A DC City Council hearing Thursday morning on the viability of United Medical Center, the city’s only public hospital, unleashed a brewing battle between two major medical corporations for control of the health-care market in the nation’s capital.
City council members and staff call it the “battle of the titans.”
Thursday’s testimony before the council’s health committee seemed tame. Richard Davis, president of Sibley Memorial Hospital, spoke on behalf of his hospital’s proposed collaboration with United Medical Center and Howard University to bring the latest cancer treatment to DC. Sibley wants to build a $129 million “proton therapy center” that would introduce a radiation treatment it describes as much more targeted and efficient than current systems.
“Indeed,” Davis testified, “the project has been specifically designed to ensure all residents of DC have access to this critical cancer treatment.”
Officials from UMC and Howard University testified in favor of Sibley’s proposed cancer treatment and its desire to share the new technology.
But Sibley, a small, not-for-profit hospital in far Northwest, is now owned by Johns Hopkins Medical Center in Baltimore. The proton cancer treatment facility would be Johns Hopkins’s first major foray into the DC market. MedStar—a not-for-profit company that owns Georgetown Hospital, among other facilities—now dominates the DC health-care market and has been fighting to kill Sibley’s venture.*
“I support and appreciate MedStar,” says council member David Catania, who has devoted the past decade to rebuilding DC’s health-care system. “But I have a disagreement with limiting competition from a world-class provider such as Hopkins.”
Says a council staffer with firsthand knowledge of the fight: “It’s a pitched battle. It’s all about market share. MedStar can’t be too excited about Johns Hopkins planting a flag in its city.”
The “pitched battle” has been taking place before the city’s State Health Planning and Development Agency, a small but powerful agency that controls expansion by any health-care provider, especially hospitals. To expand or establish a new facility, such as the proton therapy project, a hospital must procure a “certificate of need” from SHPDA.
On Thursday, Davis referred to the certificate of need only in his written comments, but the retaliation before SHPDA has been brutal. MedStar is seeking its own certificate of need to build a smaller proton therapy center at Georgetown Hospital. In the process, it has attacked Sibley’s proposed cancer center.
In a January 15 filing, MedStar claimed “numerous deficiencies” in Sibley’s application for a certificate of need. It questioned everything from the ownership of Sibley’s proton center to whether the city needed it. MedStar called Sibley’s application “devoid of reason or rationale.”
MedStar did not testify at Thursday’s health committee hearing, but hours after chairwoman Yvette Alexander gaveled it closed, MedStar blasted Sibley and Johns Hopkins.
“The underlying business purpose of the Sibley-Hopkins proton therapy center is to permit Johns Hopkins to be able to send its cancer patients to one of its affiliated facilities for proton treatment,” MedStar lawyer John Brennan wrote to Alexander. He suggested Hopkins would ship its patients from Baltimore to DC. “This is Johns Hopkins’ true business strategy—not the care and treatment of the residents of Wards 7 and 8.”
But at the hearing, officials with Howard University Hospital and United Medical Center disputed MedStar’s contention that Sibley’s cancer treatment center was not needed in the District.
Sibley’s Davis described a dire cancer mortality rate in the nation’s capital, skewed heavily toward African-Americans. He quoted a DC Cancer Center Consortium that reported: “Cancer mortality in the city is highest in Wards 5, 7, and 8—those with the highest concentration of African-Americans and low-income residents.”
Davis described Sibley’s plan to provide treatment to patients at the United Medical Center, which is in Ward 8, together with Howard University Hospital, which also treats the city’s poor. He outlined a system that would offer consultation and transportation to poor patients.
“The key difference from traditional treatment,” Davis said, “is that protons provide a more accurate means of treating patients with radiation as compared to traditional radiation therapy.”
Cyril Allen, UMC’s chief medical officer, testified that without the collaboration between Howard and Sibley, “many Ward 7 and 8 patients will wait to the last minute or until the cancerous mass is exposed. At that point they are so sick that they don’t have a choice but to go see a doctor.”
Referring directly to MedStar’s cancer facility, Allen said, “Let me be perfectly clear: Currently, Wards 7 and 8 do not have an adequate level of support from the Lombardi Cancer Center.”
Meanwhile, Catania welcomes the battle of the titans.
“This level of competition is not happening in other cities,” he says. “Good for us. Both MedStar and Hopkins will have to step up their game to win District residents over.”
It would take as long as four years for Sibley to build its cancer research and treatment facility, but if MedStar succeeds in thwarting its certificate of need, the project and its collaborations will die on the vine.
*This post has been updated from a previous version.