Wake Forest Baptist Hospital

Shows a woman in a McDonald's takeout window wearing a branded mask against COVID

Pandemic-related job loss nixes health insurance for nearly 200,000

July 15, 2020 by Rose Hoban

Pandemic-related job loss nixes health insurance for nearly 200,000 - North Carolina Health News

Medicaid advocates say expansion now would help rural and urban economies alike and provide health care to aid public health.

By Rose Hoban

North Carolinians interested in the fate of Medicaid expansion certainly are familiar with the characters and well-worn script, by now.

Now, in the middle of a pandemic, when many are losing jobs and health insurance and finding access to health care even more difficult at the precise time it should not be, expansion advocates took to the stage again to try to share their story in a different light.

Their performance was a virtual one. On Zoom, a stage that’s become all the more popular as COVID-19 circles the globe.

The N.C. advocates for expansion altered their well-worn script to include new numbers from the pandemic:

There could be from 100,000 to 191,500 North Carolinians among the newly uninsured.
Expanding Medicaid not only would help them provide care that is important for the public’s health, it also could lead to the creation of jobs in rural areas where hospitals have shuttered.

North Carolina is one of a dwindling number of states that has resisted taking billions of dollars of federal money to cover the Medicaid costs for hundreds of thousands of low-income workers who make too much to be eligible for the state- and federally funded program, but who also make too little to qualify for subsidized health insurance created as part of the 2010 Affordable Care Act.

As in many dramas where the characters are familiar and the script has been all too familiar, it’s difficult to imagine a different outcome.

In North Carolina, this production has been running since early 2013 when the North Carolina General Assembly removed the power of a governor to unilaterally expand Medicaid to cover low-income uninsured people.

No matter how much the audience and many of the actors hang onto their seats for a different outcome, the leadership in the state Senate is unlikely to take leave of its well-rehearsed lines.

No expansion.

“I don’t expect to see movement on any of these based on what we’re seeing from the legislature right now,” said Erica Palmer Smith, head of the Care4Carolina coalition that sponsored the video conference call on Tuesday. “I don’t see a pathway for any of these bills, based on legislative leadership’s statements and their intent not to deal with the coverage gap issue at this time.”

In advocates’ minds, the advent of the coronavirus pandemic has created an even stronger imperative to change the narrative around Medicaid expansion. Hundreds of thousands of North Carolina’s workers have lost their jobs since COVID-19 arrived in the state in early March, and as they lost their jobs, they’ve also lost insurance coverage.

Spotlight on increased need

A flurry of new research is attempting to put numbers behind the job losses.

It can be challenging to calculate rates of uninsurance, with tracking data about the number of uninsured usually lagging real time by more than a year. The U.S. Census currently displays data from 2019, which shows that 12.9 percent of North Carolinians lack coverage. The latest estimate of the rate of insurance from the North Carolina Institute of Medicine dates from fall 2018.

So, researchers have to look to other sources to make their estimates.

“It’s going to take us a year before we fully understand the economic consequences, the health care consequences of the pandemic,” said Jason Gray, an economist with the NC Rural Center during Tuesday’s webinar.

Gray cited recent statistics from the North Carolina Department of Commerce that show about 478,776 working-age adults lost their jobs as a result of COVID-19 in March, April and May.

graph shows an almost vertical drop off in employment statistics starting in march 2020, due to COVID — Employment took a nosedive in 2020 as the COVID-19 pandemic took hold in North Carolina. Graph courtesy: NC Dept of Commerce

He matched these numbers to a survey done by the Commonwealth Fund showing that 21 percent, to as many as 40 percent, of the newly unemployed lost health care coverage. Taken together, Gray estimated that as many as 191,000 could have lost coverage, not to mention their family members, who were covered under their policies.

“These are folks who are unable to afford their health needs, who are going to be economically distressed from, from being able to seek help,” he said. “These are people in dire need, and these are working people.”

Even before the start of the coronavirus pandemic, about 16 percent of North Carolina adults under the age of 65 were uninsured, the sixth-highest rate in the nation.

Gray’s estimates jive with a new report out Tuesday from Families USA estimates that at least 20 percent of working-age adults in North Carolina now lack insurance. Add to that their families’ losses of insurance, Families USA reckoned that at least 238,000 North Carolinians became uninsured this past spring.

