Fulton-Grady payments dispute coming to boil

By Johnny Edwards

The Atlanta Journal-Constitution

Charles Johnson thought he'd been bitten by a spider when his left hand started swelling painfully this week.

So Johnson, who sleeps at a downtown shelter, went to the emergency room at Grady Memorial Hospital, where blood tests showed a flare-up of gout. About 20 hours after arriving, Johnson left with a $76 bill for co-pays on exams, lab work and medication.

"Grady is slow, but they're thorough," he said, waiting for a bus out front. "That's why I come."

Some of the money to care for poor Fulton residents like Johnson is in jeopardy in an increasingly contentious contract dispute between the public hospital and Fulton County.

Grady and county officials remain at odds over how to calculate the amount Fulton taxpayers should subsidize treatment for indigent and uninsured Fulton residents. Negotiations have reached an impasse, County Manager Zachary Williams reported to the commission earlier this month, as the two sides can't agree on a formula for subtracting federal funds administered through the state's Indigent Care Trust Fund program from the county's allotments.

"It's still being discussed," Grady spokesman Matt Gove said. "It's not a situation where there's no hope of resolution."

Some commissioners have grown tired of waiting - and of arguing. The county budgeted an allocation of up to $52.2 million for Grady this year, plus another $9.9 million that was withheld withheld in 2010.

Fulton pays Grady in quarterly installments, contingent on a contract requirement that the hospital show proof that all county dollars go to treat poor county residents. With the next $13 million payment due in April, Chairman John Eaves wants to form an ad hoc committee to hash out contract details and determine the correct payment amount.

He envisions a group made up of Grady representatives, Fulton-DeKalb Hospital Authority representatives, county department heads and an objective technical adviser. Eaves said he has the votes to create the panel as soon as next week.

"My hope is that the stakeholders will come together and make a recommendation, so that future disbursements will be done in a more fluid way," the chairman said.

State Sen. Vincent Fort, D-Atlanta, co-chair of the Grady Coalition patient advocacy group, said that's a terrible idea. Commission scrutiny is the only leverage the community has against another neighborhood health center being cut or decisions like the controversial closing of the outpatient dialysis clinic in 2009, he said.

"We did not elect a committee," Fort said. "We didn't elect [Grady CEO] Michael Young or [Grady Board Chairman] Pete Correll. We didn't elect any of that crowd. We elected the commissioners to look out for the people of Fulton County."

The contract arrangement started in 2009, after the hospital had nearly collapsed in financial ruin and the nonprofit Grady Memorial Hospital Corporation took over operations. The county entered into a memorandum of understanding with the hospital authority requiring it prove that the money goes toward Fulton patients only.

Disagreements over those terms led to $10 million being withheld in 2009 and the $9.9 million withheld last year. Both years, the commission relented, not wanting to see the state's largest charity hospital suffer. Dissenting Commissioner William "Bill" Edwards has charged that the county has no contract if it's just  going to keep paying the money anyway.

"This is not about politics," Edwards said earlier this month. "This is about accountability and business."

This year, Grady faces a $25 million reduction in federal indigent care funding and plans 100 layoffs, with a possibility of program cuts that haven't been specified. Both Fulton's and DeKalb's 2011 allotments are $3 million less than in 2010, with DeKalb now contributing about $13 million to patient care. Meanwhile, the recession has more and more uninsured patients seeking treatment.

Whenever Grady comes up on the commission, discussions devolve into angry rhetoric and accusations, with Edwards and Emma Darnell charging that hospital officials haven't upheld their end of the bargain and criticizing colleagues for placating them. Darnell recently said Commissioner Robb Pitts has "an agenda from the Grady corporation."

Pitts and Commissioner Tom Lowe have suggested that, to end the bickering, the county just come up with a dollar figure for Grady every year, then divide it by 12 and cut checks every month.

Pitts said he also opposes forming a  committee. It can make a recommendation, he said, but the commission still has to vote on it, so the infighting will continue.

John Sherman, president of the Fulton County Taxpayers Foundation and a Grady board member in the late 1990s, said he doesn't think the county gives too much to the hospital. The problem is that only two metro counties are responsible for keeping it in the red, he said.

"Grady serves a definite purpose," Sherman said. "But placing the whole burden on Fulton/DeKalb is not fair."

Gove has said about a quarter of the hospital's indigent patients come from other counties. Through their hired lobbyists, Fulton commissioners are asking the General Assembly to route more indigent funds to Grady and to come up with a more equitable, regional funding mechanism so counties such as Gwinnett, Cobb and Clayton share costs.

Final 2010 numbers aren't available yet, but Gove said that through the end of November, Grady had $590.7 million in expenses and brought in $503.3 million in revenue. Revenue sources include federal Disproportionate Share Hospital funds, Medicare, Medicaid, private payers, cash from patients, insurance companies and grants.

Pushing her 10-month-old in a stroller, Torrie Person went to Grady on Wednesday for a birth control shot, which she gets every three months at no cost. She takes her son, Darreon, to Grady's Hughes Spalding Children's Hospital for his pediatric care, covered by Medicaid.

A single mother from Decatur, she's making ends meet with a Kroger deli job. She said she'd be in a bind without Grady services.

"I'd go apply for Medicaid," Person said. "I don't have to, because I've got a Grady card."