The Changing Political Dynamics Surrounding Grady Hospital

From a purely political junkie level the current dynamics surrounding Grady Hospital are absolutely fascinating. Here is a quick run down. Late last month, the board at Grady Hospital approved a plan to go quasi private and asked, or demanded depending on your perspective, for roughly half a billion dollars in order to stay solvent. Then, not two weeks later, the JCAHO threatened to cut off Grady's national accreditation. Now, let's take each one at a time and then look at them together.

I believe the board is playing a huge political game of chicken with the Georgia legislature. I believe this plan does NOT have the best interest of the hospital in mind whatsoever. While that is certainly important, it is unfortunately a side issue in this political battle. As a friend of mine once put it

Grady can't shut down because who would take care of all the poor folks then

Without the money called for in this plan, Grady WILL shut down. The powers that be know this, and I have said as much. While Grady Hospital has had a long history of corruption and mismanagement, much of the power structure has continued to boldly and brazenly manage it in much the same way that has landed it in its current state. The reason for this is of course quite complicated, however it is due in no small part to Grady's vital role in Georgia health care system and society at large. Remember, Grady Hospital is among the largest in the world and is overwhelmingly responsible for taking care of most Georgia's poor folks. Without it all of the many "nice" hospitals in the area would have to take care of those folks.

I have fallen in love with the Latin phrase, Res Ipsa Loquitur. (The facts speak for themselves) Given Grady's long and sordid history with corruption and mismanagement, the fact that most of the power structure in Georgia never tried to really stop it tells me that most people don't much care as long as some other entity was taking care of those that no one else wanted to take care of, THE POOR. I believe the powers that be are counting on the exact same dynamic now. I believe the only thing most of the power players in Georgia want to avoid is for the poor folks to be dropped on the rest of the health care system. As long as they are Grady's problem, in my opinion, most everyone else turns a blind eye.

Thus, we have this game of chicken. The legislature doesn't want to hand Grady Hospital anymore money. They must know that the systemic problems currently going on at Grady aren't going to be solved with this plan, however without an infusion of cash, Grady shuts down. The powers that be at Grady are counting on the legislature blinking first. The legislature meets again in January so, for now, that part of the story is on hold.

Enter the JCAHO. Just last week they publicly threatened to revoke the accreditation of Grady Hospital. To put this move in perspective only one hospital, King Hospital in California, has ever actually lost their accreditation. Many of allies on this story have extolled this move as pivotal. I am a lot more skeptical. There must have been the same kind of excitement when State Senator Charles Walker was convicted of 127 felonies at Grady and beyond. Yet, he, along with his daughter and the companies they ran, were the only ones that were convicted, and of course he got the absurd sentence of ten years. In 2004, the department of Health and Human Services conducted an investigation that concluded this...

the conditions at Grady Hospital pose a serious and immediate threat to the health and safety of the patients

That was pretty damning however besides the then CEO, Dr. Andrew Agwunobi, no one lost their job as a result of this report and the power structure stayed in place despite its damning findings.

Even in the late 1990's, Georgia Attorney General found Grady Hospital guilty of Medicare fraud. All of these were opportunities lost to clean up the corruption at Grady Hospital. The reason it didn't happen is also quite complicated, however I believe much of the blame goes to the media in Atlanta, headed by the Atlanta Journal Constitution.

In each of these stories, the truth is quite complicated and it was never fully explained to the citizens of Georgia. For instance, in the case of the HHS report, the report itself was damning, however how many people know the specifics of the report? Four departments were singled out: oncology, cardiology, General Surgery, and obgyn, in the report. Each of these departments had heads. None of these people lost their jobs because the specifics of the report weren't ever reported properly in the media. Furthermore, the heads of these departments had one boss, the Chief Medical Officer. His name is William Casarella and he has since been promoted within Emory University. This also happened because the media didn't properly report the specifics of the case. All people knew, if anything, about the investigation was the conclusion. While that was damning enough blame was impossible for a layman to determine without understanding the specifics as I now explain them.

In the case of Medicare fraud in the late 1990's, three departments were also identified: cardiology, obgyn, and oncology. Again, these departments have heads and a Chief Medical Officer above them. All of them including the CMO should have been and would have been fired if the media had properly exposed that case. As you can see the same departments are now coming up in multiple reports. No one outside the Grady structure knows this because the media, either through incompetence or worse, doesn't report the specifics of each case.

There is one other case that the media did an atrocious job of reporting. That is the case of Dr. Sam Newcom. He was for about a year, the head of Oncology at Grady Hospital and Emory University Professor. He tried to speak out about the corruption and poor patient care at Grady Hospital and he was fired and ultimately paid off and silenced, but before that he wrote an article entitled Fighting Class Cleansing at Grady Memorial Hospital. You won't find this article in any mainstream Atlanta publication. As head of Oncology, you would be right in concluding that much of his indictment centered on his own department. In other words, oncology is the subject of a great deal of indictment from people of varying motivations and knowledge.

