By NC Health News staff
PFAS, 1,4 dioxane still troubling NC waters
In the Wilmington area, the reaction was swift to news in 2017 that potentially unhealthy levels of GenX and other “forever chemicals” had been found in drinking water drawn from the Cape Fear River.
There, officials had someone to blame. The state Department of Environmental Quality determined that the Chemours chemical company was fouling the river and air with per- and polyfluoroalkyl substances — a group of chemicals commonly known as PFAS. Chemours has been fined $12 million and ordered to clean up the contamination.
But far upstream, along the Haw River, it’s much harder to determine where PFAS and the likely carcinogen 1,4 dioxane are coming from.
In Pittsboro, news that drinking water containing potentially harmful levels of contamination wasn’t getting to residents. In February, Mayor Cindy Perry estimated that only 200 of the town’s 10,000 water customers were aware of it. Pittsboro is the only town to draw its drinking water from the Haw River.
NC Health News reporter Greg Barnes spent the next four months investigating the contamination in Pittsboro, including a trip to Michigan to compare citizen reaction to PFAS in a small town there to what is happening locally.
Shortly after we published his two-part report, Pittsboro’s town leaders agreed to notify residents by mail of the contamination. In October, about 200 people attended a forum near Pittsboro to learn more about their water problems. The town is considering buying an expensive filtration system.
Pittsboro’s water problems persist today. In October, the DEQ said a Greensboro company, Shamrock Environmental Corp., was responsible for a large release of the likely carcinogen 1,4 dioxane into the Cape Fear River basin in August.
About a week after that incident became public, another large release of 1,4 dioxane was disclosed, this time in Reidsville. Both releases caused levels in the drinking water for Pittsboro to spike far above what federal regulators consider safe.
The DEQ has taken punitive action against Greensboro and Reidsville, and in July it began an effort to determine which industries are polluting the watershed so regulators can make them stop.
Meanwhile, as more private wells surrounding Chemours are found to have PFAS, the company has just begun operating a multimillion-dollar thermal oxidizer that is expected to prevent 99 percent of airborne contaminants from leaving the plant.
North Carolina fails at delivering parity in mental health services
After an interview with former congressman and mental health advocate Patrick Kennedy, reporter Yen Duong became interested in the issue of mental health parity, or treating mental and behavioral health on par with physical health. Supported by Kennedy’s nonprofit foundation, the website Parity Track, put out a report on how well state policies protect parity for mental health patients.
North Carolina received an “F” on the report, which pointed out that one in seven mentally ill North Carolinians don’t access sufficient treatment for their conditions. This spurred Duong to write a five-part series on mental health parity in North Carolina.
A public records request for all parity-related complaints sent to the Department of Insurance resulted in two articles on how parity affects patients, some of whom emptied college savings and retirement accounts to pay for rehabilitation or buy drugs from Canada, and providers who struggle to make a living with low reimbursement rates.
“Basically, my sense is that what they do is wear you down, wear you down, wear you down until you can’t take it anymore,” said one of the patients, Maggie N. “And [you] say ‘whatever’—either I’ll not take these medications, which is not an option when it’s your mental health, or you just find the money.”
Despite complaints, NCDOI has not identified a systemic problem with parity in the state. Two people who founded separate companies to help patients file insurance appeals spoke about lower rates of overturned denials in the past several years.
“I have a stack of hundreds upon hundreds upon hundreds of external appeals where I would tell families ‘You have a very strong case, odds are we’re going to win, obviously I can’t promise’,” said business owner Scott Leshin. “Now, unfortunately, while I’m still happy to do appeals, I have to tell families, ‘Look, you’re up against a rigged system’.”
The final story focused on legislation in New York and Illinois, two other states with strong parity laws and enforcement, which could serve as case studies for solving parity issues in North Carolina.
The future of parity in the state is in question, as short term limited duration plans, mentioned in the first article of the series, have become more common and are not required to respect parity.
Wake Forest Baptist and Atrium agree to merge, or maybe not
While many news outlets focused on a potential new medical school for Charlotte, we wrote about the larger issue of consolidation of Charlotte-based Atrium Health and Winston-Salem based Wake Forest Baptist Health, announced in April.
As Atrium is a quasi-governmental private entity, it cannot expand more than 10 miles outside of Mecklenburg County. This means any cooperation between the two health care giants will have to be creative and avoid a direct purchase or merger.
