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When A Hospital Is In Critical Condition

One of Hema Yadla's patients needed a pacemaker, right away. But when the staff at Prince George's Hospital Center called to order the device for immediate delivery, the vendor refused to process the purchase.

"They were afraid they wouldn't get paid," Yadla, an internist, told me. Luckily, another vendor was unwilling to put worries about the hospital's precarious position ahead of a patient's life. The pacemaker arrived, and the patient is doing well. But the game of chicken that politicians are playing with the future of the county's largest hospital is endangering lives and risking a breakdown in health services that could affect millions in Maryland and the District.

The Prince George's County Council's rejection last week of a state plan to bail out the county's financially troubled hospital system may seem like just one more case of brinkmanship, the sort of macho game that politicians play all the time. The council is in a power struggle with the county executive and a new governor from Baltimore. In the end, most likely, the county and state will apply some ugly old Band-Aid as a temporary remedy and keep the hospital going.

The damage is done. Anticipating a shutdown in June, staffers are searching for jobs. "Most would get out if they got a more stable offer," said David Goldman, vice president for medical affairs.

"It's shocked me how quickly the confidence of patients and family members is eroding -- it's by the minute," said Gary Little, the doctor who runs the emergency room at the hospital in Cheverly. "I've never before had patients ask me, 'Should I go somewhere else?' Essentially, 'Is it safe to be here?' "

More than 45,000 patients go to Little's ER each year, and even if you begged an ambulance driver to steer you to some other facility because you think of Prince George's as a hospital for the poor, you depend heavily on the existence of its ER. The 115 patients who stream into the ER each day have to go somewhere, and the county is not the District, where seven hospitals picked up patients who went to D.C. General before it closed.

"Our patients would be dispersed," Little said. "They would just diffuse out" to Doctors Community Hospital in Lanham; Southern Maryland Hospital in Clinton; Providence and Washington Hospital Center in the District; Suburban, Holy Cross and Washington Adventist in Montgomery County; and even to more far-flung hospitals.

"People don't realize: 20 additional patients a day can gridlock your emergency department to a point that becomes unsafe," Little said. "You cannot add doctors and nurses quickly enough to manage that."

Add the 3,000 cases a year that the hospital's trauma unit handles -- stabbings and shootings from Prince George's and the District were being treated during my visit -- and the regional impact of a shutdown becomes frightening.

Too many years of budget constraints and official neglect have left the hospital far behind in technology and equipment. The CT scanner is woefully outdated. The ER lacks the electronic record-keeping and patient tracking that speed services at most hospitals. All but one of the hospital's residencies were cut out, to the great dismay of doctors who trained at Prince George's and have stayed there for decades, committed to caring for those most in need.

The hospital's reputation has suffered dearly. All of the doctors I spoke with there said they have a devil of a time persuading their private, paying patients to be treated at the county hospital, yet almost every one of the docs and their loved ones have been cared for there.

Surgeon Said Daee, who has worked at Prince George's since 1976, credits it with saving his life: "I have three stents in my heart; I had it done here because the care is excellent. The Prince George's council members don't come to this hospital. They have their surgeries in Georgetown. But they think nothing of pushing us to the edge of a cliff."

It may sound slightly ghoulish to outsiders, but doctors love a place such as Prince George's Hospital Center because, as Goldman put it, "we have very seriously ill patients who are wonderful teaching patients. With sufficient resources and good management, we'd become attractive to private patients." Doctors get intensive experience that's hard to replicate at a quiet suburban hospital. In a field in which repeated procedures are the best guarantee of quality care, that's essential.

Ali Khan has been a Prince George's surgeon for 32 years, adapting as the cases that roll into his operating theater have shifted from blunt wounds of car crashes to the penetrating wounds of stabbings and gunshots. As we spoke, Khan's BlackBerry went off: He had to operate a second time on a man who was shot five times last weekend. "He's going to survive," the doctor said.

In the waiting room, the man's mother smiled through her tears and thanked the Lord, but it was the doctors who made the save, as Khan and his team do in 97 percent of cases. In a place that politicians think they can just toss on the trash heap.

By Marc Fisher |  April 15, 2007; 10:43 AM ET
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Comments

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This story elicits my admiration to the health professionals who persevere there despite the lackluster conditions, and contempt for all the politicians -- not just those from Prince George's, but the state as well -- who allowed this deterioration to happen. Another negative tossed to a county that needs all the positives it can get.

Posted by: Vincent | April 15, 2007 3:16 PM

When my oldest son was in a serious auto accident he was flown to PG Shock Trauma.

I have nothing but great praise for the treatment he received at the PG Shock Trauma center. Losing this asset will be a major blow not only to the PG county residents but the entire region. From what I have read this is happening because the PG council wants to do some political posturing. Saying they don't want to burden whoever is in office 10 years from now is the ultimate copout. They were voted into office to do the job. If they can't handle long-term thought then they should be voted out next election.

Last I heard the State/County split for the money to keep this running was 48% State and 52% county. Has this changed? Does anybody out there feel those numbers are bad for either the state or the county?

What is the problem with these people? Is getting re-elected so important to them that they are willing to let people die?

Somebody, please, give me more information that will let me believe the county and state are really working in everybodies best interest. Because I just don't see that right now.

Hope everybody is happy with the way they voted last November. You are seeing the results of that now.

Posted by: SoMD | April 16, 2007 8:29 AM

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