Medicaid expansion would cover many, if not all, of these people, picking up 90 percent of the costs.

Economic benefit

According to an analysis done by researchers from the Economic Policy Institute using federal Department of Labor data, about 9 percent of North Carolina’s labor force were receiving unemployment insurance by the end of June, about 432,351 individuals. More than a quarter million (253,496) had also applied for or received pandemic unemployment assistance of $600/ month from the federal government.

Their analysis shows about 476,000 people lost employer-sponsored health insurance.

bar graph showing the number of people losing insurance coverage along with a job loss resulting from the COVID pandemic. — One of five adults who said that they or a spouse or partner had coverage through a job affected by COVID-19 reported that at least one of them
is now uninsured. Data, graph courtesy: Commonwealth Fund

The federal benefits have, in many cases, kept these workers’ lives and families intact. But the benefits are slated to sunset at the end of this month if Congress does not take further action. According to the Economic Policy Institute, a national policy think tank, Congressional inaction on this score could result in a total of 142,496 permanent job losses in this state.

The Rural Center’s Jason Gray talked about how in the most economically distressed counties in North Carolina, expansion would create a billion-dollar economic impact in the form of jobs, revenue to health care providers and all of the ripple effects created by economic activity. In addition, Medicaid expansion could provide up to $14 billion in local tax revenue throughout the state.

He said while most of Medicaid expansion’s additional jobs would take place in urban areas, the policy would also have a dramatic impact on rural coffers.

“Even in, say, in northeastern North Carolina, 1,200 jobs, 2,500 jobs down the far southwest,” he argued. “Even our most rural areas are going to benefit in terms of jobs.”

“It’s really important to realize that the greatest predictor of health is socioeconomic status and that’s comprised of three things: income, occupation and education,” said Karen Winkfield, an oncologist from Wake Forest Baptist Hospital and their director of community outreach. “We know that right now, income is being hammered by COVID-19.

“But someone’s occupation … can oftentimes dictate whether or not someone has access to health care.”

Plot twists

Medicaid is designed to be a safety net program that is counter cyclical, meaning that when the economy tanks, Medicaid rolls increase.

To date, though, North Carolina’s Medicaid enrollment has increased only modestly, by 100,665 beneficiaries (4.4 percent) since February, a smattering compared to the large number of people who lost employer sponsored insurance when they were laid off as a result of COVID-19 closures.

According to state Medicaid Director Dave Richard, Medicaid hasn’t bumped up much because of the federal legislation passed by Congress this spring which included those pandemic unemployment benefits. That’s allowed many people to keep paying their premiums and hold onto their coverage.

Many employers also kept people on insurance in the short term, even as they instituted furloughs.

There’s an even bigger reason recently laid-off workers haven’t swelled Medicaid’s rolls: it is almost impossible for a non-disabled childless adult to qualify for the program in North Carolina. Instead, all of the program expansion is among children.

Richard said he expects that as the supplemental unemployment payments phase out at the end of July more families will feel the hurt.

“We project that we’ll see a significant increase in enrollment as we go throughout this year,” Richard said. “The thing that’s difficult for us and every other state is to actually have a prediction model that works here. Because this, as we’ve all said, this is a totally different type of event. It’s not a typical recession, it’s something that has impacted people in different ways.

“You will continue to see those numbers rise and then depending how long, what happened to our economy, how long the public health emergency is in place … a significant increase.”

Because the General Assembly failed to expand the Medicaid program, many of these newly unemployed will eventually become uninsured, a plot twist not affecting people who lost jobs in expansion states.

According to insurance analysts Health Management Associates, Medicaid enrollment will likely increase dramatically around the country, while a “disproportionate share of the newly uninsured will be in non-expansion states.”

If the state had expanded, many of the newly uninsured would have fallen into the income range that would have the stcare, something of a happy ending.

Instead, HMA’s analysis notes that people in the 14 states that did not expand Medicaid, including North Carolina, comprise 30 percent of the individuals losing employer-sponsored coverage. Tragically, though, they will comprise 70 percent of those who will be newly uninsured by the end of the year.

Families of disabled struggle with hospital visitor restrictions

May 6, 2020 by Sarah Ovaska

Families of disabled struggle with hospital visitor restrictions - North Carolina Health News

N.C. advocates say hospitals are shutting out caregivers of disabled, potentially violating of federal law.

