New hospitals may offer hope to D.C.’s poor, minority areas as Covid-19 rages

howardnewhospital-300x169Even as the Covid-19 pandemic shows the terrible toll inflicted on African Americans in the District of Columbia by health care disparities, city officials have announced they are advancing with a pricey plan to plug a giant hole in area medical services by helping to fund not one but two new hospitals that will serve impoverished communities of color.

The facilities will be in Wards 1 and 8 and will replace the Howard University Hospital and the United Medical Center (UMC) in Southeast D.C., Mayor Muriel Bowser has proposed.

The City Council in the days ahead will consider her latest $700 million or so plan to try to improve medical services for some of the poorest residents in the city by working with Howard, its medical school — one of the main training institutions for black doctors — George Washington University Hospital and two big health systems, Adventist and Universal Health Systems.

To replace the beleaguered UMC, 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.

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.

Over at the Howard campus, the city would provide $300 million in tax breaks and other support so the university and Adventist can build and open by 2026 a $450 million, 225-bed academic-teaching hospital (see illustration above).

The existing UMC and Howard hospitals will stay open until the new facilities are ready.

If council members work through the details and approve Bowser’s plan, as is expected, new hospitals may both deal with huge inequities in D.C. health care, while raising new challenges for the region.

City Administrator Rashad Young has underscored that the proposal addresses an important concern for taxpayers by getting D.C. “out of the hospital business,” notably by shutting UMC and putting the new, replacement facilities in the operational hands of GWU Hospital, which is part of the big Universal Health system.

The 224-bed, public UMC became so troubled that it had to shut its nursery and delivery areas after regulators found serious lapses in care. GWU Hospital and George Washington Medical Faculty Associate, the largest independent physicians practice in the Washington area, earlier had taken over huge parts of UMC’s operations, as politicized and contentious negotiations ensued over possible next steps in providing medical services to big parts of the district. GWU Hospital months ago emerged as a front-runner to be part of any UMC replacement.

Maternal health care became a flashpoint in the talks as patient safety and social justice advocates have pointed out the scandalous rates of deaths and other harms suffered by black women, especially in the district. Bowser underscored the importance of righting race-based wrongs, in pushing her hospital plans, saying in a news conference and as quoted by the Washington Post:

“Generations of racism and discrimination have put thousands of black Washingtonians at a major health disadvantage. We also know that today our hospitals are not entirely evenly distributed across our city, with most of our health-care centers concentrated in Northwest Washington.”

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.

Bowser and Howard deserve credit for seeking to improve the training of African Americans in medicine, a huge shortfall as reported in a 2019 published study in which the Philadelphia-based experts reported:

“Nationally, from 2002 onward, we found a persistently deficient representation of black, Hispanic, and [Native American] medical students. We also found that most states do not train physicians who are demographically representative of the surrounding population.”

The researchers noted why a more inclusiveness matters with health care professionals:

“Demographic representation has been shown to improve health care access for underserved populations, improve the cultural effectiveness of the physician workforce as a whole, and improve medical research and innovation for all populations.”

Under the mayor’s proposal, city funding with the Howard hospital also would support research and care in other “centers of excellence” targeting big challenges for D.C.’s black communities, including sickle cell disease, women’s health, substance abuse, and trauma and violence prevention.

The Covid-19 pandemic, of course, has hammered home how racial disparities in health care harm individuals and groups like African Americans, notably in D.C., as the dcist news site has reported:

“Black people make up 47% of the confirmed cases in the city, (which tracks with their share of the population), but are 80% of the people who have died from the coronavirus … in Ward 8, where 92% of residents are black and the median household income is around $30,000, residents are confronting the highest per-capita number of deaths in the district.  For those familiar with the city and its inequality, this outcome was devastating but unsurprising. They say it was fated here, where neighborhoods drive health outcomes and black people who live in the poorest parts of the city die prematurely. In Ward 8, the average life expectancy is 72 years. In Ward 3, it is 87.”

Those who pay D.C. taxes also get to share the pain of the district’s inequitable and problematic health care system — for expensive and politically connected consultants who ran UMC in less than optimal fashion, consultants who assisted district officials in figuring a way out of the mess, and the proposed fixes. The hospital plan will be tricky for politicians to push through as they also wrangle with a D.C. budget shredded by “projected revenue declines of $800 million related to the coronavirus pandemic,” the Washington Post reported. For the institutional partners, the ambitious building plans also may be tough, as Covid-19-related costs and slashes in non-emergency care have bludgeoned hospital budgets.

Patients throughout the region also may want to keep an eye on the D.C. hospital developments. They would give Adventist, with its operations mostly in Maryland, a toehold in a new market — to what end? They make GWU Hospital and Universal Health a more formidable force in D.C. health care. This is part of a national trend in which big hospitals and big health care systems keep getting bigger — not to the benefit of patients but maybe to shareholders and the pay of the MBAs with suits who run the ever-sprawling enterprises. Patients may need to regard the metrics with skepticism, but it also is worth noting that, by several different ratings or rankings by different organizations, hospitals in the D.C. area aren’t exactly national dazzlers.

We have got a lot of work to do in D.C. with our hospitals and their quality, safety, affordability, access, and social and racial equity.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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