- The Washington Times - Monday, March 12, 2001

Hospitals in the Washington area say their facilities are being strained by an increasing flow of patients from D.C. General, even before the financial control board finalizes a contract that would lead to the closure of the hospital's inpatient services.

Both Providence Hospital in Northeast and the Washington Hospital Center in Northwest say news of the closure has increased the influx of patients to their emergency departments.

Health officials in the District stress that emergency department services at D.C. General will remain open at the site even after inpatient facilities close. "It will be like a satellite to Greater Southeast Hospital," said the District's chief health officer, Ivan C.A. Walks.

Nevertheless, area hospitals say patients at D.C. General, which serves many of the city's poorest residents, are beginning to flood their emergency rooms.

At Washington Hospital Center, January was the busiest month in the history of the hospital's emergency department, said Mark Smith, director of the department.

"We have seen a 5 percent increase in the emergency department in January and February, which translates to five to eight patients a day," he said.

Part of the increase, he said, could be due to patients coming in from D.C. General. To cope with the increasing number of patients, the hospital has increased nursing staff in its emergency department and sometimes had to send patients to other hospitals due to overcrowding, he said.

"If you are functioning near capacity, even a small increase can have a major effect on the system," he said. The hospital's emergency room sees, on average, about 60,000 patients a year, while capacity is set at about 35,000, officials said.

In the first seven months of this fiscal year, Providence Hospital already had seen 1,700 more patients than usual in its emergency department, said Sister Carol Keehan, president and CEO of the hospital. Some of these patients, she added, had "clearly" said they used to go to D.C. General.

"Every time there's a story about D.C. General, people think they have already closed," she said.

There currently are 2,900 hospital beds in the city, and 235 of those are intensive care beds, including those in emergency rooms, according to Robert Malson, director of the District of Columbia Hospital Association, a nonprofit group that counts several area hospitals among its members.

Dr. James Howard, president of the Washington Hospital Center, said apart from D.C. General, his hospital has the only other level-one trauma unit in the city. He said he is worried the hospital's intensive care units would be overburdened following the closure of the trauma unit at D.C. General.

The trauma center is "absolutely full" right now, he said. "We have no capacity for additional patients in the intensive care units … We are very concerned that there will not be an adequate system in place by the time of the closure" of D.C. General.

A spokeswoman for Sibley Memorial Hospital in Northwest said because of its location, Sibley was not expecting a huge influx following changes at D.C. General.

Providence, Washington Hospital Center and Howard University Hospital "will probably take the greatest hit" due to uninsured patients coming in from D.C. General, said Stuart Seides, president of the Medical Society of the District of Columbia.

Area hospitals, he said, already provided a "lot of uncompensated care. It wouldn't take a lot to push these beleaguered institutions over the edge," he said.

However, Dr. Walks said Mayor Anthony A. Williams' plan would not additionally burden other area hospitals. Under the plan, the city would pay Greater Southeast a certain amount of money to treat uninsured patients. If the hospital then had to divert patients to other hospitals, the city would pay for these patients, he said.

"We have to work out how this will be done … whether in the form of a voucher, a card, or a referral," Dr. Walks said. "We are ensuring that their burden will not increase."

Under the current plan, Doctors Community Healthcare Corp. (DCHC) would provide health care to uninsured D.C. residents for about $88 million a year for five years. April 1 is the date for its expected takeover of D.C. General Hospital, where funds are projected to run out this week.

Dr. Walks added that there would be a three-month transition period for patients receiving treatment at the inpatient facilities in D.C. General. "Inpatient beds will not close on April 1. We will just begin the transition then," he said. "We may not even stop admitting patients on April 1."

Patients at D.C. General, however, said they are very worried because they have no idea what will happen by the end of the month.

On Friday, Marilyn Johnson and Tuesday Dodson were at the hospital visiting their brother, who has esophageal cancer. They said they do not know what will happen once the hospital's inpatient facilities close.

"Everything is just so uncertain right now … we have no alternatives. We don't know where he will be able to move," Mrs. Johnson said.

The D.C. financial control board is expected to sign the contract to hand over the hospital to DCHC, which runs Greater Southeast, sometime next week, a control board spokesman said.

Those waiting to see the plan criticize the lack of transparency in the manner in which the control board and the mayor are going about the negotiations.

"There is so little that has been shared with the community. It is hard to expect what is going to come of these negotiations," Dr. Howard said.

"It calls into question whether they really have a plan," he said.

Observers, meanwhile, are questioning the suitability of DCHC to take over D.C. General.

"It isn't clear to anyone in the local community what the motivation [of DCHC] is for a long-term commitment to this underserved population," Dr. Seides said.

If changes continue at the "breathtaking" velocity one sees now, he said, several patients would be left without care. "Nobody wants to see patients fall through the cracks, but where are they going to go?" he asked. "What if the whole thing falls apart? … All the patients will be out on the street."

Mr. Malson said there was "too much that we don't know at this point" about the plan.

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