One of the anchors drowning Grady Hospital in a sea of red ink is also the hospital's best known and most costly asset —- its state-of-the-art trauma center.

One in a series.

Metro Atlantans hurt in car wrecks or on-the-job accidents — people who otherwise wouldn't go near Grady for routine medical care — want to be taken there when their injuries are serious. When Drew Landers, the young son of University of Georgia women's basketball coach Andy Landers, was seriously injured in an auto accident in Alabama for instance, he was transferred by air ambulance to Grady.

The ubiquitous backdrop to nightly TV newscasts in Atlanta, Grady's Level 1 trauma center treats about 3,700 trauma patients a year. Like Landers, one in every four comes from outside Fulton and DeKalb counties, transported by ground and helicopter ambulances to be swarmed over by a team of specially trained doctors and nurses on call 24 hours a day. Yet there is no direct state funding to support care for these or any other trauma patients at Grady.

Many other patients brought to the hospital's "Red Zone" — the area where the most severe injuries are treated — have no insurance or are covered by health plans that start paying only after they have run up bills of $5,000 or $10,000. The cost of care in the first 30 minutes at a trauma center can easily exceed that sum. As a result, Grady writes off about $43 million in unpaid bills annually for the trauma services it provides.

At a hospital that teeters on insolvency — with debt at the end of this year projected to run up to $120 million — finding a way to offset $43 million annually in unpaid bills should become an important goal. Here's how:

Georgia should create a fully operational statewide network of trauma centers to replace the barely adequate system of 14 trauma units now scattered around the state. At the heart of that new network should be a state-financed trauma unit at Grady.

There is no question Georgia needs a bigger and better trauma network.

Previous studies have projected that 700 people die annually in the state because they are unable to get to one of the state-designated trauma centers quickly enough. To reduce the death toll, the state should double the number of trauma units and improve the level of service of those already in existence. Relying on hospitals to provide the money-losing service as a philanthropic venture is no longer a realistic option in today's competitive medical marketplace.

Outside of Grady, Georgia has only three Level 1 trauma centers, in Macon, Augusta and Savannah. All are experiencing similar problems with the high cost of uncompensated care threatening their ability to provide other services.

In contrast, North Carolina has eight state-funded Level 1 trauma centers located so that residents are within an hour of reaching their life-saving services. (For many Georgia residents, the ambulance trip to the nearest trauma center is at least two hours.) Moreover, large public hospitals in Chicago, Miami, Los Angeles and Dallas — hospitals comparable to Grady — receive direct state funding to operate trauma units.

The Ryder Trauma Center in Miami and the Shock Trauma Center in Baltimore both operate as separately run specialty facilities funded by a combination of local, state and federal funds. Those facilities double as command centers in the event of a major regional disaster and would coordinate planning for public health emergencies, such as an avian flu pandemic. Grady already provides similar services for Georgia.

The Georgia General Assembly this year had a chance to invest in securing the statewide trauma network but backed away in favor of creating another study commission. That proved a lot easier than actually doing something.

Other states have established innovative methods for financing trauma networks that aren't burdensome to taxpayers. By assessing small surcharges on vehicle registrations or cell phone bills, or by devoting a share of taxes on car insurance premiums, Georgia could finance much of the estimated $170 million in uncompensated care that trauma units at Grady and other hospitals around the state now provide.

The trauma network, like Grady, is in financial crisis. The state must secure it or more lives will be needlessly lost.

It can start by working with officials in Fulton and DeKalb counties to take financial responsibility for Grady's trauma center and use it as the foundation for improved trauma services statewide.

— Mike King, for the editorial board, (mking@ajc.com)