- The Washington Times - Thursday, November 28, 2002

The partial closing of D.C. General Hospital last year and the reduction of services at Greater Southeast Community Hospital over the past few months have continued to increase patient loads, temporary emergency room closures and ambulance diversions at other city hospitals, according to hospital records and interviews with city health care providers.
Washington Hospital Center, Providence Hospital and Howard University Hospital, the hardest hit, have seen a 45 percent to 3,000 percent jump in emergency room closures and ambulance diversions between May 2000 and August 2002. Hospitals close their emergency rooms and divert ambulances when they are over capacity.
Washington Hospital Center and Providence Hospital saw 7.1 percent and 7.9 percent more patients in their emergency rooms, respectively, between September 2001 and September 2002. Howard University has seen little change because the hospital "has maxed out" capacity in the past year.
The city total for emergency visits shows a 1.6 percent increase, while D.C. General Hospital declined by 29.4 percent in the same period.
"We have been hugely impacted by the closure of D.C. General and the slowdown at Greater Southeast," said Sister Carol Keehan, chief executive officer and president of Providence Hospital. "It is very difficult to deliver the level of care we want when the ambulances are coming in so hot and heavy."
"[Greater Southeast officials] don't seem to think there is a problem," Sister Keehan added. "They say everything is OK. And they say it with such pizzazz."
The Washington Times first reported the increases of patient traffic at city hospitals due to the closure of D.C. General's trauma unit in May 2001.
Besides taking on the extra burden of patients who once went to D.C. General, city health providers say the deteriorating conditions over the past months at D.C. General and Greater Southeast have also sent patients their way.
Patient loads increased at D.C. General clinics while wait times have doubled and tripled, doctors say. Some clinics are just canceled after a doctor isn't available. Other patients can't get appointments.
Out-of-date pharmacies run out of necessary medication; routine tests are now available only at Greater Southeast on machines that remain broken because of unpaid bills. Greater Southeast lacks nurses and beds and supplies, staff say. Pediatrics and other units have been closed or reduced their capacity.
Washington Hospital Center officials said last week they will cease accepting patients Sunday from the D.C. Healthcare Alliance, a consortium of health care providers that includes Greater Southeast, because of millions owed in reimbursements. Providence Hospital is also owed reimbursement, Sister Keehan said.
The city's medical community initially warned last spring that a plan to privatize indigent health care services was flawed because it would put too much pressure on other city hospitals and threaten the city's medical care by relying on a financially unstable prime contractor.
Greater Southeast yesterday signed a contract with National Emergency Services to provide emergency-room physicians. The three-year deal enables it to keep its ER open beyond midnight Saturday, when a contract with PhyAmerica Physician Group expires.
The contract is the latest hurdle crossed by Greater Southeast, whose parent company, Doctors Community HealthCare Corp., sought emergency financing in bankruptcy.
The D.C. medical community said it needs Greater Southeast to become fully functional again in a restructured system that will provide health care to the poor without jeopardizing other patients.
One suggestion supported by hospital officials is to put the D.C. Healthcare Alliance under the District's Medicaid program, the publicly funded health insurance program for the poor.
This way, they say, the city would foot less of the bill for health care and it would streamline enrollment procedures for health care and reduce administrative costs.
The federal government reimburses the city for 70 percent of Medicaid bills. The alliance is paid 100 percent by the city.
Medical officials have long complained that the alliance does "everything it can" not to enroll patients. Currently, 28,000 D.C. residents are enrolled in the alliance at a cost of about $81 million annually.
And the central question whether the alliance has improved health care for the city's poor can't be answered easily, most health providers say.
"The city doesn't have the data," said Joan Lewis, senior vice president of the District of Columbia Hospital Association. "They haven't put the systems together to collect the data. The Health Care Safety Net Administration consultants have called us for baseline data to begin to measure progress." The administration is the alliance's oversight body.
In an October report, the D.C. Inspector General's Office chided the Health Care Safety Net Administration for failing to hire staff or provide adequate oversight to the alliance.
Meanwhile, Greater Southeast has found three potential lenders that have expressed interest in offering it the millions in credit it needs to pay the bills and restructure, a source close to the issue confirmed.
On Tuesday, a federal bankruptcy judge released another $17 million the hospital needs to operate until another hearing Dec. 13. The federal government also pledged $4 million in expedited Medicare and Medicaid reimbursements and $1 million in deferred debt service.
Greater Southeast officials say that with more money released by the bankruptcy court, they can begin to address the issues of staffing and supplies.
One test for Greater Southeast is a review conducted this week by the Joint Commission of Accreditation of Healthcare Organizations. The commission is examining whether Greater Southeast has met standards the review agency sets in order to receive federal reimbursements for Medicaid and Medicare. In March, the commission gave the hospital provisional approval and time to remedy its problems. The report is due next month.


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