The Consequences of Shutting Down Grady Hospital and its Political Ramifications

As I mentioned earlier, Grady Hospital has joined a dubious category when the JCAHO threatened to revoke its accreditation. Only King Drew in California was ever threatened with such an extreme measure. An investigation by the L.A. Times that was ultimately highlighted by this story forced JCAHO's hand.

Despite a long history of problems at Martin Luther King Jr.-Harbor Hospital, two things set the Rodriguez case apart: the existence of a security videotape showing the woman writhing for 45 minutes on the floor of the emergency room lobby and the public release this week of two 911 calls in which witnesses unsuccessfully pleaded with sheriff's dispatchers for help.

In the case of Grady Hospital, it was community activists, not the media, that alerted JCAHO to problems. Since Grady won't release the findings we don't know what specific problems there are yet. Of course, one only needs to read these pages to know the sorts of horrors that have happened at Grady Hospital. (this story involves a medical student left alone in charge of an entire step down unit)

One night that is what happened. One time he was left in charge of the entire step down unit from 4 PM to 2AM. The first emergency came from one patient who was recovering from lung surgery. The patient's lung collapsed and Kevin was called in to save his life. The patient was suffocating and time was of the essence. Kevin was
panicked and needed to move quick. He needed to find a chest tube, but because of his own inexperience, he didn't know where they kept the chest tubes. In a rush, he did the only thing he could think of at the time. He grabbed the dirty chest tube that had already been used on the patient and injected into their lungs.

Next, Kevin was asked to read an x ray of the patient's lungs to determine if they were stable. This is again not something a medical student is supposed to do on their own and without supervision but since their was no supervision there wasn't much choice. Kevin gave it his best estimation and determined the patient was fine however as it turns out that was just a lucky guess. This patient survived but it had nothing to do with the type of care that was provided them at Grady.

I set this context so everyone understands what a total nightmare Grady Hospital is right now. Keep in mind that Grady's current financial crisis is in many ways divorced from the findings of the JCAHO report. In other words, whatever patient nightmares were going on at King Drew, they didn't also experience a financial crisis concurrently. King Drew was ultimately forced to shut down. That is a distinct possibility for Grady as well.

I believe shutting down Grady would create an even bigger nightmare with all sorts of unintended consequences and frankly a situation no one can predict or control. Let's lay out some numbers. Grady Hospital serves roughly one million patients per year. It has five thousand employees and contributes roughly 1.5 billion dollars to the economy in the area. Despite only serving two of Georgia's roughly 100 counties, Grady provides some or all of the training to one quarter of Georgia's doctors. Ninety percent of the staff at Grady is from Emory University with about 400 residents from there on staff at any given time. The entire medical school of Morehouse is trained at Grady Hospital as well. Grady Hospital has about nine hundred beds available. For comparison, South Fulton, the other hospital primarily for poor folks in the area, has 36 beds.

Its important to understand that Grady serves the poor, the indigent, almost exclusively. More importantly, in Fulton, Dekalb, and to some extent the surrounding counties, the poor and indigent are almost exclusively served by Grady. In the case of King Drew there were several other area hospitals that were also already serving the poor. Not so in the case of Grady. Without Grady Hospital the poor would be unleashed on the entire remaining health care system that remains. As a friend in Atlanta once told me

there's no way they will close Grady because the other hospitals don't want their patients

Keep in mind that most of the folks that go to Grady either have no insurance or Medicare at best. In other words, treating them is in no way a for profit operation. Soouth Fulton is the only other public hospital in the area, and there is no way it could handle the entire indigent population of Fulton and Dekalb Counties. Furthermore, Grady is the only level 1 trauma center for hundreds of miles. Severe gun shot wounds, bad car accidents, dismemberments, and other such traumas are all treated there and there only for hundreds of miles. Many times other neighboring states have their level one traumas treated there. In case of a terrorist attack, it would be Grady that would be the only hospital equipped to handle mass casualties in the area.

Furthermore, since Grady is also the main teaching hospital in Georgia, the entire health care teaching system would be traumatized. With 25% of the doctors receiving some or all of their training at Grady, the impact on the medical training is beyond words. Emory's medical school would be the equivalent Northeast Texas State Community College and Morehouse would cease to exist altogether.

I recently pointed out the absurdity of AJC reporter Mike King's column in which he called Grady board members arrogant for making demands not requests in their time of crisis. I doubt very much that you will find anyone in the Atlanta area media that will ever break down Grady's impact the way I just have, however I am certain the powers that be at Grady know full well the numbers that I have laid out. In other words, crisis or not the powers that be know what a vital part of Georgia Grady is and thus they can afford to be arrogant.

This context has political impact and it is also something that I do not believe the Atlanta media will ever explain properly either. Late last month, the Grady board approved a plan that would infuse Grady with much needed cash and make the board quasi private. The timing of this move is very important because it came right before JCAHO's announcement. While this plan purports to deal with Grady's fiscal issues, it in no way addresses the obvious medical care problems currently going on at Grady. Frankly, given the make up of the task force that recommended this plan, as well as other factors, I have already concluded that this quasi privatization plan is nothing more than a stunt that allows the powers that be to continue running Grady the exact same way only with even less oversight.

Now, I believe that the legislators and the Grady board are playing a high stakes game of chicken. It is frankly difficult to surmise which is worse: allowing a corrupt Grady to continue to operate or shutting it down and unleashing its patients on the rest of the medical system and disrupting the states medical education. It is even more dificult to figure out which is the better move politically. So far the politicians appear to be balking at Grady's proposal.

State Senate President Pro-Tem Eric Johnson (R-Savannah) took issue with the demands that state officials support $30 million more a year in funding to Grady and provide state funding for hospital trauma units around the state.

"What? They didn't require us to fund an ice cream cone for every patient?" Johnson said. "I don't think the Legislature responds well to blackmail. ... Grady cannot be treated any different than any other hospital."

I would have to beg to differ with Johnson on one point. Grady can and always has been treated differently than other hospitals. The reasons for this are numerous however most of them have been laid out in this piece. There are very few hospitals in America and the world that are more vital to the community they serve than Grady Hospital. The powers that be at Grady know this all too well and they are now using that fact to try and force the hands of the politicians in Georgia. The politicians can talk tough however if Grady is shut down, that is a situation no one can predict and control. What's going on now at Grady is despicable, corrupt and frankly evil, however it is done almost exclusively to poor folks who really don't vote. By shutting Grady down, on the other hand, the politicians will unleash a nightmare upon everyone else in Georgia, and most of those people do vote.Thus, we have this complicated and high stakes game of chicken.

EPILOGUE:If you would like to know how Grady got to this point, please read this summary. Also, please take a look at the recommendations that my colleagues and I have drawn up to fix Grady Hospital.