All right, good morning.

I'm calling this uh public oversight round table to order.

Today is Monday, April 6th, 2026.

We're in room 123 of the Johnny Wilson building.

The time is 9 02 AM.

I'm at large council member Christina Henderson, Chair of the Committee on Health, and I'm convening this round table on Cedar Hill Regional Medical Centers operations, contractual and regulatory compliance, and community impact.

For far too long, residents east of the river, particularly in Ward 7 and 8, have faced persistent barriers to accessing high quality, timely comprehensive health care.

Cedar Hill Regional Medical Center represents one of the most significant public investments in health care in the district in decades.

The district invested over 400 million in public dollars to construct the hospital and has committed another 25 million over the next 10 years to hospital operations to cover any financial deficits.

This hospital was envisioned as more than just a replacement facility for United Medical Center.

It was designed to be part of a fully integrated equitable health system that includes robust inpatient and outpatient services, strong community partnerships, a meaningful academic and training presence, and a workforce that reflects and serves the community with the expectation that Cedar Hill would improve health outcomes, expand access, and rebuild trust.

At the same time, we're here today because there have been some consistent reports and concerns that go beyond the knowing the normal growing pains of a new facility and have very serious questions about whether the hospital was indeed ready to open when it did.

Shows that Cedar Hill um was having the longest ambulance drop-off wait times of any district hospital with ambulance ways ambulances waiting, uh an average of one hour and sixteen minutes.

Taken together, the challenges have led to a financial strain, unmet healthcare needs, and a hard to repair distrust in the hospital among ward seven and eight residents.

To support this oversight, we sent some prehearing questions to George Washington University, University Health Services, and GW Medical Faculty Associates.

These questions were largely focused on the compliance with Cedar Hill Hospitals Operations Agreement, which was entered into by the district government and UHS.

The hospital operations agreement is available on the hearing management system website, which is on DC council's webpage for anyone who is interested.

Most importantly, this conversation is about the residents of Ward 7 and 8.

It is also about whether they can access high quality care when they need it, receive care from the providers that they trust in whether the hospital is meeting the needs of the community it was built to serve.

We're gonna begin today with a panel that includes a member of Cedar Hill's board and a community physician who has long served residence in Ward 7 and 8.

Their perspectives will help ground the discussion and a community experience provider realities.

We'll then hear from representatives of Universal Health Services, GW Medical Faculty Associates, and the George Washington University to better understand hospital operations partnerships and the status of contractual key contractual commitments.

Finally, we will close with the government witnesses, including Dr.

Ayana Bennett, who is the director of DC Department of Health and Wayne Turnage, who is the deputy mayor for health and human services to discuss the district's role and oversight accountability and a path forward.

Appreciate the participation of all the witnesses today, and we look forward to a candid and constructive conversation.

I will also just say for the record, um, this hearing was originally scheduled when we were supposed to have the budget.

Um and so we had to make some scheduling.

Uh we had to beg for a room, to be very honest.

Um I had to make some changes on that.

So for the public who may be watching, it wasn't our intention to quote unquote block anybody out, but we did have to make some strategic decisions in terms of us having a conversation today.

All right.

With that, we'll move to our first panel.

Uh I don't see our first witness here, Jaron Hill Lockridge, um, who is from the um advisory board and the chair of the Ward Health Ward 8 Health Council.

But we do have Dr.

Marilyn McPherson Corter, who is um former chief of staff at UMC who is on Zoom.

So we'll start with Dr.

Uh.

Dr.

Porter.

Hello, good morning.

I'm here.

Morning.

Can you hear me?

Yes, ma'am.

Um, when you're ready.

Okay.

So yes, I'm I am a ward seven.

Um I grew up in Ward 7 and 8 at well, ward 7, went to school in Ward 8 for all of 12 years.

So I'm a Washtonian three generations.

Um I became a pediatrician right here in DC Howard University, did my residency in pediatrics, and then did two fellowships, one in genetics and one was in adolescent medicine.

Uh been in private practice for all of 40 years.

And I was had the honor of being the chair of the nursery at what was called at that time Greater Southeast since night since 2000, and then became chief of service for four years, and that was in 2015 through 2018.

I am a community doctor.

I know many of the community doctors who are still in private practice, who were in private practice adjacent to the hospital, the medical uh professional office building for the physicians for 30, 40 years and practices in the area, and they practice medicine in area generations.

So when we heard of the new hospital, we were we were excited.

I mean, I was in board meetings with leaders in the district, and you know, we know our hospital was old, and I would have I wish that it had stayed open.

I said, you know, it's enough.

We have enough need that we could have two hospitals in Southeast.

But of course, that wasn't my decision to be made.

So as we continue to hear of the hospital opening, we unfortunately were beginning to see less and less funding for our hospital.

And it was a time when I had to come in front of the council to pretty much beg for the seven million dollars that they had cut from 20 to 27 million.

But we ended up getting that, um, which allowed us to function and to continue to operate in um within the financial strains that we had.

I mean, we were put in.

Our hospital was not perfect.

Well, no hospital is.

But you know, we had had complaints from the community of be it wait time or just didn't like the service.

Um as a physician on staff, we always wanted to do our best.

And as far as I saw, we were trying to do our best with the limitations that we had.

My mother and my aunt was there.

I mean, I trusted the hospital that much.

I could have had them anywhere.

I'm on staff at four other hospitals.

But I was comfortable with them having a service there, um, being treated there.

An emergency room was I felt was pretty good.

We sometimes we would have to send patients elsewhere depending upon what specialties we had, but as much as we could do.

Um after a while, GW took over the emergency room.

Um, and we ended up also having the labor and delivery closed for an incident, and I say an incident um that was not even our patient, but I won't go into there.

So that meant that the mothers in Ward 7 and 8 did not have a place to deliver babies, and I don't know how much time I had, but to deliver babies, and unfortunately had to go elsewhere to one of the hospitals in Northwest.

There are five hospitals in Northwest.

There were none in Southeast, none in Southwest, and Providence was closing as well.

So that was very distressing news.

And unfortunately, we had poor outcomes from babies being born in the ER at United Medical Center or in the ambulance trying to get across the bridge.

Where are we today?

Well, the hospital itself closed.

Um, and then the doctors, from my understanding, we were told that we could join um Cedar Hill, and then last minute we were not invited to join Cedar Hill.

And we had to go elsewhere because many of our practices was attached to the professional office building.

And that's difficult, but it happened.

Some doctors just left BC and went to Maryland.

So the patients did the same.

What I'm hearing now as a community doctor still involved in the community, are not so good news.

We're hearing not we're hearing that the services that was promised at the opening a year ago are not there.

The care, the culture is not positive, and it's very concerning.

I've been in conversation.

I want to continue conversations with the leaders because my heart is for those in ward seven and eight.

I'm in private practice in Northwest, but I can also still be come back to private practice where I grew up.

So that concludes.

If you have any questions, please don't hesitate.

But I'm fully committed to continue to serve the residents for Ward 7 and 8.

And we're willing to partner with those leaders at Cedar Hill.

Thank you, Dr.

Corter.

Um, I do have some questions, but um, I guess my colleagues aren't here.

I still want to keep myself accountable of time.

So if you could put me on a seven-minute clock, Ashley, thank you.

Okay.

Um Dr.

Gordon, one of the things that we um have heard feedback around was um the experience of um community physicians trying to apply for privileges at Cedar Hill.

Can you talk a little bit about that experience?

Um I've heard either someone was denied or I actually've heard more that they just simply haven't heard back.

Um but I wanted to hear it from you.

Well, I know personally at least five or six doctors have not heard back.

One in particular applied last year almost to this date, and he hadn't heard back, and he is a well-trained surgeon.

Um I know recently over the last three to four months, um, some doctors have applied, and I don't want to give their names because it's HIPAA violent or violation, but I gladly can let you know and and and get those names and you can reach them.

They had applied, hadn't heard, and then they were told recently that they now have to go through another process because there was changing of the guard uh in terms of their applying.

There also there have been doctors who are interested in becoming part of the ambulatory, the clinics, specialty clinics, um, and was quoted an enormous fee for renting up to $8,000.

Now I don't have that in front of me, but that was what I was told.

And my feeling, and the community doctors feeling is well, maybe because we were dispersed and um, you know, basically said you can't come.

Maybe there needs to be some consideration, not a maybe.

There should be some consideration to allowing um allowing either no rent for six months or you know, some discount because we have to reestablish our patients to come there and to um get everything back where we were as if we were at Greater Southeast, United Medical Center.

So, yes, we have had folks get either no information or denied, or mainly more no information, and it's like they keep saying apply, apply, but then there are other doctors who are like, well, you know, if we apply, what does that mean?

Who do we work for?

And where's the leadership and who we're the peer review?

So some people have said, I'd rather not apply right now until things are straightened out, until things are clear, until the outcomes and what we're hearing, um, what's going on from the ER to the inpatient to the surgery, um has a better have a better reputation.

Thank you.

Okay.

Just for comparison, um, what was the uh rent at UMC in the um professional building next door?

Well some of it was actually free, and the other ones was two or three thousand dollars versus eight thousand dollars.

So it's drastically higher.

And I know it's new, I understand, and you know, development costs brand new development, but exorbitant is majorly higher.

Okay.

Um I mean, I I had a list of questions around like some of the barriers um that community physicians are having, but it seems like the biggest barrier is that no one has called them back.

Yes.

Okay.

So that's not even a uh, you know, oh, you didn't meet the requirements, oh, you know, we don't have space.

It's literally somebody just has not made it through the process of calling folks back.

Um they've been calling and they just been getting a runaround, and you know, things are sitting on desk.

I'm not sure why.

You know, we're not GW, we're not part of the MFA, but we're community doctors who are interested.

And we did meet with um this Ms.

Daniels, and and it was a positive meeting.

I felt it was a positive meeting, and we met with the board um before Mr.

Coleman left, and they we had at least 20 doctors from the community there saying, look, you know, we really want uh our patients to go there.

They're going elsewhere, they're going to Northwest, et cetera.

But we're talking about bringing hundreds and hundreds of patients back that's convenient in their in their neighborhood to get served, but they're not gonna come.

Let me just make sure you're clear.

They're not gonna come in the way it come to a place that has right now not a good reputation.

They're hearing and they're not gonna come to a place where their doctors have not been invited, and it's not community doctor friendly.

Understood.

Um well, thank you so much, Dr.

Corter.

Uh, we've been joined by Councilmember Zachary Parker from Ward 5, who's a member of this committee and online.

Uh Councilmember Treon White from Ward 8.

Um, Jaron Hill Lockridge has also joined us virtually, but I before um Dr.

McCourt or Dr.

Corter's clearly in her office.

Um, and so I want to see whether or not um Councilmember White or Councilmember Parker have any questions for her so that she can get back to um uh the the business of serving her patients.

Councilmember Parker.

Thank you.

Um and I jumped in halfway through the question, so I may have missed this.

Uh but Dr.

McPherson Corter, um, what would you identify as the barrier to bringing more of the community vis physician physicians on board?

You know, there needs to be an in-house um medical exec team of doctors who will be community doctor friendly and will be able to get back to the doctors who apply.

You know, everything now goes to GW, and then it from what I hear and see, the response is not there.

The follow-through is not there.

And you know, they'll say put your application in, and sometimes even the link.

So in the best situations would be an HR, everything decision making would be right there at the hospital on that site.

And and and as well, we need to have a physician run administrative group that is community made up mainly of community doctors that will make sure that those things that we're needed at the hospital is addressed.

If you across the town or if you're not there, or if you're not used to that community, there are gonna be things that you just totally don't think about, um, totally unaware, and it's just not going to the outcome is not going to be good.

So it it needs to be physician, community physician, friendly as well as understanding what the community physicians can bring and want to bring back to Cedar Hill or to Cedar Hill from the as we know it's not there.

Understood.

Um it is my understanding there has been some turnover in terms of leadership, both in the emergency department as well as elsewhere at the hospital.

And what ways do you think that's contributing to the culture that you say is not quite as positive as it should be?

You know, I know 10, 20 people, at least 15 people who work there or have worked there and have said I can't stay.

My license on the line from nurses to physicians to administrative folks, they're like, I don't it's it's can I play devil's advocate?

And I I totally hear what you're saying, and I believe it to be true.

Uh I recently had a conversation with someone from Cedar Hill, and they would say it's almost like we're being picked on.

Everything is being amplified for us and being reported out in the media where hospitals across the district are dealing with some of the same symptoms.

How might you respond to that?

I'm on hospitals and I understand no place is ideal.

And I will say this other as I'm on other hospitals and have been on other hospitals.

You know, we got a bad rapid United Medical Center.

Everything that was anything negative was highlighted.

But what I'm hearing and what I'm seeing, I have relatives who have gone there.

Patients are calling me.

Um, and we are now hearing other hospitals complaining about patients coming to them after they've been mistreated or not completely treated there.

I've never seen such.

And I've been in practice, I've been in Washington all my life.

I've never seen such.

So when you ask me the comparison, I think it's majorly increased.

M more so tenfold.

Let me just say tenfold, because every it's only been open a year.

And a brand new hospital needs to have that that should be the flagship.

You know, it's like, okay, this is this is the new hospital that has all the equipment.

I'm excited as a pediatrician to come and help in the nursery as I was chair of the nursery.

We had to beg for equipment where when we were at United Medical Center.

I'm here.

I only have a minute left.

I hate to jump in and cut you off.

But Chairperson Henderson is a stickler for time.

So if I had to ask, what might you say is the low-hanging fruit opportunity for the district or this committee?

Where would you point us to focus on?

To listen and partner, the community doctors, we need to partner with the district or UHS or whomever, that they really hear us.

You know, we could talk, but really at the table and making some changes and putting our group in some leadership positions and then walking through and listening, not just listening and and and not acting, but listening with the intent to change.

Understood.

And last question, follow-up.

You may have given this.

How many doctors would you say have applied that you're aware of that have not heard back?

I know I'll be conservative, at least 12.

Wow.

Wow.

Okay.

And now now let me say for the record, I have not applied.

And I'm gonna tell you why.

I saw what was happening, and then before I put an application in, and I there's several of us that are like that.

I'm where is it gonna go?

Why is it gonna sit for long?

Who will be who can I call?

So some folks, and then some people are saying they don't want to apply because they don't they don't feel comfortable with practicing there when the different ancillary, the nurses, or the different departments are not favorable.

Understood.

I'm gonna stop there, and I'm gonna uh thank you for your engagement and I appreciate you taking a break from serving um to testify today.

So thank you.

Thank you.

Thank you.

Councilmember uh White, do you have any questions for Dr.

Corter?

Yes, I have one.

I want to thank you, Dr.

Quarters, for your years of leadership and service to the community, your particular advocacy, not just for you, but for other doctors that has been serving residency Santa Costa River for decades.

Uh, I guess though my corresponding with Dr.

Daniels, she explained that some people were making progress in their application process.

Do you see that at all?

Can you speak to what progress has it made to those who have applied to and you know what I like to do, and thank you, Councilman?

Um, White, that's what we keep hearing.

And then when we talk back to the doctors, they're like, well, we did, and they call back and they said now we have to start all over again sometime in April.

So it is not a favorable turnaround or response.

And I'm not, and like I said, I didn't apply.

I have not applied for for these reasons.

So I think that whomever is saying that, um, they need to look at the applications, and we can send the doctors to them and then say, okay, where are we now with this?

Is it temporary?

Is it apply somewhere else?

You have to start all over.

Why are they starting all over?

What's that about?

Well, that was what I was told by one of the doctors.

He said his application was in the in the pipe.

And they said, Well, it's a new group of folks taking over the doctors.

Um, and and and and I think it's now UHS.

I don't know.

They didn't talk to me, but I know that it's not completed yet.

And one of the things I saw in a meeting we were in with the board was that one of the doctors said he was there, but he didn't get any patients.

Can you speak to do you know why that is?

I know it's not your question per se, but just from your perspective.

If you can give some light to that.

Well, there's a doctor who's there, and the understanding was he didn't get any patients.

They would be sent to GW, but they wanted him to bring his patients to Cedar Hill to generate business, obviously, to generate funding, et cetera.

But that particular doctor was under the impression that as he was on staff that he would be the receiving doctor of those cases that he not he did not get um that was not referred to him.

So, you know, I don't know what the status is now, but I think that what needs to happen, we need to have a real sit-down, a real positive transparent conversation.

That when we do come on board as we want to, that it's not for naught that we have active role, active leadership role, and begin to get these patients see.

Every day it's a delay, and that's a delay, and that affects health and lives.

And you know, it's not about you know what's the next move, etc.

It's more of let's just get this job done.

Let's get it done, let's open and open the conversations and let's work together because I hope I'm right that we all have the same mission, which is to care for ward seven and eight residents.

And that's what we've all been about.

This is not a power, you know.

Hey, I'm not trying to make anybody feel bad.

I really not.

I'm from Southeast from Parkness.

I'm what I've I want the residents of Ward 7 and 8 to enjoy the health that we have here in Northwest.

My office is in Northwest, you know, and and it's a different, it's it's just different the care that they receive in the hospitals here versus the hospital versus Cedar Hill.

Thank you.

Uh last to the chairwoman, just note that I see they have been talking about CD Hill has been talking about doing a job fee.

I know they have a few thousand applications.

I just know some people had there's been a high turnover in staff.

Um, I'm sure I'll be in and out of this hearing.

Just want to make sure we follow up on them as far as staffing it up at some point during this hearing.

Uh uh, that's all I have for you, Dr.

Porter.

Appreciate you coming today and speaking.

I know we have Jeremy Lockers here, who's also been in the meetings.

Thank you.

Thank you.

Thank you.

Um, Miss Lockridge.

Well, good morning.

Sorry, Dr.

Dr.

Corter, thank you so much.

Okay, thank you.

My turn out.

Yeah, go ahead, Jaren.

Okay.

Um, good morning, council members.

My name is Jerry Hill Lockeridge, and I serve as the chair of the Ward 8 Health Council, and I also serve as a board member to Cedar Hill.

Um, and I come to you as a mother, a neighbor, um, with somebody deeply rooted in the health and well-being of the Great Ward Eight.

First, I want to acknowledge that Cedar Hill Regional Medical Center represents a piece of our comprehensive health care ecosystem.

For generations, um, East of the River residents have experienced gaps in our access to high-quality health care, timely and culturally responsive needs.

And we recognize that with the opening of this hospital, that it's not just about infrastructure, but it's about trust and dignity, and we're trying to really get this right.

Um, and I want to be really clear about what I'm asking for.

As a mother, um, the the well-being of our young people is is really key.

You know, I think that there's a real opportunity here, not just a opportunity, but a responsibility to be more intentional about what we're doing as it relates to our young people.

We have Children's National that's been here in the community for quite a while, whether they were at UMC, whether they're at the ARC or whether at the big chair, and they have very long, they've for a long time been a trusted provider when it comes to making sure that our young folks are taken care of, not just across the district, but especially here in Ward A.

So one of the things that I want to be clear and asking for is some really clear understanding as to what does our health care ecosystem for our young people look like?

What does the partnership between children's um in Cedar Hill?

What what are we doing there to make sure that it goes beyond just a name and affiliation, that it's true integration, that they have shared communication and pathways, coordinated referrals, um, and that the specialists that are at children's are a part of the ecosystem over at Cedar Hill as well.

I've recent recently had a conversation with a couple of different stakeholders within again our young people specifically health care ecosystem.

And while everybody's really involved with the adults, and I'm not saying that we don't, that's not important, but as a mama, I want to make sure that we have some family centered, culturally responsive care that's integrated into the community that we currently that we currently have, um, that the accountability and feedback feedback loops are really clear.

Um, making sure that this is more than just a single moment.

Um we've been open, this has been open for about a year now, and that this is bigger than just Cedar Hill, but again, how does this relate across the entire Ward 8 healthcare ecosystem when it comes to our young people?

You know, at the Ward A Health Council, we're committed to working alongside, you know, whether it be Cedar Hill, Children's National, or any of our community partners and doctors in the district, they make sure that the promises that have been you know given to the great Ward A are finally coming to fruition.

Thank you again for the opportunity to testify.

Um, my kids are on spring break right now, so if you hear them in the background, I apologize in advance, but I'm here for any questions you may have.

Um thank you, uh Miss Lockridge.

Been there, and everybody's seen my little interns on on the screen.

Um we're gonna do five minute um rounds with Ms.

Lockridge so that we can um keep things moving.

Um Ms.

Lockridge, I um I do have some questions for you, not just in sort of your capacity as the chair of the Ward 8 Health Council, but also as a member of the board.

Um and you and I talked about this, right?

Um, in some ways, all of us, many of us are living with a hospital operations agreement for which um we weren't there at the beginning for its signature or discussion or debate about it.

Um in fact, when I was um thinking and preparing for this hearing, uh the only two people who were here at the beginning when it was signed, um, on any side of all of the stakeholders, um, is the mayor and and Wayne Turnage.

Everybody else has changed.

Deputy Mayor for Planning and Economic Development, changed.

Head of UHS, change, head of GW, change, head of GW Medical Faculty Associates, change.

Head of Children's National, changed, right?

