make every effort to treat patients without referring them elsewhere unless because of the nature of their illness they can be better treated in other facilities. Finally, various proposals now pending in Congress and which are national in scope will enable private hospitals to be reasonably reimbursed for the costs of all services rendered to indigent patients. Since H.R. 11628 would authorize the Secretary of the Department of Health, Education, and Welfare to administer the proposed program of grants and loan subsidies, the Commissioner of the District of Columbia defers to the views of the Secretary on H.R. 11628. Thank you, Mr. Chairman. Mr. STUCKEY. Thank you, Mr. Robinson. Are you saying now, then, that a lot of the private hospitals do not properly take care of the patients that are being admitted there? Mr. ROBINSON. Not necessarily that they do not properly take care of those admitted, but in many instances the indigent patients or those considered public patients are referred to public facilities, primarily D.C. General Hospital. The District, of course, has contracts with certain of the hospitals to treat many indigent patients. Mr. STUCKEY. Mr. Fauntroy? Mr. FAUNTROY. On that point, Mr. Robinson, how does your statement fit in with the complaint that I have gotten from some people in the Southeast, for example, that they are not able to avail themselves of services, that, say, Cafritz Hospital often refers to D.C. General in a fashion that they don't feel that they get prompt and adequate treatment? Mr. ROBINSON. Generally, Mr. Fauntroy, that is a correct statement. As we have indicated, in the consideration of H.R. 11628 further review should be given to that problem to insure that before additional facilities are constructed or additional funds are authorized that those types of activities be reviewed and studied to make certain that the entire medical needs of the entire population of the District are adequately met. Mr. FAUNTROY. Are you indicating that the funds made available through this bill should carry with them some sort of understanding or agreement that that complaint should not emanate from the people in that community? Mr. ROBINSON. Yes, Mr. Fauntroy. As I have indicated, the District has under active consideration a plan which in its capacity as the State agency for hospital programs in the District would require such a program. Mr. FAUNTROY. Thank you, Mr. Chairman. Mr. STUCKEY. Mr. Robinson, one more thing. If it could be made available for the subcommittee we would like to see the plan that you refer to that the D.C. Government does have. Mr. ROBINSON. Yes, sir. (The plan (District of Columbia Plan for the Construction and Modernization of Hospitals, Public Health Centers and Medical Facilities, 1971-1972) was filed with the committee.) Mr. STUCKEY. Thank you, Mr. Robinson. Mr. ROBINSON. Thank you. Mr. STUCKEY. Next we will hear from Mrs. Margaret Ewing, Attorney for the Senior Citizens Clearing House Committee. STATEMENT OF MRS. MARGARET EWING, ATTORNEY FOR SENIOR CITIZENS CLEARING HOUSE COMMITTEE Mrs. EWING. My name is Margaret Ewing. I am counsel for the Greater D.C. Area Council of Senior Citizens, the Senior Citizens Clearing House Committee of the District of Columbia and the D.C. Family Welfare Rights Organization in several lawsuits aimed at improving the level of health care received by elderly and indigent citizens. I strongly believe that greater Federal assistance is needed if all the residents of the District are to receive adequate hospital care. But I do not believe that the proposed legislation does enough to assure that more hospital care will be given to those who need it most-the poor and the elderly. I am, therefore, submitting two amendments to H.R. 11628 for the consideration of this committee. These amendments should enable the elderly and the poor to benefit more fully from this legislation. First, H.R. 11628 should be amended to make certain that the District Government and HEW enforce the obligations imposed on hospitals which receive Federal assistance. Under the Hill-Burton Act, as under the proposed legislation, hospitals receiving Federal funds are required to provide a community service and a reasonable volume of free and below-cost care. The District Government and HEW have the power to enforce this requirement, but in the past they have failed to do so. This failure is dramatically demonstrated by the situation in several hospitals. For instance, Cafritz Hospital has received substantial sums of money from the allocated funds under the Hill-Burton Act to meet the hospital needs in the District of Columbia. In order to obtain these funds, it promised to provide a community service and a reasonable volume of free and below-cost care to persons unable to pay. It also represented that it would provide the Anacostia community with a sorely needed out-patient facility. In fact, Cafritz Hospital has consistently refused to provide any free or below-cost care to the medically indigent. Until this summer, Cafritz billed and attempted to collect from every patient who used the hospital-no matter how poor. Furthermore, the