The City Council in the nation’s capital soon will delve into more details and give crucial approvals to a positive-seeming agreement to provide under-served areas of the District of Columbia with not one but two new hospitals. This deal could be improved quickly, however, if leaders also resolve what has become a prickly revolving door issue for a top city official.
D.C. Mayor Muriel Bowser this month asked the district’s Board of Ethics and Government Accountability to weigh in on D.C. Administrator Rashad M. Young’s abrupt decision to leave his top-level role in city government to join Howard University as its senior official for “future, strategic planning.”
Young, former city manager in Alexandria, created potential issues for Bowser and her administration because he was one of her longest-serving, most trusted, and empowered chiefs. He ran the city day-to-day for Bowser and the dcist news site reported this of him:
“As city administrator, Young was responsible for managing a workforce of nearly 35,000 employees and a budget of nearly $15 billion. He was also tasked with handling the long-term financial management. He is cited on the city’s website as having helped increase the city’s credit rating to AAA and leading the charge to bring about policies that closed large scale family shelters, established short-term family housing facilities across the District, subsidized public transportation for students, and helped complete redevelopment of the District’s southwest waterfront.”
A key role in hospital negotiations
Oh, and Young, WTOP reported, “helped negotiate a deal for nearly $300 million in tax breaks and public funding for a new hospital for the university.” As the Washington Post reported of the hospital agreement for Howard to build a new hospital to replace facilities on its campus in Northwest Washington:
“Under the deal he spearheaded, the District would provide $225 million in tax abatements, along with $26 million over six years to help Howard establish specialized centers, and an additional $25 million for capital expenses. The property tax savings would support construction of a new hospital and redevelopment at the site of the existing hospital. Howard would be able to charge private developers more to lease land that would be considered more valuable with lower property tax bills, according to an analysis by the Office of the Chief Financial Officer. Howard is known as a national training ground for Black physicians, who are underrepresented in the field, and as a safety net for poor African American residents of the District.”
The district also in this plan would work with George Washington University Hospital, part of the giant Universal Health system, to replace the beleaguered United Medical Center (UMC) in Southeast Washington.
The city plans to contribute to a $375-million agreement with GWU Hospital to build and open by 2024 a 136-bed hospital, which also could be expanded by 60 more beds. The facility would be at St. Elizabeths East and would include “new urgent-care clinics east of the Anacostia River, an area home to some of the District’s poorest and sickest residents,” the Washington Post reported in the spring.
The combined facilities would provide medical services, including for general surgery, neonatal and obstetrics, infectious diseases, wound care, and rehabilitation, as well as acute, med psych, and outpatient behavioral health, the city plan says. Critics have questioned why the new facility will not have the highest-level trauma or emergency care facilities — which also can be among the most expensive in a hospital to run.
Still, besides question about trauma care, the hospitals deal has not generated much controversy and opposition, with the agreement fulfilling a longtime aspiration for Bowser to boost the hospital and health care options, notably in poorer and heavily minority Wards 1 and 8.
Ethics concerns raised
Bowser, according to social media posts by journalists covering her administration, notably for the Washington Post and WAMU, learned in July from Young that he was discussing a post at Howard. The job’s duties and Young’s acceptance of it were confirmed by the reporters. Bowser has told reporters that she discussed the situation with Young and other advisors, starting in July and before deciding he should depart city government quickly — and with praise in general for his work.
The mayor wants the City Council to advance the hospital projects and has promised to be transparent about the ethics findings about Young. But she, he, the council, and the university could well serve taxpayers with a big shot of disclosure and transparency in the next consideration of the hospitals deal.
Young and Howard could confirm his hiring and spell out terms of his employment, making clear that the onetime municipal executive will not enrich himself from his negotiating on the district’s behalf. The district and the university can work with their legal staff to create fair and reasonable ethics barriers to ensure neither side has unfair advantage now, and in the days ahead, from Young’s insider role and information. This should apply, too, to Howard’s partner health organizations like the Adventist system.
The mayor could get even further ahead of questions and controversies if legal counsel can help her strike similar accords addressing Young’s potential roles with GWU Hospital and Universal Health and Howard and Adventist.
The city’s ethics experts
Bowser has insisted that the district ethics officials will sniff out and provide guidance on Young’s job hunting, as well as issues involving his non-government employment. The Washington Post reported this about the panel’s comments on the matters presented to it:
“Rochelle Ford, the acting director of the Office of Government Ethics at the ethics board, confirmed that Young sought guidance from her office on transitioning from public service to Howard University. ’If he was involved in working on the tax abatement and negotiating it, and we know he was, then he can’t go on the other side and represent Howard back before the District,’ Ford said in an interview … ‘He can’t contact the District about the things he negotiated on.’ Ford said the rules are not as straightforward regarding how District government employees should act when seeking new jobs.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
For communities of color, unacceptable and persistent inequities in society and notably in health care only worsen the problems of access and affordability as well as safety and quality of medical care. With the stakes so high and negotiations going seemingly well for a hospitals plan beneficial to so many, as a former president observed of a best course: Trust but verify. Wouldn’t transparency to the max be a great course here?
Bowser and Young also should act with vigor and alacrity on this latest hospital-related ethics matter because the mayor’s administration has found itself assailed before on cronyism criticisms in dealing with pricey, weak performing health care consultants advising the district.
All the parties could wait for the ethics board to rule, of course. But it is not clear exactly when that decision would be handed down and how it will sit with the many parties involved. It would be better for the city, taxpayers, patients, the hospitals and health systems, the university, and Bowser and Young to dicker about details now and lift any personnel-related clouds quickly and long before bigger, broader issues may emerge.