MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, how presidents have influenced and even invented the language we speak. But first, chapter two of D.C.'s attempt to reinvent United Medical Center in Southeast Washington. It was only last summer that the District took over that hospital, the only hospital east of the Anacostia River, but some of the city's lawmakers, including the mayor, are already moving to get out of the business again. Moving so swiftly that there was even discussion of an FDR-like power move to pack the hospital's board with members who'd want to privatize it again.

MR. KOJO NNAMDIWe're joined this hour by the D.C. councilmember who led the effort to foreclose on United Medical Center last year. He's here to talk about the future of the hospital and what it means for the city's health system east of the Anacostia River. David Catania is a member of the D.C. city council. He's an independent. He holds an at-large seat and he chairs the council's Committee on Health. David Catania, good to see you again.

MR. DAVID CATANIAThank you for having me, Kojo.

NNAMDIWe last spoke about this hospital in July right after the District foreclosed on it and took it over. It was a lot of baggage for the District to take on. I recall seeing one estimate that it was carrying monthly losses of a million dollars. What's happened since we last spoke and how has it squared with what you expected when you advocated for the takeover?

CATANIAActually, Kojo, there is a different, a new day in United Medical Center than last summer. And frankly, the turnaround is both programmatic and financial. And if I can just for talk -- for a second talk about the financials.

NNAMDIPlease do.

CATANIASo how do you take a hospital that loses about $6 million a year and then have it have its first profitable quarter in 15 years, which is what happened. The city took it over in July 9. We closed out the books of that fiscal year on Sept. 30, so approximately three months. This was an independent KPMG audit that showed the hospital made $1.2 million or 1.3 million, which is extraordinary. And we did that because we have at long last addressed certain issues that have burdened this hospital with respect to how the city distributes its, for instance, its DISH, it's disproportionate share hospital funds, which are Medicaid funds the city receives from the federal government as every other state does to distribute to charity hospitals or hospitals that provide uncompensated care.

CATANIAUMC has for years been providing more care than it has been receiving in funds. And pursuant to an audit which we began -- which began in 2006, where we audit the charity care across the city, we found that UMC was providing about 30 percent of the charity care and receiving 8 percent of the DISH money. So right away, we reallocated the funds to follow the patients, so their DISH patient went from being 4.9 million to 14.8 million. So $10 million right there. We then looked at what are called DRGs, diagnostic-related group of Medicaid expenses. In other words, what we pay when a Medicaid person appears. We found we were paying 87 cents on a dollar. So by virtue of simply truing that up to a dollar paid for a dollar worth of services, it's been producing about $700,000 additionally per quarter.

CATANIAWe then renegotiated with one of our largest MCOs, Chartered Health Care, which provides many of the patients. That's another 2.5 million. And then, recently, we signed a deal with Washington Hospital Center, where they took over obstetrics. We now have 13 board-certified obstetricians from Washington Hospital Center there with a newly renovated OB suite and, you know, exciting equipment, et cetera. And we expect that is gonna produce another 1.9 million. So, you know, you bring this hospital back through a game of addition both in terms of finances and then in services. And if I can for just a second talk about a few of the services we've offered since...

NNAMDIOkay.

CATANIA...the city took over. So on Sept. 27 of last year, we finally opened a $14 million Children's National Medical Center-run pediatric ER, and this was something my committee funded a couple of years ago. We had hoped, Kojo, that, you know, aspirationally, we would see 20,000 children per year at this facility, which is run by Children's. Typically, we would see 5,000 children go through the ER prior to this. So we were looking at quadrupling the number of children. What we have discovered, however, is there was so much pent-up demand for these services in part because it's a transportation-poor community that in January alone we saw 2,200 children. And we are on pace to be -- to see between 27,000 and 30,000 children in the first year of this ER.

CATANIAI mentioned the Washington Hospital Center partnership. But also, on the 6th of February, we commemorated a national African-American HIV/AIDS awareness day by opening an HIV/AIDS infectious disease clinic that is co-managed by the National Institute of Health and Howard University led by Dr. Lisa Fitzpatrick, who's a doctor of infectious disease at Howard University. So there's one program after another that we're actually adding to that facility that are meeting the needs of the people who live there and we've rearranged the finances so that -- and I'll end here -- we have a budget for this fiscal year that shows we'll make $10.2 million, which will allow us to sell fund to all the capital needs and still have about five million left over.

CATANIAAnd I'm pleased to say I've got the financials for the first four months and we're 29 percent above budget. And so, you know, it really is a new day. And I really think we need at least two years of audited financials in order to attract the kind of professional health care entity that we want to assume responsibility for the care of our residents. We have a lot of health disparities in that community, and we cannot afford to turn this facility over to some less than ideal partner.