hospital has refused to sign a medical charities contract with the District of Columbia which would result in its rendering below-cost care to indigents and it has failed to establish the out-patient facilities. In short, Cafritz has largely turned its back on the District: less than 30 percent of its in-patients are District of Columbia residents. The pattern at several other Washington hospitals is similar. Less than 35 percent of the patients at Providence and Sibley Hospitals, for example, are from the District of Columbia. This suggests that they, too, may not now be meeting their obligations to serve their community and provide a reasonable volume of free services to the poor. H.R. 11628 now provides that an application for funds must be approved under a Medical Facilities Act or, if denied under such an Act, including the Hill-Burton Act, could be approved by the Secre tary only if it complies with the same terms and conditions which would have been applicable under the other Act. In the case of applications under H.R. 11628 for funds for the modernization and construction of hospitals this means that the applicant would have to give assurances that it would provide a reasonable volume of free or belowcost care to persons unable to pay and that it would be made available to all persons residing in the territory surrounding the facility. The amendment I propose would require that the District Government or HEW enforce such obligations undertaken by the hospitals which receive money under this Act. Such enforcement should include initiation of legal action in the United States District Court when necessary. My second amendment is a closely related one. It seems foolish in the extreme to provide new million-dollar grants to hospitals which have not lived up to their obligations with respect to previous grants. I propose, therefore, that no hospital receive money under the bill now under consideration unless the District Government certifies and the Secretary of HEW makes a determination that the hospital is meeting its obligations under previous grants. In this way the Congress can assure that its mandates are being respected and that the elderly and the indigent are receiving the hospital care which Congress intended them to have. I thank the committee for this opportunity to testify and submit two amendments for your consideration. Mr. STUCKEY. Mrs. Ewing, where are you getting your figures from? Mrs. EWING. Which figures are you referring to? Mr. STUCKEY. The 35 percent of the patients at Providence and Sibley Hospitals. Mrs. EWING. Those are contained in a report by the Hospital Facilities Council of metropolitan Washington area. I can provide those for the record if you would like to have that. Mr. STUCKEY. I would appreciate it. (The information follows:) Mr. STUCKEY. Also you are saying that a lot of the poor are really not receiving the treatment that they should in many of the hospitals and that the hospitals are making efforts to collect on all the bills. Yet we have been provided with figures that there is around $22 million that goes uncollected each year. Mrs. EWING. $22 million goes uncollected? Mr. STUCKEY. Yes. Mrs. EWING. Where? Mr. STUCKEY. At the various hospitals. Mr. STUCKEY. All. Mrs. EWING. That may be true. I am sure hospitals have accounts receivable which they are unable to collect for various reasons from persons who are poor and persons who are not poor, and we don't suggest that every hospital in the city is in violation of their obligations to provide free care, but we do know that some clearly are, and I think neither the District Government nor HEW has sufficient information to know about many of the others. We suggest they get that. Mr. STUCKEY. Mr. Fauntroy? Mr. FAUNTROY. Mrs. Ewing, how familiar are you with the Cafritz Hospital situation and the complaints of the community? Mrs. EWING. Well, I am representing several community groups in a suit against the hospital. Mr. FAUNTROY. I wonder if you would detail for us the genesis of that action, where you are now? Mrs. EWING. Well, the action was brought by the three groups which I mentioned at the beginning of my testimony. Two Senior Citizens organizations and the Welfare Rights Organization in the District. It was filed in the District Court in February of this year and assigned to Judge Gesell. Judge Gesell has denied the motion of the defendant, Cafritz Hospital, to dismiss this suit. We are now in discovery and we expect that we should get a decision, or a hearing at any rate, in April. Mr. FAUNTROY. Would you detail the basis for the suit? Mrs. EWING. The basis for the suit is that the hospital has received funds under the Hill-Burton Act and the D.C. Hospital Construction Act. It also received property under the Federal Surplus Property Act free of charge from the Federal Government, all on representations that it would serve the Southeast area of Washington and that it would provide a reasonable volume of free services to the poor, and we believe that they have failed to fulfill both of those obligations, that they don't provide free services to persons unable to pay and that they don't