Nothing much has happened to clean up the oncology department and that is because the media has been asleep in reporting the specifics of what is going on at Grady.

Then, there is Emory University. When the heat gets hot on Grady, Emory does a great job of distancing itself. In fact, they are doing their own disappearing act now. The truth is that they are for all intents and purposes one and the same. Each of these departments indicted by several different groups was run and almost fully staffed by staff at Emory University. The Chief Medical Officer, Dr. William Casarella, during much of this malfeasance has since been promoted within Emory. In other words, when there is sytemic problems at Grady Hospital, the blame must be laid at Emory University since it is staffed overwhelmingly by Emory professors and students. When Dr. Newcom indicted oncology, he was indicting his own colleagues since oncology is overwhelmingly staffed, like most of Grady Hospital, by Emory University personnel.

Now, what about the JCAHO findings? We know they are threatening to cut off accreditation however why? That, we don't know because for reasons unknown (I plan on calling the JCAHO on Monday for further explanation) the specifics of the findings aren't known. We can assume that multiple specific departments are the cause of it. It might be oncology, General Surgery, obgyn, cardiology, etc. The heads of any of the departments involved must be removed. If your department contributed to an investigation that ultimately lead to the accreditation of your hospital being threatened, THAT IS GROUNDS FOR REMOVAL, in my opinion at least. The current chief medical officer, Curtis Lewis, must be removed. If you are overseeing a hospital and the hospital is threatened with the removal of its accreditation, THAT IS GROUNDS FOR REMOVAL. The Current CEO of Grady Hospital is Otis Story, Sr. He must be removed for the same reasons. In fact, the entire board ought to be removed, however the board is overseen by Vernon Jones, and anyone that knows anything about Jones knows not to expect that to happen. Of course, how many Georgia folks know the real story behind Vernon Jones? That would require the media in Georgia to actually competently report the whole truth.

This whole case proves why the first amendment, the free press, is first not second or tenth. I hope everyone sees what happens when the media itself cedes its own freedoms and doesn't bother to report the whole truth. In order for this cycle to stop, the whole truth of the JCAHO findings must be reported by the media in Georgia. The media must keep the pressure on until all parties are held responsible. That is what has to happen.

Here is what will probably happen. There will be no more then a few more articles in the AJC about this report. Anymore reporting will be on the eventual deal made between Grady and the JCAHO, a deal that will no doubt be made in some back room. The major media in Georgia will NOT reveal the specific departments responsible for this latest investigation. They won't name names and they won't demand for heads to roll. Finally, they won't call Emory out when they distance themselves. Emory University will throw its significant weight around the Georgia Legislature and no one will report it. Grady will be given a golden parachute and none of the obvious systemic problems I have pointed out will ever be reported on or addressed. I hope I am wrong and I will be watching.

For more information on this case, please read this article. Also, please read the recommendations that my colleagues have come up with and compare them to the current plan.

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.

An Updated Summary on the Fiasco at Emory, Grady, and Beyond

I just realized that anyone that picks up this story in the middle would get lost in its many mazes and connections. If anyone reads every single story in the Emory University tag, they would get a full picture, however that maybe beyond reason. First, I must disclose some things. There are things that I can prove. There are things I can assert and there are things that I believe. Finally, there are things that follow the Latin phrase, Res Ipsa Loquitor (the facts speak for themselves). I use different language for each.

So, let's start at the beginning. Emory University's Medical School runs a network of hospitals in the Atlanta area. There are five in all if my facts are right. Three are actually owned by Emory and service predominantly the affluent making them quite profitable. The other two are public hospitals and Emory has sort of contracts to staff them with their professors and students. This is no different than many teaching hospitals and if there are any ER fans, the fake hospital in that show runs in a similar manner.

That said, I want to focus a bit more on the two public hospitals with little profit potential. The first is the VA since veterans get set bills, and the second is Grady. Grady is a hospital for the indigent or very poor. Since poor folks rarely have money or insurance, it is much more difficult to make a profit on them. Grady is also a public hospital meaning that the tax payers ultimately are the ones that finance it. (as most indigent hospitals would be for the reasons that I mentioned. No one is going to want to bankroll a hospital that has no hope of making any real money so it is left to the government) Grady is also massive, one of the biggest hospitals in the country, and so while it provides little profit, it provides a bulk of the training.