So, like, we're all, I want to acknowledge we are all dealing with a document that we did not write.

That being said, I had to go back to the document.

It exists, it's online.

We put it on for folks.

Um, Article 5 of the operate hospital operations agreement is on governance.

And its first line says the hospital shall be governed by a governing board.

A majority of whose members shall be appointees of the operating entity, including without limitation, officers and employees of UHS, DHP, or the operating entity.

At what point did the Cedar Hill board become advisory in nature?

Because the operations agreement says governing, not advisory, which is a confusing piece to me that I haven't been able to get an answer to.

It's not my understanding that we are an advisory board.

It's my understanding that we are a governing board.

Okay.

Um, how do you know how many seats are currently filled?

How many are vacant of the board?

I've I've been asking.

See when every other hospital, I can go to their hospital website and I can pull up who their board is.

I tell you who's on the board at Children's.

I can tell you who's on the board at Medstar.

I don't know who is on the board at Cedar Hill.

How many seats are on the board?

It's my understanding that there are 13 seats on the board.

Okay.

Are there 13 members currently?

There are 11 members currently, is my understanding.

11 members currently.

How often does the board meet?

Quarterly.

Okay.

When was the last meeting?

Give me one second, I'll pull up my notes.

Okay.

So in your understanding of it being a governing board, was there in terms what was the onboarding for the board like?

Was there an explanation in terms of here are your roles and responsibilities?

Here's how often we're going to meet.

We have a stop coming up soon.

So I'm sorry?

We're having a board retreat coming up soon.

So a lot of those details will be fleshed out in our board retreat coming up.

So a year in the board is now having its retreat.

Correct.

Okay.

Okay.

Um when the board raises concerns or makes recommendations.

How are those handled by hospital leadership?

Or has that not occurred yet?

It has definitely occurred.

But I also want to be clear that we have a board chair that I feel like might be more appropriate for a lot of these questions.

So I want to, you know, make sure that I'm not stepping on any toes as it relates to our official board roles.

Okay.

That's fair.

Um I think we did invite the chair to join us, um, and he declined.

Uh offered a phone call instead, but it's a public hearing, so we gotta have some of these questions on.

So I appreciate you um sort of putting in on that.

Um, in terms of your ward eight health council hat, um, you know, we've certainly heard of some um experiences of folks being unsatisfied.

What do you think are are is one of the biggest barriers currently facing the hospital from a perspective of connecting with the community?

I would say that there has been, as you mentioned, the beginning of the hearing, significant leadership turnover.

Um, so that the people who made the promises a year ago, two years ago, three years ago, four years ago, are no longer in those roles, so they're not the the promises aren't holding true to what the what the community, you know, what was told to us and sold to us.

Okay.

Um so the hospital operation agreement requires UHS to establish a patient and family advisory council that includes community representatives from Ward 7 and 8.

To your knowledge, has that council been established?

Not yet, but it's my understanding that it is in the process of happening per a recent conversation with Ms.

Daniels.

I know that there was the community advisory council prior to um you know where we are now that was that was sunset and there was supposed to be a patient advisory council, but it's my understanding that it has not happened yet.

Okay, and but it's your understanding that the community advisory council has been sunset, correct?

Okay.

The letter from UHS response to me, they said that that community advisory council meets quarterly.

But I'm over my time.

Councilmember Parker I'm gonna generally pick up on the theme.

Um, and I don't know if I've met you, Miss Lockridge, so it's nice to meet you.

Uh, in terms of your governing role on the board of the hospital, what do you see as the board's responsibility?

So I think that there are a couple of different roles within the makeup of the book of the board.

There are UHS representatives, they're community representatives, their government representatives, as well as GW representatives.

I think that together we're all responsible for overseeing and and making sure that the hospital runs to the best of its ability with the resources and support that we currently have.

And what does that look like in terms of accountability?

So there are negative reviews, uh metrics aren't being met.

You alluded to high turnover.

What is the board's role there and how is that being discussed in terms of what action steps you're gonna take?

So we're currently, as I mentioned earlier, we're in the process of fleshing all of those details out.

Unfortunately, when we were on boarded, it was not clear as to who was sitting in what role and why we have recently undergone um elections to have officers with within the board, and I want to know I am a board member, however, I'm not an officer within the board.

I am not a I am a community representative trying to do the best that I can on behalf of Ward A residents.

Understood.

Oh I wanted go ahead.

Sorry about that.

Um I think there's a lag, so I don't mean to talk over you.

How many community members hold um elected office on the board?

So our board chair and our vice chair are both community members.

Okay.

And again, I just want to come back to the um accountability piece.

So when there's leadership turnover at the hospital, how is that discussed or brought to your attention as a board member?

Within the leader, the C suite, I'm assuming you mean of the hospital.

Sure.

Yes.

It is brought to us within our quarterly board meetings.

And I'm assuming it's shared as an FY or you being asked for input engagement in any way.

No, we it's being shared as an FYI.

We are not being asked for engaged.

We are not being asked for input about how they are handling their roles and responsibilities.

We heard testimony and I'm uh earlier today, and I'm sure this is gonna come up that there's um a struggle in getting these community physicians into the hospital.

What discussions, if any, have you as a board had about that?

So we had a meeting.

We had a meeting with the community doctors.

Um they actually were a part of our most recent board meeting.

Yeah, the community doctors were a part of our most recent board meeting when the previous CEO also um you know announced that he was no longer gonna be um in his role.

So we we met with them as well and heard from heard from them as well.

Okay.

Are minutes kept of your meetings?

Yes, they are.

And are you able to share with the committee uh notes of the committee's uh key actions over the past year?

I believe our chair and the board secretary can share that with you.

And I I believe one I believe one of our board members is going to um testify later on today in this hearing.

Okay.

Uh I will be sure to ask them.

Um, and on the record, I'm asking if you can assist as a board member, uh, the committee would like either the minutes uh from past meetings, but generally, what principal action steps has the board taken over the past year that is contributing to the success of the institution.

So I will definitely support and provide um provide you know whatever support I can with getting those minutes to you guys.

Um and I'll say there's been there have been a number of conversations that we've had as a board, whether it be within the board meeting, um, some of our on-the-side conversations, and I also say in my capacity as the chair of the Ward A Health Council, I have done several things to try to connect the dots um as it relates to again our our health care ecosystem, recognizing that Cedar Hill represents about 20% of the whole ecosystem and the other 80% also need traditional support.

So whether that's the FQHCs, the community-based organizations or our MCOs really trying to strengthen the pathways and the referrals while using Cedar Hill as a lightning rod of investment within our ecosystem, but understanding that it's not the silver bullet that some people are trying to make it out to be.

I hear you loud and clear.

Well, thank you for your testimony.

If you want to also follow up with recommendations for how the committee can support that ecosystem, I would be open to receiving and engaging with you on that as well.

Absolutely, I appreciate it.

Thank you.

Thank you.

Um thank you, Miss Lockridge.

And I just want to say um when uh the mayor's office was sort of pitching this project in terms of the hospital and the agreement with UHS.

I wasn't on the council at the time.

I think I might have been a staff, maybe maybe not.

Nonetheless, I was a resident.

I was a citizen.

And one of the things was that the district wanted to get out of the business of running the day-to-day to a hospital.

Um, and so this has been sort of the challenge is because um our oversight is a little bit different here than it would have been under United Medical Center.

United Medical Center, they testified every year.

Um I saw their budget, I saw them during performance.

We had their meeting minutes, we had all of this other information.

That isn't not necessarily the case for all of our private institutions.

Um there's some basic information that's publicly available, like who's on your board?

I can find that on anybody's website.

Um so we're trying to find this balance here because at the end of the day, I'm not trying to micromanage the operations of a hospital, but I do have a contract, right?

It's it's a contract.

So I got I gotta go by what the contract says, and are we doing what the contract says?

And so um and and providing the service to the to the investment that we've made.

Um Ms.

Lockridge, thank you so much.

Um I mean further questions.

Councilmember Trion White um had to jump, but he'll probably be back.

I'm still here.

I'm still here.

Oh, I didn't see you.

Okay.

Um yeah, I just want to make a quick comment because one of the things I was here on the on the council when we started talking about the conception of this hospital and where it needed to go, what we needed was about the specialties that was supposed to be offered.

Uh I don't see those yet.

It's been a year.

Um, I just want to put this on the record.

Like we need to get those specialties up and running at the hospital.

Didn't know uh you, Miss Hill Ackerish saw or spoke to us, heard that on the board or where we are to that.

Um we can ask uh the leadership of the hospital as well, but you have any thoughts on the specialties that are supposed to be offered, that's not yet offered yet at the hospital.

Well, I do know that there have been a number of specialties that they have been um saying that they are gonna roll out.

I'm not exactly sure where they are in terms of overall.

Um, as you all know, the black maternal health crisis is near and dear to my heart and that labor and delivery OB space.

Um it is I do know that they are doing tour tours of the maternity space and understanding now.

So I am hearing that there are some specialties up and running, but I don't know the extent of where they are in terms of all of them.

Thank you.

I just also want to note that whatever the conflict is between MFA, UHS, GW is really hindering the progress of getting a high quality health care service in uh DC, you know, and I just want to put that on the record as well for you.

Chairwoman Henderson, so we can just kind of dive into that at some point.

Um, Councilmember White, if you just wait, the next panel uh has all of the individuals that you were just talking about.

Okay, great.

Great.

All right.

Thank you, Miss Lockridge.

Um, so we're gonna go to our next panel.

Uh Jason Barrett, DC Region Group, VP for Universal Health Services, Kimberly Daniels, who's the interim uh CEO of Cedar Hill Regional Medical Center.

Uh William Elliott, who's the CEO of the Medical Faculty Associates, and Dr.

LaQuandra Nesbet, who is the executive director of the Center for Population Health Sciences and Health Equity at the George Washington University School of Medicine.

Okay.

Um Miss Daniels, my understanding is you're providing or Mr.

Barrett, you're not doing testimony.

You're just here for to answer questions.

Is that correct?

That's correct.

Okay.

All right.

Miss Daniels, when you're ready.

Hold on one second.

Um, because you're a little shorter than everybody.

You're gonna have to pull the mic towards you.

Just so we can hear you.

There you go.

Perfect.

All right, thank you.

Can you hear me okay?

No, I usually have to advise witnesses to sort of just hug it a little.

I guess I gotta get close to the table.

There we go.

Is this better?

Much better.

Yes, there you go.

Wonderful.

Thank you so much.

Um, good morning, uh, Chairwoman Henderson and members of the committee on health.

Thank you for the opportunity to discuss Cedar Hill's progress, current operations, and plans to expand access to high-quality care for residents of ward seven and eight.

My name is Kimberly Daniels, and I serve as the interim chief executive officer of Cedar Hill Regional Medical Center, a role I assumed in late January of 2026.

As noted in our letter, we share the council's and the community's expectation that Cedar Hill operate at the highest level of quality and performance.

We also understand the history of health care in East Washington and the reasons for strong community interest and at times skepticism.

While aspects of our first year, particularly public engagement, fell short of expectations.

We are making the necessary adjustments and are committed to building a strong and transparent partnership that improves health outcomes for generations to come.

Like many new hospitals, our first year involved a learning curve.

I am pleased to report that Cedar Hill has integrated into the district's hospital ecosystem more quickly than anticipated.

Based on emergency department volume, we are already operating at a competitive level with long-established hospitals.

Cedar Hill has effectively replaced United Medical Center as the primary provider east of the river, with patient volumes surpassing those of our predecessor within our first year of operation.

The number of patients we serve reflects the trust placed in us, and we take that responsibility very seriously.

We are especially proud to have restored maternal health services east of the river, filling a critical gap that has existed since United Medical Center closed its obstetrics unit in August of 2017 and permanently ended those services later that year.

Today, families in Ward 7 and 8 once again have access to safe, high-quality maternity care close to home.

This represents a meaningful step forward in advancing health equity in the district.

To provide additional context, Cedar Hill now operates one of the busiest emergency departments in the district, with visit volumes exceeding those of several established hospitals.

Our patients also present with higher levels of clinical complexity, reflecting long-standing disparities in health outcomes in the communities we serve.

These realities require more intensive staffing and care coordination, and we are continuing to evolve our approach to meet those needs.

At the same time, our inpatient admissions are strong and growing.

Cedar Hill averaged 359 admissions per month from July through December of 2025, compared to 228 during the same period at United Medical Center in 2024 and an average of 281 in 2023.

This growth reflects strong patient demand and confidence in the care we provide, as well as effective operations that can meet and sustain higher inpatient volumes.

It demonstrates that a well-run hospital can not only replace prior capacity but exceed it while delivering consistent high-quality care.

Importantly, this growth is supported by a broader coordinated system of care.

As shown in our urgent care data, Cedar Hill's Urgent Care Center has consistently served between 1,100 and 1,900 patients per month since opening.

Cedar Hill is not just a hospital, it is an emerging system of care.

Urgent Care absorbs visits that might otherwise present in our emergency department, allowing the hospital to focus on higher acuity patients and deliver better, more efficient care overall.

Together, these services expand access, improve patient flow, and ensure that residents receive the right level of care at the right time.

Despite this progress, we recognize there are ongoing challenges, and I would like to address a few directly.

There are four issues that I want to address here that have been highlighted in the public.

The first is accreditation.

Cedar Hill followed the standard process for new hospitals seeking Medicare certification and joint commission accreditation.

After obtaining licensure and beginning operations, we underwent a comprehensive and unannounced survey conducted by the joint commission.

This included detailed reviews of patient records, clinical practices, and operational standards.

Cedar Hill achieved its accreditation on September the 4th, 2025.

The second issue is that of staffing.

Like hospitals across the region, we have faced staffing challenges, particularly in nursing and specialized roles.

While conditions have improved, the labor market remains competitive.

We are continuing to invest in recruitment, retention, and workforce development to maintain high standards of care.

To strengthen our clinical workforce, we are in advanced discussions with the George Washington University and its medical faculty associates regarding a potential transition of physician employment and clinical operations.

We expect this to enhance staffing stability and expand access to care at both Cedar Hill and George Washington University Hospital.

At the same time, since March 1st, we have established contractual relationships with several community physicians across primary care, cardiology, pulmonology, nephrology, and surgery, and we anticipate continued expansion of these efforts moving forward.

We are also building local workforce pipelines.

Cedar Hill participates in the DC Hill Apprenticeship Program and partners with City Works DC and the Department of Employment Services.

Through these efforts, we are training and hiring district residents and building a sustainable workforce rooted in the community we serve.

We currently have approximately 574 full-time equivalents on staff and have exceeded our hiring commitments regarding district residents in every category except pharmacy technician.

We are actively recruiting to fill vacant nursing positions, a challenge shared by providers across the region.

At present, we have approximately 67 RM vacancies, which are being covered by nurse staffing agencies.

We are optimistic that our efforts will yield positive results in the future.

From my time at Cedar Hill, I have seen a team that is deeply committed to delivering high-quality care, and it is truly my honor to lead such a group of dedicated professionals.

The third issue is that of the emergency department.

Cedar Hill has scaled its emergency department quickly and effectively with utilization levels that reflect strong community demand.

We recognize that there were challenges early on, particularly as demand exceeded that of United Medical Center.

We remain focused on continuous improvement.

We have made meaningful progress in reducing wait times and improving patient flow, including reductions in patients leaving without being seen.

Over the past six months, the median wait time from patient arrival in the emergency department at Cedar Hill to physician evaluation has been 48 minutes.

While there is still considerable room for improvement, this performance is comparable to hospitals across the district.

An average of 3.6% of our patients have done so, which is well below the 6% national average reported by CMS in 2024.

Nevertheless, our goal is to ensure that every patient has a positive and timely care experience and remain committed to further improving these outcomes.

Looking ahead, UHS is developing a freestanding emergency department in Ward 7, scheduled to open in December 2028.

While initial timelines anticipated an earlier opening, delays related to site readiness that are out of our control have shifted that schedule.

This facility, combined with our urgent care center and planned outpatient clinics, will further strengthen our system of care by expanding access points and reducing strain on the main hospital.

Finally, community engagement.

Cedar Hill is committed to consistent and transparent engagement with the community.

In 2026, we are expanding our community programming to address long-standing health disparities.

We plan to convene the both the community advisory board and the patient family advisory committee in the coming months.

We will also submit our first annual quality report by the end of May 2026, reflecting a full year of operations.

In addition, we welcome ongoing engagement with the council and district leadership to provide regular updates on our progress.

The last issue is that of the immediate jeopardy.

During a February 23rd, 2026 survey, Cedar Hill was cited with an immediate jeopardy finding based on the D on DC Health's finding that the hospital failed to ensure timely provision of surgical services for a patient.

Notwithstanding, Cedar Hill leadership implemented immediate corrective actions, and DC Health lifted the IJ finding the very next day on February the 24th, 2026.

An immediate jeopardy is a citation issued by a surveying agency at one or more specific areas in a hospital, which requires immediate corrective action.

The entire hospital was not found to be an immediate jeopardy institution, nor designated as an immediate jeopardy hospital, as some have correctly stated, incorrectly stated, excuse me.

There was merely one area, surgical services, where the surveyors and their subjective view determined the situation met that criteria.

As stated, the deficiency was remedied in one day, and the immediate jeopardy finding was lifted.

The hospital is not in jeopardy of closing due to this issue.

Further, contrary to false claim that only a tiny number of facilities have received an IJ finding in the country, immediate jeopardy citations, while unfortunate, are not uncommon.

In fact, in the past five years, there have been almost 700 immediate jeopardy citations at hospitals nationwide, including many well-respected and well-known national and local institutions.

Cedar Hill Regional Medical Center remains committed to upholding the highest standards of care and compliance with all regulatory requirements to help ensure the safety and trust of our patients and community.

When deficiencies are noted and occurrence that happens at all hospitals, immediate remedial actions are implemented to alleviate any such matters.

In conclusion, please know that the entire Cedar Hill team and I are fully committed to building a hospital that delivers high quality care, earns the community's trust, and makes the district very proud.

I look forward to working in partnership with you to continue this progress.

Thank you, and I'm happy to answer any questions.

Thank you.

Mr.

Elliott.

Good morning, Councilmember Henderson, members on the Committee of Health, and fellow invited guests.

My name is Bill Elliott, and I am honored to serve as the Chief Executive Officer of the GW Medical Faculty Associates, or as we commonly refer to it, the MFA.

I have more than two decades of administrative experience leading high performing multi-specialty academic faculty group practices.

I genuinely appreciate the invitation to participate in this round table on Cedar Hill.

The subject of today's discussion is critically important to me and my organization of more than 500 physicians and nearly 200 advanced practice providers, nurse practitioners, and physician assistants.

The MFA is a nonprofit physician group practice made up of the academic clinical faculty of the GW Medical School.

We are the largest independent academic physician practice in the D.C.

metropolitan area.

MFA currently provides comprehensive care and more than 50 medical and surgical specialties to patients at multiple locations around Washington, D.C., Maryland, and Virginia.

We are proud to partner with George Washington University School of Medicine and Universal Health Services to provide innovative, high quality and equitable clinical care to global, national, and local communities.

Importantly, MFA physicians live and work in the communities they serve.

Nothing is more important to these professionals than ensuring that all individuals, regardless of circumstance, status, or zip code, have the very same access to quality health care that they provide.

Many of them became physicians and chose to work for the MFA because of their unyielding belief and dedication to this very principle.

In connection with the focus of today's round table, I start by highlighting MFA's distinct role at Cedar Hill.

The MFA is responsible for providing physician and advanced provider staffing at Cedar Hill Regional Medical Center and the Ambulatory Care Center, both of which are operated by Universal Health Services.

These two distinct locations, the hospital and the ambulatory care center, represent separate spheres of responsibility for the MFA.

Each location is governed by different agreements and places different staffing responsibilities on the MFA.

At each location, pursuant to our contract, UHS sets the number of physician and advanced practice provider staffing it wants at the hospital and the ambulatory care center for specialty and subspecialty services.

The MFA then works to meet those numbers.

Under this agreement, the UHS with UHS, the MFA must either one supply the physicians requested or two inform UHS that it is unable to do so.

This notification mechanism allows UHS as the operator of both the hospital and the ambulatory care center to identify community physicians or locum tenants to ensure appropriate coverage.

At all times, the MFA followed this process for physician and advanced practice provider staffing at both locations.

To be sure, challenges existed, and to be sure they continue to persist, but Cedar Hill Hospital was fully staffed with physicians since the opening of April 2025.

And as early as July 2025, the MFA was ready to support the ambulatory care center with nine service lines.

However, UHS did not open the center until December of 2025.

At that time, MFA provided physician staffing to support six service lines UHS decided to maintain at the opening.

I am honored to participate here today because I understand the objective of this round table is to chart collectively the future of Cedar Hill so it may live up to its promise.

Achieving this objective is more important to the MFA because it is made up of physicians who care deeply about the patients they serve.

Our physicians have a steadfast belief in the principle that all individuals deserve access to quality health care.

They have devoted their careers to bringing this principle to life.

Our physicians work very hard to ensure that the population of Ward 7 and 8 have access to quality health care, including by serving patients at both Cedar Hill Hospital and the Ambulatory Care Center.

