Atlanta Hospital in Grave Condition

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.

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.

Do you suppose this could be part of the problem?

Emory University OB/GYNs Addressing Growing Number of Hispanic Births at Grady Memorial Hospital

More poor and disadvantaged Hispanic women in Fulton and Dekalb counties are giving birth at Grady Hospital, a growing trend that many Emory University OB/GYN doctors at Grady Hospital believe will continue for years to come.

Of the live births at Grady since 1995, 64 percent are black, 33 percent Hispanic, and 3 percent white. In 1992, the number of Hispanic births at Grady was estimated at only 10 percent.

The number of Hispanic births is up largely because of increased labor opportunities in the metropolitan Atlanta area. As many Hispanics find work here, many of them settle here and start families, doctors say. Yet, the problem is many of the women, like their male counterparts, are illegal or undocumented aliens without medical insurance.

The growth has also brought its share of challenges. Many the Hispanic women who come to Grady are not in the best health. Take one Hispanic woman, who prior to giving birth at Grady Hospital last summer, was diagnosed with Rh disease, a serious blood disorder that causes severe anemia, and sometimes death, in infants. To save the unborn child’s life, doctors performed seven intra-uterine fetal blood transfusions, which is a technical and tedious procedure. Each transfusion began by inserting a needle through the mother’s abdomen into the womb, and then through the umbilical cord for direct transfusion of blood to the fetus. As a result, the baby was born healthy, and is in good health.

But Dr. Hugh Randall, an Emory University School of Medicine professor who heads the department of gynecology and obstetrics at Grady Hospital, says so many other Hispanic women who come to the hospital also lack proper prenatal care.

“It’s going to be a challenge, in terms of how we’re going to care for this growing population,” Randall says. “Finding a way to pay for their health care and health insurance is one of the biggest challenges. Hispanics play a vital role in our economy, and they’re going to need health care and support services.”

What often leads to improper prenatal care is the women’s inability to pay. So rather than come in for regular prenatal visits, many of the Hispanic women who come to Grady limit the number of prenatal visits or come for only a few.

Claire Westdahl, a certified nurse-midwife at Grady, says the nurse-midwives, nurse practitioners and physicians’ assistants who care for the majority of pregnant Hispanic women in the Grady neighborhood clinics of Fulton and DeKalb counties are sensitive to the cultural and social issues of monolingual, immigrant women.

“We need to invest our time and energy in culturally appropriate prenatal care because these babies are our future Americans,” she says.

Many of the health care providers at Grady, for example, are able to provide pregnancy care in Spanish. When needed, translators are available to assure that health care needs are met. An effort is also made to assure that support staff in the clinics, such as medical clerks, financial counselors and medical assistants is not only bilingual, but bi-cultural, as well.

Quarterly, Grady sponsors a “Celebration of Motherhood” program inviting all pregnant women from the neighborhood clinics to tour Grady’s Family Birth Center and nursery. Classes in Spanish are provided on breastfeeding and childbirth. Women and their families are especially interested in information about the Medicaid and birth certificate application process. This one-day celebration offers an opportunity to meet the Spanish translators who are available when women and their families come to Grady for the birth.

To address even more needs, group prenatal care has been offered in Spanish at one Grady neighborhood clinic. Women due the same month have their prenatal appointments at the same time of their care.

Through the group, women are able to develop social relationships and receive their prenatal education and prenatal care at one time and in their native language. A Spanish-speaking nurse-midwife, social worker and clinic assistant lead the group, providing care in Spanish and addressing the specific needs of each group of women.

Beginning January 2001, the Grady Health System, in partnership with Emory University and Morehouse schools of medicine, will introduce a “package price” for prenatal care. The program will allow Hispanic women and others to come in for care earlier in pregnancy and receive the full content of prenatal care. For $1,000, women will be eligible for 13 prenatal visits, routine prenatal lab work, and one ultrasound. Women are able to pay for the services within eight months.

http://whsc.emory.edu/_releases/2000december/randall_grady_births.htm

Take a look at this article about Grady Memorial and illegal aliens. It’s a real tear jerk piece, be warned. They’ve spent a fortune on ‘hispanic outreach’ and treat aliens with leprosy, aids and other VERY expensive treatments.

But not a word in the posted article that this might be an economic problem for Grady.

http://whsc.emory.edu/_pubs/ph/autumn01/obra.html

[snip]The rash had been with him for a year and was still spreading when he arrived in Atlanta last winter. Lesions, nodules, and open wounds marred his face, chest, and back. Shooting pains in his hands became too much to bear. So Perez took a taxi to Grady Memorial Hospital, where he had the luck to meet infectious disease specialist Carlos del Rio, MD, chief of medicine at Grady and a faculty member at the Rollins School of Public Health (RSPH) and Emory School of Medicine. He prescribed Perez a two-year course of medication and urged the infectious disease fellows and residents on the ward to take a look at Perez. A patient with leprosy doesn’t come along very often.

La mano de obra: The hand of the worker

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