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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
Back to top of page
District of Columbia
Hospital Closure Contingency Plan
Department of Health
November 22, 2002
Table of Contents
Background
Approach
Tables
Work Plans
Back to top of page
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:
- 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;
- 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.
Back to top of page
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.
- Pre-c1osure/Stabilization Phase - the period before the hospital
closes or stabilizes
- Closure Phase - the period when the hospital announces that it is
closing
- 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 |
|
|