D.C. GENERAL HOSPITAL --KEYSTONE TO THE HEALTH, WELFARE OF THE PEOPLE OF THE WASHINGTON, D.C.


by Marianna Wertz and Linda Everett

Printed in the American Almanac, January, 2000.


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Historically, in the United States, not-for-profit community hospitals, which open their doors to everyone--no matter what the color of their skin, infirmity, or ability to pay--have been the backbone of our health-care delivery system. One would think that the hospital system in our nation's capital, would be a sterling example of such a system working at its best, the paradigm for the nation.

But, that is not at all the case. In many ways, the hospitals in the District of Columbia are, instead, a paradigm for the ravages of decades of post-industrial ``managed health care,'' free-market deregulation of health care, and the gutting of Federal Medicare and Medicaid hospital funding. (Medicare is the Federal insurance program for older and disabled Americans; Medicaid is the Federal-state program which covers the indigent and disabled.) In D.C. and nationwide today, hospitals of all sizes are in real calamity--slashing staff, closing such crucial units such as pediatrics, obstetrics, home health, nursing and community programs, all amidst a blizzard of mergers, takeovers, facility closings and shifting of acute-care facilities to outpatient care centers.

What we present here is the heroic battle now being waged in the District, in which the LaRouche political movement is playing a crucial role, for the survival of D.C. General Hospital, the keystone of the District's hospital and health-care infrastructure. D.C. General--the only public acute-care hospital in the District--has been the ``provider of last resort'' to the poor, the uninsured, the homeless, and all those residents of Washington D.C., whom other facilities refuse to treat--since 1832.

Later this month, on Jan. 30, Mayor Anthony Williams and the D.C. Financial Control Board (the people who run the city for the banks and insurance companies), will be reviewing bids to sell D.C. General to the highest bidder, or, if the bids don't meet the bankers' demands, shut it down outright, when the Public Benefit Corporation (PBC)--which runs D.C. General, and oversees its clinics, nurses in 147 public schools, and health care in the city jail--runs out of funds later this winter.


Health, and the `General Welfare'

As you will read below, Lyndon LaRouche has outlined the general approach to a competent health-care policy for Washington, D.C., which begins with a commitment to the General Welfare policy, spelled out in the Preamble to the U.S. Constitution and the Declaration of Independence. That idea was embodied in the 1946 legislation known as the Hill-Burton Act, the ``Hospital Survey and Construction Act'' (see below), which must now be implemented, and the rotten managed-care legislation, which has increasingly supplanted Hill-Burton since the Nixon administration, dismantled it.

Many of those now preparing their bids for D.C. General, including the very managed-care companies whose policies are responsible for the financial crisis facing D.C. General, are circling the hospital, like vultures over a dying carcass, to see what meat is left for the picking.

At the same time, however, some of the District's leading health-care practitioners are preparing their own proposal, along lines that are coherent with LaRouche's policy direction. Leading this effort is Michael Barch, Executive Director of the PBC.

In November 2000, Barch, on behalf of the PBC, put forth a proposal for an ``Urban Health Campus on Capitol Hill,'' which includes development of a fully integrated medical campus on the grounds of D.C. General Hospital, with a new full-service hospital, mental-health facilities, comprehensive substance-abuse treatment options, HIV/AIDS services, acute psychiatric care, and long-term acute care.

The plan's financial feasibility is based on replacing the costly old D.C. General facility with a modern hospital; a ``strategic partnership'' with other hospitals such as Howard University and College of Medicine; and the organization by D.C. General's physicians of a corporation to deliver specialty care. The plan has the backing of the hundreds of community residents, union members and physicians who have been fighting, for more than a year, to keep the hospital open.

PBC spokesman Bill Jones told New Federalist on Jan. 9 that Barch's group is optimistic that it can win control of D.C. General--but that depends on what the citizens of Washington do before Jan. 30.

According to the latest Census figures, the population of the District is now 572,059 inhabitants. But the catchment area for the District's 11 acute-care hospitals is nearly 2 million people, and the hospitals are also the tertiary referral center for a population of over 3.4 milllion people.

According to the District of Columbia Hospital Association, about 50% of the patients using the District's hospitals come from outside the city--37% from Maryland and 8%-9% from Virginia.

Besides having the busiest of the six trauma-care units in the District, D.C. General has 52,000 emergency room (ER) visits a year. If D.C. General closes or downsizes, hospitals in the District simply would not be able to absorb the additional ER patients. The fact is, today, D.C. General is the only hospital which cares for every patient who comes through the door--and is almost never paid for the ER costs of screening and treatment by Medicaid managed-care plans.

The hospitals in the District were already forced to close their doors to ambulances, or forced to go on diversion (because they had no beds available, or no nurses to staff those beds), for 5,745 hours last year. Even during the ``slow season,'' D.C. hospitals now are on ``bypass'' daily: Increasingly, D.C. ambulances are forced to send ambulances out of the District for care, due to lack of beds.

But, capacity in the suburbs is also limited. During the 2000 flu season, when hospitals throughout northern Virginia and Maryland were repeatedly on ``red alert,'' ``yellow alert,'' and hospital bypass status, emergency rescue crews brought their emergency patients to District hospitals for care.

