The era of free or nearly free medical care at Atlanta's Grady Memorial Hospital is over for people who live outside Fulton and DeKalb counties, hospital officials said. People from Gwinnett, Cobb and other counties seeking non-emergency care began paying fees on a sliding scale based on income, effective April 1. About one in four indigent patients—about 37,000 patients a year—come from outside Fulton and DeKalb, officials said.