List Archives

Tue Nov 27 17:07:58 GMT 2007

On Nov 27, 2007 10:54 AM, ROBERT ARNOLD <robsidarn at msn.com> wrote:

"p.s. when is LegalCare, the equivalent of Medicare, for attorneys going to
surface?
and the answer, never, because the majority of senators and representatives
are attorneys!"

>From the 'Miranda rights' (Wikipedia):
"....has the right to consult with an
attorney<http://en.wikipedia.org/wiki/Lawyer>and to have that attorney
present during questioning, and that, if he or she
is indigent <http://en.wikipedia.org/wiki/Poverty>, an attorney will be
provided at no cost to represent him or her."

The solvency of trauma centers is an important topic, but lawyers and the
Iraqi war play a very peripheral role in the root causes.

Regards,
Alex Garbino

On Nov 27, 2007 10:54 AM, ROBERT ARNOLD <robsidarn at msn.com> wrote:

>
> having been born and raised in atlanta, i maybe be able to add another
> perspective.
> the Varsity has the best onion rings anywhere.
> now that something positive has come out of this discussion....
> i agree that we should leave Iraq.
> the only reason we are over there is to stake our claim for more oil.
> an alternative energy solution could be the end of this present evil.
> i am an Air Force Academy graduate who served my time during the Vietnam
> War.
> i think we should allow all people physically able to serve THEIR country
> with military or civil service for 2 years.
> they already do that in mutiple countries in europe who have been around a
> lot longer than us.
> americans would have a much more balanced view of who deserves what, if
> that were in place.
> and i fully agree that all people should be held accountable,
> so those that choose not to work get to do community service jobs,
> just like the ones that are on probation or parole.
> we should not give illegal immigrants ANY sort of hand out other than an
> escort home.
> make the coyotes that bring people in take them right back.
> allow our Republic to stand for what it should and cease political
> posturing.
> i.e. death to political correctness for money's sake.
> i bet ya the anonymous sole that stepped forward is a Woodruff heir.
> and if you do not know who Woodruff is, think Coca-Cola.
> god bless america.
> p.s. when is LegalCare, the equivalent of Medicare, for attorneys going to
> surface?
> and the answer, never, because the majority of senators and
> representatives are attorneys!
> my 2 cents.
>
> <html><div><FONT face="Lucida Handwriting, Cursive" size=4>Robert S
> Arnold, MD</FONT></div></html>
> From: trauma-list-request at trauma.orgSubject: trauma-list Digest, Vol 53,
> Issue 32To: trauma-list at trauma.orgDate: Tue, 27 Nov 2007 16:32:59
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> --Forwarded Message Attachment--From: rfsmithmd at comcast.netSubject:
> GradyCC: trauma-list at trauma.orgDate: Tue, 27 Nov 2007 07:52:13 -0500To:
> rockmd at aol.com; fbokhari2000 at yahoo.com Atlanta Hospital Moves to Unburden
> Itself of Debt   By KEVIN SACK<
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack/index.html?inline=nyt-per>
>  and SHAILA DEWAN<
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dewan/index.html?inline=nyt-per>
>  ATLANTA, Nov. 26 - The politically appointed board of Atlanta's
> troubledcharity hospital effectively voted itself out of business Monday,
> the firststep in at least a short-term escape from the insolvency that had
> threatenedthe region's only top-level trauma center. Without the financial
> bailout made possible by the vote, the hospital, GradyMemorial, was at risk
> of not meeting its payroll, perhaps by the end of theyear, hospital
> officials had warned. Though Grady, like most publichospitals<
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier>
> , has faced intermittentfinancial crises in the past, this one has generated
> real anxiety<
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/overview.html?inline=nyt-classifier>
>  because of its roots in a collision ofnational forces, including the
> unchecked growth of uncompensated care anddeep cuts in government
> reimbursements.  Political leaders and medical officials have worried that
> Grady, woven intoAtlanta's social fabric since 1892, might follow Martin
> Luther KingJr.-Harbor Hospital in Los Angeles County as a casualty in 2007.
> If so, theconsequence would be a "patient tsunami" at other area hospitals,
> theMetropolitan Atlanta Chamber of Commerce said in a report earlier this
> year. Grady - which supplies the region with its only 24-hour trauma center
> aswell as poison control and burn units and large clinics for AIDS<
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier>
>  and sickle<
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/overview.html?inline=nyt-classifier>
>  cell anemia - has operated in the red for 10of the last 11 years. It is
> expected to run a deficit of $50 million to $55million in this year's $730
> million budget.  The hospital owes an accumulated $63 million to its biggest
> creditors, themedical school at Emory University<
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emory_university/index.html?inline=nyt-org>
>  and the Morehouse School of Medicine,which provide its doctors and have
> threatened to train residents elsewhere.Republican state legislators had
> threatened a state takeover if localofficials did not reconstitute the
> hospital's governance structure. Following a raucous meeting marked by
> chants and protest, the 10-memberFulton-DeKalb Hospital Authority voted
> unanimously to hand daily control ofGrady and its affiliated clinics and
> services to a nonprofit corporation tobe formed for that purpose. A Chamber
> of Commerce task force had advised earlier this year that agovernance change
> was needed to remove the hospital from the control of theelected
> commissioners of Fulton and DeKalb Counties and to restore theconfidence of
> lenders, foundations and Georgia's Republican leaders.  Advocates for
> patients have warned that the hospital would become lessresponsive to
> community needs if it was operated by a less political board.But with few
> other options and Grady's fiscal condition worsening, theauthority felt it
> had little choice. "In three weeks, our cash position would have been zero,"
> the authority'svice chairman, Dr. Chris Edwards, said at the meeting Monday.
> In its resolution, the hospital authority, which would continue to
> ownGrady's buildings and land, made explicit that its willingness to hand
> overcontrol depended on substantial financial commitments from both the
> publicand private sectors. Before the lease, to be executed by Dec. 31,
> becomes effective, the hospitalmust receive written commitments for a
> capital infusion of $200 million frombusinesses and philanthropies. In
> addition, the resolution demands that state leaders provide writtensupport
> for $30 million in new state aid. A. D. Correll, a former chairman of the
> Georgia-Pacific Corporation and theco-chairman of the task force, said he
> considered the vote a critical firststep, though with provisos attached.
> "They were a surprise, a lot of them,"Mr. Correll said of the conditions,
> "and they require action on a whole lotof people's parts."  Mr. Correll said
> a single anonymous donor had agreed to give the hospital$200 million if the
> donor approved of the governance system changes. He saidhe was confident
> that the private sector could raise an additional $100million in two or
> three years. The fate of the hospital has become a keenly watched civic
> drama, overlaidwith issues of race and class.  Some black activists and
> elected officials had warned that the governancechange would shift control
> of the hospital from black political leaders towhite business leaders. The
> hospital's problems, they said, are financialand not political. Chamber of
> Commerce officials, white and black, have responded that the onlycolor that
> matters in the campaign to save Grady is green. And justifiablyor not, they
> say, business leaders and state officials were willing toparticipate in a
> rescue only if they saw a real departure from pastpractice, when the
> hospital's board was perceived to lack technicalexpertise and the will to
> block corruption and cronyism.
> --Forwarded Message Attachment--From: pbjorn at emh.orgSubject: RE:
> GradyDate: Tue, 27 Nov 2007 09:24:21 -0500To: trauma-list at trauma.orgSadthat all this red ink comes to a small fraction of one per cent ofGeorgia's
> share of federal healthcare reimbursement slashed by thecurrent
> administration. Fifty million dollar budget shortfall?  End the Iraq war six
> hours earlyand let Grady keep the change. Pret BjornBangor, ME USA
>  -----Original Message-----From: trauma-list-bounces at trauma.org[mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Robert F. SmithSent: Tuesday,
> November 27, 2007 7:52 AMTo: rockmd at aol.com; 'faran bokhari'Cc: 'Trauma
> &amp; Critical Care mailing list'Subject: Grady   Atlanta Hospital Moves to
> Unburden Itself of Debt   By KEVIN SACK<
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack/index.html?inline=nyt-per>
>  and SHAILA DEWAN<
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dewan/index.html?inline=nyt-per>
>  ATLANTA, Nov. 26 - The politically appointed board of Atlanta's
> troubledcharity hospital effectively voted itself out of business Monday,
> thefirststep in at least a short-term escape from the insolvency that
> hadthreatenedthe region's only top-level trauma center. Without the
> financial bailout made possible by the vote, the hospital,GradyMemorial, was
> at risk of not meeting its payroll, perhaps by the end oftheyear, hospital
> officials had warned. Though Grady, like most publichospitals<
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier>
> , has faced intermittentfinancial crises in the past, this one has generated
> real anxiety<
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/overview.html?inline=nyt-classifier>
>  because of its roots in a collision ofnational forces, including the
> unchecked growth of uncompensated careanddeep cuts in government
> reimbursements.  Political leaders and medical officials have worried that
> Grady, wovenintoAtlanta's social fabric since 1892, might follow Martin
> Luther KingJr.-Harbor Hospital in Los Angeles County as a casualty in 2007.
