During its board meeting, the Fulton-Dekalb Hospital Authority also approved an agreement with Wachovia Bank that would give the hospital a credit line of at least $35 million and up to $50 million.

The resolution was approved 9-to-1, with board member Geoffrey A. Heard voting against the plan.

Monday's meeting of the Fulton-DeKalb Hospital Authority, which currently governs Grady, was far less crowded and contentious than the November meeting where the board initially voted to move forward with the proposal. At the beginning of the meeting, the Rev. Joseph Lowery urged the board and public to work toward the common good.

``Grady is about serving the least of these,'' Lowery. ``This is the dawn of a new era, where reconciliation and fellowship is taking a new seat on the front row.''

Several people attending the meeting raised questions about what the new board's commitment would be to maintaining Grady's mission as a safety net hospital that cares for the city's poor. Some were angry that they were not given an opportunity review the complex, 34-page legal document before a vote by the board.

Concerns have also been raised about who would make up the new nonprofit board. Critics say the city's white business community is eager to privatize the hospital, putting the interests of profits over patients.

``I think we're at the end of the beginning,'' said Sen. Vincent Fort, D-Atlanta, who has been critical of the plan. ``We're not alarmists, but you can only go by recent history and what you've seen people do and say. The language here is artful, but it doesn't get us where we want to be.''

Fort said he was concerned that a nonprofit governing board would seek to cut services like the hospital's dialysis center and pharmacy. According to the agreement, the new authority would ``irrevocably, absolutely and unconditionally provide indigent care and operate the hospital as a safety net hospital.''

The agreement also states that the nonprofit board could not cut back or cut off services now being provided unless doing so doesn't negatively affect the community's health needs, the services are being underused or are available elsewhere, or is harmful to the overall operations of the hospital.

Grady was looking at a deficit of as much as $55 million by the end of 2007, and has been scrambling for months to find a solution. The hospital also estimates it needs as much as $300 million in improvements to its infrastructure and modernization of its equipment and technology.

The Metro Atlanta Chamber of Commerce in July proposed that Grady change its governing structure to create a nonprofit board to control daily operations, though the current board would retain ownership of the health system.

Under the terms of the agreement, the Grady Memorial Hospital Corporation would be created as a 501(c)(3) and composed of 17 members, four of whom would be members of the current board.

The nonprofit board would have a 40-year lease agreement with the current board. Several conditions of the proposal hinge on that agreement, including:

A $200 million, four-year commitment from the business, charitable and philanthropic communities including $50 million in cash or in escrow before the lease agreement is executed;

A commitment to raise $100 million in private donations over four years by the same groups.

The lease agreement would not be enforceable for at least 60 days, and the new board must first get nonprofit status approval.

On the Net: Grady Health System: http://www.gradyhealthsystem.org (Copyright 2008 by The Associated Press. All Rights Reserved.)