Becky Johnson
Opponents to the Southern Loop again urged the N.C. Department of Transportation to halt planning for the new highway last week during a meeting of the Jackson County Transportation Task Force.
A handful of lucky hunting parties were about to embark on a special bear hunt in DuPont State Forest last fall when wildlife managers realized they had gotten themselves in a bit of snare.
Doctors, patients, nurses, ambulance drivers — even hospital board members — were unaware of a crisis brewing at Haywood Regional Medical Center that jeopardized its Medicare and Medicaid status and, as a result, the future of the hospital.
David Rice, CEO of Haywood Regional Medical Center for 15 years, resigned Monday in the wake of a financial crisis resulting from the hospital’s loss of its Medicare and Medicaid status.
“I think the fallout is so negative, I think a shift in leadership is called for,” Rice said. “The CEO always takes the responsibility. It is what CEO’s do. You have to protect the industry.”
The hospital board unanimously accepted his resignation after an hour-long closed meeting Monday evening. Prior to the meeting, board members said they were disappointed that Rice had failed to tell them of the brewing crisis until it imploded.
Rice said stepping aside will clear the way for the hospital to move forward rather than allow questions of his leadership to fester and interfere with the more important issues at hand.
“I think it is for the good of the hospital and the good of the community if I was to retire,” Rice said. “It will get the negative focus off me personally so the hospital can move forward. It just cleans the way and gets rid of some of the negativity and clears the way for a more positive direction.”
Ironically, Rice was just elected chair of the North Carolina Hospital Association.
“I will probably set a record as the shortest term,” Rice said of that role.
Rice, 68, had been planning for retirement in a couple years anyway, something the hospital board was aware of.
“We have had succession planning for the past three years internally to make sure we had internal talent within the ranks to pull from,” Rice said.
In a speech to a countywide meeting of doctors Monday night, Rice dropped the name of Eileen Lipham, a hospital vice president.
“I hope you will not overlook her for future leadership of this hospital,” Rice said.
For now, Al Byers, the chief operation officer of the hospital, will serve as acting CEO.
From the top
When Rice came to Haywood Regional in 1993, the hospital by all accounts was in shambles. Rice is credited with turning around the hospital financially and rebuilding its reputation as a trusted, quality health care institution in the community.
“The only way I could pull this thing out was to ask you all to stand behind me and stand behind the hospital,” Rice told doctors during his speech Monday.
Along the way, Rice built up what he called a “war chest” of $20 million in reserves.
“You have a well-equipped, outstanding hospital,” Rice told doctors.”
The crisis that prompted Rice’s resignation was a series of failed Medicare inspections primarily due to nurses improperly dispensing medication. Some within the medical community say that those problems can be traced right to the top.
Rice has been accused in recent years of fostering an overbearing culture and climate at the hospital. Numerous nurses and doctors have accused the hospital administration of being dismissive and unresponsive to their needs and concerns.
That, in turn, led to a large number of nurses leaving. The high turnover in nursing could have played a role in protocols for dispensing medication to patients not being followed.
“This is a breakdown not only because of nursing turnover, but in terms of nursing leadership to provide backup support for new or inexperienced nurses,” said Dr. Mark Jaben, a former ER doctor at Haywood. “If you have a certain core of experienced nurses on the floor they can serve that function. But when there gets to be so much turn over, you don’t that kind of turn over to support it.”
Jaben is an outspoken critic of hospital administration, butting heads with Rice many times before his practice was eventually ousted.
Rice reassured the medical community that however dire things seem in the short term, the hospital will pull through.
“The hospital can turn this around,” Rice said. “It is going to take a lot of sweat and a lot of hours.”
Prior to Rice’s resignation Monday, county Commissioner Mary Ann Enloe said the county will not let the hospital close and will intervene if the hospital board is unable to fix this problem on its own.
“We will have to be involved. I will lead the charge if it becomes necessary to get this taken care of,” Enloe said. “There are things that the hospital board can do immediately to start restoring credibility to that hospital. Let’s see if they do that.”
WestCare’s Harris Regional Hospital in Sylva will be filling a major void in the region’s health care in the wake of to the Medicare and Medicaid crisis at Haywood Regional Medical Center.
Doctors and officials at Haywood Regional Medical Center are accusing state inspectors of being heavy-handed, draconian, unprecedented, dangerous and unfair by pulling the hospital’s Medicare and Medicaid status.
When some 4,400 acres along the Little Tennessee River known as the Needmore Tract was taken over by the N.C. Wildlife Commission four years ago, a touch of the Wild West in WNC — complete with wholesome cattle ranchers and rough neck squatters — would soon come to a close.
The future of Haywood Regional Medical Center could be in jeopardy following the termination of the hospital’s Medicare and Medicaid status due to violations uncovered by health care inspectors.
Over-worked and underpaid. It’s a complaint most in America could wage against their boss. But at Haywood Regional Medical Center, it was just the tip of workplace complaints.
The National Forest Service is trying to hash out a new policy for building wind towers on public lands. The move is prompted by “increasing industry interest in development of wind energy facilities on National Forest Service lands,” according to the forest service.
The first stop for sick people in Haywood County should still be their local doctor.
A Tuscola football player charged with a felony cross burning targeting a biracial classmate will remain on the team, at least for now.
Ben Greene, a rising junior and running back on the varsity football team, will have to sit out two games and do 25 hours of community service, according to school board policy. He can continue to practice and train with the team and is free to take the field again after sitting out the requisite number of games.
Four teenagers in Haywood County were recently charged with burning a cross in the yard of a biracial classmate.
The act is considered a hate crime, a severe form of intimidation that is classified as a felony. All four students charged with the crime attend Tuscola High School.
A burley crowd wearing their long lineage of Appalachian ancestry proudly on their sleeves stared down Jackson County commissioners this week, decrying the idea of an ordinance that would muzzle their hunting dogs.
A pending sale of 19 miles of fiber lines capable of delivering high-speed internet in the greater Sylva area could once again give internet customers there a third option.
If the sale goes through, Jackson County and the town of Sylva could recoup a portion — although not all — of an economic development loan extended to the company that built and operated the lines before it went out of business.
After four major landslides, one death, several destroyed and damaged homes, washed out roads, and a $50,000 clean-up bill, steep slope construction rules are coming to Maggie Valley.
Waste, favoritism and possible fraud and corruption by state highway workers in Haywood County enriched a local contractor and cost state taxpayers, according to a sweeping investigation released late last week by the N.C. State Auditor’s Office.
A sweeping review of the Pisgah and Nantahala national forests will get under way in a matter of months, a behemoth, multi-year process that will layout a new blueprint for how the forests are managed for the first time in 20 years.
Environmentalists have been prepping for the forest plan for more than five years already. After all, the fate of 1.1 million acres of public land in the mountains hinges on the vision mapped out in the forest plan.
A million acres of national forests sounds like a lot, and indeed it is. But consider the 8.6 million people who visit the Pisgah and Nantahala national forests every year and those vast green swaths that checker any map of Western North Carolina don’t seem quite so big after all.
After inching its way back from recession-driven declines during the past year, Harrah’s Cherokee Casino and Hotel is back in the catbird seat.
You could even call it a Royal Flush. The advent of live dealers and table games coincides with a $633-million transformation of the casino into a rollicking resort.
Summer camp. It’s how generations of NOC paddlers got their first taste of whitewater, a fateful moment that ultimately grew into a lifelong love affair with the Nantahala.
“So many people learned to paddle at summer camp,” said Wayne Dickert, a championship paddler and a national guru of paddling instruction.
“Summer camp,” he proclaimed, jabbing a thumb toward his chest, then ticked through a long list of NOC leaders during the years who likewise can credit summer camp with their attraction to paddling — from NOC’s three founders 40 years ago to its new CEO and president.
Of the many challenges faced by the Nantahala Outdoor Center during the past decade, one of the most troubling — and the most difficult to fix — has been a national decline in paddling.
NOC’s steady and robust growth since its founding in 1972 through the late 1990s followed a similar trajectory to the sport in general. But after nearly three decades of growth, paddling leveled out around 2000 and even declined as a pastime.
The Nantahala Outdoor Center rose rapidly from a scrappy operation spawned by idealistic river rats in the 1970s to one of the largest and most renowned outfitters in the country. Now in its 40th year, NOC has struggled during the past decade to reconcile its founding philosophy — that of like-minded outdoors lovers carving out a living doing what they loved — with changing economic realities.
When Nantahala Outdoor Center burst onto the whitewater scene 40 years ago, it became ground zero for a new world of paddling — one where boundaries of the sport were being pushed, old paradigms were being broken, and new realities were being forged.