> If so,theconsequence would be a "patient tsunami" at other area hospitals,
> theMetropolitan Atlanta Chamber of Commerce said in a report earlier
> thisyear. Grady - which supplies the region with its only 24-hour trauma
> center aswell as poison control and burn units and large clinics for AIDS<
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier>
>  and sickle<
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/overview.html?inline=nyt-classifier>
>  cell anemia - has operated in the red for10of the last 11 years. It is
> expected to run a deficit of $50 million to$55million in this year's $730
> million budget.  The hospital owes an accumulated $63 million to its biggest
> creditors,themedical school at Emory University<
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emory_university/index.html?inline=nyt-org>
>  and the Morehouse School ofMedicine,which provide its doctors and have
> threatened to train residentselsewhere.Republican state legislators had
> threatened a state takeover if localofficials did not reconstitute the
> hospital's governance structure. Following a raucous meeting marked by
> chants and protest, the 10-memberFulton-DeKalb Hospital Authority voted
> unanimously to hand daily controlofGrady and its affiliated clinics and
> services to a nonprofit corporationtobe formed for that purpose. A Chamber
> of Commerce task force had advised earlier this year that agovernance change
> was needed to remove the hospital from the control oftheelected
> commissioners of Fulton and DeKalb Counties and to restore theconfidence of
> lenders, foundations and Georgia's Republican leaders.  Advocates for
> patients have warned that the hospital would become lessresponsive to
> community needs if it was operated by a less politicalboard.But with few
> other options and Grady's fiscal condition worsening, theauthority felt it
> had little choice. "In three weeks, our cash position would have been zero,"
> theauthority'svice chairman, Dr. Chris Edwards, said at the meeting Monday.
> In its resolution, the hospital authority, which would continue to
> ownGrady's buildings and land, made explicit that its willingness to
> handovercontrol depended on substantial financial commitments from both
> thepublicand private sectors. Before the lease, to be executed by Dec. 31,
> becomes effective, thehospitalmust receive written commitments for a capital
> infusion of $200 millionfrombusinesses and philanthropies. In addition, the
> resolution demands that state leaders provide writtensupport for $30 million
> in new state aid. A. D. Correll, a former chairman of the Georgia-Pacific
> Corporation andtheco-chairman of the task force, said he considered the vote
> a criticalfirststep, though with provisos attached. "They were a surprise, a
> lot ofthem,"Mr. Correll said of the conditions, "and they require action on
> a wholelotof people's parts."  Mr. Correll said a single anonymous donor had
> agreed to give thehospital$200 million if the donor approved of the
> governance system changes. Hesaidhe was confident that the private sector
> could raise an additional $100million in two or three years. The fate of the
> hospital has become a keenly watched civic drama,overlaidwith issues of race
> and class.  Some black activists and elected officials had warned that
> thegovernancechange would shift control of the hospital from black political
> leaderstowhite business leaders. The hospital's problems, they said,
> arefinancialand not political. Chamber of Commerce officials, white and
> black, have responded that theonlycolor that matters in the campaign to save
> Grady is green. Andjustifiablyor not, they say, business leaders and state
> officials were willing toparticipate in a rescue only if they saw a real
> departure from pastpractice, when the hospital's board was perceived to lack
> technicalexpertise and the will to block corruption and cronyism.
> --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --Forwarded Message Attachment--From: NAhmed at cchseast.orgSubject: RE:
> Trauma Care in the UKDate: Tue, 27 Nov 2007 09:24:46 -0500To:
> trauma-list at trauma.orgDr Khan,To believe that every injured patient that
> is brought in the emergencyrooms around the world, especially poor urban
> hospitals in US, haveaccess to  a vascular, thoracic and a urologist is like
> counting virginsin heaven. A general surgeon should be able to provide
> damage control inall/most scenarios, otherwise he/she has no business taking
> trauma call.Naveed -----Original Message-----From: Saboor Khan [mailto:
> hpb.surgery at gmail.com] Sent: Monday, November 26, 2007 12:49 PMTo: Trauma
> &amp, Critical Care mailing listSubject: Re: Trauma Care in the UK Dr
> Hardcastle Although the structure of general surgical training in the UK
> ischanging, until recently prior to being appointed a trainee typicallyspent
> a minimum of 8-9 years in clinical training (+ 2-3 years ofresearch),
> rotating through all the various specialties and electing tosub-specialise
> in the last two to three years (whilst still taking callfor general surgery,
> including trauma), much like a 'fellowship'. Thebad old days of 'open ended'
> training are thankfully over! That said,the newly appointed consultant is
> expected (indeed trained) to deal withabdominal emergency surgery. There is
> no formal requirement for critical / intensive care trainingbecuase these
> units are manned by dedicated 'intensivists', who aremostly anaesthetists by
> training. However, critical care and emergencysurgery (including trauma) are
> vital parts of all surgical post-graduateexaminaitons, including the exit
> exam. Finally, it is compulsary to haveattended the 'Care of the critically
> ill surgical patient'  ( as well astheATLS) course and increasingly trainees
> rotate through critical care. 'Trauma Surgeons' per se do not exist in the
> UK, unlike the U.S or othercountries. Trauma patients arrive in the
> Accident and Emergencydepartment, and in the medium to large hospitals are
> attended to by atrauma team with multi-specialty representation. The
> organisation oftrauma care in general can be better organised, as discussed
> in thisthread. The 'exposure' to penentrating truama is very low indeed and
> perhapsthat's the reason why you get so many requests for experience.
> Havingexpert vascular on-call round the clock is a welcome development,
> whichI have no doubt improves outcome for the great majority of
> vascularpatients.  You make some 'interesting, comments in your e-mail, and
> paint apicture of surgical training in the UK that I do not recognise, i.e.,
> anewly appointed consultant, unable to assess, manage or operate onsurgical
> patients outside of their narrow field ! There is increased emphasis on
> sub-specialistation, but that's a worldwide phenomenon in some guise or
> another- resources permitting? I am abit puzzled, what is your definition of
> a 'general surgeon'? Best Wishes,Saboor KhanCoventryUK    On Nov 26, 2007
> 4:47 AM, Hardcastle, Tim, Dr <tch at sun.ac.za><tch at sun.ac.za>wrote: > Mike>>
> The other challenge that now exists in the UK is that there are less > and
> less true "General Surgeons"; the majority of the "Trauma > Surgeons" are
> mainly orthopaedic trained, while the GIT surgeons > subspecialise even
> before they finish what we would know as residency. > They qualify not as
> "General Surgeons", but as one of Breast-Endocrine > / Upper GI / Colorectal
> or Hepato-biliary surgeons. Vascular is also > seperate now. This leads to
> young consultant surgeons who have little > idea of the overall patient and
> the care of trauma in particular. Add > to this the lack of a formal ICU
> requirement in the post-grad trainingand you see where some of the
> deficiencies lie.>> For this reason we in South Africa are inundated with
> requests for > people to do three month mini-trauma-fellowships to get some
> > experience in General Trauma care.>> Regards> Dr T C Hardcastle> M.B.,
> Ch.B.(Stell); M.Med(Chir); FCS(SA) Senior Surgeon / Senior > Lecturer:
> Surgery (Trauma and ICU) ATLS  instructor and DSTC Cape Town > Course
> Director Intern program Coordinator: Surgery M.Med (Emergency > Medicine)
> Executive Committee member Clinical Head (Director): Diana > Princess of
> Wales Trauma Unit Division of Surgery (General) Room 4064 > Department of
> Surgical Sciences Tygerberg Hospital / University of > Stellenbosch PO Box
> 19063 Tygerberg 7505 Western Cape South Africa> e-mail: tch at sun.ac.za>
> Cell: +27824681615> Office: +27219389281 or 4911 pager 0302>
> --Forwarded Message Attachment--From: Rgross at harthosp.orgSubject: RE:
> GradyDate: Tue, 27 Nov 2007 09:53:28 -0500To: trauma-list at trauma.orgOhPret, my dear friend Pret.  Why does it always come back to that one issue -
> the WAR - which you have decided is the root of all financial evils in our
> profession (and all others, I presume).  Why not mention tort reform and its
> effect on malpractice insurance costs?  Why not mention the multi-million
> dollar malpractice awards given out by juries "of our peers" that keep the
> costs going up?  Why not mention the gobs of hostage money that our
> hospitals are now forced to pay to our sub-sub-sub-specialty physicians who
> will not take call in the EDs unless they get paid more just to take call
> then our family practice colleagues earn in one year?  Why not mention the
> uninsured and their effect on the inner city hospital's ability to pay the
> ever-increasing cost of doing business.  Why not mention the obscene cost of
> prescription medications , allegedly that high to pay for R&D of new and
> better medications.  Why not mention what this new mandate from the feds
> that will deny payment to hospitals for patients in those hospitals who will
> suffer complications that are, in fact, well known and almost unavoidable
> consequences of our incredible advanced medical capabilities, without which
> these folks would have simply died from their diseases at the get-go. In
> short, what in hell's name does any of that have to do with OIF (Operation
> Iraqi Freedom, just in case you haven't kept up on the lingo).  And yes, I
> know the cost of the war is billions per year (50 billion in the last
> request, as I remember it).  But just what does that have to do with any of
> the things I mentioned above. I am glad to see that you are as zealous on
> one side of the coin as i am on the other........ain't America great?? Take
> care,Ron >>> "Bjorn, Pret" <pbjorn at emh.org> 11/27/2007 9:24 AM >>>Sad that
> all this red ink comes to a small fraction of one per cent ofGeorgia's share
> of federal healthcare reimbursement slashed by thecurrent administration.
