|A PROPOSAL TO DEVELOP A COMPREHENSIVE URBAN
HEALTHCARE CAMPUS ON THE GROUNDS OF DC GENERAL HOSPITAL
November 3, 2000
Prepared by: Councilmember David Catania
Councilmember Sandy Allen
Councilmember Kevin Chavous
The District of Columbia, like much of urban America, is facing a
public healthcare crisis. Notwithstanding the considerable evidence indicating the
disparities in health between residents of urban America and other Americans, there
remains no proactive strategy for resolving these differences.
The institutions and programs in place to address these healthcare
concerns are scattershot and incomplete. Moreover, the lack of coordination and
integration of these healthcare services leaves too many holes for the District's
underserved and indigent to fall through. It is no longer acceptable to simply express
regret regarding urban America's healthcare deficits. We must construct an architecture to
aggressively confront and resolve this intolerable situation. The cornerstone of this
integrated healthcare infrastructure must be a comprehensive Urban Healthcare Campus.
II. The State of Health in the District of Columbia
The District of Columbia -- despite enormous financial expenditures --
has made little progress in constructing a successful healthcare infrastructure.
Tragically, the District leads the nation in its failure to address certain very serious
health crises. Several examples of this failing healthcare system within the District
concern HIV/AIDS, Tuberculosis, infant mortality, substance abuse, and mental health. The
District is at or near the top in national averages of occurrence for these problem areas.
The District ranks first in the nation for annual cases of AIDS per
100,000 population. In the twelve-month period ending on June 30, 1998, the District had
178.3 annual AIDS cases per 100,000 population, or a total of 10,887 cases. In that same
time, the United States as a whole had only 19.6 annual cases of AIDS per 100,000
population, or a total of 643,350 cases. The Center for Disease Control and Prevention
(CDC) reports that the District is the metropolitan area with the fifth highest number of
AIDS cases in the United States. As of December 31, 1999, the CDC reported 21,648 active
cases of AIDS in the District. The District also comes in with the ninth most AIDS cases
among states and territories as of this December 31, 1999 report.
Equally disturbing as the AIDS rate in the District is the rate of
Tuberculosis. The District ranks second nationally in number of annual Tuberculosis cases
per 100,000 population, behind only Hawaii. In 1999 the District had 13.5 annual cases of
Tuberculosis per 100,000 population. The United States in 1999 had an average of 6.4
annual cases of Tuberculosis per 100,000 population.
Infant mortality is another alarming health problem in the District.
Infant mortality is an indicator of numerous other problems including substance abuse,
physical abuse, disease, high rates of teen pregnancy and a lack of accessible healthcare.
In 1997 the infant mortality rate was 12.1 deaths per 1,000 live births, which is 70
percent higher than the national average of 7.1 deaths per 1,000 live births.
The root of many of the Districts health problems can be traced back to
substance abuse. In 1999, the Substance Abuse & Mental Health Services Administration
(SAMHSA) reported that an estimated 7.6 percent of the District's population had used an
illicit drug within the month of their survey, while 17.5 percent had participated in
binge drinking of alcohol. It has been estimated that there are 70,000 District residents
with an addiction problem.
All of the above health issues create the most important and alarming
health indicator in the District, life expectancy. Nationwide life expectancy has been
going up. The same cannot be said for the District. Life expectancy for District men is 10
years below the national average and 5 years below for women. When these numbers are
separated by race, they become even more alarming. For Black men in the District, life
expectancy is now 56 years or less. This 56year life expectancy for Black men is lower
than for any nation in this hemisphere except for Haiti. The numbers are alarming and
something must be done to stop this trend.
III. An Urban Healthcare Campus
This proposal calls for the creation of a fully integrated medical campus on the
grounds of DC General Hospital. Among other features, this proposal envisions a full
service hospital, mental health facilities, comprehensive substance abuse treatment
options, HIV/AIDS services, etc. Essentially, this proposal seeks to end the past District
practice of "silo" style services where illnesses rather than people are
treated. For too long, the lack of cooperation and coordination between various aspects of
our healthcare infrastructure has impeded our ability to provide meaningful and successful
healthcare. An integrated Urban Healthcare Campus, treating the many illnesses of our
patients, should dramatically improve the quality and efficiency of our healthcare
IV. The Proposal
The District must become more proactive in addressing our healthcare deficits. This
proposal represents an exciting opportunity to create an institution which can be a nation
model. This proposal includes the following elements:
A. Creation Of A Federal/District Partnership That Is Focused On Specific Urban
As discussed throughout this proposal, urban healthcare providers are confronted with
unique challenges. Rates of trauma, drug abuse, Tuberculosis, substance abuse, HIV/AIDS,
and injury associated with violent crime are far greater among urban providers than
The Federal Government has not addressed the urban/non-urban healthcare divide. This
proposal seeks a partnership between the District and the National Institutes of Health
(NIH) in the completion and operation of the new Urban Healthcare Campus. A partnership
with NIH will afford the District the opportunity to utilize NIH's expertise in both
healthcare management and research. In exchange, the new Urban Healthcare Campus can offer
NIH a setting to continue their research and training mission, especially in the area of
Among the promising partnerships include accessing the following NIH Institutes and
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and
supports basic and applied research and provides leadership for a national program in
diabetes, endocrinology, and metabolic diseases; digestive diseases and nutrition; and
kidney, urologic, and hematologic diseases. Several of these diseases are among the
leading causes of disability and death; all seriously affect the quality of life of those
who have them.
