The failure of the state Legislature to approve longterm trauma care funding is a blow to efforts to save Grady Memorial Hospital, and it also raised fears that other trauma centers might reduce services or get out of the business, health advocates said Saturday.

Advocates said the death of a bill that would have funded $74 million for hospitals providing care for victims of car accidents and other trauma will hurt an already-fragile system of care. The state Legislature ended its 2008 session late Friday without taking final action on the plan.

"It's a huge defeat for trauma [hospitals], but it's also a huge defeat for every Georgian," said Kevin Bloye, spokesman for the Georgia Hospital Association. Stressing the large geographical gaps between the state's 15 trauma hospitals, Bloye said, "We're losing lives unnecessarily."

The defeat was particularly bitter, advocates say, because support for the additional funding seemed high, in large part because of the spotlight on the financial crisis at Grady. The only top-level trauma center in North Georgia, Grady loses about $40 million a year in providing trauma care to people, many of whom are poor, uninsured or underinsured.

Grady had hoped to receive a bump of about $30 million a year from the trauma bill, which would have added a $10 fee to the annual registration of automobiles.

Grady CEO Pam Stephenson said the defeat of the bill would hurt Grady's effort to turn around the hospital, and could spur discussions about revamping or reducing trauma services.

"The lack of funding is problematic to the operation of trauma services," Stephenson said Saturday. "It's a terrible place to be at."

But she stressed that several other efforts have begun that would help stabilize the cash-strapped hospital, which also is Atlanta's primary provider of care for the poor and needy. Grady is expecting $200 million over four years from an anonymous donor, and the Atlanta business community is set to start a campaign to raise another $100 million for Grady.

Meanwhile, Grady and the other trauma hospitals will benefit from the separate one-year state boost of $58 million in trauma funding. Also, Grady officials say some changes in Medicaid funding could generate an extra $20 million for the hospital.

That money might just postpone tough decisions next year, health advocates said.

"We can't sink the ship," said Don Faulk, president of the Medical Center of Central Georgia in Macon, which handles trauma cases from DeKalb County to the Florida line.

Advocates said the trauma bill had its best chance this year, by garnering bipartisan support and promises from top state leaders for action, only to fall victim to larger politics over tax cuts.

The House version of the trauma bill tied the $10 car tag fee to Speaker Glenn Richardson's plan to eliminate the ad valorem tax on automobiles. In the final days of the session, the state Senate passed a trauma bill that uncoupled those two issues.

Amid a flurry of last-minute negotiations, it became clear that if the ad valorem measure failed so would the trauma bill.

"You can have a very necessary measure, that is highly popular, with strong bipartisan support," said Dr. Art Kellermann, the associate dean for health policy at the Emory University School of Medicine, "but it can die if it gets caught up in politics."