Paddlers wanted to be a part of it, and as a result NOC rapidly amassed a deep bench of the most elite canoeists and kayakers in the country. It was one of the few places where paddlers could make their living at their sport.
“The cadre of people we had here was unbelievable in those early days,” said John Burton, a former paddling Olympian and one of the early NOC pioneers who still works at the company today.
The dizzying concentration of paddling greats at NOC created a buzz around the Nantahala that was integral to its early success.
“This has been the center of expertise in the paddling world,” one of NOC’s founders Payson Kennedy said.
NOC was appealing to paddlers who reveled in the minutiae of the sport — particularly as they experimented with new ways of teaching the growing masses, said Bunny Johns, another NOC pioneer and one of the top female paddlers in the country in the 1970s and early ‘80s.
Staffers would spend hours dissecting the mechanics and physics of paddling in order to hone their teaching techniques — translating the fluid, almost intuitive body movements into anatomical step-by-step instructions for beginners. Take the roll, for example, a move kayakers yearn to master.
“Before, it was like, ‘You do your body like this,’” Johns said, rotating her body and lunging her arms in the mock-movement of a kayak roll.
Over dinner, instructors would share strategies for getting students to keep their head down through the roll, or how to pick up with their knee.
“They pioneered a fairly elegant way to teach people how to do the roll,” Johns said. “It was so exciting that people talked about it all the time.”
By year three, six of the paddlers from the 1972 U.S. Olympic team were staffers at NOC, launching a tradition of greatness on the Nantahala that persists today.
Kennedy admits he can’t take credit for the strategy, however.
“It just kind of happened,” he said.
What began as an accident proved an invaluable business strategy.
“It established real street credibility,” said Mark Singleton, the head of NOC’s marketing department from 1990 to 2002.
Come to NOC, and you would be paddling among the greats. But by the 1990s, the company was getting further removed from that aura.
“You had to go back to the first 1972 Olympics to get that,” Singleton said.
Not wanting to rest on past laurels, NOC leaders realized they needed to proactively position themselves at the center of the elite paddling world.
Further, the paddling competition of the 1996 summer Olympics would be staged on the nearby Ocoee River. It was a time to shine, and an opportunity they didn’t want to squander.
“We wanted to have a big presence around that close-by Olympics,” said Wayne Dickert, a top national paddler and whitewater author who worked at NOC for two decades.
The challenge, however, was to consciously replicate the natural attraction and draw NOC had for pro paddlers in its early days. NOC no longer had a lock on the river outfitter market for paddlers wanting to make their living on the water while training. There were other places they could go and have access to whitewater as a job perk.
To lure them, NOC put up the money to hire and pay a director for the Nantahala Racing Club in the early 1990s and continuing through 1996. Anyone racing under the banner of the club would have access to a formal instructor, training regimen and organizer.
“Before, it was just a bunch of NOC staffers, a bunch of guys who said ‘Hey, we are the Nantahala Racing Club,’” Dickert said.
The plan worked. Ultimately, six out of the seven paddlers on the 1996 Olympic Team trained at NOC.
“It was a renewal of NOC’s commitment to the highest levels of the sport. It gave us something we could really hang out hat on in terms of our marketing,” Singleton said. “It didn’t only drive business, although it was certainly very successful in that, but it also helped to reinforce an athletic culture.”
The man tasked with making it happen was Joe Jacobi, who was hired as that first-ever director of the Nantahala Racing Team. Jacobi knew first hand what a great place NOC was to work while training. Jacobi came to NOC as a dishwasher in 1989 while training as an Olympic hopeful for the ’92 games.
“It was the perfect job to do while training,” Jacobi said, who washed dishes in the morning and evening and filled his days with river workouts.
Jacobi was 19 when he came to NOC, and he describes those early years as magical. He lived in company housing, had a company meal plan, used the company laundry. He didn’t have to worry about the hassles of normal life, like grocery shopping or commuting to work. His life was self-contained and revolved around the river.
“The support of the NOC community, I couldn’t put words on what that meant to me,” Jacobi said.
One of the biggest perks he remembers: the company meal plan.
“When you are training, you get hungry a lot, and the whole food thing was very appealing to us,” Jacobi said.
Aside from the food itself was the dinner table conversation.
“The quality of conversation we would get into about kayaking and paddling and how paddling was taught and sold and how you would accomplish results on the elite side of it was stimulating and engaging,” Jacobi said.
Meanwhile, the star paddlers were worth their weight in gold when it came to NOC’s appeal for guests. Sutton Bacon, who would later become NOC’s president and CEO, paddled on the Nantahala as a child during those years. Bacon ticked off the Olympic paddlers he rubbed elbows with as a boy while paddling on the same river as them — there’s been 22 Olympic paddlers on NOC’s staff in all its 40-year history.
“I remember NOC vividly in the ‘90s, which in many ways was the heyday of NOC,” Bacon said. “Part of it I would have to caveat as nostalgia, but there was an electricity. All the paddling experts who were writing the books and producing videos were NOC staff members. That level of energy was probably the biggest remembrance as an NOC guest years ago that I want to make sure we replicate today.”
Horace Holden remembers the deal like it was yesterday.
He set out from Atlanta with a few blank checks in his pocket and a portable typewriter on the back seat of his car. He checked in to his favorite room in the 14-unit Tote ‘n’ Tarry motel, a mom-and-pop on the banks of the Nantahala River that catered to paddlers, and waited for an innocuous moment to strike up a conversation with the owner, Vincent Gassaway.
“I didn’t want him to think I was very interested,” Holden recalled. “I said, ‘How did your summer go?’ and he said, ‘Not too well.’ I said, ‘Well, you’ve never thought of selling this place have you?’ And he said, ‘Well I’ve thought about it.’”
A few minutes later, Holden went back to his room, typed up a contract and wrote a $1,000 check as earnest money to buy Gassaway’s motel, gas station and 40 acres on the river.
Forty year later, as Holden toured the grounds of the Nantahala Outdoor Center flashing his signature charismatic smile to the throngs of tourists and seasonal employees already swarming the place in these early days of summer, it’s easy to see how Holden transformed the isolated gorge into a bustling outfitter’s campus and one of the most successful river operations in the country.
He’ll claim the recipe for success lay with the Nantahala itself. But in fact, it was Holden’s own infectious idealism that carried the vision forward.
Holden had been staging paddling races on the Nantahala River since 1969. By 1971, the race was attracting hundreds of paddlers eager for competition venues in the growing sport of whitewater.
“The third year I said ‘Let’s call it the Southeastern championship,’” Holden recalled. “They said ‘You can’t do that.’ I said, ‘Why not? It’s the Southeast.’”
If Holden can think it up, he’s apt to try it.
Years later, Holden learned that Gassaway had bragged about the deal to the owner of a filling station up the road.
“Finally, I found somebody who was fool enough to buy the place,” Gassaway allegedly said of Holden.
Holden simply had a hunch — a hunch something here would work. What exactly, he wasn’t quite sure, but something.
At the time, Holden ran a summer camp in Georgia, and originally envisioned the Nantahala as a great outpost for his camp. Or maybe as a whitewater teaching center and paddling clinics for canoe clubs.
For good measure, Holden figured he could always serve up guided raft trips to help cover the annual mortgage.
But Holden, who was dedicated to running his summer camp, realized he needed a partner. He turned to his childhood friend, Payson Kennedy. The two had attended church together as boys.
“He was honest as the day was long,” Holden said, when asked why he picked Kennedy. Plus, Holden thought, Kennedy worked at Georgia Tech and had his summers off, giving Kennedy flexibility to oversee the yet-to-be-determined venture on the Nantahala.
“I asked him ‘Would you like to start a little canoeing operation?’” Holden recounted.
Kennedy was already looking for a lifestyle change and was about to go work for Outward Bound wilderness school when Holden approached him. Kennedy sold his house to raise money to become a co-founder of NOC along with Holden. The two would ultimately remain the majority stockholders for 40 years.
When asked about how he knew it would work, Holden says he didn’t.
“You can’t know. You can never know,” Holden said.
Somehow, though, it seems like he did.
When Payson and Aurelia Kennedy quit their jobs in Atlanta, cashed out their retirement, packed up their four children and headed for the wild and rugged Nantahala River 40 years ago, their mothers weren’t sure what had gotten into them.
The idea that tourists would pay $10 a head to go rafting down the river — enough of them to put food on the family’s table no less — sounded ludicrous.
“It seemed like a harebrain plan,” Aurelia admitted.