When I prepared for today's round table, I reviewed the MFA's history of physician staffing at both Cedar Hill Hospital and the Ambulatory Care Center.

This history allows me to make two important observations.

First, the MFA worked in partnership with UHS, the operator of Cedar Hill, to ensure that a combination of MFA clinicians, locum tenants, and community physicians together provided the necessary complement of clinicians necessary for hospital operations when it opened in April 2025.

As you know, securing the necessary physician staffing is a process, and part of that process for particular specialties or subspecialties, the MFA was confronted with challenges.

For example, OBGYN, General Surgery, and Neprology.

The MFA notified UHS that non-MFA clinicians were necessary to support operations at the opening.

This challenge arose in part due to the unique recruiting timeline for physician roles.

Specifically, recruiting for an April start date is a challenge because most physician contracts start in June of each year given the operation of academic calendars.

As a result, it took longer than the MFA had hoped to identify and recruit high caliber performers for these specialties and subspecialties.

This recruiting process, which can take up to two or three years in some cases, is the same one we use at GW Hospital.

We use the same recruiting process because patients at Cedar Hill deserve the same quality of care as patients at GW Hospital.

UHS and the District of Columbia agreed to this principle in the operating agreement.

When I describe this challenge, please know that it did not result in any physician staffing shortfall at Cedar Hill Hospital.

To the contrary, prior to opening in April 2025, the MFA notified UHS of these recruitment challenges for particular provider specialties and subspecialties.

UHS then worked very hard to ensure that any of these identified gaps were filled by a combination of locum tenants and community physicians when the hospital opened.

As an epilogue, by June of that year, the MFA had found permanent physician staffing for almost all specialties.

Through the UHS and MFA partnership, Cedar Hill Hospital has maintained sufficient provider staffing since its opening.

The second observation I make is that at the request of UHS, the MFA began providing physician staffing at the ambulatory care center in December of 2025.

The MFA worked throughout 2025 to prepare for the center's opening and had the staffing and financial support available to act when called upon.

Any suggestion that financial issues or economic difficulties impeded the MFA's ability to provide necessary physician staffing at either the ambulatory care center or Cedar Hill Hospital is simply incorrect.

It's wrong.

The MFA has consistently received financial support from GW that allows it to provide the necessary high-quality physician compliment at both facilities.

While the MFA is currently providing physician staffing for sick service lines and growing as requested by UHS, our physicians and advanced practice providers remain at the ready to serve Cedar Hill.

And that availability, that readiness is emblematic of MFA's efforts to serve Cedar Hill community in partnership with GW, UHS, and the District of Columbia.

We remain committed to acting with diligence, transparency, and open communication.

I look forward to our discussion.

Again, thank you for the invitation to address you today.

Thank you, Mr.

Elliot.

And Dr.

Nesbet.

Welcome back to the table.

Thank you.

Good morning, Chair Person Henderson and members of the Committee on Health.

Thank you for the opportunity to testify today regarding community engagement, education, and training programs at Cedar Hill Regional Medical Center.

My name is Dr.

Laquan Dranezbit, and I serve as executive director of the Center for Population Health Sciences and Health Equity and Senior Associate Dean at the George Washington University School of Medicine and Health Sciences.

I am pleased to share how our work at GW reflects a deep commitment to community partnership, health professional education and training, and improving health outcomes for residents of our community.

At the George Washington University School of Medicine and Health Sciences, at the core of our shared values is the understanding that meaningful, sustained community engagement is essential to improving health outcomes.

Our approach goes beyond consultation with community.

We are building structures that position community members, service providers, and patients as co-creators of health solutions.

GW has established a formal structured approach to community engagement that aligns with our contractual responsibility to support population health research and respond to community-identified needs.

At the outset, I would like to briefly explain the commitments GW has made with respect to Cedar Hill as set forth in the Cedar Hill Professional Services Academic Affiliation and Research Agreement between GW, the Medical Faculty Associates, Universal Health Services, and Cedar Hill, or the CHAP for short.

Under this agreement, GW agreed to utilize its expertise as an academic medical enterprise to develop research programs related to addressing the underlying conditions leading to health disparities for community residents.

We also agreed to implement community-based outcomes and population health research for patients with chronic and or complex complex conditions and support additional health needs identified in the districts or UHS's community health needs assessment.

GW also agreed to develop and or expand residency and fellowship programs, develop a new family medicine residency program, and provide students, residents, fellows, and interns for patient care activities.

In 2023, as part of this undertaking, we launched the Cedar Hill Alliance for Health Equity, a community-centered initiative designed to bring together residents, community-based organizations, clinical providers, and GW faculty and research staff to work together in interdisciplinary teams.

The alliance ensures that the lived experiences, preferences, and priorities of the community directly inform how care is delivered, how programs are designed, and how population health research areas are prioritized.

Since its launch, this work has translated into tangible action, including community engagement in the design of programs at GW's Cancer Center located on the campus of St.

Elizabeth and GW's Center for Global Mental Health Equity, training over two dozen community providers and evidence-based interventions to support behavioral health.

Importantly, our engagement efforts are ongoing and evolving.

As part of our sustained commitment to shared decision making and accountability, GW is currently leading a new community-driven health needs assessment titled, What Would You Like to Be True?

This initiative invites residents to identify not only health challenges but also their vision for healthier communities.

Through facilitated discussions and workshops, residents are helping map root causes of health issues and co-develop solutions that will inform a community health improvement plan.

However, implement implementation of that plan will require sustained funding.

At present, there is no identified dedicated funding stream to support execution of this community health improvement plan.

Without that investment, the impact of community engagement efforts GW had envisioned spearheading will be limited.

In addition to community engagement, our partnership at Cedar Hill reflects a strong commitment to building a diverse community responsive health workforce.

Under our agreement, GW serves as the exclusive partner for education and training programs at Cedar Hill, spanning medical students, residents, fellows, and allied health professionals.

We have made meaningful progress in designing an interprofessional education model that brings together medical students, physician assistant students, nursing students, and other trainees.

This model emphasizes team-based care, aligning training needs aligns training needs with real-world clinical environments, and prioritizes patient-centered care while supporting learners.

Our goal is to prepare a workforce that is not only clinically excellent, but also equipped to address the complex health and social needs of the communities they serve.

Another key component of the interprofessional education vision is the development of a family medicine residency program intended to address the critical shortage of primary care providers in Ward 7 and 8, areas designated as medically underserved.

Over the past two years, we have taken several foundational steps.

We have established a joint committee with hospital partners to guide planning, conducted detailed assessments of accreditation requirements and financing pathways, reestablish the Department of Family and Community Medicine to support the program, and initiated partnerships discussions with community-based health centers to ensure adequate training sites for continuity of care.

However, despite this progress, the development of the family medicine residency program is currently paused due to uncertainty regarding sustained funding support.

As you know, graduate medical education programs require stable, multi-year financing to support faculty, residents, and educational and clinical infrastructure.

Without institutional or partner investment to bridge the prior to period prior to federal funding, these programs cannot move forward.

In closing, I want to emphasize that GW's work in Ward 7 and 8 reflects a broader commitment to advance health, strengthen communities, and build a health professional workforce that meets the needs of the district.

As we stated when Cedar Hill first broke ground and when the hospital opened, we believe Cedar Hill has the potential to dramatically improve health outcomes and reduce health disparities in Ward 7 and 8.

Based on our academic experience, three factors are key to success as we move forward.

First, community engagement must be resourced to be effective.

Planning processes alone are insufficient without funding to implement community identified priorities.

GW has demonstrated that authentic community engagement is not only possible, but essential to improving population health.

We have launched population health research and community health programs and created pathways for innovation grounded in community voice.

We have built the infrastructure, partnerships, and program designs necessary to continue to implement research programs related to addressing the underlying conditions leading to health disparities for community residents and for those living with chronic and or complex conditions.

Second, workforce development, particularly in primary care, requires upfront investment.

The absence of funding for residency programs will perpetuate provider shortages in medically underserved areas.

At the same time, realizing the full promise of Cedar Hill Regional Med Regional Medical Center as a hub for training and care will require sustained investment in undergraduate medical education, graduate medical education programs, and allied health.

Third, alignment between hospital operators, academic partners, and public stakeholders is essential.

Fragmentation and funding or strategy or or strategy directly limits the ability to deliver on the intended mission of Cedar Hill Regional Medical Center.

Irrespective of funding from UHS, GW remains committed to working with the Council and our partners to ensure that Cedar Hill Regional Medical Center achieves its intended role as a high quality, community responsive teaching hospital serving the residents of Ward 7 and 8.

Thank you for the opportunity to testify, and I welcome your questions.

Thank you.

Thank you to this panel of witnesses.

We're going to do 10 minute rounds to try to be efficient.

Okay.

We'll see.

We'll see.

Okay.

Thank you all.

Let me say at the outset, thank you for being here.

Also thank you for the meetings that we've had prior.

I will let you know too that I've read every report that DC Health has done, inspections of Cedar Hill.

And so that goes into a little bit of our questioning as well from the regulator.

So the hospital operations agreement clearly assigns responsibility across UHS, GW, and the MFA.

From your perspective, has coordination broken down.

How often are the three entities talking to each other about the operations of the hospital?

Go forward.

I guess I'll dive in.

The water is warm.

First and foremost, good morning.

I'm Jason Barrett.

I'm a group VP for the DC region with UHS.

Yes, we meet quite often.

And as you I think to give further context and be thoughtful about the answer, and certainly I would invite my colleagues to speak to this as public record in real in-depth conversations about the acquisition of the MFA by UHS.

And just by way of background, I think you recognized that the university made a decision last January that the financial strain was undermining or largely their academic mission.

So we have been working in concert with the university and the MFA in structuring this transition.

You know, and I think it bear and I think it goes without saying that this is a very large acquisition.

It is.

No, I understand, but that protracted negotiation has played a direct role in the operations of the hospital.

Okay.

Hence why I was giving background.

And to the point of we're in a spot where the MFA was losing $10 million a year, that's after 110 million dollars worth of funding from UHS.

So we are in a position, and I believe the broader point I'm making here is that the three parties, really four parties, if you include the district, have been working in concert.

I will say the protracted negotiation has under has impacted the operations.

However, I feel very bullish about where we are now.

I think we're at the 11th hour of coming to an agreement, which will not only sustain operations at Cedar Hill, but for the broader district.

Okay.

At the um well, then let me ask you this way, since we're going to talk about it.

I I wasn't planning to, but since we are.

Um Mr.

Elliott, your testimony says that what has been happening in terms of the negotiations between GWMFA and UHS or the university has not impacted staffing, correct?

Physician staffing.

Okay.

So Mr.

Barrett, then how has that impacted the operations if staffing has not been impacted?

Well, and and I have a dear you know affinity for Mr.

Elliott.

So I will just simply say this.

You know, I I disagree with the assertion.

Um and that's borne out.

There's a difference between readiness and sustainability.

Okay.

And that's borne out by the use of locums.

I didn't want to talk about it today.

I know.

All right.

I got a lot of other things I want to talk about.

So picked the opening date for Cedar Hill.

Anyone remember?

I know most of y'all weren't there, but the free dates beam.

Who picked April?

Seems an interesting time given Mr.

Elliott's testimony that April creates a challenge in terms of recruitment given that June is usually when we do physician acquisitions in terms of aligning with the academic year.

Anybody remember?

Okay.

Okay.

Uh Dr.

Nesbitt, I think you may have still been with district government when the hospital operations agreement was initially signed.

Uh is that correct?

I I was, but I was also managing a public health emergency.

Okay.

Who wrote the agreement?

Which agencies were engaged in that?

Mostly the city administrators office, I think was the lead for most of the activity at that time.

Okay.

All right.

Okay.

Um there was a uh February report from DC Health that reads in part, Chief Operating Officer confirmed that a planned 16-bed medical surge unit was not open.

Um it is worth noting that this unit had 16 licensed medical surgical beds, but has not been used since the hospital opened.

How many bays or beds are we currently operating with now?

So we have we have um 48 med surge beds that are currently operating and open.

Um 20 ICU beds that are currently operating and open.

Okay.

Um I know that you all have been using a lot of temporary or excuse me, travel nurses.

What does onboarding look like when you're bringing on a travel nurse to ensure that they are complying with the protocols that have been outlined?

Sure.

So initially when they're on boarded, they come into a one-day orientation.

Um during that one-day orientation, they learn about the basic hospital policies and procedures.

Um the second and third days, they are taken directly into a skills training.

And in that skills training, we're assessing the competency, making sure um that they have the appropriate skill set to administer basic nursing care.

Um, in addition to that, we have educators on board who are providing ongoing training.

Um, when they get to the unit, the expectation is that they would have um elbow to elbow support by the educators who are um dedicated to those specific units.

Okay.

Um so I'm assuming the educators are permanent staff.

The educators are permanent staff, yes.

Okay.

Is there any situation in which a um house supervisor would be a travel nurse?

There should not be an instance where a house supervisor is a travel nurse.

Okay.

How or at all um our clinical staff currently shared between Cedar Hill and Foggy Bottom?

Currently, there are no clinical staff.

We do not share nurses.

Um we are in the process of establishing a central pool for imaging, which is an ancillary service, but beyond that, we're not sharing team members.

Okay.

So anesthesiologist Cedar Hill has their own?

Cedar Hill has their own group of anesthesiologists.

That is correct.

And for surgical texts as well.

That is correct.

Okay.

Are they often all on call?

So we have our surgical techs who are on call, but during the on-call time, they are actually in-house overnight.

We have on-call rooms where they are spending the night.

Okay.

I've had a conversation with children.

They're not testifying today.

Um, but I I understand some of their particular concerns is for the awareness of the public.

Um the relationship at UMC, children's, when they were operating there, provided both their physicians as well as their nurses and their techs.

My understanding is that Cedar Hill, they are only providing the physicians.

Um are you all in the process of revising that agreement with Children's National?

No, we are not.

Okay.

Are we addressing some of the staffing concerns that Children's has raised?

Yes, we are.

So we have a joint operating council between the leadership at Cedar Hill and the leadership at Children's National.

Um through that, we are working through some of the issues of quality.

We're working through the issues of staffing.

Um we're working through the issues of communication, and we're working through the issues of the operations and the finances.

Okay.

Unfortunately, that predates me, so I am unsure of who was selected.

Okay.

Do you all made the selections, excuse me?

Do you all consider the board of Cedar Hill to be governing or advisory?

I I consider it to be advisory.

Okay.

So I read the hop hospital operations agreement.

When did that change become made and did anyone inform district government of this change?

So if I may, um trying to this is almost term of art, because the board of directors is UHS's board.

So that's to when dealing with indebtedness that deals with sale of facility, that deals with entering deploying capital, things of that nature.

That is the board of directors.

The board of governors throughout all UHS facilities is advisory.

So they oversee medical staff bylaws, they say oversee quality and safety, uh patient experience.

Um so there is a distinction, you know, almost term of art, I apologize, but that's how we frame it.

And I came from long time ago.

I, you know, it was a different board of governors and board of trustees at a different meeting.

Right.

So is the board at GW University Hospital advisory?

Yes.

Okay.

Um that's interesting.

Are you all comfortable with who's on the advisory board for Cedar Hill?

I would tell you one of the things that was distinct and noticeable to me and sort of comparing the two is that multiple chairs of the faculty at GW med school, nursing school, school of psychiatry, all of the they're on their board.

When I look at the list, at least the one that I have of the board of Cedar Hill, I think there might be only one person who has a medical background.

Well, and again, I'm not trying to be evasive.

But the in the structure of it, what we have and how the folks came to be, you know, the current makeup is 80 percent UHS, 20 percent district, and that can be selection, whether it's MDs, which we have on the GW board.

But we do want it to be more community-facing.

And, you know, and I think that we've heard that from you know, certainly our council members, um, it better it's a better representation for the organization.

I think there was a little bit of uh replicating kind of a GW model at Cedar, and it's distinctly different as someone who's run community hospitals for 30 years.

It's distinctly different.

But I would say, as someone, again, I wasn't here at the beginning, but Cedar Hill was never meant to be an offshoot of GW.

And I don't think anybody had this idea that it was just going to be some community hospital.

It was supposed to be a part of a network and a system.

And in the history of DC, particularly for East of the River, where residents have always had to go west for good quality care.

They wanted a hospital that is at the same caliber of GW, Sibley, Med Star Georgetown, et cetera, right?

So yes, we're making comparisons because we have to make comparisons.

Um and I think that who is advising matters from any sort of board structure, right?

I I deal with boards for charter schools when when it's great to have community members on, but when they don't have background in finance or curriculum or other things, it impacts the questions that they ask and it impacts how they provide input in that.

But I'm well over my time.

Councilmember Parker.

Thank you.

Mr.

Barrett, I'm gonna uh start with you.

Um what if you could level set for us in a 10 to 15 second headline?

What is the relationship between Cedar Hill, UHS and GW in your view?

Well, we were partners, certainly.

Yeah, I mean Cedar Hill is an you know, obviously a partnership with public private partnership with the city.

GW is our and the MFA are our academic and clinical providers.

Um so it's a partnership.

Um it's a complex one, as you can imagine.

Um and I think that you know the if there is a broader optimism not only for CEDAR, but for the broader district, is this alignment with the MFA coming under UHS will allow us to align on greater strategic initiatives because as you know, as a Fortune 300 company, we'll have the balance sheet to support their their sustainability.

And just quick follow-up there, what responsibility, and I don't mean this as a gotcha question, but there are clear challenges at Cedar Hill.

At what point do those challenges become the responsibility of GW and or UHS to step in more aggressively to meet those challenges?

Well, I can't I won't speak for my university partner or the MFA.

I will simply say that you know, any green field hospital, you know, it takes some time for lift off.

Now, no one's taking away that this was not the you know the launch that we wanted.

Um I think that we have been working more collectively now.

And again, uh, you know, for uh for the chairwoman, the reason I brought up the structural nature of this and the economic integration, it was fundamental to our ability to provide the type of care the decisions in Ward 7 and 8 deserve.

Understood.

Um what is the plan to establish or identify a permanent CEO at Cedar Hill?

And let me just say Ms.

Daniels, I've heard nothing but glowing reviews, and I'm not just saying that because you're sitting here.

I've heard that from folks at Cedar Hill, folks out in the community.

Uh but knowing that you're toggling between GW and Cedar Heel, what is the plan for permanent leadership?

Well, we are in the process.

There, you know, the the job is posted.

Um I wouldn't I'd be you know, I think that we're in a position where we are very proud of our pipeline within UHS and promoting within.

Um, certainly I think the watchword for CEDAR has been stabilization.

I would say Ms.

Daniels has done a wonderful job in that role.

Can you give me a window of time?

Next six months.

Six months.

Six months, you're hoping to have a new CEO.

In your view, Mr.

Barrett, what are the top priorities to turn the hospital around?

I think it well, there's certainly quality and safety is always your job number one.

Um but I would also point out that we have to build an amuletary network.

And that's why the partnership with Unity and Community of Hope and our community providers is so critical.

Um, you know, much of what we do today is largely based on the ED, and we've improved operations dramatically there under Ms.

Daniels' leadership.

Um but I would say that, you know, again, and then also the stabilization of workforce, which every health care provider is dealing with.

You know, building a team, hospitals are more than bricks and windows, you know, it's it's a culture, it's a soul, and it needs to represent that community.

So safety, ambulatory services, staffing general are key priorities.

Ms.

Daniels, I wanted to come to you.

I appreciate it you noting the work that is going into tackling long wait times and ER operations.

What are your plans for uh continuing to improve the efficacy of the emergency department at Cedar Hill?

In your microphone.

First is to stabilize staffing and leadership.

Um we just brought in a new ED director who has a number of years of experience across the country.

Sorry to jump in.

Sure.

What number uh leader is that for the emergency department?

I believe it's the second.

Okay.

I believe they previously had an ED director.

Um that role transitioned, I want to say, in the fall of last year.

And so this would be the second ED leader.

Okay.

Um second E D leader, I think they have may have been an interim in between the two.

So so third, if you count that.

Okay.

Yeah, it it's my in my notes, I have that there's been three um, or that we're now in our third leader.

Yes.

A follow-up question I have is how are those leadership changes contributing to the inefficiencies that we're seeing play out in the emergency department?

Admittedly, I do think that the it doesn't allow us to stabilize in the way that we need and build the consistency around meeting certain metrics.

You mentioned earlier the off boarding times from the ambulance, um improving the wait times, improving the left without being seen.

And so I think that it impacts operations in that way.

Now that we have a solid team and we have the leadership, not only do we have the ED director, but we also now have a permanent chief nursing officer who has worked at um Washington Hospital Center, very familiar with the DMV, has over 13 years of experience, and so works um and has worked in this community and is very familiar.

I believe that we are significantly um stronger than we have been in the past, and we are on the path to success and writing the ship in the ED.

I think what you will see is continuous improvement.

In terms of strengthening staffing, what's the plan to bring on more community physicians?

We heard earlier that there's a backlog, folks are applying, they never hear back.

What would be your response to that?

Yes.

So first I'd like to say that we've done a lot of work in the last eight weeks that I've been here.

Um we brought on family and community medicine.

Dr.

