The Consequences of Shutting Down Grady Hospital and Its Political Implications

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.

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.

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.

Attacking Corruption: The Power and Frustrations of the Blogosphere (Updated)

INTRODUCTION: I have been known to tell many of new found allies in the case of the corruption that I have found at Emory University, Grady Hospital and beyond that our opponents cannot control what I am doing because the internet is not controllable. It is a force beyond anyone's control.

For instance, a few weeks ago I wrote this story linking the murder of Derwin Brown, the suicide of Charles Hicks to a culture of corruption in Dekalb County under its "leader" Vernon Jones. The story started its journey on the front page of Real Clear Politics\ and then traveled its way across the country until hundreds of people began emailing it to each other (I know this through the technical way in which my stat counter tracks my visitors. It is too long and boring to explain so you will have to take my word for it) I even received this email in response to the story.

Mr. Volpe, Greetings... I have recently been reading many of your comments specifically relating to corruption, politics, and particularly Dekalb County.. You Sir are right on point!!! The dynamic that resulted in the ELECTED by the people Sheriff Derwin Brown (as opposed to the establishment "appointed" Sheriff Tommy Brown) was certainly a result of a vast conspiracy not merely the action of a single individual(Sid Dorsey)..

Derwin had himself uncovered many instances of longstanding good ole boy wink and nod politics and outright corrupt practices. Additionally, he aligned himself with individuals ( such as yours truly) who had personal knowledge of corrupt practices and deals that government officials elected in Dekalb had engaged by formed cozyrelationships with business people for their personal gain and pecuniary benefit. All be it strip club operators, county vendors, bail bondspeople, or off duty officers with private security accounts; Derwin represented the end of this type graft. These miscreants wanted him stopped and they stopped him. Maybe by not necessarily pulling the trigger but by creating an atmosphere and culture that resulted in demented and ignorant individuals like Dorsey, Cuffie, et al feeling that it needed to be done and should be done..

These tacitly involved individuals have Derwin's blood on their hand to the same extent as the trigger men... Moreover, allowing individuals like Vernon Jones, Charles Hicks, Louis Graham, and Thomas Brown (the prmier figurehead) to run the government is nothing short of a farce.. Mr. Hicks may have truly had a crisis of conscience and therein lies the reason for his unfortunate death (be it suicide or murder). The real power brokers (Bob Wilson, Ray Suddeth, Mark Dehler, Frank Redding, and Sembler) are the ones reaping the real benefits $$$ from these shenaigans in Dekalb County government over the last 15 years. Unfortunately, it is at great cost to the taxpayers and underminds the sheer fiber that our Constitution is foundationed upon and yes cost at least one hero his life..

I received several such emails and a host of new and important contacts as a result of internet travels of that story. No amount of corruption can stand up to the power of the internet, email, and how that dynamics brings everyone together.

The feedback hasn't always been good. For instance, I recevied this email from Dr. Michael Ward of the University of Cincinnati. He has some incendiary things about Kevin Kuritzky, the whistle blower that first turned me onto this story.

Mike, Just wanted to let you know that you shouldn't get taken in by Kevin Kuritzky. The guy is a pathological liar and I have personally been taken in by his stories only to realize that he was flat out lying. I also know numerous other people who have experienced the same. It is quite sad because he is a very charming, intelligent person. He just uses these skills to manipulate people. Don't get taken in by him.Mike--

Michael Ward MD,

MBA

Resident

Physician

Department of Emergency Medicine

University of Cincinnati

I invited Dr. Ward etc. etc. to back his vague and incendiary statements up with examples and evidence. He has declined and since the email is now my property I have decided to use every opportunity to use it to expose him as the fraud. He is of course welcome anytime to back up any of these statements. In the meantime, his own words will be on the internet for everyone to see.

Those are examples of using the blogosphere and the internet for positive and how it becomes the ultimate equalizer. On my site, Dr. Ward etc. etc. is no more powerful than anyone else, and through the reach of sites like Google his own words will be on display for anyone that cares. Now, I have introduced the positives of the blogosphere however this piece is about some of the filth and garbage that you find will navigating through and with that the introduction is over...