make their facilities available to all residents of the Southeast area. Their in-patient statistics indicate that in fact. only 26 percent of their in-patients are from the District. Mr. FAUNTROY. Could you give us a couple of examples of the kinds of experiences the people have had? Mrs. EWING. People come to the emergency room in many cases and are given emergency treatment when that is needed, and then are either referred or just told that they may not come back to the hospital for any further care unless they can pay. A patient who comes and seeks to be admitted as an in-patient is denied admission unless he has third party insurance coverage, Blue Cross, Blue Shield, or a private insurer, covered by Medicaid or can put up a $350 cash deposit. Their is no other arrangement for the admission of in-patients except for meeting those financial requirements. Mr. FAUNTROY. What is your estimate of how much money Cafritz would receive if this bill were passed? Mrs. EWING. I understood that under this bill they were asking for a $10 million grant and an $8 million subsidized loan, so it would be an $8 million grant, as I understand it, largely to finance an out-patient facility which we think is indeed needed. Mr. FAUNTROY. So you feel it is needed but you would want to assure that the people receive the services? Mrs. EWING. Yes. The out-patient facility they have now is only available to persons who make an arrangement to see a private physician in that office. You don't walk in off the street and ask to make an appointment in the Pediatrics Clinic, for instance. It does not operate that way. Mr. STUCKEY. Basically, you are in favor of the bill but you just want to be sure that the poor and the indigent receive the case? Mrs. EWING. Yes. The only point we want to stress this morning is that hospitals ought to be asked to fulfill their past obligations and the assurances which they made when they received funds in the past and that the obligations which they will undertake under this bill also ought to be enforced by the District of Columbia Government and HEW. Mr. STUCKEY. If there are no objections we would like to include in the record the two proposed amendments to H.R. 11628. They will be made a part of the record. (The amendments follow:) PROPOSED AMENDENTS TO H.R. 11628 MARGARET EWING, WASHINGTON REPRESENTATIVE, HEALTH LAW PROJECT, UNIVERSITY OF PENNSYLVANIA LAW SCHOOL 1. Add to Section 4(c): Before any application is approved, the appropriate State agency or District of Columbia shall certify to the Secretary whether the applicant has complied with all terms and conditions applicable to previous grants it has received under the Medical Facilities Act, the District of Columbia Hospital Center Construction Act, the District of Columbia Medical Facilities Construction Act, and any other Acts providing federal or District of Columbia funds for the construction of medical facilities in the District of Columbia and with any assurances made in applications or other documents submitted to any Committee of Congress, the Secretary, the appropriate State agency, the District of Columbia or metropolitan area wide planning body with respect to such grants. The Secretary shall not approve any grant or loan under this Act unless he determines, on the basis of this certification and any other evidence which he obtains or is submitted to him, that the applicant has fully complied with such terms, conditions and assurances. 2. The heading of section 6 should be changed to "Enforcement." The present text should be subsection (a) and a subsection (b) should be added as follows: The Secretary and the appropriate State agency or the District of Columbia shall have the responsibility to enforce compliance with the same terms and conditions as are applicable to applications for grants under the Medical Facilities Act and with any assurance made in the application or other documents submitted to the Secretary, the appropriate State agency, the District of Columbia or metropolitan area planning body for grants or loans under this Act. Such enforcement shall include the initiation of legal action in the United States District Court for the District of Columbia to compel such compliance. Mr. STUCKEY. Thank you so much. Mrs. EWING. Thank you. Mr. STUCKEY. At this time we again have Father Collins of Georgetown University, and Mr. Bucher of the Hospital Council. STATEMENT OF REVEREND T. BYRON COLLINS, S.J., CHAIRMAN, TRUSTEE PLANNING COMMITTEE; ACCOMPANIED BY WILLIAM M. BUCHER, EXECUTIVE DIRECTOR, HOSPITAL COUNCIL OF THE NATIONAL CAPITAL AREA, INC., WASHINGTON, D.C. Fr. COLLINS. Mr. Chairman, Mr. Fauntroy, on behalf of the hospitals of the District of Columbia Mr. Bucher and myself would like to respond to the questions and the points raised by the three previous speakers, which will be brief, and then try to answer any questions in your minds. I would like to first start by stating that in meeting with the hospital representatives that the task that I as Chairman said I would undertake to do was because of a religious reason, to help the poor of the District of Columbia, and that is why I am here. |