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.
In my neighborhood, they get transported unless they specifically sign a release form (AMA - against medical advice form). The problem’s liability if the medic makes a wrong call. The same liability issue limits the ability of a triage nurse to send the patient home. There’s a little bit of a finesse that can be done, though, involving pointing out that the nurse-practitioner is available right now, but it’ll be three hours until the doctor can see them. I’ve been pushing for that approach at the local hospital for a couple of years now. There’s a problem with getting reimbursed for the care if it’s not provided by a physician in an ER that’s holding things up.
Essentially, every time government has gotten involved in the process it’s added greater and greater inefficiencies without any noticable increase in quality of care.
Interestingly enough, England's NHS has come to the same conclusion, and is rapidly transitioning a large portion of its health care to non-MD's.
No, it wouldn't b/c the hospital would be in court getting its rear-end sued. How? Why? Well, for starters how 'bout discrimination (against the "poor")and/or racism (as I expect most of these ER non-emergency patients are "people of color")? Lord love a duck, the NAACP, ACLU, etc., would have a field day!
Ding! Ding! Ding!
We have a winner!
I find that hard to believe in non-emergent cases. Do you have a cite?
If you care to wade through this and explore the actual EMTALA act, you will see why patients are not turned away. Many physicians and hospitals have been fined obscene sums for refusing to treat poor patients. Believe me, this can occur with even trivial medical conditions
Grady, AKA, “Sick fags over Georgia”
bump
I’ve been to SFoG, years ago. I got sick on a rollercoaster there but I didn’t have to go to this hospital.
Morehouse has a medical school and runs a residency, both through Grady. The quality of care and education is lower, but not bad. Still, I guffawed when I saw the note about the bumper sticker reading “If I’m in a car accident, take me to Grady.” The only such slogan I ever saw was the joke amongst residents that they had tattoos on their chests, in case trauma befell them, that says, “I have a Emory number.” (The last two digits of your SS# determine which program you go to - 1-29=Morehouse, 30-99=Emory)
I made fun of it as “MO-house,” for this reason: Though the local racialists loved to preen over the fact that they had a “predominantly black school,” in fact it was largely staffed by native Africans, who were on immigration visas. As many know, this is another one of the Great American Liberal Myths — that science, health care at the high levels, the grant process, and much of the whole racist Affirmative Action beneficiaries are loaded with people who come from places like Nigeria and Kenya. There are bona fide Americans whose skin happens to be Black, but not like the great racialist success story Leftist would love for you to believe. Yes, the racket is loaded with native Africans, who you would have to admit, have much less in common with the average “Hood” warrior than Americans of European ancestry. Your hard-earned tax dollars are not just going to racialist programs that have repeatedly failed to help Americans of the correct hue. No, it’s much worse; tax dollars are going to fund the third world immigration wealth transfers, under the cloak of failed racialist programs.
This is why I like to call Obama Hussein, Barry the Kenyan Mulatto. Afterall, that’s the truth.
I’m not trying to offend anyone’s Leftist sensibilities with this strong tonic.
That's what I figured. And I bet a Fulton County jury would be more than happy to find a "rich" doctor liable and turn in a big damage award.
They cannot turn patients away and refuse care. After triage, they can legally refer the non-emergent cases to the clinic next door. Which reminds me, they ought to have a clinic next door.
This is a serious problem for the Atlanta area. Grady is a financial Charlie Foxtrot, but the standard of care is excellent. Especially for trauma. Military medics train at Grady, like other inner-city hospitals, to gain exposure to and experience with trauma, including gunshot wounds.
This applies to abortions performed at Grady as well. The taxpayer picks up the tab.
No sympathy.Sorry.Our town just built a new hospital at a cost of seventeen million dollars,not counting overruns.This is the third hospital built in the last thirty years.They are still in litigation over the first one.
When the new hospital started running in the black,they canned the Veterans which they paraded prior to voting for the new hospital.Ah,what are three hundred veterans tossed to the street worth?Three hundred miles one way for care.
NO ONE PITCHED A FIT.Go figure.
That's probably what's going to happen. But the "kicking in" will come in the form of taxes, likely at both the county and state level.
As far as I know off the top of my head, there are only two med schools in metro Atlanta -- Emory and Morehouse. The University System of Georgia only has one med school, the Medical College of Georgia, in Augusta. The state chose to concentrate all its medical education on one campus.
