Atlanta Medical Center closure brings higher costs, risks for Grady

Even before the announcement was made that Grady would soon become the only safety net hospital for the city’s poor, Grady was asking for help

Grady Health System CEO John Haupert walked into Fulton County government headquarters in April armed with documents bearing a clear message: He needed more money.

The number of patients coming to Grady was growing by the day and staffing costs were through the roof. Without a sizable increase in funds from Fulton and DeKalb counties, whose citizens form the bulk of Grady patients, he warned the hospital faced a budget shortfall.

Now, with the seismic news that Wellstar Health System is closing the city’s only other safety net hospital, even more patients will be seeking care at Grady, making its need for more funding even more urgent.

Gov. Brian Kemp is funneling a one-time $130 million payment to the hospital intended to finance nearly 200 new beds. But not mentioned in the publicity firestorm was that Grady already needed those extra beds and that extra funding.

“Clearly, the $130 million covers the capital cost,” Haupert said in a recent interview. “But that’s not enough.”

In response to Haupert’s request last spring, Fulton eventually added a one-time $11 million bonus for Grady out of FEMA dollars the county had on hand. Questions remain over how Grady’s finances can be boosted over the long term, but the need is immediate.

Wellstar Health System said it would close Atlanta Medical Center in downtown by Nov. 1, and on Thursday announced the emergency room that welcomed Atlanta’s patients for a century will shut its doors even sooner, on Oct. 14.

Beginning Monday, AMC’s emergency department will go permanently on “diversion,” telling ambulances to take patients to other hospitals. That’s when the impact will really begin for nearby hospitals like Emory Midtown, Piedmont Hospital, and most of all, Grady.

Beds and More

Much of the concern about the loss of Atlanta Medical Center’s downtown location centers on its emergency room. AMC and Grady’s emergency rooms are the only two in Atlanta certified as a “Level 1 trauma center” capable of treating the most severe injuries. But even with both hospitals operating, their emergency rooms overflow with not just trauma, but patients of all stripes, straining every department.

Metro Atlanta ambulance dispatchers are guided by an online chart of emergency rooms that tells them where there’s space available to receive ambulances. On most days, Grady glows bright red noting severe overcrowding and signaling ambulances to take emergency patients elsewhere. And too often emergency patients that are accepted wind up being held overnight in the emergency department, waiting for a regular hospital bed to open up — “boarding” as it’s known in the industry.

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“We board patients in the emergency room every single day,” said Dr. Janice Bonsu, an orthopedic surgery resident at Grady. “When you walk down the hallways of the emergency room, there are patients sleeping in cots outside of rooms because we don’t have enough rooms. … We’re performing procedures for them in the hallways because we don’t have space.”

To help manage that overflow, the $130 million Kemp promised would fully fund 185 new beds for Grady, Haupert said. The $130 million comes from federal pandemic money given to Georgia that Kemp has the power to direct. Kemp’s suggestion of an additional $50 million in private donations could fund even more beds, but so far there have been no details on when that money might be raised.

Credit: Bob Andres

Credit: Bob Andres

Adding to Grady’s current 712 beds, the new beds would be a combination of intensive care and regular patient beds and would bring Grady’s total to about 900 beds.

To make room for them, Haupert said Grady will move some administration offices to offsite locations and relocate some existing beds. Grady has a newly built wing called the Correll Pavilion coming online in December, which will house clinics and a cancer center, freeing additional space within the hospital. Within weeks, a state-owned temporary pop-up hospital kit will arrive from Macon, able to hold 24 beds. By the end of 2023, the newly built hospital beds should be in place.

Credit: Christina Matacotta

Credit: Christina Matacotta

So Grady may be able to compensate for some of the lost AMC hospital beds, with its expansion plan speeded up. But its leaders are clear: Grady was already planning those new hospital beds regardless of AMC’s closure, because it already needed them. In addition, other essential medical services could be harder to replace.

Private practices around AMC provide a welter of essential health services, send patients to the hospital and provide care after the hospital. Grady is doing what it can to find those patients and connect them to Grady, Haupert said, but Wellstar has not given Grady individual patient information.

