When Emory physicians at Grady do receive reimbursement for services to Grady patients who have coverage, these funds are invested back into Grady via the Emory Medical Care Foundation. The foundation supports Emory's mission at Grady, and its funds are used for a broad range of activities, from buying equipment to research and salary support for vital patient services. In 2005–2006, the EMCF provided $35 million to support the work of Emory faculty at Grady.

At publicly funded Grady Memorial Hospital, where 85% of the physicians are Emory medical faculty, the uncompensated care provided by Emory was $24.7 million in fiscal year 2005–2006 alone, a total that is up $2.7 million from the previous year. (This is in addition to the $70.7 million that Emory Healthcare provided in 2005–2006 in charity care, which is mentioned on page 12.) An important part of Grady's mission is to provide care to the uninsured citizens of DeKalb and Fulton counties, and the hospital struggles to stay solvent as these numbers rise and support stays flat. Despite the fact Grady cares for more than 145,000 self- or no-pay patients each year, it continues to provide extraordinary services, many offered statewide, many recognized nationally, thanks in large part to the extraordinary talents, efforts, and generosity of the faculty physicians from Emory and from Morehouse School of Medicine.

The last thing on your mind when you see a dying child
One sunny day in South Georgia, 14-year-old Sean Thomas was examining a 50-caliber shell from a friend's gun when it exploded, sending shrapnel into his chest. An Emory Flight helicopter, carrying a flight nurse and paramedic, was dispatched to transport him to Grady, the nearest level-1 trauma center, 100 miles away. Level-1 means, among other distinctions, that trauma surgeons are in-house around the clock. Not on call. There.
     Minutes after the helicopter set down on the Grady helipad, surgeon Jeffrey Salomone opened Sean's chest and managed to control the bleeding from his punctured lungs. The shrapnel had punctured the boy's aorta, going straight through but miraculously not severing the connection to the heart. The wrong move by the surgeon could send blood spurting like a geyser and mean instant death. This was nothing Salomone hadn't seen and fixed before. The delicate, painstaking surgery took hours. But Sean eventually recovered and went home for his 15th birthday.
     Did Sean's doctors receive compensation for their heroic work? No idea, says Salomone. "I get a letter once a year from the Emory Medical Care Foundation saying we billed this much for your services and we collected this much money, which we are placing in the fund to improve services at Grady. The money collected usually represents about 10 cents on the dollar for what was billed. But money is the last thing on your mind when a dying child arrives in the trauma center. When I saw Sean, all I could think about was what I needed to do to keep him alive."

Life support for patients and their doctors: Four times a year, trauma surgeon Jeffrey Salomone volunteers to teach Advanced Trauma Life Support to physicians who cover emergency rooms in suburban and rural Georgia. Many of these doctors, especially in smaller communities, are trained in family practice, internal medicine, or other nonemergency medicine fields. The patients who show up in their ERs, however, are victims of car wrecks, gunshot wounds, work accidents, and the other catastrophes that Salomone and his colleagues deal with on a daily basis. More than 100 Georgia physicians a year take the trauma course, developed by the American College of Surgeons, coordinated in the Atlanta area by Salomone, and taught by him and his Emory colleagues in surgery and emergency medicine, with support from community physicians who know its value firsthand. These physicians say that the course is a lifesaver, both for ER doctors working outside their area of training and for their patients.

A rock of Gibraltar in the storms of a difficult diagnosis
Shortly after 17-year-old Belinda discovered she was pregnant, she also found out that the baby's father had infected her with AIDS before he left town. She thought she knew the end to this story. She had watched her best friend's happy, bubbly baby grow steadily sicker, weaker, quieter, and then die two years before his mother also succumbed to AIDS.
     But Belinda's story, and that of baby Steven, now a feisty second-grader, has turned out differently, thanks to the Grady Infectious Disease Program (IDP) founded by Emory physicians in the 1980s. During her pregnancy, Belinda's Emory obstetrician at Grady made sure that she had the medicines needed to treat her own infection and lower the chances that her baby would be infected. Soon after Steven was born, Belinda and the baby were sent to the IDP clinic, more often referred to as the Ponce Clinic because of its location on Ponce de Leon Avenue, to meet their case manager and a team of Emory doctors. The Grady IDP would become their Rock of Gibraltar.
     If Belinda had felt alone and overwhelmed by the prospect of handling a complex disease, she no longer felt that way after her first afternoon at the clinic. Selected by the University HealthSystem Consortium as one of the nation's top three HIV/AIDS outpatient clinics, the IDP works to provide as many clinical services as possible under one roof, from medical and mental health to social and nutritional. While Belinda receives care from her doctors, Steven plays with a special IDP babysitter, until it's his turn to receive care. "Thanks to my Emory doctors, Steven is not HIV-positive," says Belinda, "and I was given my life back to make something of it. Steven and I can enjoy life together and make plans for the future, knowing that we will have many, many more years together."

The Grady Infectious Disease Program (IDP) was established by Emory physicians in the mid-1980s when the impact of AIDS was first beginning to be felt. It moved to the 90,000-square-foot Ponce de Leon facility in 1993, and it now serves over 4,000 men, women, adolescents, and children, a high figure even for a major city. The IDP is particularly vital to those most vulnerable in society, those with alcohol or drug problems, the mentally ill, or those for whom simply surviving in a new country leaves little time to try to penetrate the mysteries of the American medical system.

Access to cutting-edge care: Because of the highly specialized services provided at Grady, including trauma care, the hospital is sometimes the site of major national clinical trials conducted by Emory physicians. This gives Grady patients early access to cutting-edge therapies and accelerates application of these treatments to the population as a whole. Emory physicians reported results of an NIH-funded trial using progesterone to treat traumatic brain injury, for example, in the October 2006 issue of Annals of Emergency Medicine. They found a 50% reduction in death rate in the group treated with progesterone as well as significant improvement in functional outcome and level of disability. Progesterone is a promising treatment because it is inexpensive and widely available and has a long track record of safe use in humans to treat other diseases.