Insider Follow Up:

Suddenly, A Lot Of Interest In Mysterious Grady Audit

By Dick Pettys
InsiderAdvantage Georgia

(8/29/07) Suddenly, a whole bunch of people under the Gold Dome are interested in an audit - said to have been conducted two years ago and kept secret since - of compliance with the contract between troubled Grady Hospital and Emory Medical School, which - with Morehouse - supplies all of the public hospital’s doctors.

After the audit’s existence became known through a letter circulated at the Capitol earlier this week, Sen. David Shafer was first to announce he would seek a copy under the Georgia Open Records Act. Then a spokeswoman said that Lt. Gov. Casey Cagle was looking forward to the results of Shafer’s request, and then the chairman of a special House study committee said she, too, wanted to see the audit.

What’s in it? Opinions differ.

The man who wrote the letter - former Grady Trustee William Loughrey - put it this way: “The report to the board found numerous problems with compliance with the contract, particularly with the requisite record keeping by Emory to document that their employees were providing the services for which Emory was being paid under the contract.”

Loughrey’s letter came to light just in advance of the first hearing of the House study committee on Grady. It happened that one of the first witnesses before the committee when it met on Tuesday was Dr. Thomas J. Lawley, dean of the Emory School of Medicine and he was asked about the audit.

Lawley confirmed there was such a report but said Emory never got a copy of it. In addition, he said the report pointed a finger at Grady - not at Emory.

"Our understanding of it is, the medical schools were found to be in complete compliance with the contract and Grady was found not to be. That's my understanding of that report. We were never given an official version of it. At least I've not seen a final copy of it, but that's my understanding. I think that it would be totally appropriate to make that public."

Told that the allegation was completely the opposite, he said, "I disagree with that to the best of my knowledge."

There was a lot more in Loughrey’s letter.

For example, he suggested Emory was steering paying customers away from publicly-owned Grady and toward its own privately-owned hospitals, and was failing to emphasize programs at Grady - cardiology and orthopedics, for example - that might turn a profit.

“To my knowledge, we surely haven’t been under-funding this at all ... Why would we systematically transfer paying patients out of a hospital that owes us $45 million? We would like to be paid,” the Emory dean said.

As for steering paying patients to its own hospitals, he used the example of someone seeking treatment for an elective orthopedic procedure.

Trauma cases, which often require orthopedic treatment, always get first priority at Grady, he said, and elective surgery must wait its turn. Rather than being "steered" to, say, Crawford Long, he said, "I think it is more likely that they would send themselves. Patients have the ability to go wherever they like..."

Nevertheless, the letter seems to have created a bit of a stir. Where it goes from here remains to be seen.

Rep. Ben Harbin, R-Evans, a member of the study committee as well as chairman of the House Appropriations Committee, was asked during a break in Tuesday's hearing whether he was concerned by the charges in the letter.

"I think it's brought up some good questions for us to ask ... Does that audit exist? Has it been kept secret? It's just information that we need to know. If the letter is truly factual, there will be a lot of concerns ... but right now I think it's just allowed us to ask the right questions and try to look in the right direction so we can hopefully fix this problem."

The letter was only one aspect of Tuesday’s hearing, which opened with presentations by Lawley and by Dean Eve Higginbotham of Morehouse.

At the morning session, committee members seemed to focus on a couple of issues. One was on a rotational system in which specific Emory and Morehouse doctors are only at the hospital certain days of the week. Chairman Sharon Cooper R-Marietta, said she’d heard that meant that patients would have to spend unnecessary and expensive days in the hospital waiting for their particular doctor to rotate back in.

Both deans said they were working towards a more seamless blending of services.

Another issue: Grady pays the liability insurance premiums of Emory doctors for the portion of the time they are at Grady. Is that an expense that could be covered some other way, Emory’s Lawley was asked.

He argued that’s a trade-off for the expense Grady is spared in recruiting qualified doctors for the hospital.