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Cynthia Perry, 1199 Metropolitan District DC
National Union of Hospital and Health Care Employees, AFSCME, AFL-CIO
Testimony to the City Council Committee on Human Services on the
DC Department of Health Proposed FY 2002 Budget
March 29, 2001




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MARCH 29, 2001

Good afternoon. My name is Cynthia Perry and I am an 1199 Metro DC District Staff Representative. I am speaking today on behalf of the unions of the Metropolitan Washington Council, AFL-CIO, and the Health Care Now Coalition, a community-based group of health care advocates and caregivers. Quality health care is very important to all of us, and we appreciate the opportunity to speak at the Committee on Human Services budget hearing on the D. C. Department of Health budget request for Fiscal Year 2002.

In this budget proposal, the Mayor requests that in Fiscal Year 2002, the Public Benefit Corporation (PBC) be dissolved and all operations at D.C. General Hospital be closed. As you know, the PBC receives an annual subsidy from the District for reimbursement of medical services provided to the District's uninsured and underinsured residents. The Mayor requests that the PBC subsidy funds move to the Department of Health. The Department of Health would establish a unit known as the Health Care Safety Net Administration to administer, monitor and fund the contract to deliver health care services to indigent and uninsured District residents.

Furthermore, the Mayor is asking the Council to approve this request even though he has provided few details about the components and cost of a privatization plan with Greater Southeast Community Hospital and its parent company, Doctors Community Healthcare Corporation of Arizona. Apparently, the contract is still being negotiated. Likewise, the Mayor has not yet provided the Council with the details and costs of a transition plan.

We urge the Committee on Human Services and the Council as a whole to reject the mayor's request regarding the contracting of functions now provided by the Public Benefit Corporation Subsidy. Instead, we urge that you support the plan proposed by DG General's new CEO, Michael Barch, called the PBC2 Urban Health Campus.

We do agree with and support the Mayor's objective of "ensuring access to quality health care to every man, woman and child in the District -- no matter their ability to pay." We also agree that there is a need to expand health insurance coverage to more District residents, that the District must ensure the provision of quality health services, and that the PBC cannot continue to function as it has in the past.

However, we do not agree that the Mayor's proposed plan would work satisfactorily. And if we shut down D.C. General Hospital, we don't see how we can turn back. We believe that the Mayor's plan is a prescription for disaster.

The closing of D. C. General Hospital, a hospital that has long served the inner city urban population of the district -- a hospital that serves the uninsured -- a hospital that serves a minority community -- is exactly a hospital we do not want to close if we are serious about these health objectives. Why would we even consider closing this hospital? What would we substitute for the provider access, financial access, transportation access, and cultural access? Certainly, we should not rely on an Arizona-based for-profit company.

D.C. General is a hospital that serves more than the poor. It is a major trauma center that the entire community relies upon. The continued presence of Level 1 trauma services at D.C. General is critical to preventing additional loss of life due to trauma especially for residents in Wards 6, 7, and 8. While we recognize that there may be a surplus of Level 1 trauma units in the city, there is no such surplus in the area serviced by D.C. General Hospital. Eliminating the presence of a Level I trauma service in this area of the city will result in delays in residents being treated for their injuries, which will have an adverse impact on patient care outcomes. We agree with the Washington Hospital Center concern that existing trauma units will be overwhelmed with patients in absence of the D.C. General trauma unit.

To address the health care and financial crisis involving the PBC, particularly D.C. General Hospital, and to ensure a safety net for the District's medically uninsured residents, we urge that the funding that the mayor has allocated in his budget proposal be redirected to support an integrated community-oriented primary care system, in which D.C. General Hospital is the hub. We feel very-strongly that inpatient acute care, a Level 1 trauma service, psychiatric care/substance abuse, and graduate medical education programs are critical to efforts to improve the health status of D.C. residents.

The Mayor has pointed to the dismal health statistics of the District to justify his health services plan. However, it is wrong to blame the PBC and D.C. General for the serious health problems in the District. The District of Columbia has a large number of residents without health insurance. People without health insurance coverage tend to have a worse health status than people with insurance because they tend to go without care and prescription medication because of cost. As a result, people without insurance are more likely to need to visit an emergency room or stay in the hospital, than the general population.

It's not surprising that D.C. General Hospital is one of the highest providers of uncompensated care in the country. However, the level of support for uncompensated care that D.C. General receives from the District and its Medicaid program is one of the lowest in the country. No health care system could meet these responsibilities with the level of support that the District has been willing to provide. A solution for the District's health care safety net requires adequate financing and elimination of political interference.

We need to find ways to strengthen the health care safety net in Washington so that its citizens are well served and no one is turned away. Privatization is not the solution.

We support the plan proposed by DG General's new CEO Mr. Michael Barch, called the PBC2 Urban Health Campus. This plan will transform the existing site of D.C. General Hospital into an Urban Health Campus serving as the hub of a vertically integrated system of primary, specialty and inpatient care, school health, home health and long-term care interconnected by a single information system. This plan includes a Level 1 Trauma Center, Emergency Room and an Urgent Care Center as well as a Women's Health Care Center, a modern birthing facility and a Senior Wellness Center. Our Community Health Centers will partner with non-profit clinics. School health will emphasize health education, preventive medicine, immunizations and screening. Services will include enabling social services, nutrition, care management, mobile health vans and home visitation. "Centers of Excellence" will be established to assist patients with management of chronic diseases that disproportionately affect African-American and low-income city residents. A new strategic partnership will be formed with Howard University's Cancer Center, Howard University Hospital and Howard College of Medicine as well as other organizations such as the National Institutes of Health.

The decisions and choices you make in coming weeks and months will likely shape the future of health care in the District of Columbia for the 21" Century, for better-or for worse. A streamlined version of the current health care system, appropriately funded, could provide the necessary care at less than the cost of contracting for services. We urge you to preserve and protect an institution with a proven track record in delivering care to the District's low income and uninsured patients: In November of 2000, D.C. General received a score of 94 percent from the Joint Commission on Accreditation of Health Care Organizations.

The goal of those of us who support the Urban Health Campus on Capitol Hill is to be a part of the solution. We want to help build a health care system that will eliminate disparities in access to care and health outcomes.

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