NNAMDIWe're talking with David Catania. He's a member of the D.C. city council, an independent who holds an at-large seat. He chairs the council's Committee on Health. We're taking your calls at 800-433-8850, 800-433-8850. We're talking about United Medical Center in Southeast. What do you think is at stake for the District now that it's back in the business of running a hospital? 800-433-8850, or you can go to our website, kojoshow.org, ask a question or make a comment there. Given what you have just described, David Catania, a couple of questions spring to mind. Who said that the city can't run a hospital profitably? Who said that the city should not be in the business of running hospitals because DC General was so messed up some many years ago? Why are we even thinking about privatizing this hospital again?

CATANIAWell, you know, I think it's safe to safe that, you know, cities, counties, states, generally don't run hospitals efficiently. And from my perspective, I believe that the city could do this and would be well served by doing it. But in the best interest of those who are in that community, we really need this hospital associated with another hospital. Free-standing hospitals are really a relic. They are a thing of the past. And I'll give you an example. You know, I'm trying to integrate this facility admittedly into the MedStar family, which runs Georgetown Washington Hospital Center, National Rehabilitation Hospital and others, just the economy of scale, being able to purchase, you have so many benefits by being in a larger outfit.

CATANIAIn addition, you can share the doctors. And that's, you know, frankly, we have hospital centers now taking over radiology there. We hope they'll soon take over anesthesiology. And frankly, aspirationally, I wanna see another MedStar facility with an anchor on that side, and that is Georgetown University's Lombardi Cancer Center, with a satellite office there. We have a lot of colorectal cancer, prostate cancer, breast cancer in the Ward seven or eight community. And again, the lack of transportation inhibits people from getting the care they need. So, you know, I think that, you know, what's in the best interest of our residents is to stabilize it, improve it, and then integrate it into a larger professional outfit.

CATANIABut, Kojo, I really wanna speak to what you've said about, you know, this genuflecting that we do in the city about we can't do things, that government can't deliver. You know, that is true, sometimes, government does come up short. But I really think that this could be a success story for the district, where we can say, look, we don't have to live our history over and over again. We are capable of delivering on behalf of our residents. And more importantly, you know, people are obsessed with this being a profit center. We don't ask the police department to be a profit center. We don't ask parks and rec to be profit center. And these are core services that a government should provide. And health equality, eliminating health disparities, has long been a priority of this government and yet we refuse to fund it. And we wonder why we continue to repeat the mistakes of the past.

NNAMDIWell, let's get into the politics of it. Stories circulated last week about Mayor Vincent Gray trying to pull an FDR, trying to pat the hospital board with people who agreed with his intention to sell the hospital. He ended up pulling that proposal after some members of the board announced plans to resign anyway. Can you bring us up to speed on exactly what happened?

CATANIAWell, let me say that our mayor shares my vision for ending the health disparities in the community. As he makes the point, he lives in that community and has the best interest of those residents at heart, as do I. In the end, we were able to compromise where we did not increase the number of the members of the board but we will change the legislation to allow him to pick the chairman of the board. And I think that's a fair compromise. But again, I think we need our leaders working together to solve these problems, not fighting with each other. And certainly, not the appearance of fighting with each other. I think this is a good investment. I think it will be a success story for our city.

CATANIAAnd I think, you know, not to get ahead of the next story, but our next partnership will be bringing the community college from UDC that we have space that has been built out at the facility for allied health training. And we expect that the community college will assume that space in March and begin training people for some of those allied health professions, which we know are going to exist because of the President's health plan.

NNAMDIYou say you and the mayor share the same vision for health care in that part of that city. But sharing the vision is one thing, sharing the specifics is another. You mentioned two years here. What's the yardstick? What's the measuring stick that you are planning to use to determine that the hospital is ready to be marketed? And is that something about which you have to convince the mayor because one gets the impression that he would like to do it in a shorter period of time.

CATANIAWell, I think that's fair. I think the mayor, having just returned from Wall Street, is feeling the pressure from bond rating agencies to move this along as expeditiously as possible. I'm of a different point of view. I think it's more important to do it right than to do it fast. I think if we rush this again, if we try to sell this facility without audited financials, we are going to attract exactly the wrong kind of partner, exactly what we've done in the past. And in the end, the city will be further injured if we have to step in and resurrect this again. I appreciate and have long valued our improved bond ratings with Wall Street, but there has to be a conversation about what is the right rating to have. We're now double A. And at what price to we go to triple A?