Daniel Moore, he is in our ambulatory operation five days a week.

He's seeing patients anywhere between 40 to 60 patients per day.

Um we've also signed on Dr.

Julian Cray, who is a pulmonologist who is starting with us.

Um we also have um cardiology signed on, but wants to start in um July 1st, I believe it is.

But we heard earlier there is at least 12 people who have applied who've never heard that.

And so my goal is to kind of go back and understand who those individuals are.

In my experience, I have not I am not aware of who those 12 individuals are and what the law backlog would be, but I am more than happy to go back and research that.

I can tell you that I did personally meet with all of those community physicians twice as a group and individually, one on one except for four, walk through the entire process of how they could partner with us based on what their intention was, whether it's was to become employed or whether it was to become simply just to have privileges or to lease space in our facility.

Um so I am not aware through those discussions or currently of any backlogs that have impacted their ability to move forward in the process, but certainly happy to follow up.

Okay.

So if folks are waiting for a response, they should call it.

Maybe they should call or reapply.

No, they should call me, but I will do a warm touch and I will proactively reach out to each of them.

Understood.

Yes.

Can I ask about compensation?

How does compensation for physicians and staff compare to other hospitals in the region?

So I'll have to defer that to uh Mr.

Elliott.

And the reason why I'm asking that as you come on, in what ways is that contributing to our staffing challenges?

I can speak to the physician component of that.

And we have a market standard schedule that we use when we recruit that is fairly competitive in the market.

So I don't know that the physician side of the recruiting piece, the the salary component has been a major obstacle.

With the average physician at GW or some other institution match the compensation at Cedar Hill?

It's actually a little bit more at Cedar Hill because it's not an academic facility, so there aren't the residents there and there aren't the actual support.

So the the schedule at Cedar Hill is actually a little more.

Okay.

And what about the other staff?

What I've heard is that compensation is a challenge for folks to sign up to come to Cedar Hill.

Yeah.

So I can tell you specifically with nursing, the compensation for nursing at Cedar Hill is higher than the compensation at GW.

Um we offer an incentive plan an incentive of a plus six per hour for each hour that the nurses are worked on top of their base salary, which puts them significantly over what the um nurses are making at GW.

Okay.

I'm running out of time in this round, this round.

Uh what information can we see in that quality report, Ms.

Daniels, that you are producing by the end of May?

So we are looking at all of our nursing indicators that would allow you to see kind of how we're performing with each event on things like our um uh falls, our mortality rate, our um uh infection rates, hospital acquired, um pressure ulcers, so on and so forth.

And is that report comparing Cedar Heel against itself?

It will be.

Or will you will I be able to re review that and see how Cedar Hill is stacking up against other institutions?

Yes, this is a public report.

You will be able to see not only how Cedar Hill is stacking up in the local market, but nationally as well.

So this is a date, this is a report that is benchmarked against national data.

Understood.

Okay, thank you.

You're welcome.

Um, Councilmember White.

Yeah.

Dr.

Daniels with the first round of questions.

Uh, how much does Cedar Hill lose last year?

How much is being lost on the on a monthly basis?

And I guess thoroughly, what is being done to get us going in the right direction?

Okay.

So first, um, Councilman uh White, I appreciate you promoting me, but I am not a doctor.

Okay.

Um I just wanted I don't want that on the public record.

Um, but last year um Cedar Hill lost, I believe it was about 54 um to 60 million dollars.

Um and when I met with you guys, you guys were citing some of that to getting started, getting everything done, being behind.

I guess my next question is what is being done to turn that around so we can eventually be profitable.

Yes.

So it is all the work we're doing from an operations perspective to build access.

Um that is our greatest opportunity.

Um our main entry point right now has been the emergency department, and we need to have more of a comprehensive um build.

We need to really focus on um bringing in elective surgeries and elective cases into the environment, and so that is what our focus is.

Uh thank you.

Um I would like to follow up on that later on because I have not heard something concrete to help us get it where we need to be, is just generalized statements.

I guess I know that you all reported at some point you were short 67 RNs have 67 vacancies and wanted to get those filled.

Are those filled yet?

So those are not permanently filled.

We're using travel nurses to fill those positions.

So, yes, we have bodies in those roles, but they're with travelers and not with permanent positions.

We're currently recruiting to fill those roles permanently.

I know there was a agreement that was uh between uh community-based organization out of time organization and GW originally about they were training nurses.

Do you know if that relationship is still ongoing?

I know they were training in Ward 8 under uh Ms.

Tanya Ritley.

Are you familiar with that?

I am not familiar with that, but happy to follow up.

Okay.

Um I do have a question I want to jump to Mr.

Elliott as relates to staffing.

Um you said in your testimony that Cedar Hill was fully staffed in April 2025.

I'm not sure if that's a correct statement.

Um this goes against what I've seen and heard from the community from being in meetings, particularly as it relates to specialty physicians.

Can you give some more information on that?

Sure, happy to.

So in April 2025, we were fully staffed with the start-up proposed start-up staffing um roster that was provided to us.

Other than from the MFA perspective, the the ones I mentioned, the OBGYN, surgery, and nephrology.

But working with my colleagues, we were able to fill those with locum tenants, so we were able to meet the needs of the community starting on April 2025.

So we did have enough physician staffing.

I can't speak to the other support staffing.

How many staff vacancies do we have in the executive level and at the I guess under the executive level currently at the hospital?

So at the executive level, all of our C-suite positions are filled with permanent leaders.

And all other stuff?

Except for the the CEO role.

What about uh all other staff?

Uh all other staffing, are you meaning director level staffing or the reason why I'm asking is because I get, you know, I've contacted you a few times, um, even before to your leadership, I get so many people contacting me saying I applied to the hospital, I'm getting no answer, I'm getting no call back.

Um, and then recently you all put out saying you are doing a job for your had a few hundred applicants, maybe a thousand, not sure.

That's what I'm asking how many of those positions have been filled, because at one point you all were short 500 staffers.

I'm not sure what that number is now.

That's what I'm trying to get to the bottom of.

So we have about 574 FTEs against a budget of about 634 in total for staffing.

So we have significantly narrowed the gap from a staffing perspective.

And this is the 600 plus and 34 positions, I think you said the couple of the hospital 24-7?

That is correct.

That seems like a low number.

So you also have to consider that we have contractors who also provide services to help with the operations of the hospital.

So we have contract relationships through CBE contractors who provide services to help support the hospital in addition to our FTEs, our hired FTEs.

So right now we have how many vacancies?

100 and what?

Let me get that number specifically.

I know we have 67 RM vacancies.

Let me get the number for the non-nursing vacancies.

Okay, while you're doing that, I want to jump back to Mr.

Elliott.

You said that any suggestion that the financial issues or economic difficulties impeded the MFA's ability to provide the necessary physical staff, physician staffing at either the ambulatory care center or Cedar Hill Hospital is simply incorrect.

Then I'm hearing, even heard from Councilman Parker that some of the issue may be money as relates to payment.

What is the breakdown into and the financials as it relates to getting these doctors what they need or staff what they need to be a fully run hospital?

I can speak to the component about providing salary and compensation for the providers that we have at Cedar Hill, as well as at GW University Hospital.

And we have never wavered on our commitment to Ward 7 and 8 in Cedar Hill, nor have we at GWUH.

We do not have directly the funds at MFA, but we have had continued financial support from GW to support all of our missions.

So we haven't haven't had any setbacks or delays in recruiting or payment of physician salaries and compensation ever.

To Mr.

Barrett's point earlier, it is unsustainable, but it hasn't kept us from continuing operations.

At some point there was a disconnect between the community doctors getting even an ear to the hospital, and now there's been some traction.

Early on, what were some of the burries and breakdown and those community doctors getting a uh a shot, as I may say, at working at the local hospital?

Do you want me to start with that one?

You can start with that.

Sure.

Sure.

I'm happy to start with that one.

And then if my colleagues want to add they can.

I had this conversation not too long ago about the community physicians and their engagement at Cedar Hill.

And from the MFA's perspective, we we support the use of community physicians and the engagement and participation.

The only time we may have had some hesitation there in the past is if we were already recruiting and had somebody who made an offer that was coming on board, we may have said, well, we already have that particular specialist who has resigned from their current job and moving their family to DC.

So we may want to pause on bringing in a community physician for that particular specialty, but we support the use of community physicians certainly going forward.

It can only help make the uh health care more robust.

So we're I hear you saying we support, but I haven't seen it materialize in reality.

Um even I heard uh Dr.

McPherson quarters say today that there has been some conversation, but now they have to start over.

So support meaning how what is how does support equals contracts?

How many of those doctors actually have contracts near the hospital now?

On the credentialing and an onboarding process, I may have to defer to my UHS colleagues.

I'm sorry, can you repeat the question?

I was trying to Yes.

Um he was saying that uh Mr.

Elliott was saying that there is a desire or some appetite to appease and make sure there's community-based doctors there.

Um, but it seems like it's just a desire.

I don't see where the contracts are because I did hear from the hospital based on our conversation back and forth that you all are making progress.

When I heard from Dr.

McPherson quarters today, she said that there were two doctors there, I believe, of that large number, and some didn't get contact back, and then they have to start the application process over again.

So the desire doesn't mean actual contract.

It just it just sounds like feel good words.

Where are we if actually bringing those doctors back so we can get the quality health care services from our community-based doctors?

Right.

So we're currently evaluating to um community contra community doctor contractors, contracts that would allow them to come and move their practices back to the facility on a full-time basis.

So in terms of the the tactical work that we're doing, we're reviewing the agreement, we're making sure that we're meeting the needs that the request of the physician and the physicians group, as well as making sure that we're working compliantly within our contractual relationships that we have with other partners.

With how many of the doctors that were listed?

So we have two independent of the of the individuals that have were in that initial community meeting group.

Um two of those individuals, we are looking at their contracts specifically of those initial of that initial group, some of them are not choosing to have contractual relationships in that way.

Um some of them have decided to simply just lease space in our facility.

I think I named about three or four of those earlier.

Over my time.

Thank you.

All right.

I'm gonna go to some of the um pre-hearing uh questions that I sent to you all and want to follow up on a couple of things.

So according to the responses, GW and UHS established a Cedar Hill Executive Steering Committee in February of 2023, which included GW faculty clinicians and US UHS administrators to plan research clinical and educational activities of the hospital.

When was the last time that this committee met?

Uh the last Wednesday in March of this year.

Um do any members of the steering committee now serve on the Cedar Hill board?

Uh no.

Um GW has two appointees to the board.

Um both of our appointees, one is a physician, faculty member who is um uh medical director for hospitalist services, Dr.

Juan Reyes.

The other one is a um nurse who lives in Ward 7 with a doctorate in health care administration, uh Dr.

Sharon Lewis.

Okay.

Um the prehearing responses, uh Dr.

Nesbit, you indicate that GW is the exclusive research partner for Cedar Hill.

However, the operations agreement seems to require UHS to work with a a wider group of partners to develop and implement a community engagement plan.

This kind of seems a bit conflicting.

How have you all been working through this tension?

Sure.

Uh so in um in UHS's uh agreement with the district, uh UHS has a requirement to uh do population health research and implement uh population health initiatives that are responsive to uh the long-standing health disparities uh and chronic health conditions that um have uh the residents of Ward 7 and 8 have um faced.

Um and they have to do it in a way that is responsive to the needs of residents of Ward 7 and 8 as the residents themselves have expressed them and in partnership with community partners.

Um and because GW as a university has expertise in approaches and strategies in doing that work when G UHS entered into an agreement with GW for clinical services or professional services, um academic affiliation and research, they passed those uh requirements from the district on to GW and had a financing or financial model for that.

So through a number of mechanisms, the university primarily led through the School of Medicine and Health Sciences has started to do that work, population health research, but we're doing it in partnership with community convened spaces.

Okay.

Um the executive steering committee had worked through 2023 to 2024 to establish a family medicine residency program, and GW had worked to start re-establishing its department of family and community medicine.

However, UHS recent recently informed GW that it wants to terminate that current academic and educational agreement and not commit to any future funding for the residency program.

Now, I'm going back to how this was sold to the community that Cedar Hill was supposed to be a teaching hospital.

So why are we deciding not to move forward with residency program?

Would you like me?

So um a couple things.

We are obviously in the nationwide, there's a scarcity of primary care.

We are committed to primary care.

Um but this again goes back to the broader discussion.

Um GW recently was not going to fund any of their fellows.

We UHS took that on.

So we are in a position of trying to deal with this broader acquisition, you know, which is you know, it's gonna be material impact to GW as well as CEDAR.

But we have every intention.

I actually just spoke with the dean about a family practice residency.

It's just we got to put one foot in front of the other.

Okay.

So it's not dead forever.

It's just uh postponed.

Yep.

Okay.

Um so we we need to be clear, however, that the responsibilities that UHS has to the district for population health research and its commitments that they have for the residency program that UHS has to make those investments, that the university cannot make those investments on behalf of UHS.

So we want to be clear about that.

Okay.

Okay.

I'm I'm clear in terms of how I heard it.

It's on pause, but the financial responsibility for unpausing would be on G on UHS in terms of move movement forward.

Okay.

Um so currently, right now, no one is training at Cedar Hill.

Is that accurate?

Correct.

Correct.

Okay.

All right.

Um there was a never mind, I'm gonna move on.

Okay.

Uh Ms.

Daniels, you mentioned um in your response uh, I think to Councilmember Parker that the nurses at Cedar Hill are now technically making more than the nurses at Foggy Bottom.

That wasn't always the case.

Um when was this change made?

That change was that change was made.

Um I want to say in the fall of 2025.

I can get the exact date for you, but it was in the fall of 2025.

Okay.

I I'm glad that the change was made.

I'm saying in terms of I had committee staff who just did sort of a let's look at what HR is sort of recruitment on all of the websites of all of the hospitals in the region, and Cedar Hill was the lowest.

Um so that I think might have um put into some of the things.

Um I want to ask more about community engagement because there's something I've learned about DC, and I don't know if it's DC specific, but I've been here for a while.

Um reputations are really hard to change once something has sort of seeped into the community.

Um there are people like even on the school side, you haven't been a student at that school for 35 years, but you still feel like it's bad, right?

These are some of the conversations that we have, and so one of my worries is that in year one, Cedar Hill has gained this sort of reputation, and so now I have to ask the question around like how do we um how do we fix this?

How do we sort of turn this around?

Um Dr.

Nesbitt, you mentioned that you all started the Cedar Hill Alliance for Health Equity.

Is that work still continuing?

Yes.

Okay.

How often is that group meeting?

And it is that a conduit for conversation around some of these things or no?

It is, and and Ms.

Daniels and I have had a number of conversations about that, and there are some of the work groups where some of the uh UHS and Cedar Hill staff are engaged, and we've talked about opportunities for um more collaboration in that space.

Um and it it has waxed and waned, and I think a function of that has been um the need for some of the uh Cedar Hill leadership and staff have been focused on clinical operations, but um under her leadership, there is an increasing um engagement of them in the work groups and as touch points for broader community engagement.

So we we our last meeting was Friday to answer your previous question about how frequently people are meeting.

Okay, so I mean Miss Daniels, what benchmarks should the committee, this committee use to measure success?

Yeah.

So I think that by this time next year.

I'm gonna give you a year.

Because you only been there for eight weeks.

And I think it's supremely unfair for us to sort of blame you for the things of the last eight weeks because some of this has been ongoing and baked in.

So a year from now, what does success look like?

Sure.

So I think what success looks like um from an access perspective, you will see a full complement of services, including all of your um primary care as well as the specialty services to amply take care of all of our patients inward seven and eight.

I think that what you will see um are as a result of that the metric you can use to um measure the success would be the volume.

Um you will see a significant increase in our ambulatory volume as well as an increase and likely an increase in our system-wide services when you consider the urgent care as well as the emergency department services.

Um I think quality from a quality perspective, what you will see um that we will be exceeding at least um on par, but likely exceeding our quality metrics from a national perspective.

Um from an equity perspective, you will see an improvement in the health care of the residents of ward seven and eight, and that will be measured by um the social determinants of health.

You'll be seeing an impact in that and a decrease in some of those issues around transportation, medication compliance, opioid addiction, addiction, um, so forth and so forth.

Maternal child health care.

Have you met with the team over at Whitman Walker?

Um I did meet with Whitman Walker on last week.

Okay.

Yes.

I don't like Miss Lockridge sort of said at the beginning.

I don't think that the hospital is panacea.

I don't think that a hospital can ever be panacea, right?

I don't want actually people have to come to your hospital, no offense.

But like success is your ED doesn't have a two, three hour wait because folks are going to the urgent care down the road and um seeing the doctors in terms of doing the preventative care over time.

Um so we have to think about this from a full system.

I don't think that Cedar Hill can handle everything.

You're not supposed to fix it all.

Um in that regard, I want to ask um Mr.

Barrett.

I'm I'm dang it, I'm over my time, but I'm gonna ask it anyway, sort of chair's prerogative here.

Um do we need a freestanding ED or would another urgent care work better?

And I'm asking that because I feel like with a freestanding ED, you're training people to come to the emergency room in some ways when we want them to not come to the emergency room for things that are not urgent.

That was one of the bigger financial challenges that Cedar Hill had in Q1.

82 percent of the people who came to your ED didn't actually need to be there.

So while there's sort of a pause on that project, I'm curious.

Can we talk about whether or not that's really the need in the infrastructure?

Well, again, if we're talking the broader concept that we're talking about, and part of that I believe the reason the district came on with UHS is they wanted an integrated system.

They we so we talk a lot about system cohesion.

And so the idea of decanting our ER for the tertiary, the acute, which is what we've done.

We have 35 freestanding EDs throughout the country.

It allows us to take on certainly a GW, the most acute, and then at CEDAR, it will afford us the ability not to be in a position where we're dealing with those that are truly um those that that fall into that category of treating street to use the the local language.

Okay.

I'm over my time.

Councilmember Parker.

Thank you.

Um Ms.

Daniels, I wanted to come back to you.

You mentioned that there was an immediate jeopardy citation that was found during the February 26 survey and that the citation was lifted the next day.

Correct.

How many surveys are outstanding to your knowledge outside of that one that was lifted?

Well, you define outstanding.

Uh the reason I asked that question is we had a recent survey in February, we've submitted our uh plan of correction.

Um we consider a plan closed is once that plan of correction is accepted, and then we have a follow-up visit within the requisite time to ensure that what we said we would do in that plan of correction has actually been completely.

That is correct.

Okay.

I did want to follow up.

There was a multiple on-site survey visit conducted last year.

Now, this was prior to your time and leadership, but I do want to ask about the the practices today connected to this.

The the visit was April 30th through May 5th with the follow-up visit on May 7, 2025, and it found pretty damning uh things at the hospital.

The hospital operated with insufficient staffing, resulting in four closed inpatient units.

Uh there were severe emergency department overcrowding, extended patient boarding with one individual, I believe, waiting up to 51 hours uh for a bid in a hospital.

And these so I'm trying to bring it to today.

How does the leadership determine that it is safe to operate uh the medical surgical units when closed, which is one of the findings of the report or the survey?

Will you ask your question?

Let me ask it a different way.

How does leadership today determine that the hospital or the units are safe to operate?

Okay.

So we have a capacity, a surge plan that allows that has certain triggers in it, allows us to know when we need to open up an additional unit or if we need to go on divert because we don't have either the space or the staff to take care of patients.

And so we follow that capacity management plan.

Okay.

And I'm assuming let me ask, when was that plan implemented or created?

Because presumably it didn't exist May of last year.

Yeah.

So that plan um I can tell you that I signed off on an updated plan when I started.

So that plan I can tell you that I signed off on an updated plan when I started, so in February, I believe that the date of correction to that plan or the date that it was last revised would have been in the fall of the the 2025.

Okay.

So yes, it would have been later than that initial visit.

And what what is the threshold for intervention for overcrowding or understaffing?

Because that was also uh identified challenge.

So there are several factors.

So one one we look at what we call a kneedox score, which basically measures the acuity level in the ED.

Um we also look at how many beds we have available on the inpatient units and the ability to bring those patients upstairs.

We also look at the staffing.

Um our staffing ratios on our med surge units are one to five.

So the you know, based on you know typical acuity, and so we ensure that we have the ability to take care of those patients safe safely at that ratio.

And so we look at all of those factors to be sure that we have both the capacity and the nursing staff and the tech staff to take care of the patients.

Another finding was that there was a hypertensive emergency with the individual.

This was on the news, I believe this person had to be metavaced away from the hospital.

I I thought this might have been a typo, but with blood pressure over 200, over 171.

I didn't even know one's blood pressure could get that high.

And it was misclassified as non-urgent by the hospital staff.

Again, now this is predated you, but my question is learning from these instances, what protocols are in place to ensure that these types of misdiagnoses don't happen.

Right.

So what I've done since my time at Cedar Hill is I take every um we have something called uh a STAR report where folks can freely under psychological safely freely report um incidents that they believe are either um near misses or situations that put us at risk.

I have um sorry, who files that any individual in the organization, any any employee um from housekeeper or on the other hand.

And who are they filing that to?

It goes directly into our system and our risk manager, she reviews each each of those incidents every single day.