“Both [Atrium’s] footprint already and Wake Baptist’s footprint is probably already beyond the cut off” for violating anti-trust laws, said Dr. Kevin Schulman, a Stanford University professor who was a long-time health economist at Duke University. In the spring announcement, Atrium and Wake Forest Baptist claimed there would be more details by the end of the year, but those details have yet to emerge.
Such a combination may boost the local economy, but at the expense of patients: already, Charlotteans pay prices 12 percent higher than the national average, but use health care services 20 percent less than the national average, per the nonprofit Health Care Cost Institute.
“For patients, usually, large mergers are not good,” said Dr. Ashish Jha, a Harvard University health economist. “As competition goes down, prices tend to go up and quality tends to get worse.”
An Atrium spokesperson pointed to expanding a successful Wake Forest value-based care program as a way to keep health care costs under control.
Only a month before the announcement, UNC officials published an op-ed of reasons why Charlotte doesn’t need a medical school.
“It’s not really clear to me why two hospital systems need to merge, in order to open up a medical school,” Jha said. “If Wake Forest wants to open up a medical school in Charlotte, they can.”
Change and upheaval become the norm for many North Carolina hospitals
North Carolina hospitals, particularly rural ones, have had an eventful year amidst continued challenges in the state’s health care market. Some signs of economic distress were evident as several hospitals across the state curtailed necessary but costly services. Continuing a trend from previous years, several facilities across the state shut down their maternity wards. One of these hospitals, Martin General in Williamston, signaled it wanted to keep offering gynecological services even as it wound down its obstetrical services. But after the hospital’s two obstetricians left, the hospital announced it will shut down its women’s clinic in early 2020. A neighboring hospital, Vidant Beaufort in Washington, signaled it would open a satellite obstetrics and gynecology clinic in town to try to attract new patients to its birthing center.
Earlier this summer, Vidant Beaufort had a closing announcement of its own, when it wound down its mental health unit, citing “the complexity of delivering health care in rural communities.”
And the state’s biggest county-owned hospital began exploring options for its future, including an affiliation or sale. New Hanover Regional Medical Center officials commenced the process several months ago amidst an intense public outcry.
But it wasn’t all doom and gloom for North Carolina’s hospitals. In August, the state health department unveiled the long-awaited Broughton hospital facility in Morganton. The facility, costing $130 million construction, debuted roughly five years later than the state intended and millions over budget.
In November, Chatham Hospital in Siler City announced that it will open a five-bed maternity unit staffed almost entirely by primary care physicians. The model, hospital officials said, will likely make the tiny unit financially sustainable even at lower birth volumes.
Later in November, one coastal hospital, Carteret Health in Morehead City, joined the prestigious Mayo Clinic Care Network. The network is a “clinical working relationship” that would grant patients and physicians at Carteret physician-to-physician consultations with Mayo experts, special staff trainings and patient access to Mayo’s clinical trials.
And at the beginning of 2019, Asheville-based Mission Health converted from it’s long-time not-for-profit status to becoming run by hospital behemoth HCA Healthcare, with an independent monitor looking over its shoulder.
Tussle over Medicaid expansion holds up the state budget
Finally, debate has continued this year on whether or not to expand the state’s Medicaid program to cover somewhere between 350,000 and 500,000 new beneficiaries.
The policy, made possible by provisions in the Affordable Care Act, would add these mostly low-income workers making between $6,250 and $17,236 each year to the more than 2 million low-income children, pregnant women, people with disabilities and seniors who currently receive health care through the program.
Since expansion became a possibility in 2012, advocates across the state have been pushing for the policy, but legislators in the Republican-dominated General Assembly have firmly said no, despite the fact that lawmakers in many so-called “red” states have chosen to expand.
The advocates got a boost when the results of the 2018 elections broke the Republicans’ veto-proof majority in the General Assembly. Gov. Roy Cooper also indicated he would not sign a budget without Medicaid expansion as part of the deal. Advocates also had reason to believe that this year would bring change when a group of Republican members of the state House of Representatives introduced a bill in April to use Medicaid as a vehicle to provide coverage for many low-income workers.
But when the state budget was presented in June, the policy was not part of the document. This set up a showdown between the governor and the legislative Republicans, who lack enough votes to override Cooper’s veto. As a result, North Carolina has not had an overall state budget since July.
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