Ever since Pam Stephenson assumed the helm of Grady Memorial Hospital in January, people have been pushing to oust her from metro Atlanta's top trauma hospital and charity care center.

Criticism that she lacks experience and qualifications and brings with her conflicts of interest rose as high as Lt. Gov. Casey Cagle, who said Stephenson is "obviously unqualified" and exercising "personal greed" in pursuit of the $600,000-a-year job.

Stephenson isn't budging. Rather than stepping aside, she is poised to step up as a candidate in the national search for a permanent Grady CEO.

"I can see that happening," she said last week. She wants to run the idea by the Grady board before she applies.

By standing her ground against critics, some say, Stephenson has shown backbone and a dedication to Grady and its historic mission of serving the poor.

Others say she is pursuing her own ambitions at the expense of the hospital.

Although he called her presence at the hospital "healing," Dr. William Casarella, executive associate dean for clinical affairs at Emory School of Medicine, added:

"I'm concerned about her lack of in-depth understanding about the whole field of hospital administration, and being able to oversee all of the things that hospitals have to do these days, in terms of regulations and accreditation and governmental relations and financing and operations and electronics."

Stephenson has never been chief executive of any size hospital. And Grady, one of the country's largest public hospitals, has an annual budget of $730 million and registers almost a million patient visits a year.

Grady is the most publicly scrutinized medical facility in the region because of its size, its crucial roles as a teaching hospital and Atlanta's only top level trauma center, and its financial failings.

And Stephenson has become for many the face of the institution: in addition to standing in as CEO, she has been head of the Grady board since 2006, and she is vice chairwoman of the new nonprofit hospital board, which will take over management of the hospital about May 1 and begin looking for a CEO.

Just as the hospital has its strong advocates and detractors, so has the woman now in the CEO's office.

"I have a skill set and I'm qualified," Stephenson said.

She rattled off her résumé: She's a health care attorney, former head of the state health planning agency, a leader on both Grady boards, a state lawmaker.

If she's selected CEO, she said, she likely would step down from both the Grady board and the nonprofit corporation board, potentially easing concern about conflicts of interest.

She may already be stretching herself too thin. Stephenson said she has set aside her legal work. But, as a state legislator from Decatur, she had the second-worst record for missing votes in this year's session, according to an analysis by The Atlanta Journal-Constitution.

Nonetheless, her supporters say that in 10 weeks as Grady CEO she has been open and accessible to workers, patients and doctors.

Others, including a hospital vice president who quit since she became CEO, say she is selective about whom she opens her door to.

The Rev. Tim McDonald, a longtime advocate for Grady, said that despite controversy outside the hospital about Stephenson's multiple roles, her presence inside the hospital has brought some calm among doctors and employees worried about the hospital's future.

"Pam has in a very short time gained the confidence of workers and doctors," he said. Having irons in so many fires isn't so much a conflict of interest, he said, as a benefit to the hospital, since she can help Grady in several different circles.

Still, he said, her chances of holding on to the reins are "slim to none."

McDonald believes the new Grady board wants "somebody they control. They would not be able to control her."

Pete Correll, the head of the new Grady nonprofit, said, "If Pam wants to be a candidate, she can certainly be a candidate."

Correll added, however, "I think given the magnitude of the challenge, I personally would like to see us bring in a world-class proven CEO that is a hospital-runner and has a track record."

Still, Stephenson has convinced numerous doctors, patients and administrators she is good for Grady at a critical juncture in its 112-year history.

"She's doing a lot of healing," said Casarella, the Emory dean. Emory and Morehouse medical schools supply doctors for Grady.

Even that level of success has surprised some people who were concerned about her abilities, as well as the circumstances of her arrival. The Grady board appointed Stephenson to serve in the interim after the abrupt dismissal of CEO Otis Story.

Some of the concern has focused on the need to address tough problems at the hospital: Grady ended 2007 with a $48 million deficit; it is fighting to retain its accreditation; and last year it was forced to reduce staff. Late in 2007, hospital managers were talking about the possibility it could close.

Ten weeks is hardly enough time to judge her in the role, said Dr. Curtis Lewis, Grady's chief medical officer.

"I can tell you, she's done a really good job. She's one of the most accessible CEOs in some time," Lewis said.

Stephenson, he said, regularly tours the hospital talking to staff. She chats with workers in the cafeteria. When she visited a surgery clinic, workers complained about aging computers and she replaced them within a week, Lewis said.

Rita Valenti, a staff nurse, liked an e-mail Stephenson circulated to staff asking for input, and that she met with the workers union.

"She listened," Valenti said. "I don't know if any results came from it."

But some say Stephenson has not been so open as head of the Grady board.

"The board process is very closed," said Richard Teters, a member since last summer. He said he feels he has been kept him out of the loop on several issues.

Dan Brooks, who was Grady's head of strategic planning, said Stephenson did not meet with him until six weeks after she arrived. He felt she marginalized him because he was an appointee of the prior CEO. Brooks quit about a month ago.

"I wasn't even on the radar screen," he said.

Stephenson said Brooks could not adjust to her leadership style of working more with groups than individuals.

Stephenson's largest hurdle to job security may be her familiarity with Grady. New management boards tend to bring in their own leaders. She is head of the Grady board, which some associate with a time of failure for the hospital.

"Change doesn't occur when the same folks are calling the shots," said Lynne Riley, a Fulton County commissioner who has closely followed Grady.