Here is where things get interesting. Emory enjoys a lucrative relationship vis a vis Grady (I will explain as I go along how that relationship get consummated so to speak). For instance, they get a fat yearly fee of about 50 million dollars to provide staffing at Grady. Keep in mind that Grady is the training vehicle for most of its medical students. Emory already charges its medical students tuition and uses Grady for a lot of the training that this tuition is supposed to go for. Many people refer to this as double dipping. In other words, Emory University has one of the premiere medical schools in the country and one of the main reasons is their association with Grady Hospital, one of the largest hospitals in the country. Thus, Grady provides just as much to Emory is Emory does to Grady. Furthermore, since Grady is a public hospital it is ultimately the tax payers that are stuck with the bill that Emory charges Grady yearly. Also, Grady Hospital pays for Emory's malpractice insurance. It goes without saying that such a relationship invites exploitation.

Exploitation and corruption is what you have at Grady in my opinion, and I really only need to do a Google search to provide plenty of evidence. For instance, Grady Hospital settled a case for Medicare fraud in the late 1990's for about 5 million dollars. A few years later former State Senator Charles Walker committed so much criminality at Grady and beyond that he was ultimately convicted of 127 felonies. (you can click this link for a full write up of the case including its particulars and most importantly what each hero and villain wound up receiving from Grady and Emory) In 2004, the Dept. of Health and Human Services conducted an investigation of Grady Hospital and here are the conclusions,

there is a serious and immediate threat to the health and safety of the patients

That is frankly the equivalent of a builder building you a house that falls down on top of you when you move in. (Only one person was let go in the aftermath, Dr. Andrew Ogwunobi, who has continued to travel an interesting path. You can find his full dossier here. It is important to note that the Chief Medical Officer of Grady Hospital, William Casarella, was cited most often in the actual report. I point this out because Casarella has since been promoted within Emory University. This is important for several reasons not the least of which because it goes to show that in many ways I believe the two entities cross over whenever it suits the powers that be)

Finally, currently Grady is in such financial turmoil that is about to be shut down unless there is a huge infusion of cash, about a hundred million minimum by my estimation. There were also other investigations that started and stopped like an interesting one conducted by the NIH in 2000. While there was ultimately no damning conclusions to those reports, I have my suspicions about how it was exactly that they ended. (for more information on that report and more importantly the role of Kent Alexander, Chief Legal Counsel for Emory University, please go this link. This is probably my most incendiary piece and illicited a flurry of looks from the Emory admin IP upon publishing)

This body of evidence is in my opinion an example of Res Ipsa Loquitor.

Now, while Grady is staffed by almost entirely Emory faculty, it is still a public hospital. It has a board and a CEO. The board chooses the CEO, and the board is chosen by the CEO of Dekalb County. The current CEO of Dekalb County is Vernon Jones. He is an elected official with a remarkable knack for thriving in what I would think are dicey political situations. (when I say dicey I mean things like rape accusations, shady land deals, and all sorts of malfeasance by those close to him Just like everything else, I have written a full write up of Jones as well. Jones is I believe the link between the corruption at Grady and the corruption that infects much of Georgia. We have a running debate about who the ultimate ringleader is and one theory is the Dixie Mafia, and you can vote in my fun poll after getting the full scoop)

Now, the problem as I see it is summed up by this cliche, the fox guarding the hen house. The board is supposed to oversee the CEO who is supposed to oversee the staff, and the CEO of Dekalb County is supposed to oversee all of them. The problem is that all the entities, in my estimation, are corrupted. From Jones, to the board, to the CEO, to the staff, the foxes are guarding the hen house so to speak. For instance, one very prominent member of the board was until two years ago Robert Brown. Robert Brown also runs an architecture firm. Three guesses which firm gets many of the most lucrative contracts for Grady expansion. If we dig deep enough, I have no doubt that there would be an almost endless amount of transactions with really or perceived conflicts of interest.

Enter, whistleblower Kevin Kuritzky...first, there is full disclosure here. Kevin and I have developed a tight relationship, and I have even done a radio show with. (It is linked at the end of my piece on Kent Alexander. Kevin is the calm one and I am the hyper one) I have never claimed traditional journalistic objectivity, and I am not a traditional journalist. I believe the quality and accuracy of the information I have provided speaks for itself. Every piece of data has been double and triple sourced minimum. I have hard copies for anything I don't link to like the aforementioned HHS report. (I can email or fax to anyone upon request)

Kevin has made some incendiary accusation about the quality of patient care at Grady Hospital. He claims that Emory staff goes to one of their for profit hospitals when they are supposed to be at Grady and many times he claims they leave medical students unsupervised. (In fact, in this piece I give an example that was verbalized to me by Kuritzky that is frankly straight out of a bad nightmare.) It goes without saying that his accusations, if true, amount to not only an obscene violation of several laws but frankly every doctor's oath. Kuritzky was expelled from medical school with forty one days remaining. (That is in a four year program) Kevin believes the charges are trumped up and he is now in the middle of a law suit. The Emory Wheel inaccurately reported that Kuritzky's case has been dismissed. It hasn't Kuritzky's side has lost a motion that is being appealed. (again, I have seen the disposition of this motion and it is NOT a dismissal) This was inaccurately reported in a trade journal for academics. (The fact that this was written in a trade journal for academics obviously raises all sorts of issues and I explored them here)

