Posted on 11/27/2007 3:06:47 PM PST by Baladas
ATLANTA (AP) - For generations, Grady Memorial Hospital has treated the poorest of the poor, victims of stabbings and shootings, and motorists grievously injured in Atlanta's murderous rush-hour traffic.
Now, Grady itself is in grave condition.
Staggering under a deficit projected at $55 million, the city's only public hospital could close at the end of the year, leaving Atlanta without a major trauma center and foisting thousands of poor people onto emergency rooms at other hospitals for their routine medical care.
"I don't have the words to describe the onslaught of health care needs that will hit the region if Grady were to close," said Dr. Katherine Heilpern, chief of emergency medicine at the Emory University medical school, which uses Grady as a teaching hospital and supplies many of its physicians. "This is a huge deal. We may literally have people's lives at stake if the Grady Health System fails and spirals down into financial insolvency."
On Monday, Grady's governing board of political appointees was scheduled to consider turning day-to-day operation of the hospital over to a nonprofit board in hopes the move would attract big corporate donations and enable Grady to keep its doors open.
Founded in 1892, Grady has struggled financially for years. But now it has reached a crisis because of rising health care costs, dwindling government aid, a lack of paying customers, and years of neglect - a situation not uncommon among urban hospitals like Grady that primarily serve the needy.
In addition to losing money on patient care, Grady needs an estimated $300 million to repair and modernize its buildings and acquire new equipment such as CT scanners and an up-to-date computer system.
The loss of Grady would be unconscionable to many political and civic leaders in this booming metropolitan area of 5 million people. The overwhelming majority of the 900,000 patients treated at Grady each year are poor and black, and the institution is considered a vital part of Atlanta's black community.
But the proposed switch to a nonprofit governing board is problematic, too. Some fear that the hospital would be less committed to the poor, and that the board would go from mostly black to mostly white.
State Sen. Vincent Fort, a black Democrat from Atlanta, said Grady is "absolutely critical" to the city's black poor. And he charged that Atlanta's "white power structure" - including the business leaders and politicians who are pushing for the nonprofit board - is trying to orchestrate a takeover.
"To the extent that you have African American doctors, nurses and other professionals operating a big-city hospital and taking care of black people, that is a source of pride in the black community," Fort said. "So there is a great deal of skepticism that the Chamber of Commerce is interested in Grady. There are some of us who believe that is a self-interest."
With 953 beds and 5,000 employees, Grady is an anchor of Atlanta's downtown, and accepts all patients, without regard to their ability to pay.
Only 7 percent of Grady's patients have private insurance, and 75 percent are on Medicaid. Because they lack of insurance and have no family doctor, many go to Grady's emergency room even when they don't have an emergency. The ER ends up treating sore throats and other ordinary aches and pains.
Besides Atlanta's poor, Grady's patients include tourists passing through on their way south to Walt Disney World and victims of auto accidents, since Grady is the only hospital in a 100-mile radius of Atlanta that has a Level 1 trauma center, capable of treating the most serious injuries. (A popular bumper sticker seen on cars along Atlanta-area highways reads: "If I'm in a car crash, take me to Grady.")
Grady played a critical role after the bombing at the 1996 Olympics blocks away. And in March, when a bus carrying a college baseball team from Ohio plunged off an overpass, 19 students and coaches were rushed to Grady.
"Quite frankly, that would've overwhelmed any other system in the city," Heilpern said. "That was sort of all in a day's work for us."
Grady also has the state's only poison control center, obstetrics intensive care unit and comprehensive sickle cell center. And the city's emergency command center for handling plane crashes and terrorist attacks is based at Grady.
If Grady were to close, poor people would probably swamp other hospitals' ERs with everything from ordinary colds to genuine medical emergencies.
"It will be a sad day for Atlanta if Grady closes. If people realized the benefits Grady provides, closure would not be on the table," said Dr. Marsha Regenstein, a health policy professor at George Washington University in the nation's capital.
Doctors, activists, lawmakers, business leaders and the hospital leadership are scrambling to find a fix for Grady, which gets most of its funding from Medicare, Medicaid and Fulton and Dekalb Counties and is run by a governing board whose members are appointed by the two counties' politicians.
In July, a 17-member task force of business leaders recommended the shift to a nonprofit board. Some of Atlanta's major corporations have said they would contribute to Grady if it were run by a nonprofit board because it would manage the hospital more efficiently.
