List Archives

Tue Nov 27 18:22:01 GMT 2007

Man, I have a lot to say today!

Alex, Alex, Alex....the Miranda rights is simply a tool to 1) get the guilty to speak freely and 2) to make sure their constitutional rights are upheld.  But, getting a fresh out of law school atty to represent you in a capital murder trial....ummm, not good.  But, more importantly, those attorney's who are appointed DO get paid.  The defendant doesn't pay anything, it's paid for by the city/state/feds.  It's a great gig for a new lawyer just getting started.

Funny though...we won't allow people to starve in this country...not saying they don't...many do, but it's not for a lack of food.  Yet, we don't ask the Piggly Wiggly to give out free milk and eggs if you don't have money.  Aside from the liberal organizations building homes for those who can't get a loan, we aren't giving away housing.

And, yes, attorneys are the root cause of evil.

> Date: Tue, 27 Nov 2007 11:07:58 -0600> From: agarbino at gmail.com> To: trauma-list at trauma.org> Subject: Re: Native of Atlanta> > 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> > +0000Send trauma-list mailing list submissions to> > trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web,> > visit http://list.mistral.net/mailman/listinfo/trauma-listor, via> > email, send a message with subject or body 'help' to> > trauma-list-request at trauma.org You can reach the person managing the list> > at trauma-list-owner at trauma.org When replying, please edit your Subject> > line so it is more specificthan "Re: Contents of trauma-list digest..."> > --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.> 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-l

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