The New D.C. Hospital and the Need to Need
The beauty of the debate over whether to build a National Capital Medical Center (NCMC) on the site of the old D.C. General hospital is that it is utterly transparent and, as we say around here, raw.
Amazingly, there's not even a pretense of calling in those who know how to measure medical need for such a facility. Talk to the docs who monitor Washington's troubled health? Nah. Use the process that's been developed to determine where to put new hospitals nationwide? Don't bother.
Now, finally, someone stands up for reason, and of course, this being the District, the only person willing to do so is a lame duck, council member Sharon Ambrose from Ward 6. Get this: The council member who represents the very ward where the new hospital would be built turns out to be the only one with the courage to say, um, shouldn't we first use honest and commonly accepted measures to decide if this massively expensive political project is necessary?
The city--mainly in the form of Mayor Tony Williams, City Administrator Robert Bobb, and east of the river council members Vincent Gray and Marion Barry--has been pushing to launch the new hospital by circumventing the standard Certificate of Need procedure, which dares to take some time to ascertain whether a hospital is medically necessary. No one doubts the tremendous medical needs of a city that rates very poorly in most health metrics. But virtually the entire medical profession is shouting to the winds about how the District's medical needs are largely in the arena of primary care--not hospital beds.
Yes, the city's emergency rooms are overrun, but that's not because of any shortage of hospitals. Rather, it's because too many people have no access to or no knowledge of the primary care clinics that are vastly better equipped to handle the great majority of people who are now crowding ERs.
But alas, the debate over the new hospital has--surprise, surprise--become entangled in matters of race and class. An ugly series of exchanges on themail, the city's leading online forum for political discussion, has degenerated into name-calling about such spurious notions as "black hospitals" and "white hospitals," with some proponents of the hospital focusing on a prominent opponent being Jewish and some opponents alleging that black proponents are driven more by race consciousness than by medical fact.
You'd hope that in a city with a mature political culture the elected representatives would occasionally rise above the muck to make decisions based on what's best for the people. But here you'd run into Linda Cropp, the council chairman, who is desperately trying to please all in her race for mayor. Just as she spent the past year-plus trying to prove to voters that she's both the person who saved baseball in Washington and the person who fought hard to force baseball into a better deal for the District, she's now positioning herself both for and against the hospital.
Cropp's words continue to support the new hospital--in today's story, she denies any attempt to put obstacles in the path of the NCMC project:
"Oh, no, not in the least," she said. "Folks want it to be done. This is an issue that is important to many members on the council, and I do not see any one council member holding up an issue of such importance to the city."
Yet Cropp's actions are restoring some sanity to the runaway train that the hospital project was in danger of becoming: She has craftily divvied up the five hospital bills now before the council to four different council committees, a surefire way to assure that the process gets at least slowed and, more likely, stalled. As Sharon Baskerville of the D.C. Primary Care Association, a strong opponent of the new hospital, put it, Cropp's move "decimates" the hospital project. "Parceling it up causes multiple hearings, delays, potential confusion and more questions," she said.
The real debate here is about whether to go through the ordinary Certificate of Need process, which the city used in the decision to build the new George Washington University hospital. The certificate process for the GW hospital didn't take the five years that NCMC proponents claim it does; no, it took only 160 days. That process might help shed some light on why GW was able to build a hospital for about $100 million while the new NCMC is already estimated to cost nearly $500 million.
But the larger question is why it falls to a lame duck council member to be the one to stand up for the city's taxpayers and for those most in need of improved health care. Why is it politically infeasible for those in the city's most important positions to cut through the racial fog and focus on how best to deliver medical care to people who are obviously improperly served?
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