By Sarah Ovaska

Velvet Gammons rarely left the side of her disabled son Scottie, who had complex medical needs requiring around-the-clock care at their Mount Airy home.

But when Scottie, 32, went into Wake Forest Baptist Medical Center for treatment, staff at the Winston-Salem hospital told her that pandemic-related visitor restrictions meant she couldn’t be with Scottie in the ICU, despite his well-documented cognitive issues.

Scottie died on April 7, and the mother who pleaded to be able to be by his side was not there for his final breaths.

Gammons and several disability rights groups in the state argue that hospitals’ visitor restrictions in situations such as the Gammons’ violates basic civil rights provisions that should allow Scottie and others with intellectual or developmental disabilities access to their caregivers, even during the COVID-19 pandemic.

“How, when you are mentally [the same as] a child, can you be by yourself when you cannot speak for yourself, you can’t understand?” Gammons said she asked Wake Forest Baptist staff about Scottie.

Her son had myotonic dystrophy, a genetic condition that left him unable to speak and on ventilators and feeding tubes for much of his life.

Spokespeople for Wake Forest Baptist indicated that they could not comment on specific cases but the hospital does “make exceptions for a number of different circumstances” and staff is committed to providing compassionate care.

Advocacy groups sound alarms

The COVID-19 pandemic has upended much of how the state’s health care systems operate, initially delaying everything but the most essential surgeries as health care providers responded to the spread of the dangerous and highly contagious pathogen. Hospitals in North Carolina and elsewhere have enacted visitor restrictions to try to prevent the spread of the disease.

That means more patients are alone, although access has been given to those deemed essential such as parents or guardians for pediatric patients, as well as allowing the birth partner of a woman in labor to be by her side.

But pushed aside in some instances have been the caregivers of those with disabilities, both adults and children, said John Nash, executive director of the Arc of North Carolina, an advocacy group for those with intellectual disabilities. He has heard of four instances of caregivers in different parts of the state being denied access to their disabled loved ones in North Carolina hospitals and believes there are many more instances that he and other advocates haven’t heard about.

He believes this violates long-held principles outlined in the landmark 1990 Americans with Disabilities Act and other federal laws including the CARES Act, the recently passed COVID-19 stimulus bill.

“This is not just a request,” Nash said. “This is a part of a person’s civil rights.”

A parent or caregiver can often provide the only means a person with disabilities has to communicate or have their needs understood by hospital staff. Cutting off that connection jeopardizes health outcomes, he said.

“If we see someone in an ER or a hospital without those abilities to communicate, the chance of things going wrong goes way up,” Nash said.

The Arc and other advocacy groups such as the North Carolina Down Syndrome Alliance, N.C. Developmental Disabilities Consortium and Autism Society of North Carolina issued a letter for families to use if they are facing resistance from hospital administrators. The groups have also reached out to the N.C. Department of Health and Human Services in recent weeks as well to relay their concerns, but the state agency has yet to send out specific guidance to hospitals outlining what is and isn’t allowable.

That guidance is expected to come out today, however, according to N.C.DHHS.

Corye Dunn, the public policy director for Disability Rights North Carolina, said they too have heard from families encountering issues with hospital visitor restrictions. Most are able to eventually get hospital officials to relent, but even having to push to allow that access is contrary to what should happen, she said.

For its part, N.C. DHHS officials agree that those with disabilities have the right to have caregivers accompany them in the hospital, even in the midst of the COVID-19 pandemic, pointing to CDC and U.S. Health and Human Services’ advice on the topic.

“For individuals with a cognitive impairment, their caregiver is an extension of the individual with the impairment, and should be treated as such,” Kelly Haight Connor, a N.C. DHHS spokeswoman, said in a statement. “Unless it negatively impacts a facility’s ability to ensure the safety of other patients or visitors, anyone with a cognitive impairment should be allowed to have their caregiver with them either in the ambulance or in the hospital.”

Hospitals are waiting to see that guidance from NC DHHS directing them to do this, according to Cynthia Charles, a spokeswoman for the N.C. Health Association, the trade group that represents the state’s hospital systems.

Meanwhile, hospitals are making case case-by-case decisions on how to handle caregiver access for those with disabilities.

