Publisher's Note: We've been a bit short of staff this week, so we here at BCN do very much appreciate this excellent submission from the staff of the Beaufort Observer.
As a footnote, some may think the main hospital in Dare County, the Outer Banks Hospital in Nags Head, is involved but it actually is not. Outer Banks Hospital is owned jointly by Pitt Memorial and Chesapeake Hospital and "the money pots are separated" according to what UHS told the Dare County Commissioners. So while Outer Banks Hospital reportedly operates at a surplus, that "profit" could not be used to maintain services in Avon and Hatteras. The details of that are probably not germane to Beaufort but here's the point. The health care market in Dare County is split, but controlled by UHS but UHS was not willing to use locally generated profit to support the system serving the entire county.
But in talking to Mr. Judge one other facet becomes clear. What started out as a mutually satisfactory relationship, built very much on the personality of the individuals involved, eventually changed when the personalities changed and then Dare County found itself without a strong, binding agreement. Thus, Mr. Judge's admonition to Beaufort: "Be very sure you have all the details nailed down and every 'i' dotted and every 't' crossed." And the implication as he elaborated was that critical decisions, such as reduction in services, need to be joint decisions rather than unilateral decisions that can devolve to a "take it or leave it" scenario.
We specifically asked Mr. Judge about his gut feeling about UHS's integrity and he talked at length. We'll summarize by saying that he was very complimentary of the people at UHS when the partnership first began. He spoke highly of Dave McRae, UHS CEO and the president as well as the UHS board. "Some of my best friends have served on that board and I have the highest regard for them." But (here it comes)..."things change, particularly when times get tough." "They brought in a new crowd of number crunchers that we have been dealing with recently and it is a whole different situation. The new people seem much more concerned with numbers than in providing good health care to people," he said.
This brought us back to his response when we asked him what his advice would be to Beaufort. "You need to ask all the right questions, probably in public so the people can hear the questions and UHS's answers, and then you need to hammer out a detailed agreement that will be fixed regardless of the personalities that come and go. Things change and the only way you can protect the county's interest is to have as good an agreement as possible."
We talked with another Dare County official, who did not want to be identified for what we found to be legitimate reasons, so we will honor that.
He told us essentially the same thing Mr. Judge said. "We were promised great things. And UHS delivered until the economy turned down. Then the people we were dealing with were a long ways away. They had us over a barrel; they knew it and they took advantage of it. They're making money in Nags Head but they cut Hatteras off like a jilted lover." He told us the same thing about how personalities changed but added to what Mr. Judge said by suggesting that the relationship changed because times got tough but also because UHS got much bigger. "Dare County got caught up in changes we had not anticipated and we were left hanging out to dry," he said.
We also talked to a heath care professional who offered a different perspective. She explained: "the doctors on the Outer Banks were private practitioners originally. But after UHS took over it was a control thing. They were treated like hired hands and had little incentive to go above and beyond the call of duty; but they did for a while. But it seemed like the more we did the more UHS took advantage of us so you don't have to be a brain surgeon to figure what happened. UHS is a huge conglomerate and it is very removed from the providers on the front line. Things changed."
This "change" was confirmed by a local patient. The theme, if we had to boil it down, to what we learned was: "Things change."
Note: the Observer has talked to officials in other counties served by two of the proposers. We will be reporting those articles as the process develops. But we can tell you now that the message of "things change and you need a very good detailed agreement" was the same in every place we went and with both proposers.
