Arnel Jean-Pierre has been a nurse at Washington, D.C.’s United Medical Center for seven years, and he’s seen a lot. If the D.C. city council has its way, though, the hospital will shut its doors for good in the coming years. According to Jean-Pierre, that’s going to cause a lot of avoidable pain for the residents of D.C.’s poorest neighborhoods.
“The end result is a lot of people are going to suffer,” he said.
D.C.’s council recently gave preliminary approval to a plan that would close United Medical Center, known as UMC, in January 2023, while reducing the city’s financial contributions to the capital’s only public hospital in the intervening years. Hospital officials say they need some $40 million to keep operating in this fiscal year alone, but the city’s payments going forward would be capped at $15 million annually.
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The move — which will be up for a final vote on Tuesday — has activists and workers at the hospital concerned, for a whole host of reasons. It also fits into a wider recent trend of hospitals closing up shop in the neighborhoods that can least afford it.
UMC is currently the only hospital in Washington that is not in the city’s northwest quadrant — which is both its whitest and richest. The city is grappling with the effects of widespread gentrification and rapidly changing demographics. By one measure, it is the fastest gentrifying city in the country, and in the top four for most black residents displaced. The population UMC serves is majority black, the poorest in the city, and disproportionately composed of Medicaid and Medicare patients.
If the budget cap is implemented, UMC will have to cut back services before ultimately closing. Already, UMC has reduced services due to budget constraints and financial woes, including closing its cancer clinic; a notice that the hospital will lay off employees within the next 60 days was circulated recently. Meanwhile, a proposal to open a new private hospital in that part of the city is far from a done deal, meaning the current hospital has an explicit end date, but the plan for replacing it is only half-baked.
“There is a closing date in the legislation that is not tied to the opening of any other hospital and right now, the city is still only in negotiations with the new Ward 8 hospital provider, which seems to have many roadblocks. So we don’t know what a realistic timeline is to have a new hospital in that part of the city,” said Elizabeth Falcon, executive director of D.C. Jobs With Justice, which is fighting the budget cuts.
Cutting back at UMC will mean longer wait times for its patients, and according to Jean-Pierre, higher mortality rates for those who suffer from strokes, heart attacks, and gunshots, as they are the most vulnerable when delays occur.
“There’s a lot of delays now, but to even cut more is going to create a catastrophic event,” he said. “They’re paying taxes just like the folks in Georgetown, [the richest part of D.C.]. Why should they have the delay in health care when they face a stroke?” For some residents in the area, the next nearest hospital after UMC is a nearly nine-mile drive away, which can take more than an hour in rush hour traffic. And the hospitals closest to UMC already say they have more patients than they can handle.
“Too many of our debates in DC are win-lose or lose-lose. UMC is another example. The debate shouldn’t be: New hospital in Ward 8 or responsible patient care at old hospital in Ward 8. It needs to be both. Vulnerable lives are at risk,” tweeted D.C. council member Elissa Silverman.
But the closing of UMC is about more than just one hospital in one part of one city. It is also emblematic of larger trends in which hospitals are closing, consolidating, and moving out of low-income urban neighborhoods in favor of neighborhoods with richer residents.
In 2014, a Pittsburgh Post-Gazette/Milwaukee Journal Sentinel analysis found that the number of hospitals in major U.S. cities fell by nearly half between 1970 and 2010, and most of those that closed were public hospitals or hospitals located in low-income neighborhoods. Meanwhile, two-thirds of hospital openings during the same time period were in more affluent neighborhoods.
That tracks with D.C.’s experience. The city lost Providence Hospital, in its northeast quadrant, earlier this year, and now UMC has been put on life support, while its four other major hospitals are in wealthier or rapidly gentrifying parts of the northwest.
Not surprisingly, hospital closures lead to worse health outcomes, particularly for those who suffer from heart attacks or injuries that require immediate medical attention. Areas that lose hospitals also tend to lose other medical services as well, as doctors and other practitioners move away or decide to open new practices elsewhere. This turns low-income areas into health care deserts.
Plus, those same areas tend to be the least served by public transit, and have the most residents who don’t own their own modes of transportation, putting ever-higher barriers between patients and the care they need.
“Localities are getting out of the business of running hospitals. That doesn’t mean people are out of the business of getting sick in every neighborhood,” said Falcon. “We are at a moment in history where governments don’t like paying for government services.” Available data on hospital closures is not great, but between 1996 and 2002, per one study, at least 13 public hospitals closed; another study found that public hospitals that closed between 1990 and 2010 were in neighborhoods with significantly higher percentages of black residents than public hospitals that remained open.
On the private side, meanwhile, powerful, multi-facility health systems are responsible for much of the hospital consolidation cities have experienced. Between 2005 and 2017, there were 1,000 hospital merger and acquisition deals announced. 40 percent of hospital stays now occur in markets in which there is only one hospital owner. Such consolidation, in addition to making hospitals fewer and farther between, drives up prices and drives down management quality.
UMC has had its struggles, of course. A slew of errors led regulators to shut down its obstetrics ward in 2017. The only reason the city has been running the hospital at all is that its financial misadventures necessitated a 2010 rescue from bankruptcy. But few think that the city would let it collapse completely. Organizers are moderately confident that, if a new hospital is not completed in the neighborhood by January 2023, the council would at least continue to keep UMC’s emergency room open.
But none of that stops the slow bleeding already occurring there, or makes up for the preventable illnesses, injuries, and deaths that will happen in the intervening years due to the cap on funding; it says nothing good about the city that its poorest residents are saddled with its least-functional hospital. None of UMC’s problems change the fundamental fact that the bulk of D.C.’s available health care services are in the parts of the city where the residents are the wealthiest.
“We are trained to do no harm,” said Jean-Pierre, the UMC nurse. “But the D.C. council does not live by the same code of ethics. Based on the cutting, they’re doing a lot of harm.”