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Greater Southeast Hospital Closure Contingency Plan
Carolyn N. Graham, Deputy Mayor
November 25, 2002

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GOVERNMENT OF THE DISTRICT OF COLUMBIA
EXECUTIVE OFFICE OF THE MAYOR

MEMORANDUM

CAROLYN N. GRAHAM
Deputy Mayor for Children, Youth and Families

To: Linda Cropp, Chairman of the Council of the District of Columbia
Sandra (Sandy) Allen, Chairman of the Human Services Committee

From: Carolyn N. Graham

Subject: Greater Southeast Hospital Closure Contingency Plan

Date: November 25, 2002

Attached for your review and consideration is the Hospital Closure Contingency plan for Greater Southeast Community Hospital.

This Plan was developed by the Department of Health in response to issues raised at the Council's Briefing on November 21, '02, with the Interim Director of the Department, Mr. James Buford. Should you or the Councilmembers have any questions concerning the information in this Plan, please do not hesitate to let Mr. Buford or me know.

Attachment

DISTRIBUTION:

Harold Brazil
David Catania
Phil Mendelson
Carol Schwartz
Jim Graham
Jack Evans
Kathy Patterson
Adrien Fenty
Vincent Orange
Sharon Ambrose
Kevin Chavous

The John A. Wilson Building - 1350 Pennsylvania Avenue. NW Washington, DC 20004

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District of Columbia

Hospital Closure Contingency Plan
Department of Health

November 22, 2002

Table of Contents

Background
Approach
Tables
Work Plans

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Background

The District of Columbia Department of Health plays an important role in monitoring the closure of hospitals in the District. Under the District's law, hospitals are required to submit a closure plan when they are about to close. The plan must include information on how the hospital will transfer its patients to other hospitals in a safe and orderly manner. It is the responsibility of the closing hospital to carefully implement its closing plan.

The Department of Health's role in the closure process is to monitor the quality of care of patients in the hospital both before and during the closure and to assure access to services on an ongoing basis. It is the responsibility of the Department of Health to closely monitor this process and to provide technical assistance where necessary.

Current Problem

The Department of Health began closely monitoring the status of Doctors Community Healthcare Corporation and its District subsidiaries, Greater Southeast Community Hospital and Hadley Memorial Hospital, when National Century Financial Enterprises recently filed for bankruptcy protection. National Century Financial Enterprises is the major funding source for Doctors Community Healthcare Corporation and its subsidiaries. Since that time, Doctors Community Healthcare Corporation and the two local hospitals it operates, also filed for bankruptcy protection, thus escalating the impact on access to local emergency, acute and long- term health care.

These unfolding events have national implications, but they also have a more immediate impact locally. The threat of closure of two important health facilities in the southeast section of the District portends a significant impact on access to emergency and acute care services for local residents and visitors. It also has a ripple effect on the District's entire health care system, which will be forced to absorb the additional patient load should the threat of closure become a reality. This impact has already begun since Greater Southeast Community Hospital has had to downsize its operations pending a stabilization of its finances.

The situation is further complicated by the fact that Greater Southeast Community Hospital is also the prime contractor in the District financed DC Healthcare Alliance, which is a group of local health providers that serve the District's uninsured residents. Recent events have raised concerns about the viability of Greater Southeast Community Hospital to carry out its role as the prime contractor in this program. Their role indudes operating the Ambulatory Care Center (ACC) on the grounds of DC General Hospital, including emergency room services. The Department of Health is, therefore, evaluating the hospital's ability to continue in the role as prime contractor for the DC Health Care Alliance and is establishing short- and long-term alternatives should a change become necessary.

In summary, this situation presents two serious challenges for the District:

  1. The possible closure of a major hospital and a long-term care facility in the southeast portion of the city, where there are no other hospitals;
  2. The impact of this situation on the Health Alliance, which is the District's program for serving the uninsured, where Greater Southeast Hospital is the prime contractor.

The purpose of this plan is to describe the role the Department of Health (DOH) will play in monitoring downsizing activities and the eventual closure of Greater Southeast Community Hospital in the event that closure occurs. This contingency plan will focus primarily on the Greater Southeast Community Hospital, because of its prominent role in the District's health care system. The closure of Hadley Memorial Hospital will be discussed in another document. In summary, this document presents

  • The DOH's Contingency Plan, which outlines three phases of actions that will be taken if Greater Southeast Community Hospital closes;
  • The pre-closure steps that the DOH has implemented to address day-to-day issues while the hospital attempts to stabilize its financing; and,
  • Work plans for implementing all phases of the contingency plan.

