North Carolina Health News
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One Little Trim in the State Budget Makes Recreation Tougher for Tens of Thousands


By Rose Hoban

At Hanging Rock State Park, there are 60 sites where people can picnic, but only one table can be used by someone in a wheelchair.

People in wheelchairs who want to get onto the beach at Fort Macon State Park have been unable to unless they bring their own special wheelchair with oversized wheels.

Videos at state historic sites don’t have captions on them, rendering them meaningless for people with hearing problems.

Philip Woodward displays copies of ACCESS NC in both English and Spanish.

Philip Woodward displays copies of ACCESS North Carolina in both English and Spanish. Photo credit: Rose Hoban

One guy, Philip Woodward, a project manager with the Department of Health and Human Services, has been working to change all of that for the estimated 1.24 million North Carolinians who report a disability. According to the Carolina Population Center, about 717,000 people in North Carolina “have serious difficulty walking or climbing stairs.”

But Woodward lost his $41,000-a-year job on Oct. 31, the casualty of a cut in the final state budget passed by the General Assembly in late September.

Online only

The other thing cut in the budget was Woodward’s magnum opus: He was the man behind ACCESS North Carolina, a vacation and travel guide to state-run and state-managed sites expressly for people with disabilities. The budget repealed the part of state law that provided for ACCESS North Carolina.

“It’s a loss not just to the people who were working in the program, it’s a loss to every person with a disability and every family with children with disabilities who want to take advantage of the recreation in your beautiful state,” said Ron Pimentel, a disability activist who was in North Carolina last week to give the closing address at the annual GREAT (Global Rehabilitation Enhanced with Assistive Technology) conference in Raleigh.

“We offer it, or used to offer it, as a printed travel guide, and also made it available on CD and also online, depending on what that person’s needs are,” Woodward said. “But the legislature eliminated the funding and moved the funding to the roadside vegetation-management program.”

The product will still be available online. But he worried about the vast parts of the state, primarily in the east and in the western mountains, where there’s poor, if any, Internet and cellular access, making the resource inaccessible for people traveling to those areas.

ACCESS NC is 514 pages of information on how people with disabilities can access state parks and facilities.

ACCESS North Carolina is 514 pages of information on how people with disabilities can access state parks and facilities.

And without Woodward, the book won’t get updated.

“I tried to travel across the state and visit as many sites as possible to survey them for accessibility,” he said. He surveyed managers at state-run sites about accessibility and would also counsel them on improving accessibility for people of all abilities.

Woodward spent two and a half years traveling across the state research ACCESS North Carolina, all 514 pages of it, completing a major update in 2012. The book indicates whether sites are accessible, providing details such as “restrooms in the picnic area have 52-inch by 58-inch stalls,” important details for, say, a mother who needs to help her daughter in a wheelchair on and off of the potty.

The publication also gives shout-outs to places that engage in particularly good practices, such as the Fine Art Museum at Western Carolina University, where, the guide notes, “Staff has undergone etiquette training on interacting with visitors with disabilities.”

“I developed relationships with the tourism industry and the people who work at the sites,” Woodward said.

Money for upgrades

Woodward had a particular interest in making attractions useful for people with hearing disabilities. He’s had a profound hearing loss since the age of four.

The U. S. Census estimates about 130,610 North Carolinians between the ages of 18 and 64 have a hearing disability. And according to the National institute on Deafness and Other Communication Disorders, nearly 25 percent of people nationwide aged 65 to 74 and about half of those who are 75 and older have disabling hearing loss.

The other thing that was cut, along with Woodward’s job, was money for upgrades. When Woodward’s budget had leftover money, it went to the State Construction Office in the Department of Administration to do accessibility upgrades – a project at Hanging Rock to increase the number of picnic sites, for example.

“Picnicking is a big activity there,” he said. “They’re building an accessible picnic shelter for people of all abilities to be able to have more accessible opportunities.”

“Also, the state construction office told me earlier this week that beach wheelchairs that they ordered for Ft. Macon State Park just arrived,” he said.

But Woodward said he’s unsure of what the funding supply will be.

“They may or may not have the funding to do all the projects I have proposed, such as making all state historic site orientation videos captioned,” he said.

It takes someone with Woodward’s expertise and training to find the gaps in accessibility, said Monty Honeycutt of the Division of Vocational Rehabilitation. He noted that many able-bodied people think their facility or business might be accessible when it’s really not quite.

Honeycutt recounted a story of when his office was moving into a small strip mall in Asheboro.

“The landlord of the property was very proud of himself because he had more handicapped-accessible parking spaces than the law requires, and he was patting himself on the back,” Honeycutt said. “But every one of those spaces was on a hill,” rendering them useless for many people with physical disabilities.

“You don’t think about it if you don’t know,” Honeycutt said.

