Testimony of

Victor G. Freeman, MD, MPP

President, Medical Society of the District of Columbia

Public Oversight Hearing on

Progress of the District of Columbia and Howard University in

Developing the National Capital Medical Center

July 13, 2005

Council of the District of Columbia

Committee on Health

Councilmember David A. Catania, Chair

Good morning.  I am Doctor Victor Freeman, President of the Medical Society of the District of Columbia. On behalf of the Society’s 2,000 physician members and the tens of thousands of patients they serve, I thank you for holding this public oversight hearing regarding the status of the proposed National Capital Medical Center.
 
I want to start by commending Mayor Anthony Williams, Howard University, and especially City Administrator Robert Bobb for taking on the important issue of access to health care and offering a proposal that reflects a clear understanding that solving this long-standing and complex problem will take more than band-aids.  Because we received a copy of the most recent iteration of the proposal just yesterday, we have not been able to review its details.  Therefore, we will not comment on its specific provisions here.  However, we do want to acknowledge that the proposal's intent appears to be to enhance patient access to both basic and cutting edge, high quality medical care, particularly focused at the underserved parts of our great city.  This is a goal we can all applaud.
 
Looking back, we remind you that a few years ago, the Medical Society of the District of Columbia did stand with the City Council to support extensive reforms designed to enhance DC General Hospital.  At that time, we indicated then that if there were no hospital on the DC General Campus, we would be talking about building one. 

And so we are here today, talking about building one.

 As we look at the City today, we have three major access issues: 

• a geographic access to care issue,
• a socioeconomic access to specialty care issue, and
• a surge capacity/disaster preparedness issue. 

On the geographic access to care issue, we have heard anecdotes from the EMS about patients dying from inordinately long travel times in ambulances trying to cross the city to get to much-needed critical care.  As physicians, we understand that the first precious minutes and that "golden hour" after a sudden medical event are times that often determine life or death.  We recognize that we cannot and should not have hospitals on every corner, but we do want to make sure that there is accessibility for our neighbors, especially in the southeast part of the city.

On the socioeconomic access to care issue, our city's uninsured as well as Alliance and Medicaid patients are struggling with access to high quality specialty care.  The issue may be access to orthopedics for fractures and joint injuries or access to a cardiologist for heart disease or access to an endocrinologist for diabetes management.  It is crucial that this proposal for a new hospital be judged in terms of how it addresses the issue of access to specialty care, especially for the most vulnerable of our city residents. 

I remind you, however, that the issue of access to a specialist is not just a geographic one.  With extraordinarily large DC jury awards driving up medical liability premiums, we now face three crises:

• Current specialists are finding themselves unable to afford their liability premiums if they serve large numbers of Alliance and Medicaid patients, due to the poor reimbursements provided by these programs.

• Hospitals and even the clinics, that serve the poor are having to rethink what programs they can afford to offer indigent patients given the growing percentage of their budget that they need to devote to ever-increasing high liability premiums for care providers for the underserved. 

• We, as a city, face great difficulty in recruiting physicians to practice in underserved areas because medical liability insurance premiums for a doctor who chooses to practice in DC can be anywhere from $4,000 to $40,000 greater than if that doctor chooses to practice across the state line in Maryland or Virginia.  All hospitals in the District face a similar situation, so clearly the financial viability of the National Capital Medical Center and its ability to serve the city's most vulnerable populations are inextricably linked to medical liability reform in the District of Columbia.

 
Finally, regarding the surge capacity/disaster preparedness issue:  Given that we are the nation's capital and a prime terrorist target, we need a Metro- and helicopter-accessible comprehensive medical center for addressing surge capacity in the event of a major health crisis. The DC General site does offer a potentially secure site, near the medical examiners office and, if need be near the DC jail, Correctional Treatment Centers of America.  The proposal under consideration must be judged on how it will help this city respond to a local disaster.

Before we close, I want to sound some alarms.  From what we have seen in the proposal . . .

• It is unclear what adverse effects the National Capital Medical Center would have on hospital emergency department use, acute care hospital admissions, and medical specialty care across the city.

• There is a very real danger that the proposed National Capital Medical Center could destabilize an already fragile hospital market.

• There are very concerning questions about the impact that the proposed National Capital Medical Center would have on the viability of the vulnerable hospitals that serve the eastern half of the city.
  

 We commend Howard University and the Mayor for taking on such a noble mission as the development of this proposal;  however, we caution them about proceeding down this road in isolation.  The viability of the National Capital Medical Center - whatever form it takes - will be dependent on open communication and true partnerships with the other health care providers in the city. 

Thank you for allowing me to speak on this important issue.