D.C. Mayor Says City Will Support ‘Threatened’ Indigent Health Care System

Patients in the D.C. Healthcare Alliance, the private corporation that runs Washington, D.C.'s indigent health care system, will not lose their health benefits, even though Arizona-based Doctors Community Healthcare, which manages the program, entered Chapter 11 bankruptcy protection Nov. 20, D.C. Mayor Anthony Williams (D) said, the Washington Post reports (Goldstein/Woodlee, Washington Post, 11/23). However, patient access to care has been threatened by the bankruptcy of Greater Southeast Hospital, which treats patients enrolled in the alliance who require hospitalization or trauma care (Moreno, Washington Post, 11/24). Doctors Community is looking to secure private financing to continue operations, but if that effort fails, Williams said that the city could operate the alliance even if Greater Southeast is forced to shut down. Williams added that other providers in the alliance could provide health services and that patients requiring hospital services could be moved to Maryland or to other hospitals in the city if Greater Southeast closes. Also, the emergency medical systems in the city, as well as Prince George's County, Md., would "adapt," Williams said. If Doctors Community is unable to find funding, Williams added that another local hospital could manage Greater Southeast temporarily, while new investors and "turnaround consultants" are found. The Post reports that city officials also are looking to replace Doctors Community as the contractor of the alliance. City officials are in discussions with D.C. Chartered Health Plan, a Medicaid HMO; Howard University Hospital, a trauma center and teaching hospital that had resisted joining the alliance; and Unity Health Care, a not-for-profit chain of clinics. Williams said that although he has the authority to switch the manager of the alliance, he would consult the D.C. Council before making any changes (Goldstein/Woodlee, Washington Post, 11/23).

Impact on Greater Southeast
Doctors Community is the latest customer of National Century Financial Enterprises, the nation's largest health care lender, to file for bankruptcy following the collapse of the lending company. On Nov. 18, National Century filed for Chapter 11 bankruptcy protection because it owed approximately $3.6 billion to bondholders, large money-management firms that buy bonds and other creditors, the New York Times reports (Oneal, New York Times, 11/21). A federal bankruptcy judge on Nov. 21 granted Doctors Community access to $5.4 million in funds over three business days to keep the network's hospitals open to prevent disruption in patient care, the Post reports. Another hearing is scheduled for Nov. 26. Greater Southeast's share of the funds helped it meet its $2.1 million payroll on Nov. 22, according to Karen Dale, the hospital's CEO. While health officials say that the "immediate effects" on health care delivery "have not been great," Dale said that several of Greater Southeast's nurses have resigned, many patients have opted to go to other facilities and the emergency room is diverting ambulances with patients who require immediate or intensive care because of the nursing shortage. The Post reports that disruption at Greater Southeast comes after the hospital already closed its pediatric unit and merged three surgical units before the bankruptcy (Goldstein/Barker, Washington Post, 11/22). In addition, two nursing agencies have terminated their relationship with the hospital and the contract with the agency that provides emergency room physicians may not extend past Nov. 30 (Washington Post, 11/24). USA Today reports that the NCFE and Doctors Community bankruptcies have "threatened" the care of critically ill patients nationwide, especially among Medicaid and Medicare beneficiaries. According to W. David Leak, medical director of Pain Control Consultants in Columbus, Ohio, "figuring out the blame" of the health care lender's collapse "might take years," but "there could be an immediate impact on a health care system that was already 'teetering on life support'" (Jones, USA Today, 11/22).