As the “Hospital Crisis” in the Washington Metropolitan area deepens, its dimensions have become increasingly more alarming. “Greater Southeast Community Hospital and Prince Georges Hospital Center serve thousands of the region’s most vulnerable people, many of whom cannot afford medical care. But the issues that have pushed the two institutions to the edge of failure go far beyond the burden of poor and uninsured patients”, say Susan Levine and Rosalind S. Heldeman, Staff Writers for the Washington Post.
The causes of these two hospitals moving from one crisis to another in the last few years include leadership and funding issues which are longstanding and unresolved as well as unattended allegations of poor management. Perhaps most of all, protracted political acrimony and the accompanying instability and uncertainty of funding and funding sources has paralyzed management and the decision making processes at both of these hospitals. The lack of resolution of these issues has now resulted in formal litigation of those issues over which the Circuit Court has subject-matter jurisdictions. The Court by definition, however, does not have jurisdiction to address political questions and the accompanying managerial deficiencies resulting from personal and political acrimony and intrigue. Furthermore, to complicate the matter, the political and personal feuding which underlies this dispute more than the individuals involved wish to admit or even realize is getting worse not better. Most importantly, and obviously, the Court can’t address management issues which aren’t based on contract principles or other statutory or case based rights and responsibilities.
This was evidenced most recently when the Circuit Court for Prince Georges County addressed the Prince Georges Hospital Board’s request for preliminary injunctive relief. Preliminary, and therefore temporary, relief was provided in the form of a $2 million dollar injection of funds in order to deal with the “imminent” problem of the hospital needing funds to continue to operate until the next hearing. That was legally all the Court had authority to do at that time. So Judge Dwight Jackson did all he could do legally do to prevent what appeared to be a result which would be “devastating”. The Court certainly did not address any issues other than the threat of “imminent and irreparable harm” which the Judge was convinced would occur if he did not act. Nor did the Circuit Court intend to do more because it had no authority to go beyond the relief granted at this stage of the legal proceedings.
The bottom line is that litigation will not produce a long-term solution to a crisis that has resulted from all of the causes listed earlier in this column because litigation is a process that doesn’t address the underlying causes of the economic, political, personal, demographic and policy disputes that have caused the crisis and further prevented a resolution of the issues to this date. Nor can litigation frame the ultimate issue which is “what if these two critical healthcare providers collapse?” in a way that legally compels the interested and affected parties to face the ultimate issues directly and be held accountable for their action or inaction.
Part of the reason litigation can’t address the real issues is that many of the affected, and therefore necessary parties, are not represented as parties in the actual case. The State of Maryland is not a litigant in the case. The other hospitals in the region who would be directly affected are not in the case. They must be a part of a comprehensive solution or there will not be one.
What dispute resolution technique offers the best hope of reaching a comprehensive solution which would prevent what Sharon Baskerille, Executive Director of the D.C Primary Care Association, describes as an impending “perfect storm”? This storm would carry with it strong economic winds that could carry the thousands of patients diverted to the remaining regional hospitals. These hospitals would quickly be overloaded and potentially paralyzed. These other regional hospitals therefore have a strong economic and professional interest in preventing the closing of either, let alone both, of these hospitals. They therefore need to be involved directly in the prevention of this scenario. The specter of this set of events should be more than sufficient to motivate all of the region’s other hospitals to enthusiastically participate in the Crisis Prevention effort that needs to be made.
The process that is best suited to produce a comprehensive and long-term resolution is Mediation and it should be convened immediately with all of the stakeholders in this regional community in the room(s). As Robert C. Fiskis, J.D. and Peter S. Adler, PhD point out in an article in the 2007 edition of AC Resolutions, entitled “Leading From Behind”,…”If conflict is the crucible of leadership, negotiations are the mortar and the pestle. Responsible professional and political officials must lead the people and organizations they represent through the grinding and stirring that makes something useful out of sometimes mundane ingredients. The job of the Mediator is to lead the process of bringing out everyone else’s best leadership.”
Everyone else’s best leadership has yet to emerge in this high stakes political, personal, policy and economic dispute. It’s time to “Bring It On!”