THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, March 24, 1996 TAG: 9603210181
SECTION: CAROLINA COAST PAGE: 12 EDITION: FINAL
TYPE: Cover Story
SOURCE: BY JACK DEMPSEY, CORRESPONDENT
LENGTH: Long : 322 lines
AS TOURISM and population boom on the Outer Banks, medical care is experiencing a growth spurt of its own.
That's the consensus of community medical leaders, who cite dozens of improvements to health care that have been made recently and will continue for years to come.
The barrier islands are awash with medical facilities and a surging number of doctors who provide services from checkups to surgery.
Growth has come so fast, medical professionals say, that few people can grasp the scope of the changes.
The Albemarle area yellow pages now list about 620 phone numbers under Physicians and Surgeons. More than 100 of those are Outer Banks numbers.
Lists include providers at major medical centers, as well as local specialists such as podiatrists and ophthalmologists. Specialists from as far away as Norfolk and Greenville also want a piece of the Outer Banks market.
Although some still believe health services are few and far between on the Outer Banks, in truth the health sector rivals many other, more visible, sectors in sheer economic size. Medicaid alone spends $10 million in Dare County each year.
Leadership for the growth in Outer Banks medical services has been provided by four area hospitals, the Dare County government and dedicated program personnel.
Virginia's Chesapeake General Hospital has steadily enlarged its sponsorship of local services over 12 years of operation. Its Outer Banks Medical Center in Nags Head provides the only continuously staffed, 24-hour urgent care on the Outer Banks, as well as general family medical services. Patient visits have climbed to 25,122 annually.
Chesapeake General also maintains the Chesapeake Medical Specialists facility in Southern Shores' Marketplace. A dozen of Chesapeake's affiliated medical specialty groups travel regularly to the facility.
Dr. Charles Dennis, an ear, nose and throat specialist, is among the regular visitors to the center. He brings an audiologist, two allergy nurses and a surgical nurse with him.
``We treat about 25 patients each trip,'' Dennis said. ``We save a lot of people a lot of travel off the beach. That's especially important for the elderly, and we thoroughly enjoy coming here.''
Visits to the specialists have risen to 7,500 annually.
Elizabeth City's Albemarle Hospital hosts a broad array of services at the Regional Medical Center in Kitty Hawk.
Drs. David Hurley and James Wilkinson head Beach Medical Care at the front of the building, where they provide general family and urgent care there from 9 a.m. to 9 p.m. daily. Patient visits total 21,000 per year.
The rest of the building and quarters across the street house medical specialists with regularly scheduled Outer Banks hours, plus rehab and laboratory services.
Dr. Antonio Ruiz, a surgeon and Albemarle Hospital's chief of staff, said outpatient surgery typifies the growth of specialty services at the center.
``We started four years ago and have steadily increased outpatient surgeries to 400 a year - especially cataract surgery,'' Ruiz said. ``In July, Dr. Charles Brown moves down here as a full-time anesthesiologist. That will considerably increase the types of surgeries we can perform on the coast.''
Pitt Memorial Hospital in Greenville has
recently entered the Outer Banks market at the invitation of the Dare County commissioners. Pitt president and CEO Dave McRae said several members of the Outer Banks medical community have expressed suspicions about Pitt's intentions.
``There's no cause for alarm,'' McRae said. ``We aren't going to buy practices or try to close anything down. We want to add value to everything already there.''
McRae and associates have already held exploratory discussions with executives at Chesapeake General, Albemarle and Chowan hospitals. He said the first collaborative effort will likely be with Albemarle Hospital on a new family practice in Nags Head.
``We have no long-term agenda at the moment,'' McRae said. ``We just want to start with a helpful project or two, then decide where to go from there.''
Many medical administrators consider psychiatry the Outer Banks' most critical shortage. In that regard, Edenton's Chowan Hospital occupies a unique position among the four nearby hospitals.
In collaboration with the Elizabeth City-based Albemarle Mental Health Center, Chowan maintains 20 psychiatric beds and crisis intervention teams for six northeastern counties. The hospital also provides one crisis intervention worker in Dare County for night and weekend emergencies.
Ann Laughlin directs the Dare County division of the state-administered Albemarle Mental Health Center, which serves about 800 patients a year.
``Mental health is the largest program,'' Laughlin said. ``Substance abuse is next. In our mental retardation/developmental disabilities program, we have one group home and one adult disability activity center.''
Dare County mental health offices are located in Nags Head, Manteo and Avon.
``Yes,'' Laughlin said, ``psychiatric services are in short supply. However, we are currently trying to recruit a full-time psychiatrist for the Outer Banks. A condition of employment is that he lives in Dare County.''
Most patients begin their medical care at the ``primary'' level, visiting such centers as Beach Medical Care and the Outer Banks Medical Center.
