As political debate swirls around the future of the Grady Health System, patients continue to pour into the 115-year-old public hospital and its clinics. Physicians from Morehouse and Emory University schools of medicine continue to treat them.

The DeKalb County Commission is set to vote Tuesday on whether to approve a lease transferring management of Grady from the Fulton-DeKalb Hospital Authority to a private nonprofit corporation. The county's OK could be the last hurdle in a change that brings with it a promise of hundreds of millions of dollars in capital funds.

Rich Addicks/AJC (ENLARGE)

The Morehouse perspective from Dr. Lawrence Sanders: 'We have to be careful going forward if we lay off ... more people.'

Rich Addicks/AJC (ENLARGE)

The Emory perspective from Dr. Leon Haley: 'Our ability to take care of patients with older equipment will be compromised.'

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But consultants who have examined the hospital have said some cuts or changes in services could be needed to turn around the hospital's huge financial losses of the past decade.

The Atlanta Journal-Constitution asked two of Grady's top doctors for their diagnosis and prognosis for the health care system as it faces a potentially historic transition.

Dr. Lawrence Sanders Jr., associate dean for clinical affairs at Morehouse School of Medicine, is a graduate of Vanderbilt University Medical School and also holds an master's of business administration from the University of Pennsylvania's Wharton Business School. He has served in the epidemic intelligence service of the Centers for Disease Control and Prevention.

Dr. Leon Haley, deputy senior vice president for medical affairs and chief of emergency services at Grady, is also an associate professor at Emory University School of Medicine. His medical degree is from the University of Pittsburgh School of Medicine.

Q: Where is Grady right now in terms of equipment, staffing and ability to take care of patients?

Sanders: I would say Grady has always been challenged for ... every resource you can imagine ... but we have managed to take care — I believe good care — of patients and provide high-quality service. ... I think we have to be very careful going forward if we lay off or RIF more people. We don't make widgets here. We care for people.

Haley: I think sometimes the perception is that Grady is this old, broken down county hospital where the lights don't work and the equipment is being held together by duct tape and paper clips. That's really not what we do. That's not the equipment we have. That being said, do we have aging equipment? Absolutely. Do we have equipment that is probably functional but beyond the manufacturer's recommended life span? Absolutely. Can we still take good care of patients with it? Absolutely. Now all that being said, that's ... where the lease change is really critical. Moving forward, our ability to take care of patients with older equipment will be compromised. Some of the initial funding that's been identified for Grady is really to help support equipment purchases, to help support technology.

Q: What are some specific areas where doctors want to spend some of the money that's expected to come in?

Sanders: One area is integrated medical records — a medical records system that moves beyond pen and paper, that allows us to connect medical records from inpatient, outpatient and emergency services. We have computer systems that work, but they're all independent.

Haley: We're looking at, to be specific, to upgrade the ultrasound machines in the emergency department. We have two. One is 8 years old. One is 12 years old. We need the next generation. ... We are also looking at replacing beds across the system. ... That's critical for patient care. ... We're also going to replace all our IV pumps with smart pumps. That is a highly sophisticated system with a patient safety feature that will stop someone from moving forward until the medication is properly identified and the dosage is accurately punched in.

Q: Is there a master plan for capital improvements?

Haley: There are approximately $600 million in needs identified. ... Obviously we don't have $600 million to buy it all tomorrow. ... We're looking at a matrix of patient safety, regulatory requirements, replacement of systems that manufacturers are no longer making. And, of course, cost.

Q: What are some of the long-term goals doctors have for improving Grady beyond the capital needs?

Haley: I think the physicians here want the services they provide to be the best they can provide, whether surgery, emergency care, trauma or HIV care. They want this to be one of the great teaching institutions in the world ... and they want to do high-quality research. ... Are the physicians realistic enough to realize that not every service can get as fully developed as we'd like it to be? Of course.

Q: What are the underlying social issues that make the Grady patient mix not necessarily the same kind of cases you might see at Piedmont, Crawford Long or St. Joseph's?

Sanders: Grady sees a group of people who live without health insurance or without enough health insurance. As a result, they may not seek care as early in the course of disease as people with insurance. ... The other thing is that many of the people we care for have many, many other social issues that compete with health care. Just the basics of meeting their needs of housing, of food, of transportation compete with their need for health care.

Q: Will cutbacks be necessary to make Grady solvent?

Haley: Do I think that? No. But a lot of it is going to depend on the two counties ... whether the philanthropic community comes through with their support ... whether the state funds trauma care.

Sanders: I think there are limits of what you can provide with limited resources. ... Grady is actually a sentinel for what is happening around the country in terms of health care. ... As a society, we need to move toward some system that allows people access to health care and ensures people that they're covered for health services.

Haley: Atlanta has a great, tremendous opportunity to rethink how we deliver care. ... We could certainly go down the route of ... allowing Grady to close or cut back services, which would create tremendous havoc in patient care in our area. ... Or we could make this a flagship model of how to take care of patients in a compassionate way, serving the underserved, but also providing excellent care to anybody who comes here.

Sanders: I believe the leadership in Atlanta and Georgia has come to grips with the fact that Grady is important. Now it's a matter of working out the political details. ... I actually believe this public dialogue is good for Grady.

Q: It seems that while Grady is keeping services for the patients in the most acute need, it's removing [preventive] services that might keep patients from getting to that point.

Haley: It's not because somebody says we no longer need that service, that patients no longer need access to nutrition services, smoking cessation, diet control. We all know that these are critical needs for the patients' survival and life expectancy. But ... you're forced with X amount of dollars, X amount of resources, to make some choices. ...

Sanders: When resources are limited, prevention gets lost. ... I believe we're going to have to have good working partnerships between a new reorganized Grady Health System and public health departments who do prevention so that we're working together, where we provide a seamless set of services ranging from prevention all the way through acute care. ... We're going to have to look at new ways to reinvent ... the public health care safety net.

But I never see a day when Grady wouldn't be the core of that safety net.