Nurses and community members gather for an Aug.30 rally at Providence Hospital. (Photo courtesy of National Nurses United)
Nurses and community members gather for an Aug.30 rally at Providence Hospital. (Photo courtesy of National Nurses United)
Following the July announcement by the Catholic health system Ascension that Providence Hospital would stop providing acute care, community members and staff of the hospital have expressed opposition to the decision.

On Aug. 1, the hospital’s Board of Directors condemned Ascension’s decision to stop providing acute care, and later that month, Ascension fired nine of the 12 members of that board. On Aug. 30, nurses, doctors and community members gathered for a rally on the hospital’s campus, protesting the announced closure.

On Sept. 17, Ascension announced, “to dedicate the time and resources needed to pursue a transformational model of healthcare, Providence will transition out of all services, except for Carroll Manor and primary-care related services on December 14, 2018.”

Providence Hospital was founded by the Daughters of Charity in 1861, with a charter signed by Abraham Lincoln, and is the longest continuously running hospital in Washington. It is currently run by Ascension, the world’s largest Catholic health system and the largest not-for-profit health system in the U.S., with about 150 hospitals across the country. Their mission states, “Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable.”

Currently, Providence Hospital carries out that mission by serving some of the poorest areas of Washington. They do not turn anyone away because of an inability to pay, and 87 percent of their patients are insured through either Medicare or Medicaid. It is because of this commitment to serving the underserved that some community members feel the decision to close the hospital will exacerbate already existing socioeconomic and racial disparities within the city, as 82 percent of the hospital’s patients are African-American.

Elissa Curry, a nurse who has worked at Providence for seven years, said her patients have been asking her, “Where will we go?” She and many of the other nurses in the hospital are upset about the closing, and she noted that many of her colleagues have worked there for more than 25 years.

“They’ve invested their life there,” she said. “They are committed to Providence and the mission. They are committed to serving the indigent and the underserved and the poor. We could go anywhere, but we choose to stay at Providence and take care of that population of people.”

By choosing to close the hospital, Curry said she felt Ascension was not exemplifying their Catholic values.

“I am Catholic as well, and the Catholic Church and especially this hospital has always been (focused on) joy, care, respect, and to heal the sick and to take care of the poor, the underserved,” said Curry.

Many community members expressed similar concerns during a nine-hour District of Columbia Council public oversight hearing on Oct. 10. Following this hearing, the D.C. Council unanimously voted to approve legislation empowering D.C. Mayor Muriel Bowser’s administration to force hospitals to remain open. It is so far unclear whether the mayor will be using that new authority.

The legislation requires hospitals to get approval from the city before they close or end services, and authorizes the director of the Department of Health to issue a provisional license to Providence for up to three years, as it is set to expire in December.

As one of the reasons for deciding to close acute care services at Providence, Ascension has cited an over-abundance of hospital beds in Washington, as the city’s per-capita number of hospital beds is twice the national average. But opponents of the closure have noted that the problem is that those beds are not well distributed, with Providence being one of only two hospitals serving the eastern half of the city. Six hospitals are located in the more affluent western wards of the city.

“Although the message around the closure seems to be that the district has an abundance of beds to absorb the uptick in inpatient and sister hospitals, when analyzing these decisions through the lens of racial equity, the services that would no longer be available would have a disparate impact on people of color,” said council member Kenyan McDuffie (Democrat, Ward 5).

In addition, during the Oct. 10 hearing, Health Committee Chairman Vincent Gray (Democrat, Ward 7), noted that the number of licensed beds in the city “drastically overstates” the actual capacity, because not all of those beds are actively in operation.

“Even if other hospitals can add staff to use some of the inactive beds, the District’s health care system is still becoming less convenient and less accessible to residents on the eastern end of the District of Columbia,” said Gray.

In October 2017, Providence closed its inpatient psychiatric ward and its labor and delivery ward. At the hearing, health care professionals from different hospitals in the city testified that the closures had placed a strain on the hospital system, and expressed fear that closing acute care services would make the problem worse.

“I love being a nurse because I can make a real difference in people’s lives,” said Zoe Bendixen, a labor and delivery at MedStar Washington Hospital Center. “…Too often patients do not get the best care possible because of excessive wait times, lack of care when they need it, and chronic and dangerous understaffing. Closing Providence will exacerbate the problems patients already face around the city.”

