The waiting area at Atlanta Medical Center’s emergency room was desolate at 6 a.m. Friday. The “Level 1 Trauma Center” sign had been peeled from the hospital’s walkway the day before. Now, security guards walked down the driveway to post a new set of signs: “Emergency Department Closed — Authorized Personnel Only.” 

On a normal day, the room would be crowded with people waiting as long as four hours to be seen, one security guard said. But as Wellstar Health System officially shut down the emergency room — one of just two Level 1 trauma centers in Atlanta — the environment was anything but normal. The closure brings the health system one more significant step toward the complete shutdown of AMC by Nov. 1, after more than a century of service. 

Wellstar said it also will be closing several of its medical clinics next month. While Wellstar plans to relocate some of those clinics to Cobb County, the closures will worsen the shortage of medical services in the predominantly Black neighborhoods southwest of Atlanta. 

If there’s anyone who knows how much that community relied on the hospital, it’s Johnni Jones. Jones, who worked in general surgery at AMC for 12 years, grew up near the facility when it was Georgia Baptist Hospital. 

“I feel sad for my community,” she said. “Think about all the people that depended on this emergency room. With the gun violence we have here in the city that’s growing rapidly every day, what are they going to do?” 

As AMC prepares to end its tenure as a lifeline to the city and state’s health care infrastructure, doctors who will take on the additional flow of patients are worried that Grady Memorial Hospital — the closest Level 1 Trauma Center to AMC — will be insufficient to fill the gap. 

Level 1 trauma centers are capable of treating severe injuries like gunshot wounds. AMC’s closure will make Grady the only facility in the city capable of providing care for the most critical patients.

The emergency department at AMC had been seeing fewer patients since the announcement of the closure, according to Wellstar — down by more than half from the average of 110 visits per day. 

“We’ve put ourselves in a position as a community, as Atlantans, to where we’ve become dependent on far too few places to take care of humans,” said Anwar Osborne, a professor of internal medicine at Emory University who works at Grady. 

Dr. Janice Bonsu, an Emory University orthopedic surgery resident who works in Grady’s trauma center, said her workload there already has been challenging. She recalls one night when she had to consult with 47 patients with broken bones — a scenario she fears will be exacerbated with the closure of a hospital. 

“When I see one patient, it takes me one hour to get everything done. Times 47. That was before AMC closed,” Bonsu said. “I’ll be going back to Grady on Nov. 1 when a lot of this is going to be realized, and I’m honestly a little terrified.” 

AMC’s closure also comes as hospitals across the metro Atlanta area report staff shortages. Georgia has one of the lowest nurse-to-state population ratios in the country, with fewer than 10 nurses for every 1,000 people in the state.  

“Your doctors are tired, your residents are tired, but also our hearts,” Bonsu said. “Your heart breaks every time these things come in. So there’s an emotional toll of it. There’s somebody who is crying, their parents are crying, you want to comfort them. You don’t want to be that callous surgeon who walks in and walks out. But you have to recognize that, you know, I’ve done what I can do surgically for them.” 

Staffing is key for Grady and other hospitals to pick up the patients Atlanta Medical Center is leaving behind, said Dr. Hilary Jessup, an Emory trauma surgeon who works at hospitals across the metro Atlanta area. 

The nursing staff at Grady is “just too short, and ultimately, we need nurses to take care of patients,” Jessup said. “[Doctors] provide care, and we put in orders and we do things and say things, but nurses really deliver care.” 

Some have blamed AMC’s closure on the failure to expand Medicaid in Georgia. Hospitals like AMC typically lose money on patients who are uninsured, and Medicaid expansion would increase the number who could cover the costs of the hospital’s medical care, making AMC more financially viable, they say.

“If Medicaid is expanded, AMC stays open. We’re able to keep our current volume, which is too much,” Bonsu said. 

Medicaid expansion has been a top issue in the gubernatorial election, set to take place on Nov. 8. Gov. Brian Kemp follows a line of Republican Georgia governors who have rejected traditional Medicaid expansion under former President Barack Obama’s Affordable Care Act. On Tuesday, a day after AMC began diverting emergency room ambulance traffic to other local hospitals, Kemp doubled down on his stance that Medicaid expansion isn’t the solution to AMC’s woes, because hospitals also tend to lose money on Medicaid patients. 

Wellstar also has said a full Medicaid expansion may have helped some of its financial woes, but there was too much strife, like issues with the building’s infrastructure, for Medicaid alone to save it. 

In the short term, Kemp has allocated $130 million to add 200 more beds to Grady’s operation in light of losing the 460-bed AMC. When asked previously about long-term solutions, Kemp said a new hospital could take up to a decade to build. 

Tresie Barnes, a registered nurse who worked in AMC’s emergency department and said she’s taken a new job with Grady, said she’s worried about how sustainable the money from Kemp will be. 

“It’s going to be almost impossible to take care of everybody, even though they hired a lot more people and got a few more beds, but we need AMC,” Barnes said. 

Osborne, the Emory professor, said there’s a lot to be discussed in the next legislative session, from Medicaid expansion to changes in the state’s certificate of need program, which governs how health care facilities can operate. But in the short term, he’s more focused on what he can do right now, when Grady is front and center to fill the void for its most indigent patients. 

“I can’t personally exist in this camp where I’m like, ‘We’re all gonna die,’” he said. “I can’t do that. I can’t open up AMC, but I can listen to whatever candidate is putting forth solutions.”

Kenya Hunter is Capital B Atlanta's health reporter. Twitter @KenyaTheHunter