Finally, I have counted four former Emory professors that have been paid off for silence. I have only seen the settlement agreement for one pay off. That is for Dr. Jim Murtaugh. He was paid off right around the time that the NIH investigation was happening and he was paid off along with another person, Diane Owen (though her agreement I haven't seen) Murtaugh's settlement has been the subject of much media buzz because State Senator David Shafer has lead a group of state senators who have demanded that it be unsealed (and one main reason why I was able to see the agreement. (If you go here I explore the case of his records being unsealed. Interestingly enough, certain links disappeared in the aftermath of me publishing that, and I explored that here) (also, the Shafer link has some interesting information about who did and didn't approve his settlement so I encourage you to link there)

Now, why should you care? If you are a resident of Georgia, then it is your tax dollars that will ultimately go to fund something you should see is totally corrupt. This corruption is in my opinion part of even bigger corruption that I probably don't even have the full story to. If you are an Emory student, then your tuition, and likely your parent's money (who are you kidding), is contributing to this corruption. Furthermore, if Kevin really was only expelled because he dared blow the whistle on this, what is to stop Emory from targeting someone else. What if you become a threat to them for this or for anything? Clearly, if you believe my assertions, Emory eliminates all threats to them. They pay some off and they expel others. If you believe Kevin, then he had his life ruined for daring to the right thing. (he often tells me that his friends still in the medical school tell him that he should have kept his mouth shut and graduated and moved on) Furthermore, if you believe Kevin, then your school exhibits the traits of the common sociopath. Sociopaths with power is the worst combination you can have. If you are a citizen, then you should want that all corruption be dealt with appropriately and people be held responsible.


(UPDATE)

Some of you may be wondering where the media in Atlanta fits into all of this. This piece should drive home how the media's coverage, or rather lack thereof, fits into this whole story. This piece contrasts the Atlanta media with another situation in which the media actually did its job. Finally, here is an example of the sort of reporting you will find at the AJC.

The Fox Guarding the Hen House

This is the final report filed by the Grady Task Force. Let me sum up for anyone that doesn't want to bother to click the link. This is a report that is about thirty pages that is full technical jargon that almost no one can understand.

So, what is the Grady Task Force and why should anyone care? If you have been following my work, you know that Grady Hospital has been in financial turmoil for years and it has now come to a head. Grady Hospital is one of the biggest hospitals, one of the biggest public hospitals, and one of the biggest hospitals for the indigent in the country. It needs a huge infusion of tax payer funds, up to nine digits, or it will close down.

The Grady Task Force is a sort of consulting group, created by the Metro Atlanta Chamber of Commerce, designed to make recommendations to "fix" Grady Hospital. The very fact that Grady Hospital needs this sort of consulting group is curious in and of itself.

This past spring Grady fired Alvarez and Marsals, a professional consulting firm it hired to recommend ways in which it could avert financial ruin. That was only after paying the firm a cool 300K plus, PER MONTH, and over 3 million dollars total. Consulting firms are nothing new for Grady Hospital. Frankly, Grady Hospital goes through consulting firms the way that Liz Taylor goes through husbands. They pay each of them handsomely and they are even thinking of hiring yet another despite having a "consulting firm" hand picked for them by the Chamber.

One would think that after spending roughly eight digits on consulting firm in about two years, Grady would finally figure out WHAT THE F$%K IS WRONG. That is if these consulting firms are being hired for their advice rather than other reasons. For instance, would it surprise anyone to learn that the principles of Alvarez and Marsals have close ties to Grady board member Michael Hollis? Would it surprise anyone to learn that all of the prior consulting firms were in one way or another hired for some reason other than their professional qualifications? It wouldn't surprise me, and my proof is in these Latin words, res ipsa loquitor. The facts speak for themselves, and the facts are that at least four consulting firms have produced a hospital on the brink of financial ruin. Again, Grady paid about ten million dollars for all of this consulting. If these relationships were on the level, this money would have produced something better than what we have.

Now, we have the Grady Task Force, an unpaid consulting firm. When, we examine the facts, I think that we will see that the Task Force has other financial considerations in Grady Hospital. The bulk of the members are community and business leaders and that gives the force a sort of rep. They are also individuals and entities with financial and professional interest in Grady, which makes me wonder if their advice is on the level.

