As one internist with Georgetown privileges puts it: "At one time Georgetown was bringing in a number of outstanding people in many specialties like gastroenterology, kidney disease, and cardiology. It should have been a first-rate medical center, but it imploded." The situation appeared so ominous that rumors began to circulate that the hospital might close.

In 2000, the nonprofit corporation MedStar Health, which also owns Washington Hospital Center, National Rehabilitation Hospital, and four Baltimore hospitals, bought Georgetown University Hospital. Many questioned the move at the time and still do.

The conventional wisdom is that MedStar bought Georgetown to gain a strong presence in a part of the city where it didn't have one and for the prestige value of owning a venerable academic hospital that had an international reputation. At the time of the purchase, Georgetown had appeared on the U.S. News & World Report best-hospitals list for the previous nine years. The purchase also would allow Washington Hospital Center to consolidate and dominate Washington's cardiovascular market, a mission it has accomplished. Since the acquisition, Georgetown's cardiovascular department, including cardiovascular surgery and interventional cardiology, has effectively disbanded. Only a few diagnostic cardiologists remain.

MedStar bought an outdated hospital. Many Georgetown buildings date from the 1940s. Only recently has Georgetown begun discussing renovations and expansion.

Georgetown is also still feeling some effects of years of friction between the Georgetown medical faculty and private practitioners. According to several private-practice doctors, many Georgetown faculty doctors considered themselves exalted and seldom gave private doctors the courtesy of reporting back to them after they'd been referred a patient.

"The attitude of Georgetown's staff doctors seemed to be that they were too busy to talk to you," said one physician who referred many patients to Georgetown.

Such tensions have eased, say doctors, because Georgetown, like other hospitals, needs patients funneled in by private doctors. But there is lingering hostility, which may be why some doctors speak so critically of Georgetown. One said the hospital's overall efficiency is a "nightmare," and several complained that Georgetown's medical records were a mess. Some surgeons complained that Georgetown's operating room is inefficient.

In our physician survey, Georgetown scored below several suburban hospitals in virtually all categories. And doctors ranked it the worst-managed hospital. This may not be fair or accurate because not all doctors listed a "worst-managed" hospital, but it is a perception.

These harsh judgments overlook some of Georgetown's strong points. It is one of two area hospitals to have been awarded magnet status from the American Nurses Association, a designation that indicates high-level nursing care (Johns Hopkins also has that status). It has also retained a number of very good physicians in different specialties, maintained an active organ-transplant service, and made significant purchases of high-tech equipment.

In 2002, Georgetown became the first CyberKnife Sterotactic Radiosurgery Center on the East Coast. The CyberKnife is a noninvasive radiological device that improves the precision targeting of tumors of the brain, neck, and spine. Georgetown also has an active deep-brain-stimulation program for the treatment of Parkinson's disease and other movement disorders. Cancer treatment is a strong focus, and Georgetown remains an important clinical research center for experimental cancer treatments. It is also making efforts to improve its medical records and overall hospital efficiency.

"We are working very hard to improve customer service," says Dr. M. Joy Drass, president of GU Hospital. She adds that MedStar has brought a much-needed business expertise. She says the marriage of the Washington Hospital Center and Georgetown is "an ongoing journey." For example, both hospitals now have an active kidney-transplant program. Will this continue, or will only one survive? What will they do about other duplications? Stay tuned.

Although Georgetown's financial woes have not ended, Drass denied rumors of Georgetown Hospital's demise.

"We have a specific mission and community that we serve here," she says. "We will be here for at least the next 15 years. After that, I cannot say."