Other public hospitals that have been in distress in recent years include D.C. General Hospital in Washington, which in 2001 stopped taking inpatients, and Martin Luther King Jr.-Charles Drew Hospital, which was built in Los Angeles after the 1965 Watts riots. The hospital lost its government accreditation last summer because of shoddy care and closed its trauma center.
1. What is EMTALA?
The Emergency Medical Treatment and Active Labor Act is a statute which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when he is in an unstable medical condition.
EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, and it is sometimes referred to as “the COBRA law”. In fact, a number of different laws come under that general name. Another very familiar provision, also referred to under the COBRA name, is the statute governing continuation of medical insurance benefits after termination of employment.
Reportedly, a 1989 amendment to the statute removed the word “active” from the official name of the statute. The amendment, however, cannot be found in the report of the official public law.
EMTALA is also known as Section 1867(a) of the Social Security Act. It is included as part of the section of the U.S. Code which governs Medicare.
EMTALA applies only to “participating hospitals” — i.e., to hospitals which have entered into “provider agreements” under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the U.S., with the exception of the Shriners’ Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients, and not just to Medicare patients. (See Section 15 below.)
The avowed purpose of the statute is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to “charity hospitals” or “county hospitals” because they are unable to pay or are covered under the Medicare or Medicaid programs. This purpose, however, does not limit the coverage of its provisions — see Sections 15 and 16 below.
EMTALA is primarily but not exclusively a non-discrimination statute. One would cover most of its purpose and effect by characterizing it as providing that no patient who presents with an emergency medical condition and who is unable to pay may be treated differently than patients who are covered by health insurance. That is not the entire scope of EMTALA, however; it imposes affirmative obligations which go beyond non-discrimination. See Section 16 below.
2. What are the provisions of EMTALA?
The essential provisions of the statute are as follows:
Any patient who “comes to the emergency department” requesting “examination or treatment for a medical condition” must be provided with “an appropriate medical screening examination” to determine if he is suffering from an “emergency medical condition”. If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute’s directives.
What constitutes “coming to the emergency department”? See our special note on the 250 yard rule and its discussion of presentations to locations other than the emergency room, as well as the further discussion below.
If the patient does not have an “emergency medical condition”, the statute imposes no further obligation on the hospital.
A pregnant woman who presents in active labor must, for all practical purposes, be admitted and treated until delivery is completed, unless a transfer under the statute is appropriate. The statute explicitly provides that this must include delivery of the placenta.
In essence, then, the statute:
* imposes an affirmative obligation on the part of the hospital to provide a medical screening examination to determine whether an “emergency medical condition” exists;
* imposes restrictions on transfers of persons who exhibit an “emergency medical condition” or are in active labor, which restrictions may or may not be limited to transfers made for economic reasons;
* imposes an affirmative duty to institute treatment if an “emergency medical condition” does exist.
I’m learning more about this hospital in this thread then I ever thought was possible.
Anchor baby mill, ya. Just off the top of my head, they could seek funding from Soros, Lewis, and homeboy Turner as well....
Wealthy city like Atlanta which has seen better days in the city proper going to seed unless they can conquer and accumalte the suburbs....they all try this tactic
There was talk at one point of opening a hospital here in S. Georgia, in Brooks County. (One of the poorest counties in Ga)
On the local radio call-in show, a Welfare Recipient had the nerve to call in and say, “They needs to bring the hospital and as long as we gets things for free, we use it!”
I can see Grady’s problem, and if they privatize it, what will happen. I know my MD could retire on his outstanding accounts if they were paid in full.
I find it really hard to have sympathy for those who choose to have the latest cell phone and not medicine if you need it.
As I have said many times before here on FR: we already have universal health care in this country. The only question that remains is how we may organize it so that it works best.
What possible self-interest could the Chamber of Commerce have in taking over a money losing hospital?
Well.. okay... maybe one: keeping it from closing and deluging all the for-profit hospitals with non-paying patients.
Even so, you’d think keeping it open would be in the interest of the black community, even if a bunch of business types have to do the job they’ve proven to be incapable of. For some reason, the ‘activists’ are more concerned about someone else succeeding than about the hospital going under. What ever happened to the old ‘diversity is our strength’ routine?
If the patient does not have an “emergency medical condition”, the statute imposes no further obligation on the hospital.