They had a fleet of just four rafts and used the family van to transport river runners that first year. They lived on savings and hope while scrapping out a vision of a paddling outpost.
“The only accounting was the checkbook,” Payson recalled. “I didn’t even keep account of how many people we took, but I made an estimate at the end of the first year we took 800 down the Nantahala and 400 down the Chattooga — which is less than we take in one day now.”
By year three, however, they were still losing money. Even Aurelia had begun to have her doubts.
“When I was in charge of three restaurants and four children, Payson had to listen to me have some flying fits those first years,” said Aurelia, who found a teaching job in nearby Andrews to supplement the family.
Indeed, it wasn’t easy. Payson and Aurelia slogged through 80- to 100-hour work weeks trying to realize their dream. Along with the raft trips, the fledgling Nantahala Outdoor Center had a small motel, a gas station, restaurants and a paddling school.
“It was erratic business,” Payson said. “Everybody did everything. We didn’t have specific jobs. If motel rooms needed cleaning, we cleaned motel rooms. I was once the breakfast cook. But, it was such a fun atmosphere. Everybody had a good time together even though it was hard work and long hours.”
The kids — ages 10, 12, 14 and 16 that first year on the river — were expected to pull their weight. They washed dishes, made beds in the motel, guided raft trips and took care of horses in the stable. By the second year, the kids got $20 a week, plus room and board of course, Payson added.
It wasn’t until nearly a decade later, when the company cleared $1 million in annual revenue for the first time, that Aurelia’s mother relented her initial doubts. Years would pass before Payson’s mother confessed to squirreling away savings during those early years in anticipation of bailing her son out when he had to throw in the towel and come back home.
The couple, joined by a love of paddling and the outdoor lifestyle, were as committed to each other as they were to NOC. They had their first date at 14, and never seemed to get over that teenage love affair.
As they flipped through an old family photo album at their kitchen table last week, Aurelia planted her hand on a picture of Payson taken in 1972, his shaggy brown beard and tanned skin looking as wild and rugged as the river he called home.
“Isn’t he handsome?” Aurelia said.
The page turned and landed on a photo of Aurelia resting against a large boulder taken in that same era.
“Isn’t she beautiful?” countered Payson, who’s about to turn 80.
As the Nantahala Outdoor Center stares down its 40th anniversary, few companies, let alone a river outfitter with such humble beginnings, could claim the kind of growth NOC has witnessed. It’s come a long way from the four rafts and family van used by the Kennedys to shuttle those first guests down the Nantahala. Today, NOC boasts a fleet of 1,000 rafts, 120 busses and 850 employees during peak season — shepherding 150,000 rafters down the Nantahala and 6 other rivers in the southern mountains each year.
Looking back, Payson said he never doubted their dream would work.
“We could see the people coming off the trips were so exhilarated, and it was growing by word of mouth. So I knew it was a matter of time,” Payson said.
When the Nantahala Outdoor Center was launched in 1972, paddling was still a newfangled sport.
“Very few people paddled. In that era if you saw a car with a boat, you usually knew who it was. It was that small,” said Bunny Johns, one of NOC’s early pioneers who logged nearly three decades at the company.
For paddlers who wanted to eat, sleep and breathe whitewater, NOC stood out. There were only two other river outfitters in the entire Southeast.
“The idea that you could really give of yourself for the betterment of the outdoors and expose more people to the outdoors and make a living doing it was very unique for 1972,” said Joe Jacobi, an Olympic gold medalist who worked at NOC as a dishwasher in the early 1990s and is now the director of USA Whitewater.
Whether it would work as a business or not was somewhat untested, however, and took a hefty dose of idealism by the Kennedy’s and fellow founder Horace Holden.
“You put out your concept and your dream in a unique and engaging way, and you just start,” Jacobi said. “If you think it is worthwhile to take kids down the Nantahala River, you just start doing it — and that’s where the buy-in and appeal came from.”
Paddling among the greats
Like so many of NOC’s early pioneers, John Burton gave up a promising, big-city, high-paying career for life on the river. His epiphany came at a rather inopportune time — at the outset of an all-day interview with the investment banking giant Goldman Sachs on Wall Street in the 1970s.
“About an hour into the interviews, I knew I was in the wrong place. I was not motivated by money. I could not go to Wall Street. I said, ‘Well I’ll see you later,’” Burton recalled. “I came to the Outdoor Center because it totally fit with my value set.”
Burton quit his job as an investment advisor making $16,000 a year for a job at NOC that paid just $7,000 a year. Burton had been on the 1972 Olympic team and a member of the U.S. paddling team for four years. More than half his fellow paddlers from that 1972 team — including all three women from the team — had already found their way to NOC.
“It was sort of a network of paddlers. Those who decided we wanted to train, that we wanted to get good at it, NOC was a place where you could get paid to work in the world of paddling and be surrounded by your friends and get paid to be on the river guiding rafts or teaching canoeing,” said Burton.
Burton came along in the nick of time. The skill set NOC needed most, it turned out, wasn’t another paddling pro, but his financial smarts.
“It was a seat-of-the-pants operation for sure,” Burton said, recalling the state of the company’s checkbook and recordkeeping when he came on board in 1975.
Burton quickly became Payson Kennedy’s right-hand man as vice president.
“We were a great team,” Burton said. “He was the philosopher and visionary, and I had the business skill set to support that.”
Creating a community
Working at NOC came with sacrifices. The pay was small, hours were long, and the work was seasonal.
The work ethic Payson’s own family exemplified in those earlier years — rising to the occasion and pitching in wherever needed — was expected from everyone.
“Everybody did it all. We washed dishes; we guided rafts; we built the buildings,” Burton said.
But no one seemed to mind, Burton said. Everyone who came to NOC did so for the same reason as the Kennedys.
“When we came up here, it was not a business decision but a lifestyle decision,” Payson said. “We assumed we would make less money than if we stayed in Atlanta, but we would be working with friends who enjoyed the same activities we did.”
It’s one of the lasting legacies from those early years. Everyone can still be called on to pinch hit in any area, no matter what your official job duties are. At 79, Payson can still be found pinch-hitting as a raft guide on busy summer weekends. It extends to the team of new investors who assumed a majority stake in NOC earlier this year.
“If they were here on the weekend and I said, ‘We just had two housekeepers not show up and we have 50 beds to make,’ they would say, ‘I’ll go make beds for you.’ That is so critical,” Burton said. “They aren’t afraid to get their hands dirty.”
Forty years ago, the Kennedys’ and Holden’s goal was not necessarily to build one of the world’s premier river outfitters. Instead, they wanted to carve out a place where like-minded river rats could scratch out a modest living doing what they loved — and that they would be in it together.
“From the beginning, that was the guiding the principle, not that some people would be working for the owners, but it would be a community of friends working together,” Payson said.
NOC had the spirit of communal living. Employees were fed through company meal plans and lived in NOC housing quarters. Everyone worked, ate, slept and played alongside each other.
“That community kept us all there,” Johns said.
There was even a daycare for NOC employees with children. Joe Jacobi, who worked at NOC while training for the Olympics in the early 1990s, recalled one of his Olympic teammates who was a daycare worker.
“You had a national champion whitewater kayaker soon to be an Olympian who would work in the daycare taking care of other paddlers’ children. Just think about that for a minute,” Jacobi said. “There was a very tight sense of community. There was a high level of buy in.”
Early on, the company developed an employee-stock plan that would give employees shares in the company. It was a financial benefit, but more so it was a way of creating a sense of buy-in and communal ownership.
While NOC no longer has a corner on the market when it comes to finding jobs in the outdoor industry, it’s still considered among the cream of the crop.
“The Nantahala Gorge is a pretty appealing place for anybody who is interested in a broad range of outdoor opportunities, whether it be paddling, mountain biking, hiking or camping, there is a lot going on in the Gorge,” said Mark Singleton, the head of NOC’s marketing department from 1990 to 2002. Singleton still lives in Jackson County and is the executive director American Whitewater, a national paddling advocacy organization.
Seasonal work
To some, the seasonal nature of the job was one of its greatest perks. Footloose and fancy free, summer whitewater guides could take to the ski slopes of the Rockies by winter or travel to South America without being tied down.
“If you don’t have kids and your needs are small, you can make it work,” Johns said.
But the seasonal ebb and flow — being thrust into unemployment six months of the year and struggling to find work — was a deal killer for others, particularly those who wanted to start a family.
“They’ll do it a few years until they want to get married and have kids and then decide they can’t afford to stay. Some do stay and live on the low income and enjoy life but don’t expect to get a whole lot of money,” Payson said. “If the business wasn’t so seasonal, it would be easy. It’s that seasonality that makes it tough to survive.”
