Pulse of the economy

Michael McDaniel and Allen Dollar
Emory faculty like Michael McDaniel and Allen Dollar provided $23.4 million in uncompensated care at Grady last year. When patients do have coverage, all payments for Emory services go to the Emory Medical Care Foundation, which uses every penny—$38 million in fiscal year 2011-2012—to support Emory’s mission at Grady.


 

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When the ambulance arrived, sirens wailing, John Lee was lying on the sidewalk.

What had started as a heart attack had set off irregular cardiac rhythms, leading to full-blown cardiac arrest. A good samaritan who had been performing CPR pulled back to allow the emergency medical technician (EMT) to apply electrical shock. John’s heart restarted, although the EMTs had to help him breathe during the race to the Grady Hospital emergency department. There, his heart stopped again and he was again resuscitated and then placed on a ventilator. Emory interventional cardiologist Michael McDaniel performed an emergency cardiac catheterization, winding a catheter through John’s arteries until he found the huge clot, then reopening the artery with an inflatable balloon and stent. The time from collapse on the sidewalk to repair had taken less than an hour.

Only time would tell what the outcome for John would be, and the agonizing wait began for John’s family and those involved in his care. John had never regained consciousness, a bad sign. Most people unconscious following resuscitation don’t make it. Others are never the same. The heart can survive up to half an hour without oxygen. The brain has less than three minutes. Had John gotten to care in time? After three days, he awoke. His heart had not suffered too much damage. But he seemed confused, hallucinatory, uncertain who his wife was. Then slowly, his confusion cleared. After 10 days, he left Grady, himself again, effusively thanking the clinical team. 
Cardiologist Allen Dollar says the kind of multi-team coordination that brought John back from death is why he left private practice to become chief of cardiovascular services at Grady. Were the doctors ever paid for John’s care, which probably ran more than $150,000? Dollar shrugs. He doesn’t know. He remembers that when John arrived he was well dressed and later mentioned a tennis injury. But, he says, the Grady cardiology waiting room can be seen as a finger on the pulse of the economy, often filled with people in business clothes left over from when they had great jobs, money, and health insurance. They know, says Dollar, that we will take care of them just as if they still did. 

   
   
 
 

Publically funded Grady Hospital is Atlanta’s safety-net hospital, counting a large number of indigent patients among those requiring admission and outpatient services each year. The hospital provides extraordinary care in programs not widely available elsewhere in the region: a poison control center, regional burn center, regional perinatal center for high-risk mothers and babies, comprehensive treatment center for HIV/AIDS, and programs in stroke, cancer, diabetes, and sickle cell. Emory physicians head these programs, providing 85% of the hospital’s physician care. 

 

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