I will direct everyone to two separate sites in which, in my opinion, all of the worst of the internet came out. First, I have an admission to make. I traced a tentacle of this story down to Florida in the person of Dr. Andrew Agwunobi. He appears to be knee deep in the scandal at WellCare. Since he is currently in the REPUBLICAN administration, I see his exposure as a boon to all Democrats. Well, in terms of size and power the ultimate Democratic blogging site is Daily Kos.

While a true blue Republican would have difficulty there, I simply couldn't ignore their sheer size and numbers. I knew that I couldn't go there as myself, so I went there under the pseudonym, theprovacateur. (I know it is misspelled and so be it.) I received a lukewarm reception to my expose of Dr. Agwunobi. While most of the people that read it liked it, it wasn't nearly as popular as the most recent "expose of a Bush Lie, impeachable offense, and example of incompetence".

Next, I thought I would be more confrontational and inflammatory in a piece that was in response to another piece published by a regular of Daily Kos vis a vis Vernon Jones. Anyone who knows anything about the Kos knows that confrontational and inflammatory are not only welcomed but encouraged there. Welcomed and encouraged that is I found as long as you are attacking what they consider the enemy. Since I dared to attack one of their own, well suddenly the entire Kos site became quite sensitive. (Yes, this is a case of being able to dish it out but not taking it)

Here are some examples of the comments...

you need to give some serious thought to your approach to diarying here. You don't raise awareness about an issue by attacking another diarist who wrote something only very indirectly related to your issue, six freaking months ago. I suggest you delete this diary and try again. If Vernon Jones is your problem then write a diary about Vernon Jones. Don't write diaries accusing others of being "pathetic". That's not going to win you loyal readers.

And a last piece of advice: before you issue sweeping statements of condemnation about Kossacks, you'd better know what the f$%k you're talking about, because I will personally guarantee you that whatever the subject, there will be at least one person around who knows 10X more about it than you ever will. Now delete this ridiculous diary so that it doesn't show up on your "permanent record," and welcome to DailyKos.

Keep in mind that Vernon Jones is the subject of much of my wrath. Vernon Jones is most likely a multiple rapist, probably tied to a great deal of personal corruption, and certainly oversees not only a corrupt police force but also a corrupt public hospital. In other words this is a bad guy. Did I mention he is running for U.S. Senate? Yet, most of the wrath is directed at me, not Jones, because the language I used was "inappropriate". Those weren't the most revealing comments though. These two were.

Lots of places besides DailyKos to send this. (7+ / 0-) Recommended by:
Rebecca, JeffSCinNY, eeff, joanneleon, sbdenmon, Unduna, Goodbye Kitty
TPM Muckrakers, Open Left, FireDogLake, Americablog. Go for it. One more
crook killing people doesn't even qualify as news anymore. Good luck.

Local GA political blogs (3+ / 0-) Recommended by: Rebecca, JeffSCinNY, joanneleon
would be an even better choice. Tondee's Tavern, for example. Link's in my blogroll, if you're interested, diarist...

These folks, who claim to be appalled by all of this corruption around them, passed on actually doing anything about corruption put right in front of them. It was pretty clear that they like to chat back and forth about all of the supposed corruption they see but can't do anything about, rather than trying to tackle any corruption in front of them. Keep in mind that Jones is running for the Democratic nomination of the U.S. Senate. Despite proclaiming how large and powerful they are whenever they think it matters, they are now suddenly powerless to this corruption. Not only did I, not Jones and his corruption, become the issue, but they frankly had no motivation to actually challenge any of the corruption that many of them ceded he has caused. While they found nearly endless energy to attack me, they had none left for a real bad guy, Vernon Jones.

Of course, what happened vis a vis this piece was nothing to what happened when I published this piece that is a detailed summary of the corruption at Grady Hospital, Emory University and beyond. The first few comments were fine, however since much of my piece linked to my own blog, soon enough people noticed they were reading a conservative. Here are some of the comments that followed.

This is being cross posted with permission of Mike Volpe of Proprietor Nation
A quick look at the blogroll of PN gives us: RedState, Powerline, Michelle Malkin, LGF, Hot Air, Captain's Quarters, etc., etc. Judging by your comment about the radio show, I'm assuming you are "snooper." The top story on your personal blog is "The Leftinistra Brainwashing Our Youth." That blog's tagline currently reads: Dedicated to the men and women of the United States Military fighting the Islamic Menace that our government has wrongly mistaken as a peaceful religion. Call me cynical, but these things make me question your motives for posting here, as well as your read on the situation with Grady Hospital, given your inherent bias.

