- The Washington Times - Friday, September 1, 2000

Don't be shocked by the layoff last week of 550 employees at D.C. General Hospital. The upheaval is the predictable consequence of mismanagement, deficit spending and wholesale neglect. Accusing fingers point to the D.C. Health and Hospitals Public Benefit Corporation (PBC), the quasi-independent board charged with overseeing D.C. General and a network of citywide clinics. But the PBC/D.C. General debacle is the work of a collective.

Former Chief Financial Officer Anthony Williams sat on the PBC board. Didn't he see warning signs of financial improprieties? Did the control board's refusal to permit a more independent model play a role in the PBC's demise? (Mayor Marion Barry and his city administrator Michael Rogers, following the model of the hospital corporation system in New York City and Denver, wanted more autonomy for the PBC). When the D.C. Council buckled under pressure from private hospitals eager for a piece of the Medicaid pie, did that set in motion the PBC's ruin? Did former Medicaid administrator Paul Offner's resistance to assigning more indigent Medicaid patients to D.C. General affect the hospital's ability to be reimbursed in a timely fashion? A deconstruction certainly is needed if for no other reason than to prevent a repeat performance.

"It is a squandered opportunity," said Mr. Rogers of the PBC's collapse. "The least among us, who are most dependent upon the resources and services of the city are hurt the most by this."

The PBC was expected to function much like the Water and Sewer Authority. When WASA ran into trouble and was threatened by a regional takeover, Mr. Barry and Mr. Rogers negotiated a new configuration for the agency with representatives from each of the suburban jurisdictions serving on the board. (WASA remained an entity of the District government.) The board was given complete control, including independent bonding authority. The results have been remarkable.

The same cannot be said for the PBC. It was hampered by a directorate that lacks sufficient knowledge and that diverted its attention from pressing problems. Consequently, the executive director, John Fairman, was free to treat the hospital and clinics as his private preserve. He routinely overspent his budget and he used the hospital as an employment agency for hundreds of new workers, many with political ties. But, while spending increased and the payroll swelled, the quality of patient care declined noticeably.

Just ask Paula Bess, who took her 83-year-old, blind aunt to D.C. General, ostensibly because she was having a seizure. Days later, Mrs. Bess learned after questioning the doctor that her aunt had had a massive heart attack. While recuperating at D.C. General, the aunt had personal items stolen from her room. She was allowed to lie for hours in her own fecal matter. Some days the woman went without being fed. For two days her aunt did not receive her seizure medication. Later, a catheter was inserted incorrectly, causing an infection to develop; that caused her death.

"She didn't die because she was old. She didn't die because she had a heart attack or because she had a seizure," Mrs. Bess says in an interview. "She died from neglect and malpractice.

"Is there indeed a caste system in the medical treatment of the elderly and the blind in America?" Mrs. Bess asked.

Reading a Washington City Paper article, "First, Do No Harm," one would find it easy to conclude the answer is a resounding yes. In a rigorously researched and well written cover story, Stephanie Mencimer documents incident after incident where the care of patients bordered on criminal. The offenses, too numerous to list here, went from wrong-side surgery, to misdiagnosis, to a callous disregard for clinic scheduling.

What's worse, the system protected the perpetrators. Thankfully, Ms. Mencimer names names including Dr. Norma Smalls, who performed the wrong-side surgery, and the moonlighting Dr. Easton Manderson who reportedly bumped a patient for surgery for nearly a year leading to the patient's permanent paralysis.

But these stories were not touted during last week's rowdy public hearing where nurses, doctors and other personnel shouted about how important D.C. General is to health care for the poor. The fact is that all these years D.C. General's greatest importance has been its role in maintaining the black middle class.,which history proves has occurred at the expense of the poor, who continue to have few health care options.

Ms. Mencimer and Mr. Rogers think D.C. General can still be saved. They suggest privatizing it, or perhaps finding a buyer. I join the circle of folks who are less optimistic. The PBC board's intention of downsizing and redirecting the hospital's mission, yet again, may be on course.

But the greater attention simply can't be on cutting costs and preventing violations of the federal Anti-Deficiency Act. How best to serve the poor and working poor should be the focal point of all discussions. A plan should be developed for building the neighborhood clinics into an efficient, quality, community health care system, designed to provide preventive medicine and typical clinic services OB-GYN and outpatient surgery.

Taxpayer dollars should not continue to finance the kind of criminal behavior Ms. Mencimer documents. And no one, absolutely no one, should ever die the kind of death Mrs. Bess' aunt did.

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