With the planned closing of the 63-bed Hadley Memorial Hospital in the District on Jan. 31, the ER crisis is about to get worse. But with the proposed closing or gutting of D.C. General Hospital--the city's critical safety net--the crisis will reach catastrophic proportions.


Treating the Poorest

D.C. General treats some 10,200 inpatients annually. Nearly 30% of D.C. poor, non-elderly residents--approximately 81,000 people--are uninsured, and 60% of the District's uninsured use D.C. General Hospital as their health-care provider. D.C. General serves the poorest section of the District, the Southeast quadrant, with the highest concentration of poor and black residents, and the highest incidence of disease, infant mortality, and cancer. Infant mortality in 1997, was 12.1 deaths per 1,000 live births--70% higher than the national average. The number of AIDS cases per 100,000 people, at 189 in 1997, is nearly nine times the national average.

It's an outright lie that other hospitals can and will take the place of the District's only public hospital. No matter how willing they may be, hospitals in the District had an aggregate operating margin of negative 6.68% in 1999 (hospitals must maintain an operating margin of 4% for necessary infrastructure). Last year, D.C. General had an operating margin of minus 8.64%; Greater Southeast Community Hospital's operating margin was minus 28.63%; Columbia Hospital for Women Medical Center's margin was minus 30.20%; and Howard University Hospital was minus 23.43%.

District hospitals are no different than hospitals and teaching facilities nationally, which are all hemorrhaging a sea of red ink, especially after massive looting by managed-care plans, and the Balanced Budget Act of 1997 (BBA), which gutted Medicare payments to hospitals.

When the BBA was passed, the District of Columbia Hospital Association announced that ``the future of District hospitals is clearly in jeopardy.'' Some District hospitals, including D.C. General, have already slashed staff and programs, while others, like Georgetown University Hospital, spent huge revenues, time, and personnel to determine what medical treatment was necessary from the perspective of managed-care plans and their HMOs (health maintenance organizations)--just to ensure the hospital was paid for care they provided.

Many District hospitals already have large Medicare and Medicaid populations--which automatically means they receive far less than the full costs of care. For 1999, 61% of D.C. General's patients were on Medicare or Medicaid; Greater Southeast Community Hospital had 70.11% of its patient load in these programs; Howard University had 62.82%; and Providence Hospital had 75.60%. While District hospitals provided over $200 million annually in charity care, they, like all hospitals nationwide, find it increasingly hard to do so, because of Federal cutbacks and managed care. How likely is it that these hospitals can possibly take on 10,200 more patients at still lower payments from the city?


Looming Disaster

Yet even if District hospitals had unlimited financial capacity, it would be impossible to absorb D.C. General inpatients, due to the dramatic loss of 1,000 acute-care beds in the District in the last decade. From 1994-98, the District saw an overall loss of nearly 19% of its acute-care bed capacity, or about 740 beds. Greater Southeast Community Hospital lost 32.66% of its beds; Georgetown University Hospital lost 24.25%; while Howard University Hospital lost 32.95%. This is disastrous from a public health standpoint.

In the event of a full-blown epidemic of influenza--let alone a pandemic influenza (which researchers have repeatedly warned is likely soon), or a bioterrorist attack (a serious concern, in the nation's capital)--the District would be completely incapable of providing the beds necessary.

In the event of such calamities, the country once counted on its veterans and Army facilities to provide the critical reserve of hospital beds, equipment, and staff. But, in the District, between 1994 and 1998, the Veterans Affairs Medical Center lost 69.26% of its beds (down from 527 beds to 162); and the Walter Reed Army Medical Center lost 65.90% of its beds (from 698 to 238)--together, a total of 1,147 beds were eliminated.

The total loss of District hospital beds between 1995 and 1998 was 42.11%, or about 2,627 beds.

Another onerous result of closing or downsizing the hospital, or turning it into an urgent-care center, is the loss of critical life-saving interventions. D.C. General now cares for 90,000 patients a year at dozens of its speciality clinics. D.C. General used to have some 12 public-health clinics throughout the city. Now, it's down to six, with plans to close one more and to merge two. One plan would have all the clinics close as of September.

Patients go to the public-health clinics for primary care, but in the course of delivering treatment, physicians routinely discover other life-threatening conditions and send these uninsured patients to D.C. General's speciality clinics for cardiac work-up, cancer screening, etc.

D.C. General also holds a critical key to serving future needs of the city and the nation. With the worldwide nursing shortage worsening by the day, it is noteworthy that the three nursing colleges in the District, send their undergraduate students to D.C. General to do their clinical rotations. Howard Medical School, among others, sends its medical residents to train at both D.C. General's inpatient units and its speciality-care clinics.

What hospital is capable of replacing the care and service which D.C. General provides to the nation's capital, if D.C. General closes? There is none. As LaRouche told a D.C. audience on Dec. 12, ``you know that the people who decide these kinds of policy trends in health care, know what they're doing. You know the effects, but they also know the effects.''

The deliberate murder of thousands of the District's poorest residents must be stopped.


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The preceding article is a rough version of the article that appeared in The American Almanac. It is made available here with the permission of The New Federalist Newspaper. Any use of, or quotations from, this article must attribute them to The New Federalist, and The American Almanac


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