For instance, there is Robert Brown. He is the former head of the Grady Board. He served on the board during a period in which Grady was convicted of Medicare fraud, State Senator Charles Walker was convicted of 127 felonies, many related to Grady, and an HHS report came out and concluded this,

there is a serious and immediate threat to the health and safety of the patients

Does it sound to anyone as though he has any business being on the board given his history of failure at Grady, and possibly obscene amounts of corruption. Did I mention that Robert Brown is also of RL Brown and Associates, an architecture firm? Would it surprise anyone if his own architecture firm was the recipient of several "sweetheart deals" for additions and upgrades to Grady during his tenure? The list is full of such names: Michael Johns, of Emory University, Michael B. Russell of H.J. Russell (also a recepient of several contracts), John E. Maupin, MD – ex-officio President & CEO Morehouse School of Medicine (another proprietor of Grady Hospital), Phil Humann CEO SunTrust Banks, Inc.(with significant financial ties to Emory University but who doesn't in Atlanta), etc. One would think that if a hospital is near financial ruin the last people that would be in charge of recommendations to fix it would be those who put it there in the first place. Not with Grady, in this case the very same people that were responsible for putting Grady in this position are now in charge of fixing it. That is why I call this piece: The Fox Guarding the Hen House.

Like I said earlier, most of the recommendations are quite technical and difficult for the layman to understand. One has caught my eye and it is a plan to make Grady Hospital run by a private corporation. Under this plan, Grady would still receive public funds so the only practical effect would be more secrecy when it came to public fund usage. Given Grady's history with corruption: State Senator Charles Walker, the Medicare fraud, so called double dipping and atrocious patient care, and all sorts of other unproven cases of malfeasance. Is going private and more secretive really the best way to "save Grady". It probably isn't however if I were looking to commit more corruption at Grady, I would certainly want to make it private.

I would love to hear what possible public benefit Grady going private would have. There appears to be none to me, though there is an obvious one if you wanted to commit more corruption. There is a vote coming soon in the Georgia legislature. My own read is that the folks of Georgia don't want the hospital to go private. There appears to be no public good in it. Thus, I can only see one reason for any politician to vote for that plan and by my estimation that vote disqualifies said politician from serving again.

Oh and finally, you want to add insult to injury. After Grady is done listening to the consulting recommendations of the unpaid Grady Task Force, they plan on hiring another paid consulting firm. Frankly, if the Grady Task Force is on the level one would think there would no longer be need for anymore consulting firm. If, that is, the Grady Task Force is on the level.

UPDATE:

While I tried to make this piece as comprehensive as possible, if this is your first exposure to the story behind the crisis at Grady Hospital you may very well be quite confused. Thus, I have put together a summary of the entire fiasco that tries to put all of its moving parts together in one piece. Please read it for guidance. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.

Maintaining The Secret

The Grady Task Force is a group that I will definitely give a great deal examination to in the near future, however in the meantime, I will cede to Ron Marshall again who is well versed in it himself.

Every time the public ask can we get a look at certain documents, or ask why we weren’t invited to the meetings. We are denied answers. Then the public ask why are you having secret meetings and why can’t we see these document from these meeting. Why are we denied? Some of our elected politicians are not asking. We have become a secret society that has levels of secrecy that only the secret privileged who are a secret themselves know the secret. There is an abusive attitude for power here. By training the workers to keep the secrets, intimidation and retaliation has made robots out these workers and the one’s that want to speak out or expose the secrets they are kept in check or worse.

Emory and Grady secrets have paralyzed open and transparency laws and it seems the thought of having a Sunshine Law is a fraud. Over the years I have been trying to get these and other records the show how the robbery of Grady has been commented. This has not been a Secret to the New Grady Coalition not a secret that Grady and Emory have been keeping the illusion they are clean. Emory and
Grady are not tainted by anything like threatening employees if they speak out
or retaliate against the ones that do. Have they lost their humanitarian equilibrium?

It is not a secret Emory and Grady have kept secrets on how money has been diverted to different owned entities to make them rich and keep the workers under the arm pits of threats that if they spoke out, we will get you. It is not a secret that Grady has over paid management and too many managers on staff, that unqualified workers working in areas where a certification is a must or has management that stole money through bonus payments. We don’t know if the pension funds have been threatened, that’s a secret.

And again the board selected an advisory board that consist of the foxes watching the hen house so the continue pattern of secrecy adds to our concern, is all government and public officials bought and paid for. We also know that Grady and Emory pay large sums to keep their secrets. Hire top lawyer firms to protect their secrets. We know that Emory hired a PR firm to cover up their secrets. It is not a
secret that Emory threatens and retaliates against students that attend its prestige school if they speak out against how Emory treats the student body. Emory is not in the helping poor people business. So we have to ask why all the secrets. Is money and power the ultimate secret?


The local press has said the people who want to know the secrets are just making
things difficult, they are called brow beaters by the press but we keep showing you the secrets. Is the media bought and paid for? I guest if you were a sheep herder you have to keep your sheep in place. One way is by allowing the secret meetings and payoffs to be conducted secretly. Go to this site http://www.maxexchange.com/ybj/chapter15.htm and start looking at the plan that is bigger than Grady and Emory but they use the same technique to accomplish the ultimate goal, get rich and let you die trying.

