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Sharon Baskerville, Executive Director, DC Primary Care Association
Testimony to the Committee on Human Services on the
Public Benefits Corporation
September 18, 2000




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Madame Chair and members of the Committee on Human Services, thank you for this opportunity to offer comments on the proposed closure of DC General Hospital.

I am Sharon Baskerville, the Executive Director of the District of Columbia Primary Care Association. Our mission, as you know, is to facilitate the integration of a health care delivery system of primary and preventive care, which guarantees access to all people of the District of Columbia and eliminates the shocking disparities in health outcomes that occur in our city for people of color and people living poverty.

Today our community is being asked to give input on the decision of the Public Benefit Corporation Board of Directors to convert DC General Hospital from a full service hospital and trauma center to a scaled back Community Access Hospital. I know what an agonizing decision this was for the Board and the countless hours put into investigating options and clarifying numbers and issues. All this was amidst a firestorm of media attention and public questioning and community outrage ...all in all a painful and thankless job. I commend them for their service and their courage.

Where do we find ourselves? After years of overspending and the accumulation of massive debt, Congress has said "No More". We have confirmed from all resources available, including the office of Congresswoman Norton and Congressman Ishtook that there will absolutely be no further money appropriated for the Public Benefit Corporation beyond its current subsidy. It is clear that the CFO has said that DC General must operate within the limits of its appropriated funding. It appears therefore that there is no option.

The truth is that DC General has been a political football in our city for way too long. And in being that we have made the health care needs of our most vulnerable residents a political football as well. There is nothing to be gained now from pointing fingers and assigning blame. There is enough blame to go around for all of us from the government, the provider sector, and even the community for being silent too long on this critical issue. We have joined the ranks of other public hospitals across the country, which have closed because of the ever-increasing costs of health care and the growing number of uninsured.

This is a difficult decision but one we as a community have to make. Do we all pull together to create something which is financially feasible and will serve the health needs of the community or do we engage in endless rhetoric and the explosion of anger and sense of injustice and create an even more severe crisis by having a decision forced on us by Congress and lose everything. That is the crossroads at which we find ourselves. If we do not support a viable plan of delivery for the community served by DC General THEN IT WILL CLOSE.

We have examined the plan put forward by Dr. Walks for what is being called the Community Access Hospital. There seem to be many positive aspects to this plan as presented. First and foremost, it appears to be a plan that could be financially sustained.

It expands access to urgent care that is a crying need in our community where emergency room utilization for non-emergency conditions is the highest in the country. It maintains critical primary care services in a community with a severe lack of access to a medical home. It promises to treat all but 4000 of its 58,000 ER visits with the same level of care. It promises to stabilize people until safe transfer to another facility can be arranged. There is great potential here to be a model of an urgent and primary care center in a city that has few models of effective and integrated continuums of care for the uninsured. We need to at least give it a careful look. Consideration of the many intricate details is where our focus should lie. Can the hospital community absorb the number of closed beds that would be created? On paper anyway it would appear so. That requires confirmation and a guarantee from the hospital community to accept those patients. Can we reconfigure the routing patterns of our EMS system to guarantee at least the same level of trauma access available to this community? We have more Level 1 trauma care available in our city that the states of Maryland and Virginia combined. It would seem then that we should. Will the city invest in the additional emergency service equipment, like more advanced life support vehicles, that will be required to safeguard the citizens of this community? It will work no other way. Where will the money for transition and demolition and the support of transfer of care of the uninsured at other facilities come from? These among others are critical question which Council must feel are adequately answered.

Last but in no way least is the question of the toll on the lives of members of our community, employees of DC General who will be RIFed in order to downsize to a manageable facility with a thousand fewer employees. What is the city's plan for a compassionate and creative way to move these people into the workforce? What assistance and counseling will be offered to ensure that we have done all we can to help maintain employment for people affected by this.

There are many other questions to which you, as our government watch guards, must require answers. In the interest of brevity we have attached those for submission with our testimony.

