Lack of Progress on Proposed Hospital Arouses Frustration

Posted October 18, 2005 at 4:01pm

The National Capital Medical Center has been touted as the answer to Washington, D.C.’s public health crisis. The proposed new hospital, coupled with the Medical Homes D.C. initiative — a program sponsored by the District of Columbia Primary Care Association and Brookings Institution Greater Washington Research Program, among other partners, which aims to strengthen existing primary care facilities — should provide the District with all of the health coverage it needs.

So why is it that, in light of the recent $1 million worth of grants handed out to D.C. clinics and primary care facilities by Medical Homes D.C., only one-half of this wheel seems greased? According to D.C. Councilmember David Catania (I-At Large), the answer is simple.

“They’ve left the community bewildered as to what the plans are,” Catania, chairman of the city’s Committee on Health, said of the proposed medical center. “It’s been a long and unprofessional process.”

The NCMC has been in discussion for almost two years, Catania said. The proposal calls for a $400 million state-of-the-art facility to be built on Reservation 13, a 67-acre parcel of land located in Southeast D.C. Catania said the proposal is no further along today than it was two years ago. And the delays have him concerned.

“Of course, we’re very frustrated that we don’t get the documents as promised on plans for” the NCMC, Catania said. “There have been several deadlines missed. It’s hard to speculate against ourselves, what will or won’t happen.”

D.C. Mayor Anthony Williams (D) had set a self-imposed Oct. 1 deadline to release specifics on the hospital, including total costs and funding. That information has not been released yet. Williams’ office did not respond to a request for comment.

Catania has attempted on several occasions in the past year to solicit information from the District, he said. He has held issue forums to help connect the public’s concerns and the District’s plans. And still, Catania said, residents are in the dark.

According to Jan Eichhorn, president of The Ward 6 Democrats, the concerns voiced most often by residents of Ward 6, in which the proposed medical center would be built and which includes parts of Capitol Hill, are whether it will improve health care outcomes — as compared to a primary care center — and if it is financially viable. City Administrator Robert Bobb, who didn’t respond with comments, has said in the past that the D.C. government will not subsidize the hospital, which Eichhorn said could leave taxpayers in a precarious situation if the hospital operates at a loss.

The problem, according to Eichhorn, is that the local government is shutting residents out of the decision-making process, leaving them without answers to their questions.

“The most important thing is that the people be informed about what the pros and cons are,” Eichhorn said. “I think a lot of people are not aware of what’s at stake. The community has not been actively engaged in that.”

Robert Malson, president of the District of Columbia Hospital Association, said there are ramifications to building a new hospital that he believes the city may not have taken into proper consideration.

District officials and other proponents of the medical center have stated there is a need for emergency-room service for residents in Wards 6 and 7, where primary health coverage is sparse, according to a study released by the DCPCA in January.

Malson said he believes the residents of these underserved areas would be better served, both health-wise and fiscally, by an ambulatory care center.

“Obviously, the best place to have a heart attack is in the ER, with doctors standing around waiting for you to have it,” Malson said. “It’s the classic argument — 2 inches is better than 2 feet, which is better than 200 feet … but for society you’ve got to ask, what makes the most sense?”

Malson also believes the most recent development in this process makes little sense, as well. Williams announced last month that the District wants to bypass the certificate-of-need process to determine whether there is a need in the community for such a facility. It was an effort by Williams to help streamline the process, but Malson said the move is not in the best interest of D.C. residents.

“The certificate of need is important, so that people can actually raise … questions in a professional, non-argumentative manner,” Malson said.

“It’s all very complex, but the point is, do we really need another Level One trauma center?” Malson said. “Do we really need to spend $400 million on something that doesn’t need to be done?”

The basis of this reasoning, according to Malson, is that the existing Howard University Hospital, located on Georgia Avenue Northwest, is the second-newest hospital in D.C. Additionally, he said, there has been no discussion as to whether that hospital would be downsized or shut down when the NCMC opens it doors.

And since Howard would, according to the preliminary plan laid out by city officials, be shelling out $100 million to help build the new medical center, Malson said it all comes down to one thing: “The bottom line is I don’t believe this expenditure of funds is necessary. It’s wasteful.”

It’s hard to know whether District officials understand this, Catania said, because of the quiet manner in which they’ve gone about the process.

“I think it’s a lack of attention to the subject,” Catania said. “If you ask who is in charge of the subject — the mayor, the city engineer — is it a priority for them? Who’s driving the train? Who’s in charge? … We need emergency rooms for emergency-room services, we need primary care and specialty care for residents. If the mayor is somehow unwilling or unable to bring forward [the NCMC], we need to know.”

The bottom line, he said, is that it’s time to proceed, no matter which direction the city plans to go in.

“We definitely need, in the Ward 6 community, more primary care, more specialty care, and the residents on the eastern side of the city need an emergency room,” the councilmember said. “Whether it needs to be Level One trauma … or whether it can be an emergency room on the level of Georgetown University [Hospital], we definitely need to move forward. We’ve wasted too much time and effort on this already.”