NOC can’t entirely shut down in the off-season, of course. A core cadre has to run the place year-round, from marketing to IT to finance to planning out next year’s programs.
Those who stuck around long enough — and had skills deemed useful to the business side of the operation — could sometimes finagle their way into a year-round job.
Such was the case with Wayne Dickert, one of the championship paddlers NOC proudly claimed on its who’s-who of paddling instructors for two decades. When he started in the mid-1980s, however, he was just a lowly seasonal raft guide. Dickert spent his winters working for Silver Creek Paddles, a mom-and-pop company just down the road in the Gorge that made hand-crafted wooden paddles. Never straying far from the paddling arena, he also cobbled together a part-time winter income repairing banged up fiberglass boats and broken paddles.
Why not give up and get a real job?
“I bought into the whole idea and loved being able to give people that outdoor experience,” Dickert said.
The “Deliverance” factor
Of all the ingredients that set the stage for NOC’s unprecedented success, none was as unexpected and out of ordinary than the release of the movie “Deliverance” in 1972, set on a rural river not far from the Nantahala. The blockbuster movie catapulted Southern Appalachian paddling into the consciousness of mainstream America and captured the public imagination.
“That gave us a flurry of interest and excitement and attention,” said Payson, who starred as Burt Kennedy’s stunt double in the movie.
Four decades later, paddlers still sport T-shirts that say “Paddle faster, I hear banjo music.”
The movie was a game changer, according to NOC historians.
“It was that spirit of the urban adventurer, and NOC served as a destination point that spoke to that,” Jacobi said.
The same year, whitewater paddling made its debut as an Olympic sport.
Ultimately, the Kennedy’s and Holden had impeccable timing, even though they can’t take credit for planning it that way.
“That is the beauty of it — it is a little bit of a leap of faith,” Jacobi said.
Jacobi sees a parallel in the evolution and rise of NOC to the sport of kayaking.
“When you put a boat on the river, it is kind of like chaos in a controlled environment, and you don’t know every time how it is going to work out, and that is part of the appeal of it,” Jacobi said.
Luke-warm welcome
When the Kennedy’s first showed up with their meager collection of rafts hawking guided trips down the river, the rural community where they made their home wasn’t entirely sure what to make of them.
“We were looked at as those weird people,” said Johns. “It has been a gradual process.”
The long hair and beards sported by many of the male paddlers earned them an instant label of hippies in a rural region of Appalachia not exactly known for its liberal leanings.
“Some didn’t like these outsiders coming in,” Payson admitted. It was probably the toughest on his children, who had to leave the protected river community in the Gorge and venture into Bryson City for school.
“For me personally, and I feel just about everybody would agree with this, Bryson City and the Gorge tend to be two different fish bowls,” Dickert said. “There is cross over, they go into each other’s world. The Gorge comes in to do shopping and everything else, but there hasn’t been a lot of social interaction between the two.”
Far from its early days of being ostracized, NOC has become a dominant force in the landscape of Swain County — both economically and socially.
“Carolina Builders I think were the first ones to look at us and say, ‘These people are OK. They pay their bills,’” Johns recalled.
On the business side, NOC was a virtual gravy train, pulling in thousands of tourists ripe for the plucking. NOC rapidly rose in the ranks as a major employer.
“People certainly realized what it meant to this whole area,” Johns said. Kennedy agrees the business community was the first to welcome NOC into the fold.
But, there’s been a social acceptance too — thanks in part to people like Wayne Dickert. Dickert left his job with NOC this year to become the full-time minister of the United Methodist Church in downtown Bryson City.
Dickert is a walking, talking example of what’s likely NOC’s greatest gift to the region: people.
Hundreds of people have come to the mountains to work at NOC, whether for a couple of summers or half their lives like Dickert, and then found their way into the wider community, from construction workers to school teachers.
“As they come out of the Gorge and go into different jobs, it helps cross over the two communities,” Dickert said. “You start to develop relationships and see beyond what labels that might be attached to them.”
On his desk in the church office, a fistful of ballpoint pens baring the name of the church have been stuffed into a stainless steel cup with NOC’s logo — a pointed symbol of how the two worlds of NOC and the greater Swain community have merged.
“That’s been the biggest factor,” Payson Kennedy said of winning the community’s acceptance. “Having employees that decided to stay here and buy homes and build homes and get married and have children in the schools.”
Change on the horizon
Keeping up with its own growth was one of the biggest challenges faced by NOC during the first two decades.
The original founders felt at times like they’d jumped on board a runaway train.
“There were some years they intentionally cut back on their marketing efforts because they thought they were growing too big,” Dickert said. “NOC was it. NOC was the place.”
In 1978, six years after its own launch, NOC saw its first competition spring up — and welcomed it.
“At that time interest in whitewater was growing so rapidly, we still had all the business we could handle. It was all about how many guides could we train, how many buses could we add,” Payson recalled.
But as more and more rafting outfitters jostled for a piece of the action, the Nantahala showed signs of stress. Fear that it would become overrun by commercial trips and undermine its very essence prompted the national forest service, which controls most of the land along the river, to cap the number of outfitters in 1984. A new permit system was implemented for paddlers, a move NOC by that time welcomed.
To outsiders, NOC seemed to be rolling in success by the mid-1980s. Tens of thousands of people were flocking in droves to the fabled river outpost. Despite the booming business seen three short months of the year, NOC never stopped fighting and scrapping to ensure its viability.
“NOC has a checkered history. It never made a lot of money,” Johns said. “We struggled some years. We might have an up year one year and plan for another up and it goes down a little bit.”
Margins were always uncomfortably thin, and hiccups could seem like earthquakes. By the mid-1990s, the steady growth enjoyed during the first 25 years began to taper off and NOC entered an era of slow decline.
The list of reasons was long and varied, from forces outside NOC’s control — like the birth of artificial whitewater training centers and a national decline in paddling — to internal decisions, like hanging on to employee perks the company could no longer afford.
By the end of the ‘90s, NOC had posted three years of continuous losses. What worked in the past clearly wasn’t working anymore, but the company’s long-time leaders were reluctant to change.
“They realized we’ve got to change our vision, but they struggled with that and went back and forth a lot,” Dickert said. “They struggled with going from a bunch of cool hippies who hung out at the river and raft-guided, to at some point they grew large enough they had to think like a corporation.”
A tumultuous decade followed, and where the future will end up is still not entirely clear.
The Kennedys and Holden sold their majority stake in the company earlier this year, turning the reins of NOC over to a group of six young businessmen from the Atlanta area — including NOC’s own Sutton Bacon, who has been the CEO for five years. The new owners see NOC as a place to merge their love of outdoor recreation with their business and investment acumen.
Their interest in NOC isn’t entirely business-driven. They are all paddlers. They all have young children. And they all want NOC to be part of their own families’ lives for another 40 years, Sutton said.
While Holden and the Kennedys have kept some of their shares and seats on the board of directors, the changing of the guard clearly marks the end of an era. Money put up by the investors allowed NOC to buy out the remnants of the employee stock plan that had once been a symbol of NOC’s communal philosophy.
For Bacon, the responsibility he and other investors have to steer NOC into the next generation — balancing the financial realities of the times without losing the values that made NOC what it is — is all too real. NOC could not be replicated if starting out today, Bacon said.
“NOC started as a very pioneering young venture with great dreams and aspirations,” said Bacon. “I would say through the determination, wisdom and luck of Horace and Payson and many others, most the those visions came true.”
It was the perfect intersection of time and place — but it’s the unique philosophy planted deep in NOC’s company spirit during the formative years that has set the stage for an enduring legacy.
“No other businessman, and I’ll use that in quotations, would even fathom taking care of the employees and staff and the community and putting himself last and profit last as Payson Kennedy did,” Bacon said. “There is nothing like NOC — I have traveled and looked.”
Coming next week: NOC reinvented
The Nantahala Outdoor Center rose rapidly from a scrappy operation spawned by idealistic river rats in the 1970s to one of the largest and most renowned outfitters in the country. Now in its 40th year, NOC has struggled during the past decade to reconcile its founding philosophy with changing economic realities.
See The Smoky Mountain News next week for a look at factors behind NOC’s most tumultuous decade and its next generation.
Swain County’s uphill battle to get the federal government to make good on its promise of a $52 million cash settlement may have just gotten tougher.
The federal government is supposed to pay Swain County $4 million a year over the next decade — a deal intended to finally compensate the county for a road that was flooded when Fontana Lake was built in the 1940s. But after an initial down payment of $12.8 million in 2010, Swain hasn’t seen a penny since.