> Fifty million dollar budget shortfall?  End the Iraq war six hours earlyand
> let Grady keep the change. Pret BjornBangor, ME USA    -----Original
> Message-----From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Robert F. SmithSent: Tuesday,
> November 27, 2007 7:52 AMTo: rockmd at aol.com; 'faran bokhari'Cc: 'Trauma
> &amp; Critical Care mailing list'Subject: Grady   Atlanta Hospital Moves to
> Unburden Itself of Debt   By KEVIN SACK<
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack/index.html?inline=nyt-per>  and SHAILA DEWAN<
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dewan/index.html?inline=nyt-per>  ATLANTA, Nov. 26 - The politically appointed
> board of Atlanta's troubledcharity hospital effectively voted itself out of
> business Monday, thefirststep in at least a short-term escape from the
> insolvency that hadthreatenedthe region's only top-level trauma center.
> Without the financial bailout made possible by the vote, the
> hospital,GradyMemorial, was at risk of not meeting its payroll, perhaps by
> the end oftheyear, hospital officials had warned. Though Grady, like most
> publichospitals<
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier> , has faced
> intermittentfinancial crises in the past, this one has generated real
> anxiety<
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/ove
> rview.html?inline=nyt-classifier>  because of its roots in a collision
> ofnational forces, including the unchecked growth of uncompensated
> careanddeep cuts in government reimbursements.  Political leaders and
> medical officials have worried that Grady, wovenintoAtlanta's social fabric
> since 1892, might follow Martin Luther KingJr.-Harbor Hospital in Los
> Angeles County as a casualty in 2007. If so,theconsequence would be a
> "patient tsunami" at other area hospitals, theMetropolitan Atlanta Chamber
> of Commerce said in a report earlier thisyear. Grady - which supplies the
> region with its only 24-hour trauma center aswell as poison control and burn
> units and large clinics for AIDS<
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier>  and sickle<
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/over
> view.html?inline=nyt-classifier>  cell anemia - has operated in the red
> for10of the last 11 years. It is expected to run a deficit of $50 million
> to$55million in this year's $730 million budget.  The hospital owes an
> accumulated $63 million to its biggest creditors,themedical school at Emory
> University<
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emory_university/index.html?inline=nyt-org>  and the Morehouse School
> ofMedicine,which provide its doctors and have threatened to train
> residentselsewhere.Republican state legislators had threatened a state
> takeover if localofficials did not reconstitute the hospital's governance
> structure. Following a raucous meeting marked by chants and protest, the
> 10-memberFulton-DeKalb Hospital Authority voted unanimously to hand daily
> controlofGrady and its affiliated clinics and services to a nonprofit
> corporationtobe formed for that purpose. A Chamber of Commerce task force
> had advised earlier this year that agovernance change was needed to remove
> the hospital from the control oftheelected commissioners of Fulton and
> DeKalb Counties and to restore theconfidence of lenders, foundations and
> Georgia's Republican leaders.  Advocates for patients have warned that the
> hospital would become lessresponsive to community needs if it was operated
> by a less politicalboard.But with few other options and Grady's fiscal
> condition worsening, theauthority felt it had little choice. "In three
> weeks, our cash position would have been zero," theauthority'svice chairman,
> Dr. Chris Edwards, said at the meeting Monday. In its resolution, the
> hospital authority, which would continue to ownGrady's buildings and land,
> made explicit that its willingness to handovercontrol depended on
> substantial financial commitments from both thepublicand private sectors.
> Before the lease, to be executed by Dec. 31, becomes effective,
> thehospitalmust receive written commitments for a capital infusion of $200
> millionfrombusinesses and philanthropies. In addition, the resolution
> demands that state leaders provide writtensupport for $30 million in new
> state aid. A. D. Correll, a former chairman of the Georgia-Pacific
> Corporation andtheco-chairman of the task force, said he considered the vote
> a criticalfirststep, though with provisos attached. "They were a surprise, a
> lot ofthem,"Mr. Correll said of the conditions, "and they require action on
> a wholelotof people's parts."  Mr. Correll said a single anonymous donor had
> agreed to give thehospital$200 million if the donor approved of the
> governance system changes. Hesaidhe was confident that the private sector
> could raise an additional $100million in two or three years. The fate of the
> hospital has become a keenly watched civic drama,overlaidwith issues of race
> and class.  Some black activists and elected officials had warned that
> thegovernancechange would shift control of the hospital from black political
> leaderstowhite business leaders. The hospital's problems, they said,
> arefinancialand not political. Chamber of Commerce officials, white and
> black, have responded that theonlycolor that matters in the campaign to save
> Grady is green. Andjustifiablyor not, they say, business leaders and state
> officials were willing toparticipate in a rescue only if they saw a real
> departure from pastpractice, when the hospital's board was perceived to lack
> technicalexpertise and the will to block corruption and cronyism.
> --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/   --trauma-list : TRAUMA.ORGTochange your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --Forwarded Message Attachment--From: roydanks at hotmail.comSubject: RE:
> GradyDate: Tue, 27 Nov 2007 09:12:07 -0600To: trauma-list at trauma.orgYes,
> by all means.  Let's continue to fund those who won't go out and work for a
> living, who are too lazy to flip burgers at McD's, who would rather peddle
> drugs than legal wares, who use violence to solve problems, who have
> children but no way to pay for them...let me pay more taxes so that others
> can live the high life and never lift a finger. And, let's take funding away
> from the soldiers in Iraq so they don't have the means to defend themselves.
>  Let's forget 9/11, it was probably a once-in-a-lifetime occurrence.   Pret,
> how would you pull out of Iraq?  Have you contacted your Congressman or the
> President with a grand plan?  How do you pull out thousands of soldiers
> without leaving a few behind to be massacered?And, the answer isn't "we
> should never have gone there".  Because, we are there and without a plan to
> get out, we'll be there a long time. Hey!  Maybe the physicians at Grady
> could work for less money!  Yeah!  Cut their earnings so that others may
> continue to suck off the government tit! Get real, Pret.  You're not part of
> the solution.   > Date: Tue, 27 Nov 2007 09:24:21 -0500> From:
> pbjorn at emh.org> To: trauma-list at trauma.org> Subject: RE: Grady> > Sad that
> all this red ink comes to a small fraction of one per cent of> Georgia's
> share of federal healthcare reimbursement slashed by the> current
> administration.> > Fifty million dollar budget shortfall? End the Iraq war
> six hours early> and let Grady keep the change.> > Pret Bjorn> Bangor, ME
> USA> > > > > -----Original Message-----> From:
> trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org] On
> Behalf Of Robert F. Smith> Sent: Tuesday, November 27, 2007 7:52 AM> To:
> rockmd at aol.com; 'faran bokhari'> Cc: 'Trauma &amp; Critical Care mailing
> list'> Subject: Grady> > > > Atlanta Hospital Moves to Unburden Itself of
> Debt > > > By KEVIN SACK> <
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack>
> /ind> ex.html?inline=nyt-per> and SHAILA DEWAN> <
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dew>
> an/i> ndex.html?inline=nyt-per> > > ATLANTA, Nov. 26 - The politically
> appointed board of Atlanta's troubled> charity hospital effectively voted
> itself out of business Monday, the> first> step in at least a short-term
> escape from the insolvency that had> threatened> the region's only top-level
> trauma center.> > Without the financial bailout made possible by the vote,
> the hospital,> Grady> Memorial, was at risk of not meeting its payroll,
> perhaps by the end of> the> year, hospital officials had warned. Though
> Grady, like most public> hospitals> <
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto>
> pics> /hospitals/index.html?inline=nyt-classifier> , has faced intermittent>
> financial crises in the past, this one has generated real anxiety> <
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/ove>
> rvie> w.html?inline=nyt-classifier> because of its roots in a collision
> of> national forces, including the unchecked growth of uncompensated care>
> and> deep cuts in government reimbursements. > > Political leaders and
> medical officials have worried that Grady, woven> into> Atlanta's social
> fabric since 1892, might follow Martin Luther King> Jr.-Harbor Hospital in
> Los Angeles County as a casualty in 2007. If so,> the> consequence would be
> a "patient tsunami" at other area hospitals, the> Metropolitan Atlanta
> Chamber of Commerce said in a report earlier this> year.> > Grady - which
> supplies the region with its only 24-hour trauma center as> well as poison
> control and burn units and large clinics for AIDS> <
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inli>
> ne=n> yt-classifier> and sickle> <
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/over>
> view> .html?inline=nyt-classifier> cell anemia - has operated in the red
> for> 10> of the last 11 years. It is expected to run a deficit of $50
> million to> $55> million in this year's $730 million budget. > > The
> hospital owes an accumulated $63 million to its biggest creditors,> the>
> medical school at Emory University> <
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emo>
> ry_u> niversity/index.html?inline=nyt-org> and the Morehouse School of>
> Medicine,> which provide its doctors and have threatened to train residents>
> elsewhere.> Republican state legislators had threatened a state takeover if
> local> officials did not reconstitute the hospital's governance structure.>
> > Following a raucous meeting marked by chants and protest, the 10-member>
> Fulton-DeKalb Hospital Authority voted unanimously to hand daily control>
> of> Grady and its affiliated clinics and services to a nonprofit
> corporation> to> be formed for that purpose.> > A Chamber of Commerce task
> force had advised earlier this year that a> governance change was needed to
> remove the hospital from the control of> the> elected commissioners of
> Fulton and DeKalb Counties and to restore the> confidence of lenders,
> foundations and Georgia's Republican leaders. > > Advocates for patients
> have warned that the hospital would become less> responsive to community
> needs if it was operated by a less political> board.> But with few other
> options and Grady's fiscal condition worsening, the> authority felt it had
> little choice.> > "In three weeks, our cash position would have been zero,"
> the> authority's> vice chairman, Dr. Chris Edwards, said at the meeting
> Monday.> > In its resolution, the hospital authority, which would continue
> to own> Grady's buildings and land, made explicit that its willingness to
> hand> over> control depended on substantial financial commitments from both
> the> public> and private sectors.> > Before the lease, to be executed by
> Dec. 31, becomes effective, the> hospital> must receive written commitments
> for a capital infusion of $200 million> from> businesses and
> philanthropies.> > In addition, the resolution demands that state leaders
> provide written> support for $30 million in new state aid.> > A. D. Correll,
> a former chairman of the Georgia-Pacific Corporation and> the> co-chairman
> of the task force, said he considered the vote a critical> first> step,
> though with provisos attached. "They were a surprise, a lot of> them,"> Mr.
