Despite major administrative changes at Atlanta's Grady Memorial Hospital, the hospital's finance chief projects that the facility will run a deficit of $18 million to $43 million in 2008. On the higher end, that loss in a $618 million budget nearly matches the 2007 shortage and ranks among the largest in the hospital's history. Hospital officials say that while the hospital is turning around, major challenges such as rising healthcare costs, dwindling government aid and old equipment remain.