Ron Marshall
The New Grady
Coalition

Mr. Marshall mentions uses the metaphor the fox guarding the henhouse when describing the Grady Task Force. The best illustration of this metaphor is Robert Brown, and I wrote about him and his role in the task force here.

What if John Gotti Headed Up the Task Force To Stop the Mafia

Robert Brown's tenure as head trustee for Grady Hospital is eventful for sure. Upon taking over in the mid 1990's the hospital faced a series of issues from budget problems, to corruption, to egregiously poor health care. In 1998, Grady Hospital settled with the state of Georgia for $4.5 million dollars in a suit of Medicare fraud. The investigation covered four years and several of those involved the tenure of Robert Brown. While the Attorney General found no criminal violations, the sheer number of the settlement speaks for itself. Had this been the only run in with the law that Grady had under his tenure, it frankly wouldn't be an issue. It wasn't though. The most egregious case of criminality came when State Senator Charles Walker was charged with 137 separate offenses and convicted of 127 of those counts. (unbelievably Walker, his daughter and the companies they ran were the only ones charged or convicted) Grady was one of a handful of hospitals that was the target of much of this criminality.

This criminality began in the late 1990's and lasted all the way until his indictment in 2002. As I have already pointed out, a source told me that the chief prosecution witness, Joyce Harris, accused Robert Brown of several incendiary crimes along with pointing a huge finger at Walker. Harris accused Brown of such things as witness intimidation and accepting sexual favors for contracts at Grady. Harris is not the only one to point the finger at Robert Brown as far as corruption goes. Here is what Ron Marshall of the Grady Coalition had to say about Robert Brown, (from an article emailed to me. I can't seem to locate it online)

It was Robert Brown who insisted that no-bid contracts be given to former Senator Charles Walker, who is now serving ten years in prison for 127 felonies, many of which were committed at Grady with Brown's knowledge.

Furthermore, I am holding onto a 223 page report filed with the Dekalb Ethics Committee that charged Robert Brown with among other things: quid pro quos, retaliation, kickbacks, and obstruction of justice.

Since corruption doesn't exist in a vacuum, Brown's tenure was often met with financial woes. While the current financial woes facing Grady are the most extreme they have ever been, this is not the first time Grady has faced financial turmoil. For instance, here is how things looked in 2001 for Grady.

Board members of the state's largest public hospital want to know how the struggling charity-care provider plans to dig itself out of deepening financial trouble.

Grady Memorial Hospital's 10-member board is scheduled to meet July 23 to, in part, review recent audit results showing the hospital suffered a $17.2 million loss last year and is now operating in the red.

"We were told [Grady] would have an $8 million shortfall this year and that [CEO Edward Renford] would come up with a proposal in July to fix it," said board member Bill Loughrey.

Grady leaders have remained tight-lipped about specific plans for a recovery, but a spokesperson for the hospital said discussions are under way and that any changes would be cleared through patients and employees of the hospital first.

In fact, the current plethora of editorials and analysis that can be found in any current Atlanta area newspaper have a familiar ring to them.

Finally, and most importantly, the Center Medicare and Medicaid Services (CMS) of the Department of Health and Human Services did an exhaustive investigation of Grady Hospital that ended right around the time that Charles Walker trial ended. Here is the scathing conclusion of that investigation. (Again, I hold onto a hard copy myself though I cannot find it online) They identified...

an immediate and serious threat to the health and safety of the
patients

It was after this scathing report came out, that finally Robert Brown was forced out of his position at Grady. Not to worry, upon leaving Grady, Robert Brown was able to snag a lucrative position on the state's transportation board MARTA.

Now, let's get back to the unconventional title of my piece. In my opinion, if there things weren't rotten at Grady, Emory University, and Atlanta at large, along with investigating State Senator Charles Walker, the powers that be would have investigated Brown to see if he should occupy the cell next to Walker. If things weren't rotten at Grady, Emory, and Atlanta at large, the powers that be would investigate Brown's architecture firm R L Brown & Associates and see if he ever gave his own company any sweetheart deals while he served as the Chief Trustee at Grady Hospital. If things weren't so rotten though, someone besides Walker would have been charged with some crime, because I find it impossible to believe that one person could be convicted of so many crimes and no one else did anything wrong.

Things are rotten, so instead of being investigated, Robert Brown finds himself as a prominent member of the Grady Task Force. The task force was set up the come up with solutions to the current fiscal crisis. Robert Brown, who oversaw Grady as it tumbled into financial crisis, is now one of the people in charge of getting it out of the crisis. Excuse me, if this doesn't seem like John Gotti being asked to come up with solutions to dealing with the Mafia.