Grady is also still hoping for Fulton and DeKalb counties to chip in more.

Fulton County’s 2022 budget allocated Grady Health System $63.9 million, not including the one-time contribution of $11 million approved to address Haupert’s recent request for more funding. DeKalb County has allocated $19.3 million for Grady in 2022, up by a few million dollars from 2021. It’s possible more funding could be on the way.

”Negotiations are ongoing as DeKalb County seeks to strengthen the partnership with Grady Hospital and ensure that access to quality health care is available to all who need it,” DeKalb CEO Michael Thurmond said in a statement.

In a previous era of crisis for Grady, metro Atlanta business leaders through the Metro Atlanta Chamber led a total reorganization and financial rescue of Grady, including hundreds of millions of dollars in private donations. But this time, Wellstar didn’t even tell the Chamber AMC was closing, Chamber President and CEO Katie Kirkpatrick said.

Kirkpatrick, speaking to The Atlanta Journal-Constitution’s editorial board last week, said she was in Boston on a business trip when the shocking news broke. While the Chamber stands ready to help, she said, “I’ll be very clear, we were not given a heads up.”

She said this health care emergency will be a test for the community.

In response, Wellstar said it has previously told the public about AMC’s financial troubles, and in 2020 looked for a partner or buyer to help out, and told public leaders, the Chamber and other hospitals about it.

As to patients that are about to lose AMC treatment, Wellstar said in a statement it was now working with Grady, hospitals and doctors to transition its AMC patients to them.

A protest for funding

Bonsu, the orthopedic ER doctor, stood on the sidewalk facing Jesse Hill Drive in front of Grady this week to argue for the state to expand Medicaid to all poor adults. If that happened, the federal government would pay 90% of the cost of the new Medicaid patients’ care, bringing an estimated $3 billion per year into the state. According to Grady, 17.4% of AMC’s patients have no insurance.

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Full Medicaid expansion is opposed by Kemp and other GOP state leaders, partly because of the cost to the state budget. Wellstar has said it would have closed AMC anyway even if its indigent patients had Medicaid.

The group of doctors and health care workers protesting outside Grady this week warned that the impact of AMC’s closure could be life or death for some patients. For example, when a patient has a stroke, the brain loses its supply of oxygen. That means for every extra minute of travel time to the hospital, it’s another minute of damage to that patient’s brain function. The same urgency is true for patients who are experiencing a heart attack.

Dr. Mark Spencer, a resident in internal medicine at Grady, said that Wellstar’s earlier closure of an emergency room and inpatient hospital beds at AMC South in East Point is offering a preview of what’s to come when the downtown location also closes.

“There’s already been documented cases of patients having worse outcomes because they’re coming from south of I-20,” said Spencer, who is also a resident at Emory hospitals including Emory Midtown. “That’s a direct consequence of AMC South closing, and we’ll see more of the same when AMC closes.”

AMC winds down operations

On a recent mid-September morning, it was hard to believe that Atlanta Medical Center was still operating. Handfuls of patients and medical staff were out walking across the campus, either heading to appointments or on their way to buy food during a break.

The scene was also increasingly empty on the inside. An anonymous social media account that is chronicling AMC’s closure is posting videos of the floors that have already closed. The patient beds are neatly made, the floors sparkling clean, and not a single patient or worker in sight.

Judith Smith, who is 67, has a peek into the dwindling number of patients. Smith works in the kitchen, putting food on plates for the patients at Atlanta Medical Center.

Her workload has steadily been dropping: Typically the kitchen would put together more than 200 plates for patients, Smith said it was already down to 120 plates. She heard the kitchen will stay open until Oct. 31, but she wouldn’t be surprised if it will shut down even sooner.

“You’ve got a lot of people who may have bought homes and cars, and they are really stressed,” she said of all the workers at AMC. “There’s a lot of stressed people up in here right now.”

Yvonne Ford, a patient who was about to start physical therapy for back problems, felt jaded about the facility shutting down.

“You know what, they’re going to do what they want to do,” she said of Wellstar. “They already made up their minds. They are going to make condominiums like they do everywhere else.”

Staff writers Tyler Estep and Zachary Hansen contributed to this report