...


You have destroyed any credibility you might have here at dKos by the sources you've used in this diary. Your entire theory hinges on the ravings of a far-right loon and the company he keeps, yet you claim that to be "irrelevant."You despise Vernon Jones; we get it. GA Kossacks despise him, as well, so you're not likely to make any new converts. No one outside GA has the time to care. There's a primary or two coming up in the next few weeks, if you hadn't heard.How will that make the Democratic party look? Please. Concern troll much?

...

Here are Mike Volpe's "recommended blogs" (3+
/ 0-)
Recommended by:
joanneleon, sbdenmon, irishwitch
Volokh
Conspiracy
Varifrank
Tygrrrr Express
Twin Cities Conservative
The Mortgage Reports
The Minority Report
Take Our Country Back
Simon Power
Red State
Powerline Blog
No Hillary Clinton
Michelle Malkin
Michael Yon
Michael Totten
Little Green Footballs
Iraq the Model
IMAO
Hot Air
Hinz Sight Report
Gerry Charlotte Phelps
Faultline USA
Draft General Pace
Deborah Lipstadt
David Frum
Daniel Pipes
Captains Quarters
Austin Bay

Side note: There is a lot of room for abuse when inner city hospitals are used as teaching hospitals for universities -- that particular symbiotic relationship is a very tricky one. At the same time, this write-up is at least 75% innuendo. It reads to me like Emory is the presumptive "bad guy," when in actuality the problem is lack of oversight in hospital administration. So, no, poor medical care for the indigent is not a partisan issue, but the way this is written up sure seems to have a David Horowitz ring to it. I think you could re-assemble these facts without that central assumption and have a piece that would get a better reception.

Here is my personal favorite...

And libelous bulls$%t at that.They've got a good law school, too. You might invest in an alumni directory, unless Michael Horowitz has already lined up an attorney for you.

So, does everyone understand? I am wrong because I am a Conservative, and Emory can't be corrupt because they have a good law school. As Kevin Kuritzky pointed out to me long ago, this is not a partisan issue, it is an issue of corruption. The irony is that almost all of the allies I have gotten on this story are themselves Democrats. The worst part was that I was arguing with people who had never heard of this story before. They proceeded to think that they knew more than me and they were confident in their thoughts because I was linked to a Conservative. (at this point they still assumed that theprovacateur and Mike Volpe were two different people) For instance, I got this comment...

Yes, I read the piece. Mike Volpe alleges four professors were "paid off" -- but only gives information about one. The link shows that Dr. Murtaugh's lawsuit centers on not getting a promotion, and he get a settlement. He also alleged medicare fraud. But to say that the settlement was a payoff to silence him about the medicare fraud is a gross oversimplification.I conceded that there was probably some wrongdoing by Emory. But you completely ignored my point that this piece is fundamentally dishonest because of its anti-Emory framing -- it seems like very few of the issues are actually Emory's fault. They get paid 50 million because they staff the hospital and inner city hospitals don't staff
themselves. By doing so, you are conceding the innuendo argument.

I'm assuming that you're repeating this and are being used, and are not a troll yourself. Think of our reaction this way: suppose a diary comes up that focuses on an important misuse of CIA intelligence that led to the Iraq War, but frames it as being the fault of Senator Rockefeller because he was on the Intelligence Committee. You and I can agree on the importance of the problem, but find the framing dishonest. That's what we're saying here, and I'm not criticizing you, just trying to get you to see that supporting the recognition of the problem doesn't mean uncritically accepting everything in a diary about the problem...

This poster is referring to four doctors that I said were paid off. They say that I have no evidence because I have little to say about any of them besides one, Dr. Jim Murtaugh, and this poster seems to find this as evidence of my shotty reporting. Keep in mind they were paid off and silenced, and so by nature there will be little evidence of the specifics of each case. The only reason that Murtaugh's case came up is that State Senator David Shafer lead a Congressional delegation to unseal the settlement. Furthermore, someone at Kos laughably claims that my piece is dishonest because I take a preconceived bias. First, I do. I am certainly biased against the administration. This comes after two months of research in which I have concluded that they pilfer Grady Hospital, land a sweetheart deal at the tax payer's expense, and pay off or expel anyone that gets in their way. (they will even make articles disappear from internet archives if it is discovered those will make them look bad) Of course, what is laughable is the Kos claiming that an arguement is flawed if it is biased. If that is the case, they have condemned each of their own diaries.