Can those be filed anonymously or do you have to identify yourself?

You have to identify yourself because it goes through a system, but there is no retaliation.

Um again, it's under psychologically safety and a system of just call just care.

We don't um we encourage our team members to bring these forward because this is how we learn and to that point.

Um what I've done is I've taken each of those cases and used them as a case study.

We have an established 830 a.m.

safety huddle every single day, and we're reviewing those cases to be sure that everyone is aware of the issue, how we can avoid the issue in the future, and then in their huddle, when they go back to their teams, this is with the leaders, they go back to their teams in a huddle, and that information is cascaded.

Okay.

If I can make a recommendation, I think there could be benefit to making that anonymous because if I am worried about retaliation, maybe I do have valuable information you should know, but I'm not willing to risk my job to report it.

Just throwing that out there.

Um there were also findings that the uh physicians and nurses uh didn't record information accurately uh with this visit as well as others.

What escalation protocols are in place now as well as how are you vetting or verifying the information that physicians are documenting in people's records?

So I have implemented a um uh an audit process on all of the records.

We do something called an IPASS round every single day.

And so the nurses, the bedside nurse is responsible for doing performing that round um as part of that round, they have to do what we call a bedside shift report where they're actually handing off to the oncoming nurse as they are the offgoing nurse in front of the patient and sharing that information.

The leader of that unit, the unit-based leader is responsible, and this has to be documented in our in our EMR system.

The leader of the unit is responsible for pulling that information on a daily basis, reviewing to ensure that those um records have been closed, that they've been completed and documented, and then we report out in our safety huddle every morning at 8 30 what the compliance has been by unit.

Okay.

And now again, I'm not trying to shame and blame the hospital, but I do want to get to the bottom of some of these.

There is also a report of a wrong site surgery, maybe there are multiples, but one that I identified, or individual came in to have an appendix removed, and instead their ovary was removed.

They only found out that their appendix wasn't removed weeks, months later when they actually had to have their appendix removed at another institution.

Given the partnership with GW, it's my understanding that at least in the past, you would send specimens to GW for testing or follow-up.

How does that happen?

That I'm supposed to remove an appendix, I remove an ovary, I'm sending information to GW, and nowhere in that process does someone say, hey, there's an issue.

So what I will say is that unfortunately mistakes do happen.

I would say that every case at that level, so every case has is given a level, a harm level, if you will.

And then cases that are at the um the the most severe harm level goes into an immediate what we call root cause analysis.

So I just see my clock.

I'm sorry to jump in.

So can you just speak to the um the process where specimens are going to GW?

Is that still the case?

That is still the case.

So what is that process?

How do we ensure that there is a stopgap so that if there is something wrong, someone at GW is saying, hey, we have an issue here, because there was another hospital that ultimately identified that this individual's appendix was still intact?

The expectation is that the pathologist who is reading that is documenting that information and then is providing that follow-up information to the surgeon.

So what's the protocol today to ensure that we don't have another situation like this?

It's 100% auditing to ensure that we don't have any wrong site surgeries.

So every every morning I receive a report for any cases that occurred um throughout the 20, the last 24 hour period, and then we are actually going through and reviewing those through my quality um, my chief quality officer is going through and reviewing each of those cases on a daily basis.

Okay.

Last question.

I know I'm at time.

But how do you ensure that staff actually do feel uh safe to report unsafe conditions, that uh errors were made uh without fear of retaliation?

Sure.

So we've started a stop the line campaign and the stop the line campaign um is a campaign that allows the physicians to work alongside the staff to let them know that there is equity in the process, so that if I as a team member see that a physician um should not continue with a particular case for whatever reason, um that they are empowered to stop the line without any retribution or any retaliation.

Um this is collaborative I'm sorry, I'm not a doctor.

When you say stop the line, does that mean someone has the power to tell the doctor?

Exactly.

So a nurse, a tech can say we need to stop this case, or we don't need to move forward with this case because of whatever they're seeing.

And then we will we will immediately stop the case and do a review of whatever the particular issue is that is being addressed.

I have so many follow-up questions.

But just who's the arbiter in that like we have a sick patient in front of us, someone stopped the line.

Who gets to say the doctor is right or the tech is right?

Right.

So the escalation process would first of all would be the attending who's in the room.

Um if it needs to be escalated beyond that, it would then go to the chief medical officer.

If it needs to be escalated beyond that, it would then come to me.

Understood.

Thank you.

I'm over time, but thank you.

Of course.

Councilmember White.

Yes, thank you.

Um staff.

Someone was supposed to get back to me on that.

Ninety.

Ninety.

Yes.

Okay.

And could you speak to some what those types of positions are?

Um, those would be any non-nursing positions.

So those would be um tech positions.

Um I believe that we have um maybe three or four cooked positions in that um uh in that we have some ancillary positions like um radiology text um in that number, and then we have pharmacy text and that number as well.

So it would be non-nursing staff, and it could include um clinical team members in imaging as well as support staff persons in food and nutrition services.

So this is 90 plus to 60 plus nurses.

That is correct.

All right, got you.

Um in your testimony, you gave some uh record about getting seen in emergency room may take 48 minutes for initial person to be seen.

And I don't know if that speaks to I know it doesn't speak to an entirety time, because I think that you in your report that I read, it said about five, five and a half hours.

Um can you speak to the specifics of what that is you were explaining about the 48 minutes?

Sure.

So that's the time that the patient arrives and checks in to the time that they are actually seeing a physician in the triage or a provider in the triage to assess their situation.

And uh on average, how does City Hill measure with other local hospitals?

Um we're at about 48 minutes and the others the average is 46 minutes.

Yeah, I'm talking about time in emergency room.

Total time in emergency room?

Yeah, it's what and what how does it release to other hospitals?

That information I don't have with me, but I'm happy to follow up.

So you'll produce a report.

It says something about five and a half hours.

It was there in the presentation when I was there.

I'm not sure.

Are you referring to the board meeting?

Yes.

I'll have to go back and pull the the minutes for you.

And I'm happy to follow.

So if if I may, I mean that you can go to the CMS website hospital compare.

Um but the reality is it does it by level of intensity.

So high low volume, medium volume, high volume e-bars, all have different door to provider, total turnaround time.

But by rule of thumb, where we are, we're probably you know, five hours is too long.

We're shooting for anywhere between uh, you know, 180 minutes.

So uh yeah.

This is a hearing, so uh actually for public record on average, how long is a person there in the emergency room?

Uh I will follow up.

Thank you.

Somebody should be able to get that information.

Everything is a follow-up.

Um I do have I'll come back to that.

Uh let me see.

Uh Ms.

Daniels, you talked about uh a plan to turn the hospital around economically to get out of the red per se.

Can you walk us through what those goals are specifically, the metrics, and how we know that we're moving in the right direction, and and how long you think it's gonna take to get it turned around?

Is it one year, two years, five years?

If you can give us some more specifics to that, that'd be helpful.

So I think you'll see improvements within this year.

So so by the end of our fiscal year, which is December of this year.

Um when you think about the balance sheet um and and kind of what that net profit is at the end of the day on the revenue side, the top side, it's again it's the access.

It's a growth strategy to ensure that we're bringing in elective cases, that we're growing our ambulatory services, and that we're um managing uh very well our inpatient throughput.

Um on the expense side, it is looking at our productivity and making sure that we have the right number of staff doing the right work at the right time so that we can take care of patients safely.

Um it's also looking at our our supply expenses and making sure that they're commiserate with the volume that we have coming in and that we're managing our expenses well.

Um also things like our length of stay, making sure that we're getting patients in and out of the hospital according to their geometric length of stay, which is the time that's estimated based on their condition and the acuity level of their care.

So I think that it is a comprehensive kind of strategy to look at profitability and to ensure that we are um financially sustainable as we move forward.

Um the the greatest opportunity that we have though is the growth strategy and ensuring that we are improving the volumes throughout the facility.

Yes, uh and also uh marketing and keeping the name good because that also affects the the care people wanting to come there.

And I guess I was looking for if we do these two things, these four things, we should see some 25% improvement here, 15% improvement there, anything like that to help us to as a counsel because we have to be as responsible to the public for putting almost 400 million dollars into the hospital, what's our return on investment of providing a quality health care system, East Anticos and River?

Do you have any of those type examples?

Yeah, so if you're how am I going to go out and increase the volumes in the facility?

How am I going to increase those um elective cases?

That is my direct interaction with physicians and that be community physicians and making sure that they are through to your earlier point, that they are credentialed, that they have the supplies and the staff that they need to feel comfortable in providing services in the facility.

That is my work to do in terms of making sure that we're getting their credentialing applications in and making sure that there are no bottlenecks when it comes to remoteing them and providing them with privileges.

So that's one tactical action that will be taken to grow the volumes, is bringing those community physicians in and removing any kind of barriers that they may currently be experiencing.

Now I spoke briefly about marketing.

As you know, the fastest way something travels by word of mouth and now through social media.

CD Hill has not, his in the community has not gotten a re good reputation, good reputation as the course of this year.

What type of marketing tools, uh outreach and engagement, have are you all have planned to re-engage to make people feel safe?

Make sure you can provide you can come there and have great great experience and high quality services.

What are some of your thoughts around that?

Yeah.

So I'm I'm really excited to answer this question because we have a full um comprehensive and thoughtful public relations media campaign that will actually be rolling out this month.

Um that campaign that campaign um has several layers to it.

One is some very grassroots efforts where we're actually going beyond the walls of the hospital.

We're going out into the community, we're doing pop-up clinics at some of the local churches in the community.

We're doing some pop-up clinics and some of the other community-based facilities.

We're partnering with the federally qualified health centers to to do some um some screenings and some education, um, also kind of building out some networks as we look at the whole continuum of care.

Um, Madam Chair Um uh Henderson mentioned earlier that we can't do this in isolation.

So a large part of what we're doing is reaching out to our partners in the community to build networks.

For example, um, we've already signed on with um uh Mama Toto and the the doula-driven program for maternal child health.

Um we have a lot of work that's going on in April for Black Maternal Health Month.

Um we're working the Nestle Corporation has tagged us as one of um the beneficiaries for um some donations that they will be making around maternal child health.

And so all of that will be is packaged and will now be promoted.

In addition to some media packaging, um, commercials, things that will be going out on social media.

Um, we also have some collateral material that we'll be sending to residents in the community now, letting them know what services we're offering in our ambulatory space and how they can access those services.

So a full comprehensive um plan that's from grassroots efforts all the way up to kind of marketing um and media publication.

Thank you.

I have less than a minute.

I want to jump jump to you, Dr.

Nesbitt, uh, real quick, welcome.

Uh, as I understand that your work council member here involves research, academics, and workforce focusing on health disparities.

I'm sorry.

Council.

Yeah, I can't just uh Dr.

Nesbitt had to leave.

Oh, so yeah.

Yeah.

If you have another question that you wanted to use.

Um, I did want to uh ask about uh she spoke to the Media Jeopardy citation in its testimony.

Um I haven't gotten a concise answer on what the plan is to for a full-time CEO.

I think it was asked several times.

Um if anybody have any clarity on that, uh I know you got a lot of praises, uh, Ms.

Daniels, as the interim, but we want to know what's the process for uh full-time.

So uh I'm sorry, I'm trying to balance all this right.

So six months is the the horizon we're looking at and backfilling that position.

Um and uh council member white, if I may, just to follow up on your question in terms of total turnaround time in the ER averages.

This comes directly from CMS.

Um this is October 24.

The median average in the country is two hours and 42 minutes.

DC is the longest in the country at five hours and 14 minutes.

So that's turnaround times.

As it relates to key metrics in the industry, we look at median and arrival to doctor exam.

In April 2025, which is an important date, we were at 87.9 minutes.

In March of 2026, we're at 46 minutes.

So that's a 47% reduction.

Medium arrival to triage.

We were at 26 minutes, we're now at 11 minutes.

That's a 57 percent reduction.

Loaf without being seen, right, which is a marker in the industry, was at 6.19%.

It's down to 3.29%, a 47% reduction.

So I I would assert that there has been considerable progress, mate.

Thank you for the clarity within with those numbers of the string be helpful as to monitor the progress of this hospital.

Thank you, Councilmember White.

Also, I see Dr.

Bennett as well.

Hello, I see you in the background.

She'll be up next.

I have a couple of just tie-up questions, and then we'll done with this panel and we'll take a five-minute break because I think Deputy Mayor Turner has slides that we need to load.

Well, yes, star to report and then stop the line in terms of the campaign.

Mr.

Elliot, if your physicians, um, because I think this part is getting confusing to some people for the public, right?

Um GWMFA provides physicians, and as you guys explained to me, you come in, your physicians come with themselves, uh, their jackets, and maybe their bag, but everything else, band-aids, gauze, scheduling, nurses, text, et cetera, that's all UHS Cedar Hill's responsibility in terms of providing.

If there is a situation where there's a physician under GWMFA who uh observes something that they feel like is problematic within the Cedar Hill operations or the hospital, what's their reporting structure?

Um, or is there a reporting structure where they can report um their concerns?

Thank you for that question.

And I and I I do before we do that, I do want to pile on and say it has been a welcome addition to have Miss Ms.

Daniels and and her expertise to help put in these types of processes.

So our physicians would join this process just like Ms.

Daniels explained before and raise their hand.

If they're not getting traction there, they would raise it up to the medical director and even up to Ms.

Daniels or to their chair at the clinical department at GW and/or myself.

So there's plenty of mechanisms to stop the line or provide star uh feedback.

So they're they're integrated and woven into the health care and safety.

So I don't I don't want to give the impression that we punch a clock and and we're we are embedded into the health care safety and quality measures there and a and a big part of that.

Uh and and if there are certain things that that we feel are unsafe, we would have a conversation with our UHS colleagues and either delay those types of services until it could be safe or continue forward when it's safe.

So there's plenty of mechanisms to to raise the hand there.

Okay.

Um also, Ms.

Daniels, in a uh response to a question with Councilmember Parker about a particular incident in I think the appendance um uh mistake.

Um you talked about how you review it as a case study.

There was a case that happened in February where a patient was uh or a surgeon had labeled something as a hot urgent, um which has a particular connotation for the industry, and unfortunately that wasn't adhered to.

What happens in those particular cases?

Because to me that feels like that's not just a case study, that's a process um there was a process breakage in that.

Yes.

So in the very same way, um that that particular case, I think, was around the surgical services.

Right.

And so what should have occurred in that case is that um that that was brought to our attention.

I want to say um from a team member.

I want to say a nurse brought that to our attention, and so that was also escalated through through the process.

Um a physician, one of the physicians was also involved in that, and that escalation needed to go to the medical director of the surgical services, and was then subsequently escalated to our chief medical officer, who then called for an RCA to review the entire event to understand um what some of the breakdowns were and some of the opportunities for improvement.

Okay.

Um, I want to thank you all for your time.

I know I've kept you longer than I said that I would.

Um we're gonna take a five-minute break so we can set up we may have some follow-up potentially.

Um, have a conversation with our government witnesses because like I said, the whole point of the the relationship in terms of building Cedar Hill and bringing UHS in was to get out of the district government doing the day-to-day operations of a hospital.

And so I myself am trying to understand with my colleagues what does our oversight look like because it can't look like what it looks like for everyone else.

I I want to treat y'all like sibly and every all the other members of the DC Hospital Association, except for St.

Elizabeth's, because we have a more direct relationship with them.

Um, so we're trying to figure out what does that look like in terms of monitoring essentially our contract.

Um, and so I'll have that conversation with our government partners on that front.

But I want to thank you for being here.

I want to thank you for your time again for the meetings and conversations we've had.

And of course, um the prior pieces.

Um, you guys have a full-time HR now.

Correct.

Okay, we do.

Um, because you know, ninety staff positions, that's that's the that's the nurses are wonderful, physicians are wonderful, but you can't have any of that operate if you don't have a tech.

Right.

Or if you don't have housekeeping or someone in nutrition services, so those positions are important too.

Okay.

Uh, we're going to take a five minute break.

Thank you so much.

Thank you.

Okay, and we're back.

Uh we have our government witnesses with us, Dr.

Ayana Bennett, who is the director of DC Department of Health, and then Wayne Turnage, who is the deputy mayor for health and human services, as well as the director of the Department of Healthcare Finance.

So if you can raise your right hand.

Well, you and any person on your team who might speak.

I see you were not just hanging out over there.

All right, do you swear and affirm under penalty of law that the testimony you're about to provide to the council of the District of Columbia and this committee is the truth, the whole truth, and nothing but the truth.

Great.

Um Director Turns, are you going first or okay?

Wait, are you providing testimony?

Oh, you are just uh answering questions.

Okay, your mic's not on it's good to see you.

It's good to be here.

I I am uh here on your insurance that uh neither you or Councilmember Parker will send me into cardiac arrest, but I brought Dr.

Bennett just in case you you do.

She said pediatrician.

Uh good morning, uh Chair Person Henderson and members of the committee on health.

My name is Wayne Turney, and I have and I serve as the Deputy Mayor of Health and Human Services and the Director of the Department of Healthcare Finance.

Now serving a joint role as my chief of staff.

With uh Ben Stutch's departure, Melanie now provides the critical nexus between DHCF, UHF, UHS, Cedar Hill officials, and the district's regulatory agencies responsible for oversight of the hospital's operations in the city.

Not without some prodding when necessary, but I believe it is well on its way.

Also, uh Madam Chair, with respect to your request that this be a forward-looking round table.

The community narrative around this issue has been irresponsibly poisoned by self-serving false narrative.

So before these flagrant uh prevarications ossify and metastasize in the community, I think a quick fact-based presentation is warranted on how we got to where we are with UHS as the operator for Cedar Hill.

If you see on slide five, uh we had essentially a uh process that stretched across uh five years trying to find an operator uh in part for us for Cedar Hill.

It began with a partnership search.

This is slide four, I'm sorry.

It began with a partnership search for United Medical Center.

Uh so we, in that effort, we secured three health care operators who agreed to explore a partnership with UMC, and these were health care operators of significant note.

That happened during the winter of 2015 to the spring of 2016.

They all expressed interest, but they all eventually walked away from the project.

No doubt fearing the uh the massive uh subsidies that the district had been putting into Cedar Hill.

Uh probably if you look at the beginning of UMC to uh its end probably over close to $500 million in operating in capital subsidies to keep the hospital upright.

A lot of it done under uh the guidance of uh then committee chair uh David Catania, who was very interested in making sure people in Ward 8 had health care.

Um so when they backed away, we went to a consultant firm here on and asked them to do a detailed market analysis and help develop some criteria for the new hospital for a new hospital because it was clear that UMC would not find an operator that would uh be a full risk operator uh for the for that entity.

Uh Huron did its work from early the early 2017 to spring of 2018, and they delivered four major deliverables, which are outlined in the uh in the slide.

Um I give a special note to the um fourth deliverable, which was we asked them to tell them we gave them what our our um image was for an operator of a new hospital, and we asked him to help us come up with partnership criteria.

Um once we had that report, we directed Huron to engage as many hospital, potential hospital operators as possible, not only in the DMV, but across the country, to see if they would be interested in operating a hospital if the district essentially handed them the building and said you take full risk for the operations.

Uh Huron interviewed about 16 uh regional and national health care hospital systems.

Um, and we received confidential expressions of interest from a limited number of major health care providers in the DMV market.

One and one expression was informal.

But at the end of the day, um, the three we had only three providers, potential providers, who would agree to even um compete for uh the opportunity to run a new hospital, I mean a brand new hospital at full risk.

So the the reason I I walk through that is to one to give people, to give the community some sense for what the effort that was made to try to find an operator, and two, the difficulty that we experience in finding an operator under the most favorable circumstances, where the district is paying for the capital cost of a brand new hospital, roughly 440 some million dollars, and we would be asking the operator to take on the uh business of running a health care uh hospital, something that they are known for at full risk, with you know a 25 million dollar uh uh stop loss uh provision that covers some losses up to X number of years of the contract.

So, that out the way, I also want to go if you go to slide six.

I want to make sure people understand the nature of the agreement that we have.

Our agreement is with Universal Um Health Services.

It is the agreement that I'm sure you have read multiple times, Councilmember, um, that basically uh outlines the process through which uh Universal Health Services will direct the work at uh Cedar Hill.

Uh our contract is not with GWMFA nor George Washington University, and as you know, they have been in significant negotiations for uh uh a revision to their agreement, and I understand this morning that there's a press release announcing major progress in that regard as well, and that will be very beneficial should the uh major progress turn into a final agreement.

Um Universal Health Services fully owns George Washington Hospital and Cedar Hill Operations operates uh as a part of that system.

It is intended to be a community hospital embedded in an integrated system of care where uh there can be a seamless movement of patients depending on their need from community care to trauma care if necessary, and to certainly um you know more complex care at GW uh hospital.

Now, I'm not going to belabor uh you all with the nature of the uh four agreements on page seven, other than to say that there are four agreements, a collaboration operating development and lease agreement that govern this really uh um I think uh wonderful project.

Um the most pivotal is the operations agreement, which sort of guides the work of the executive in its uh relationship with universal health services.

If you go to uh slide number eight, excuse me, my mouth is getting a little dry, so I have to.

