Each year, more than 125,000 indigent patients from DeKalb County seek treatment in Grady Memorial Hospital's emergency rooms, nurseries, inpatient wards and outpatient clinics, running up bills in excess of $60 million that the state's largest public hospital must absorb.

But each year over the past decade, DeKalb County has on average paid just $20 million to the hospital to offset the cost of that care, part of the deal the county struck decades ago with the Fulton-DeKalb County Hospital Authority.

And in preliminary budget discussions for next year, the DeKalb County Commission has proposed to cut that subsidy despite the fact that Grady's costs and patient load continue to rise and the 115-year-old facility is teetering on the verge of bankruptcy.

More perplexing still, the DeKalb commission has yet to act on a proposed contract to turn over Grady management to an independent nonprofit group that will be responsible for putting the hospital back on sound financial footing.

Both items —- funding for Grady and the new management agreement —- are on the commission's Tuesday agenda. Virtually all of the major players in the effort to save Grady from bankruptcy have stepped up to the plate —- the hospital authority, state legislative leaders and the governor, the Fulton County Commission and the Atlanta business community.

It is time for the DeKalb County Commission to step up and do its part.

The management changeover, in the works since November, is Grady's only real hope for survival. When finally executed, it will open the door to a $200 million philanthropic investment in Grady and could also turn the key on millions of additional dollars in state money.

Both the DeKalb and Fulton commissions have insisted for years that state aid for Grady was necessary. DeKalb commissioners are now the largest remaining obstacle to seeing that demand satisfied.

The DeKalb commission has said it is simply being diligent in examining all parts of the management contract. Due diligence is certainly necessary. However, by hiring an outside law firm to look for opportunities to reduce Grady spending, the commission seems more interested in trying to manage the place itself than in turning over control to a nonprofit board.

Once a new governing board is in charge, the county will have ample opportunity to discuss its financial commitment to Grady before its contract for providing charity care to DeKalb residents expires in 2013.

At the Capitol, the General Assembly has started moving legislation that, for the first time, acknowledges Grady's statewide impact. Gov. Sonny Perdue's budget proposal includes first-of-its-kind funding for Grady's Level 1 trauma center, as well as additional reimbursement for the thousands of low-income Medicaid patients treated by Grady.

The Metro Atlanta Chamber of Commerce has already enlisted about a dozen well-connected retired business executives and educators to serve on the new board. Everything is in place to ensure Grady's survival; it's time for DeKalb County to do its part.

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

A PROMISE TO CARE FOR DEKALB'S POOR

Grady's contract with DeKalb County calls for the Atlanta hospital to provide charity care to DeKalb residents who can't pay their bills. In exchange, the county is supposed to offset Grady's losses. For the past decade or so, DeKalb has put up about $20 million annually for Grady, including money to help pay off its bonded indebtedness. Next year it proposes to spend less.

The impact

4,392

The number of patients admitted to Grady from DeKalb County who are classified as indigent or charity-care patients

$30 million

Costs those patients incurred while being treated at Grady

130,983

The number of outpatient visits to Grady's clinics, emergency room and other services by DeKalb residents classified as indigent or charity-care patients

$38.4 million

Costs incurred by those outpatients

The result

$21.5 million

DeKalb County taxes appropriated to Grady in 2005

$46.9 million

The difference between Grady's cost of providing charity care to DeKalb patients and what the county paid for that service

$42.9 million

Grady's net operating loss for 2005

Source: Grady Memorial Hospital Financial Survey for 2005, filed with the Georgia Department of Community Health (most recent survey available)

DECISION TIME IN DEKALB

The DeKalb County Commission is scheduled to vote Tuesday on the new management arrangement for Grady Memorial Hospital. Most commissioners say they are undecided about the plan. Let them know it is time to save Grady.

Chief Executive Officer

Vernon Jones

404-371-2881

District 1

Elaine Boyer

404-371-2844

njmcbrid@co.dekalb.ga.us

District 2

Jeff Rader

404-371-2863

jrader@co.dekalb.ga.us

District 3

Larry L. Johnson

404-371-2425

larryjohnson@co.dekalb.ga.us

District 4

Burrell Ellis

404-371-4907

Burrell@BurrellEllis.com

District 5

Lee May

404-371-4745

lmay@co.dekalb.ga.us

District 6

Kathie Gannon

404-371-4909

kgannon@co.dekalb.ga.us

District 7

Connie Stokes

404-371-3053

conniestokes@co.dekalb.ga.us