Families deal with access issues

Gammons was given some access to Scottie over the course of his five-day ICU stay at Wake Forest Baptist after a Greensboro television station aired a story about her plight early in his stay. She was allotted an hour visit each day, a situation that Gammons thinks introduced more risk of introducing COVID-19 into a hospital setting than if she stayed there the entire time, as she’d hoped.

Though glad she had those hour-long daily visits, she wrestles with not being able to comfort Scottie all those hours when he was without her.

“He would just look at me, and I know he was thinking, ‘why is Momma leaving me?’” Velvet Gammons said about those visits.

Visitor restrictions kept Randy Walker from seeing his son Landon, who has multiple disabilities. The photo shows Randy looking down at Landon, who is in bed with medical equipment attached to him. — Landon Walker, left, of Wilkes County with his father Randy during a previous hospital stay. (Photo courtesy of Walker family)

Gammons, who is a registered nurse with 30 years of experience, also wonders if Scottie would have survived his hospital stay had she been there. She contends hospital staff misinterpreted scar tissue on Scottie’s lungs from prior issues as a current bout with pneumonia and failed to properly treat the gallbladder issues that prompted the five-day hospital stay.

The parents of 26-year-old Landon Walker of Wilkes County faced similar issues when their son needed to be airlifted to Wake Forest Baptist late last month after low blood sodium levels brought on seizures.

Walker suffered traumatic brain injuries from an ATV accident at 17, leaving him completely dependent on his parents, Tracie and Randy Walker, with medical complications that required around-the-clock care. Landon is unable to talk or walk and uses a ventilator at night to breathe while an overnight nurse sits with him to ensure he’s safe while his parents sleep.

“We are his voice in every sense of the word, in every aspect of his life,” Tracie Walker said.

Wake Forest Baptist staff would not let either of his parents join him during this four-day stay at the hospital, citing the visitor restrictions enacted to keep the spread of COVID-19 low in the hospital, Tracie Walker said. He’s now back at the family’s home recuperating.

Nurses at Wake Forest Baptist accommodated the family as best they could, Walker said, setting up Zoom conference calls several times a day. It was during one of those calls she noticed there was no equipment in the hospital room for Landon’s daily chest compression therapies, which help prevent pneumonia or other complications he faces from being prone and on ventilators for several hours a day.

“We’re going to have another problem if we don’t get that equipment in there,” Walker said she relayed to Wake Forest Baptist staff after noticing the issue on Zoom.

She’s grateful that they were able to get Landon discharged and back home, knowing that a normal hospital stay can be challenging for Landon and other disabled individuals even before COVID-19 added more layers of complications.

Nonetheless, Walker worries about what they might face if he or others with similar needs have to be hospitalized again and aren’t able to have caregivers with them.

“This is a much more stressful time because of COVID,” she said.

Stories to Watch in 2018 – Part 2

January 2, 2018 by Rose Hoban

Stories to Watch in 2018 – Part 2 - North Carolina Health News

We asked our reporters to look ahead to the coming year and what stories they'll be following. Today we look at environmental issues and business trends.

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.

shows low level satellite photo of a dam feeding into a river, surrounded by trees — 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.

shows vast grey impoundment with earth movers on top — 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.

man reaches otu to touch a hog that's in a crowded pen. — 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 front of UNC Hospital emergency department — 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.

Shows the front of the building — 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.”

New ASU Health Sciences Facility to Benefit Students, Region, Says Dean

June 14, 2016 by Thomas Goldsmith

New ASU Health Sciences Facility to Benefit Students, Region, Says Dean - North Carolina Health News

By Thomas Goldsmith

A new College of Health Sciences building for Appalachian State University in Boone will broaden students’ educational experience as well as the college’s reach into underserved Western North Carolina counties, the college dean said Monday.

When the 203,000-square-foot building breaks ground next week it will consolidate several fast-growing degree programs, Dean Fred Whitt said.

“We are trying to set up interprofessional delivery of services,” Whitt said. “We think we’ll be training the health-care leaders of tomorrow today.”

In anticipation of an increasingly team-oriented health-care environment, the new building will allow speech therapists, nurse practitioners, dieticians, physical therapists and other specialists to train side-by-side.

Gov. Pat McCrory’s office announced last week that contracts have been let for the facility, using $70 million in funding from the state’s Connect NC initiative. The Council of State approved $200 million June 7 in the first segment of the $2 billion bond program voters OK’ed in March.