Dr. Greg Argyros, president of MedStar Washington Hospital Center, noted that their emergency room already treats 87,000 people annually, and said it is “difficult to imagine we could absorb much more.” He also noted that Providence’s emergency room is one of the few in the city that has seen an increase in visits in the past few years.

During an Oct. 10 testimony, 27-year-old Washington resident Aaron Lewis-Ralph Phillips, who was born with asthma and had visited the emergency room frequently as a child, noted how he and other under-insured people relied on Providence for health care. Because of financial challenges, his family relied on Medicaid.

“Providence has always taken me no matter what my insurance was,” he said. “Emergency room visits were always timely. The level of service always good.”

It was not until he was at the hospital recently for physical therapy that he found out about the planned closure.

“Before that, I, like many patients, was completely unaware that I might lose this important provider of health,” he said. “…Closing this hospital will lead to unnecessary deaths among those who are inadequately insured or who can’t otherwise get care from hospitals in northwest – mainly people of color and seniors.”

In place of acute care services, Ascension has said that they will transition to more preventative health care, such as care coordination, telehealth or virtual care, primary and urgent care, home care, community-based behavioral healthcare, and senior care.

“To be clear, the decision to close Providence Hospital was not an easy one. For many years, Providence has been performing very poorly financially. Providence is simply not serving this community in a sustainable way: its discharges have been declining over the past five years, and the District of Columbia's data show that the hospital is underutilized,” Ascension said in a statement. “Further, studies have indicated that the highest healthcare needs in the D.C. community include providing place-based care and care coordination. Instead of investing in an underperforming hospital facility, we are committed to transforming Providence into a new healthcare delivery system.”

In addition, the statement said they hope to provide “a new community-focused perspective that addresses healthcare inequities and provides other types of needed services to improve health and wellness.”

But Curry does not believe that those new services will actually serve the needs of the community.

“These are the sickest of the sickest people that come there,” she said, explaining that they serve a large senior population as well as mentally and physically impaired patients from group homes. “…I don’t think it would be something that is highly accessible for them. They would get the same sick people that would go there, but they wouldn’t be able to help them. They are targeting people who are already healthy.”

With the hospital closing, she also expressed concern about the patients’ ability to get to hospitals that are further away from their homes.

“A lot of the patients that we see, they barely can get to Providence,” she said. “They have issues with rides, and we have a lot of people who come by Metro access…A lot of them don’t even have rides to go home after surgery.”

Dr. Lester Miles, president of medical and dental staff at Providence Hospital, said he was “disappointed and angry” following the announcement of the hospital’s closure, and noted a disconnect between what Ascension has been doing and their communication with the hospital’s staff. Though he has been told that Ascension had been making plans to close the hospital for about a year, he said he and the rest of the medical staff were not told until July.

Though Ascension representatives did not appear at the Oct. 10 hearing, they said in statement that they are “actively engaging with members of the D.C. community to ensure that the services that Providence will provide make a substantive impact on the health of the D.C. community.” They have been holding internal listening sessions with associates and have assembled transition teams to help with transition plans.

“We are regularly engaging with the DC Department of Health and, in partnership with the DC Hospital Association, we created workgroups with other local hospitals and healthcare institutions that meet regularly to ensure a smooth transition of services and patients,” Ascension said in a statement. “In addition, we continue to work with our associates whose jobs will be impacted and are committed to providing them with support for transitioning their roles with dignity and respect.”

On Oct. 8, Mayor Bowser wrote a letter to Cardinal Donald Wuerl asking that the Archdiocese of Washington play a leadership role during the transition of the hospital. According to Ed McFadden, the archdiocese’s secretary of communications, the archdiocese is in the process of setting up a meeting with the D.C. Department of Health in order to discuss the options surrounding the hospital’s closure. He said Catholic Charities of the Archdiocese of Washington has also expressed interest in being a part of that discussion and determining how they could be of assistance in meeting the health care needs of the community.

Dr. Miles said he hoped the Catholic community in Washington would see "there is a need in the Washington, D.C. area for this hospital, which I think there is.”