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The final report on how well the Detroit Medical Center is meeting its obligations to its patients and community raises concerns about the future of health care in the city.

The Legacy DMC Board, the watchdog group established to oversee the hospital system's transition to a for-profit enterprise 10 years ago, concluded the medical center is not investing enough to adequately maintain its facilities. It has, however, fulfilled its obligation to spend $500 million to upgrade the hospitals, which include Sinai Grace, Hutzel, Children's, Receiving and Harper hospitals, among others. 

When Vanguard Health Systems purchased DMC, it agreed to a number of conditions to gain state permission to convert the hospitals from their nonprofit status. Later, Vanguard sold the system to Dallas-based Tenet Health Care, which assumed the obligations.

Along with spending $50 million a year on maintenance and upgrades, the new owners pledged the DMC would continue through 2020 to do charitable work, serve as a research and education center and provide high quality care. 

However, the final report from the watchdog board cited other concerns beyond inadequate maintenance, including a declining commitment to education: the loss of accreditation of a prestigious training program for neurosurgeons, and the reversal of an announcement last year that DMC would hire an additional 79 resident physicians. It also estimated the system is spending $20 million a year less than is needed to keep its facilities in top shape. 

The 10-year oversight is ending, but obviously the problems at the DMC remain.

Throughout its private ownership, the hospital has been dogged by failed health and safety inspections. A 2018 Detroit News investigation revealed a failure to properly clean surgical tools, endangering the lives of patients.

The nagging issues are fueling speculation that Tenet will sell the DMC, as it did its Philadelphia facility.

That could be beneficial, if a new owner finally addresses the need to fully upgrade the hospitals and make the teaching programs more robust. 

It also could go badly. 

In Philadelphia, the hospital Tenet sold eventually closed. Like DMC, it was a vital health care resource for a largely poor and African American population reliant on government insurance. And it, too, was a major teaching hospital

DMC is the primary teaching hospital for the Wayne State University school of medicine. The college’s residents handle much of the caseload at DMC, which is a key provider of care to the indigent in Detroit.

Should it close, or if its mission substantially changes, inequities in health care in Detroit are bound to grow.

The COVID-19 pandemic has brought the issue of unequal care to the forefront. African Americans make up 32% of the virus cases in Michigan, while accounting for just under 14% of the population. 

Whether Tenet decides to keep or sell DMC, the quality of care and the condition of its facilities must improve.

The devastation COVID-19 wreaked on Detroit residents should be a call to action to hold health care facilities that deliver care to the poor to the highest standards.

DMC is not serving this community in the way it promised when the system went public a decade ago. It must do better. 

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