Wednesday, May 23, 2001

The premature closure of D.C. General Hospitals trauma center and some of its services, despite pledges for a gradual phase out, has physicians and paramedics scrambling to provide health care services to their patients, said city doctors and paramedics.
“This is being felt all over. But they knew all along this was going to be a shock to the system. Its a bad idea to decrease beds and overwhelm other hospitals,” said H. Donald Marshall, an emergency physician at D.C. General.
City health officials overseeing the transition say there is an increase in traffic at all city hospitals, but there are no data to link the phenomenon to the partial closure of D.C. General.
“They are all busy,” said Larry Siegel, senior deputy director for medical affairs for the citys Department of Health. “We dont know the reason.”
But anecdotal information shows the closure has overwhelmed hospital capacity around the city and put the health needs of patients at risk.
When Pastor Mildred King collapsed in Judiciary Square last Friday after a hunger strike protesting partial closure of D.C. General, ambulance drivers first tried Howard University Hospital, then Providence Hospital. Both were full.
Finally, the ambulance joined six others waiting to drop off patients at Washington Hospital Center.
“They were driving around, trying to decide where they could take me,” she said, laughing. “I am just lucky I wasnt shot or had a heart attack. But I was shocked at how many people were waiting to be seen.”
Three weeks ago, the financial control board signed a contested contract with Doctors Community Hospital to close trauma services and gradually phase in those and inpatient services at Greater Southeast Community Hospital.
Then, city officials said they were unaware that medical residents from Howard and Georgetown universities were due to leave in July, causing D.C. General to be understaffed, so the transition was accelerated.
But many doctors and city leaders said the medical residents schedule was no surprise and that the gradual phase-in plans were a lie. City health officials deny that claim.
Mr. Siegel blamed D.C. Councils delay in signing the contract because of concerns as the reason for the accelerated phase-in. He said the situation will stabilize as Greater Southeast increases its bed capacity.
In the meantime, the health department will continue to assess the situation.
“We are responsible for patient safety, and that is what we are going to make sure of, even if that requires making alternate arrangements,” Mr. Siegel said.
So far, D.C. General has curtailed accepting ambulances or new pediatric and obstetric cases, leaving Washington Hospital Center, Providence and Howard University hospitals to pick up the slack in walk-in visits and ambulance traffic, which have increased over the last six months. Last week was the busiest ever at these hospitals, officials said.
Walk-ins at Providence Hospital rose 17 percent to about 130 daily, according to Dr. Margaret Barron, director of the hospitals emergency department.
“Right now, I have 30-something names on my board. Every bed, stretcher and chair is full. Two ambulances are waiting outside to unload patients,” Dr. Barron said, adding that the situation is typical.
The uninsured patient rate at Providence Hospital has reached 50 percent, up from between 30 percent and 40 percent, an indication that closing the citys only public hospital is having a spillover effect.
Visits to the emergency room at Washington Hospital Center are up an average of 22 a day from last May and will reach more than 8,000 new patients this year if that pace continues, a hospital spokesman said.
And as emergency rooms max out and close, ambulances are routed elsewhere and response times are increasing for critical calls, health officials said.
City medics cannot leave a hospital until a patient is off the stretcher and in a hospital bed. When all the emergency beds are full, “we sit there, and we may sit there for two to four hours,” said Kenneth Lyons, a D.C. paramedic and chairman of AFGE Local 3721, the union for paramedics and emergency medical technicians.
“Theyre asking [medics] to do more with less,” Mr. Lyons said. “We cant do any more than what were currently doing. This policy is a virus, and its killing everything it touches.”

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