Prince George's Hospital Center, the largest medical facility in the state's second-largest county, could close within months, sending its largely indigent patient population into the already crowded emergency rooms of hospitals in the region, including neighboring Anne Arundel and Howard counties, officials say.
"It's not just a financial issue but the impact on the health delivery system in Maryland," said Lt. Gov. Anthony G. Brown, a former delegate from Prince George's County who helped lead unsuccessful negotiations to bail out the hospital 30 miles south of Baltimore. "If this hospital closes, it will be felt in every community in Maryland as other facilities have to absorb the patient load that relies on the Prince George's Hospital System."
The Prince George's county executive, Jack B. Johnson, said he was not giving up hope of saving the financially troubled health system. But officials at the quasi-public agency that runs the Cheverly hospital said the County Council's refusal late Monday to accept Gov. Martin O'Malley's eight-year, $329 million plan to modernize and financially strengthen the institution means it will likely close, sending its 188,000 annual patients elsewhere.
State leaders called the County Council's decision "childish" and "criminal," but council members defended their action, saying they did not have sufficient time to evaluate the deal and shouldn't be held financially accountable for the not-for-profit hospital system's mismanagement. They also expressed concern about tying the hands of the next County Council.
The system, which has its main campus off Route 295 in Cheverly and satellite branches in Bowie and Laurel, includes most of the hospital beds in the county. Many of its patients lack health insurance.
"We're just waiting," said Suzanne C. Almalel, spokeswoman for Dimensions Healthcare System, which operates the hospital on county-owned land. "We're hoping something comes up, but our only plan is our closure plan."
She said the health system's chief executive officer, G.T. Dunlop Ecker, would recommend closing the facilities at a board of directors meeting Monday.
O'Malley offered $159 million in state aid over eight years, provided that the county put up $170 million, enough to cover operating losses and help build a new hospital on the Prince George's Hospital Center campus. A new, independent governing authority - appointed by the governor and local officials - would have managed the system, with bids to be sought for a new operator in 2008 or 2009.
"We really wanted to be able to fix this and get us on a course to bring high-quality health care [that] the people of Prince George's County deserve, and unfortunately we weren't able to convince the council of that," O'Malley said.
The health system has been in a downward spiral - punctuated by state and county bailout payments, consulting studies and changes in management - for more than five years.
"The patient has gotten sicker. It has been allowed to deteriorate," John M. Colmers, the state health secretary, said yesterday.
Absent a deal, the state has committed $20 million to facilitate the orderly closing of the hospital, and Colmers said yesterday he is drawing up plans to carry it out.
The budget approved by the General Assembly doesn't require that the state close the hospital, but that may be the practical effect. Without aid, the hospital would be forced to shut its doors within weeks because it can't afford required debt service payments. The state budget said that if a deal weren't struck before Monday night, O'Malley could only provide aid as part of a plan to close the facility. The hospital has 2,300 employees, county and union officials said.
Johnson declined to cast blame, saying he would have to lead negotiations to resurrect a deal. But he left no doubt that it was the council, not he, who walked away from the bargaining table. Other Prince George's leaders were not so diplomatic.
"What happened is the council threw a childish fit and decided to close the hospital," said Del. Doyle L. Niemann, a Prince George's Democrat. "They have a million excuses for their behavior, but none of them make any sense."
Senate President Thomas V. Mike Miller, who represents Prince George's and Calvert counties, called the council's actions "criminal."
"You've got the county executive, the governor, the General Assembly agreeing on a plan, and the council saying, 'We're not going to come up with any money at all,'" Miller said. "It's ridiculous."
Prince George's council members defended their decision.
"We can't and will not authorize additional county funds unless it presents a long-term, viable solution," Council Chairwoman Camille A. Exum said. "The proposed deal didn't accomplish the goal, and the last-minute push to enact it left too many unanswered questions."
Exum said council members were given only an hour to look over the deal as the clock ran out on the General Assembly session, but legislators, Johnson and O'Malley administration officials say they were included in negotiations over two weeks.
"All parties were involved," Brown said.
Exum blamed the hospital's problems on mismanagement by Dimensions. She sits on the Dimensions board.
Colmers and hospital officials acknowledged management problems over the years, but they said they are not the sole reason for the system's financial woes.
With the largest share of uninsured patients in the state, it had to absorb the salaries of 100 doctors because the doctors couldn't collect from many of the patients, Almalel said. That accounted for about half of the $11.1 million operating loss that Dimensions has posted so far this fiscal year, according to filings with the state Health Services Cost Review Commission.
Other Maryland hospitals treat almost as large a share of uninsured patients as Dimensions but have managed to remain solvent and even profitable.
Circumstances are different at the others, said Calvin Pierson, president of the Maryland Hospital Association.
Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and University of Maryland Medical Center in Baltimore have medical residents to help in care for the uninsured, Pierson said, while Bon Secours Hospital has a sponsoring religious order that subsidized its losses in down years.
As cash flow tightened, the Prince George's hospitals deferred some pension contributions, and the system is now facing a $4.7 million pension payment due April 15.
The problems spun into a vicious cycle. Dimensions didn't have the money to recruit and retain staff. And it didn't update facilities at a time its competitors were building amenities-laden new wings - leading some patients to choose more attractive facilities in Anne Arundel, Howard and Montgomery Counties.
"People with insurance would rather go to other hospitals," Almalel said.
Anne Arundel County Executive John R. Leopold said he has been following the negotiations over Prince George's Hospital and was worried to hear about the demise of the state's deal, because the hospitals in his county are already crowded.
"It is of concern," Leopold said.
Only the General Assembly can create a new hospital authority to take over management of the health center, and it is not due to return until January. The governor could call a special session of the legislature, but that would be unlikely unless the county agrees to a deal first.
"I'm always willing to talk," O'Malley said.
The immediate solution will likely be a repeat of the piecemeal aid that has kept the hospital struggling along for years, said Johnson, who estimated the county might have to come up with $30 million.
"I know no one wants to do another year" of aid, Johnson said. "But the first thing we've got to do is find the resources for another year, and that's on the county executive and the council. We've got to keep it open for a year."
Sun reporter Jennifer Skalka contributed to this article.