> Correll said of the conditions, "and they require action on a whole> lot> of
> people's parts." > > Mr. Correll said a single anonymous donor had agreed to
> give the> hospital> $200 million if the donor approved of the governance
> system changes. He> said> he was confident that the private sector could
> raise an additional $100> million in two or three years.> > The fate of the
> hospital has become a keenly watched civic drama,> overlaid> with issues of
> race and class. > > Some black activists and elected officials had warned
> that the> governance> change would shift control of the hospital from black
> political leaders> to> white business leaders. The hospital's problems, they
> said, are> financial> and not political.> > Chamber of Commerce officials,
> white and black, have responded that the> only> color that matters in the
> campaign to save Grady is green. And> justifiably> or not, they say,
> business leaders and state officials were willing to> participate in a
> rescue only if they saw a real departure from past> practice, when the
> hospital's board was perceived to lack technical> expertise and the will to
> block corruption and cronyism.> > > > --> trauma-list : TRAUMA.ORG> To
> change your settings or unsubscribe visit:>
> http://www.trauma.org/index.php?/community/> > > --> trauma-list :
> TRAUMA.ORG> To change your settings or unsubscribe visit:>
> http://www.trauma.org/index.php?/community/_________________________________________________________________Sharelife as it happens with the new Windows
> Live.Download today it's
> FREE!http://www.windowslive.com/share.html?ocid=TXT_TAGLM_Wave2_sharelife_112007
> --Forwarded Message Attachment--From: nappio at aol.comSubject: Re:
> GradyDate: Tue, 27 Nov 2007 15:10:25 +0000To: trauma-list at trauma.orgSure,
> must be this administrations fault and not decades.of slashing healthcare
> and pork barrel spending. DaveSent from my Verizon Wireless BlackBerry
> -----Original Message-----From: "Bjorn, Pret" <pbjorn at emh.org> Date: Tue,
> 27 Nov 2007 09:24:21 To:"Trauma &amp; Critical Care mailing list" <
> trauma-list at trauma.org>Subject: RE: Grady  Sad that all this red ink comes
> to a small fraction of one per cent ofGeorgia's share of federal healthcare
> reimbursement slashed by thecurrent administration. Fifty million dollar
> budget shortfall?  End the Iraq war six hours earlyand let Grady keep the
> change. Pret BjornBangor, ME USA    -----Original Message-----From:
> trauma-list-bounces at trauma.org[mailto:trauma-list-bounces at trauma.org] On
> Behalf Of Robert F. SmithSent: Tuesday, November 27, 2007 7:52 AMTo:
> rockmd at aol.com; 'faran bokhari'Cc: 'Trauma & Critical Care mailing
> list'Subject: Grady   Atlanta Hospital Moves to Unburden Itself of Debt   By
> KEVIN SACK<
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack/index.html?inline=nyt-per>
>  and SHAILA DEWAN<
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dewan/index.html?inline=nyt-per>
>  ATLANTA, Nov. 26 - The politically appointed board of Atlanta's
> troubledcharity hospital effectively voted itself out of business Monday,
> thefirststep in at least a short-term escape from the insolvency that
> hadthreatenedthe region's only top-level trauma center. Without the
> financial bailout made possible by the vote, the hospital,GradyMemorial, was
> at risk of not meeting its payroll, perhaps by the end oftheyear, hospital
> officials had warned. Though Grady, like most publichospitals<
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier>
> , has faced intermittentfinancial crises in the past, this one has generated
> real anxiety<
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/overview.html?inline=nyt-classifier>
>  because of its roots in a collision ofnational forces, including the
> unchecked growth of uncompensated careanddeep cuts in government
> reimbursements.  Political leaders and medical officials have worried that
> Grady, wovenintoAtlanta's social fabric since 1892, might follow Martin
> Luther KingJr.-Harbor Hospital in Los Angeles County as a casualty in 2007.
> If so,theconsequence would be a "patient tsunami" at other area hospitals,
> theMetropolitan Atlanta Chamber of Commerce said in a report earlier
> thisyear. Grady - which supplies the region with its only 24-hour trauma
> center aswell as poison control and burn units and large clinics for AIDS<
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier>
>  and sickle<
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/overview.html?inline=nyt-classifier>
>  cell anemia - has operated in the red for10of the last 11 years. It is
> expected to run a deficit of $50 million to$55million in this year's $730
> million budget.  The hospital owes an accumulated $63 million to its biggest
> creditors,themedical school at Emory University<
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emory_university/index.html?inline=nyt-org>
>  and the Morehouse School ofMedicine,which provide its doctors and have
> threatened to train residentselsewhere.Republican state legislators had
> threatened a state takeover if localofficials did not reconstitute the
> hospital's governance structure. Following a raucous meeting marked by
> chants and protest, the 10-memberFulton-DeKalb Hospital Authority voted
> unanimously to hand daily controlofGrady and its affiliated clinics and
> services to a nonprofit corporationtobe formed for that purpose. A Chamber
> of Commerce task force had advised earlier this year that agovernance change
> was needed to remove the hospital from the control oftheelected
> commissioners of Fulton and DeKalb Counties and to restore theconfidence of
> lenders, foundations and Georgia's Republican leaders.  Advocates for
> patients have warned that the hospital would become lessresponsive to
> community needs if it was operated by a less politicalboard.But with few
> other options and Grady's fiscal condition worsening, theauthority felt it
> had little choice. "In three weeks, our cash position would have been zero,"
> theauthority'svice chairman, Dr. Chris Edwards, said at the meeting Monday.
> In its resolution, the hospital authority, which would continue to
> ownGrady's buildings and land, made explicit that its willingness to
> handovercontrol depended on substantial financial commitments from both
> thepublicand private sectors. Before the lease, to be executed by Dec. 31,
> becomes effective, thehospitalmust receive written commitments for a capital
> infusion of $200 millionfrombusinesses and philanthropies. In addition, the
> resolution demands that state leaders provide writtensupport for $30 million
> in new state aid. A. D. Correll, a former chairman of the Georgia-Pacific
> Corporation andtheco-chairman of the task force, said he considered the vote
> a criticalfirststep, though with provisos attached. "They were a surprise, a
> lot ofthem,"Mr. Correll said of the conditions, "and they require action on
> a wholelotof people's parts."  Mr. Correll said a single anonymous donor had
> agreed to give thehospital$200 million if the donor approved of the
> governance system changes. Hesaidhe was confident that the private sector
> could raise an additional $100million in two or three years. The fate of the
> hospital has become a keenly watched civic drama,overlaidwith issues of race
> and class.  Some black activists and elected officials had warned that
> thegovernancechange would shift control of the hospital from black political
> leaderstowhite business leaders. The hospital's problems, they said,
> arefinancialand not political. Chamber of Commerce officials, white and
> black, have responded that theonlycolor that matters in the campaign to save
> Grady is green. Andjustifiablyor not, they say, business leaders and state
> officials were willing toparticipate in a rescue only if they saw a real
> departure from pastpractice, when the hospital's board was perceived to lack
> technicalexpertise and the will to block corruption and cronyism.
