With Jackson executives using end-of-life terms like ``death spiral'' and ``insolvency'' and a grand jury starting to investigate the public health system's problems, Miami-Dade Mayor Carlos Alvarez said Wednesday he would help get Jackson get a short-term loan but demanded its governing body speed up a decision on a recovery plan.

``At this point, delays are simply too costly to accept lightly,'' Alvarez wrote to Jackson Chief Executive Eneida Roldan, who has called for the Public Health Trust to approve a plan to cut $160 million by March 22. Alvarez wants to see a plan presented to the County Commission on Tuesday.

``I strongly urge you to continue to meet daily, including weekends, to ensure you can submit a realistic plan,'' Alvarez wrote.

Roldan did not immediately respond to a request for comment, but after the letter was sent, the Trust announced it will meet Friday.

``We're working as hard as we can,'' Trust member Abraham Galbut said. ``Every one of us is a volunteer.'' But he wasn't sure if the trust could get a decision as quickly as the mayor wanted, considering the complexities of Roldan's proposal to eliminate 4,500 jobs and close two suburban hospitals if additional funding is not found.

Meanwhile, Miami-Dade State Attorney Katherine Fernández Rundle said she had presented to a grand jury complaints about ``gross mismanagement'' at Jackson. Grand juries decide on their own what subjects to investigate, and testimony is secret. Two highly reliable sources have told The Miami Herald that the grand jury has started hearing testimony from witnesses.

Last month, Martha Baker, president of Local 1991 of the Service Employees International Union, sent a letter to Fernández Rundle calling for a grand jury to look at Jackson's executives as she demanded ``better accountability on the part of management'' and decried what she termed gross inefficiencies that caused the hospital to lose $244.5 million in fiscal 2009.

While it may take months for a grand jury report to be made public, Jackson's cash problems are immediate. The system is already late in paying many bills and it expects to be down to 1 ½ days of cash in early April unless it receives $67 million as a loan so that it could keep going until it receives a payment in special state-federal funds of about $90 million in late April.

Mayor Alvarez said Wednesday he had ``instructed the county manager to take a look at how we can come up with the money,'' but he expressed growing concern that Jackson's finances could drag down the county. By law, the county is responsible for paying Jackson's union workers if the hospital system can't -- about $80 million a month.

If Jackson runs out of cash in May -- as its financial people predict unless drastic measures are taken -- ``the county could face layoffs, further service reductions and a likely immediate drop in our bond ratings,'' the mayor wrote in a sternly word letter. ``This is simply unacceptable.''

Jackson's troubles could lead to cuts ``from existing county services in areas such as public safety, human services and economic development,'' the mayor wrote.

Roldan revealed her recovery plan last Friday and the Trust held a 12-hour meeting on it Tuesday -- at which the ``plan was discussed without any tangible progress,'' Alvarez said.

``I have reviewed your proposed recovery plan, and I am forced to conclude that it currently lacks detail and an in-depth, measurable implementation strategy,'' the mayor wrote. ``Further, I question how realistic many of your proposed reductions are and whether you are proceeding with the urgency demanded by the crisis.''