Since 2008, the College of Health Sciences, with more than 3,300 students, has more than doubled its enrollment.

“We had just run out of room,” Whitt said.

The new facility will offer “specialty laboratories, classrooms and support space centralizing several different health sciences degree programs under one roof,” according to a news release.

“New university facilities like the Health Sciences Building at Appalachian State will prepare students for high-demand medical careers to further enhance the health and quality of life in the region and state,” McCrory said in a statement.

The 16-county area around Boone has some of the state’s largest deficits in health-care professionals per 10,000 residents, Whitt said. Because professionals often remain in the area where they are educated, Western North Carolina should see ongoing benefit from the college’s growth.

“If you are trained in rural areas, you’ll want to go back and work in rural areas,” Whitt said. “When you get in the rural health area, it really means enhancing the quality of life in the region. In some counties up here, you may have only one physical therapist.”

In 2015, the college received funding for a Rural Health Care Services Outreach Program to provide services through partnerships with Wake Forest School of Medicine physician-assistant program and the High Country Council on Governments Area Agency on Aging.

How’s that arrangement working out?

“Awesome,” Whitt said. “They have a cohort of physician assistant students training here in our college.

“On the other hand, for our benefit, we are able to place some of our nursing students in clinical rotations in certain specialty areas at Wake Forest Baptist.”

Health-care jobs are represent one of the state’s strongest employment sectors, with about 400,000 people working as health-care practitioners, technicians or support employees, according to the commerce department’s Labor and Economic Analysis Division.

ASU offers undergraduate degrees in areas including athletic training, communication sciences and disorders, exercise science, health-care management, nursing, nutrition and recreation management, as well as masters programs in exercise science, nutrition, speech language pathology, social work and health administration.

A master’s program in nursing is slated to begin this fall.

This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina.

Bill Would Require Health Assessments for All New N.C. Public School Kids

August 18, 2015 by Editor

Bill Would Require Health Assessments for All New N.C. Public School Kids - North Carolina Health News

The General Assembly has passed a bill requiring health assessments for all kids entering North Carolina public schools.

By Rachel Herzog

Parents sending their kids to North Carolina public schools for the first time this August will face slightly different health assessment and vaccine regulations.

Previously, North Carolina required health assessments for kids entering kindergarten, but those entering the public school system at any other grade were exempt.

The NC General Assembly passed new rules around immunizations and kids who start school in North Carolina. Photo shows a young boy getting a shot. — The N.C. General Assembly passed new rules around immunizations and kids who enter public schools. Photo courtesy Judy Schmidt, CDC

The North Carolina House and Senate hammered out their differences on House Bill 13, and sent it to Gov. Pat McCrory last week.

“If children do come into North Carolina’s system at a grade other than kindergarten [and] have a hearing impairment or eyesight impairment, maybe those can be treated early,” said primary sponsor Rep. John Torbett (R-Stanley).

Torbett said he wanted to push the measure to allow kids to reach their full potential.

‘We haven’t been doing that?’

Sen. Jeff Tarte (R-Cornelius) said he supported the bill and didn’t think there would be much opposition.

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“It is merely capturing some of the stuff that goes on in a doctor’s office that’s basically primary clinical input and making sure it gets into a school’s record appropriately,” Tarte said.

Torbett said a constituent back home brought the issue to his attention. Most people he talked to about the bill didn’t realize that kids entering at grade levels above kindergarten weren’t assessed.

“It’s kind of funny,” he said. “They’ve got this look on their face, ‘We haven’t been doing that?’”

The bill would not require kids entering private or religious charter schools to undergo assessments.

New vaccines

Lisa Cassidy-Vu, assistant professor of family and community medicine at Wake Forest Baptist Medical Center, said the new requirements match the recommendations from the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention.

She said she hopes the bill will improve the administration of the meningococcal vaccine, which prevents meningitis, in particular for teens and young adults who are heading off to college. The vaccine is now required along with the already-mandatory combined tetanus, diphtheria and pertussis, or Tdap, vaccines.

Two varicella, or chickenpox, vaccines are now required for kindergarteners, as is the last dose of the polio vaccine, before entering school for the first time.