Today and tomorrow we will all be witness to the expression of anger and outrage and grief from a community faced with the loss of a historic institution in our city. PBC employees will be here to fight for their jobs. Community members will be here to shout the pain of injustice and fear for a community once more faced with loss from fiscal and organizational mismanagement beyond their control. Providers will defend their relative positions and perspectives and financial bottom lines. Government will try to present some rational alternatives and we need to all listen carefully. Somewhere on the Hill congress is listening for the courage of a community to hold itself accountable.

When the dust settles, what will we have? What we hope is a facility that has the potential of serving people with high quality health care delivered with compassion and dignity regardless of color of skin or money in pocket. We hope we have a point of access where people without insurance can be screened and qualified for Medicaid so their ability to get good primary and preventive care is guaranteed. We hope we have a facility with a good referral system that gets people appropriate care, especially for chronic illness and helps connect to a permanent medical home. We hope we have a community of trauma and emergency care providers that steps up to the plate and cooperates to guarantee critical trauma care for every member of our community, regardless of resources or geographic location. We cannot afford another failure of leadership. We need real sustainable solutions.

Finally, I wish to express our concern as the community representing providers of primary care for the uninsured. As the city looks around for funds to cover the needed transition expenses, we urge the Mayor and Council to protect the current tobacco funding plans to expand Medicaid and invest in the improvement of the system of primary care delivery for our medically vulnerable. Somehow this government found some $l, 000, 000 to prop up the failing DC General Hospital to no avail. Do not sacrifice this pot of money from the tobacco settlement securitization on the altar of fiscal expedience. The reforms needed to improve our overall health care system are critical to building a system that really works to guarantee seamless care to all people and begins to finally reduce the horrendous health care outcomes we experience as a city. Just as DC General was unable to adequately serve the needs of our poorest residents, the Community Access Hospital cannot hope to reverse the tragic health outcomes of the District's poor on its own. The entire system must be dedicated to that end.

Thank you for your attention.

DCPCA Questions Regarding the Community Access Hospital and the future PBC

Note: To date, no budgetary plan or accountability plan has been provided by the PBC or DOH.

New PBC:

1.) What will the relationship of the new PBC be to the DC government? To DOH?

2.) Will PBC be required to provide care to all uninsured? What will the relationship of the PBC be to the other safety net providers?

3.) Will the PBC law be re-written to require the PBC to sign a contract with DOH each year for accountability and modifications?

4.) How will the PBC be held accountable for performance in the future?

5.) Will there be an ombudsman program to increase patient accountability? With direct access to the Board of Directors?

6.) When will the PBC produce a long-range plan for financial stability that will include maximizing Medicaid and third party payers? What will the impact of increasing the number of Medicaid enrolled be on the new PBC?

Access Hospital

When will the operating budget of the Access Hospital be released?

Overall observation: the city will still have two classes of uninsured residents: those who use the PBC and those who don't. This is an inhumane philosophy.

Hospital referrals:

For emergencies, the admission to another hospital will be handled immediately. For non-emergencies, what process will be in place to make referrals?

Who will be eligible? If all DC residents are eligible, and the system runs efficiently, there will be a dramatic increase in patients seeking hospital care. What plans are there to handle this "pent up demand"?

When will we establish a citywide policy on hospital admission for the uninsured?

Emergency vehicles:

What city Department will handle the purchase and maintenance? How will this be coordinated with the PBC?

Medicaid enrollment/case management:

Will there be trained case management staff to handle Medicaid enrollment, referrals to other services, and referrals to primary care providers?

Will there be an Income Maintenance workers assigned to the Access Hospital to speed enrollment into Medicaid?

Building and grounds

Is there money to make the DC General campus look better? Friendlier?

Is there money to reconfigure the parking lot to make is usable for the new facility?

What plan will be put in place to make sure the old DC General doesn't become a dead, empty building? That it is becomes a resource for the local community?

Primary Care Clinics

When will a complete plan be developed to improve facilities, quality of care, hospitalization needs and integration with the rest of the safety net?

What will the mission of the clinics be? Who will they be mandated to serve?

How will the performance of these clinics be improved?

How will the patients of these clinics get hospital care?

What will the relationship of these clinics be to the rest of the safety net?

When will a complete plan be developed to improve facilities, quality of care, integration with the rest of the safety net, and [the testimony ends at this point]

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