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Wed Nov 28 02:47:39 GMT 2007

OK, I said I was going to keep quiet but-

Having done my fellowship at Grady I can say with certainty
that Dr Mattox is absolutely right that the issues there go
way back before the first Gulf War. They are a combination
of many issues only some of which are mismanagement. And
for a good part of those blame the politicians, not the
administration-- mos tof whom, at least when I was there,
were working far longer hours at far less pay than they
could have gotten from any other institution. They were led
from the top by an administrator from the public hospital
old school- a type that Dr Mattox and the older members of
the list will remember-- that truely were dedicated, not to
the financial progress of their institution -although they
were financially savy- but to having the ability to provide
the best possible care for everyone who presented to their
facility. Hard to believe in this day and age of million
dollar CEOs isn't it

Rather blame the present medical "business" climate,
hospitals that are more than happy to rake off the
profitable patient without seeing the borderline or non
profitable individual-not to mention absurd overheads
produced by escalating drug prices, layers of unnecessary
administrators and all the other ills that are routinely
hashed over on this list

When I was at Grady (or as we knew it "The Gradies") it was
funded out of two county budgets plus whatever the various
penal institutions that we served kicked in. A paying
patient was almost unheard of, they were selectively taken
to other facilities-- if we had some one with Medicare it
was almost a cause for celebration. At that time Atlanta
was starting the trauma system designating process-- that
tells you how long ago it was. One of my jobs as a fellow
was to put together the documentation for Grady's
application so I was intimately involved with the process.
At that time, as I remember, there were 22 hospitals in the
Atlanta Metroplex applying for designation as either a I or
II. Again, as I remember, eventually we ended up with about
seven designated facilities.

And now Grady is "the only 24 hour trauma facility"? (and
by the way what is a non 24 hour trauma facility?)

Need we look any further for what is really wrong? 

R Wigle MD FACS
LTC USA (Ret)

--- "Robert F. Smith" <rfsmithmd at comcast.net> wrote:

> Roy,
> 
> Re: years of mismanagement. No doubt. Ditto for the big
> hospital in Chicago.
> I think the creation of a "non-political" governing
> agency could be an
> important first step. It's a model that's recommended by
> virtually every
> "blue ribbon" commission that looks at problems of public
> hospitals. I hope
> it helps. Obviously I think these hospitals do a lot of
> good for people
> whose access to quality care is limited.
> 
> Rob
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Roy Danks
> Sent: Tuesday, November 27, 2007 12:56 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: Grady
> 
> Rob,
>  
> I don't have a solution for Iraq, but what little I
> understand of war (and,
> it's complex), if we just up and pull out, we're going to
> leave a few troops
> behind...we can't possibly get every one out, en masse. 
> Do I think we are
> in Iraq for solid reasons?  No.  But, hindsight is 20/20,
> to abuse a cliche
> and we have to support the current troops, that's all I'm
> saying.  Would I
> go to Iraq and be a surgeon there?  Absolutely. 
>  
> Public hospitals:  First, Rob, I didn't use the term low
> life's...that's
> yours buddy.  Not disagreeing, but I don't need that one
> charged to me.
> Ah....I don't know the answer to this.  I mean, here I
> am, for all intents,
> a "rural" trauma surgeon.  Sure, we're Level I...we have
> about 10%
> penetrating trauma.  I can't imagine how they do it at
> Grady, LAC, Ben
> Taub...all of those.  We know this is an expensive
> business, but we can't
> expect the feds to bail everyone out all of the time. 
> Grady is where it is,
> presumably, because of years of poor management and
> neglect.  Give them more
> money and they'll find a way to blow it.  We have proven
> that time and again
> in medicine.  Businessmen we ain't.
>  
> It goes back to the Biblical reference of giving versus
> teaching a man to
> fish for food....
>  
> Sincerely,
>  
> Roy
> 
> 
> 
> > From: rfsmithmd at comcast.net> To:
> trauma-list at trauma.org> Date: Tue, 27 Nov
> 2007 10:53:31 -0500> Subject: RE: Grady> > 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 & 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 &
> 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,> 
=== message truncated ===

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