> --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/  --trauma-list : TRAUMA.ORGTochange your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --Forwarded Message Attachment--From: hpb.surgery at gmail.comSubject: Re:
> Trauma Care in the UKDate: Tue, 27 Nov 2007 15:27:25 +0000To:
> trauma-list at trauma.orgDr Ahmed, I have no illusion about healthcare in the
> U.S, virgins in heaven orelsewhere not withstanding. The question is about
> 'availability' ofresources and organisation. The skill set required of
> surgeons is matched towhat the situation asks for. The NHS has the capacity
> to organise its traumacare better, a start should be to divert poly trauma
> to nearest designatedcentre rather than the nearest hospital. Although, you
> exhort the skill of the 'general surgeon' in an isolated ruralsetting in
> USA. The patient is already at a disadvantage arriving in ahospital not
> equipped to receive such cases, regardless of the skill of thesurgeon.
> Further, if such rural surgeons only deal with 1-2 poly traumacases / year,
> it is unfair to expect exemplary outcomes. Finally, insettings where there
> is no prospect of experienced help, what would youexpect any surgeon to do?
> Saboor KhanCoventryUK   On 11/27/07, Ahmed, Naveed <NAhmed at cchseast.org>
> wrote: > Dr Khan,> To believe that every injured patient that is brought in
> the emergency> rooms around the world, especially poor urban hospitals in
> US, have> access to  a vascular, thoracic and a urologist is like counting
> virgins> in heaven. A general surgeon should be able to provide damage
> control in> all/most scenarios, otherwise he/she has no business taking
> trauma call.> Naveed>> -----Original Message-----> From: Saboor Khan
> [mailto:hpb.surgery at gmail.com]> Sent: Monday, November 26, 2007 12:49 PM>
> To: Trauma &amp, Critical Care mailing list> Subject: Re: Trauma Care in the
> UK>> Dr Hardcastle>> Although the structure of general surgical training in
> the UK is> changing, until recently prior to being appointed a trainee
> typically> spent a minimum of 8-9 years in clinical training (+ 2-3 years
> of> research), rotating through all the various specialties and electing to>
> sub-specialise in the last two to three years (whilst still taking call> for
> general surgery, including trauma), much like a 'fellowship'. The> bad old
> days of 'open ended' training are thankfully over! That said,> the newly
> appointed consultant is expected (indeed trained) to deal with> abdominal
> emergency surgery.>> There is no formal requirement for critical / intensive
> care training> becuase these units are manned by dedicated 'intensivists',
> who are> mostly anaesthetists by training. However, critical care and
> emergency> surgery (including trauma) are vital parts of all surgical
> post-graduate> examinaitons, including the exit exam. Finally, it is
> compulsary to have> attended the 'Care of the critically ill surgical
> patient'  ( as well as> the> ATLS) course and increasingly trainees rotate
> through critical care.>> 'Trauma Surgeons' per se do not exist in the UK,
> unlike the U.S or other> countries. Trauma patients arrive in the Accident
> and Emergency> department, and in the medium to large hospitals are attended
> to by a> trauma team with multi-specialty representation. The organisation
> of> trauma care in general can be better organised, as discussed in this>
> thread.>> The 'exposure' to penentrating truama is very low indeed and
> perhaps> that's the reason why you get so many requests for experience.
> Having> expert vascular on-call round the clock is a welcome development,
> which> I have no doubt improves outcome for the great majority of vascular>
> patients.>> You make some 'interesting, comments in your e-mail, and paint
> a> picture of surgical training in the UK that I do not recognise, i.e.,
> a> newly appointed consultant, unable to assess, manage or operate on>
> surgical patients outside of their narrow field !>> There is increased
> emphasis on sub-specialistation, but that's a world> wide phenomenon in some
> guise or another- resources permitting? I am a> bit puzzled, what is your
> definition of a 'general surgeon'?>> Best Wishes,> Saboor Khan> Coventry>
> UK>>>>> On Nov 26, 2007 4:47 AM, Hardcastle, Tim, Dr <tch at sun.ac.za>> <
> tch at sun.ac.za>> wrote:>> > Mike> >> > The other challenge that now exists
> in the UK is that there are less> > and less true "General Surgeons"; the
> majority of the "Trauma> > Surgeons" are mainly orthopaedic trained, while
> the GIT surgeons> > subspecialise even before they finish what we would know
> as residency.>> > They qualify not as "General Surgeons", but as one of
> Breast-Endocrine>> > / Upper GI / Colorectal or Hepato-biliary surgeons.
> Vascular is also> > seperate now. This leads to young consultant surgeons
> who have little> > idea of the overall patient and the care of trauma in
> particular. Add> > to this the lack of a formal ICU requirement in the
> post-grad training> and you see where some of the deficiencies lie.> >> >
> For this reason we in South Africa are inundated with requests for> > people
> to do three month mini-trauma-fellowships to get some> > experience in
> General Trauma care.> >> > Regards> > Dr T C Hardcastle> > M.B.,Ch.B.(Stell);
> M.Med(Chir); FCS(SA) Senior Surgeon / Senior> > Lecturer: Surgery (Trauma
> and ICU) ATLS  instructor and DSTC Cape Town>> > Course Director Intern
> program Coordinator: Surgery M.Med (Emergency> > Medicine) Executive
> Committee member Clinical Head (Director): Diana> > Princess of Wales Trauma
> Unit Division of Surgery (General) Room 4064> > Department of Surgical
> Sciences Tygerberg Hospital / University of> > Stellenbosch PO Box 19063
> Tygerberg 7505 Western Cape South Africa> > e-mail: tch at sun.ac.za> > Cell:
> +27824681615> > Office: +27219389281 or 4911 pager 0302> >>>> -->
> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:>
> http://www.trauma.org/index.php?/community/>
> --Forwarded Message Attachment--From: Rgross at harthosp.orgSubject: RE:
> GradyDate: Tue, 27 Nov 2007 10:30:59 -0500To: trauma-list at trauma.orgRoy,
> You actually said what I was thinking but didn't have to stomach to put it
> out there. Ron >>> Roy Danks <roydanks at hotmail.com> 11/27/2007 10:12 AM
> >>>Yes, by all means.  Let's continue to fund those who won't go out and
> work for a living, who are too lazy to flip burgers at McD's, who would
> rather peddle drugs than legal wares, who use violence to solve problems,
> who have children but no way to pay for them...let me pay more taxes so that
> others can live the high life and never lift a finger. And, let's take
> funding away from the soldiers in Iraq so they don't have the means to
> defend themselves.  Let's forget 9/11, it was probably a once-in-a-lifetime
> occurrence.   Pret, how would you pull out of Iraq?  Have you contacted your
> Congressman or the President with a grand plan?  How do you pull out
> thousands of soldiers without leaving a few behind to be massacered?And, the
> answer isn't "we should never have gone there".  Because, we are there and
> without a plan to get out, we'll be there a long time. Hey!  Maybe the
> physicians at Grady could work for less money!  Yeah!  Cut their earnings so
> that others may continue to suck off the government tit! Get real, Pret.