Um this is a critical slide because it speaks to the significant regulatory authority that the government has over um Cedar Hill, but not because it's Cedar Hill, but because it's a hospital.

Um as the director of uh DHCF, uh I work with the uh Chief Operating Office of Melanie, um, and we receive from uh UHS an annual compliance report, which is due soon, uh, and we also get an investment report.

They agreed to spend $75 million in addition to um the cost of operating the hospital.

And so we get a report on how they are doing with respect to spending that $75 million.

Um, if you look down, um there are four agencies uh that have some regulatory of uh uh impact on Cedar Hill.

Again, because it's a hospital and not just because of Cedar Hill.

DC Health does licensure and uh patient safety.

Um DC Health also does the work required to determine whether or not they are being compliant with uh the CON and whether or not they are and whether and how they are addressing uncompensated care.

There was some uh mention uh in the community about whether or not, you know, are we at a point where you want to uh pursue with the Attorney General a possible breach of contract?

That is just unmitigated nonsense.

Um has not reached a point where they are saying they cannot do uh portions of the agreement that uh was signed uh uh some uh uh last year that where there is work to be done, they are fully acknowledging that uh some of the work has lagged, but they have also given us a schedule of when they plant they plan to complete that work.

Uh DHCF, the agency that I am director of, is responsible for for rate setting, and I think we have one of the uh uh best of uh uh analysts, actuaries and rate analysts in the city, uh, and we do an outstanding job of setting rates for hospitals, not always to their um uh liking, but uh certainly we are very thorough and analytical.

DSLBD, as you know, is responsible for their CBE compliance, and DOES monitors their um first source compliance, the workforce partnership, and their training arrangements.

Um in this process, there are some uh key operational questions that you know we ask internally.

Uh and I will call the health department occasionally uh and I'll ask for information, but there is a cadence that we've established where at the end at the uh annual uh date of the hospital's opening, uh we will start um collecting formally and uh data on we collect the data now, but we'll start presenting it formally as uh the hospitals and uh uh performance with respect to these key questions.

We asked about the number of reclant complaints regarding patient quality and safety at Cedar Hill, and we asked whether those complaints were satisfactorily resolved.

Of course, we never tell DC Health how they should evaluate a complaint or how they or whether they should evaluate a complaint.

That would be an egregious uh breach of uh uh uh duty on my part.

Um so we don't do that.

We ask them, tell us about the complaints and tell us how they were resolved.

We asked whether or not Cedar Hill has fully uh met the requirements for having the number of licensed beds on site, uh, inpatient service lines and outpatient service lines.

And if not, is there a reasonable plan in place to meet these requirements?

If the s if uh if Shifter tells me that um Cedar Hill is not meeting its license bed requirements, they don't have those beds in the facility, and they don't plan them plan to uh bring those beds and facilities, unless they can get some agreement from their mayor to accept that, then yeah, you would be talking about something approaching a breach of contract.

Um we asked uh more recently and and and we'll ask consistently how many times and why has Cedar Hill been forced to execute a full hospital diversion?

Uh are there plans in place to mitigate the number of such occurrences?

And I will say in the uh uh for the sake of full transparency, when I looked at the divergent numbers, I was a little surprised.

They are high.

They're a lot higher than what you would see across the city for other hospitals.

Uh, and that's some I think Cedar Hill acknowledges and will certainly work on it.

We asked whether or not Cedar Hill has met its CBE requirements and and what and what are the numbers that demonstrate compliance for failure.

And then we asked how much of the 75 million dollar target for this project has been achieved by UHS.

Now, I was planning to conclude my presentation at this point, but I wanted to do something uh uh Director Dane was very modest uh in her presentation, and I wanted to go to some slides that using some data that I drew from across the city and and from some of her her testimony, but I wanted to highlight it so people will see what um is going on at Cedar Hill with respect to some some quantitative measures.

Um clearly, as we stated on and it's slowing on slide 12, Cedar Hill has met its inpatient license bed requirements, but like other hospitals, it is not presently staffed in 100 percent of those beds.

Um they are staffing um 59 percent of those beds, which is not the lowest in the city.

Howard University is at 37 percent.

But uh, and I think you will see some improvement on this measure as the hospital continues its operation.

And again, because I'm a regular we are regulators and not uh the operators, I don't engage with the hospital over its um staff beds.

I mean that's a hospital operational issue that I'm not qualified to direct anybody on, and no do I have the legal authority to do it, but my sense is from talking to UHS and Kimberly Dance, which I do regularly, that uh that that number will improve.

May not get to 100 percent like you see at children's or St.

Elizabeth's, George Washington is at 95 percent, uh uh Georgetown is at 92 percent, uh, and Washington Hospital Centers at 90 percent.

Now, there was a lot of questions about whether or not Cedar Hill has met its um uh ambulatory service requirements, uh service line requirements as I as listed in the uh certificate of need that is you know monitored by Terry Thompson.

Um I counted 14.

I asked her to send me some data on what service lines they were operating and what service lines were in development and whether or not they had identified any that they were not going to do.

And you know, I I'm apologizing up front if I've counted an error, but I haven't been feeling uh well lately, but my by my best count, they have they have to meet 14 uh outpatient service lines.

They've they've met seven.

Uh those seven are listed uh to the left of the uh page, and they are uh in process of meeting the uh remaining seven, which is outpatient dialysis, a urology clinic, a cardiology clinic, uh primary and OB clinic, um, another OB clinic, which I'm not sure, I may that may be a typo, uh orthopedics and and uh neurology.

Now, uh all of these clinics, service lines have dates uh that such by July 1, I believe, of this year, they will all be online.

That is their promise.

Now, if that doesn't happen, that is where we as a regulator would communicate with UHS that you know we these were not implemented uh when the hospital was opened, and we understand the reasons.

These are the dates you have given us that they will be fully online, and we expect that, and so if they don't meet that, then we'll have significant conversations about you know what the problem would be and whether or not they're gonna be able to fulfill that requirement.

Now, something that I think is overlooked.

If you go to the next slide, in the first 11 months of operation, Cedar Hill has experienced 3,002 three total visits.

That's a 30 percent higher than United Medical Center reported in its last 11 months of operations.

I have one criticism of uh Cedar Hill and its execution.

It would be at the very beginning of the process.

And I remember having this conversation with Kim's predecessor, Kimberly, whom uh uh I'm sorry, uh Kim Russo, who I think is just a superstar.

And one thing she told me that we didn't agree on, but I couldn't argue with it because she knows this stuff a lot better than I do.

In their pro forma for uh the new hospital, they based it on the uh data from UMC.

And I think I don't know if it was the last 11 months, but it was somewhere in that time period.

I thought that was a uh too conservative of a uh estimate of the business that they would see in their first year of operation, primarily because Cedar Hill is a new hospital, and it would attract a lot of folks who some of them would be just interested in seeing how it worked.

So I thought they should have uh uh uh planned for a slightly higher census.

But be that as it may, they are serving 30 percent more than UMC served in its um last year of operation.

Now, if you go to the next slide, in terms of emergency room visits.

Uh in its first eight months of operation, there are only three hospitals in the city.

Say that real slowly, there are only three other hospitals in the city.

George Washington University Hospital, Med Star Washington Hospital Center, and children's that have experienced a higher number of emergency room visits compared to Cedar Hill in its first eight months of operation.

And I would remind people that George Washington University and Met is a level one trauma center.

Medstar Washington uh hospital center is the largest hospital center, second largest in the region, is the largest in the city, and of course children's is is is our uh national jewel for uh serving kids.

Um these hospitals, and some of them barely have uh in the case of GW, it barely has more emergency room visits than Cedar Hill experienced in its first eight months.

So this is not a hospital, a beautiful uh edifice sitting empty.

They are getting that they are seeing patients and they are doing uh quality patient work.

Have they made mistakes?

Yes, all hospitals make mistakes.

If you look at medical errors across the country, the numbers range, the numbers are in the hundreds of thousands.

Uh they are all unfortunate when they happen, but they do happen.

And the question is if can you avoid them in the future?

Uh next slide.

I asked the Department of Health to tell me um the number of complaints that have been reported uh um on uh Cedar Hill based on uh patient visits and how and whether or not those complaints were successfully resolved.

As you can see, uh since its opening, Cedar Hill has uh been hit with 38 complaints, which is less than one percent of patient visits, and 76 percent of those complaints have been resolved.

If you uh look at those uh complaints as a proportion of uh not just total visits but total ED visits, I think the number of uh the percentage is like um.008 of total visits.

Uh again, complaints are to be taken seriously as these are, and when they create uh unfortunate outcomes, they must be addressed and they must be addressed expeditionally, expeditiously, but the notion that the hospital is overrun by complaints due to poor care is not supported by the data.

Now, this is the area where I think Cedar Hill has to do some work, uh one of you know a couple of areas.

Uh they've been on full hospital diversion uh or partial hospital diversion 20 times during its first year of operation.

I don't know if Dr.

Nesb remembers the numbers for the other hospitals, but they don't particularly come close to that.

Bennett, I'm sorry, I call you Nesbitt.

Yeah, you did.

You didn't smack me.

I'm sorry, Dr.

Binebo.

She was sitting there, you know, and some of my blood is still not flowing that well, so I still have delayed reaction.

Um full hospital diversions, I think is high, uh, too high.

Um the reasons are listed to the right.

Typically they occur because of facility crowding.

Um they also occur because of staffing shortages.

Um there's a so 11 of them occurred for the uh one of those two reasons.

One of them occurred for facility crowding and staffing shortages, one of them was a systems issue, and six of them were other reasons, and uh I would think Renata may have to comment.

I don't know the details behind those other reasons.

If she has them and you weren't interested, she can maybe can provide it.

Um I would uh uh a quick story, I remember actually I was visiting with Kim Russo once when she was at a GW and a staff member came in to say that they wanted to go on full diversion, and she had it fit.

She wouldn't, she wouldn't allow it.

Uh so it's not something that hospitals take any pride in and they want to avoid it, and I think this is something Cedar Hill will will work on, and I think they will do a good job.

Um with respect to universal health um commitment to the city, uh they agreed to spend 75 million dollars in addition to the cost of operating the hospital.

They are well on their way to achieving that.

They reached 77 percent of that investment goal.

Um to date they have invested or will invest three million to open the uh Ward 8 Urgent Care, which is doing brisk business.

Um they've spent and I I would shudder to think what the emergency room at Cedar Hill would look like if they if UHS had did not have the wisdom of opening that urgent care facility right around the corner.

Um they spent $17.1 uh million to build an additional floor at Cedar Hill so that if we get to a point where volume is continually overrunning a fully staffed hospital with respect to its licensed beds, they can add beds without major disruption to the hospital.

Um they are spending 28.7 uh million to build the uh Ward 7 FED that we we talked about earlier, and they are spending 9 million for any kind of services in the construct, they spent 9 million on the construction management of Cedar Hill.

So to date, they have invested 57.8 million dollars.

I will um uh the the next slide deals with their performance uh uh with respect to first source, it has been strong.

Uh they have uh made 175 new hires, uh, and their that rate um and of those new hires, 100 132 were DC residents, which is well above the 51 percent rate uh required by uh uh law, and they are in uh communication and coordination with uh OFC OFSC and DOES to uh build a pipeline for training employable DC residents, residents for work at Cedar Hill.

Um there's some discussion about what takes so long at the new um site for the free standard emergency room.

It's a very complex site to negotiate.

It was sitting up on a hill, it was an old school, and I think they underestimated uh not just Cedar Hill, but the government underestimated how difficult it would be to get that site ready.

Um but that site work um will be finished and turned over to UHS by the end of 2026, possibly sooner.

So we expect the construction to end in late 2026, early 2027, and the council should receive the uh land disposition documents uh prior to that time, and if you all act uh expeditiously, hopefully we'll have a um after a 15-month construction and a two to two to three-month inspection process, the facility will be opening no later than the spring of 2028.

So uh those are my uh comments for the record, Madam Chair.

Um, and again, I would close by re-emphasizing that I do not share the view that Cedar Hill is a listing ship.

I think it has had some bumps in the road as you would expect in any new uh operation of a very, very complex uh entity such as a hospital, but I think they are well on their way with the great leadership of uh Kimberly Daniels, uh, well on their way to uh becoming a hospital that we want it to be.

Thank you.

Thank you.

Um we'll do 10 minute rounds.

Um and then we'll start from there.

Um thank you, Deputy Mayor Turnage.

Um I also want to sort of note thank you, uh Dr.

Bennett for being here.

Um in this role, you're the regulator, you're the state regulator.

Um and you've been doing your job.

We have the reports to um note that the staff has been working, but we have some follow-up questions.

Um I'll start with Director Turnich.

Who is the current contract administrator within the district government with regard to the Cedar Hill agreement?

Well, contract administrators probably a somewhat of misnomer, but I would say Melanie Williamson in her role as chief operating officer is responsible for uh providing oversight uh to the contract.

Um if there are changes that require the mayor's approval, she will bring that to my attention.

Okay.

And uh I will bring it to the attention of the city administrator and the mayor.

Have there been any material changes to the agreement since uh the hospital opened?

No.

Okay.

So let me start with some other questions before I get there.

Uh who made the decision regarding Cedar Hill's opening date?

Oh, that decision was made based on um, you know, I was a part of that process, so I'm trying to let me sort of call upon my memory to figure out exactly how it worked.

The we had to, we worked backwards from um what we expected to be the completion of the construction process.

And the concern was once you complete construction, you don't want to have a hospital sitting there vacant for months.

Sure.

But you don't have staff.

Well, well, but you know, we would think so.

We would we were talking a year before the hospital was completed, and we made sure that everybody, all of that UHS understood, and UHS agreed with it as I recall, that we would be opening a year from the date that we had that discussion, and and we would target the date as being the opening date of the hospital or the completion of the construction date.

Actually, we opened 15 days after we had initially said we would.

But all parties were fully notified, significantly in advance, such that any staffing shortage could have been contemplated and accounted for.

Did at any point UHS say we're not ready?

Did they have the space to say that?

Sure they did.

If um if UHS had come to me, because you've got to understand I reported the mayor and the city administrator.

Right.

And I I was informing the mayor that this would be a go on in April of 2025.

If UHS had come to me and said, you know, um GWMFA is telling us they can't be ready, and we agree with them.

No, no, not GWMFA.

No, I'm just let me see well, whatever reason they would have offered.

Okay.

If they are coming to me and said we will not be ready, I would have said to the CA and the mayor, we are not ready.

But I have multiple conversations with a lot of people in this process, and there was the only entity, the only person who said that, well, we might not have the staff was Dr.

Nesbitt.

Um and she was the only person, and she in her own inuitable way made it very clear to me that she didn't think the hospital would be ready at all.

Dr.

Nesbitt or Dr.

Bennett?

Dr.

Nesby.

Oh, the real Dr.

Bennett.

The real Dr.

Okay.

And I was like, well, we this is a year out.

Uh and as we got closer, when those conversations intensified as you as you would imagine they would.

My question was we still have six, seven months out.

Wha why won't we be ready?

At no point did UHS say put the brakes on, we won't be ready.

So you are not aware that in December of 2024, Cedar Hill still didn't have a HR.

No, I but I I I wasn't involved in that part of the process.

I was involved with making sure that my um attestations to the city administrating the mayor that they would be ready to open in April, they would be ready.

And you gotta you gotta consider this.

I'm focused on when I talked about staff, I was focused on the fact that at UNA Medical Center, you know who was providing the care at that time?

GW.

So what is the complication from going to UMC to GW?

I don't necessarily want to sort of go back and forth.

The reason I'm asking that is I want to make sure that the decision to open that hospital was not a political one.

Oh, it was not about the ribbon cutting that was driving it, but rather was the hospital ready for operations.

And that people have the the space to say, hey, you know what, we might need another month, or did they feel like they couldn't?

It was me that went to the CAA and the mayor and said we can open in April.

I was I never got any communication from the mayor or the city administrator that we had to open in April.

No, I I I don't even recall having a conversation with her about uh the opening date until we said we were certain that it was it was to be it was to be in April.

Okay.

Uh you said in your testimony, well, actually just in the question that I asked you that there were no material changes to the hospital agreement.

You heard the exchange I had earlier around the composition of the board.

Yeah.

The operations agreement says a governing board.

Everyone has been operating as an advisory board.

When were you all informed that it was an advisory board?

From day one.

Which day?

The day the board was constituted.

If if if and I know from my my my past experiences, the difference between uh a governing board and uh for a hospital and an advisory board.

This hospital this board is not a governing board for a hospital.

I think the language in the operation agreements is probably unfortunately uh mischaracterized.

Um who wrote the agreement?

Which which uh offices were involved in that?

Oh, it's I don't know.

I city administrators office, uh, all of the um resources that he would have.

And I and I was in the room, uh, but when I saw governing board, I didn't think that we were talking about a typical hospital governing board.

The reason?

Okay.

If you look at any hospital governing board, and I was at one meeting several weeks ago at Children's, uh, at Cedar Hill, 11 of the, I believe it was the majority of the members are from uh UHS.

You can't have a hospital governing board with the entity that's being governed having the majority of the members.

That's a that's a that's an advisory board.

Okay.

Um has the mayor uh appointed all of her individuals to the positions that she has for that board?

She appointed me, and I understand there are two that are presently being vetted.

Okay.

Do you know the timeline for those individuals?

I do not, but I will check with uh hopefully before the retreat for this board.

Yeah, that would be helpful.

I think.

Yeah.

Nice little onboarding.

Yeah.

Retreats are overrated, but I think this is a good one.

Wow.

Retreats can be a helpful tool for everybody understanding their rights and responsibilities.

Okay.

They can also be boondogger, but we won't go down there.

Um Ms.

Williamson, I know you're new in terms of this role now, and I hope Wayne has given you a raise, but here we are.

Um do you receive the reports from DC Health when they do surveys uh and document particular complaints or issues that arise from Cedar Hill?

So I can't speak to what my predecessor may have received, but um that cadence is not currently established with me.

Right now I'm working on understanding the full structure of the agreement, um, ensuring that I have engagement with UHS as well as with the government partners to fulfill um the review of our annual report, which is due in April.

Okay.

But obviously, you know, we do have access to surveys and whatever other information is shared as a result of investigations.

Okay.

Um Mr.

Turnage and the operations agreement, um, which I thought was interesting, but perhaps there's a a purpose behind it.

Um there's essentially like a two-year runway uh before the district government can really sort to sort of have conversations around uh sanctions or whatnot in terms of challenges with regard to quality.

Um why was the two-year ramp up?

Because you want to give a hospital time to stabilize its operations.

Okay.

So at what point, and you've mentioned this, uh, what point do st typical startup issues become contractual performance failures?

I think when there is a systematic and long and long-standing failure that creates uh certainly uh patient safety uh issues, uh I think that is a a a level of uh um problem that would require us to to basically determine whether or not the operator could could continue to do the job.

We have not seen that.

Um you also have to remember CMS has a um a fairly rigorous reporting process, and you know uh D DC Health can um can comment on that, but they look at significant quality data for all hospitals.

If they don't if they see evidence of problems, they will reduce your payments uh for Medicaid and Medicare.

They will also uh take stronger sanctions if if if warranted.

Right.

But I'm sort of suggesting that um while I know we want to treat Cedar Hill as every other hospital, we have a different financial relationship with within terms of Cedar Hill.

So are you receiving the reports from DC Health that they have raised?

I can get any report that I ask for, and they've been D DC Health is always you asked for them.

Sure.

I've uh I called uh Dr.

Nesb, I mean uh sorry.

I call Dr.

Bennett all the time, sometimes weekends and nights when I when I hear things that triggers a request for a report, I talk to her staff.

I talk to Terry Thompson regularly.

Uh Renata and I communicate by email, Renata communicates with uh Melanie.

So but we we just established a report cadence around the annual report to the mayor.

So what the thinking is when we go to the mayor with when UHS comes to the mayor with their annual report, we will have reports from all of the government entities that provide their data on how UHS is doing that will supplement the reports and also serve as a check on the information that UHS is providing to the mayor.

Again, that's you're putting a lot of stock on an annual report.

Well, it's it's just it's it's the data for that.

Have you seen the format for that annual report is pretty extensive?

Sure.

But also, Dr.

Bennett, how many uh complaint-based surveys has DC Health conducted of Cedar Hill thus far?

So I just want to clarify that the complaints are not necessarily number of incidents.

So multiple people might be concerned about the same thing.

Right.

And so sometimes so we've had 38 complaints.

Some of them are of the same incident.

And so we've done eight surveys related to those, but some of those surveys bring together multiple complaints.

The current one is nine.

So those are related to not necessarily nine different incidents, but nine different complaints.

Eight surveys in 11 months.

Yes.

Is that common?

No.

Okay.

Councilmember Parker.

Thank you.

Um Deputy Mayor.

Sure.

It's good to see you.

It's good to be here.

Um I totally take to heart you qualifying the performance of Cedar Heel to say it's a new hospital.

Uh before I zoom in to my questions, when is a fair point for us to say, all right, we should expect the hospital to be flying high?