This document will continue to be modified as events unfold in the next few days and weeks.

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Approach

The approach that the Department of Health will take in monitoring the operations of Greater Southeast Community Hospital during this time of instability includes the following three phases.

  1. Pre-c1osure/Stabilization Phase - the period before the hospital closes or stabilizes
  2. Closure Phase - the period when the hospital announces that it is closing
  3. Post-closure Phase - the period after the hospital closes

Each of these phases are described in the following narrative.

Phase 1: Pre-closure/Stabilization Phase

The first phase of the DOH closure plan is the Pre-closure/Stabilization Phase. This is the phase during which the hospital reduces its operations in anticipation of securing altenate financing or in anticipation of actually closing. This phase can last a few days or a number of months. The following activities will take place in this phase.

1. Daily monitoring of patient care at Greater Southeast Community Hospital, Hadley Memorial Hospital, and Ambulatory Care Center (ACC) on the grounds of D.C. General.

  • Assigned an on-site monitoring team to:
    • Assess and monitor compliance with quality patient care standards,
    • Review occupancy levels in the inpatient units,
    • Track emergency room utilization and frequency and cause of ambulance diversions/re-routes,
    • Review emergency room patient wait times and over crowding,
    • Track critical inventory levels in central supply,
    • Monitor critical care bed availability,
    • Monitor staff to patient ratios by discipline and status of agency staff availability.

2. Engage in daily communications with Greater Southeast Community Hospital and staff at the Ambulatory Care Center at D.C. General.

  • Greater Southeast Community Hospital shall provide detailed financial information that allows DOH to assess the current and future financial condition of the hospital,
  • DOH monitors: communications, business plans, the cash position of the hospital, as well as the parent company Doctors Community Healthcare, and the status of any new financing arrangements.

3. Convene daily DOH senior staff conferences.

  • Initiate daily meetings and conference calls with key DOH staff members to review information collected over the previous 24-hour period,
  • Review and recommend contractual and other legal issues and actions.

4. Request Contingency Plan from Greater Southeast Community Hospital and Doctors Community Healthcare Corporation.

  • Provision of hospital closure contingency plan.

5. Meet with District and community agency officials the keep them informed regarding the Hospital's status.

  • Meet with the Mayor, City Administrator, Deputy Mayor and other key District Officials,
  • Brief the City Council as necessary,
  • Meet with community agencies and groups to brief them on the current status.

6. Communicate regularly with other District providers, including hospitals.

  • Meet regularly with the DC Hospital Association and its members,
  • Communicate often with local hospitals to determine impact and issues,
  • Assess potential of other providers to expand services and to facilitate continued access to care.

7. Determine when stabilization period ends if new financing is successfully achieved.

  • Obtain plan from Hospital to return to normal operating levels,
  • Assess impact if the Hospital's normal operating levels fall short of pre-crisis levels,
  • Finalize long-term modification to Alliance agreement, as necessary.

Phase 2: Hospital Closure Phase

When a hospital closes in the District, the hospital is responsible for developing and executing a closure plan. This plan provides a process for transferring remaining patients to other hospitals and closing down the hospital as a business. In the event that Greater Southeast is unsuccessful in acquiring the resources to sustain its operations, it is responsible for conducting an orderly closeout of the hospital.

The role of the Department of Health is to:

  • Provide oversight of the closing process,
  • Monitor the closure activities to protect the health and safety of patients, and
  • Provide technical assistance where and when necessary.

This contingency strategy will address the oversight issues for which the DOH is responsible. The first objective is to maintain the viability of the Greater Southeast Community Hospital. This may be accomplished by working with the bankruptcy judge to engage a local provider in the District or an independent hospital firm to manage the affairs of the hospital. If this can be done, it would allow for the continued availability of needed health care services to the community.

If the hospital closes, the Department will require Greater Southeast Community Hospital to immediately execute its closure plan for triaging, discharging, and transferring patients, and closing the facility.

In the event of a hospital closure, the DOH will implement the following contingency plan steps:

1) Immediately meet with Greater Southeast officials to initiate closure procedures to include:

  • Obtaining the number and types of patients in the hospital at that time,
  • Reviewing the discharge plans for patients who are assessed to be ready for discharge,
  • Working with Greater Southeast Community Hospital to facilitate the transfer of remaining patients to other hospitals where appropriate hospital beds are available.