>  You're not part of the solution.   > Date: Tue, 27 Nov 2007 09:24:21 -0500>
> From: pbjorn at emh.org> To: trauma-list at trauma.org> Subject: RE: Grady> >
> Sad that all this red ink comes to a small fraction of one per cent of>
> Georgia's share of federal healthcare reimbursement slashed by the> current
> administration.> > Fifty million dollar budget shortfall? End the Iraq war
> six hours early> and let Grady keep the change.> > Pret Bjorn> Bangor, ME
> USA> > > > > -----Original Message-----> From:
> trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org] On
> Behalf Of Robert F. Smith> Sent: Tuesday, November 27, 2007 7:52 AM> To:
> rockmd at aol.com; 'faran bokhari'> Cc: 'Trauma &amp; Critical Care mailing
> list'> Subject: Grady> > > > Atlanta Hospital Moves to Unburden Itself of
> Debt > > > By KEVIN SACK> <
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack>
> /ind> ex.html?inline=nyt-per> and SHAILA DEWAN> <
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dew>
> an/i> ndex.html?inline=nyt-per> > > ATLANTA, Nov. 26 - The politically
> appointed board of Atlanta's troubled> charity hospital effectively voted
> itself out of business Monday, the> first> step in at least a short-term
> escape from the insolvency that had> threatened> the region's only top-level
> trauma center.> > Without the financial bailout made possible by the vote,
> the hospital,> Grady> Memorial, was at risk of not meeting its payroll,
> perhaps by the end of> the> year, hospital officials had warned. Though
> Grady, like most public> hospitals> <
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto>
> pics> /hospitals/index.html?inline=nyt-classifier> , has faced intermittent>
> financial crises in the past, this one has generated real anxiety> <
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/ove>
> rvie> w.html?inline=nyt-classifier> because of its roots in a collision
> of> national forces, including the unchecked growth of uncompensated care>
> and> deep cuts in government reimbursements. > > Political leaders and
> medical officials have worried that Grady, woven> into> Atlanta's social
> fabric since 1892, might follow Martin Luther King> Jr.-Harbor Hospital in
> Los Angeles County as a casualty in 2007. If so,> the> consequence would be
> a "patient tsunami" at other area hospitals, the> Metropolitan Atlanta
> Chamber of Commerce said in a report earlier this> year.> > Grady - which
> supplies the region with its only 24-hour trauma center as> well as poison
> control and burn units and large clinics for AIDS> <
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inli>
> ne=n> yt-classifier> and sickle> <
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/over>
> view> .html?inline=nyt-classifier> cell anemia - has operated in the red
> for> 10> of the last 11 years. It is expected to run a deficit of $50
> million to> $55> million in this year's $730 million budget. > > The
> hospital owes an accumulated $63 million to its biggest creditors,> the>
> medical school at Emory University> <
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emo>
> ry_u> niversity/index.html?inline=nyt-org> and the Morehouse School of>
> Medicine,> which provide its doctors and have threatened to train residents>
> elsewhere.> Republican state legislators had threatened a state takeover if
> local> officials did not reconstitute the hospital's governance structure.>
> > Following a raucous meeting marked by chants and protest, the 10-member>
> Fulton-DeKalb Hospital Authority voted unanimously to hand daily control>
> of> Grady and its affiliated clinics and services to a nonprofit
> corporation> to> be formed for that purpose.> > A Chamber of Commerce task
> force had advised earlier this year that a> governance change was needed to
> remove the hospital from the control of> the> elected commissioners of
> Fulton and DeKalb Counties and to restore the> confidence of lenders,
> foundations and Georgia's Republican leaders. > > Advocates for patients
> have warned that the hospital would become less> responsive to community
> needs if it was operated by a less political> board.> But with few other
> options and Grady's fiscal condition worsening, the> authority felt it had
> little choice.> > "In three weeks, our cash position would have been zero,"
> the> authority's> vice chairman, Dr. Chris Edwards, said at the meeting
> Monday.> > In its resolution, the hospital authority, which would continue
> to own> Grady's buildings and land, made explicit that its willingness to
> hand> over> control depended on substantial financial commitments from both
> the> public> and private sectors.> > Before the lease, to be executed by
> Dec. 31, becomes effective, the> hospital> must receive written commitments
> for a capital infusion of $200 million> from> businesses and
> philanthropies.> > In addition, the resolution demands that state leaders
> provide written> support for $30 million in new state aid.> > A. D. Correll,
> a former chairman of the Georgia-Pacific Corporation and> the> co-chairman
> of the task force, said he considered the vote a critical> first> step,
> though with provisos attached. "They were a surprise, a lot of> them,"> Mr.
> Correll said of the conditions, "and they require action on a whole> lot> of
> people's parts." > > Mr. Correll said a single anonymous donor had agreed to
> give the> hospital> $200 million if the donor approved of the governance
> system changes. He> said> he was confident that the private sector could
> raise an additional $100> million in two or three years.> > The fate of the
> hospital has become a keenly watched civic drama,> overlaid> with issues of
> race and class. > > Some black activists and elected officials had warned
> that the> governance> change would shift control of the hospital from black
> political leaders> to> white business leaders. The hospital's problems, they
> said, are> financial> and not political.> > Chamber of Commerce officials,
> white and black, have responded that the> only> color that matters in the
> campaign to save Grady is green. And> justifiably> or not, they say,
> business leaders and state officials were willing to> participate in a
> rescue only if they saw a real departure from past> practice, when the
> hospital's board was perceived to lack technical> expertise and the will to
> block corruption and cronyism.> > > > --> trauma-list : TRAUMA.ORG> To
> change your settings or unsubscribe visit:>
> http://www.trauma.org/index.php?/community/> > > --> trauma-list :
> TRAUMA.ORG> To change your settings or unsubscribe visit:>
> http://www.trauma.org/index.php?/community/_________________________________________________________________Share life
> as it happens with the new Windows Live.Download today it's
> FREE!http://www.windowslive.com/share.html?ocid=TXT_TAGLM_Wave2_sharelife_112007--
> trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --Forwarded Message Attachment--From: NAhmed at cchseast.orgSubject: RE:
> Trauma Care in the UKCC: trauma-list at trauma.orgDate: Tue, 27 Nov 2007
> 10:40:08 -0500To: brombwi1 at memorialhealth.comDr Bromberg, We get a lot of
> penetrating trauma. For, us mostly golden 15 minutes.Patients transferred
> out, are stabilized by the trauma surgeon beforetransfer. Point I tried to
> make (not very effectively), was that traumasurgeon should be able to
> provide initial stabilization and thantransition into to primary care for
> the injured patient. I agree withyour position completely but it has been
> impossible to recruit subspecialist for trauma and even harder make them
> take call, acute care isthe only way out, at least in my opinion.Naveed-----Original Message-----From: William Bromberg [mailto:
> brombwi1 at memorialhealth.com] Sent: Tuesday, November 27, 2007 10:07 AMTo:
> Ahmed, Naveed Subject: RE: Trauma Care in the UK Every injured patient in
> the US is guaranteed access to subspecialistcare regardless of ability to
> pay via transfer to a higher level ofcare. This is a mandate under EMTALA.
> No-one has claimed that to have amature trauma system requires every
> subspecialty at every hospital. Thepoint is to get the patient to the
> hospital that they need. Howeverwithout a trauma system in place the
> facilities to which to transfer thepatient are not there. And before someone
> points out my apparent hypocrisy between the last twoposts I will add two
> things. 1. I believe that it should be the state'sjob not the feds (anyone
> remember the tenth amendment?) and 2. "Afoolish consistency is the hobgoblin
> of little minds"-----Original Message-----From: "Ahmed, Naveed " <
> NAhmed at cchseast.org>To: "Trauma &amp; Critical Care mailing list" <
> trauma-list at trauma.org>Sent: 11/27/07 9:26 AMSubject: RE: Trauma Care in
> the UK Dr Khan,To believe that every injured patient that is brought in the
> emergencyrooms around the world, especially poor urban hospitals in US,
> haveaccess to  a vascular, thoracic and a urologist is like counting
> virginsin heaven. A general surgeon should be able to provide damage control
> inall/most scenarios, otherwise he/she has no business taking trauma
> call.Naveed -----Original Message-----From: Saboor Khan [mailto:
> hpb.surgery at gmail.com]Sent: Monday, November 26, 2007 12:49 PMTo: Trauma
> &amp, Critical Care mailing listSubject: Re: Trauma Care in the UK Dr
> Hardcastle Although the structure of general surgical training in the UK
> ischanging, until recently prior to being appointed a trainee typicallyspent
> a minimum of 8-9 years in clinical training (+ 2-3 years ofresearch),
> rotating through all the various specialties and electing tosub-specialise
> in the last two to three years (whilst still taking callfor general surgery,
> including trauma), much like a 'fellowship'. Thebad old days of 'open ended'
> training are thankfully over! That said,the newly appointed consultant is
> expected (indeed trained) to deal withabdominal emergency surgery. There is
> no formal requirement for critical / intensive care trainingbecuase these
> units are manned by dedicated 'intensivists', who aremostly anaesthetists by
> training. However, critical care and emergencysurgery (including trauma) are
> vital parts of all surgical post-graduateexaminaitons, including the exit
> exam. Finally, it is compulsary to haveattended the 'Care of the critically
> ill surgical patient'  ( as well astheATLS) course and increasingly trainees
> rotate through critical care. 'Trauma Surgeons' per se do not exist in the
> UK, unlike the U.S or othercountries. Trauma patients arrive in the
> Accident and Emergencydepartment, and in the medium to large hospitals are
> attended to by atrauma team with multi-specialty representation. The
> organisation oftrauma care in general can be better organised, as discussed
> in thisthread. The 'exposure' to penentrating truama is very low indeed and
> perhapsthat's the reason why you get so many requests for experience.
