ATLANTA - 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.
