After years of failed efforts, the District is one step closer to reaching a deal to build a new hospital in Southeast D.C., where residents face the most stark health inequities in the city.

On Tuesday, the D.C. Council voted in favor of a bill approving a deal with George Washington University Hospital to build a new hospital on the St. Elizabeths campus in Ward 8. The bill still needs to come up for a second vote before its final passage.

The $375-million deal will include the construction of a 136-bed hospital in Congress Heights, with the ability to expand to 196 beds.

Twelve councilmembers voted in favor of the bill, with one recusal from Ward 3 Councilmember Mary Cheh, who is a professor at George Washington University. The bill’s unanimous vote stands in stark contrast with previous versions of the legislation, which generated heated debate on the dais.

Mayor Muriel Bowser originally announced GWU Hospital, run by Universal Health Services, as a partner on the new hospital in 2018, but a series of controversies stalled the bill in the D.C. Council. The largest point of contention was Universal Health Services’ ask for hundreds more beds at its Foggy Bottom hospital location, which it claimed it needed to fund the new hospital. Several community groups, Howard University, and even George Washington University itself voiced opposition to the deal.

In May 2019, GWU’s opposition led to the repeal of a council bill approving the first version of the deal, which—after long debate—had allowed for the extra beds.

That winding road left the future of the Ward 8 hospital up in the air. For months, it was unclear what a new deal might look like. Then, in late April, the city announced a deal that included a 136-bed hospital at St. Elizabeths East, with the ability to expand to 196 beds, expected to open in 2024. The deal for the hospital includes an ambulatory care pavilion, behavioral health programs available to those who have substance use addictions, long-term chronic care services, obstetrical care, a level II neonatal intensive care unit, a level III trauma center, and other services.

In addition to the new hospital, there will be two urgent care centers in wards 7 and 8, which have never been present in either ward.

The new hospital will replace United Medical Center, a city-run hospital and currently the only hospital located east of the Anacostia River. UMC has faced harsh criticism for mismanagement and medical errors, sometimes resulting in patients’ injury or death. The hospital was also required to close its obstetrics ward after medical mistakes.

Ward 7 Councilmember Vincent Gray has been pushing for a new hospital in this part of the city since he was mayor, and he has been a forceful proponent of the city’s deal with GWU on the council.

United Medical Center “was built and opened back in the mid 1960s. And there’s very little work that’s been done in the interim,” says Gray. “It’s a very old facility. Secondly, it’s had financial problems along the way. In fact, the city at one point essentially brought it out of bankruptcy.”

The need for quality healthcare, specifically in wards 7 and 8 is desperate. There is a significant life expectancy gap between white and Black D.C. residents.

According to a Georgetown University report, while Black men in D.C. have a life expectancy of 68 years old, white men in the District are projected to live, on average, until age 83. Meanwhile, Black women are expected to live nine years fewer than White women.

Wards 7 and 8 are predominantly Black neighborhoods, as each ward has over 92% Black residents, according to DC Health Matters.

When the deal was first announced in April, At-large Councilmember Elissa Silverman raised concerns about the new hospital not providing the same level of care as those west of the river, where there are three Level I trauma centers.

“I think that the biggest question that Wards 7 and 8 ask is, ’Why do we get a Level III trauma center when Wards 2 and 3 — which, let’s be honest, are the whitest, richest wards in the city — get a Level I trauma center each?'” Silverman told NBC Washington.

Gray maintains that the hospital will still be able to serve the community.

“Based on the data, 85 to 90% of the trauma situations we experience on the east end of the city will be handled in an effective way by the hospitals we build,” says Gray. “Second, there are four trauma centers across the city. A state like Virginia, for example, has maybe three to four trauma care centers across the entire state. In D.C. we already have four trauma centers.”

Recent health disparity findings with the coronavirus have echoed the need for adequate and quality facilities. The population of the District of Columbia is 46% African American, but Black Washingtonians have made up the vast majority of the city’s coronavirus deaths.

“There is no question that that need [for healthcare services in Southeast] has been further demonstrated [by the pandemic],” Gray says. “We think that need already existed. We felt we had worked hard to be able to further underscore the importance of meeting that need but the coronavirus has really substantially underscored it.”

The new hospital will address multiple challenges in Southeast, including unemployment, he says. “It will increase jobs by virtue of construction that’s going to be done… We can look for additional construction jobs that will go substantially to people who live in wards 7 and 8,” says Gray.

The bill also prioritizes United Medical Center staff. There will be a training program for existing Medical Center staff who want to work at the hospital to help ensure that existing staff meet the credentialing and hiring standards of the new hospital. “The new hospital staff who meet those standards and who are interested in working at the new hospital will receive a hiring preference,” Gray says.

Another part of the deal announced by Bowser in the spring, which approves the construction of a new Howard University Hospital, has not yet come up for a vote before the full council.

Gray says that the new hospital is an equity issue for communities living east of the river.

“They pay the taxes just like everybody else,” he says. “We need to make sure that they have the opportunity to benefit from those tax dollars being invested on their behalf.”