National Institute of Allergy and Infectious Diseases (NIAID) research strives to
understand, treat, and ultimately prevent the myriad infectious, immunologic, and allergic
diseases that threaten millions of human lives.
National Institute on Aging (NIA) leads a national program of research on the
biomedical, social, and behavioral aspects of the aging process; the prevention of
age-related diseases and disabilities; and the promotion of a better quality of life for
all older Americans.
National Institute of Mental Health (NIMH) provides national leadership dedicated to
understanding, treating, and preventing mental illnesses through basic research on the
brain and behavior, and through clinical, epidemiological, and services research.
National Institute on Drug Abuse (NIDA) leads the nation in bringing the power of
science to bear on drug abuse and addiction through support and conduct of research across
a broad range of disciplines and rapid and effective dissemination of results of that
research to improve drug abuse and addiction prevention, treatment, and policy.
National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducts research focused on
improving the treatment and prevention of alcoholism and alcohol-related problems to
reduce the enormous health, social, and economic consequences of this disease.
National Institute of Child Health and Human Development (NICHD) research on fertility,
pregnancy, growth, development, and medical rehabilitation strives to ensure that every
child is born healthy and wanted and grows up free from disease and disability.
National Cancer Institute (NCI) leads a national effort to reduce the burden of cancer
morbidity and mortality and ultimately to prevent the disease. Through basic and clinical
biomedical research and training, NCI conducts and supports programs to understand the
causes of cancer; prevent, detect, diagnose, treat, and control cancer; and disseminate
information to the practitioner, patient, and public.
National Heart, Lung, and Blood Institute (NHLBI) provides leadership for a national
research program in diseases of the heart, blood vessels, lungs, and blood and in
transfusion medicine through support of innovative basic, clinical, and population-based
and health education research.
B. An Integrated System Of District Government Services
The District Government's healthcare infrastructure does not provide comprehensive
care. The goal of a successful healthcare infrastructure should be to completely treat the
patient. In this proposal for a comprehensive Urban Healthcare Campus we envision the
following facilities to be among the facilities located on the Urban Healthcare Campus:
a. A Comprehensive Hospital
b. Mental Health Facility
c. Substance Abuse Treatment Facility
d. HIV/AIDS/STD Treatment Facility
e. Tuberculosis Treatment Center
f. Physical Therapy Rehabilitation Facility
C. Professional Private Management
Many of the problems associated with the failure of the Public Benefit
Corporation (PBC) concern its management structure, as well as its relationship with the
District government. The inefficiencies of the District Government were transferred to the
PBC: poor information management services; inadequate capital facility planning;
cumbersome contracting and procurement; expensive labor contracts; etc.
To shed these inefficient practices and lack of expertise, this
proposal seeks a private management -structure for the new Urban Healthcare Campus. This
proposal leaves unaddressed whether that private management should be
"for-profit" or "not for-profit." Some examples of what could occur
include a lease agreement, a joint operating agreement, or a joint venture.
One possible solution would be to lease the hospital, its clinics and
equipment to a management firm. This approach was taken in Austin, Texas, which leased its
public hospital to Seton Health Care Network for 30-years. All indigents still have
access, but the subsidy for indigent care is capped at $17,000,000.00 annually.
A second possible solution would be for the District to turn over the
operation of the hospital to the private sector, but retain a measure of the influence by
appointing a portion of the board members to the joint venture. An example of this working
occurred in Oklahoma where the state transferred the operation of its state teaching
hospitals to Columbia/HCA Healthcare Corporation under a 50-year contract. The state of
Oklahoma and Columbia/HCA Healthcare will each appoint five directors to the board of
directors of the newly formed hospital authority.
A final possible solution would be for the District Government to sell
a portion of DC General's assets for cash, retaining power to appoint a portion of the
board members. An example of this is what occurred with California's Sequoia Healthcare
District. In 1997, it netted $30,000,000.00 in cash by affiliating with Catholic
A. Available Capital To Construct The Urban Healthcare Campus
Over the next six years, approximately $330.6 million in capital ($192 million in
tobacco dollars and nearly $138.6 million in unexpended capital dollars identified in the
Departments of Health and Human Services, the Public benefits Corporation, and the
Commission of Mental Health) will be available for this proposed project. Please see
attached Memorandum from Arte Blitzstein, the Council's Budget Officer and Clarence
Campbell, Senior Budget Analyst.
