and progress are on the horizon
for health care in Ocracoke and Hatteras
By IRENE NOLAN
Cheryl Ballance sat at a conference table outside her office at the
Ocracoke Health Center on a warm late winter day to talk about changes
and progress that are on the horizon for health care in Ocracoke,
Engelhard, and Hatteras village.
Ballance is a registered nurse who has spent most of her career in the
field of public health in rural and underserved areas. She has worked
as a nurse at the Ocracoke Health Center (OHC) and as a home health
nurse for Hyde County.
In 2002, she became the first full-time administrative director of OHC,
a 30-year-old non-profit, federally designated rural health
center. Today she is also administrative director of the
6-year-old Engelhard Health Center, another federally designated rural
health center, and she has recently added the Hatteras Village Medical
Center to her managerial duties.
Ballance has been working with the Hatteras Village Medical Center
Board of Trustees and she says the center will re-open in May as a
non-profit rural health center.
HealthEast Family Care closed its Hatteras location on Dec. 30, and
villagers began looking for another health provider to keep the medical
It was villagers who banded together to establish the first medical
facility on the site in the 1960s. It was opened as a rural health
center and operated that way for a number of years before it was
occupied by private practitioners who eventually sold their practice to
HealthEast, part of University Health Systems in Greenville, N.C.
The National Park Service owns the land where the building is located.
The site was given to Dare County in the 1960s, with the proviso that
it must be used as a health-care facility or it reverts to the Park
In January, the Dare County Board of Commissioners agreed that Bobby
Outten, county manager and attorney, would help Hatteras villagers
incorporate a board and obtain non-profit status for the health
The corporation will operate the center, which will be managed by
Ballance. Dare County will continue to provide the building and pay for
its upkeep but will not fund the operation.
That process is well underway, said Ted Midgett, president of the
five-member Hatteras Village Medical Center Board of Trustees. He said
that the board is meeting weekly with Ballance and its members are
hopeful that the doors will re-open in May.
“I think we
it,” Ballance said recently, “though it may not be
(open) five days a week in the beginning.”
When you talk with her about the change she is managing, you can’t help
but catch some of her very upbeat, informed, and optimistic enthusiasm
about the future of health care on the islands and Engelhard, just
across the Pamlico Sound on the mainland.
Both the Ocracoke and Engelhard centers, she said, have been operating
with funds and grants through the North Carolina Office of Rural Health
and Community Care, which works to help rural communities serve the
indigent and uninsured.
money “goes up and down,” and make planning for
health care at the center difficult. And the state’s budget in now
under more pressure to make cuts than ever before.
“We are in a position,” she said, “of not being able to break even by
charges from patient services alone.”
In 2009, Ballance began looking for “other avenues” for grants. She
applied for and received a grant for $80,000 to explore how the
communities of Ocracoke, Engelhard, and Columbia in Tyrell County could
work together and whether they could become Federally Qualified Health
The “federally qualified” designation, she said, is different from
“federally designated” rural health center status and would make the
center eligible for some of the $9 million in new federal money for
Ballance said that Columbia eventually elected not to participate, but
that she submitted a grant application for Ocracoke and Engelhard for
$650,000 in renewable federal funding for operations at the two
The application was submitted in December, and she said the grants will
be awarded in August, but she is very optimistic.
“I feel like we have put in a very strong grant application,” she said.
The new funding would allow both clinics to expand their medical
Currently, the Ocracoke Health Center has a full-time doctor, Erin
Baker, who is a doctor of osteopathy; a full-time nurse practitioner,
Gail Covington; a full-time registered nurse, Tosha Collins; a
part-time registered nurse, Carolyn Wynn, and front office manager,
Jamie Tunnell. Baker and Covington are full time, but each
seven days on and seven days off, because of a rural health funding
The center is open Monday through Friday from 8 a.m. until noon and
from 1 until 5 p.m. and provides after-hours urgent care.
With the Federally Qualified Health Center (FQHC) designation and the
grant, the Ocracoke and Engelhard clinics would expand to include
dental care and mental health and pharmacy services.
The Ocracoke and Engelhard centers would reorganize and merge their
boards into one corporation, which will be known as the Coastal
Community Health Alliance. Ballance would continue as administrative
director of both.
Though the focus of state and federal funding is to serve indigent and
uninsured patients, Ballance noted that the centers will also serve
patients with insurance or who are covered by Medicaid and Medicare.
She added that the federal government has many reporting requirements
from the health centers that are expected to set goals for the
management of such chronic medical problems as high blood pressure and
“The government is looking for improved outcomes,” she said.
Ballance explained that the Hatteras Village Medical Center would
eventually operate under the Coastal Community Health Alliance
umbrella. It was not incorporated in time to be part of the FQHC grant,
but would operate as a “satellite” location.
The Hatteras Center, she said, will have a full-time medical provider,
a registered nurse, and a front office staff person. The medical
provider will ideally be a physician, she said, but could be a nurse
Ballance has already obtained a one-time grant of $100,000 from NC
HealthNet to get the doors open in Hatteras.
It’s “start-up” money, she said, that is designed to hire the health
provider, and it will eventually be supplemented with patient care fees
and even other grants that Hatteras would be eligible for as part of
the Coastal Community Health Alliance.
The challenge now, she said, is to get the Hatteras Medical Center
furnished and equipped, since HealthEast removed all of the equipment
when it moved its operations to Avon, and to hire staff.
Ballance stressed that the Hatteras Medical Center will not compete
with other medical providers in the community or the Community Care
Clinic of Dare County, but will supplement them and work with them.
“This is an exciting time for health care in Ocracoke and Engelhard,
and, I hope, Hatteras,” Ballance said.