Commissioners say ‘no’ to more money for Hatteras health clinics
In a vote that all but ensures closure of one health clinic on Hatteras
Island, the Dare County Board of Commissioners on Monday unanimously
agreed to continue to provide $100,000 to subsidize medical care on the
Dare County Manager Bobby Outten said that the county does not have the
additional $200,000 that Greenville-based University Health Systems of
Eastern North Carolina said is needed to keep HealthEast Family Care
clinics operating in both Avon and Hatteras.
“What they’ve told us is that they’ll close one of the offices,” Outten
said on Tuesday. “It’s their decision which office.”
Outten said he expects UHS officials to respond in the coming weeks
with a plan that will detail shutting down one facility.
With no “knight in white”on the horizon, he said, the board decided it
was better to give more time to face up to the inevitable rather than
wait until its December meeting to vote.
“We would love to maintain the status quo,” Outten said. “But since we
can’t do that, our goal is to disrupt the health care as little as
medical centers open on Hatteras appears less likely
escalating costs make it increasingly likely that Hatteras Island is
going to lose one of its health care clinics.
Dare County Manager Bobby Outten said this week that other health
providers have shown no interest in taking over operations of
HealthEast Family Care in Avon or HealthEast Family Care in Hatteras ,
currently run by Greenville-based University Health Systems of Eastern
“We’ve pretty much exhausted all of our possibilities,” he said. “We
haven’t found a suitor, if you will.”
After UHS told the county in July that it could no longer afford to
keep both clinics open without additional revenue, Dare officials made
proposals to The Outer Banks Hospital, Albemarle Hospital and Sentara
Healthcare. But there were no bites.
“Economically, I’m guessing, it just wasn’t their market,” Outten said.
An update on the status of the clinics will be presented to the Dare
County Board of Commissioners at its meeting on Monday, Nov. 15, he
The health system, which runs Pitt County Memorial Hospital in
Greenville and is partner in The Outer Banks Hospital in Nags Head,
provided three scenarios to the county in July:
UHS would completely leave Hatteras Island.
The county would continue to pay about $100,000 a year to provide for
reduced on-call services and keep one clinic open, but with after-hours
nursing care discontinued.
The county would pay $300,000 annually to keep both clinics open, with
reduced on-call services and a cut in after-hours nursing care.
With UHS requesting the county’s answer by Jan. 1, Outten said that he
expects the board will make a decision at its Dec. 6 meeting, the last
one of the year.
Warren Judge, the board’s chairman, said that the county is committed
to providing “good and dependable” health care to islanders, as well as
visitors. The county, he said, is grateful to UHS for the
care given by the clinics’ three doctors.
“It’s regrettable with changing economic dynamics, it’s beginning to
appear that a contraction of facilities is a real possibility,” he
“But it does not mean that there will be a contraction of
Judge said that it is premature to say what the board will decide, but
he said he anticipates that a reasonable agreement can be made with
“We’re not naive to the fact that there’s going to be changes,” he
said, “but we’re certainly optimistic that we’re going to work out the
best possible deal.”
The Hatteras clinic is situated on federal land, which was donated to
the county on the condition that it would be used only for a health
facility. But Judge said he is confident that if that clinic
closed, the county will be able to maintain the terms of the agreement
with the federal government.
The health system has said that the cost-saving measures were necessary
to address a $400,000 to $500,000 budget deficit.
Whatever the county’s decision, there will not be any abrupt bolting of
doors on New Year’s Day, said Travis Douglass, vice-president and
executive director of University Health Systems physicians, the company
that contracts with UHS doctors.
There will likely be a 90-day to 120-day transition period, he said, to
implement the changes.
“There’s a lot of logistics,” Douglass said.
Since each of the three options had specific costs associated with
them, Douglass said that there is little room for the county to
negotiate on issues like after-hours care.
But he said if one clinic closes, existing numbers of staff would not
be reduced, and hours at the remaining clinic would be expanded.
Douglass said that even though UHS has not been charged any rent for
the Hatteras clinic, and the county pays for most of the utilities and
upkeep, the fact is that irrespective of direct costs, neither clinic
generates enough revenue.
Many patients lack medical insurance, he said, or they are covered by
Medicare or Medicaid, which provide lower compensation than private
insurance plans. At the same time, it is expensive to attract primary
Considering that Hatteras Island is relatively isolated and rural, he
said, it is “atypical” to have three primary care physicians on
staff. In many parts of the rural North Carolina, he said,
patients drive long distances for primary health care,.
“No doubt it’s a difficult challenge,” Douglass said. “It’s part of the
paucity of care we have across the state.
“We’re hopeful that health care reform is going to help. It’s
a Dare County problem ---- it’s an issue everywhere.”
Outten, the county manager, said that under a prior agreement to cover
some clinic costs, $100,000 had already been budgeted for this fiscal
year, and he anticipates that the county will be able to “continue
spending what we’ve been spending.” But he said that an additional
$200,000 is unavailable in the budget, and is unlikely to be found for
Belt-tightening may be necessary, he said, but that does not mean the
county has diminished its commitment.
“The sentiment of the board,” Outten said, “is there has to be health
care on Hatteras Island.”