“I haven’t had any pushback from these vaccines,” Cassidy-Vu said. “I think they are less controversial than some others, such as those for HPV prevention, and so they are readily accepted.”

Creating access

Tarte said the bill would help make sure schools and providers have access to updated and accurate information on each child’s health status.

“If a kid has a health issue, it’s good to know about it up front,” he said. “If something develops or turns into an acute situation, the school’s prepared to deal with that kid.”

Torbett said that during committee hearings, legislators expressed concerns about kids not having access to health care to receive these assessments, but he said access is a bigger issue that will exist whether or not the bill is passed.

“If you have that concern, that concern’s already existed,” he said.

Cassidy-Vu said the new regulations could actually make it easier for kids to get access to health care.

“The great thing is that anyone without a primary care physician or with financial strain can be seen at their local health department and receive the necessary immunizations free of charge,” she said.

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

‘Those Days’ Are Over, So What Lies Ahead for a Rural Hospital?

August 17, 2015 by Editor

‘Those Days’ Are Over, So What Lies Ahead for a Rural Hospital? - North Carolina Health News

While fondly recalling the past, Yadkin County residents ponder the future of their community hospital.

By Taylor Sisk

To anyone who’s been around Yadkinville for a while (and most folks up here have), it was “Hoots,” and forever would remain so.

Sure, the name – Hoots Memorial Hospital – was changed about five years back, but, as Yadkin County Manager Lisa Hughes sees it, when Yadkin Valley Community Hospital has been long forgotten, “this will still be Hoots.”

Rural Rx: NC Health News coverage of rural health issues. This week: Yadkin County.

In fact though, Hughes and many of her fellow Yadkin County residents would prefer that Yadkin Valley Community Hospital, which today sits shuttered, not soon be forgotten. Rather, they’d like for it to be reopened and revitalized in the spirit of the community institution that Hoots was.

Which is not to say that the hospital was all things to all people.

LuAnn Brown, a nurse at the hospital from 1981 to 1992 and now a nursing instructor at Surry Community College, acknowledges that for as long as she can remember “lots of people have had negative views about the hospital.” Some people didn’t trust it, she said, simply because it was rural.

But it was theirs. And for Brown and many others, that amounted to something.

“You felt like everybody cared,” she said. “And they did.” She rues what she perceives as the general loss of a more personal interaction between provider and patient.

“We need to get the family feel back in the hospital,” Yadkinville Mayor Hubert Gregory said in agreement, “get the trust back with the people here.”

But Yadkin County government officials and leaders in the medical community recognize that those days have gone. Hoots Memorial is no more. A new model is needed.

Breaches of contract

Hoots Memorial Hospital opened its doors in Yadkinville on May 7, 1952, and was regarded at the time as a more or less state-of-the-art facility.

But times had changed.

LuAnn Brown, a former nurse at Hoots Memorial Hospital, awaits the return of the community hospital. Photo credit: Taylor Sisk

HMC/CAH Consolidated Inc., a Missouri-based for-profit company, arrived in May 2010 promising to modernize the facility. The company’s advertising states: “Our corporate goal is to own and operate new, safe hospitals that are cost efficient and offer the highest quality care. We can assist communities in replacing older hospitals with new, state-of-the art facilities.”

But those plans never materialized. According to Yadkin County Attorney Edward Powell, HMC/CAH signed a contract in 2010 to renovate, but never delivered.

Then on Friday, May 22, just past 6 p.m., the hospital was shut down, with HMC/CAH walking away from a lease agreement with the county to operate it through July 31.

In a letter to the state Department of Health and Human Services informing the agency of the company’s intention to close, hospital CEO Shawn Bright cited lease renewal terms offered by the county as being “so onerous that the Hospital cannot accept them and still operate in a fiscally responsible manner.”

At the time, HMC/CAH was operating rent-free.

Times change

Yadkin County isn’t faring too badly these days.

According to the U.S. Census Bureau’s American Community Survey, 14.1 percent of families live below the poverty line; the national average is 11.3 percent and the state’s is 12.9. About 15 percent of its residents have no health insurance, right at the national average and a percentage point below the state’s.

But like so many rural communities, it’s aging.

“We have a lot of elderly citizens who don’t like to drive in I-40-type traffic, so they relied on our small hospital here for their doctors’ [appointments] and some acute care,” David Moxley, vice chair of the Yadkin County Board of Commissioners, told N.C. Health News when the hospital closed.