CATANIAIn other words, for that modest reduction in debt service that we get from an upgrade, who will we sacrifice for that? And I'm not willing to short circuit 140,000 people having access to high-quality acute care in their community and the other services that we are offering there for that marginal increase. And so I would respectfully tell Wall Street -- and by the way, by the time we go next year, we're going to have one year complete audited, which as I mentioned shows us making money. I think that would perhaps reduce some of their concerns, so we could go there next year, telling them that we need one more year to do this right. I think it shows us as a responsible government and as a sovereign independent government and not one that simply takes its cues from bond rating agencies who know nothing of us.

NNAMDIHow do we -- how have we learned from this in the past? You say that if Wall Street would like us to do -- or the mayor, for that matter, would like us to do more quickly in order to get a better bond rating, we have been down this road before as far as looking for a private operator to run the hospital. Are you convinced that if we allow this two-year period to elapse, if the hospital is on a more stable financial footing, then we will avoid the mistakes we made of the past, that if the private operator comes in, we can be relatively sure that it won't be back in the city's hand in another six months or a year?

CATANIAWell, again, my preference is for us to integrate this hospital into either the MedStar family, the Howard family, perhaps the Johns Hopkins, maybe Nova. One of the large, sustained, you know, well-resourced, global capitalized companies. You know, are we going to sell this? I mean, we had a recent appraisal that had the hospital appraised at $60.1 million. Are we going to get 60, or 70 or $80 million? Frankly, I'm not interested in having a cash transfer. If we can get it, that's fine. What I would be satisfied with is a management agreement that integrated this hospital almost like a confederacy, with one of the other larger chains, where we get the benefit of their systems, their doctors, et cetera.

CATANIAAnd so, you know, Kojo, it just depends what are underlying value system is as a community. Are we guided by a Wall Street bond rating, or are we guided at a system of justice, where people in one part of our city lived 20 years fewer than people in another, in part because we have deprived people of insurance, access to quality care. You know, and frankly, some people are poor because they are sick. And if we don't do something about that, I mean, we're only going to halfheartedly attempt to attack the disparities that affect our cities. So two years...

NNAMDIMy question, of course, does anyone care? Do you use the services of United Medical Center?

CATANIAI do.

NNAMDICall us at 800-433-8850.

CATANIALet me say, I do.

NNAMDIYou've used the services?

CATANIAAbsolutely. One of the things -- I had a shoulder injury. And so when people look at our investment over the last three years, we've invested about $100 million, which is identical to how much we've spent for debt service for the baseball stadium in the last three years. The numbers are identical. I had a shoulder injury. One of the things I was very excited to bring to this hospital was an MRI, which did not exist east of the Anacostia River. There are four within two blocks of my house in Dupont Circle. There was not one east of the river. So when I had a shoulder injury, I had my radiology work done there. I had - Dr. Serralano (sp?) was my primary care doctor. And so, yes, I think we need to walk the walk so to speak.

NNAMDIWe're gonna take a short break. When we come back, we'll continue this conversation with David Catania about United Medical Center. Do you care whether or not there is a hospital east of the Anacostia River? If you don't, call us, 800-433-8850. But also call us if you do. And if you think that it's best that the city continue to run it for at least another two years or so, as Councilman Catania suggests, 800-433-8850. We're gonna take a short break. When we come back, we'll continue this conversation. I'm Kojo Nnamdi.

NNAMDIWe're talking with D.C. city council member David Catania. He's an independent who holds an at-large seat. He chairs the council's Committee on Health. And specifically, we're discussing the future of United Medical Center in the Southeast, which is being run by the city right now. I'm inviting your calls at 800-433-8850. What do you think are the essential components of the medical safety net in the District and where do you see a hospital east of the Anacostia River fitting into it? 800-433-8850.

NNAMDIDavid Catania, both inside the Wilson building and inside the Beltway, it's hard to escape all the doomsday talk about budget. The District's working against a $600 million shortfall. How do these concerns about spending play into your concerns for funding and executing the city's public health strategies?

NNAMDIAnd before you respond, let me read this e-mail we got from Jasmine in Columbia Heights. "This hospital is an important thing for the city not to mess up. I'm impressed by the councilmember's comments on it so I'm impressed -- so impressed that I'm confident we can do this well, especially if he continues running it. After reading the news this weekend and the stories about how much Vince Gray is paying certain people, my confidence in the mayor and this administration is lacking. You can't say you're so concerned about the city's finances and our sacred bond rating while you're driving around in a tricked out truck and paying every person in your team more than $100,000 a year whether they're worth it or not. What does the councilman think, however, of the team the mayor has put together on health issues?"

