Monday, July 23, 2007

Grady - A Microcosm of Public Health

I have made reference to our local charity hospital before. The problems of Grady Hospital are not unique. All hospitals, but particularly those who cater to the indigent, suffer tremendous financial burdens.

They're receiving care despite cutbacks that crippled the staff of Grady Memorial Hospital's ophthalmology department.

The eye clinic — a relatively small service in a medical complex serving almost a million patient visits a year — now schedules 60 to 80 patients a day, down from 120 just weeks ago. Many of its patients include those with advanced glaucoma or diabetic eye complications

One million patients per year.

Most without insurance.

Almost all receive "free" care courtesy of the taxpayers of Fulton & Dekalb county Georgia.

Patients without Medicaid or insurance have no choice but to live with the delay, said Annie Tribble, 51, the uninsured glaucoma patient who stays at a women's shelter. Waiting, she said, "is better than not seeing about yourself at all."


Symptomatic of public health.

More than 400 of the health system's 562 eligible employees accepted, about twice as many as administrators said they expected. A third were nurses, nursing assistants, clerks and other workers in patient care, which accounts for 1,500 of the hospital's 5,000 workers, said Kirk Wilks, Grady's vice president for public affairs. Another 13 percent came from laboratories and radiology.

Of the 422 positions vacated by retirees, about 300 have been or will be refilled since no bedside nursing jobs will be eliminated, Wilks said.

A few days later, Wilks was gone — laid off in an additional cutback

Cutbacks in non-essential personnel.

The buyout was an attempt to stem losses at the state's largest public hospital, which has operated in the red every year since 2000. Consultants hired by the hospital's governing board reported $67 million in losses last year and said 2007's deficit could be even higher.

The more money that comes in, the more that flows out.

There is no end.

In a cash-strapped hospital with aging equipment and a largely indigent patient population, "people learn to make things work and maximize resources," Lewis said. In addition, he said, the senior staff "developed long-term relationships. Those are the things you lose."

Aging equipment.

Delays in care.

Is this any way to run a health system?

One uninsured ophthalmology patient who came through the emergency room this summer told doctors she had been sent there by a private physician who told her that, because of the wait for a clinic appointment, she should lie and say she'd been hit in the eye, said ophthalmologist Broocker. His team discovered a tumor.

The woman now receives ongoing treatment at Grady.

Told by her doctor to go to Grady.

Because care there is perceived as "free".

Even by someone who (should) know better.

Sure, this is Grady. Just one hospital in one city. But the issues Grady faces are reflective of what can happen with taxpayer funded, government mis-managed health care.

Is this really what the public wants?
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