It seems to me that the rub is what constitutes an an "appropriate medical screening examination.” Is it sufficient for the triage nurse to evaluate the person or do they have to put each person through to see a doctor? If it's the latter, it appears that the hospital still doesn't have to treat a non-emergent case.
Sigh! If only they could. You not only can't legally turn them away, you also can't have anyone but a doctor treat them.
Free services ain’t that free as the results here prove.
Konk this thing in the head.It is a piss poor run hospital in piss poor liberal city.
Me too. I suspect that if such people had to pay up front for their medical care, they'd either find a way to pay or decide that they didn't need to go to the ER after all. I consider cost when I decide how badly I need to see the doctor. Why shouldn't they?
“I find that hard to believe in non-emergent cases. Do you have a cite?”
Be careful, you are grabbing on to the thread that can unravel health care before your very eyes.
I trained at Grady from 1995-1998. It was great for my purposes. However, it was obvious even then that this was a Leviathan of Socialism, a redistribution scheme, bilking the taxpayers, rewarding irresponsibility, a specious jobs programs for undeserving or underachieving community Afro-Americans; They were constantly spending gazillions, renovating perpetually.
The same racialist so-called Black Leaders continue their chutzpah, insinuating some conspiracy by greedy whites, when in reality, the raped taxpayers of Fulton and DeKalb County have been leeched of almost all of there blood, paying for their own health care, as well as for the free-loaders.
It is a boondoggle, a throwback, a sink-hole.
It also trained some mighty fine physicians in its time. Remember, 30 percent of Grady’s patients are taken care of by Morehouse physicians. That’s a whole different story.
Holy crap. The article reads like it came from The Onion. I can’t believe this isn’t satire.
Illegal under federal law.
I think I know where you're going with this, but tell me more. I didn't know Morehouse had a medical school.
Emergency rooms are not for routine medical care, hence the term “emergency”. The domino effect will cause more hospitals to close for the same reason.
There is plenty of precedent here in Tucson. One million people and no trauma center.
Triage them (nurse does triage) to a 24 hour clinic. They try to go back to the ER, they lose their place in the clinic line. One of the Ohio cities, Cincinnati maybe, now allows paramedics to determine on scene if the patient actually needs an ambulance ride to the ER. If not, see your doc, or get to the clinic on your own.
I wonder how cheaply a cash-only clinic could be run, Walmart type, staffed largely by nurse practioners. Maybe some public subsidy, but a minimum of $30 to $50, no exceptions, and better service than the free clinic.
Maybe Walmart should do it.
And then there’s sending the bill run up by Mexicans to Mexico...
Exactly. All the huffing and puffing about “sociaized medicine”, “government-run health care” and “universal coverage” is pure hot air. We already have socialized, government-run, universal health care in this country. It’s called the ER. The voters of the United States long ago decided that health care is a human right, not a privilege. That debate is over. It is pointless to keep rehashing it.
With this in mind, the only thing remaining to discuss is whether or not the ER is the best place to provide the citizens of this country with socialized, government-run universal healthcare services. I say “no”. I’m for a United States Public Health Service system of neighborhood clinics, staffed by uniformed doctors working there in exchange for a 100% government-paid medical education. I also support religion-based free hospitals, allowing RNs and PAs to perform basic medical treatment, and taxpayer-funded medical-care vouchers for the indigent poor.
It’s all very well to talk on the Internets about letting sick people with no money die in the streets, but in reality such a situation will lead to plagues, public disorder, and eventually a communist revolution. Since we must have some system of taxpayer-paid universal health care for the indigent poor, the best we can do is figure out the least evil option for providing it.
“appropriate medical screening examination.”
It is irrelevant what you or I believe is appropriate. Take a tour around the area to see the billboards, or open the phone book to the attorneys section. These are the people who decide the definition of “appropriate.” In reality, the cost of risking one foul up on screening (the end of a career before it even really begins, tried by 12 peers of Fulton Co) is much greater to any one sane individual than spreading the pain to others by seeing every bump and bruise. The ethical lapse then comes into play: Hospitals and physicians are then rewarded if they order tests, rather than actually taking a lowly reimbursed history and examination. ER docs can sit at the command station, order tests, and make money for themselves and employer, without risking the social embroglio. They can sit there safely, as it’s hard to blame someone you don’t know. But I digress again...
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