Following is a statement written by Dr. Michael M.E. Johns, Chancellor, Emory University, published by InsiderAdvantage Georgia on November 2, 2007. The piece was in response to an earlier column by DeKalb Commissioner Elaine Boyer.
Viewpoint: Dr. Michael M.E. Johns:
Emory Gives Generously At Grady
By Dr. Michael M.E. Johns
Grady Memorial Hospital for many decades now has been one of the jewels in Georgia’s crown. And the incredibly committed, hard-working, underpaid (by marketplace standards) doctors of the Emory and Morehouse schools of medicine have been the glue that has held this jewel firmly in place.
One of the largest public hospitals in the entire Southeast, Grady has sparkled for the excellence of its patient care and its training programs in critically important areas such as emergency medicine, trauma care, HIV/AIDS, mental health, stroke, cancer, and sickle cell anemia – among many others.
All of this is now at risk of being lost. Grady faces a crisis in under-funding.
In many ways, Grady has been a success story. It has done the job the counties asked it to do. But as is all too clear, the world is shifting beneath our feet. . We have seen an explosion in uninsured and under-insured patients – not only in Atlanta, but in Georgia, and nationwide.
The uninsured have flocked to Grady for treatment they could not get elsewhere. And Grady’s bottom line has suffered. This should come as no surprise. For more than 15 years, annual contributions from Fulton and DeKalb Counties – the actual owners of Grady – have been flat, even while medical costs have risen here and nationwide every year. For the past two years, Grady has lost massive amounts of revenue it counted on from the state’s Disproportionate Share funds because of changes in the formula used to allocate that precious pool of indigent care funding.
The dollars have shrunk, but the numbers of patients, and the actual costs, have grown.
In response to this agonizing crisis, which poses a real threat to the public health of the entire state, DeKalb County Commissioner Elaine Boyer declares that Emory University has a special obligation to give financial assistance to Grady Hospital – a publicly owned institution -- because of the many private and public gifts Emory has received over the years.
There is a huge leap of logic in this argument, but first, one broad point of agreement.
We agree: Emory has been given much, and we do owe much. Like all nonprofit religious, charitable, and educational institutions (all of which are exempt from local property taxes), we believe that we have an obligation to society that goes beyond the bottom line. That’s one reason why we bring more than $140 million a year to the table at Grady, for the benefit of the hospital and its patients. All of the numbers (from 2006) are laid out on our web site.
They include more than $25 million a year in uncompensated medical treatment for those who simply cannot afford to pay, and more than $30 million a year from our faculty medical practice at Grady, which we invest back into programs and facilities at the hospital. They include more than $70 million a year in patient care grants that Emory is awarded by the federal and state governments for Grady patients and programs.
Suffice it to say that Emory does give back generously to society through the work we do at Grady – and not just in dollars, but in the sweat and commitment of our faculty, residents and fellows, and medical students. Let us be clear: Emory loses money on its contract with Grady. This is factually indisputable.
However, to suggest further that Emory should be willing to forego money we have earned under contract with Grady, because others have given the university major gifts over the years, does not pass the test of logic. We are indeed a nonprofit, but we have to balance our books. Our generous private donors expect us to practice good stewardship of their gifts and to run the university in a way that is sustainable for generations to come. In fact, most gifts are restricted in nature and it is illegal to use them for other purposes. Our doctors work for a living, and they expect to be paid. We do not have the taxing powers of DeKalb County, other counties, or the State of Georgia.
As of the end of October, Grady owed the Emory and Morehouse medical schools, combined, $63 million for legally-documented medical services we already delivered. Grady management periodically confirms the balance owed in writing. The total keeps climbing by $5 million per month.
We cannot and will not continue to do business that way. Because of underfunding, Grady is in breach of the contract between the medical schools and Grady every day. Money that the hospital received from the federal government, which is generated by the teaching programs of the two medical schools, is being used to meet payroll and keep the lights on instead of being used to pay the residents as required by law.
In point of fact, Emory (along with our partners at Morehouse) is by far the most patient, and the most generous, friend that Grady has ever had. No other supplier of goods and services would keep showing up at the hospital every day and working around the clock with no diminishment of effort, despite Grady’s being tens of millions of dollars in arrears.
The loss of Grady would be a catastrophe for the state. In addition to the huge volume of health care delivered there, Georgia would lose a venue where about one-quarter of all the doctors in the state have trained. It would be a painful experience for Emory. But it could happen, and we are prepared to continue our excellent programs elsewhere if it does. In fact, if the solution to Grady thriving is for Emory to no longer participate as a partner, we will begin to exit at the request of the counties and the Grady Board.
The answer to this crisis will not be found in one private medical school – Emory – or in two private medical schools – Emory and Morehouse. It has to be found in the community at large, and in local and state leadership.
The time for realism has arrived. The future of Grady hinges on it.