> Havingexpert vascular on-call round the clock is a welcome development,
> whichI have no doubt improves outcome for the great majority of
> vascularpatients.  You make some 'interesting, comments in your e-mail, and
> paint apicture of surgical training in the UK that I do not recognise, i.e.,
> anewly appointed consultant, unable to assess, manage or operate onsurgical
> patients outside of their narrow field ! There is increased emphasis on
> sub-specialistation, but that's a worldwide phenomenon in some guise or
> another- resources permitting? I am abit puzzled, what is your definition of
> a 'general surgeon'? Best Wishes,Saboor KhanCoventryUK    On Nov 26, 2007
> 4:47 AM, Hardcastle, Tim, Dr <tch at sun.ac.za><tch at sun.ac.za>wrote: > Mike>>
> The other challenge that now exists in the UK is that there are less > and
> less true "General Surgeons"; the majority of the "Trauma > Surgeons" are
> mainly orthopaedic trained, while the GIT surgeons > subspecialise even
> before they finish what we would know as residency. > They qualify not as
> "General Surgeons", but as one of Breast-Endocrine > / Upper GI / Colorectal
> or Hepato-biliary surgeons. Vascular is also > seperate now. This leads to
> young consultant surgeons who have little > idea of the overall patient and
> the care of trauma in particular. Add > to this the lack of a formal ICU
> requirement in the post-grad trainingand you see where some of the
> deficiencies lie.>> For this reason we in South Africa are inundated with
> requests for > people to do three month mini-trauma-fellowships to get some
> > experience in General Trauma care.>> Regards> Dr T C Hardcastle> M.B.,
> Ch.B.(Stell); M.Med(Chir); FCS(SA) Senior Surgeon / Senior> Lecturer:
> Surgery (Trauma and ICU) ATLS  instructor and DSTC Cape Town > Course
> Director Intern program Coordinator: Surgery M.Med (Emergency> Medicine)
> Executive Committee member Clinical Head (Director): Diana > Princess of
> Wales Trauma Unit Division of Surgery (General) Room 4064 > Department of
> Surgical Sciences Tygerberg Hospital / University of > Stellenbosch PO Box
> 19063 Tygerberg 7505 Western Cape South Africa> e-mail: tch at sun.ac.za>
> Cell: +27824681615> Office: +27219389281 or 4911 pager 0302>  --trauma-list
> : TRAUMA.ORGTo change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --Forwarded Message Attachment--From: KMATTOX at aol.comSubject: Re:
> GradyDate: Tue, 27 Nov 2007 10:40:09 -0500To: trauma-list at trauma.orgTheroot causes of many of the troubles in health care delivery at Grady
>  Memorial Hospitals pre dates even the FIRST Gulf War.      I am organizing
> some of my thoughts about just how to react to at least 10  different points
> made in the NYTs article and which affect EACH OF US, in our  private,
> international, and public hospitals.     There are  some sentinel events
> that must be reviewed , and reviewed  soon.     Not the least of which is
> the inadequate LOCAL,  STATE, and FEDERAL funding for health care.    We are
> now back  into the perennial debate about the 10% cut in Medicare .   In my
>  simple view, Congress SHOULD NOT fix this deficit for physician payments
> this  year.   In my view congress and organized medicine have NOT addressed
>  the many root causes and have just annually created a "fix" which adds to
> the  deficits.      By NOT fixing it this year, it forces  all of us, in
> government and practice to deal openly with the real  problems.      Draw a
> line in the  sand.     k   **************************************Check out
> AOL's list of 2007's hottest products.(
> http://money.aol.com/special/hot-products-2007?NCID=aoltop00030000000001)
> --Forwarded Message Attachment--From: rfsmithmd at comcast.netSubject: RE:
> GradyDate: Tue, 27 Nov 2007 10:53:31 -0500To: trauma-list at trauma.orgRonand Roy, So we should close the few remaining public hospitals in the US
> because ofthe low lifes that seek care there? And the compelling reason to
> have our soldiers continue to get killed inIraq is because if we brought
> them all home some of them would get killed inthe process?  Rob Smith PS
> Please tell me you're not saying Iraq was involved in 9/11. And I alsothink
> drug pricing here is an outrageous boondoggle and all solutions shouldstart
> with getting rid of the lawyers. -----Original Message-----From:
> trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On
> Behalf Of Ronald GrossSent: Tuesday, November 27, 2007 10:31 AMTo: Trauma
> &amp; Critical Care mailing listSubject: RE: Grady Roy, You actually said
> what I was thinking but didn't have to stomach to put itout there. Ron >>>
> Roy Danks <roydanks at hotmail.com> 11/27/2007 10:12 AM >>>Yes, by all means.
>  Let's continue to fund those who won't go out and workfor a living, who are
> too lazy to flip burgers at McD's, who would ratherpeddle drugs than legal
> wares, who use violence to solve problems, who havechildren but no way to
> pay for them...let me pay more taxes so that otherscan live the high life
> and never lift a finger. And, let's take funding away from the soldiers in
> Iraq so they don't havethe means to defend themselves.  Let's forget 9/11,
> it was probably aonce-in-a-lifetime occurrence.   Pret, how would you pull
> out of Iraq?  Have you contacted your Congressmanor the President with a
> grand plan?  How do you pull out thousands ofsoldiers without leaving a few
> behind to be massacered?And, the answer isn't"we should never have gone
> there".  Because, we are there and without a planto get out, we'll be there
> a long time. Hey!  Maybe the physicians at Grady could work for less money!
>  Yeah!  Cuttheir earnings so that others may continue to suck off the
> government tit! Get real, Pret.  You're not part of the solution.   > Date:
> Tue, 27 Nov 2007 09:24:21 -0500> From: pbjorn at emh.org>
> To:trauma-list at trauma.org> Subject: RE: Grady> > Sad that all this red
> inkcomes to a small fraction of one per cent of> Georgia's share of
> federalhealthcare reimbursement slashed by the> current administration.> >
> Fiftymillion dollar budget shortfall? End the Iraq war six hours early> and
> letGrady keep the change.> > Pret Bjorn> Bangor, ME USA> > > > >
> -----OriginalMessage-----> From: trauma-list-bounces at trauma.org>[mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith>
> Sent:Tuesday, November 27, 2007 7:52 AM> To: rockmd at aol.com; 'faran
> bokhari'> Cc:'Trauma &amp; Critical Care mailing list'> Subject: Grady> > >
> > AtlantaHospital Moves to Unburden Itself of Debt > > > By KEVIN SACK><
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack>/ind>
> ex.html?inline=nyt-per> and SHAILA DEWAN><
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dew>an/i>
> ndex.html?inline=nyt-per> > > ATLANTA, Nov. 26 - The politicallyappointed
> board of Atlanta's troubled> charity hospital effectively voteditself out of
> business Monday, the> first> step in at least a short-termescape from the
> insolvency that had> threatened> the region's only top-leveltrauma center.>
> > Without the financial bailout made possible by the vote,the hospital,>
> Grady> Memorial, was at risk of not meeting its payroll,perhaps by the end
> of> the> year, hospital officials had warned. ThoughGrady, like most public>
> hospitals><
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto>pics>
> /hospitals/index.html?inline=nyt-classifier> , has faced
> intermittent>financial crises in the past, this one has generated real
> anxiety><
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/ove>rvie>
> w.html?inline=nyt-classifier> because of its roots in a collision
> of>national forces, including the unchecked growth of uncompensated care>
> and>deep cuts in government reimbursements. > > Political leaders and
> medicalofficials have worried that Grady, woven> into> Atlanta's social
> fabricsince 1892, might follow Martin Luther King> Jr.-Harbor Hospital in
> LosAngeles County as a casualty in 2007. If so,> the> consequence would be
> a"patient tsunami" at other area hospitals, the> Metropolitan Atlanta
> Chamberof Commerce said in a report earlier this> year.> > Grady - which
> suppliesthe region with its only 24-hour trauma center as> well as poison
> controland burn units and large clinics for AIDS><
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inli>ne=n>
> yt-classifier> and sickle><
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/over>view>
> .html?inline=nyt-classifier> cell anemia - has operated in the redfor> 10>
> of the last 11 years. It is expected to run a deficit of $50million to> $55>
> million in this year's $730 million budget. > > Thehospital owes an
> accumulated $63 million to its biggest creditors,> the>medical school at
> Emory University><
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emo>ry_u>
> niversity/index.html?inline=nyt-org> and the Morehouse School of>Medicine,>
> which provide its doctors and have threatened to train residents>elsewhere.>
> Republican state legislators had threatened a state takeover iflocal>
> officials did not reconstitute the hospital's governance structure.>>
> Following a raucous meeting marked by chants and protest, the
> 10-member>Fulton-DeKalb Hospital Authority voted unanimously to hand daily
> control>of> Grady and its affiliated clinics and services to a
> nonprofitcorporation> to> be formed for that purpose.> > A Chamber of
> Commerce taskforce had advised earlier this year that a> governance change
> was needed toremove the hospital from the control of> the> elected
> commissioners ofFulton and DeKalb Counties and to restore the> confidence of
> lenders,foundations and Georgia's Republican leaders. > > Advocates for
> patientshave warned that the hospital would become less> responsive to
> communityneeds if it was operated by a less political> board.> But with few
> otheroptions and Grady's fiscal condition worsening, the> authority felt it
> hadlittle choice.> > "In three weeks, our cash position would have been
> zero,"the> authority's> vice chairman, Dr. Chris Edwards, said at the
> meetingMonday.> > In its resolution, the hospital authority, which would
> continueto own> Grady's buildings and land, made explicit that its
> willingness tohand> over> control depended on substantial financial
> commitments from boththe> public> and private sectors.> > Before the lease,
> to be executed byDec. 31, becomes effective, the> hospital> must receive
> written commitmentsfor a capital infusion of $200 million> from> businesses
> andphilanthropies.> > In addition, the resolution demands that state
> leadersprovide written> support for $30 million in new state aid.> > A. D.
