — compared with 80 percent at some critical-care facilities in the District, according to data from the D.C. Hospital Association.
The hospital recorded a greater decline in surgeries this year than almost any other hospital in D.C. Revenue is projected to be about $100 million this year, after climbing from $101 million in 2013 to $150 million in 2016. Expenses exceed $140 million. The hospital has regularly asked the city government to make up the difference.
Last week, council members balked. Rather than raising the hospital’s no-consequences subsidy from $15 million to $40 million, as council member Vincent C. Gray (D-Ward 7) had asked, lawmakers voted to abide by the law Gray had proposed in 2019, which triggers the outside control board if the hospital requires more than $15 million in city money.
Turnage, who would be a member of the control board, pleaded with the council before the vote, asking it to raise the subsidy cap, as it did last year, to avoid triggering outside oversight.
“If the control board comes in, the hospital will be viciously pruned,” he said. “It will be a fix that probably none of you have the stomach for.”
Health advocates east of the Anacostia River are torn over whether a control board drastically paring back services would be such a bad outcome for patients, given the quality of care at the hospital.
While the hospital has treated fewer coronavirus patients than other facilities in D.C., the hospital’s March board-meeting minutes say 50 percent of the 113 admitted to UMC’s intensive care unit with covid-19 died, a rate drastically higher than rates at other hospitals.
The minutes also noted that nationally, hospital standards say that no more than 3 percent of blood drawn from patients should become contaminated. At United Medical Center, more than 20 percent of ICU patients have a contaminated blood sample, a problem that the chair of critical-care medicine blamed on poor staff training, the minutes said.
Many nearby residents are counting down the days until the hospital is torn down, said Stuart Anderson, the community engagement director for the Anacostia Coordinating Council.
“The service provided to this community has been terrible,” Anderson said. “I know a lot of people who don’t go to that facility who live blocks within that facility. I wouldn’t go there if the wait time is zero.”
But Calvin Smith, chair of the Ward 8 Health Council, argued that people who cannot easily travel west for services — and who suffer disproportionately from chronic ailments such as kidney disease and high blood pressure — need a full-service health-care provider east of the Anacostia River.
Bowser, who opposed the council’s decision not to raise the subsidy cap, has made the same point, as has Gray and council member Trayon White Sr. (D-Ward 8).
“The facility will be closing in the next two years, but we don’t want it to be stripped of almost everything . . . until the new facility is open,” Smith said.
He also worries that two years without a hospital could undermine the new facility before it even opens. “Once the traffic pattern has been established, it’s kind of hard to reroute people once they get in the comfort zone of going over the bridge to get health services,” Smith said.
The council could still take legislative action to avert the control board, but Mendelson said he did not know of any members willing to change their vote. That leaves the hospital’s leaders weighing what an outside management board might mean.
The 2019 legislation says the hospital’s 13-member board will be dissolved and replaced by a control board made up of nine members, including the deputy mayor for health, a Ward 8 citizen appointed by the mayor, the city’s chief financial officer and two union representatives.
That board must submit a budget within 30 days that keeps the hospital’s emergency room and psychiatric department open and makes other cuts so UMC can operate within its means. A wide variety of services, from surgery to dialysis to mammograms to diabetes care, could be shuttered. Turner said the emergency room and psychiatric ward could also be affected.
“Emergency department, behavioral health — it doesn’t say anything about the scale of those operations,” Turnage said. “So in the real world, those operations would have to be scaled down to fit within the revenue-generating capacity of the hospital.”
Roberta Lenoir, the hospital’s D.C. Nurses Association president, said employees are concerned about the possibility of drastic cuts in services, as well as layoffs, after a taxing year of treating coronavirus patients.
She disputed Turnage’s claim that the hospital is 45 percent overstaffed by national standards, noting that there often are not enough workers in the most heavily trafficked parts of the hospital, especially the emergency room.
According to the board-meeting minutes, the hospital has resorted to hiring some temporary nurses, whose rates soared to as much as $225 per hour during the pandemic.
“There is no more room in ICU,” Lenoir said. “We’re full. I just don’t understand where they’re getting that the census is low and we’re so overstaffed. We’re hurting.”
The March meeting minutes said the number of monthly emergency-room visits had dropped from nearly 4,000 before the pandemic to 2,725 in February of this year. In some months, nearly 14 percent of those patients leave without ever being seen by a medical professional.
On Monday, Michelle Austin, 58, said she was not sure what she will do if UMC cuts its services. Her adult daughter and her 4-year-old granddaughter had coughs and runny noses, so Austin brought them to the emergency room at the hospital to get tested for the coronavirus.
Though Austin described the emergency room as unbearably slow, she said she would rather take her family there than to her granddaughter’s pediatrician, farther away from her home.
“They need to fund it. They need to stay open and keep all the services as it is,” Austin said. “Where would we go? In this area, what other hospitals are there around here? None.”