CATANIAThank you, caller. Well, Kojo, you know, this hospital again can save us money. And as we were speaking about on break, you know, we have a skilled nursing facility there, 120-bed skilled nursing facility we opened in October, which is a nursing home essentially. We have -- and we were talking on break about how we are moving 14 patients from St. Elizabeth's Hospital to this skilled nursing facility. These are individuals who have been in the hospital, who are of advanced years, who require greater care, health care than we can provide at a hospital. St. Elizabeth's is not a hospital in the traditional sense. It's what we call it.

CATANIABut -- so by virtue of moving these individuals from St. Elizabeth's to United Medical Center's skilled nursing facility, we go from paying on average $740 a day to $284 a day. And the $284 a day, because it's in a Medicaid-eligible facility, which St. Elizabeth's is not, the federal government pays 70 percent. So simply moving 14 people, we've got 11 moved so far, three more move on Wednesday, we save $3.3 million. And so, you know, yes, 600 million is a big number. I don't believe it's 600 million. The CFO doesn't believe it's 600 million. In fact, in 2012, our revenues are coming back fairly strong. We expect a 3 percent increase in revenue in '12 over '11.

CATANIASo these numbers just are not realistic. I think we -- in magnitude. I think there may be some inflationary pressures and some numbers that might be south of 150, somewhere between 100 and 150 million. But look, this is what belt tightening is about. But we, you know, we look at budgets as a moral document, those things which we value.

NNAMDIWell, how about the team that Mayor Gray has put together? He's made a number of appointments on the health front this month. He named Gregory Pappas the head of the city's HIV/AIDS administration. What did you make of the mayor's personal decisions, specifically his appointment of an AIDS czar? But as our e-mailer asked about the health team he's put together, these people that can work with, I guess you have to work with them.

CATANIAI've met with Wayne Turner. He was the head of health care finance, and he is an exceptional appointee. He comes from Virginia. He has -- he worked for Gov. Kaine. He has a real focus on quality and on access. Dr. Akhter, who was our health commissioner in the early '90s, he and I have met on a couple of occasions and share, you know, a sense of urgency and innovation. And Gregory Pappas has a very, very distinguished career in the field of HIV/AIDS, and I think he's also an inspired choice. Again, it's important that, you know, there will be disagreements as there always will be between executives and councils and legislatures. But I really think the foundation is there for a winning team.

NNAMDIHere is Chris in Washington, D.C. Chris, you're on the air. Go ahead, please.

CHRISThank you. Hello, Kojo and David. I live in D.C., obviously, we need as much health care options as possible. I have, I guess, two questions and a comment. David, will we be getting back the initial investment laid out by the city to take over the hospital if, you know, how hard are you gonna try to get as much of that back as possible? And I can't recall. I think, you know, it was in the tens of millions but I can't recall the price. Second, on D.C. General Hospital, you know they had a world-class emergency gunshot -- they were really special in terms of helping people who have been suffering from gunshot wounds. Is this campus as suitable as our D.C. General was?

CHRISAnd then, finally, just a point on D.C. General. You know, when the city was running that, this is about 10 years ago now, it was closed by Mayor Williams at that time in the control board, the sense I got -- and it's one of the biggest scandals in D.C. You know, we were gonna make a $15 million profit in 2001. And yet it was closed because they said it was bleeding money, but some of this federal Medicaid funds had gotten lost in the translation from the government, federal government to our coffers. It is true that if the public stays on top of things that we could turn profits with these medical centers, and that could be...

NNAMDIChris, we're running out of time. What's your question?

CHRISJust the point that the government could do this well. We've known -- been known to use health care well, and that maybe rushing to get it back into private hands isn't the answer.

NNAMDIWell, David Catania made a point that that model seems to be a relic of the past.

CATANIAWell, first of all, with respect to the investment, I think we should all be somewhat satisfied that we actually had the money to begin with. And the money came about because we secured ties to our tobacco money, unlike other jurisdictions that just spent the money, we actually sequestered the money and we had it available. Just to remind people, we spend 29 million actually buying the facility out of bankruptcy. No money went to the former owner. It went to pay off former bankruptcies. We spent 30 million putting a new shell on the building, new radiology equipment, new capital improvements, elevators, et cetera. We gave them a $20 million operating line of credit and about 14 million went into the pediatric ER aspect. How much we get back is gonna be subject to negotiations. Obviously, I would like to get more back than less, but I'm not gonna negotiate a deal that hampers the new owner operator to the point where they're going to be seeking resources in the future. As far as the level of the emergency room at UMC, it is vastly improved.

