The Washington PostDemocracy Dies in Darkness

In quest for new Prince George’s hospital, new management seen as a must

A rendering of the proposed Prince George’s Regional Medical Center. (N/A)

The state officials weighing an effort by Prince George’s County to launch a new regional medical center have one common concern: Dimensions Healthcare System, the long-troubled nonprofit group that has operated hospitals in the county for decades.

Early this year, when Gov. Larry Hogan (R) balked at giving millions of dollars to keep existing county hospitals afloat while the new one is built, he wanted assurances that Dimensions would not play a role in running the new medical center.

State health-care commissioner Robert E. Moffit sought the same guarantee in May, when he refused to approve the new hospital and requested changes and more information by the end of the summer.

More setbacks for long-delayed regional medical center

Even Democratic state lawmakers who have championed the regional hospital project and forced Hogan to provide subsidies have made those funds contingent on Dimensions handing over hospital operations to the University of Maryland Medical System, which is heading the ambitious effort to build the medical center.

“Everybody wants to phase Dimensions out of the system completely,” said Senate President Thomas V. Mike Miller Jr. (D-Calvert). “It has a bad track record. It’s just a history of bad debt, a history of mismanagement and of not collecting bills.”

But just weeks before their self-imposed deadline to submit a new plan to Moffit, UMMS officials say the “details such as mechanics, structure, governance and branding” of the new hospital system have not been defined. It would be premature to comment further, a UMMS spokesman said in an email, while negotiations are taking place.

Prince George’s politicians have said repeatedly that Dimensions will “cease to exist” once the regional hospital opens. But few, if any, know how that will happen. Thomas Himler, budget and finance director for County Executive Rushern L. Baker III (D), said the parties’ goal is to have a memorandum of understanding executed when they submit their revised certificate of need application to the state by Aug. 31.

“We’re working on it,” said Del. Barbara A. Frush (D-Prince George’s), a member of Dimensions’ board, adding that she thinks there will be a place for board members such as herself in the new governance structure. “We have not made any monumental decisions.”

Delay in approving hospital project stirs worry in Prince George’s

Hospitals in Prince George’s were run by the health department until 1982, when the government formed a nonprofit entity and leased Prince George’s Hospital Center, Greater Laurel Regional Hospital, Gladys Noon Spellman Nursing Center and Bowie Health Center to that group.

Community Hospital and Health Care Systems faced problems immediately. There were massive layoffs in 1983 and 1985, threats that their medical facilities would lose accreditation, nurses strikes and, in 1988, lawsuits over alleged negligence in the intensive care unit. Constant bickering among board members led to allegations of mismanagement from elected officials, ethics investigations and the ouster of several members.

In late 1986, the organization renamed itself Dimensions Healthcare System, part of an effort to give itself a fresh start, said former county executive Winfield Kelly, who headed the system for 18 years.

Kelly partnered with the private sector to build medical offices­ and made plans to build a pharmacy on the campus of the hospital in Cheverly. The facility’s maternity wing was renovated in an effort to draw higher-paying patients.

In the late 1980s, the company started making a profit, thanks to cost-cutting, an improved bill-collection system and the hiring of a private firm to manage day-to-day operations. Laurel Hospital, in particular, experienced a surplus.

But Dimensions soon fell behind again, lacking the funds to match its competitors in mounting money-generating operations such as in-vitro fertilization clinics.

Larger and more sophisticated hospitals in the District and Montgomery County continued to draw privately insured patients out of the county. The state froze and changed how it reimbursed hospitals for Medicaid in the late 1990s, and several affiliated HMOs went bankrupt, deepening the financial pressure. The company relied on regular infusions of taxpayer dollars from the county and state to survive.

Himler, who at the time was an aide to then-County Executive Wayne K. Curry (D), said he remembers taking calls from Dimensions telling him they couldn’t make payroll.

In 1985, then-County Executive Parris N. Glendening (D) and the council called for an investigation into allegations of nepotism, unethical payments to board members and other misconduct. The Dimensions board formed its own review committee, which concluded that certain decisions had been unwise. But the report ultimately absolved board members of wrongdoing.

“The issue was and continues to be the high amount of indigent care,” said Kelly, who resigned following a public disagreement with then-County Executive Jack Johnson (D). “All during those times, we tried to merge with another entity where there was additional revenue, because the hospital just couldn’t carry itself without some sort of assistance.”

Moffit’s May letter asked planners specifically about how the new hospital would be run differently.

“The history of PGHC has been one of long-standing managerial and financial difficulties,” Moffit wrote. “One of the key objectives of UMMS’ involvement is to assure a turnaround and put the institution on a path toward permanent progress. Please provide detailed plans for incorporating the Dimensions system into UMMS.”

The university system operates 12 health systems in the state. In the past, when it has taken over an existing hospital, the boards are often consolidated. In some cases, existing leaders continue to serve for some time.

“There is no rule of thumb on how boards are reconfigured,” Ben Steffen, executive director of the Maryland Health Care Commission, said in a statement. The state “does not have any specific requirements regarding the configuration of a hospital board after acquisition.”

The struggles of hospitals in Prince George's are familiar to Hogan, 60, a native of the county whose father served as county executive from 1978 to 1982. He was working for his father in 1981 when the elder Hogan — the last Republican to serve as county executive — proposed selling the county hospital to a for-profit enterprise.

The idea was rejected by the majority-Democratic Prince George’s County Council, which instead created what eventually became Dimensions.

A spokesman for the governor said Hogan is eager to see the county health-care system succeed under UMMS’ leadership.

“The system that was in place clearly wasn’t the right one,” spokesman Matt Clark said. Hogan is “keenly interested in ending the system’s reliance on state subsidies.”