N. C. Medical Society Foundation Gets Grant to Improve Preventive Care in Rural Areas


By Taylor Sisk

The North Carolina Medical Society Foundation was last month awarded a $440,500 Kate B. Reynolds Charitable Trust grant to help health care providers in rural communities across the state form accountable care organizations.

The ACO model is based on physician practices making a commitment to preventive care and enhanced coordination of services while meeting quality-of-care benchmarks for a given population of patients.

Image courtesy College-Guide, flickr creative commons

Image courtesy College-Guide, flickr creative commons

The overriding objective is to achieve what’s now termed the “triple aim” of health care: a more satisfactory patient experience, improved health outcomes and lower per-capita costs.

The grant will support the formation of up to 15 rural ACOs over the next three years. ACO classification will allow the practices to receive financial benefits from the Centers for Medicare and Medicaid Services. If the practices save money on Medicare patients, they share the savings with CMS.

In 2013, a state legislature-convened advisory group proposed a version of Medicaid reform founded on ACOs, but legislators eventually settled on a different model.

‘Bag of medicines’

The NCMSF has partnered with CHESS, a High Point-based physician-managed health care services organization. According to the press release announcing the grant, CHESS will provide IT support; training in care coordination, patient-engagement skills and how best to integrate community health and faith community resources; and facilitate the “major culture shift as a practice moves to a value-based model of care.”

Lisa Shock is a network-development officer for CHESS and a practicing physician assistant. She practices in rural Person County, and said she has patients who end up in the emergency room or as a hospital inpatient and has no knowledge of it until they arrive for their next visit to her clinic with “their bag of medicines and their [papers] from the hospital.”

Improved care coordination, Shock said, means, for example, more telephone outreach and using every member of an interdisciplinary care team “to the top of their license.”

She said it means reaching out to a patient with heart disease to say, “‘Hey, are you checking your weight? Are you watching your diet? Can we coordinate your care and have a better understanding of what resources you might need?’”

And it means educating patients in how to most effectively spend their health care dollars.

In regards to the IT support CHESS will provide, Shock said an example is looking at claims data available from CMS to look for unhealthy patterns that can be addressed – something particular to a region or a practice.

She said CHESS has developed proprietary tools that assign risk scores.

“So we might say, ‘Mrs. Young has heart failure and she’s depressed and she lives alone.’ Those three things are putting her at higher risk. She’s having trouble breathing and she maybe doesn’t have good family support and is going to call 911 right away. She might need more attention and more monitoring,” Shock said.

“So we use the analytics to make better decisions about what resources need to be provided to patients and how we can deploy different members of our care team to deliver the highest-quality care for that patient.”

A shift

The transition to being an ACO, she said, requires a “real mind shift.”

The idea, Shock said, is that providers will be “paid for taking care of patients and measured on outcomes instead of ordering more tests, which is the fee-for-service mentality.”

According to the press release, this initiative will use the Medical Society’s Community Practitioner Program as the “foundation from which to recruit rural practices to take part.”

The Community Practitioner Program steers primary care physicians, physician assistants and family nurse practitioners to rural areas by providing grants in return for service in underserved communities.

“The Medical Society’s thinking is, ‘We have this entire cadre of providers who’ve been providing great care over many years. Why not tap into that as a basis for creating rural accountable care organizations across North Carolina?’” Shock said.

Also eligible for assistance will be federally qualified health centers, rural health clinics, critical access hospitals and hospitals with fewer than 100 beds.

According to the press release, while the initiative will benefit all patients, NCMSF estimates that an average of 60 percent of patients in each participating practice will be financially disadvantaged.

Should the Smoking Age Be 21? Some Legislators Say Yes


By Jenni Bergal


While a growing number of states have turned their attention to marijuana legalization, another proposal has been quietly catching fire among some legislators: raising the legal age to buy cigarettes.

This summer, Hawaii became the first state to approve increasing the smoking age from 18 to 21, starting Jan 1. A similar measure passed the California Senate but stalled in the Assembly. And nearly a dozen other states have considered bills this year to boost the legal age for buying tobacco products.

Since funding for North Carolina's teen smoking cessation program was cut, more teens are using nicotine, either by lighting up or using e-cigarettes.

Since funding for North Carolina’s teen smoking-cessation program was cut, more teens are using nicotine, either by lighting up or using e-cigarettes. Photo courtesy Nerissa’s Ring, flickr creative commons

“It really is about good public health,” said Democratic Hawaii state Sen. Rosalyn Baker, who sponsored the legislation. “If you can keep individuals from beginning to smoke until they’re at least 21, then you have a much greater chance of them never becoming lifelong smokers.”

Supporters say hiking the legal age to 21 not only will save lives but will cut medical costs for states. But opponents say it would hurt small businesses, reduce tax revenue and violate the personal freedom of young adults who are legally able to vote and join the military.

