Revisiting East of the River medical care: United Medical Center

One of the reasons I've been blogging way less of late is dealing with a family health care emergency, which has introduced me to the current state of hospital and nursing home/rehabilitation care practice.

It had been years since I've been to a hospital and I had no clue to how much health care has changed--e.g., bringing the x-ray machine to the patient instead of taking the patient to the "Radiology Department" or the way ICUs are set up, the state of hospital food service is nothing like it was, etc.

Similarly, the nursing home we utilized for short term rehab was old but super well maintained--it didn't have that "institutional smell" you expect from such facilities, and came with engaged staff, excellent food, etc. and the Medicare comparison website listing all the various facilities was useful, and helped us make what we believe was the right choice of a facility in DC as opposed to the Maryland facilities that Maryland-based Holy Cross Hospital was trying to steer us to.

So reading the story ("‘I can’t breathe!’ A nursing home patient called for help: His nurse left him on the floor") in the Washington Post a couple days ago about the death of a patient in the nursing home section of DC's United Medical Center was completely shocking as it described a charge nurse not addressing the needs for more than 20 minutes of a patient who had fallen out of bed in her presence.

There is no way that Warren Webb would have been so neglected at Stoddard Baptist Nursing Home in DC's Mount Pleasant neighborhood or Holy Cross Hospital in Montgomery County, Maryland, the two institutions I've spent a fair amount of time in over the past weeks.

In those facilities such an avoidable death is unimaginable.

But it didn't surprise me about UMC, because of how things can work in the 'hood, regardless of people being trained.

Somehow, "streetwise culture" becomes the norm instead of professionalism. (This isn't a problem only in DC. It was a huge problem in Los Angeles County too, see the Los Angeles Times investigative series, "The Troubles at King/Drew.")

The problems appear to be deep-rooted and structural.

Granted a hospital serving predominately low income patients has financial issues, and I have written about the issues at UMC and Prince George's Hospital Center for years:

-- "Area health care planning," 2011
-- "Revisiting an example of a real need for regional planning: hospital and wellness services," 2012
-- "When the problem is defects in the structure of "the market", financial incentives won't do much good: Maryland's health enterprise zones," 2013

While PGHC is going through a transformation and the construction of a new facility in Largo will lead to the system being absorbed into the University of Maryland Medical System, UMC doesn't appear to be showing substantive signs of improvement.

Various management entities have come and gone and the current group assigned management control of the hospital, which is now owned by DC, seems to be floundering, although Howard University Hospital, which hired a different management group ("Howard University strikes deal with hospital turnaround partner," Washington Business Journal), seems to be stabilizing.

The group running UMC, Veritas, is getting high fees, is associated with political donors to Mayor Bowser, and in the Spring, the hospital was forced to close its obstetrics section ("D.C. shuts down obstetrics ward at United Medical Center" Post). The latest story about the death of and the failure to substantively investigate is only the latest problem.  DC City Council has had hearings on the "current problems," but the financial and care problems with the hospital go back for more than one decade.

Transforming health care access East of the River

The problems of health care East of the River and in Prince George's County derive from the same issue, poverty, lack of insurance, extranormal demands, etc., and it is unfortunate that the border between DC and Maryland prevents creating a unified solution.

I'd prefer that UMC become joined with Howard University Hospital, even though the Howard system is not much better financially, at least it's associated with a medical and dental school.

Although UMC just signed a contract with a George Washington University hospital affiliated medical practice to run the emergency services.

Ideally, out of the city's two weakest hospitals we could build a stronger system, reduce back office costs, do a better job with billing, etc.

But also, it would be an opportunity to reconfigure health care in a way that focuses on health promotion rather than only triage.

In past entries I've mentioned the integrated health care and public health system in Denver ("Denver Health Becomes Profitable After Using Toyota as a Template: Lean manufacturing has made Denver Health a model for public health care" and "Mile-High Health Reform," Governing Magazine) and the proposed rebuilding of St. Anthony Hospital in Chicago into a multi-faceted center with community recreation and health facilities beyond hospital functions, a project called FocalPoint.

-- Creating Community-Centric Hospitals in Lower Socio-Economic Areas: A Study in Chicago's Near Southwest Side, Summary of Research

-- Chicago Tribune article "Chicago safety-net hospitals face uncertain future amid changes to health care system: Area has 20 safety-net hospitals, which are a stop-gap medical system for the poor":

St. Anthony embarked on its turnaround after assessing the needs of its community and tailoring its services to match. It now functions as a de facto community hub, teaching language classes and hosting courses for people studying to take high-school equivalency tests. It also added health services like dialysis and occupational health and expanded its infusion, pediatric and maternal centers.

"If you're doing what the community needs, you become very valuable to them," Medaglia said. "And to continue to serve them, you really have to think out of the box. You have to think:  What can we do that's different, that can service this community at a lower cost and higher quality?"

St. Anthony is pushing forward with plans to build a 1 million-square-foot commercial development at 31st Street and Kedzie Avenue anchored by a 100-bed replacement hospital. The $430 million Focal Point development is slated to be built on 11 acres acquired from the city for $1 by a nonprofit affiliated with St. Anthony. The complex is set to include two schools, retail stores, a child-care center, an indoor recreation facility and an athletic field.

But I just learned about a "community clinic" being created in Baltimore by the Bon Secours Health System and Kaiser Permanente ("Kaiser, Bon Secours join forces on plan to improve health through economic opportunity," Baltimore Sun). From the article:

The initiative comes as hospitals are learning they need to do more than treat patients' medical conditions, but also help address social issues, such as transportation and poverty, that may prevent people from going to the doctor.

"It is not enough to provide excellent health care," said Celeste James, Kaiser's director of community health initiatives. "People need their basic needs met around economic stability to really focus on health."

Bon Secours' Baltimore hospital already provides many of the services that will be offered at the new resource center through a program it runs called Community Works. Rather than reinvent the wheel, Kaiser officials thought partnering with a hospital with roots in the community would be more beneficial.

The partnership with Kaiser will allow Bon Secours to expand its offerings, which include job training and a transition program for people being released from incarceration. The two health systems will work together on programming.

Most of the patients that frequent Bon Secours come through the emergency room, said CEO Dr. Samuel Ross. Many live in poverty and have untreated chronic conditions that could be better controlled with preventive care. ...

The resource center will also offer mental health services. The health systems will partner with community groups such as Roberta's House, which provides grief counseling to those who have lost loved ones to violence.

Kaiser hopes the resource center and partnership last as long as a similar project in Los Angeles. The health system opened a counseling and learning center there shortly after the Watts riots 50 years ago. The center started in a small room with three employees and is now located in a 9,000-square-foot facility and employs 30 therapists, teachers, counselors and other workers.

As part of the partnership, Kaiser and Bon Secours plan to help support the creation and growth of 10 businesses in the community. The health systems also hope to attract more partners to embark on larger economic development projects and reduce the area's unemployment rate in the future.

It's not a hospital but a support program, to be delivered in a shuttered library building.

It looks to be offering the kind of programming that would make sense as part of the St. Anthony Hospital project in Chicago, and could be developed as part of a new United Medical Center in Southeast Washington, DC.

UMC needs transformation.  And in general, DC government doesn't appear to be positioned to be able to bring about that kind of substantive change.