Transfer of St. Elizabeths Hospital to the District of Columbia

GAO discussed its report which presented a plan to transfer financial responsibilities for St. Elizabeths Hospital from the Department of Health and Human Services (HHS) to the District of Columbia. In preparing its plan, GAO assumed that the proposed system would be under the authority of the District and should be consistent with the Dixon Consent Decree, minimize costs to the District, and use existing resources. Main aspects of the proposal include: (1) overall financial responsibility would be carried by the District's Mental Health Services Administration; (2) three mental health districts would have responsibility for patient treatment and financing; (3) outreach services would be provided by each district; and (4) shifting acute psychiatric care from St. Elizabeths to community hospitals. GAO noted that St. Elizabeths would change significantly if the proposal were adopted since it would no longer offer outpatient services or acute psychiatric care. Staffing levels would change. GAO estimated that costs under its proposal would be significantly less although the District's contribution to the system would probably double. GAO suggested that the District: (1) implement the system over a 2-year transition period beginning in October 1985; (2) assume responsibility for the system at the beginning; (3) be provided funding subsidies by the Federal Government during the transition period; and (4) evaluate which St. Elizabeths buildings it needs. Finally, GAO discussed the HHS and District proposals for changes in financial responsibility and mental health care at St. Elizabeths.