Measures to raise the smoking age to 21 also were introduced this year in Massachusetts, New York, Oregon, Rhode Island, Utah, Vermont, Washington and the District of Columbia, according to the Preventing Tobacco Addiction Foundation, an advocacy group aimed at keeping young people from starting to smoke.

Iowa and Texas considered measures to increase the legal age to 19. None of those bills passed. And just last week, a Pennsylvania legislator introduced a bill to up the minimum age there to 21.

Cities act first

In almost every state, the legal age to buy tobacco products is 18. Four states – Alabama, Alaska, New Jersey and Utah – have set the minimum at 19.

Anti-tobacco and health care advocates say that hiking the smoking age to 21 is a fairly new approach in their effort to reduce young people’s tobacco use. Until recently, research on the topic has been somewhat limited, they say.

That hasn’t stopped a growing number of local governments from taking action on their own in the last few years. As of late September, at least 94 cities and counties – including New York City; Evanston, Illinois; and Columbia, Missouri – had passed measures raising the smoking age to 21, according to the Campaign for Tobacco-Free Kids, an advocacy group that promotes reducing tobacco use.

One of those communities is Hawaii County, the so-called “Big Island” of Hawaii, where the law changed last year after a grassroots effort by health care advocates, anti-smoking groups and local high school students. That coalition, joined by teens from across Hawaii, continued its fight at the state level, and legislators heard the message, said Baker, whose bill also included e-cigarettes, battery-powered devices that deliver vaporized nicotine, which have become popular among young people.

Cutting the ‘pipeline’

Supporters of raising the smoking age to 21 say that a turning point was a March report by the Institute of Medicine, the health arm of the National Academies of Sciences, Engineering and Medicine, which predicted that raising the age to 21 would cut smoking by 12 percent by the time today’s teenagers are adults and would result in about 223,000 fewer premature deaths.

The institute’s report also supported health care advocates’ argument that preventing or delaying teens and young adults from experimenting with smoking would stop many of them from ever taking up the habit. About 90 percent of adults who become daily smokers say they started before they were 19, according to the report.

“Raising the age to 21 will keep tobacco out of high schools, where younger kids often get it from older students,” said John Schachter, state communications director for the Campaign for Tobacco-Free Kids. “If you can cut that pipeline off, you’re making great strides.”

A man smokes an e-cigarette. Often the devices are made to look like traditional cigarettes. Photo by Taylor Dahlin, flickr creative commons

North Carolina receives more than $140 million from the tobacco company master settlement agreement, but spends only $1.2 million on smoking-cessation programs. Photo credit: Taylor Dahlin, flickr creative commons

California state Sen. Ed Hernandez, a Democrat who sponsored a measure to raise the smoking age, said it’s good public policy.

“If we make it a law to drive with your seat belt on to protect the consumer, or to require helmets for people on motorcycles, why can’t we raise the smoking age to protect young adults from becoming addicted to tobacco?” he said.

Supporters also point out that 21 became the national legal drinking age after President Ronald Reagan signed legislation in 1984 that forced states to comply or risk losing millions of dollars in federal highway funds. That has resulted in reduced alcohol consumption among young people and fewer alcohol-related crashes, national studies have found.

“President Reagan thought young people were not ready to make this decision to drink or to drink and drive before they turned 21,” said Rob Crane, president of the Preventing Tobacco Addiction Foundation. “Smoking kills more than six times as many people as drinking.”

Personal choice

Opponents say that raising the smoking age to 21 would have negative consequences for businesses, taxpayers and 18-year-olds who should be free to make a personal choice about whether they want to smoke.

Smokers’-rights groups, retailers and veterans’ organizations are among those who’ve opposed such legislation.

“If you’re old enough to fight and die for your country at age 18, you ought to be able to make the choice of whether you want to purchase a legal product or not,” said Pete Conaty, a lobbyist for numerous veterans groups who testified against the California bill. “You could enlist in the military, go to six months of training, be sent over to Iraq or Afghanistan and come back at age 19 and a half to California and not be able to buy a cigarette. It just doesn’t seem fair.”

Opponents say it’s wrong to compare cigarettes with alcohol. “If you smoke one or two cigarettes and get behind the wheel of a car, you’re not driving impaired,” Conaty said.

Opponents also say taxpayers would take a financial hit if the smoking age is raised because it would mean less revenue from cigarette taxes.

In New Jersey, where a bill to hike the smoking age to 21 passed the Senate last year and remains in an Assembly committee, a legislative agency estimated that tax revenue would be reduced by about $19 million a year.