What was really insulting is that I have no doubt that almost no one I was arguing with had even heard of Grady Hospital before I pointed it out to them. The only reason this became confrontational is because they thought that a Conservative had provided the sourcing. At this point, I have spoken with so many insiders on so many angles of this scandal that the only people that know more about it are the insiders themselves. I have traced tentacles to the Dekalb Police Department, the WellCare Scandal, and I am now working on connections to real estate developers and possibly even the Dixie Mafia. I bring this up not to toot my own horn but so that everyone understands how well I understand this story. For someone to challenge me without knowing much of anything is simply insulting.

Of course, the lunacy is not exclusive to the left of the blogosphere. I got into a verbal joust with some commenters on the Georgia blog, Peach Pundit. There were mostly Republicans and Georgia residents and so their problem with me was entirely different. Here are some examples of the comments...

Fascinating that you are so connected and interested while living in Illinois. And as far as Derwin Brown. He was my sheriff and a good man. His death was heinous. So is your ridiculous attempt to tie it into this mess.

...


It isn’t “going private” at all. Just being restructured as a non-profit, likely with state funds being provided. And given the way the laws work down here regarding following state money, I doubt it will be “impossible” to follow the money. Interesting that you throw around the term private since from the beginning that’s been a codeword for many of the anti task force activists down here.But what do I know? It’s not like I ever talk to anyone involved.

...

Oh thank the good Lord above we gots somebody smart to show us the way. Not
one of us ignorant hicks have ever questioned why some many consulting firms
were hired. Not one of us have questioned the mismanagement of Grady. Lord bless
us all that we now have this fine man to show us the way. To lead us out of the
wildereness where we are all a party to such sin.

...

Oh I don’t know, Jace. Maybe the repetitive condescension that we don’t know what’s going on. Repeatedly ignoring the fact that some have raised many of the same questions. Conspiratorially tying the Derwin Brown murder to corruption of Grady. Transitively tying any questioning of his theories into sheeplike acquiesence to being rolled by the Devil. Continually making Charles Walker’s conviction about Grady when mostly it was not. And even when us ignorant hicks refute points fall right back to saying we don’t know what we are talking about.It could be that unless we see through the God-given clear lens of Mike Volpe, we just don’t know what the hell we are talking about.Nah. It’s none of that.

In this case, it came down to tone and territory. I was too confrontational and condescending, and of course I wasn't from Georgia. I got only one defender on the site...

Why does everyone seem out to get this “mike volpe” guy? He is raising some interesting points

There are several things here. First, as I later pointed out, Derwin Brown was never sheriff because he was murdered (by the outgoing sheriff and a conspiracy of deputies and others in the police department) so the initial statement is not only condescending but factually wrong.

Second, the death of Derwin Brown and the corruption at Grady can be tied to one man, Vernon Jones, who was connected to both. (He is still currently the CEO of Dekalb County and not only overlooks the DEKALB POLICE DEPARTMENT, which Brown was elected sheriff of, but he also picks the board at Grady Hospital) Whether or not the corruption is linked directly together or not is up for debate, however I have no doubt that at minimum there is a culture of corruption that links all of it together.

Now, as for the reference to the new plan by the Grady Task Force, it is too in depth for an explanation here, so if you want to know my thoughts, please read my piece on it. (also, I welcome you to read the recommendations that me and my allies have come up with for Grady Hospital)

Also, they claim that most of the corruption committed by State Senator Charles Walker wasn't at Grady Hospital. While this is true, Walker's crime was expansive and not very picky, most of the evidence of his corruption came from whistleblower Joyce Harris, who was the head of H.R. at Grady Hospital.

Their points finally turned from factually wrong to absurd with this comment...

Is it possible that the convictions were tagged on solely to Walker because folks were out to get him? I’m not saying he didn’t do wrong - believe me, as an Augusta native, he did a lot of things wrong and deserved punishment - but he also had a lot of guys gunning for him, particularly a lot of folks in Augusta.

Could it be that the focus was to get Walker and not to investigate Grady? And that getting Walker meant piling up the felony charges?