And now, with the federal budget process barely out of the starting gate for 2013, Swain is already starting from behind. Its promised $4 million was left out of President Obama’s budget for next year.
Congressman Heath Shuler, D-Waynesville, said he is baffled at how or why the $4 million cash settlement appropriation was left of out of the Presidential budget, pledging to press the White House until resolved.
“White House officials acknowledge that the omission of North Shore Road funding in the 2013 budget is problematic and have pledged to work with us to deliver the funding as promised,” Shuler said in a statement.
Shuler has twice gotten the annual $4 million payment appropriated for Swain County as part of the National Park Service budget — but both times it failed to actually reach Swain County. In 2011, the payment was rescinded after being caught up in an across-the-board clamp down on earmarks. So far in 2012, the National Park Service is refusing to release it, citing bureaucratic procedures that it wants followed.
For 2013, the payment could still make it in Congress’ budget even though it didn’t show up in the president’s. The president’s office has signed on in theory to support the funding even though it was somehow left out of its own budget document.
“I have been working closely with the administration to resolve this issue swiftly as well as release the $4 million in already-appropriated fiscal year 2012 funding currently sitting in the National Park Service’s account,” Shuler said.
But, Shuler is a lame duck now, having announced his retirement at the end of this year.
Shuler was perhaps one of the best advocates for the cash settlement Swain could hope for — at least in his willingness to expend political capital trying to land the appropriations each year. Growing up in Swain County, Shuler was unavoidably immersed in the raging battle over the road that hung over the county like a black cloud for so many decades.
Now, it will be up to his predecessor to carry the torch for Swain or not.
The Democrat running for Shuler’s seat, Hayden Rogers, said he supports the cash settlement and would fight for the annual appropriations as Shuler has.
“If elected, I will work to ensure that the remaining funding owed to Swain County is delivered as promised,” Rogers said in a written statement.
Rogers, who grew up in neighboring Graham County, served for six years as Shuler’s chief of staff, and is likely well versed in the political maneuvering behind the cash settlement appropriations.
The leading Republican candidate for Shuler’s seat, Mark Meadows, said it is a sad state of affairs indeed.
“We have an obligation we agreed to many, many, many years ago that wasn’t fulfilled and so we did another agreement and now we are not fulfilling that. At some point, we have to be good to our word,” Meadows said.
But, Meadows questioned how genuine it was for Shuler to lead Swain County to believe that he could land these appropriations each year in the first place.
“A current Congress can’t really obligate a future Congress to appropriations and therein lies the problem with the agreement,” Meadows said.
Meadows said it is unfortunate the cash settlement has fallen victim to the earmark ban, even though in principle the ban on earmarks was necessary to rein in federal spending and pork. But, it begs the question how Rogers plans to carry the torch.
“For Hayden (Rogers) to say he is going to continue to fight for that when we have an earmark ban, that is problematic,” Meadows said. “It is like saying ‘I’ll do my very best.’”
Meadows said Rogers, as Shuler’s right hand man, had his chance and didn’t perform. At this point, a strategy of meting out annual line item appropriations will continue to be difficult. A better strategy may be to get a larger, one-time budget allocation.
Meadows still faces a special primary election run-off July 17 against fellow Republican Vance Patterson to decide who will ultimately advance to face Rogers in November.
Park service hang-up
Shuler and Swain County leaders hold out hope they can convince the National Park Service to release the $4 million that was appropriated in 2012 budget. Specifically, it was included in the National Park Service’s construction budget, a total of some $159 million.
But, the park service claims it needs specific authorization — special language spelling out that $4 million should be handed over to Swain County.
When it comes to the rest of the $154 million construction budget, the passage of the appropriations bill itself counts as authorization, according to Jeffrey Olson, a spokesperson for the park service in D.C.
But as for the $4 million cash settlement contained in that same construction budget, simply passing the appropriations bill doesn’t cut it, Olson said. For that one particular line item out of everything else in the $159 million construction budget, the park service wants special language passed by Congress saying they really meant for the money to be spent that way.
“As I see it this as a problem with Washington, D.C.,” Meadows said. “You have money both people acknowledge was probably put in there for Swain County, and now we can’t release it because it doesn’t have the proper authorization.”
The fate of the $4 million at this point isn’t clear. The park service can’t spend it on anything else. If the money isn’t turned over to Swain County, the park service would give it back unspent to the federal government’s treasury.
Not surprised
Meanwhile, those who never stopped fighting for the road — and were opposed to the idea of a cash settlement in lieu of building it — have been quick to chime in with an “I told you so.”
“I never thought we would get the money to start with,” said David Monteith, a Swain County commissioner who was for the road and against the cash settlement.
Monteith believes the cash settlement was a sell out. He wanted to keep fighting for the road, hoping that eventually one day it would get built. By signing the cash settlement, the county gave up its claim to the road in exchange for cash — but it is contingent on the federal budget process and comes with no guarantee.
“It’s ‘if and when’ they want to release the money. That’s pure stupid,” Monteith said.
Of course, there was a similar caveat in the original agreement by the federal government promising to rebuild the road it had flooded. The government promised to rebuild the road “if and when” Congress appropriated the money to do so. The nation was in the throes of WWII, so it seemed reasonable to give a war-embroiled nation a little wiggle room on building back a flooded road in remote Appalachia. Seventy years was obviously more wiggle room than the people of Swain County expected, however.
The latest double-cross by the National Park Service is par for the course, according to Mike Clampitt, a Swain County resident who also sided with the “build the road” camp.
“Again we have an empty broken promise to the people of Swain County by the federal government,” Clampitt said. “I am not surprised that there are these complications getting the money to the people of Swain County because of quote ‘red tape.’ It is insult to injury.”
Swain County leaders have been hoping Shuler could fix the hang up with the National Park Service. So far, they’ve not waded into the bureaucratic quagmire to demand that NPS release the money and instead let Shuler do the heavy lifting. Clampitt said they should be more proactive at this point.
Two weeks after the primary election, an official winner has finally been declared following a recount in an insanely tight race between two prominent Waynesville Democrats for the N.C. House of Representatives.
Joe Sam Queen beat out Danny Davis by a mere 17 votes — less than 0.002 percent of the 9,969 votes cast in the race.
“It definitely shows that one vote can make a difference,” said Lisa Lovedahl-Lehman, the director of the Jackson County Board of Elections.
While Democrats were clearly torn on which man they wanted to send to Raleigh, Queen said he is pleased to win.
“I want to pull together because this is an important year,” said Queen, who will now face the Republican opponent Mike Clampitt from Swain County come November.
Queen and Clampitt are vying for the N.C. House seat currently held by retiring Rep. Phil Haire, D-Sylva. The seat represents Jackson and Swain counties and the greater Waynesville and Lake Junaluska area of Haywood County. The district leans strongly Democratic.
The race between Queen and Davis came down to the wire on election night, with Queen emerging as the top vote-getter by a mere 11 votes. Queen’s margin widened to an 18-vote lead the following week after a few dozen provisional ballots and late absentee ballots were added to the results.
Provisional ballots are cast when poll workers can’t find a voter’s name on the roster of registered voters. They are given a provisional ballot, which is then set aside in a special stack until election workers have a chance to research whether the ballot should be counted.
A few late absentee ballots usually trickle in after the election as well, but as long as they are postmarked by Election Day, they get counted.
Davis then called for a recount — a right entitled to any candidate under state election law when a race is within a 1-percent margin.
In today’s era of computerized voting terminals, however, recounts rarely change the outcome. But, Davis did pick up one extra vote in the recount, discovered by election workers in Jackson County when hand counting a handful of paper ballots from voters who mailed in absentee ballots.
“They just didn’t do the bubble correctly,” Lovedahl-Lehman said. “The scanner wouldn’t read it, but the board members could look at it and see the voter intent was for Davis.”
Queen said he and Davis both ran fair, clean campaigns.
“It is by far the most pleasant election I have been through,” said Queen.
It might be a day late, but it’s certainly not a dollar short.
A $235,000 playground is coming to the daycare center at Haywood Community College, a long-awaited capstone on a project that was heralded as a model child development center when it opened three-and-a-half years ago.
Clark and Leatherwood construction company of Waynesville was the lowest of five bidders. The playground will take two months to build and could begin as early as next week.
“We hope we can get these kids out there playing by the end of July,” said Bill Dechant, an architect and director of campus development at HCC.
It’s not a moment to soon for Steffie Duginske, a mom with two kids at the HCC child development center.
“We were told when we enrolled our kids there that the money was in the bank and they were in the process of getting a playground going, but time just clicked on and here we are three years later and there is still no playground,” Duginske said.