Additional primary care providers in central Dare County include Drs. Walter Holton and Brian MacDowell, who head the Dare Medical Associates and the MacDowell Family Health Center. Dr. Charles Davidson heads the First Flight Family Medical Center in Nags Head.
An Elizabeth City-based group practice, Tar Heel Internal Medicine, will open an office in Corolla in May. Dr. Robert Poston said the three partners will serve the Currituck beach communities five days a week in the summer and as often as needed in the off-season.
Obstetrical and gynecological services, generally regarded as primary care, are offered mainly at the Regional Medical Center, Chesapeake Medical Specialists, the Virginia Dare Women's Center in Nags Head and the Eastern Carolina Women's Center in Nags Head.
Most babies are delivered at Albemarle and Chowan hospitals.
Just as inpatient services are increasing, home-based and nursing home care are growing.
This burgeoning sector grew out of an increasing dependence on in-patient and acute hospital care, which have sent health-care costs skyrocketing. The search for less expensive and more human alternatives spawned the nursing home industry and the home-based service network.
Britthaven, next to the Outer Banks Medical Center in Nags Head, is the only nursing home on the barrier islands.
``We have 144 beds for mainly frail, elderly patients,'' said Administrator Richard Blackmon. ``And we work closely with home care agencies to keep patients here on the Outer Banks.''
Three different government agencies and several major private agencies offer home care services from offices on the Outer Banks.
``We are able to keep costs down,'' said Leslie DeLigio, community nurse manager of Compassion and Personal Care Services Inc. ``More importantly, we allow patients to stay home with their families, their pets, their cherished belongings.''
Medical care on the Outer Banks goes well beyond the traditional family doctor. Specialists, agencies and volunteer organizations all chip in to provide a range of services.
Independent non-physician practitioners include dentists, chiropractors, pharmacists, optometrists, opticians and physical therapists.
Nurses with various levels of training and various specialties work throughout the system. Veterinarians protect human health in ways such as rabies immunizations.
Physician assistants, audiologists, psychologists, speech therapists, rehab specialists, technicians, nutritionists and various types of counselors head a seemingly endless list of highly specialized personnel who work at least part time on the Outer Banks.
And volunteer organizations such as the Red Cross and Hotline, along with the mutual support groups, do their part.
Unfortunately, the distribution of talent favors the central Outer Banks, leaving the Currituck beach communities, the Dare County mainland and the Hatteras-Ocracoke extremity underserved.
Travel problems especially plague the southern communities, which have only two full-time physicians for a widely dispersed population.
The energetic Dr. J. Seaborn Blair III supervises medical operations at the Ocracoke Health Center. With Dr. Al Hodges Jr., he also runs the Hatteras Medical Center and the satellite Buxton Medical Care.
``Dr. Hodges and I alternate being on call every other night and every other weekend. We can't do that indefinitely without burning out,'' said the tireless, but tired, physician.
``Fortunately, we're getting some help,'' Blair said. ``We've recruited Dr. Brian Magrane to join us this July. He'll give us more time for personal living and help us make services more accessible farther north on the island.
``We get a lot of help from Mental Health, Cardiac Rehab in Kitty Hawk and home health agencies. But we're still desperately short of psychiatric and hospice services. Thankfully, we have three EMS stations down here. Flat out, we couldn't operate without them.''
Harry Seymour, Dare County's public safety director, agreed. ``Distance will always be a problem on the Outer Banks,'' he said.
The county covers 855 square miles, with a total staff of 86 for the 24-hour operation of 10 ambulances and one helicopter at eight stations. Last year, there were 7,750 ambulance runs and 244 flights, Seymour said.
``We think we have one of the best EMS programs in North Carolina, if not the best,'' he said. ``And we sincerely believe we are THE best along the entire East Coast.''
Public ambulances are also available in Currituck County's beach communities and Hyde County's Ocracoke. Dialing 911 is the best bet for getting an ambulance in any medical emergency.
The two largest missing pieces in the Outer Banks' mosaic of health services are a hospital and a managed care option, especially an HMO.
A hospital is still a gleam in the community's eye. But an HMO may be coming. Rick Gilstrap, chairman of the Eastern Carolina Health Network, said managed care could be here in two years. The network is an association of 20 hospitals in eastern North Carolina, including the three in-state hospitals near the Outer Banks.
``We don't want an investment group from, say, Minnesota, coming in here and setting up an HMO,'' Gilstrap said. ``They'd send 17 cents on the dollar back to the investors. We'd rather do it ourselves and keep the price down. We're working on it now.''
The future of health services on the Outer Banks looks excellent, said Dr. Tom Irons, associate vice chancellor of the East Carolina University School of Medicine and president of Health East, a subsidiary of Pitt Memorial Hospital.
``You build a strong medical care system from the primary care level up, and you already have most of the pieces in place,'' Irons said. ``You have great political leadership there. Dr. Magrane will be of enormous help down in Hatteras. Dr. Pat Crow over here will lend his years of experience to our proposed primary care unit in Nags Head.