Here is how I refuted it...

If they were “out to get him”, why did he get ten years for 127 felonies or less than a month per felony. Folks weren’t “out to get him”. Folks were out to keep his affair as quiet as they could. If the chief prosecution witness fingers everyone, then why isn’t anyone else investigated?If Walker committed so much crime that it lead to 127 felony convictions, and people were on the level, they would want to follow it further and see if the hospital involved had systemic corruption in and that lead to his crimes? That is, if people were on the level.

My point was never disputed and ultimately nothing I said in any of the debate was proven inaccurate. (something I can't say for those that I argued with)

I bring up these factual points to once again point out that I was arguing with people that were frankly a lot less knowledgeable. Once again, rather than focusing on the merits of the corruption and finding ways to connect through the power of the internet, these commenters made me the story.

The facts were no less important to these Georgia Republicans than they were to Kos liberals.
I was combative and an outsider, they immediately assumed I was wrong. They never had their facts straight, but that didn't stop them from arguing. Ultimately, rooting out the corruption in their own state wasn't the important thing. What was important was "beating" so to speak an outsider that they felt was demeaning their state.

In both cases, an opportunity was lost for people to band together to take on bad folks. Instead, it turned into the twenty first century technological version of a school yard arguement. Rather than focusing on the real bad guys, the ones perpetrating the corruption at Grady, Emory and beyond, they focused on me. I went out searching for allies in a story that not only needs to be told, but found the worst of human nature in folks from both sides of the aisle.

UPDATE:

I realize that anyone that picks up this story somewhere in the middle may get quite confused. For instance, if you happen to read this particular piece but you aren't familiar with the goings on at Grady, you will likely get lost in this particular story. 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.

JCAHO Threatens to Shut Down Grady Hospital

The Atlanta Journal Constitution (which I believe to be a suspect news organization) broke this this morning...

As if things weren't bad enough for the financially strapped Grady Health System, now the hospital faces a list of criticisms, including issues with patient care, that put its national accreditation at risk.

In a five-day inspection last week, the Joint Commission —- formerly the Joint Commission on Accreditation of Healthcare Organizations —- identified "numerous
requirements for improvement," according to a statement issued by Grady on Monday. Hospital officials gave no details about the kinds of shortcomings inspectors found.

Dr. Christopher Edwards, vice chairman of the Grady board, said the report cited "opportunities for improvement in various areas, including patient care."

Anyone who has been reading my work, knows that the tone of this article is wrong. It is frankly long past time that the powers that be, be held responsible for the mess at Grady. Keep in mind that about three years ago, the HHS conducted an investigation that concluded this about the patients at Grady Hospital...

there is an immediate and serious risk to the health and safety of the patients

Obviously, it can't get any worse than that for a hospital. Now, three years later the hospital needs an injection of half a billion dollars to stay solvent. Before that, Grady Hospital was convicted of Medicare fraud. State Senator Charles Walker committed so much criminality at Grady and beyond that he was ultimately convicted of 127 felonies. I am fond of the Latin phrase Res Ipsa Loquitur (the facts speak for themselves), and in the case of Grady Hospital, Res Ipsa Loquitur.

One only needs to do a Google search to discover that there are serious and systemic problems at Grady Hospital that frankly, in my opinion, warranted intervention from authorities long ago. Given the current crisis and latest report from JCOHA, it is clear that proper steps weren't taken in response to the report from HHS about three years ago. I hope that this latest episode winds up with a different result.

Here is the so called inside baseball on how this transpired. Much of the credit should end up going to Ron Marshall of the Grady Coalition. He sent letters for years to JCAHO complaining about stonewalling on the part of Grady staff as far as open records requests and in answering their many questions on a whole host of issues related to corruption, poor patient care, and effective hospital management. Here is an example of an email that he sent that I got a hold of...

Mr. Bressler,>> YOU often appear not to have the evidence we have presented to you> over the years. We hope you have protected all documents we have sent> to you from spoilage.>> NATIONAL WITNESSES: THE GRADY SYSTEM HAS FAILED> Because of the severe suffering at Grady, we cannot rest until JCAHO> violations are stopped. We are bringing on board new witnesses.

