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By Catherine Clabby and Mark Tosczak

In today’s political climate, it can be a dangerous thing to try to predict the future. But each NC Health News reporter looked at what trends and stories they’ll likely be following in 2018. Today, we take a look at environmental issues that have affected the health of hundreds of thousands of North Carolinians and trends that could change how health care looks in the state.

Questions persist around Cape Fear chemical contamination

Big questions persist about how extensively a DuPont-built chemical plant polluted the Cape Fear River basin.

The Cape Fear River winds over 200 miles through central and eastern North Carolina. It is a source of water for industry and public drinking water systems. This aerial view captures Lock and Dam No. above Wilmington. Image courtesy U.S. Army Corps of Engineers.

It’s known that the site, now run by DuPont spinoff company Chemours, released unregulated GenX and related chemicals into drinking water wells nearby and into public drinking water supplies miles downstream in and near Wilmington. But how much was released and over how long? Were the amounts dangerous? Did any escape into the air? Were soils beyond the Bladen County complex tainted? What about food? A recent state disclosure that GenX was detected in honey late in 2017 chilled many neighbors.

The situation could be a test for Donald Trump’s EPA. When Republican George W. Bush was president, the EPA came down hard on DuPont for failing to report possible health risks linked to perfluorooctanoic acid (PFOA), a chemical used to make Teflon that GenX replaced. Will this administration’s EPA rule that Chemours violated a 2009 consent orderagreement banning the release of GenX from one site at the facility? There are also questions about whether the state Department of Environmental Quality will pull the company’s wastewater permit as agency leaders said they would after learning that Chemours did not disclose a GenX spill this fall.

Finally, the U.S. Attorney’s office in the Eastern District of North Carolina quietly started a grand jury investigation last summer. It remains unknown whether the panel’s findings will result in any legal action against DuPont, Chemours or any other entity.

How much coal ash must Duke Energy dig up?

Four years after more than 30,000 tons of coal ash spilled into the Dan River from a Duke Energy site in Eden, regulators in 2018 could decide how much coal ash the utility must dig up statewide.

A concrete pipe below this coal ash impoundment in Rockingham County failed, releasing coal ash and ash pond water into the Dan River in Feb 2014. Photo credit; USFWS/Steven Alexander

Duke owns more than 100 million tons of coal ash stored over decades in unlined pits at 14 properties near protected waterways, including the Eden site. Five were in poor enough condition that federal prosecutors cited Clean Water Act violations after the spill and Duke paid a $68 million criminal fine.

Duke is required to move ash at seven sites into lined landfills or recycling facilities. But staff from the state Department of Environmental Quality could allow impoundments at seven remaining sites to be capped only, staying in place so long as Duke gets alternative water supplies to nearby well owners and proves dams confining ash on the sites are sound. A final decision is due in November 2018 unless DEQ grants a one-year extension.

Duke has offered $5,000 goodwill payments, money for 25 years of water bills, and compensation for property value loss to neighbors. However, ill will persists. Property owners have sued the utility alleging environmental hazards near its Allen, Asheville, Belews Creek, Buck, Cliffside, Lee, Marshall, Mayo, Roxboro and Sutton plant sites.

Hog CAFO neighbors may get a day In court

Despite efforts by some legislators and the livestock industry to prevent it, neighbors to industrial-scale hog farms in eastern North Carolina seem poised to pursue monetary damages against hog farms.

Dave Hall, a farm manager at Butler Farms in Harnett County, interacts in this 2014 photo with one of the 6,000 pigs raised at that time for Prestage Farms in 10 barns. Photo courtesy of wholhognc.org, UNC-Chapel Hill.

U.S. District Judge W. Earl Britt in December rejected a plaintiff’s claim that state right-to-farm laws shield the operations from nuisance litigation. He said that trials in the first of 26 lawsuits against densely packed hog farms could start in April.

More than 500 people living near tightly packed swine barns have filed 26 suits under the state’s nuisance laws.They say animals in the facilities create offensive odors, fumes and toxic waste, and that neighbors deserve monetary damages for enduring it.

Last spring, some Republican legislators backed by hog and poultry trade groups tried to pass a law limiting court awards in these cases. After some Republican and Democratic legislators warned against meddling in ongoing court cases, a bill passed but exempted ongoing lawsuits.

Such nuisance lawsuits have increased nationally in recent years, with plaintiffs losing and winning. Some court awards have exceeded $10 million dollars. The North Carolina suits were filed against a subsidiary of WH Group, the Chinese food company that absorbed Smithfield Foods in 2013.

UNC Health Care/Carolinas HealthCare seek to join forces

UNC Health Care and Carolinas HealthCare announced Aug. 31 that they planned to form a new company to operate the two entities as a single system. It would combine dozens of hospitals, hundreds of other clinical facilities and thousands of doctors together in a single system — by far the largest in the state.

The proposed merger between UNC Healthcare and Carolinas could result in one of the largest hospital systems in the country. NCHN file photo.

The two systems said the deal would have positive impacts in four key areas: “increasing access and affordability, advancing clinical care expertise, growing their renowned academic enterprise and contributing to the region’s economic vibrancy.”

If the deal goes through, it would create a mammoth entity likely ranked as one of the largest health systems in the country. UNC and Carolinas had a combined $13.3 billion in total revenue in 2016; if that were a for-profit company, it would have ranked No. 208 on the 2017 Fortune 500 list of largest public companies.

Taking into account management agreements and other affiliations, it would put nearly half of North Carolina’s 125 hospitals under a single corporate umbrella.

But the announcement was immediately followed by a host of questions and concerns from health insurers, patients, state legislators and others.

Experts say they’re doubtful, especially, about whether even larger health systems can actually reduce health care prices.

Continued hospital realignment

For the last several years there’s been a steady drumbeat of hospital sales, mergers and acquisitions.

Morehead Memorial Hospital. Photo credit: Mark Tosczak

“Over the past 10 years we’ve seen kind of these waves of M&A activity,” said Steve Lawler, president of the North Carolina Hospital Association. Frequently, he says, they’re driven by cuts or changes to government health care spending that squeeze (or sometimes eliminate) hospital margins.

Expect that to continue in 2018.

High Point Regional Hospital, which was acquired by UNC Health Care in 2013, is being sold to Wake Forest Baptist Medical Center. Morehead Memorial Hospital in Eden, which filed for bankruptcy this summer, has inked a deal to sell itself to UNC. Greensboro-based Cone Health is exploring a deal to acquire Randolph Health. And far-western Murphy Medical Center is looking to sell itself to a system based in Tennessee.

“We still have a fair number of hospitals that are independent,” Lawler said. “There’s been a wave over the past year of hospitals that were independent that have chosen to be part of another system.”

Those mergers are not always an out-and-out sale, Lawler said, but it might mean, for example, a small hospital signing a management agreement with a larger hospital in hopes of gaining additional expertise and purchasing power that the smaller entity couldn’t muster on its own.

High-end care, such as complex surgeries or specialty care, is increasingly moving to large, urban hospitals, Lawler said. More of that care is delivered there, while he said smaller, more rural hospitals have to “reimagine their place and purpose in the market.”

“We’ve got a unique opportunity to create this remarkable incubator on how to solve the rural health care problem,” Lawler said. “But it is going to require an investment by someone.”

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...