Issue link: https://nnumagazine.uberflip.com/i/198096
7/3/08 1:25 PM Page 16 lege located near "the Gradys." Morehouse School of Medicine also affiliated with Grady in 1975. Today, the hospital is almost entirely staffed by interns, residents, and faculty from those medical schools. The city of Atlanta's ownership of the hospital ended in 1941 when the Georgia State Legislature created the Fulton-Dekalb Hospital Authority, the two counties that the city of Atlanta straddles. The FDHA became financially and operationally the hospital's governmental owner. Grady's governing board was appointed by the elected Fulton and DeKalb county commissioners and thus publicly accountable, even if reluctantly. By the 20th century, Grady was the largest public hospital-based system in the Southeast. It is the only Level 1 trauma and burn center in more than a 100-mile radius. It has a network of 10 neighborhood clinics, the largest and critically acclaimed infectious disease clinic in the east (founded by a nurse practioner), a nursing home, international clinic, and literally hundreds of specialties. Grady houses the state's only poison control center. Its emergency room is the busiest in the region and its ambulances make more than half a million runs a year. More than 5,000 people work at Grady caring for over 30,000 inpatients annually and an outpatient population of roughly one million. Though it is so clearly central to greater Atlanta's, and even the entire state's, healthcare network, Grady Health System, as it became known in recent years, has always struggled to stay afloat financially. While the numbers of uninsured in Georgia have doubled over the last decade to more than 1.7 million people, funding from Fulton and DeKalb, the two counties responsible for Grady, has remained flat for the last 10 years. The Georgia State Legislature has never wanted to play a role in funding Grady, which is designated as a county hospital but in practice serves millions throughout the entire southeast region. The spring and summer of 2007 produced the perfect conditions for shipwrecking Grady. The hospital had been running at a deficit for a few years, to the tune of about $55 million in 2007. Highly contested charges were also made that Grady owed the medical schools around $72 million, the bulk to Emory, for the work of their doctors. Earlier, the Georgia State Legislature had forced Medicaid patients into a series of private, Medicaid-funded HMOs. Predictably, Medicaid reimbursements to Grady declined by more than 15 percent. Medicaid covers about one-third of Grady's patients but accounts for nearly 80 percent of its revenue. Another third are uninsured. Fewer than 8 percent of Grady's patients have commercial insurance. The rest are mostly Medicare insured. As stated, county funding had not increased in a decade. State grants to Grady from the Indigent Care Trust Fund's Disproportionate Share Program and the statewide trauma network had been reduced by about $60 million, while costs for uncompensated care had increased by $73 million. The stage was set. Rumors and accusations of mismanagement by the FultonDeKalb Hospital Authority, Grady's governing body composed of largely African-American members, had been widely circulated for years and couched in not-so-subtle racial overtones. What happened last spring showed how class interests dominated the process while manifesting in real racial inequality. In March 2007, one of numerous studies by a high-priced hospital consulting firm declared that Grady was on the verge of bankruptcy and could indeed close. A day after the report was released, the Metro Atlanta Chamber of Commerce announced its formation of a "Greater Grady Task Force." The task force member roster reads like a who's who of Atlanta and Georgia's captains of industry. It included Pete Correll, former CEO of 16 REGISTERED NURSE pulp and paper giant Georgia-Pacific and a then-member of Emory's Medical Advisory Board. Correll also just formed a new private equity investment firm with one of its focuses being the health industry. Then there's Tom Bell of Cousins Properties, a company which owns interest in a major medical office building of Emory University's Crawford Long Hospital. Crawford Long is located just a few miles from Grady and is generally known to siphon off paying patients and dump indigent and poorly insured patients on Grady. H.J Russell, a prominent AfricanAmerican businessman, was also on the Chamber's task force. His company, Russell Construction, was contracted by the hospital authority to build Grady's last expansion, completed in 2002 and financed with $200 million in bonds from DeKalb and Fulton counties. Another task force member was Joe Rogers, CEO of the Waffle House restaurant chain, a major Republican Party donor, and chair of the Board of Trustees of Children's Health Care of Atlanta, a private nonprofit spinoff of Grady's formerly public Hughes Spalding Children's Hospital. The task force quickly recommended that control of the hospital be handed over to a new private, nonprofit corporation. The new corporation would lease Grady from the hospital authority and have control over its budget, policies, managers, and all day-to-day operations. The task force argued that, to successfully run Grady in the black, hospital management needed a clean break from "interfering" politicians and that it would be able to raise much more financial support as a separate nonprofit, even though Grady already had an affiliated nonprofit foundation committed to raising private funds to help the hospital. As incentive to change the governing structure, the Robert W. Woodruff Foundation, endowed by Coca-Cola's longtime president, dangled out a pledge of $200 million over four years. Fulton and DeKalb county commissioners, perpetually stuck in the difficult position of running a hospital with too-little funding, were more than willing to hand off responsibility to a private entity.Private and public universities also played a leading role in pushing to turn over control of Grady. Emory University, with huge endowments from the Woodruff Foundation, had little to lose if Grady privatized. Emory has three other major and, in some instances, competitive teaching hospitals under its control, and is seeking reimbursement from Grady to the tune of around $50 million for providing faculty staff for Grady interns and residents. Morehouse School of Medicine, a historic black college, may indeed have something to lose if Grady were to close because it is its only teaching hospital. However, Morehouse sided with Emory in the drive to privatize Grady and also seeks millions in reimbursement for its staffing of Grady. There's also Georgia State University, which initiated a huge expansion several years ago. Having gobbled up nearly all the available land in its proximity, it may now be turning its eye to the mammoth Grady campus, which shares a border with one of its recent W W W. C A L N U R S E S . O R G JUNE 2008 ZUMA PRESS / NEWSCOM Grady:FINAL