2) Immediately inform the other District and suburban hospitals of the closure by:

  • Making phone calls to the hospitals,
  • Faxing a notice to each hospital, and
  • Sending emails to each hospital administrator.

3) Coordinate patient transportation arrangements and ambulance rerouting with Fire and EMS by:

  • Making arrangements to transport critically ill patents to other hospitals,
  • Rerouting emergency ambulance transports to other hospital emergency rooms,
  • Expanding emergency room activities at D.C. General Hospital site,
  • Increasing the number of ambulances in the Southeast area of the city.

4) Coordinate activities among other affected District agencies for Emergency action by:

  • Coordinating the provision of emergency assistance among the following government agencies:
  • Fire and Ernergency Medical Services
  • Emergency Management Agency
  • Police
  • Corrections
  • Human Services
  • Mental Health

5) Modify the Healthcare Alliance Agreement to remove Greater Southeast Hospital as the prime contractor by:

  • Implementing the Alliance contingency plan including activating all contracting actions necessary to remove Greater Southeast Community Hospital as the prime contractor and contracting with other entities to provide the required services under alternate arrangements,
  • The DOH temporarily assuming some of the administrative functions of the prime contractor,
  • Selecting and engaging a new prime contractor.

6) Establish interim agreements for the provision of inpatient, outpatient, specialty, and emergency health services to the residents of the southeast portion of the city by:

  • Developing agreements with local health providers for the distribution of patients served by Greater Southeast Community Hospital,
  • Determining the additional cost and fiscal impact on funding sources,
  • Securing appropriate government approvals for contract modifications.

7) Inform patients and the general public about the new patient care arrangements by:

  • Meeting with community agencies and leaders to explain the new arrangements,
  • Developing public notices for publication in the paper, public service announcements, and posting on the DOH homepage,
  • Developing flyers and brochures for circulation in the community, specifying the new locations where they can get health care.

Phase 3: Post-Closure Phase

After Greater Southeast Hospital closes, the DOH must work with public and private agencies and the community to ensure that there is a long-range strategy for ensuring the provision of appropriate health services to residents in the southeast portion of the District. A review of the data indicates that in 2001, Greater Southeast Community Hospital experienced about 19,687 admissions and a little over 74,OO0 patient days. Tables l throngh 6 depict the approximate resources and utilization of the Greater Southeast Community Hospital, and the extent to which inpatient services are provided by other key District facilities that might be relied upon in the event of a Greater Southeast closure. Table 1 indicates the distribution of operating beds by service categories at the Hospital, and the approximate level of Emergency room utilization.

Table 2 summarizes the other District providers, and their operating beds, occupancy levels, and emergency room visit capacity (assuming that prior utilization levels indicate current capacity).

Hospital occupancy rates ranging from 65-80% occupancy suggest that these facilities could accommodate some additional utilization.

The service level data is presented on Table 3. This table demonstrates how the volume of service provided at Greater Southeast Community Hospital may be able to be absorbed by other District facilities.

In the immediate time period following the Hospital's closure, the foflowing activities will be undertaken to ensure that health services remain assessable in the District.

1) Expand primary and preventive health care services by:

  • Working with primary care agencies to develop a strategy for ensuring access to primary care,
  • Working with primary care agencies and the Alliance to ensure community outreach, screening and disease focused care.

2) Make arrangements to assure the provision of specialty care by:

  • Providing medical services for populations under the jurisdiction of other District Agencies.

3) Make arrangements to ensure the provision of health care to the Corrections population by:

  • Following the Healhcare Alliance contingency plan for effecting service provider changes,
  • Establishing a long-term relationship with a hospital provider to treat Correction patients.

4) Work with the District of Columbia Metropolitan Police Department on health services for prisoners by:

  • Following the Healthcare Alliance contingency plan for effecting service provider changes,
  • Ensuring all patients receive appropriate quality care in a safe secure environment,
  • Providing consistency in location of treatment for non-life threatening cases,
  • Providing stabilization of patients at DC General Hospital site.

5) Work with Fire/EMS to develop more permanent re-route protocols to ensure that ambulance patients are transferred to alternative emergency rooms by:

  • Developing long-term ambulance re-route protocols,
  • Adding additional ambulances in the southeast portion of the District.