``Looks good.'' MEMO: Jack Dempsey has a doctorate in public health from Johns Hopkins
University. He worked in health programs in rural parts of Vermont and
Maryland before moving to the Outer Banks with his wife, Judy, and
daughter, Kathy. He has published two books on health care, another on
gardens, and has written for journals, magazines and newspapers. Before
his move here, he was a full-time consultant to the Maryland State
Health Department.
HEALTH PROGRAMS
The following programs are offered by the Dare County Health
Department.
General number: 473-1101
Personal Health: Ext. 136
Immunizations
Communicable diseases (including TB, AIDS)
Health education
Family planning
Maternal health
Child health (including school nurses)
Nutrition
General clinic
Home health: Ext. 281
Environmental services (including wastewater management, food and
facility inspections, etc.): Ext. 136.
DARE HEALTH CARE
Dare County provides at least partial funding for:
The Dare County Health Department.
Emergency Medical Services.
Fitness and health-related activities at the Baum Senior Center.
The Disability Program in the schools' exceptional children
programs.
Home health services through Social Services.
Mental health services from ABC sales.
A kidney dialysis unit, pending approval.
WHERE TO FIND MEDICAL CARE
ELIZABETH CITY
Albemarle Hospital
Open 24 hours for emergencies. U.S. Route 17.
335-0531
KITTY HAWK
Regional Medical Center
Family and specialist medical care; same-day surgery center. Urgent
care provided through Beach Medical Care. Hours 8 a.m. to 9 p.m.
beginning May 29.
U.S. Route 158, Milepost 1 1/2 at the Regional Medical Center.
261-4187.
Beach Medical Care
Hours: 9 a.m. to 9 p.m.; Beginning May 31 for summmer 8 a.m. to 10
p.m. daily; U.S. 158, milepost 1 1/2 at the Regional Medical Center.
261-4187.
NAGS HEAD
First Flight Family Medical Center
Hours: 8 a.m. to 6 p.m. Monday through Thursday, 8 a.m. to noon
Friday. U.S. 158, milepost 11.
441-3177.
Outer Banks Medical Center
Open 24 hours for emergencies. West Barnes Street at milepost 11.
441-7111.
Eastern Carolina Women's Center
Hours: 9 a.m. to 4 p.m., Nags Head Professional Center, Suite 6, U.S.
158 Bypass at Woodhill Dr., milepost 11 1/2
441-8330
MANTEO
MacDowell Family Health Center
Hours: Monday, Tuesday, Wednesday, Friday, 8:30 a.m. to 5 p.m. U.S.
Route 64/264.
473-2500.
Dare Medical Associates
Hours: 8 a.m. to 5 p.m. Monday through Thursday, 8 a.m. to noon
Friday. U.S. Route 64/264.
473-3478.
HATTERAS
Hatteras Medical Center
Hours: 8:30 a.m. to 5 p.m., Monday through Friday; 9 a.m. to 1 p.m.,
Saturday. N.C. Route 12 next to Methodist Church.
986-2756.
BUXTON
Buxton Medical Care
Doctor's Hours: 1:30 p.m. to 5:30 p.m. Monday, Wednesday, Friday;
N.C. Route 12.
995-4455.
OCRACOKE
Ocracoke Health Center
Okcracoke Health Center
Hours: 8:30 a.m. to noon, 1 to 5 p.m. Monday, Tuesday, Wednesday,
Friday; 8:30 a.m. to noon Thursday.
928-1511.
WHAT'S COMING
Here are some of the expected, probable and possible new medical
facilities coming to the Outer Banks.
A new internal medicine practice in Corolla.
A full-time psychiatrist for Dare County.
A full-time anesthesiologist at the Regional Medical Center.
A full-time additional physician on Hatteras Island.
Expanded Chowan Hospital facilities.
Probably a new primary care practice in Nags Head jointly sponsored
by Albemarle Hospital and Pitt Memorial Hospital.
Probably a kidney dialysis unit.
Possibly an HMO or other managed care option. ILLUSTRATION: Color photo on cover by DREW C. WILSON
Photos by JACK DEMPSEY
Dr. Ellyn Meshel, left, and nurse Trish Emmert check patient Karol
Browder's blood pressure at the Outer Banks Medical Center.
Regional Medical Center's operating room is staffed by surgical
nurse Cindy Nilson and Dr. Antonio Ruiz, a surgeon and chief of
staff.
Gloria Patrick, right, of Compassion and Personal Care Services,
provides daily assistance with physical therapy for Chris Smith in
Smith's Kill Devil Hills home.
Photo by DREW C. WILSON
Dr. Al Hodges Jr., left, and Dr. James Seaborn Blair III operate
Hatteras Medical Center and the satellite Buxton Medical Care by
alternating being on call every other night and every other weekend.
Dr. Brian Magrane will start sharing the work load when he joins
them in July.
by CNB