Photo credit: Valentin Ottone, flickr creative commons

According to UNC-Chapel Hill researcher Erin McClain, annual health costs in North Carolina directly caused by smoking tops $3.8 billion per year. Photo credit: Valentin Ottone, flickr creative commons

In California, a fiscal analysis by the Senate appropriations committee estimated that raising the age to 21 would cut tobacco and sales tax revenue by $68 million a year. That would be offset by what the analysis said could be “significant” health care cost savings to taxpayers, reaching as much as $2 billion a year.

Stores that sell tobacco products and e-cigarettes also fear the effect. The Hawaii Chamber of Commerce opposed the measure there. And Bill Dombrowski, president of the California Retailers Association, suggested that raising the smoking age would simply drive young people to the black market.

“If you raise the age, people under 21 will find the cigarettes somewhere else,” he said.

Health care savings

Cigarette smoking is the leading cause of preventable death in the U.S. and is responsible for more than 480,000 deaths a year, according to a 2014 U.S. Surgeon General report, which said the direct medical costs of smoking are at least $130 billion a year.

Supporters of the 21 smoking age say that the savings in health care costs, especially through Medicaid, the federal-state health insurance program for the poor and disabled, will far outweigh any loss in tax revenue for states.

Schachter and other advocates say Hawaii’s action, along with that of dozens of cities, will help spark legislation in other states and create a new standard for when young people take their first puff.

“There is momentum on this issue, and I think you’re going to see more and more states and cities moving in that direction,” Schachter said.

Turning 65 In 2016 Could be Expensive for Many N.C. Seniors

UPDATE: The U.S. Senate passed this bill after midnight Thursday night/ Friday morning, and it’s on its way to Pres. Barack Obama’s desk, where he is expected to sign it.


By Rose Hoban

About 109,000 North Carolinians turn 65 next year and will be eligible for Medicare, the program providing health care coverage for seniors.

But many new Medicare recipients are going to be in for a big financial surprise, courtesy of low inflation.

That’s because Medicare recipients pay a premium for Medicare Part B, the portion of the plan that pays for doctor and outpatient care. Since 2014, that premium has been $104.90 per month, said Gina Upchurch, leader of Durham’s Senior Pharm Assist, a program that helps seniors access medications.

“When we see people who are new to Medicare, they’re often shocked at how much cost sharing is involved,” she said.

Upchurch also explained that federal law requires that the premiums paid by seniors across the U.S. for Medicare Part B go towards paying for the program; so, as program costs go up, the premiums paid by seniors also tick up.

But if inflation is low, and there is no cost-of-living adjustment for people on Social Security, a different federal law prohibits raising that rate.

This year, there’s no Social Security cost-of-living adjustment and the cost of providing Medicare Part B has increased, putting those two federal laws in conflict.

So how will federal accountants reconcile the budget gap that’s opened?

New Medicare recipients.

Happy Birthday! Now pay up!

People who turn 65 in 2016 will have to bear the brunt of the difference between what Medicare Part B needs and what’s available from current recipients’ premiums, paying about 50 percent more for their premiums. Others who will be paying higher premiums are those who have high incomes: more than $85,000 per year for a single person and $170,000 for a couple.

Since 65-year-olds haven’t paid a premium before, their birthday present will be that their collective premiums will have to cover the difference between what current recipients pay and last year’s bills.

When it’s all said and done, newly eligible Medicare recipients will be staring down premiums that are estimated to be around $159. That’s a cool $650 more per year than their brothers and sisters born before 1951 will be paying. Those folks’ premiums will stay at the $104.90.

Turns out that’s a bitter pill for many seniors to swallow – in particular, the low-income folks who make up the bulk of retirees.

“When we put $30 back into someone’s Social Security check, it’s meaningful when you live to such a strict budget,” said Carla Obiol, senior deputy commissioner at the N.C. Department of Insurance. Obiol has been involved in the Seniors’ Health Insurance Information Program since it’s inception in the 1980s.

Obiol said that extra $40 could be the amount a senior sets aside for groceries for a week, or medicines.

“They’re retired, they’re not working, there’s no new money coming in,” she said. “They have a set amount of money. And people are living longer, so that nest egg has to be stretched out.”

Congress has said it wants to do something about fixing the problem. A proposed budget agreement passed out of the U.S. House of Representatives on Wednesday would cap the premium increase at $120 per month.

How did N.C. lawmakers vote on the budget bill?

Yeas: Pittinger, Butterfield, Price, Adams, McHenry, Walker, Rouzer

Noes: Ellmers, Foxx, Holding, Jones, Meadows

Not voting: Hudson

Because Medicare statutes require that the program be solvent, capping premiums would require Medicare to take a loan from the federal government’s general fund.

But that will need to be paid back, in the form of higher premiums for all Medicare beneficiaries.

“The cost of limiting the increases in 2016 will be paid for by a loan of general revenue from the Federal Treasury to the Part B Trust Fund,” read a press release from the D.C.-based Center for Medicare Advocacy. “Medicare beneficiaries will pay back the loan over time from set increases to future premiums.”