Table 1

Greater Southeast Community Hospital Inpatient Capacity
Total 0perating Beds

Hospital Operating Beds*
Med/Surg 194
OB/GYN 22
Peds 10
ICU 40
NICU 16
Psych 20
Other 32
Emergency 44,972 visits

*Source: District of Columbia Hospital Association, Financial Indicators Fiscal year 2001. Fall 2002

Table 2

District Hospitals Resource Use

Hospital Ward Operating Beds** (2001) Occupancy (2001)II Emergency Room Visits (2001)**
George Washington 2 270 77.3 46,338
Georgetown 2 338 65.6 25,559
Greater SE 8 334 65.6 44,972
Howard 1 281 76.6 48.435
Providence 5 305 73.7 41,437
Washington Hospital 4 757 79.3 67,130
Children’s 4 188 90.9 62,847

**Source: District of Columbia Hospital Association, Utilization Indicators Calendar year 2001. Fall 2002

Table 3

Greater Southeast Community Hospital Inpatient Capacity
Total Beds (Licensed)

Hospital Greater Southeast Georgetown Howard Children’s Washington Providence GW
Med/Surge 332 339 249 0 653 257 218
ICU 18 74 77 0 64 17 48
Ob/GYN 28 62 53 0 41 48 37
Nursery 24 24 12 40 33 17 20
Neonatal 20 50 25 0 20 9 12
Pediatric 30 46 40 239 0 0 0
Alcohol/Chemical dependency 0 0 0 0 22 31 0
Rehab 20 0 0 0 17 0 16
Psych 22 14 26 0 57 29 20
Total 494 609 482 279 907 408 381

*Source: District of Columbia Hospital Association, Financial Indicators Fiscal year 2001. Fall 2002

Table 4

District Hospitals Resource Use
Emergency Room Visits

Hospital Ward 1998 1999 (2001)**
Howard 1 40,821 41,116 48,435
George Washington 2 41,928 43,439 46,338
Georgetown 2 21,547 21,777 25,559
Washington Hospital 4 51,425 55,513 67,130
Children’s 4 48,543 48,863 62,847
Providence 5 31,898 33,054 41,437
Greater SE 8 38,914 37,302 44,972

**Source: District of Columbia Hospital Association, Utilization Indicators Calendar year 2001. Fall 2002

Table 5

District Hospitals Resource Use
Ambulatory Surgeries

Hospital Ward 1998 1999 2001
Howard 1 4,566 4,669  
George Washington 2 5,813 5,740  
Georgetown 2 6,945 8,495  
Washington Hospital 4 10,804 11,047  
Children’s 4 3,846 4,116  
Providence 5 7,289 6,746  
Greater SE 8 3,230 2,865  

**Source: District of Columbia Hospital Association, Utilization Indicators Calendar year 2001. Fall 2002.

Table 6

District Hospitals Resource Use
Payor Mix by Gross Payor Revenue

Hospital Ward Mcaid Mcare Other Self
Howard 1 34.5 32.2 19.6 13.7
George Washington 2 6.9 25.1 70.0 0
Georgetown 2 8.5 26.6 62.9 2.0
Washington Hospital 4 7.5 35.1 54.0 3.4
Children’s 4 44.4 .46 52.9 2.3
Providence 5 20.0 56.1 20.3 3.6
Greater SE 8 16.2 66.8 11.5 5.5

**Source: District of Columbia Hospital Association, Utilization Indicators Calendar year 2001. Fall 2002

Work Plan for Phase 1: Pre-closure/Stabilization Phase

Tasks Due Date Agency Responsible Status
1. Monitor the patient care at Greater Southeast Hospital, Hadley, and DC General      
1.1 Maintain DOH monitoring teams Daily DOH  
1.2 Monitor quality of patient care Daily DOH  
1.3 Monitor service utilization levels Daily DOH  
1.4 Monitor emergency room diversions Daily DOH/EMS  
1.5 Monitor inventory levels in Central Supply Daily DOH  
1.6 Monitor staff to patient ratios Daily DOH  
2. Maintain daily communications with Greater Southeast Hospital      
2.1 Establish a daily conference call Daily DOH/GSCH  
2.2 Review hospital financial status daily Daily DOH/GSCH  
2.3 Establish rapid status update process 11/22/02 DOH/GSCH  
3. Convene daily meetings with DOH senior staff      
3.1 Convene daily conference calls 11/15/02 DOH  
3.2 Hold emergency status meetings as needed DOH  
3.3 Review information collected every 24 hours Daily DOH  
3.4 Assign actions to be taken Daily DOH  
4. Request for Greater Southeast Closure Plan      
4.1 Request updated hospital closure plan 11/25/02 DOH  
4.2 Submit hospital closure plan 11/27/02 GSCH  
4.3 Review hospital closure plan 11/28/02 DOH  
4.4 Execute hospital closure plan Upon closure GSCH  
5. Meet with District and Community agencies to keep them informed of the hospital’s status      
5.1 Meet with District and health providers Ongoing DOH  
5.2 Brief City Council Ongoing DOH  
5.3 Meet with community groups Ongoing DOH/GSCH  
6. Communicate regularly with other District providers, including hospitals      
6.1 Meet with DC Hospital Assoc and members Ongoing DOH/DCHA  
6.2 Communicate with hospitals regarding impact and issues Ongoing DOH  
6.3 Assess potential of providers to expand services Ongoing DOH  
7. Determine end of stabilization period      
7.1 Obtain plan from GSECH to return to normal operating levels When refinancing is available GSCH  
7.2 Assess new operating levels for sufficiency When plan is received DOH  
7.3 Finalize long-term modification to Alliance Agreement, as necessary When plan is received DOH  