The playground primarily will be paid for with money left over from construction of the childcare center. Indeed the money was there, but Duginske has been frustrated with the slow pace of bringing it to fruition and the lack of a clear time table until now. Meanwhile, she has looked longingly at the plans and blueprints for the playground that hung on the wall in the hallway for more than a couple of years.
The design was based on brainstorming sessions with parents and children who were asked to envision their dream playground.
“It was a long process, and I don’t know if people realized it would not be something that happened overnight,” said Karen Denney, the director of business operations at HCC. “Every time we had a focus group that mentioned something, the designer was going back and doing renderings based on the input.”
Just as plans were finally getting finished, the person in charge of the playground left and the project ended up in a holding pattern for the lack of a point person over it.
Also, because HCC is a state government entity, it has more arduous policies to follow, including a multi-step bid process when seeking contractors.
“It just wasn’t a quick process to do,” Denney said.
The children do go outside to play, but the spot where the playground is supposed to be is just a large expanse of wood chips. The toddlers have their own play yard with a smattering of temporary plastic toys placed around it.
The long-awaited playground will arguably be first-rate.
“We are very happy it is happening now,” said Rita Wilson, director of the HCC child development center.
The HCC child development center is less than half full. It was built for a capacity of 163 children but serves only about 70 at the moment.
The center opened just as the recession hit. Parents who lost their jobs no longer had a need for childcare, with the number of stay-at-home dads rising in particular.
Meanwhile, state and federal subsidies for childcare have been cut, so working parents with low-wage jobs or parents trying to go to school simply can’t afford childcare, Wilson said.
Given the on-campus location, the childcare center is popular with HCC employees and students. But, it is open to anyone — something that many parents might not realize and could be another reason for the lower-than-anticipated enrollment numbers, Wilson said.
The quest to bring live table games to Harrah’s Cherokee Casino faces a final political hurdle.
Both the Governor and N.C. Senate have given live table games their blessing, with the N.C. House of Representatives now the lone hold-out.
Harrah’s Casino is limited to video-based gambling only. Adding live table games like roulette and poker would attract a new clientele of player, and in turn more money and jobs flowing through the entire region, according to the Eastern Band of Cherokee Indians.
“We aren’t going to see a big influx of industry coming in to Western North Carolina, so we have to do what we can to ensure we have economic development,” said Rep. Roger West, R-Marble. West sees the casino, which could employ more than 2,000 if it gets live dealers, as a key economic pillar that spins off in the region.
Whether the Eastern Band has the requisite votes to get the measure passed is unclear at the moment, however. But West is hopeful.
“I think the votes are there. If they aren’t, it is just a matter of getting them,” said West, who represents Macon, Clay, Graham and Cherokee counties.
However, many of the House legislators who are opposing live dealers cite moral and religious grounds, and convincing them to relinquish their convictions in the name of economic development might not be easy.
“My opposition stems from my longstanding belief that state sanctioned gambling has a corrosive effect on our society,” said Rep. Ray Rapp, D-Mars Hill.
Rep. Phil Haire, D-Sylva, said the good the casino has done in the region outweighs any negatives.
“I remember the days before they had Harrah’s — it has brought a whole lot of prosperity to the Eastern Band,” Haire said.
Haire said the jobs provided by Harrah’s are significant, not only the salaries but the health insurance. And Haire personally enjoys going to the concerts at Harrah’s major performance venue. He saw Diana Ross recently, and is headed to see Natalie Cole this weekend.
Haire hopes Cherokee’s casino operation won’t be held hostage to personal ideology.
“I think some people want to put a moral tag on it, but nobody makes you go to Cherokee to gamble. It is all voluntary,” Haire said.
Rapp was willing to go along with live table games for the existing casino campus, since gambling was already going on there. But Rapp is not comfortable with the prospect of Cherokee opening more casinos in the region on their land holdings.
The deal initially inked with the governor would have permitted Cherokee to open more casinos anywhere on land holdings it owned currently.
However, in an attempt to assuage legislators uncomfortable with expansion of gambling onto some of Cherokee’s more recently acquired holdings, new language was added. The new language limits the Eastern Band to a max of four more casinos, and they can only be built on land under the tribe’s domain as of 1988 — making newer land acquisitions off the table.
Live table games passed the senate last week by 33 to 14. All four state senators from the mountains voted for it: Sen. Jim Davis, R-Franklin; Sen. Ralph Hise, R-Spruce Pine; Sen. Tom Apadoca, R-Hendersonville; and Martin Nesbitt, D-Buncombe.
The tribe has hired lobbyist Steve Metcalf, a former legislator from Asheville, to shepherd live table games through the General Assembly. Metcalf declined to comment for this article.
A vote could come as early as next week. If it doesn’t come, it could be a bad sign.
“You never go to a vote unless you have the votes,” West said.
The General Assembly will only be in session for about six weeks.
Education fight resolved
It took years of lobbying and negotiations for the tribe to reach where it is now. In an historic agreement signed with Gov. Bev Perdue last November, the tribe agreed to give up a cut of its revenue from the new table games — on a sliding scale starting at 4 percent and maxing out at 8 percent over the next 30 years. In exchange, the state would grant live dealers and a guarantee that no other casinos would be allowed to encroach on its core territory, namely anywhere west of Interstate 26.
While Perdue and Republican leaders in the General Assembly had agreed in theory to live dealers last fall, they had locked horns on a seemingly obscure sticking point. Perdue wanted the state’s cut of casino revenue to go directly to schools, bypassing the General Assembly. That way, lawmakers couldn’t be tempted to tap the money for other uses.
The Republican leaders, however, said casino revenue couldn’t legally be put in a lockbox and earmarked for future years. One set of lawmakers today can’t impose mandates on how future lawmakers can spend money.
A compromise was reached that places the money in a special “Indian Gaming Education Revenue Fund.” The General Assembly can tap the fund at will — so it does put legislators hand in the till — but they have to hold a special vote to get money out. Otherwise, the money will be disbursed quarterly to school systems across the state based on their student body population, and can only be spent on “classroom teachers, teacher assistants, classroom materials or supplies, or textbooks.”
Noreen Gay doesn’t have a moment to spare these days. She’s busily finishing the final stitches of a quilt she plans to enter in the Smoky Mountain Quilters Guild show barreling down in a mere two and half weeks — so busy, in fact, she’s hauling it around on the backseat of her car when she runs errands, in case she has a few spare minutes to put to good use.
“Sleep? What’s sleep? Cook for my husband Bill? He’s on his own,” said Gay, a member of the Smoky Mountain Quilters Guild.
“It’s crunch time,” agreed Cindy Williams of Franklin, president of the Smoky Mountain Quilters Guild.
More than 1,300 people are expected to visit the Stars Over the Smokies quilt show coming to Western Carolina University June 7-10. For many quilting fanatics, it will take every bit of the three-day show to soak up the quilts on display.
“I could spend three hours today and come back and spend another three tomorrow and see things I didn’t notice before,” Williams said.
Viewers peruse the quilts on display wearing a single plastic glove on their right hand, given out at the door so all the fondling doesn’t soil the quilts over the course of the show.
Quilting has evolved from a necessity — piecing together scraps of fabric for warm blankets because entire bolts of cloth were too costly — to an art form today.
“There has been a metamorphosis in quilting in the past 10 years,” Gay said.
Many quilters have their own personalized style. Some fancy the traditional, heirloom quilt patterns, handed down through the generations for centuries. Others create their own patterns, sometimes in the traditional vein and sometimes, as Gay describes herself, “out of the box.”
Creating your own patterns comes with some risk, but like any artistic endeavor, risk is inherent.
“All of them end up being risky. Even a traditional quilt, if you choose the wrong color, it won’t pop like it should,” Gay said.
Serious quilters usually have multiple projects at various stages of completion in their queue at a time.
“You get tired of looking at blue, you get tired of making triangles, so you go to a different project and you come back to that one,” Williams said.
Sadly, some quilts are destined to linger in those half-finished forms for years, the quilter unable to get up the gumption to finish. It’s such a common ailment, these unfinished projects are universally known in quilting circles as “Unfinished Objects,” or UFOs.
Quilters tormented by their own UFOs periodically have the chance to pawn them off on another quilter at UFO swaps. Hidden from sight in a brown paper bag, quilters bring in a UFO they don’t want anymore and go home with someone else’s UFO. The catch: you’re obligated to finish whatever UFO you pick from the bunch.
Personally, Gay has banished UFOs from her life.