Many of those seniors were James McGrath’s patients. McGrath was the hospital’s medical director, and his practice was in the hospital – a practice that was likewise padlocked when the facility was shut down.

County Manager Hughes said most of the calls her office now receives are, “Where’s Dr. McGrath?”

McGrath practiced medicine in Yadkin County from 1983 to 1990, moved to Durham for 16 years, then returned.

“Life was interesting” in his first tenure at the hospital, he said over lunch last week at the Yadkin Dairy Freeze.

He’d developed an interest in obstetric care. The hospital was part of the Wake Forest Baptist Health system at the time, and system administrators encouraged the contribution he could make in a state that, at the time, had the second-worst infant mortality rate in the country. (Though that rate has improved somewhat, disparities between rural and urban communities persist.)

McGrath zeroed in on prenatal care, and, he said, was told by the Wake Forest administrators that, “Anything you folks out there in the hinterland can do will help.”

“Nine months later,” he said, “the baby’s fine and the mama’s fine. And you think, ‘Maybe we did something.’ Because this was a person who right from the get-go was a setup for a bad outcome.”

‘Sweet spot’

McGrath delivered babies right up until he left for Durham. But by the time he returned, the practice of medicine had changed. Specialty practices were no longer a part of the hospital landscape.

Experts say that in order to survive, rural hospitals must respond to changing times, and providing needed specialty services might be one of the few means of survival.

In a May interview with N.C. Health News, UNC-CH health economist Mark Holmes said rural officials should “figure out what makes most sense for their community and tailor to that.”

Find the “sweet spot,” Homes urged.

“Maybe you find one or two specialties that aren’t otherwise available, and use those to help support your emergency facility.”

Hughes agrees.

“We need to make sure that we’re providing services that people want to receive in Yadkin County,” she said, “that they don’t want to go to Elkin or Winston[-Salem] to receive.”

She said county officials would welcome the passage of a Congressional bill sponsored by U.S. Sen. Chuck Grassley (R-Iowa). The bill calls for critical access hospitals, like Yadkin Valley Community Hospital, to have the option to be redesignated as “rural emergency hospitals,” allowing them to continue to provide emergency medical services without maintaining inpatient beds.

“That would be a tremendous benefit to us,” Hughes said. “It would offer us, without the expense of the inpatient beds, to be able to have an emergency room,” to have a few beds available for short-term needs and observation, transporting to nearby hospitals the more critical cases. And to provide a select few specialty services.

‘It was gone’

“My heart aches for Yadkin County residents as we await word on the outcome of our small community hospital,” LuAnn Brown wrote in a letter to the county’s attorneys.

County Manager Lisa Hughes inside the abandoned hospital. Photo credit: Taylor Sisk

“The hospital and the physician offices are truly a lifeline for many residents,” she wrote, describing elderly residents who felt “safe and secure” with the hospital. “Now, that security is gone and many long-term patients will suffer.”

Hughes said the county is consulting with a couple of firms to determine how best to move forward: examining the best options from a financial perspective, and learning of service models that might best match the community’s needs and the facility.

McGrath would like to see a hospital system “look at this facility and see how it could dovetail with their larger strategic needs.”

And maybe, in so doing, reestablish some of that Hoots-like “family feel” that Mayor Gregory spoke of, in a more tightly focused environment.

As for his practice, McGrath intends to be “up and running here, hopefully within a few weeks,” back in the hospital. But he acknowledges the facility needs renovations. “The physical layout that traditional practices have just doesn’t fit anymore.”

He said, for example, that a “central area for support staff with the examining rooms configured like a clock face” would be ideal.

But, McGrath said, he can’t realistically expect the county to foot the bill for that; they’ll need some outside resources.

UNC’s Mark Holmes said it’s not uncommon for rural communities to “think of their hospital as metropolitan areas think of their professional sports team: This is what puts us on the map; this is a big part of our identity.

“And then you lose that.”

But Cari Harold, an EMT employed by the county to be at the abandoned hospital lest someone come by in need of the ER, said the loss of the hospital is more basic: “A lot of citizens will tell you it was a comfort having this hospital here. Whether they used it or not, it was a comfort.”

“And then, all at once,” Brown said, “it was gone. And we need it.”