> Correll,a former chairman of the Georgia-Pacific Corporation and> the>
> co-chairmanof the task force, said he considered the vote a critical> first>
> step,though with provisos attached. "They were a surprise, a lot of> them,">
> Mr.Correll said of the conditions, "and they require action on a whole>
> lot> ofpeople's parts." > > Mr. Correll said a single anonymous donor had
> agreed togive the> hospital> $200 million if the donor approved of the
> governancesystem changes. He> said> he was confident that the private sector
> couldraise an additional $100> million in two or three years.> > The fate of
> thehospital has become a keenly watched civic drama,> overlaid> with issues
> ofrace and class. > > Some black activists and elected officials had
> warnedthat the> governance> change would shift control of the hospital from
> blackpolitical leaders> to> white business leaders. The hospital's problems,
> theysaid, are> financial> and not political.> > Chamber of Commerce
> officials,white and black, have responded that the> only> color that matters
> in thecampaign to save Grady is green. And> justifiably> or not, they
> say,business leaders and state officials were willing to> participate in
> arescue only if they saw a real departure from past> practice, when
> thehospital's board was perceived to lack technical> expertise and the will
> toblock corruption and cronyism.> > > > --> trauma-list : TRAUMA.ORG>
> Tochange your settings or unsubscribe visit:>
> http://www.trauma.org/index.php?/community/> > > --> trauma-list :
> TRAUMA.ORG> To change your settings or unsubscribe visit:>
> http://www.trauma.org/index.php?/community/_________________________________________________________________Share life
> as it happens with the new Windows Live.Download today it's
> FREE!http://www.windowslive.com/share.html?ocid=TXT_TAGLM_Wave2_sharelife_112007--
> trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/--trauma-list : TRAUMA.ORGTochange your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --Forwarded Message Attachment--From: Traumamd at nyc.rr.comSubject: Re:
> GradyDate: Tue, 27 Nov 2007 11:31:03 -0500To: trauma-list at trauma.orgIn a
> semi related matter, have any of you seen Zeitgeist? Its a movie that talks
> about war (all wars) and that they are all financially driven. I am aware
> that it us pretty biased but it does open ones eyes to some interesting
> coincidences. You can only get it online. Okay back to business....ron simon
> Robert F. Smith wrote:> Ron and Roy,>> So we should close the few remaining
> public hospitals in the US because of> the low lifes that seek care there?>>
> And the compelling reason to have our soldiers continue to get killed in>
> Iraq is because if we brought them all home some of them would get killed
> in> the process? >> Rob Smith>> PS Please tell me you're not saying Iraq was
> involved in 9/11. And I also> think drug pricing here is an outrageous
> boondoggle and all solutions should> start with getting rid of the
> lawyers.>> -----Original Message-----> From:
> trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]> On
> Behalf Of Ronald Gross> Sent: Tuesday, November 27, 2007 10:31 AM> To:
> Trauma &amp; Critical Care mailing list> Subject: RE: Grady>> Roy,>> You
> actually said what I was thinking but didn't have to stomach to put it> out
> there.>> Ron>>   >>>> Roy Danks <roydanks at hotmail.com> 11/27/2007 10:12 AM
> >>>>>>>         > Yes, by all means.  Let's continue to fund those who won't
> go out and work> for a living, who are too lazy to flip burgers at McD's,
> who would rather> peddle drugs than legal wares, who use violence to solve
> problems, who have> children but no way to pay for them...let me pay more
> taxes so that others> can live the high life and never lift a finger.>  >
> And, let's take funding away from the soldiers in Iraq so they don't have>
> the means to defend themselves.  Let's forget 9/11, it was probably a>
> once-in-a-lifetime occurrence.  >  > Pret, how would you pull out of Iraq?
>  Have you contacted your Congressman> or the President with a grand plan?
>  How do you pull out thousands of> soldiers without leaving a few behind to
> be massacered?And, the answer isn't> "we should never have gone there".
>  Because, we are there and without a plan> to get out, we'll be there a long
> time.>  > Hey!  Maybe the physicians at Grady could work for less money!
>  Yeah!  Cut> their earnings so that others may continue to suck off the
> government tit!>  > Get real, Pret.  You're not part of the solution.>>>>
> >> Date: Tue, 27 Nov 2007 09:24:21 -0500> From: pbjorn at emh.org> To:>>
> > trauma-list at trauma.org> Subject: RE: Grady> > Sad that all this red ink>
> comes to a small fraction of one per cent of> Georgia's share of federal>
> healthcare reimbursement slashed by the> current administration.> > Fifty>
> million dollar budget shortfall? End the Iraq war six hours early> and let>
> Grady keep the change.> > Pret Bjorn> Bangor, ME USA> > > > > -----Original>
> Message-----> From: trauma-list-bounces at trauma.org>> [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith> Sent:>
> Tuesday, November 27, 2007 7:52 AM> To: rockmd at aol.com; 'faran bokhari'>
> Cc:> 'Trauma &amp; Critical Care mailing list'> Subject: Grady> > > >
> Atlanta> Hospital Moves to Unburden Itself of Debt > > > By KEVIN SACK>> <
> http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack>>
> /ind> ex.html?inline=nyt-per> and SHAILA DEWAN>> <
> http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dew>>
> an/i> ndex.html?inline=nyt-per> > > ATLANTA, Nov. 26 - The politically>
> appointed board of Atlanta's troubled> charity hospital effectively voted>
> itself out of business Monday, the> first> step in at least a short-term>
> escape from the insolvency that had> threatened> the region's only
> top-level> trauma center.> > Without the financial bailout made possible by
> the vote,> the hospital,> Grady> Memorial, was at risk of not meeting its
> payroll,> perhaps by the end of> the> year, hospital officials had warned.
> Though> Grady, like most public> hospitals>> <
> http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto>>
> pics> /hospitals/index.html?inline=nyt-classifier> , has faced
> intermittent>> financial crises in the past, this one has generated real
> anxiety>> <
> http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/ove>>
> rvie> w.html?inline=nyt-classifier> because of its roots in a collision
> of>> national forces, including the unchecked growth of uncompensated care>
> and>> deep cuts in government reimbursements. > > Political leaders and
> medical> officials have worried that Grady, woven> into> Atlanta's social
> fabric> since 1892, might follow Martin Luther King> Jr.-Harbor Hospital in
> Los> Angeles County as a casualty in 2007. If so,> the> consequence would be
> a> "patient tsunami" at other area hospitals, the> Metropolitan Atlanta
> Chamber> of Commerce said in a report earlier this> year.> > Grady - which
> supplies> the region with its only 24-hour trauma center as> well as poison
> control> and burn units and large clinics for AIDS>> <
> http://health.nytimes.com/health/guides/disease/aids/overview.html?inli>>
> ne=n> yt-classifier> and sickle>> <
> http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/over>>
> view> .html?inline=nyt-classifier> cell anemia - has operated in the red>
> for> 10> of the last 11 years. It is expected to run a deficit of $50>
> million to> $55> million in this year's $730 million budget. > > The>
> hospital owes an accumulated $63 million to its biggest creditors,> the>>
> medical school at Emory University>> <
> http://topics.nytimes.com/top/reference/timestopics/organizations/e/emo>>
> ry_u> niversity/index.html?inline=nyt-org> and the Morehouse School of>>
> Medicine,> which provide its doctors and have threatened to train
> residents>> elsewhere.> Republican state legislators had threatened a state
> takeover if> local> officials did not reconstitute the hospital's governance
> structure.>>   >> Following a raucous meeting marked by chants and protest,
> the 10-member>>>     > Fulton-DeKalb Hospital Authority voted unanimously to
> hand daily control>> of> Grady and its affiliated clinics and services to a
> nonprofit> corporation> to> be formed for that purpose.> > A Chamber of
> Commerce task> force had advised earlier this year that a> governance change
> was needed to> remove the hospital from the control of> the> elected
> commissioners of> Fulton and DeKalb Counties and to restore the> confidence
> of lenders,> foundations and Georgia's Republican leaders. > > Advocates for
> patients> have warned that the hospital would become less> responsive to
> community> needs if it was operated by a less political> board.> But with
> few other> options and Grady's fiscal condition worsening, the> authority
> felt it had> little choice.> > "In three weeks, our cash position would have
> been zero,"> the> authority's> vice chairman, Dr. Chris Edwards, said at the
> meeting> Monday.> > In its resolution, the hospital authority, which would
> continue> to own> Grady's buildings and land, made explicit that its
> willingness to> hand> over> control depended on substantial financial
> commitments from both> the> public> and private sectors.> > Before the
> lease, to be executed by> Dec. 31, becomes effective, the> hospital> must
> receive written commitments> for a capital infusion of $200 million> from>
> businesses and> philanthropies.> > In addition, the resolution demands that
> state leaders> provide written> support for $30 million in new state aid.> >
> A. D. Correll,> a former chairman of the Georgia-Pacific Corporation and>
> the> co-chairman> of the task force, said he considered the vote a critical>
> first> step,> though with provisos attached. "They were a surprise, a lot
> of> them,"> Mr.> 

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