“I’ll throw away UFOs that I hate,” Gay said. “I only have ‘X’ amount of quilts in me at this age, so I am going to work on what I like.”
Nancilee Dills of Franklin has sworn off UFOs as well. But for her, that means committing herself to giving every quilt in her ongoing repertoire a little love and attention on a regular basis. She keeps a spreadsheet of all her projects and won’t work on one more than six or eight hours without rotating to the next.
It’s no small feat — she has about 30 quilts in various stages, each neatly organized in clear plastic bins, labeled on the outside and with the requisite patterns, tracings and fabric squares contained within, making it easy to grab her quilting project du jour.
Quilting can be obsessive, as many of the quilters in the Smoky Mountain Quilt Guild have learned the hard way.
“We’ve now had two ladies burn pans quilting,” Williams said, imparting the stories of two quilters who got so absorbed while dinner was on the stove they almost burned the house down.
Most quilters have dedicated a room in their house to their endeavors. Mary Ann Budhal, a quilter with the guild in Jackson County, converted her son’s bedroom into her quilting hideaway. Once his old dresser drawers and closet got stuffed to the gills, she had to buy shelving units to hold all her fabric stock and UFOs.
Budhal specializes in miniature art quilts, intended as wall hangings rather than bed coverings or throws. The quilting pieces are tiny — some just a quarter of an inch — with hundreds of them in a single quilt.
With that many pieces in play, Budhal toys with her designs and color palettes on a project wall, a large piece of foam covered in flannel that she can tack pieces up on.
She’s lucky to have a live-in sounding board for her design process. Her husband is a painter and former art instructor at Western Carolina University and willingly offers up his take on a pattern — rather than the typical “looks great to me, honey” answer most women when get pressing their husbands to weigh in on this-or-that shade of burgundy.
But the perk comes with a downside.
“If it weren’t for him and all his pictures we have hanging up, I might have room for more quilts,” Budhal said.
The final throes
Last week, Williams and Gay spent two hours studying the great hall in the University Center where the quilt show will be held, measuring and calculating just how they will fit all those quilts into the space.
Williams will take the dimensions home and plug them into a computer program to come up with a floor plan.
“This will take me untold hours,” Williams said.
The guild had new racks built for this year’s show, fashioned from PVC pipes that fit into sturdy custom-made metal bases.
“Our old racks took screw guns and screw drivers and hammers and nails — and men — to put them together,” Williams said. “These are heavy but they are simple.”
About half the quilts being entered in the show will come from the 150 members of the Smoky Mountain Quilter’s Guild in Macon and Jackson counties. The other half are trickling in from around the country.
Budhal’s living room is rapidly filling up with quilts being mailed in from far-flung locations ahead of time. Not all quilters entering their work will be so lucky to have them finished ahead of time, however.
“They will be sewing on the binding as they approach campus to turn them in,” laughed Budhal.
While some quilts in the show are masterpieces, it will run the gamut from beginners to master quilters.
“We want a show that covers every level of experience,” Williams said. “Quilters want to see everything. You never know what you are going to learn. I have been quilting 30 years and I learn something new at every show.”
This is the first year that the guild will stage its show in Jackson County, and the community has embraced the big event. There is a quilt block planted on the lawn of the historic courthouse in Sylva. The Jackson County Chamber of Commerce has a quilt display in its visitor center. And many of the downtown Sylva merchants have incorporated quilts into their storefront windows.
Additionally, WCU has an art quilt exhibit at the Fine Arts Center and a vintage quilt exhibit at the Mountain Heritage Center.
The quilt show is being held in conjunction with the North Carolina Quilters Guild Symposium. This year marks the farthest west it has ever been held in the state.
So far, 250 people have registered for the symposium, which includes two days of classes with renowned national quilting instructors, lectures and socials.
Williams began lining up the quilting instructors more than two years ago, an early start that helped land some of the biggest names in quilting. That is certainly part of the draw, but so is immersing one’s self in all-things-quilting for three days.
“No telephones, no televisions, no children to feed, no husbands to — deal with. You are with your peers and like doing what you like doing,” Williams said. “It can be very intense. But everybody comes with the spirit of friendship and happy to be here.”
Want to go?
Stars Over the Smokies quilt show and symposium hosted by the Smoky Mountain Quilters Guild will be held June 7-10 at Western Carolina University.
The major quilting event will feature a quilt show with more than 350 quilts and 24 vendors.
Hours are 3-7 p.m. Thursday; 9 a.m. to 7 p.m. Friday and Saturday; and 9 to 11 a.m. Sunday. $5. Located in the great hall of the Hinds University Center.
Additionally, WCU has an art quilt exhibit at the Fine Arts Center and a vintage quilt exhibit at their Heritage Center.
A recount is likely in the race for N.C. House of Representatives between two well-known and prominent Waynesville Democrats, Danny Davis and Joe Sam Queen. The race came down to the wire on election night last week, with Queen emerging as the top vote-getter by a mere 11 votes.
Results on election night are considered “unofficial” for another week, however, until election workers have a chance to weed through a few dozen provisional ballots and late absentees and determine if any should be counted.
Those provisional and late absentees were processed Tuesday but failed to change the outcome of the race.
Davis picked up an additional 13 votes, while Queen picked up an additional 19 votes — so Queen actually widened his margin of victory from 11 votes to 17.
Queen and Davis were vying for the N.C. House seat currently held by retiring Rep. Phil Haire, D- Sylva. The seat represents Jackson, Swain and the greater Waynesville and Lake Junaluska area of Haywood County. The winner in the Democratic primary will face the Republican opponent Mike Clampitt from Swain County come November.
Given how close the race is, Davis said he will likely call for a recount. Under state election law, any candidate can request a recount in any race. The state election board then decides whether one is warranted.
If a race is within 1 percent, however, the state is obligated to conduct a recount if the runner-up requests it.
“There is a reason the state has a mandatory recount if it is less than 1 percent,” Davis said, explaining why he would most likely ask for a recount.
Davis spent 26 years as a District Court judge in the seven western counties. Queen, an architect with a side business managing a vast inventory of rental property, has served six years in Raleigh as a state senator.
Both candidates were holding their breath in the days following last week’s election, curious whether some 115 provisional ballots and a handful of late absentee ballots would alter the outcome of the race.
Provisional ballots are cast on Election Day when poll workers can’t find a voter’s name on the roster of registered voters. They are given a provisional ballot, which is then set aside in a special stack until election workers have a chance to research whether the ballot should be counted.
“Every voter has the right to vote. They are given a provisional and if it is cleared they count. If not, they don’t,” said Joan Weeks, director of the Swain County Board of Elections.
There are several reasons why someone’s name might not show up on the roster at the polls. Perhaps they registered to vote under their maiden name, but give poll workers their married name. Perhaps they thought they registered at some point but in fact had not.
Often, they registered to vote in another county and didn’t realize they have to re-register to vote when they move.
This is particularly common in Jackson County, where college students at Western Carolina University registered in their hometown but show up at the polls on Election Day thinking they can vote in Jackson.
Election workers across the state hold a “canvas” the week after the election, where they go through all the provisional ballots and decide which, if any, are legitimate.
Ultimately, the majority don’t count.
“Legally you can’t say ‘No you can’t vote,’ but in the end most of them are not going to count,” Lisa Lovedahl-Lehman, director of the Jackson County Election Board, said.
But there are a few instances where a voter has indeed registered yet doesn’t show up in the official roster at the polls.
Sometimes, people will register to vote at the Division of Motor Vehicles when getting a driver’s license. The DMV then transmits the voter registration to the appropriate county election board. Occasionally, it gets sent to the wrong county or something simply goes wrong with the transfer.
“There are times, albeit rare, when you put a batch of things in the scanner and somebody at DMV had syrup on their hands and two of them stick together and one of them doesn’t scan,” said Robert Inman, director of the Haywood County Election Board.
As for the majority of provisional ballots that never get counted, how that person voted will never be known. Election workers first verify whether the ballot is eligible, and only then is the ballot opened and counted. Whether those not counted could have changed the outcome of the election remains a mystery.
“This is not five card draw where you have to show your hand,” Inman said.
Haywood County is looking to off-load a few of its now vacant office buildings and is searching for help to do it.
The county has been playing musical chairs with several departments during the past year, consolidating county functions once spread out over three separate satellite office buildings into more centralized locations.
Rather than attempt to sell the resulting collection of empty buildings itself, which has yielded no results so far, the county plans to contract a real estate agency to do the job.
“Just putting up a ‘for sale’ sign and hoping someone drives by, there is no real advertisement happening and no connections in the commercial real estate community. We don’t have access to that market,” said County Commissioner Chairman Mark Swanger.