The problem is this. Grady Hospital is a public hospital and so it is run with tax payer money. Grady's financial woes will probably take an influx of roughly 100 million dollars of tax payer money. If the funds are being directed by the very people that created the problem, then each tax payer is about to sink more of their money into a black hole of corruption and incompetence.

Re Examining the Case of State Senator Charles Walker

For more than a decade State Senator Charles Walker was among the most if not the most powerful politicians in the state of Georgia. His reign came to a humiliating end in June of 2004 when he was indicted on 142 separate counts of corruption related charges. His indictment read like an alphabet soup of terms straight out of your favorite law or cop show: wire fraud, conspiracy, tax evasion, extortion. If it was on your favorite lawyer show, he was probably charged with it. Of those 142 charges, he was convicted on 127 counts.

The scope and breadth of his crimes was staggering, shocking, and ultimately it is the back bone of the widespread corruption that is currently leading to the potential closing of Grady Hospital. Walker used a network of power and influence to either get into bed with powerful people or strong arm those that refused to play ball. For instance, Walker ran a newspaper and anyone that wouldn't play ball would be threatened with negative publicity from his newspaper. He used his ability to procure government funds as a string to get hospitals to hire temps at his temp company.

Here is where the case gets shocking. After being convicted on 127 counts he was sentenced to ten years in jail. Now, normally, when someone receives such a light sentences after being convicted of so many things, we would assume that he flipped on others. In this case, he didn't. In fact, besides Walker, his daughter, and the companies they ran, NO ONE, NO ONE, was charged or convicted of anything. Furthermore, the authorities would have us believe that the proper sentence, without ratting out anyone, for 127 separate convictions is ten years. There are people busted with drugs that are serving more time than that. It seems the corruption that Walker pulled off was nothing compared to the corruption involved in investigating and executing his case.

In fact, we don't need to speculate as to whether or not others were involved in the corruption. One only needed to be in the courtroom on the day that Joyce Harris, the chief prosecution witness, testified. According to a source that was there when she testified, she accused Walker of demanding a quid pro quo. Grady is a public hospital. Walker, who again was one of the most powerful politicians in Georgia, was able to influence just how much money they received. He demanded that the temp company he ran hire up to 50 people per day (if you read the link Grady normally hired a handful per day) in order to receive funds. Harris testified to a lot more than just Walker. She accused Grady CEO Ed Renford, and Tim Jefferson Chief Legal Counsel of Grady, of threatening her safety if she blew the whistle. She accused Robert Brown, President of the board of Trustees of Grady Hospital, of accepting kickbacks and sexual favors. She accused William Casarella, Chief Medical Officer at Grady, of looking the other way. Yet, despite these incendiary accusations and 127 separate convictions of Walker, the powers that be at Grady were never investigated.

In other words, first, the authorities would have us believe that this guy was able to pull off so much criminality that it lead to the conviction on 127 separate counts, and that he pulled all of this off on his own. Furthermore, the authorities would have us believe that a proper sentence for the conviction on 127 separate charges is ten years in prison.

Furthermore, right around the time that Walker's trial was ending, the Center for Medicare and Medicaid Services (CMS) in the Dept. of Health and Human Services issued a report on Grady. Here is the conclusion of the report.

the conditions at your hospital pose an immediate and serious threat to the health and safety of your patients

You think that is shocking. What is really shocking is what happened to all of the players that were not only involved in the corruption of Walker but the conditions that lead to the scathing conclusion of that report.

The only one to lose their job as a result of the Walker scandal was Joyce Harris the one person who tried to stop the corruption. Ed Renford retired with a pension that pays him six figures per year. Tim Jefferson continues in the exact same position. William Casarella was actually promoted within Emory University. Robert Brown did eventually lose his sweetheart position but that was due to a separte scandal.

The reason this is important is because Grady is on the verge of collapse and its collapse threatens the entire medical system in Atlanta and Georgia. As a friend and Atlanta resident recently told me, the people the are the most scared are the other hospitals because Grady treats the patients no one else wants. Now, the legislature is debating whether or not to feed Grady with millions of more dollars. Make no mistake, Grady is in this mess because it is obscenely corrupt, and the exact same people that caused the corruption continue to be in power now. If they are fed more money, that is the ultimate throwing good money after bad.

If people are serious about saving Grady the first thing they need to do is clean house. You cannot save Grady if the same people that put it in this mess are in charge of getting it out. I hope the good people of Georgia will wake up to the obscene levels of corruption that have put this essential hospital on the brink of collapse and that they demand that the resolution is once and for all no longer the same old same old.

(Updated)

Much of the story about Grady Hospital is so confusing that anyone that winds up in the middle is likely to be confused. I don't believe that this particular one is an example of this, however, you should also know how State Senator Charles Walker fits into the entire puzzle so to speak. Thus, I have put together a summary of the entire fiasco that tries to put all of its moving parts together in one piece. Please read it for guidance. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.