Emory has an endowment of three or four billion dollars. It could take over Grady lock, stock and barrel, and write off the losses as the cost of the teaching and research they could do there. The CDC and the American Cancer Society are both just up Clifton Road from the Emory campus, and they could kick in a few bucks in research grants. A cross-section of humanity passes through Grady, and their patient records, blood and tissue samples, etc. would make a pretty good pool for research.
I live near the Emory campus, and if I were to have a heart attack, that's where I'd want to be taken. But for trauma, take me to Grady. They've seen it and done that.
“This is a serious problem for the Atlanta area. Grady is a financial Charlie Foxtrot, but the standard of care is excellent. Especially for trauma. Military medics train at Grady, like other inner-city hospitals, to gain exposure to and experience with trauma, including gunshot wounds.”
You said what I was thinking. There is no better trauma care out there. The ER physicians at Grady are some of the best docs anywhere, and the rest of the staff is excellent as well.
The problems at Grady are governmental and managerial in nature. The funding structure is ridiculous, with two counties funding a hospital that serves the entire area. The cost should be shared by all who benefit.
Management at Grady is appalling, and I can’t imagine a nonprofit board being any worse. I don’t care if they are white, black or purple, the current management has failed too many times to get another chance.
As for the anchor babies issue, I think this one is barking up the wrong tree. Grady started soliciting for birthing business because it brought in money, to help defray the costs of other treatment. I don’t think they were actively soliciting hispanics, but that seems to be what happened. I believe that this is one of the profitable or less depleting service areas in the hospital.
There are so many problems at Grady that it would take a book to write them all down. Crack babies abandoned at the hospital and running up million dollar bills, Extensive fines for overbilling, failure to bill for other patients. Excessive spending, no oversight, all factor in. But the bottom line is that the trauma care at Grady is exceptional, and the hospital is an extremely valuable asset to Atlanta.
Grady doesn't make the babies. It just delivers them and keeps mother and baby healthy.
If there's too much garbage, you don't blame the guy who drives the truck.
HMOs got there a long time ago. To put it in military terms, nurse practitioners and physicians' assistants act as a force multiplier, enabling an MD to handle more patients. There's no reason an MD has to perform a basic vital signs check, administer a shot or dress a minor wound. In fact, nurses are usually better at that sort of thing.
And you have how much knowledge of either Grady or Atlanta?
Grady's bureaucracy and management are FUBAR. The medical care is top-notch. There is an insanely long wait in the ER, unless you're in a clear crisis, and it's the usual inner-city municipal hospital. but the standard of care is good, especially in trauma cases, and the burn unit is often used as a model for other hospitals.
And if Atlanta's such a "piss poor liberal city," Does that mean all the f'n Yankees will stop moving here in droves?
Agreed. In practical terms, that probably means state funding. That's going to be a hard sell in the General Assembly, because there's always resentment of any move that sends more state money to metro Atlanta.
That's why I would love to se Emory step up with the money -- but they won't do it for nothing. If they kick in more money, they're gonna want greater control. That's not necessarily a bad thing; Crawford Long has done pretty well since Emory took it over.
Management at Grady is appalling, and I can’t imagine a nonprofit board being any worse. I don’t care if they are white, black or purple, the current management has failed too many times to get another chance.
Amen. Transferring control to a non-profit board gets it out of politicians' hands, and could inspire enough confidence to get corporate donations and grants from other non-profits. Emory among them.
As for the anchor babies issue, I think this one is barking up the wrong tree. Grady started soliciting for birthing business because it brought in money, to help defray the costs of other treatment. I don’t think they were actively soliciting hispanics, but that seems to be what happened. I believe that this is one of the profitable or less depleting service areas in the hospital.
I'm inclined to go along with the notion that childbirth is a profit center for hospitals, because they compete so avidly for that business. Georgia Baptist (where my mom was born) and Dekalb General Medical Center (where my sister was born) are pressing that part of the business, and hospitals on Pill Hill are offering delivery rooms that have everything you'd find in a luxury hotel except the mini-bar.
But the bottom line is that the trauma care at Grady is exceptional, and the hospital is an extremely valuable asset to Atlanta.
An irreplaceable asset. If Grady fails, it will cost billions to build a new hospital to serve the need Grady serves. It simply has to be kept afloat. Reformed, reclaimed, rethought -- but saved.
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