That House budget deal now goes to the Senate.
Cash Register image

Medicare: Not as cheap as you think

There’s a lot of small print in the Medicare program, which means seniors pay quite a tidy sum for their “free” health insurance.

Under traditional Medicare Part A, which covers hospitalization costs, the government pays 80 percent of all those bills. So seniors are on the hook for 20 percent of increasingly expensive hospital care, unless they purchase so-called “Medi-gap” insurance policies.

Those policies can cost a couple thousand dollars a year, and can include deductibles.


Medicare Part B, the subject of this story, pays for doctors and outpatient visits. If your individual income is below $85,000 per year, your premium is $1,258 per year.

Part B also includes deductibles, but the deductible for this year hasn’t been determined yet because of the confusion over premiums.

It currently is $147 and likely to go up,” said Senior Pharm Assist’s Upchurch. “That is not kept in check just because [there’s] no Social Security cost-of-living allowance.”


Medicare drug insurance, called Medicare Part D, requires seniors to purchase separate insurance policies for pharmaceutical coverage. Premiums for that coverage in North Carolina range between $18.40 and $120.50 per month. That cost doesn’t include deductibles and changes in coverage that kick in when beneficiaries hit the infamous “donut hole” of coverage.

According to Upchurch, the Affordable Care Act will phase out the donut hole, reducing confusion somewhat.

“I can’t wait for that, when its easier to explain!” she said.


Finally, a senior can opt into a more all-encompassing Medicare Advantage plan, where private insurers cover all of a senior’s medical needs for one monthly premium. But those aren’t free either. Prices for those plans range all over the map, literally: Every one of North Carolina’s 100 counties has different plans, offered by different insurers, at different prices.

One thing to know: If a senior is low-income, they’re eligible for assistance from the federal government to help pay their premiums and deductibles.

Want to know about your Medicare choices? The best resource is to give the Seniors’ Health Insurance Information Program a call at 1-855-408-1212 (toll free) or log in and find a SHIIP counselor in your county.

McCrory Caps a Busy Year for Environmental Rewrites


By Gabe Rivin

Gov. Pat McCrory has given his signature to a bill that eliminates several environmental rules, including requirements for idling trucks and farmers who want to burn agricultural plastics.

In signing HB 765 on Oct. 22, McCrory capped a 2015 legislative session that included numerous efforts to redefine the state’s rules for polluters.

HB 765, the Regulatory Reform Act of 2015, is a broad piece of legislation, which, among other things:

  • eliminates restrictions on heavy-duty vehicles’ idling;
  • requires that the state potentially stop using some air pollution monitors;
  • allows some farmers to burn agricultural plastics instead of sending them to landfills or recycling them;
  • and prohibits the state from enforcing new federal rules governing air pollution from wood heaters.

Environmental groups, which had lobbied McCrory to veto HB 765, decried the bill’s passage into law.

Governor McCrory signed HB 765, a bill that rewrites several envirionmental rules.

Gov. McCrory signed HB 765, a bill that rewrites several environmental rules. Photo courtesy the
governor’s office

“This bill undoes so much of the progress our state has made in the last decade to clean up our air and water, build healthier communities, and create a stronger workforce,” said Dan Crawford, the director of governmental relations for the N.C. League of Conservation Voters, according to a press release. “Now, using false claims about how these regulations were holding back business, our governor and legislative leaders have allowed polluters to have their way with our natural resources and the future prosperity of our state.”

But the N.C. Department of Environmental Quality, until recently known as the Department of Environment and Natural Resources, applauded the bill. In a blog post Oct. 26, the department wrote that the new law “will help focus resources on the environmental issues that matter most and improve environmental protection.”

HB 765 isn’t the only new law from this year’s legislative session that addresses environmental issues. On Sept. 30, McCrory signed SB 513, the Farm Act of 2015. The new law allows some older, retired hog farms to reopen without meeting new requirements to control animal waste.

And in June, McCrory signed HB 795, a bill that rewrote central provisions of the State Environmental Policy Act, or SEPA. Like the regulatory reform bill, HB 795 received widespread criticism from environmental groups, who said it effectively repealed SEPA, a decades-old law that requires the state to consider environmental effects from some state-funded projects.

Rep. Chuck McGrady (R-Hendersonville), a vice chairman of the House Environment Committee, also criticized SEPA reform, echoing environmentalists’ claim that the bill was essentially a repeal of the older state law.

Yadkin County Leaders Work Toward Reopening Hospital


By Taylor Sisk

As crews of workers continue the task of cleaning and mending the shuttered confines of Yadkin Valley Community Hospital, Yadkin County officials report they’ve made progress in once again providing hospital services to their constituents.

