Saturday, December 1, 2007

My Recommendations For Fixing Grady Hospital

Introduction: If you haven't been following the plight of Grady Hospital in Atlanta, Georgia, here is a quick run down. Grady is one of the biggest hospitals not only in the Southeast but frankly in the entire country and the world. It has also been the scene to a great deal of corruption throughout the years. It has faced a series of financial crises throughout the years, however none are as critical as its current. Grady Hospital faces being closed down unless it is infused with cash to the tune of an estimated half a billion dollars according to some reports. Since Grady Hospital is the main hospital for the poor of Dekalb, Fulton and other area counties, this has become the subject of great debate and controversy. Because hospitals that cater to poor folks have limited profit potential, Grady is also naturally a public hospital. Thus, in the end, the taxpayers own it.

Enter the Grady Task Force which is a sort of consulting firm created by the Metro Atlanta Chamber of Commerce which has recommended a series of steps to save Grady. If you look at the link, you will see that for the most part the report is quite technical, however there is one recommendation which has become quite controversial. That is a plan to make the board quasi private. It should also be noted that Grady has paid four separate consulting firms about eight digits just in the last two to three years already. They have already hired another consulting firm even after the so called recommendations of the Grady Task Force.

I believe this plan, like the force itself, is nothing more than a sham and I wanted to offer my own alternative plan.

I want to point out that almost none of the ideas are actually my own, but rather those of folks that I have spoken with since I began tracking this story nearly two months ago. None of these folks ever saw any power at Grady, and I believe that after you read my plan you will see that there is no doubt that the wrong people are in charge. You will also see what it would actually take to turn Grady around.

The first thing Grady Hospital needs is some serious improvements in its infrastructure. For instance, its HVAC system is totally shot. Doctors have told me that sometimes it gets so bad at Grady that they themselves can't breathe. Now, imagine if you are a patient that has a breathing problem, what would such a state do to you. There is asbestos in the wall. The elevators are old and they breakdown all the time. There are patients that are in critical condition and time is of the essence. If they need to be moved from floor to floor, you simply cannot have the elevators broken. Doctors tell that this can be a regular occurrence. The computer system for tracking their medical records is old, from the seventies people tell me. Many times patients history can't easily be looked up, and thus allergies and other ailments may not be known. The building simply must be brought up to code.

If this is shocking to you, and you think this couldn't happen because the patients would talk, keep in mind the patients are the poorest folks in the area. They simply have no alternative and many times they don't know any better.

One of the tragedies at Grady is that they recently had a giant addition added. That's right, while their infrastructure was falling apart they added a huge addition about five years ago. If you want to know why, you maybe interested in knowing that powerful board member Robert Brown also owns an architecture firm and while the firm is equipped to add on to hospitals they can't fix elevators. (He is also a prominent member of the Grady Task Force and one main reason why the force is in my opinion a total sham)

Grady also needs to be held accountable, so money will be given in tiers. The state legislature will choose a committee to oversee upgrades in infrastructure, and money will only be given if standards are met.

The Grady Board, currently chosen by the Dekalb County CEO (currently Vernon Jones), needs to be elected and it must be split up by districts so that it evenly represents the folks currently treated by Grady Hospital. This board, which would serve four year terms, would be in charge of hiring and firing the Grady CEO.

Instead of paying Emory University and Morehouse (the two schools that supply the bulk of Grady staff) a flat fee for their services, the Grady Board would institute a tiered sort of grading system (based on JCOHA grades, patient feedback and whatever other measurements they chose). Keep in mind that as representatives of the people, the board would be giving Emory and Morehouse the people's money. This means they would be more inclined to grade the two schools harsher than softer. This would give the two schools that much more incentive to perform better.

Also, the two schools would be responsible for their own malpractice insurance. Unbelievably, at least at Emory, Grady pays for the malpractice insurance of Emory professors and medical students. Essentially, this means that Emory, a private institution, has it so the public, through a public hospital, covers its malpractice insurance. Not only is this an obscene misuse of public funds, but obviously can lead to all sorts of abuse. Obviously, if you aren't responsible for your own malpractice insurance, you are more likely to act a lot more recklessly. I believe that is exactly what Emory has done to tragic results. This will remove that motivation.

The state legislature would set up a committee that would be in charge of funding Grady. They would set their own set of benchmarks for receiving funding and would also be in charge of deciding how much Grady Hospital got. Since the legislators are also spending the people's, or their constituents, money, they would also be disinclined to grade easily. This would give the board more motivation to make sure performance is up to par. We saw just how tragic it could be in the case of State Senator Charles Walker when funds are determined by corrupt reasons rather than performance.

Grady would develop a new position called the Office of Conflict Interest. Each transaction, each finance, each so called deal, would be scoured by this office to make sure that say a board member's architecture firm isn't getting the deal because the owner is on the board. I believe there are many such deals like the one I refer to with Robert Brown and the addition his company got, and that can't happen. This hospital didn't just find itself in financial crisis for no reason. It got there because its financial dealings were corrupted. This office would be in charge of making sure every deal was on the level.

Grady would need to update its by laws. First, it would no longer be allowed to have retaliatory behavior against whistleblowers. People must be able to report malfeasance without the threat of losing their job. Joyce Harris lost her job when she blew the whistle on State Senator Charles Walker. I also firmly believe that Kevin Kuritzky was expelled for blowing the whistle on serious corruption as well. These are jus two examples and I believe there are many more. There needs to be a truly anonymous tip line so that malfeasance can be reported without threat of retaliation.

Grady Hospital can no longer be allowed to stall in providing financial records to outside sources. I have been told by more than one person that getting records can be maddeningly time consuming. In fact, I was told that by the time records were received the incident or incidents in question were so far in the past that most didn't care. For instance, it took my sources several years to finally figure out that Brown's company received the lucrative contract. Grady Hospital would now be the subject of stiff fines if records aren't turned over in a timely manner. Furthermore, an outside party, a judge or a lawyer, would act as a mediator, in disputes over records requests. Finally, the by laws would declare that Grady would from now on follow due process.

Grady Hospital would no longer be allowed to settle any lawsuits under seal. I have counted four Emory professors that I believe have been paid off. The case of Dr. Jim Murtaugh is the only one that has been unsealed so far and it provides a glimpse into just how far some will go to keep malfeasance quiet. This can't go on, and it will have to be outlawed.

From now on, meetings held on the finances of Grady Hospital would be open to the public and the media. Currently, those meetings, like many others, are held in secret. Secrecy is a bedrock of corruption. By turning Grady over to a private board, it would make it even easier to maintain secrecy, and it is this diarists contention that secrecy is the end goal of the private board plan. In order to fix Grady, we need the opposite of secrecy. We need everything to be open. Keep in mind that Grady is a public hospital. It uses public funds. The public has every right to know where those funds are going. Open finance meetings are one way to assure that.

With these recommendations Grady would actually have a chance to thrive long term. While I am sure there will be those that will poke holes in it, I would dare anyone to compare my plan, less than two pages, to the plan by the Grady Task Force.

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