B. Recent Cost Of Building Other Healthcare Facilities
The development and construction of new healthcare facilities is not as
expensive as one might imagine. The current 371 bed George Washington University Hospital
construction project is estimated to cost $96,000,000.00. This project is to include an
expanded emergency room and larger operating rooms capable of accommodating today's
advanced surgical equipment. The majority of the patient rooms will be private, allowing
appropriate space for patients and their families as well as physicians and staff.
A sampling of other ongoing hospital construction projects can help
illustrate that the notion of constructing a new Urban Healthcare Campus on the grounds of
DC General is feasible and affordable. In Statesboro, Georgia the construction of the new
East Georgia Regional Medical Center is expected to cost $53,000,000.00. This facility is
a 150-bed hospital that includes a women's pavilion, which will house 21 beds for
postpartum and gynecological medicine including mammograms, ultrasounds, general X-ray and
lab equipment and prenatal and nursery care. The space will also provide space for
specialties including cardiology, neurology and gastroenterology.
In Suffolk, Virginia they are building the new Obici Hospital, a
138-bed hospital, at a projected cost of $85,000,000.00. In Marion, Illinois they are
building a 92-bed hospital that has not yet been named at a projected cost of
$48,000,000.00. New Island Hospital in Bethpage, New York is undergoing a capital
improvement project that will include 36 new medical beds, a new emergency department, and
7 additional operating rooms for an estimated $48,000,000.00.
The following hospitals are going through an expansion and renovation
process to improve their healthcare facilities. St. John's Hospital in Springfield,
Illinois is finishing a project that encompasses 40,000 square feet at a cost
$10,700,000.00. Allegan General Hospital in Allegan, Michigan is going through a similar
project at a cost of $8,500,000.00. A 445,500 square foot project at Overlake Hospital
Medical Center in Bellevue, Washington is expected to cost $56,000,000.00.
It is clear from the above figures that we have the capital to proceed with the
construction of a new Urban Healthcare Campus on the grounds of DC General Hospital. With
the utilization of a modern facility we are certain to save millions of dollars in
operating cost each year. A new healthcare campus can be constructed in a manner that
allows for the most efficient and best medical service possible saving not only dollars,
but also lives.
C. Operating Costs
The District spends per capita an extraordinary amount on providing
healthcare services to its residents. The inefficiencies and lack of quality certainly
contributes to these enormous costs. While this proposal has not calculated the additional
costs associated with operating an integrated campus, intuitively there is no reason to
believe that integrated care is any more expensive to provide than non-integrated.
Successfully treating the whole person for all of their illnesses is
another way the District will save money at the new Urban Healthcare Campus. Eliminating
return visits will lead to significant cost savings. For example, our failure to treat an
individual for both their depression and substance abuse means that the untreated illness
continues and contributes toward a relapse of the treated problem.
By completing the stated goal of improving the leadership and
management within the District's healthcare infrastructure, cost savings and additional
revenues will certainly be generated. For example, an aggressive and experienced
management team will have the ability to improve the hospitals system of billing and
collecting. An efficient management team can also insure that all hospital services and
programs are licensed and properly registered. This is important because a number of
services and programs are not currently receiving the revenue they could be if they were
properly licensed or registered.
In addition, the proposed Urban Healthcare Campus can generate
additional revenue for the new campus by serving more patients. A quality healthcare
campus, complete with the prestige of NIH, would certainly attract more patients.
Additionally, the successful marketing of the new Urban Healthcare
Campus can raise its revenues. In the past, the PBC has failed to market itself to
patients that do not fall within their local service boundaries. The new Urban Healthcare
Campus must reach out to the regions entire population and proclaim it is ready and
willing to successfully serve them. The combination of a first class healthcare facility
and more marketing is likely to add new clients to Urban Healthcare Campus' daily patient
list, therefore increasing revenue.
VI. Plan of Action
The first step in realizing this Urban Healthcare Campus is the
creation of four working groups, specifically:
1. Facility Group
Among other functions, this group would be responsible for surveying
recently or newly constructed healthcare facilities. Because time is a factor, there is an
advantage in building upon existing models. In the end, this group is responsible for
developing the plan for the physical infrastructure of the new campus.
2. Medical Services Group
Along with representatives from NIH, representatives from our existing
healthcare infrastructure (both public and private) are needed to construct this
comprehensive medical infrastructure.
3. Collective Bargaining/Labor Group
The status of the existing collective bargaining agreements remains a significant
issue. This Group should focus on minimizing these costs while at the same time working
closely with labor to retain as many existing employees as possible.
4. Financing/Management Group
This Group should focus on developing a comprehensive and aggressive management
strategy that will assure financial stability for the new Campus in the years to come.
Among other task to be completed is a survey of possible forms of management as well as
A successful healthcare infrastructure requires planning, commitment and
accountability. The model proposed contains all of these elements. This model, if properly
implemented will permit the District to lead the nation in common sense healthcare policy
for its underserved residents.