If if you look at the data on new hospitals and when they um depending on the function that you look at, I've seen estimates that anywhere from four months to a year for a new hospital to be at a point where um you would expect to be able to say that um they are stable, they've stabilized from an operational standpoint, you know, figuring out throughput, uh sort of mastering what their work their workload is and and using staff to match it, uh stabilizing their performance.

People don't talk about the fact that you know this some of the challenges that um you know uh Cedar Hill has experienced, it's not because of a lack of spending.

Uh they put um Cedar Hill is that their their financials do not look good.

Um if this was a city-owned hospital, you all would be looking for you know, maybe $50 million to find any current budget to pay for the operation of the hospital.

So you know, I think it's going to take a minute, and my hope is that um the financial turnaround when the operation stabilize and and this negative narrative in the community is properly rebutted, and people understand that they can go to the hospital.

All hospitals have risk.

You know, I just came out of the two hospitals, actually, three in the last month.

And I I can't tell you how many times I heard code, code, cold people were dying.

So it happens.

And sometimes it happened because of medical error, and you when that happens, you need to fix it.

And how do you respond to the criticism that the district partners are slow to act with urgency with Cedar Hill given the population it serves?

When you said district partners, who are you talking about?

UHS, GW.

Oh, I think that's just nonsense.

I mean, based on my conversations with uh you know uh Kimberley, based on my conversations with Jason, the notion that they are less concerned about the challenges at Cedar Hill because their population is predominantly black.

Well, we can't judge their concern.

Right.

But we can reflect on the actions that are being taken to stabilize the hospital.

Well, which informs my original question.

At what point do we say the sub-performance of Cedar Hill is no longer acceptable because by this point we expect you to have stabilized as an institution?

I think you give them the time that they have asked for with respect to first of all, I think the the year baseline is is is an appropriate measuring point as to where they are.

So that would be this month.

I think we're in April.

And then they have said that they will have outpatient fully staffed uh by July.

I understand their hesitancy.

Is it fair to I'm jumping in just because of the clock?

Mr.

Baird earlier said within six months they expect to have a CEO in place.

Is it fair to say within that six-month window, leadership as well as operations in the hospital should be stabilized?

Well, I think certainly.

I think within six months, it should certainly be uh stabilized.

And I my my hope is that they have the good sense of uh keeping Kimberly on.

Uh I think she is phenomenal.

Uh she's has great operational skills.

No, I I mean I I look for good people.

I mean, I uh uh uh it would be to my detriment to have a CEO over there who was incompetent, because that would make my life miserable, and I'm sure I would be sitting in front of you all on a more regular basis if the CEO was incompetent.

So my So just zooming out, uh, and I'm getting feedback, but zooming out, it's been a rocky takeoff, but within the next and there's been progress.

I do want to acknowledge there's been tremendous progress made in recent months and time, uh, in part due to the work of Ms.

Daniels, but within the next six months, it is your expectation things should be stabilized across the board.

Yes.

I would uh first of all, I want to see the uh annual report that they are going to produce for the mayor.

Um my expectation is that once we once we see that annual report and see what the uh level of performance has been, if there are significant indicators of trouble that certainly within six months those troubles will be addressed.

You all are not paying any attention to the uh the impact of the um lack of an agreement between all the entities that uh are involved.

Not that that's an excuse for anything, but if you are a UHS and you're uh about to invest significant dollars uh in an operation, clearly you need to have um some understanding for what the financial parameters will be between you and your other partners.

So that's not an excuse, but that's certainly if I am in UHS's shoes or stepping in their shoes for a minute, I can understand why they would want to see just what their obligations are with respect to any new agreement uh before they uh you know make major major new commitments uh outside of that agreement.

I could certainly see that.

Okay.

I'm gonna come back to the report is due when this this big report that you are waiting for.

I'm gonna come back to the report is due when this this big report that you are waiting for.

It was due in is due in April, but there uh there was you've seen the report.

No, I have not.

Um this is why there were we gave more time because there was some significant personal issues about uh from some of the people who were involved in putting the report.

Will this report be made public?

Yes, once once it's presented to the mayor, it's a public document.

And I imagine there is going to be a briefing of sorts between the mayor's office or the district government's Cedar Hill, GW other partners.

Yeah.

I I don't know who UHS will bring, but I would imagine it would be the CEO of Cedar Hill.

Uh the CEO of uh uh GW.

And on the mayor's side, it would certainly be the city administrative, me and uh uh Melanie uh and um whom I've asked the mayor would want to.

Yeah, I think to act on whatever this report is produced.

Clearly if there are um you know deficiencies identified uh through the report, but certainly there will be deficiencies identified.

Certainly.

Hope Hope Springs eternal that we could you know we can get to that point and there will be a very limited number of deficiencies.

There will always be some focus on what needs to be done better and what's the time frame for getting that done.

Will that action plan also be made public?

I had not thought about it, but what if it's once it's committed to paper, it will be a public document, yes.

Okay.

I think that would be important to build confidence to the public, but also so the committee can follow up.

Um you mentioned in your testimony that you're looking to see how many times and why Cedar Hill has been forced to execute a full diversion.

You had a slide here, I think it was 30.

No.

It were 20 uh 20 diversions, 19 were full, one was uh a service land.

How does that compare with the other hospitals?

So for a person that is not in the weeds of this stuff.

DC Health would know, but I I didn't see any diversion, and maybe Ronaldo knows of or Dr.

Bennett.

Do you know how many how I didn't see any more than three or four from other hospitals?

There are there are more.

Um I will say that um diversions are um for various reasons and for various parts of the hospital and for different amounts of time.

So someone can be on diversion for an hour because there's something, a breaker in the electrical, and they have somebody they fix it and then they're off diversion.

So it is we're using the term as if it as a single thing when there's there's little ones and big ones and important ones and less important ones.

So um from January of 2025 to today, Cedar Hill has 20.

Howard and Med Star both have a significant number.

Howard was 20, Med Star um Washington Hospital Center was 34.

However, those are almost entirely labor and delivery.

We have a labor and delivery site shortage in the district, and so when they are full of beds, they both go on diversion, and that is a known issue that we have.

Do you have a breakdown of diversions from January of this year to date compared to last year?

I don't, not for everyone.

Because there is clearly been uh operational shift, and I think it would be more it will be fairer to look at January to today to see are we seeing progress from diversions at Cedar Hill.

Whether we're seeing progress compared to last year?

Yes.

We had as many this year as we had last year.

Half of those are this year.

Got it.

That's good to know.

That's good to know.

Um there was a cluster.

So there was a a period of days in February where I I believe it was a staffing issue that is since passed.

We haven't seen any since then.

And given your note and I'm at time for this round, but uh I assume for Cedar Hill it's not labor and delivery, those diversions.

It is I I believe it was one time, but every other time it's been um full, mostly related to the ER.

Got it.

All right, thank you.

Um Dr.

Bennett, for clarification on the diversions for the other hospitals.

It sounds like those were partial.

Yes, those were partial.

In terms of full diversions, um Howard did have 10.

And for the most part, Sibley had two, George Washington had three.

Mocha had zero.

Okay.

Um Councilmember Parker, I I learned about diversions when I was giving birth to my first child.

Multiple hospitals in the city were on diversions at the same time.

Um but I gave birth at GW.

So there you go.

Labor and delivery.

They have great labor and delivery.

Help our problem.

Um I want to ask um Dr.

Bennett.

In terms of complaints.

So I believe the slide that Director Turnich put up, while it is the slide of how many you have received.

We have had this tension in community where people believe that saying something on social media or submitting something to a Google form amounts to an actual complaint that makes it to DC Health.

When we find out about them, they do amount to an actual complaint.

Okay.

People have stopped being, you know, if somebody says something to me, I call Renata, it's an actual complaint.

So those are not all people who filled out a form or did anything technical.

Some of those are in email to somebody or a root.

So if somebody's just unhappy and has general sense of unhappiness, that's not a complaint.

But if you tell us a thing happened to a person, that is a complaint.

And if you if that happens through some non-formal means, we still take it.

Okay.

And Councilmember I would add that DHCF gets a lot lots of calls from residents who are upset at the care they receive across the city.

Yep.

Without exception, we always refer them to DC HR.

I will say though that I I think it is a mistake to assume that the number of complaints is entirely linear relation to quality.

People use lots of other methods to deal with their um a problem that they see.

If there is our good internal systems, many people may be satisfied with whoever they talk to who resolved their issue.

And as those systems work better, you get fewer people using this method as a way to address an issue.

And it it does not necessarily mean that there aren't people who have similar issues in other hospitals, but they may have functioning systems internally that help those get resolved or help improve a thing in a way that doesn't need it to escalate to us.

So we we're not the only system in this in the industry.

Okay.

How does DC Health then determine if a complaint is an isolated issue or evidence of a broader system failure or pattern and practice problem?

So we never look at just that incident.

So there is always an audit of additional um charts that deal with a similar issue.

There's always an audit of the system around the incident.

So what was the staffing that day?

What is your policy related to this?

So whenever there's a complaint that we investigate, we are looking at what's the system surrounding that complaint.

And then is that system adequate?

That is almost always what we're asking for a correction on, not something that happened on a single time, because there isn't a way to correct that.

The past is the past.

What we're trying to correct for is the future, so that whatever systemic issue might have helped that happen, even if it didn't cause it, whatever enabled that to happen can be corrected to prevent the next incident from happening.

Okay.

Um you all you were your uh I think it's Herla.

Is it her?

His BA.

His B.

Sorry.

Oh, HISPA.

Oh, new names.

Okay, great.

Health services and preparedness helps all of my health stuff separated out from some of the environmental health things.

Okay.

His pa.

Um when the staff go out to do the investigation on site.

Are all of the employees who are involved in the incident required to speak with DC Health?

Yes, except when they have been deployed overseas or moved to there are circumstances that are beyond our or the hospital's control.

So we don't always get to talk to anybody, but we do talk to anybody we ask.

Okay.

So no one can say I don't want to speak to to you all.

No.

Well, let me ask Renata on that one.

She'll let me know.

But if that is not our experience that people do that.

We're phoning a friend.

If you could just introduce yourself for the record.

Well, good afternoon.

Renata Cooper.

I'm the associate director for the Office of Health Facilities.

Um, we try our best to interview all staff involved in an incident or staff um at the facility who may be abreast of how things actually should go.

Um and then we're also looking at how it actually does go.

You know, for instance, you may talk to leadership and they're telling you their responses based off of what the house hospitals um practices and policies are.

But I'll then interview the nurses who are actually involved in the in the direct care to find out exactly what happened for that particular incident.

Um at time staff aren't available.

We make every effort to interview them on site if they're on shift.

We come in at different times.

We also get contact information and make phone calls.

Um, but as Dr.

Bennett um indicated, if they are not available, um, then unfortunately we're not able to talk to them.

We may talk to leadership for that department or someone else in that department just about how the department runs if that's applicable.

Okay.

I just want to point out that is why the surveys take a while.

People sometimes say I called you and then you didn't hear back.

Right.

We read all the policies.

If somebody's not on that shift, we come back the next day.

If they won't be working till four days from now, we come back four days from now.

So to get a real view of the entire incident, it does take time to get everybody's input and to look at all of the the materials involved, sometimes looking at video.

So we do a full investigation.

Okay, Miss Cooper, when you guys are done with your part of the investigation and you have written up the report, what what are the steps thereafter?

Once the report is final and drafted, um it's issued to the facility leadership, they then um are responsible for responding back to our agency with an identified plan of correction.

How long do they have?

They have 10 calendar days, if I'm not mistaken, that's written um in a regulation that they have 10 calendar days to respond to us, and then we respond um appropriately with our acceptance or denial of the plan of correction.

If we deny the plan of correction, that is um based on the components needed not being met.

Um that we see that what their plan is is not going to ensure that this doesn't incur again, um, or maybe that they indicated they were going to educate certain staff, but it doesn't include all of the staff that would be um involved in that particular incident, so make sure it doesn't reoccur.

Um, and so we articulate that to them via um in in writing on a teleconference usually ensues between the survey staff and the leadership at the facility to make sure they're fully clear on what needs to be corrected and responded to.

Okay, so I read a report from February that didn't have the associated corrective plan, nor was it signed.

The earlier ones had been it had the plan and then was signed by the hospital leadership.

This one in February did not.

Um have you all received the a response to that survey?

We have.

It is still under review, has not been accepted at this time.

Okay, all right.

Um can you follow up when you that has been accepted or or not?

Okay.

Um now DC Health staff has been citing staffing deficiencies since a month after the hospital opened.

You've been citing staffing deficiencies since May of 2025.

Um what's the escalation?

Because every time you got out, every survey is about staffing almost.

So we don't have staffing regulations in the district that say you must have this number of staff.

What we have is a process that allows us to go in and look and say, based on what we see happening, this level of staff seems inadequate to the volume and complexity that you are seeing.

And that is intentional because volume and complexity are very different depending on the time of year, when people and and they have to be able to flex around that in their staffing as a as an industry.

However, um, when we do see an issue, they make a plan of correction about what it is they're going to change.

We do come back to see that they did enact that plan, but we cannot stay there to be aware of changes as they happen.

So if a staffing agency has a call out or something happens, what we saw may not be true later on.

Are there follow-ups periodic after you receive the correction act corrective action plan?

I'll let you speak to that, Renata.

Yes, um, it differs in timing.

Um just quite honestly, as you can see from the reports.

We've been there quite frequently.

Yeah, no, I mean we've been there.

Um the follow-ups I would say have been reoccurring.

Um we would look at um if we're receiving the same types of concerns or complaints from the public or um anyone, those types of things we would follow up on when we go back the next time.

Um and in some of the reports you can see we're looking at some of the same things, and it's it's a repeated concern.

Um, then we're asking different questions.

Like clearly the plan that we hadn't or that the facility had in place initially is not working.

Right.

Some of them are situational and they're isolated though.

I and to give Cedar Hill credit as well as any other facility, we recognize that there are times that you can have a great plan, but their hiccups along the road.

Right.

If staff call out and you've planned appropriately for um what you deem necessary based on um what your metrics and your your numbers are showing, I can't necessarily say that they're wrong for that because you you can plan up to a certain extent.

What we would then look at is what is your backup plan, right?

You have staffing contracts.

What is your ability to get staff on board within a number of hours?

And I think you will what we see likely is at times where those diversions come into play are likely in those times that maybe they can't get someone until maybe the next shift change, which may be nine, um, seven or nine in the morning, depending on what their hours are.

And so that I I can say honestly, I don't know that that is something that is um indicative of something necessarily at Cedar Hill, because I think that you could probably find that at any of our facilities.

Okay.

The reports that you all put together.

Who else sees them?

Anyone who asked for them at this time.

No, no, no.

I mean, you don't have to report are you reporting those to CMS or no?

If it is a federal report, um, those reports are sent out by CMS.

They're not issued by DC Health.

Right.

And they would have reviewed the different report.

It's a different report.

Yes.

Okay.

But I I guess I'm just trying to determine in terms of regulation of health facilities, you guys are the stopgap.

We also do the local work of CMS.

Right.

So we are the stopgap, but sometimes we are we are looking at both our state regulations and at CMS's regulations and reporting to them about what we see of their regulations when we're there.

Okay.

Councilman Porter.

I want to continue there, and this may have come up already, but just want to be clear.

So when a complaint is made, what triggers a survey visit or one of these visits?

Um the complaint itself.

So there is the annual survey that we just do one every year.

In the between those two surveys, we have um surveys based on complaints.

If you do if you give us a complaint and the facts of the complaint do seem to be a violation of DC regulations, then that is a complaint that we need to investigate.

If it seems as if someone might be at risk, that is a high risk survey that we might do within two days.

If it is a lower risk, we might take 45 days, not generally, but that is the regulation.

And if it is low risk, we might say we'll see to it the next time we're there.

Understood.

So it depends on.

Yes.

More credit more credible complaints.

Yes.

Not necessarily more, because we've had more at Washington hospital center.

They had 55.

So they are bigger though.

So it's it's it's a very important thing.

It was my understanding that you've had more visits.

We have had more visits, I think.

Do you than other regional hospitals?

Do you have a sense of visits to I think there have been more visits and I think that may be attributed to the nature of the concerns as Dr.

Bennett um indicated.

Our survey process is somewhat dictated by the federal process because this is a certified hospital.

And so while we have the licensure authority, we also act on behalf of CMS as their agent in the district.

And so their procedures or guidelines around how the complaints are investigated is rather is more structured and stringent.

And so we we lean to that process of how we initiate the investigation.

So the number of visits could be attributed to, like I said, the the nature of what the concerns are.

Um if we get repeated concerns that are more egregious, then we're going to go there quicker.

That that's the case for any um provider that we have oversight over versus if there were concerns that are still concerning but not as significant at that time if it's housekeeping concerns versus a care related concerns.

I think that is the best way to kind of like uh compare the two.

We're gonna go out for the care-related concerns more frequently and quicker than we would for those other items.

And any one visit is about multiple complaints potentially.

So there may be my there may be a single visit that complaints over time that weren't urgent are all addressed in that same visit.

Understood.

Um there was a discrepancy, and I just want to make sure.

So when you shared your graphic, it said 76 percent of complaints resolved by Cedar Heel, 24 percent are unresolved.

I believe that was Deputy Mayor Turnage's graphic.

Those are all in the last February survey.

So they're not resolved because we have not gotten through the approval process further.

When I asked Ms.

Daniels earlier, are there any outstanding um issues?

I believe her response was no.

Well, they've done their part and done their corrective action plan.

They have not gotten the approval back from us.

And when might that be expected?

Um it's still in process.

So I I would imagine in the next few days, a week.

Is there reason to believe that they may not meet all of the criteria necessary in that?

If they don't, they'll be asked to fix those things.

They'll come back to us with a different plan of correction with those corrected, and then we'll be able to approach the.

So it's fair to say as of today, we don't know if there are outstanding issues until that report is issued by DC Health.

Because they are saying they're saying we're good.

And I'm here, you say no, not yet.

But it is not completed until we have a DC Health issues and said there's nothing we want them to change about their plan of correction.

If they just if we decide there's something they need to change, experiences that they will change it, and then we'll be able to approve it.

Understand.

So what I'm hearing is that it is uh it is premature to say that there are no outstanding issues until D.C.

Health issues that final vertical.

It is premature.

And can you characterize the nature of the complaints that are part of that uh last survey visit?

I believe you have that report.

We did not uh broadly.

Renato, you want to do that?

And if the committee has it, I can follow up and get it.

Okay.

I don't I don't know if you've shared.

Okay.

I don't know if you are jumping in and are we talking about the February 26th report?

And if you could just give the top line summary, I don't need every detail.

The February 6th state report was issued to the provider, and that's the one that we still have the plan of correction that's under review.

Um probably the most significant deficiency on that report was the death that occurred for an individual who um did not have surgical services performed in a timely manner per the facilities policy and and as expected expected by the physician.

Mm-hmm.

Okay.

And I believe I am Oh, yes, okay, thank you.

I will get that information from the committee.

But just if you could remind me again, when is DC Health going to issue that final uh summary of response to their poll?

Staff is still looking at their plan of correction and I would assume having some conversation with them to make sure they understand it all.

If there is something to change, there might be another week or so in there, but I expect it will be eminent in the next few days to week.

Got it.

Okay.

Would you would you Yes?

Okay.

I'll not a connect correct me whenever I.

Deputy Mayor, you described a multi-agency oversight framework with quarterly reporting, but essentially no operational authority, which totally makes sense.

Um how does DHCF ensure that the quarterly reports from DC Health, other district agencies, the hospital accurately capture operational deficiencies before they escalate into bigger issues?

In other words, you're relying on a lot of inputs, but how are we verifying that the data that you are relying on is actually accurate?

Well, I have to trust the uh regulatory agencies that, you know, based on our professional experience, that the information that they are providing meeting as as requested is an accurate reflection of the problem.

Dr.

Bennett, how are you verifying that the information that you are collecting is accurate?

So both on the number of complaints, the number of issues, uh deficiencies that are popping up at the hospital.

So you're let me understand.

So how do I know that there that the number 38 complaints is an accurate number?

For instance, yes.

I have to trust on some level that when I ask staff to come check it, that they do, and they give me an accurate number.

If there is something I know that doesn't conform with that, I ask them to recheck, and then I look for consistency over time.

I'm not myself counting them.

No, I know.

Okay.

What I'm getting at is uh what reliance on outputs from the hospital itself?

Um DC Health receiving that uh and how are we verifying the accuracy of data?

So ours are verified in person.

So a person goes and pulls charts and looks through the charts.

So all ours are not by report.

So we would be asking for the original document of the policy, not asking them about their policy.

We would be looking for the record the records of the meeting, not whether they had it.

So it ours is in investigation, so it really should be direct documentation.

That makes a lot of sense.

And I didn't mean that in an accusatory way, but it's just it seems like the Deputy Mayor is relying a lot on these reports.

So we just want to make sure they are very accurate, less so from DC Health's standpoint, but from the institution itself.

Um Deputy Mayor, the contract the district has is with UHS.

How do we hold UHS accountable for actions of partner organizations like GW, given that our contract is with UHS?

Trevor Burrus, Jr.

How do we hold UHS accountable?

Yeah.

In other words, we've heard today about things not happening as promised or agreed to in the contract.

