D.C. General Privatization Plan Mirrors Other Cities, New York Times Reports

The New York Times today reports on the decision last week to end inpatient and trauma services at D.C. General Hospital -- the city's safety-net hospital for the uninsured -- and how the plan to privatize the city's health system and essentially close its only public hospital follows a national trend. According to the American Hospital Association, the number of public hospitals has declined from 1,778 in 1980 to 1,197 in 1999. Some public hospitals have "been absorbed into [not-for-profit] university hospitals," some "have become private entities," and some "have shut down," the Times reports. With D.C. General mired in "dire financial straits for more than a decade," city officials in 1996 put the hospital and city clinics under the control of the Public Benefit Corporation, a quasi-independent agency that was tasked with coordinating care "like a business" -- a strategy that succeeded in Denver but failed in the District. According to Dr. Ivan Walks, the city's health commissioner, city officials and the D.C. financial control board -- established in 1995 by Congress to oversee the city's finances -- last year began to study other cities had successfully privatized their health systems: "San Diego, Detroit, Tampa. What we found is that if you do these transitions correctly, you can expect three things: increased access, increased quality and cost savings," he said. The financial control board agrees with Doctors Community Healthcare Corp., a private hospital chain, to run the hospital's remaining outpatient clinics and emergency room, as well as six separate city clinics. Mayor Anthony Williams (D), who along with the control board, supported the privatization plan despite unanimous opposition from the D.C. City Council, said that the uninsured will receive improved care, adding, "I am going to sleep like a baby at night because I've done the right thing."

A Cultural Institution
The Times reports, however, that many have criticized the new plan, saying that it threatens care for the city's 80,000 uninsured residents. "We are tossing public health into the trash," Dr. Michal Young, a neonatologist and president of the hospital's medical and dental staff, said, adding "When you lose public health in the capital of the most powerful nation in the world, it is an indicator of what the rest of the country is going to do." Dr. Alan Sager, a professor of public health at Boston University, said that the backers of the privatization plan "underestimat[e] the intimate relationship between patients and hospitals," and that D.C. General's closing would lead patients to "simply cease seeking care for a time." He added, "Hospitals are not interchangeable parts in some health care machine. It takes a while to reweave a connection." Moreover, the Times reports that the hospital is a "symbol of culture and history" to blacks, who constitute most of D.C. General's patients. Rev. Graylan Hagler, a D.C. pastor, said, "The eradication of D.C. General is a statement that there is no place for the black community, for the low-income residents, the people that have lived here through thick and thin, ups and downs. Not only is the hospital being removed, but those populations are being removed" (Stolberg, New York Times, 5/7).