Also, please follow this link so that you can hear me and a colleague discuss the Walker case along with several other matters related to Grady and Emory.

Grady and Emory: Culture of Corruption (Update)

As I have delved deeper and deeper into the evolving narrative that links Emory University, Grady Hospital and potential malfeasance, I have realized that is very important to separate facts and evidence from speculation, assertion, and conclusions. For now, I want to report only facts, in other words, things I can verify.

Thus, it is a fact that Grady Hospital is at the center of a culture of corruption. I know this to be a fact because one only needs to do a google search to see that there is documented corruption at Grady Hospital

...he wanted Grady to hire as many as 50 a day, though the public hospital - operated under the Fulton-DeKalb Hospital Authority - had previously hired as
few as three a day. Harris adds that her boss, then-Grady CEO Edward Renford,
demanded that she "schmooze" Walker more and cautioned her not to make him
angry.

But Harris says she made the Augusta lawmaker angrier by not hiring more temps. She claimed in a sexual harassment and discrimination lawsuit that she was fired in 1998 partly because of her complaints about payments to Walker. Grady denied her allegations. Her lawsuit was dismissed in 2002.

But she wasn't the only one accusing Walker of shady dealings. Before Democrats lost power, when lobbyists came to his Capitol office seeking favors, he reportedly would pat the head of a toy dog on his desk and ask, "What's in it for my little friend?"

According to a federal indictment, Walker's temp company earned $2.5 million from Grady between 1996 and 2000. His corruption trial begins May 23 in Augusta. Harris hopes to testify against him. Her 1999 TV interview about the senator helped spur inquiries into his dealings.

Now, let's look at more facts. Joyce Harris, the whistleblower, is no longer working at Grady and in fact doesn't even work in Georgia. Ed Renford (referenced in the article as Grady CEO)recently retired with a rather nice retirement package.

Furthermore, let's look at two more high level people at Grady who weren't mentioned in the article. First, there is lead counsel Tim Jefferson who not only continues to be employed by Emory but as chief legal counsel. Then, there is Chief Trustee of Grady Robert Brown. He is no longer employed by Grady but if you click this link you will see why.

Again, I don't want to deal with anything but facts. The facts are that there were four people people that there were four people in a position of power when this scandal broke. The whistleblower lost her job and everyone else kept theirs. Again, I only deal in facts...as for assertions, speculation, and conclusions, those I will leave to the audience.

Now, let's look at another completely unrelated bit of corruption at Grady Hospital.

By contract with the Fulton-DeKalb Hospital Authority, the Emory Medical Care Foundation provides physicians to treat patients at Grady Hospital. Most of these services are billed to the Georgia Medicaid program.

Since July 1997, the State Health Care Fraud Control Unit, composed of prosecutors from the Georgia Attorney General's office, Georgia Bureau of Investigation agents, and auditors from the State Department of Audits, has been investigating Emory's Medicaid billing. The State concluded that there were two specific areas in which Medicaid billing by EMCF was not in compliance with the policies and procedures of the Georgia Medicaid program. First, the State contended that from 1993 through mid-1997, EMCF billed for outpatient obstetrical services at higher service levels than were warranted by the documentation, a practice known as "upcoding." Second, the State's review also indicated that during the same period Medicaid billings submitted for services provided by residents and interns under the supervision of teaching physicians were inadequately documented and did not comply with Medicaid rules concerning "teaching physician presence." Although the investigation revealed that inappropriate billing and documentation may have occurred, the State found that all of the patients whose records were examined had, in fact, received treatment. The quality of services provided by Emory physicians was not an issue
in the investigation.

Attorney General Baker stated that "Emory cooperated fully with the investigation and the investigation revealed no evidence of criminal wrongdoing." He further commended Emory for its role in consistently providing high quality health care to the indigent citizens of Fulton and DeKalb counties.

Under the terms of the agreement, the Emory Medical Care Foundation expressly denies any wrongdoing, but has agreed to pay the Georgia Department of Medical Assistance a lump sum of $4,502,693 to settle all possible claims. The Foundation also agreed to several compliance provisions, including continued implementation of a compliance office and program that were initiated in 1997. The State considered this compliance program, in addition to Emory's cooperation with the investigation, to be strongly mitigating factors in the settlement of the case.

Of course, if you still aren't convinced maybe you should .re read this, or this.

(Update)

Much of the story surrounding Grady has many tentacles and thus one could get lost in the middle of it. I have found that to be the case for many readers with certain pieces. I don't believe this is one of them. I believe this piece speaks for itself, and it should be easy to follow no matter how big your exposure to the entire case. That said, I also think that everyone should understand how this culture of corruption fits into the overall picture. Thus, I have put together a summary of the entire fiasco that tries to put all of its moving parts together in one piece. Please read it for guidance. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.