Dr.> Linda Peeno, formerly a top executive at Humana, has analyzed the> situation and finds that this is a breakdown of the medical system.> Peer review is an essential part of the system to protect patients.> Bad faith peer review effects the medical judgements of all doctors> in the system, and leads to systematic poor medical care. Testimony> demonstrates it is impossible to deliver minimal standard care when> peer review has been subverted.>> CONGRESSIONAL ALLIES> We will be meeting with Congressional allies next week, and we will> be holding a press conference. We hope we receive a statement from> you by noon, Tuesday that you will implement a plan to enforce JCAHO> regulations at Grady.>>

GOOD FAITH PEER REVIEW IS ESSENTIAL TO THE INTEGRITY OF THE SYSTEM> I know you do not want to enforce peer review standards. However, I> don't see how you can enforce any standard if bad-faith peer review> is being used to hide malfeasance at the hospital. Peer review is> part of a system to protect patient care. If peer review is> subverted, doctors and staff are unable to speak up for patients and> to enforce patient care standards. The whole system is stood on its> ear. I hope you will reconsider your position and enforce JCAHO's own> standards. Grady has violated each of the provisions you outlined in> your last letter.>> BAD FAITH PEER REVIEW HAS BEEN CORRUPTING THE MEDICAL SYSTEM FOR DECADES> This has been a horrible problem for years.

Verner Waite wrote to you> about widespread violations in peer review leading to patient harm> ten years ago, and you did not respond. It is our position that you> must enforce all standards, especially peer review standards, that> impact patient care. This is at the core of your function.>> BAD FAITH PEER REVIEW IS CORRUPTING POLITICS IN GEORGIA> We have presented extensive evidence, including evidence from an> assistant DA, that the huge amounts of money stolen from Grady has> perniciously influenced Georgia politics. The 142 felony count indictment against Senator Walker was based in large part of his corruption of Georgia's hospitals by corrupting its peer review system. Bad faith peer review is a cancer on the body politic of the> entire state. Bad faith peer review can only be
stopped by JCAHO.> JCAHOs failure to enforce its standards is harming the entire state.

HOWEVER, EVEN IF YOU WILL NOT ENFORCE YOUR OWN STANDARDS, PLEASE AT>LEAST MAKE GRADY CORRECT DEFICIENCIES IT HAS ADMITTED IN MORE THAN THIRTEEN AREAS. GRADY IS THE MOST IMPORTANT HOSPITAL IN THE SOUTHEAST THAT SERVES> MINORITY PATIENTS. PLEASE TELL US IF YOU WILL ENFORCE YOUR STANDARDS> AT GRADY.>> 1. For your convenience, we have created a database showing how> violations in JCAHO policy at Grady have resulted in severe patient harm over the last five years: http://www.geocities.com/ron_marshall21/

2. We also document how Grady has retaltiated against witnesses to> prevent you from getting evidence: http://www.geocities.com/ron_marshall21/

3. We summarize severe corruption and its impact on patients:


4. We summarize witnesses available and ethics violations:

5. Current staff document new retaliations, and JCAHO violations. The staff fear to
speak to you.

6. Patient care is greatly compromised.THE HARMS TO GRADY'S PATIENTS ARE STAGGERING. PLEASE RULE ON OUR> COMPLAINT IMMEDIATELY.> A BLUE RIBBON COMMISSION TO INVESTIGATE UNETHICAL PRACTICES IS NEEDED NOW.> ROBERT BROWN AND PAUL HOWARD MUST RESIGN.>> Thank you. We know this is a lot of information, but all of it has> been sent to you
previously. This is but a portion of the documents> already in your possession.>> Ron Marshall> George Anderson> The New Grady Coalition

While many of the names are probably unfamiliar, please note this particular email is one of many over several years. Clearly, Grady refused to respond to good faith efforts to address issues that years later JCAHO has finally gotten around to forcing them to address.

I hope that everyone grabs the bull by the horn in this situation and takes steps to institute the sorts of institutional changes that are necessary to rid Grady of the culture of corruption that seems so apparent to me. Here is the plan as set by the Grady Task Force. If anyone can make sense of it, let me know because I can't. Here is the plan me and my allies have developed. I hope that everyone has a chance to read it. The time for Grady Hospital is critical, and it is time for real solutions.

For reference on how Grady Hospital got to such an extreme point you can go to this tag, or you can read this summary.

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.

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.