The contract that Grady Memorial Hospital has with Fulton and DeKalb counties makes it the only hospital in the state that must be maintained as a charity hospital.

In that pact, in effect for nearly six decades, the two counties essentially promise to cover Grady's cost of providing care to residents of Fulton and DeKalb who can't pay their bills. Yet for more than a decade, the two counties haven't come close to covering those costs.

In 2005, for instance, the two counties covered less than half the costs for the nearly 400,000 visits to Grady by indigent Fulton and DeKalb residents. Had the two counties covered the debts of their indigent patients that year, Grady would not have had a net loss in the charity care it provided. Instead, Grady ended that year and 11 of the past 12 years with an operating deficit of millions of dollars. It is now deep in debt to creditors. Evidence is beginning to mount that patient care at the 115-year-old hospital has been compromised.

A way out of Grady's chronic financial chaos is available. Over the past year, the Fulton-DeKalb Hospital Authority has negotiated an arrangement to turn Grady over to an independent nonprofit management board, which will include some of the metro area's most influential civic leaders. That opens the door to a $200 million philanthropic investment in Grady as well as a commitment from state officials to begin sharing the responsibility for paying some of Grady's regional services — changes that would substantially relieve the pressure on the two counties to cover Grady's debts. Yet some commissioners in the two counties want now, at the 11th hour, to renegotiate terms of the arrangement.

It's worth asking, why haven't the two counties upheld their part of the contract in recent years? And why would they want to stand in the way of getting Grady the help the state and business communities are willing to provide?

— Mike King, for the editorial board

Are the counties paying what they are required?

FULTON

262,689: Visits to Grady by patients from Fulton County who were classified as indigent or charity care

$149 million: Unpaid bills these Fulton patients accumulated for treatment at Grady

$81.8 million: Fulton County government payments made to Grady for indigent and charity-care patients and bonded indebtedness

DEKALB

135,378: Visits to Grady by patients from DeKalb County who were classified as indigent or charity care

$68 million: Unpaid bills these DeKalb patients accumulated for treatment at Grady

$21.5 million: DeKalb County government payments made to Grady for indigent and charity-care patients and bonded indebtedness

THE IMPACT

91.9%: Percent of Grady's indigent admissions and outpatient visits from residents of Fulton and DeKalb counties

-$113.7 million: The difference between the costs Grady incurred for treating indigent and charity-care DeKalb and Fulton residents and what it was paid by the two counties for their care

-$42.9 million: Grady's patient-care operating deficit for 2005

Source: Grady Memorial Hospital Annual Financial Survey, 2005, filed with the Georgia Department of Community Health (2005 is the most recent survey the state has on file from Grady)