County Manager Lisa Hughes inside the abandoned hospital.

County Manager Lisa Hughes inside the abandoned Yadkin Valley Community Hospital. She said county commissioners are pondering several paths for re-opening the hospital. Photo credit: Taylor Sisk

In August, the county signed agreements with two firms to explore the financial and structural viability of reopening the hospital, which was closed in July by its previous operator, HMC/CAH Consolidated Inc.

In a press release last week, the county board of commissioners said they’ve now received the two firms’ reports and are “very pleased” with the findings. “While there is still work to do to re-open the facility, or even parts of the facility, the Commissioners are very excited with the opportunities for revitalizing health services in Yadkin County for the citizens,” the release states.

The firms, Spectrum Health Partners and Criterion Healthcare, provided overviews of their findings to the commissioners during a special meeting last Thursday night.

Tennessee-based Spectrum conducted a financial analysis that included an assessment of public support for a hospital in the county and potentially viable models.

County Manager Lisa Hughes said this week that Spectrum recommended two options.

One would be to convert the hospital into an ambulatory surgery center, but Hughes said the county isn’t interested in pursuing that option.

The other option is a full hospital with about 20 beds.

“The Spectrum report demonstrates from a financial perspective that the community has supported a hospital in the past, with an Emergency Department, diagnostics, inpatient beds and physicians’ offices,” the county’s press release reads, “but it was not managed well.”

The hospital is licensed for 22 beds, but was seldom near capacity. Hughes said Spectrum’s recommendation is for a combination of inpatient, observation and palliative care beds, along with “swing” beds that can either be used for acute care or short-term nursing home-style care. Hughes said the county might also consider introducing geriatric inpatient care in the future.

Spectrum suggests that the “proper mix of services matched with doctor recruitment and proper management will result in a very successful hospital.”

Hughes concurred, saying that more efficient management and a more attractive financial arrangement would contribute to a successful formula. She said that while HMC/CAH charged the county a 9 percent management fee, Spectrum suggests a fairer market rate is between 4 and 5 percent.

“The biggest thing to glean is that they said a hospital can work here,” Hughes said.

Criterion Healthcare conducted a physical analysis of the facility.

The current facility was built in 1952, with additions made several years later and again in the ’70s, ’80s and ’90s.

Criterion found that most of the electrical and mechanical systems throughout the facility are decentralized and self-contained. Hughes said breakers and switches from 1959 were still being used.

She said the county was aware that the HVAC system was in need of repair and that much of that work is completed.

Criterion recommended that some services be moved to other locations.

‘Amazing opportunity’

James McGraths served as the hospital’s medical director and also conducted his private practice in the facility. When the hospital was closed, his practice was likewise shut down. McGrath reopened his practice on Oct. 1, and Hughes said he’s staying busy.

She said other physicians might be moving in as soon as within the next 60 to 90 days.

James McGrath’s hospital-based practice was shut down.

James McGrath’s hospital-based practice was shut down when the hospital closed. Now he’s back working in the old facility. Photo credit: Taylor Sisk

Hughes added that the county is exploring several partnership options for operation of the hospital and that they remain in negotiations with Hugh Chatham Memorial Hospital in nearby Elkin about taking it over.

The board of commissioners continues to review the reports, will hold further discussions and will then develop a plan to reopen, Hughes said.

She said her guess is that the hospital will reopen “little by little, adding different services and making sure, financially, that it’s going like we want and need it to go until we get back to the point where we do have it fully reopened as a hospital.”

“We are seeing that a hospital is certainly viable in Yadkin County,” Kevin Austin, chair of the Yadkin County Board of Commissioners, said in the press release. “There is an amazing opportunity here to create a new model for healthcare, not only for Yadkin County, but one that will be the example for communities like ours all over the Country.”

Yadkin Valley Community is among three hospitals to close in rural North Carolina towns in less than two years. Vidant Pungo Hospital in Belhaven shut down in February of last year and Franklin Medical Center in Louisburg closed earlier this month.

Convenience Drives Spike in Fair Flu Shots


By Rose Hoban

Thousands of people are likely on track to get their flu shots at this year’s N.C. State Fair, which runs through this Sunday.

Last weekend, more than 700 people got their arms jabbed with this year’s flu formulation, said Jenna Huggins from Mutual Drug, who is coordinating two tents at the fair, one near the Village of Yesteryear exhibit and the other near Dorton Arena.

Raleigh real estate appraiser Steve TKTK said you can't beat the State Fair for convenience when it comes to getting his annual flu shot.

Raleigh real estate appraiser Steve Kubera said you can’t beat the state fair for convenience when it comes to getting his annual flu shot. Photo credit: Rose Hoban

Mutual is a wholesale drug company that supplies hundreds of independent pharmacies in Virginia and North and South Carolina. The company took over the service from Walgreen’s and Kerr Drug, which had offered shots in the past.