We've heard about lapses and hiring and physician coverage and the list goes on.

There are some partners at the table that we are not in contract with, and thereby presumably we have no legal obligation over, but we do have a contract with UHS.

Correct.

So how are we holding UHS accountable for all of the folk at the table?

When agreements are not met.

The baseline is the operational agreement.

And when they report in the annual report, we will certainly ask.

So if I could push back just a little bit, so something seemingly minor, like that governing board.

Yes.

The language of the agreement says a governing board.

When we talk to the member of the board, she said our role is a governing board.

Then other folks say, no, they are advisory.

You say, oh, it's advisory.

So it's not just the language of the agreement.

Well, it I guess it it it falls to the it's in the eye of the beholder.

I I just don't see how anybody could look at their governing board language and look at an operation that has the majority of the of the members from the hospital that is uh being represented.

Um this is gonna seem more antagonistic than I wanted to.

Or if we look at the promise of certain specialties that are not in existence at the hospital.

Like how are we actu who are we holding accountable?

And this goes back to my original question.

Would we allow this to play out if this hospital were in other locations of the city?

That's a rhetorical question.

I'm not suggesting this is necessarily your fault, but how are we holding UHS accountable for all of the many players at the table?

This is how we hold them accountable.

Um I look at the requirements.

I talk to Terry.

Okay, what are their service land requirements in the C O N.

Then I look at their performance.

So I ask UHS, you gotta you have to provide these 14 outpatient service lines.

Where are you in that process?

And let's say they say we have eight.

Well, they they have seven.

Okay.

And then I say what I asked what about the other seven?

If their answer to me on uh the status of the other seven is unsatisfactory, and they're not they don't move from that, then I would report to the CA and to the mayor that they are impossible breach of that part of the agreement.

Beginning.

Your position, we're just not there yet.

Oh, I don't think we are even close to that.

Uh I think again, I go back to what people will tell you a lot more knowledgeable than I about how long it takes to stand up a new hospital.

And you know, service lines, financial stability, matching uh your your resources to uh patient flow can take a year.

So when they tell me, okay, look, you know, we have a slow start on angulatory for these reasons.

We have seven going, we have these other seven by July.

From my in my judgment, and I'm certainly not the last person to speak on that, I'll report this to the CA as I have.

And if he says, you know what, that's unacceptable.

We we will uh we don't think it's uh we don't think it's appropriate that we wait to July for all the service line.

Then that's a different conversation with the CA and the mayor.

But right now, my my recommendation to the CA, and it will be to the mayor when we have the annual report is you know, they've met half of the service land requirements that are in the CON, and I am comfortable with their position for meeting the other seven.

These are complex issues.

You got to very complex.

We are not you're not hiring, you know, um cooks.

You know, you got to go out and get qualified staff who have to deal with the human body.

That's a very those are the same.

No evidence to the cooks out there.

No, I well, you know, I I used to be a cook, so I'm you know uh I'm over time.

If I could just ask one thing as you all are meeting to review this annual report, is to build out the contingencies for accountability.

I totally hear what you are saying that you know we're gonna work together, they are coming to the table, we want to be partners.

But I do think it is important to say six months, eight months, another year, if the thresholds are not met, here are the steps we will take.

I think again, that will build some confidence in the public that there's real teeth behind our agreement.

And I think you are right, and I think uh that is one of the principal reasons that the annual report language was put in the operations agreement.

So UHS can sit in front of the mayor, the mayor will have all the data that we have, and they can explain to the mayor what they haven't met and whether or not they can achieve that.

And then the mayor can decide.

Okay.

Last push here.

But I get the data, I get the report, I get the meeting.

That those are all necessary agreed ingredients.

The question is, what happens if the data is not there, if they are not meeting the metrics?

I have heard from DC Health.

I've heard from DC Health, they're doing their part of going out, and there seem to be a consequence if you don't respond in 10 days and address these things, presumably there are additional steps DC Health could take.

Sure.

I'm not hearing that as it relates to the ultimate agreement and partnership with UHS.

Well, because we we have not had had the meeting.

If when we when we go to the meeting in May with the mayor, and if she gets a report that says UHS is falling short in these areas.

She will get a report that says that.

She could.

And UHL.

And UHS says, you know what, we're falling short in those areas and we're not gonna we're not going to be able to achieve that.

Then the language in the agreement is even if they were to say, and we can agree.

And they give us a date.

And we decide if if that's acceptable.

Fair.

I will leave it there.

I just would say, even if they give a date, I would love for there to be a response to say, and if this date is not met, here are the steps in partnership that the district will take in the interests of the residents of Ward 7 and 8 who are relying on this.

The agreement in some in some sense already does that.

The agreement enforcement mechanism.

The mayor is the enforcement mechanism in the agreement.

And the mayor looks at this and says, you know, I don't think you are doing it.

She can she can hold it to account to the point of saying, you know, we are going to move in a different direction.

There's a whole there's a whole section in there about what you would do if you believe the uh the operator is in default.

Okay.

I will leave it there.

To be fair, though, uh there's a lead up time.

I'm sorry?

She couldn't say that six months in.

UHS was meeting the way that the agreement was written, my understanding is that you can't do anything until two years out.

Well, if UHS sits in front of the mayor and says, which I don't I know they won't, yeah, we didn't meet the uh ambulatory service requirement, and we don't intend to do so.

I I would take I would I would differ.

She could do something.

Okay.

I think my my struggle with this though, Deputy Mayor, is that well, let me ask it this way.

When did they tell you that they wouldn't be able to open ambulatory services on time?

Oh, that was a a rolling conversation starting from the first day they were supposed to open it.

I was in constant conversations with it wasn't Jason, because he wasn't here yet.

It was uh I forgot the gentleman's name.

He was a regional uh CMS uh, I mean uh a regional UHS uh vice president, I believe.

Uh and so we talked regularly about when are you going to get this up, when you're going to get this up?

And they got a schedule out, and it wasn't what I thought it would be, and they said, well, this is a schedule we're going to try to accomplish before the end of the year.

Um at one point it was July, then it moved to September, then it moved to December.

And I said, okay.

And then when December came, they submitted uh in response to a letter you submitted, they submitted a new schedule, and the last information that was, I believe, submitted by the CEO Daniels, laid out the full schedule for all of the service lines.

You know, I looked at that, and again, based on my understanding of the complexity of hospital operations and then the time it takes to fully stabilize a facility uh and get it up to speed uh given the significant uh complex uh nature of the labor inputs and resource inputs, other resource inputs.

I I thought that was reasonable.

Um you as a contract administrator informed that they would be a delay?

Yes, they whenever whenever they told me they weren't going to be able to meet um the there was always a comment.

We had multiple conversations from you know, from the time the hospital opened until through December about where are you?

And some of those conversations weren't pleasant.

You know, I would say, look, you know, we need to get this running.

And what were the reasons that they gave you that ambulatory services didn't open on time?

You know, I don't want to miss states, I need I need to go back and look at my notes, but I think there was some complication around you know their hesitancy until they could figure out what things would look like uh with their global agreement.

What they're not they would they didn't say GWMFA couldn't provide the uh doctors because GWMFA clearly could.

It was UHS's position that they needed to have some comfortable, some uh a level of comfort with the global agreement between them uh and and the university before they fully committed to uh the position that they know they would once they had the agreement.

Okay.

That was typically the reason.

Okay.

I would say this, uh Deputy Mayor, and I know that the mayor's office is preparing in some ways for a transition in the future.

That um, as I said at the top, there are only two people and all the stakeholders in all of this that were here at the beginning.

You and Mayor Bowser.

A couple of more than that.

Who are at the table who were there for the signing.

Oh, but Ben Stutz was involved in the city administrator's office.

Okay.

Yeah.

Then Ben is not a director.

He's not in the cabinet.

Essentially, you are correct.

Okay.

Um what I am concerned about, and this is why we're having this hearing and and will make this available for the record, is the evolution of what was promised versus what is being delivered in terms of this particular contract.

I think the struggle for UHS, and perhaps it's it's it's not their fault on the hospital side, is that we've got another UHS entity in the district that also has had some challenges, uh PIW.

Oh.

Yeah.

And so, you know, I think now for the community, it's like I hear UHS and I don't necessarily feel like I'm you get what I'm saying?

You get where I'm going?

Yeah, I understand where you are going.

And I, you know, I just want to re-emphasize this point.

Uh this is not an easy job, and we don't have a lot of suitors.

That doesn't mean we don't hold UHS to account.

Let me please let me finish.

But if we allow if you want to characterize it as a bumpy start.

If we allow the naysayers about this hospital to turn that bumpy start unjustifiably into a a narrative that is not a reflection of what is going on at the hospital on a daily basis, and we lose the operator, we don't have any other options.

There are no other options.

I don't, you know, we we talked to the largest hospital systems in this region.

We talked to some of the best hospital systems nationwide.

Sure.

And not a one.

That was also a decade ago.

And not to say anything.

I'm not trying to get to the point of it's even having this conversation about operator versus no operator, whatever.

UHS, we we we we in a relationship and we're having some difficulty.

We're we need to go to counseling.

Somebody is going to have to do some work.

They have an action plan on their side.

We're talking about the action plan on the district side in terms of how we're going to continue to facilitate getting better in our relationship with each other.

Yeah.

I don't have any concern that we have the appropriate vehicles in place from a regulatory standpoint at DC Health, uh, from CMS's oversight, which is tremendous, um, from um the interactions and relationships that my office has with UHS uh and uh Cedar Hill, I don't have any concern that we are going to reach a point where this becomes unworkable.

Good.

I don't have any um doubts in terms of the ability of the staff at D.C.

Health to do their jobs in terms of being the regulator.

They do the jobs in terms of being a regulator for all of our other health facilities, and they do it very well.

The difference here is the relationship, right?

And I want to make sure that D.C.

Health as the regulator has the full ability to raise their hand and say, hey, we have a problem, even though we have this contractual relationship.

It's the same in terms of the conversation you and I have had about St.

Elizabeth's.

I need DC Health to be able to raise their hand and say, hey, we have a problem, regardless of the fact that St.

Elizabeth is part of our government.

Well, there's a history there that informs.

And the history is UMC.

The reason UMC's closure was expedited, because Dr.

Bennett's predecessor shut down a service lines uh and raised the alarm about quality of care.

Nobody in the government, including the mayor, me, or anybody else, told uh Dr.

Nesmet, you can't do that.

Um the regulators have the authority to do their job.

Uh we expect them to do it fairly, as even-handed as they would if they were looking at Med Star or uh uh children's as they are at Cedar Hill.

Um so I don't I don't have that concern.

It doesn't mean that I won't get into an argument with Dr.

Nesmitt.

I don't want to argue with our staff, but I will get into an argument with Nesbitt and um and and I did get into argument with Nesbits, and now I'll get into arguments with Bennett about the process more than anything else.

But I would never tell a regulator, look, I don't care what you found, you gotta sit on that report.

Would never do that.

I've been working for 40 years.

I don't want to end my career in ignomiminy because I decided to say something to do something stupid.

Uh regulators have the freedom to do their job.

They just have to do them fairly.

Okay.

Um Director Turnitch, have you talked to children's about some of their concerns around staffing?

Yes.

Well, indirectly, I would say.

Okay.

I suggest you have that.

I I've I've I understand the issue.

Okay.

Um I've talked to UHS about children's concerns about staffing.

And you know, the the narrative shifts a little bit.

So I'm not quite sure.

Uh probably what would be most useful if if I could get uh Jason and um CEO for children's in the same room uh because you know once I heard it was a there, you know, there was some alarm about staffing and then I heard they worked out some agreement.

So I'm I don't know where it is at this point, but I can certainly find out.

Okay.

Um Director Bennett, how often does DC Health move beyond plans of correction corrective action to stronger enforcement actions?

I'm not just talking about Cedar Hill, I'm talking about across the system.

Notices of infraction.

We have done that, and um if it looks like there is a problem that can't be addressed in that way, um we can do that.

We are in the process, you will see some regulatory changes to make that easier for us to do the way it's written currently doesn't make that as easy as I would like it to be, but we have done so with other hospitals and we will do so as needed.

Okay.

Ms.

Cooper, was the last survey visit uh Cedar Hill, the one in February?

Yes.

Okay.

All right.

Um, Dr.

Bennett, just for the record, can you explain what constitutes an immediate jeopardy determination under the CMS guidelines?

Yeah.

And how often does the district see IJ?

I'm gonna let Renata speak to the frequency.

Okay.

Um but there's someone has a profound misunderstanding of the system based on the way it's been described.

Hospitals aren't designated jeopardy.

Um complaints are based on incidents where because it's not there's a I mean, I would not describe it as subjective because it is meant to be based on documentary proof.

You have a conclusion based on proof, but it is a conclusion.

So if there is a risk that if this process that resulted in this incident continued or lack of process, that there is jeopardy that another person could be harmed, that rises to the level of immediate jeopardy.

That is an incident and a process or system around that incident that needs to be corrected immediately.

That's the point of that designation.

So it is around an incident, just like any of our other complaints, it is not the institution, and it is certainly not for all time.

It is about a particular thing at a particular moment.

Renata, would you like to talk about the frequency and and refine that definition for me?

Okay.

Um I'll have to phone a friend for the frequency across the district.

Okay.

I may not be able to give you that right now.

Um but for the definition actually.

For um immediate jeopardies, there are three components um that constitute that make it rise to an immediate jeopardy.

First is noncompliance, meaning whatever the thing is, we determine that it actually occurred.

Okay.

Okay.

And the second is serious adverse outcome or likely serious adverse outcome, um, which is that if this is not corrected, something really bad is gonna happen.

Like and then the third is there is a need for the immediate action.

Meaning if we don't do this, it's kind of similar to number two, but it's not that it number two is that it didn't have to actually happen.

There's the potential for it.

And for the third part of the immediate action is like if we don't do anything now, um this will reoccur.

Someone else will get hurt.

Um in those instances, because this is all a CMS protocol, um, if we identify a concern that we think may rise to immediate jeopardy, we stay on site.

Um we're not allowed to leave until we can determine that that immediate threat has been lifted or has been removed for this moment.

Not that the full issue has been corrected per se, um, but that immediate need has been resolved.

Um if we issue an immediate um immediate jeopardy to a certified facility, that is deemed, meaning they are an accredited body, they are credited by an accrediting organization um certified through CMS.

DC Health does not issue those reports.

Um DC Health has really no jurisdiction over that.

It is determined finally by CMS and the facility will receive their report um and an actual citation from CMS directly, not from DC Health.

Okay.

So immediate jeopardy, if it is uh I guess um observed that an incident occurred, that it was serious in nature, that if not immediately addressed and corrected, there would be further problem or further harm.

DC Health does not leave the site until it is corrected.

The immediate need has been resolved.

Has been resolved and addressed.

Okay.

That's helpful.

I think in some of this too, um, and I know Ms.

Daniels talked about this in terms of the communications piece.

We've got to get better, because when we allow for um things to sort of fester in the ether without everyone knowing the actual definitions of what things mean or the process, that's when there might um be some cleanup there.

There's only been one immediate jeopardy for Cedar Health, correct?

Cedar Hill has not received an immediate jeopardy citation.

If an immediate jeopardy citation were issued, that would be under federal jurisdiction.

And that would be issued by CMS.

We've done our part.

But the process involves CMS also.

So they the citation is theirs.

Got it.

And a citation is issued via a CMS 2567, which is the Federal Report.

I'm not aware of a Federal report being issued to Cedar Hill at this time.

Therefore, we cannot say that an immediate jeopardy has been issued to Cedar Hill because they have not received a report.

Yeah.

Understood.

You got that?

I learned a lot.

This would be my last round, and I may not even need all of the time.

But just a quick follow-up there.

Would you be notified from the federal government of such a designation?

Yes.

We would be copied on a federal report that would be issued to any facility in the district as CMS's agent here, because we would be responsible for the follow-up for those reports.

And given that there was a plan put in place that was satisfactory to DC Health's local concerns, let's say it that way, is there reason to believe that CMS might still issue a uh one of those formal complaints?

The two surveys are the two reports are separate in nature because they are identifying deficiencies with separate regulations.

Our report is But I'm assuming they are aware of uh the surveys that were conducted by DC Health.

They are.

Might that trigger I what I'm getting at is should is there still room for there to be uh a formal designation?

Let me just clarify, Renat, they would be talking about the incident at the time.

So even if we have done the work to resolve it, that doesn't necessarily change the designation of the incident.

Correct.

Right.

Although the hospital would be able to say we've taken X corrective actions, DC Health is satisfied, et cetera, et cetera, et cetera.

They their response to it should be robust because they would already have worked with us.

Understood.

All right.

Let me just wrap up here.

Um Deputy Mayor, how does the district or DHCF evaluate whether operational challenges, and we've named a lot of them today, uh pose a material risk to the district's guarantee obligations under the operating agreement?

Well, you know, I'm asking this a different way.

But what I'm hearing from you is that annual report, the meeting with the mayor, it seems like you're saying the mayor is the one that would uh that would make the determination that there is a breach of contract.

I know we're nowhere near that.

Uh and there is there's hope and confidence in the partnership.

Yeah.

And in the in the um I believe the language in the operating agreement is very clear, and if we were to report to the mayor that um, you know, UHS was in breach, which like I again I want to emphasize is nothing close to that.

And we have another six months.

Because in six months they should be meeting all of the obligations.

Yes.

And if they are not just not meeting all the obligations at at this time, but indicating they don't intend to meet them, then that would be something that I would raise.

And the mayor has the authority under the agreement.

And also UHA's UHS has the authority to rule that we are in breach of agreement and they can terminate the contract as well.

So it is a it is a two-way um it is it is a two-way path.

Now, again, um I am confident that using the reports that I get from the regulatory agencies, um looking at any data that might be provided by CMS that I could develop a reasonable picture of compliance or noncompliance for the mayor's benefit.

And once we do that, um if the picture is one of compliance, then I you know I think the mayor would agree that we we move forward if it was one of noncompliance and with the recommendation that you know not only are they not compliant, but they're indicating they are not going to comply.

But to be fair, you've already said there are no other operators.

So it kind of signals.

Well, that's just the reality.

Um it doesn't change the fact that it kind of signals.

No, no, no, no.

No, see that I I yeah, I'll take strong exception to that.

If trust me, if UHS told me, well, we're not gonna do that, although it's in the agreement.

I would say that's significant of compliance.

I wouldn't be concerned about the fact that there was not another operator understood.

That's I don't think I have that concern.

I um it to me it does the district no good if you have an operator that is willfully noncompliant and uh under silent that it's not gonna become compliant.

It does the district no good to have that operator, even if they were to own the suitor.

Thank God we are mild get off next to box.

But I'm a former educator.

There are some teachers that want to be good teachers, but they just aren't there yet.

So will and skill are two different things.

One or agreeing to come to the table is one thing, actually coming to the table and delivering is another.

I will leave it there.

You mentioned something in passing that I thought was intriguing, that you alluded that uh UHS is fifty million dollars.

I don't want to say in the whole, but uh for the lack of a better phrase in the whole.

So that makes me wonder how does the district ensure UHS is financially and operationally capable of fulfilling its end of the agreement.

Well, whether or not they are financially capable is uh is is a non-issue.

They are a the second largest provider of uh inpatient beds in the country.

I looked at their last annual report, financials, I think their profits uh nationally uh were I think 14 percent, something like that.

So they have the financial wherewithal.

Now, whether or not they are going to sit around and continually lose the kind of money that triggers the reserve fund that we put in place, which they which we did we did trigger for for their first year of operation, they give I think five million uh to abate partially a loss that I don't have the precise number, but I've heard of over over fifty million.

Uh whether or not they would stay around and continually absorb those kind of losses is a question I can't answer.

But my hope is and my expectation is that if this hospital is allowed to mature, uh that's not a problem they will have.

The reason public hospitals fail, even if they are properly run, and this is important for people to understand and not be demagogued by people who say, well, you you you're talking about gentrification.

The reason public hospitals fail is because the majority of their members are on Medicaid.

Most states pay Medicaid rates that are substantially below the cost.

So even if you do a swell, I mean an amazing job with all the patients that you see, if you serve in 80 percent Medicaid and you look at your books at the end of the year, you're gonna be underwater.

So what we did at DHCF and what we did is a part of the agreement that we said, look, as long as there are um I think it's 90, as long as 95 percent or more of the Medicaid beneficiaries, 95 percent or less are in managed care, I forget the precise number.

We're gonna pay you an enhanced rate.

So that enhanced rate is 140, 50, 50 percent of cost.

So what that means is when a Medicaid person walks into Cedar Hill, for from the standpoint of a payment, they look no different than you or I as a commercial payment.

That is a critical thing that people overlook.

And you cannot run a hospital without massive Federal subsidy if you don't do that.

And the beauty of this payment rate is that the Federal Government is a participant in it.

Now, if if the current administration changed the rules and they don't allow us to do it, then the city will have to make up that difference.

But right now, that is a rate that is funded at 70 percent federal and 30 percent local.

And it is the only way that a hospital that has a patient mix that is largely Medicaid can survive anywhere, let alone uh in Ward A.

That's just the reality.