CATANIAWe went from having no board certified physicians running the emergency to having a very fine group running it now. It is not a level one trauma as D.C. General was and that is a function of price and cost. To have a level one trauma, you need two board-certified neurologists, for instance, on the board at -- I mean, on staff at all time. I mean, these are expensive. And you also need a certain throughput of customers in order to support a level one trauma destination. But what we do have is a very good relationship with our other level one traumas, and we have helicopter transport. And I'm pleased to say that we just opened 50 new beds at the hospital last week. We just had approval from the Department of Health to open 50 new beds, which eases the congestion, if you will, in the emergency room.

CATANIAThe final issue is, I think, whether or not we're going to run this facility in the long run. I don't believe that is in the best interest of the facility. I believe we need to stabilize it, add services, improve it, and then find the appropriate partner that shares our sense of mission for that community.

NNAMDIWe got this e-mail from Brooks who is -- who identifies himself as a resident of Georgetown. "It's really amazing the disparity within the district. I'm a resident at Georgetown and it seems pretty clear they found the right model for the job. Bringing in the teaching programs is the only way to keep a charity model hospital providing good care. Bring Howard in, bring Montgomery Country Nursing Program in, make it more of a local concern as concerns the house staff and care will further improve as the staff treat their neighbors." That's what you're trying to do here?

CATANIAThat's it. And, again, I like the notion that the United Medical Center is both a name and a concept. It is bringing the city's best. So when we have, for instance, Children's National Medical Center there, it's the same doctors who serve the main campus who rotate through. The same is true for the OBs from Hospital Center. I -- my -- you know, the next frontier is working with Howard University in their residency program. There aren't enough children on their main campus to sustain Howard's residency program. And so, you know, Larry Warren, who runs Howard Hospital, and I spoke recently about bringing Howard's pediatric residents to the site to, you know, embolden the primary care as well.

CATANIASo we have emergency care. We have obstetrics. And to further support the children in that community by giving them access to high-quality primary care which also helps sustain Howard's pediatric program. So these are the partnerships we're looking for. And, again, I think it does take a stab at the cynicism that has long, you know, afflicted our city because people believe there's one standard here and one standard there. And by having our whole health care center integrated, where the same people see you no matter where you go, I think, helps reduce that feeling of other than or second than.

NNAMDII wanna move on another issue. Because you proposed a bill last week aimed at allowing women to bypass the doctor's office and get birth control pills directly from a pharmacist. Why?

CATANIAWell, you know, this was not an over-the-counter proposition, which it has been mischaracterized as. What the bill does, it asks the board of medicine, our doctors, and the board of pharmacists, our pharmacists, to come together with a set of protocol that will allow women to access birth control from their pharmacists. It's based on a model which we saw in Washington State where the pharmacist asks a series of family history questions, blood pressure, and a person is able to get birth control on the spot. I think it's absolutely ironic that we -- that women over the age of 17 can go to a pharmacy and get a plan B to terminate a super dose of hormones, but can't have the same access, even frankly a higher standard actually having to speak with the pharmacist to get birth control. I, frankly, don't see the problem with this. It's not mandatory. It's not meant to supplant...

NNAMDINo, I'll tell you two problems with it. You're likely to get push backs both from doctors and from anti-abortion groups.

CATANIAYou know, but I believe women have infinite system -- I mean, infinite common sense and can make choices for themselves. You know, I've seen another model of Planned Parenthood in Oregon that actually you can access, you know, birth control through a website. You enter your zip code and the nurse practitioner sends them to your house. And so I think a conversation about how do we access birth control is smart for a number of reasons. We have -- still have too many parts of our city that lack primary care. Women either don't have insurance or don't have access to a doctor and, therefore, go without. And so, you know, I also believe that pharmacists have a lot of training and expertise that we are not using.

CATANIAAnd as our health resources gets stretched thinner and thinner as more people have access to it, we have to think smart about how we use and best utilize the expertise we have. Again, this is a concession to reality. I know that people think in a perfect world, everyone goes on an annual basis to their gynecologist and has insurance and can do this.

NNAMDIDoesn't happen.

CATANIAIt doesn't happen. And we have the teen pregnancy rates to reflect it, and we have a number of unwanted children in our city as a result.

NNAMDIWell, I mentioned antiabortion groups and doctors. I did not mention the U.S. House of Representatives, but that's a whole another story for another occasion. David Catania, thank you so much for joining us.

CATANIAKojo, thank you.

NNAMDIDavid Catania is a member of the D.C. city council. He's an independent. He holds an at-large seat. He chairs the council's Committee on Health. We're gonna take a short break. When we come back, how U.S. presidents have contributed to the language, inventing some words and simply using others and helping them to become a part of our -- the popular culture and then popular usage. I'm Kojo Nnamdi.