Huggins said that by mid-afternoon Monday, about a hundred people had gotten shots, guided through the 10-minute process with the help of students from Campbell University’s pharmacy program.

“They’re all able to give vaccinations, as well as talk to the patients,” Huggins said. “They love talking to patients.”

“You can’t beat it for the convenience,” said Steve Kubera, a real estate appraiser from Raleigh. He said he gets his shot annually because he’s in and out of a lot of houses. “If i don’t work, I don’t get paid, so I’d rather not take chances with the flu.”

Mutual enlisted small independent pharmacists from all over the state to run the tents at the fair, because the distribution company isn’t authorized to do the actual immunizations. Pharmacists from Raleigh, the Charlotte area, Siler City and Lincolnton have already pulled shifts there.

Joyce Liverman, a pharmacist from Drugco Discount Pharmacy in Roanoke Rapids, was running the tent near the Village of Yesteryear on Monday. She said it was the first year her organization was involved in the state fair flu shots, and it wouldn’t be the last.

Pharmacists have been allowed to give flu shots in North Carolina for years. But they’ve been permitted to give an expanded range of shots since the N.C. General Assembly changed the law in 2013. Liverman said now that pharmacists are allowed to give more shots, more folks are getting them.

Practicing what you preach: Reporter Rose Hoban gets her annual jab

Practicing what you preach: Reporter Rose Hoban gets her annual jab. Photo credit: Jenna Huggins

“It’s a lot easier than waiting to get an appointment, going to sit in the doctors office and waiting,” Liverman said. “It’s very convenient.”

She said it costs about $25 for the flu shot and that most insurance plans cover pharmacists giving the shots.

Greensboro resident Gail Coleman said that a couple of years ago one of the pharmacists from the tent at the fair helped her set up getting a shingles shot back in her hometown.

“I get my flu shot at the fair every year,” she said.

Unlicensed Nursing School Sent Unqualified Students into Workforce


By Ariella Monti

NC Consumers Council

A phony nursing school in Fayetteville is in hot water after it charged students hundreds of dollars for unlicensed, unaccredited medical courses, according to the North Carolina Department of Justice.

After graduation, students were either unprepared or ineligible for jobs in the field.

Following a complaint by the state attorney general’s office, a Wake County Superior Court granted a request to temporarily bar North Carolina Medical Institute and its owner, Sherita McQueen, from advertising, offering, or accepting payment for any educational products or services.

Often, patients who are readmitted after being sent home from the hospital return through the emergency room. Photo shows nurses rushing a patient on a gurney into a doorway.

Image courtesy Trust for America’s Health

According to the complaint, the school potentially endangered patients by certifying some students as qualified nursing aids even though they completed far less training than required by law. N.C. Medical Institute used a former employee’s nursing license and social security number to enter 50 unqualified Nursing Aide II students into the State Board of Nursing’s electronic registry, which permitted them to get jobs.

The school continued to operate even after losing its license in May for advertising and enrolling students in unlicensed courses, employed unapproved teaching instructors and presented misleading information to the State Board of Community Colleges. An affidavit filed by a state Board of Nursing employee stated that the school continued to offer a Nursing Aide II program despite repeatedly failing to meet state requirements.

McQueen continued to tell prospective students that the courses were accredited and charged fees as high as $800 per class. Once students completed their studies, they found themselves unprepared or ineligible for jobs.

Seeking out vocational training through a private institution may be a good option for some, but prospective students should do their research before enrolling. Trade and technical schools are regulated by the NC Community College System. More information can be found by clicking here.

Franklin Medical Center in Louisburg Ceases Operations


Novant Health announced that the facility, located 30 miles northeast of Raleigh, will shut its doors on Friday after several years of declining business.

By Taylor Sisk

Winston-Salem-based Novant Health announced that Franklin Medical Center in Louisburg will cease operations at 7 a.m. on Friday, after several years of declining utilization.

Louisburg, the county seat of Franklin County, is 30 miles northeast of Raleigh.

As of Friday, Franklin Medical Center will be shut down. Photo credit: Taylor Sisk

As of Friday, Franklin Medical Center will be shut down. Photo credit: Taylor Sisk

Novant said in a press release that it will work with patients on an individual basis to coordinate ongoing care and with staff to find new employment.

This is the third rural hospital closure in North Carolina in less than two years. Vidant Pungo Hospital, in the eastern North Carolina town of Belhaven, closed in February of last year, and Yadkin Valley Community Hospital, in the central region of the state, closed this past May.

According to the National Rural Health Association, more rural hospitals have closed since January 2013 than in the previous decade combined.