Work Plan for Phase 2: Hospital Closure Phase

Tasks Due Date Agency Responsible Status
1. Meet with Greater Southeast hospital officials to initiate closure procedures      
1.1 Determine the number and types of patients at the hospital at the time of closure When closure is announced DOH/GSCH  
1.2 Review discharge plans DOH  
1.3 Work with Greater Southeast Hospital to execute their closure plan for transferring remaining patients to other hospitals DOH  
2. Immediately inform the District hospitals of the closure      
2.1 Make phone calls to the hospitals When the closure is announced DOH  
2.2 Fax notices the health facilities DOH  
2.3 Send emails to hospital administrators DOH  
3. Coordinate patient transportation arrangements      
3.1 Make arrangements to transport critically ill patients When closure is announced GSCH  
3.2 Re-route ambulances to other hospitals FEMS  
3.3 Expand DC general emergency room activities at D.C. General DOH  
3.4 Increase the number of ambulances in the southeast area FEMS  
4. Coordinate activities among other affected District agencies for emergency action      
4.1 Coordinate with District agencies When closure is announced DOH  
4.2 Communicate assignments in writing DOH  
5. Modify Healthcare Alliance Agreement to remove Greater Southeast as the Prime Contractor      
5.1 Amend the Alliance contract to remove Greater Southeast Based on financial and/or clinical viability DOH/OCP  
5.2 DOH temporarily assumes some of the administrative functions When contract modifications are in effect DOH/OCP  
5.3 Select a new prime contractor After GSCH is removed as prime DOH/OCP  
6. Inform the patients and the community of the new patient care arrangements      
7.1 [sic] Meet with community agencies and leaders to explain the new arrangements Ongoing DOH  
7.2 Put notices in the paper and on the Department of Health’s homepage Ongoing DOH  
7.3 Develop flyers and brochures for circulation in the community which explain the new locations where they can get health care Ongoing DOH  

Work Plan for Phase 3: Post Hospital Closure Plan

Tasks Due Date Agency Responsible Status
1. Expand primary and preventive health services      
1.1 Work with primary care agencies to develop a strategy for ensuring access to primary care Ongoing DOH  
1.2 Work with primary care agencies and the Alliance to ensure community outreach, screening and disease focused care Ongoing DOH  
2. Make arrangements to assure the provision of specialty care      
2.1 Provide medical services for populations under the jurisdiction of other District Agencies Based on financial and/or clinical viability DOH  
3. Make arrangements to ensure the provision of health care to the Corrections Population      
3.1 Ensure the provision of quality health care to Corrections patients Based on financial and/or clinical viability DOH/DOC  
3.2 Work with the Healthcare Alliance on this issue DOH/DOC  
3.3 Establish a long-term relationship with a hospital provider to treat Correction patients DOH/DOC  
4. Work with the Police Department on providing health services for prisoners      
4.1 Ensure that all patients receive appropriate quality care in a safe secure environment. Based on financial and/or clinical viability DOH/MPD  
4.2 Provide consistency in location of treatment for non-life threatening cases DOH/MPD  
4.3 Provide stabilization of patients at DC General DOH/MPD  
5. Work with Fire/EMS to develop more permanent re-route protocols to ensure proper ambulance transfers      
5.1 Develop long-term re-route protocols Ongoing DOH/EMS  
5.2 Add more ambulances in the southeast area   EMS  

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