Declining use

“The decision to close a hospital may be the most difficult one a health system ever faces,” Novant senior vice president Patrick Easterling said in the announcement. “We care deeply about our patients and the communities we serve, and this is something we take very seriously.”

But, Easterling said, utilization of Franklin Medical Center has “declined significantly over several years.”

Novant reconfigured the hospital last October, eliminating all but 15 of its 70 inpatient beds. Thirteen of those 15 were reserved for seniors with dementia and other geriatric disorders. Novant reported at the time that its average inpatient count for the year was fewer than 20.

Signs supporting Pungo Hospital dot the roadsides near Belhaven, a small coastal town. Belhaven's single stop light is visible in the distance in this 2014 photo.

Signs supporting Pungo Hospital dot the roadsides near Belhaven, a small coastal town. Rural hospitals are often the economic drivers of their towns, and one of the largest employers. Credit: Hyun Namkoong

Rural hospitals are facing a number of challenges today, including less need for inpatient beds as more procedures are performed on an outpatient basis.

A ‘savior’

Novant officials wrote last week that the “decision to cease operations comes after more than a year of intensive discussions, operational changes and exploring alternatives to keep the doors open. It also comes after significant investments by Novant Health to improve the hospital, including a 7,500-square-foot geriatric behavior health unit in 2013.”

Chris Szwagiel, Franklin County’s health director, said Novant put out a prospectus in hopes someone would be interested in taking over operation of the hospital. “But,” he said, “evidently, the timetable expired and they decided the only recourse for them was to board up.

“I think everybody was hoping somebody would come in and be the savior, and that just didn’t happen. At least not yet.”

Szwagiel said he anticipates his department will be tasked to do triage to assess where to send people, and that he will be relying heavily on the county’s EMTs to get people as quickly as possible to where they need to go.

The nearest emergency department is at Maria Parham Medical Center in Henderson, about 20 miles away, but Szwagiel said most often the EMTs go to WakeMed, about 30 miles, because it’s a straight shot down U.S. 1.

Szwagiel said he’s working to secure partners to provide at least short-term solutions to needs – partnering with Wake Radiology in Wake Forest, for example, and bringing mobile mammography into the county.

“We’re working to ramp up in general,” he said.

This situation, Szwagiel said, “has left us in a big lurch.”

Many Hospitals Don’t Follow Guidelines for Child Abuse Patients, Study Finds

By Alana Pockros

Kaiser Health News

About half of young children brought to hospitals with injuries indicating that they have been abused were not thoroughly evaluated for other injuries, and the use of proper care is less likely to happen in general hospitals than in those that specialize in pediatrics, a study released this summer found.

The researchers examined whether hospitals are adhering to guidelines from The American Academy of Pediatrics that all children younger than 2 years old suspected of being victims of child abuse undergo skeletal surveys, a series of X-rays used to identify broken bones that are not readily apparent, called occult fractures.

The results, published in the journal Pediatrics, reveal a significant variation in hospitals’ evaluation of occult injuries, despite the AAP’s recommendations.

Image courtesy apdk, flickr creative commons

The Pediatrics study found many children being admitted to hospitals did not get adequate screening for signs of abuse, particularly when they end up at general hospitals. Image courtesy apdk, flickr creative commons

“In the young population, medical providers can miss important injuries.… Skeletal surveys can help identify them,” said Joanne Wood, an assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and senior author of the study.

Wood and her colleagues highlight the importance of skeletal surveys, explaining how the detection of occult fractures can point to the need for additional medical services, provide additional evidence of abuse and help protect the child.

The study looked at records for nearly 4,500 children treated at 366 hospitals around the country between 2009 and 2013. That group included children under the age of 2 who had been diagnosed with physical abuse and children under the age of 1 with high-risk injuries.

Past research has demonstrated that skeletal surveys are key to assessing young children suspected as victims of abuse. Prior to this study, however, there was little information on how hospitals in general have adhered to the AAP’s protocol.

Researchers in the current study found that across all the hospitals, 48 percent of the children younger than 2 with an abuse diagnosis underwent proper occult fracture examinations. But a prior study by Wood and her colleagues reveal that approximately 83 percent of children suspected of being victims of child abuse underwent skeletal surveys when treated in pediatric hospitals.

This study reveals “a need for standardization of care” across hospitals, said Wood.

Robert Sege,  the director of family and child advocacy at Boston Medical Center and member of the AAP Committee on Child Abuse and Neglect, said in an interview the disparity in hospital practices is due to “a big educational gap for colleagues who primarily see adults.”

“Doctors who treat children should be trained to know about [occult-evaluation] procedures when there is abuse suspicion,” he said.

In a commentary accompanying the study, Kristine Campbell, assistant professor of pediatrics at the University of Utah, suggested that follow-up research is necessary, as “no study reveals how often occult fractures provide the critical evidence to assure a child’s protection.”

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