It’s unclear just what the county can hope to get in the current real estate climate. Although the county is paying for basic maintenance and upkeep of the buildings until they sell, the county can simply wait until a decent offer comes in, said County Manager Marty Stamey.
If the county decides to accept an offer, there is a mandatory upset bid process, giving other buyers a chance to make a higher offer.
There is an exception, however. The county can enter an exclusive deal with a non-profit wanting to buy the building, without going through the upset bid process, if the entity is proposing a use that serves the public good.
But for now, the county soon will be seeking proposals from real estate firms to help it market and sell the properties. During a recent meeting, Haywood County commissioners discussed what they will look for in the prospective agencies.
“I want to see their track record,” Commissioner Kevin Ensley said.
Swanger agreed, adding that the county would want to discuss each agency’s marketing strategy and what fees the county would incur.
The county ended up with a collection of vacant office buildings after remodeling a vacant Walmart to house everything from the Department of Social Services and the Health Department to planning and erosion control.
The now-vacant buildings lie along the Old Asheville Highway.
Here’s the county’s “for sale” list:
• Former board of elections/planning department/erosion control/tourism agency: $1.15 million
• Former health department: $730,200
• Former DSS (old hospital): $1.25 million
• Former Haywood Mountain Home residence on Henson Drive: $269,700
While Swain County fights to secure the rest of the $52 million cash settlement its owed by the federal government for the North Shore Road, the $12.8 million already in the bank is generating hundreds of thousands in interest every year.
Since the initial payment of $12.8 million to Swain County in 2010, it has made nearly $1.5 million in interest.
The cash settlement money is held in a trust fund managed by the N.C. Treasury Department. Every year, the state remits a portion of the accumulated interest to the county. The principle itself is safeguarded, and can only be tapped if two-thirds of Swain’s registered voters agree to do so in a special vote, per the terms of the trust fund.
So far, Swain has gotten $150,000 of the interest generated on the account. Even though the actual interest earned on the fund is much higher, some has been reserved as a cushion, intended to safeguard the principle $12.8 million.
Should interest rates take a dive, or even post a lost, the cushion that has been held back should prevent an erosion of that principle sum from dipping below the $12.8 million.
The fund currently stands at just over $14 million, according to the state treasurer’s office. Now that a sizeable cushion has been built up, Swain can expect to see more interest flowing to it each year and less held back. This year, the county could expect as much as $500,000.
How to spend the money is ultimately up to the county commissioners. The current board of commissioners don’t want to merely dump the money into the county’s general budget, but instead want to see it go toward special projects, so the public can see the good the money is doing, according to County Manager Kevin King.
“They didn’t want to see any of the money going to the operational budget because it gets lost in the shuffle,” King said. “We want to be able to identify every penny that goes to every project.”
Likewise, the commissioners are hesitant to use the money for a big-ticket item, like a new school. Dedicating the money to that kind of recurring expense — such as annual debt payments on the same large construction project year in and year out — would tie up the cash settlement interest on a single project for the foreseeable future, King said. Instead, the county is interested in special projects that otherwise would be taxing, if not impossible, for the county to undertake.
So far, the county has spent its cash settlement interest money on public restrooms at a downtown riverside park in Bryson City, a series of historical monuments, a new trash truck and renovation of the historical county courthouse for a museum.
The commissioners have dedicated $50,000 so far for a cultural heritage museum being constructed inside the iconic Swain County courthouse, and have pledged another $100,000 from future interest payments.
The National Park Service is refusing to let go of a $4 million payment Swain County is due as part of the cash settlement over the North Shore Road.
The federal government is supposed to pay Swain County $4 million a year over the next decade — a deal intended to finally compensate the county for a road that was flooded when Fontana Lake was built in the 1940s.
Swain has had little luck getting the government to make good on the pledge, however.
Swain didn’t get the money in 2011 after Congress clamped down on earmarks. This year, the money was supposedly included in the National Park Service’s construction budget by both the President and Congress, but the park service isn’t releasing the money.
“It is currently sitting in the National Park Service’s account,” said Whitney Mitchell, spokesperson for Congressman Heath Shuler, D-Waynesville. “It is unclear why the National Park Service has delayed transferring the $4 million payment out of their budget into the Swain County trust fund.”
The National Park Service claims it doesn’t have proper authorization to make the payment.
Simply including the money in its budget isn’t enough. The park service claims it needs specific authorization — spelling out that $4 million should be handed over to Swain County — included as part of the budget bill that was passed by Congress last December.
SEE ALSO: Swain uses money from first North Shore Road payment on special projects
“While the funding was included in the final bill, the necessary language was specifically excluded,” said Jeffrey Olson, a spokesperson for the National Park Service in Washington, D.C.
Without that language, it won’t turn over the money, Olson said.
“Everybody agrees the $4 million for Swain County was passed,” said Leonard Winchester, a Swain County resident who has been working on behalf of the cash settlement for years. “Why this money can’t be turned loose because someone at Department of Interior said they didn’t have the proper authorization, I don’t know.”
Shuler’s office, meanwhile, claims the money included in the budget carries clear instructions to be handed over to Swain County.
Olson was unable to address the apparent stalemate, simply reiterating that the park service lacked authorization to release the money.
“That is the end of the question for us,” Olson said. “If a member of Congress says ‘Yes it is,’ and we say, ‘We don’t have it,’ that’s as far as I can take it. It either shows up in the language of the appropriation bill or it is not there.”
Specifically, the money for the cash settlement was included as part of the National Park Service’s construction budget, a total of some $159 million. That’s something even Olson agrees with.
But where he differs is whether the $4 million for the cash settlement needs its own authorization before it can be released.
Olson said everything else in the construction budget carried the necessary authorization. That authorization usually comes in the form of an itemized list of approved construction projects.
“When we have a construction budget, it often includes a list of projects. It is my understanding that list of projects is our authorization,” Olson said.
However, that itemized list doesn’t show up in the appropriation bill passed by Congress in December. The list was left out of the final bill.
“Where it went astray was they didn’t keep the list. It just devolved to a single number,” Winchester said. “Whatever wording the National Park Service thought ought to be there went away, and they ended up with a lump sum number for their construction budget.”
That begs the question: Can the National Park Service not spend any of the $159 million in its construction budget this fiscal year because it too lacks authorization due to the absence of the list? Or is Swain’s cash settlement is being held to a double standard?
Olson said the National Park Service doesn’t need specific authorization for the rest of its construction budget. When it comes to the rest of the $154 million construction budget, the passage of the appropriations bill itself counts as authorization even though the list was left out of the final budget bill, Olson said.
“There is no requirement that this list of construction projects be attached to the appropriations bill Congress passes and the President signs before we proceed with the projects,” Olson said.
But as for the $4 million cash settlement contained in that same construction budget? The park service wants Congress to pass specific language saying its OK to pay it out.
Apparently, even though the money was included in the park service construction budget, the park service isn’t willing to consider the cash settlement as “construction.”
Leonard points out that the cash settlement is a substitute for constructing the road itself, and so in a way, it is kind of construction — since it is “in lieu of” construction.
At one point, there was indeed an itemized park service construction list circulated in budget talks. The cash settlement was allegedly on the list. The list was even referenced in budget committee documents as the “go-to” list for what the National Park Service should spend its construction budget on.
“The amount provided will fully fund the NPS construction projects as prioritized by the Service pursuant to the Administration’s revised request list provided to the Committees on June 24, 2011,” according to a draft version of the National Park Service appropriation bill.
Olson didn’t want to talk about what type of authorization the National Park Service needs at this point to fix the situation.
“Those are conversations that happen between a congressman and the National Park Service,” Olson said. “We are not going to use your newspaper as a way to communicate with Swain County.”
However, that’s exactly the question that has stymied everyone working to secure the cash settlement.
“Somebody, somewhere, has to know if there is something missing, what it is,” Winchester said.
Winchester has followed the labyrinthian appropriations process through Congress. He even flew to D.C. in 2010 along with a delegation from Swain County to meet with Ken Salazar, the Secretary of the Department of the Interior, to remind him of the cash settlement promise.
Winchester said it is disappointing to fight so hard, to see the money included in the budget, but to come up empty-handed.
Insult to injury?
The cash settlement was intended to resolve a festering decades-old dispute between Swain County and the federal government over a road flooded during the construction of Fontana Lake back in the 1940s. At the time, the government promised to rebuild the road one day, but never did.
Nearly seven decades later, the government instead promised to make good on its broken promise by paying Swain the cash value of the road that was destroyed — a value pegged at $52 million.
The money was supposed to be appropriated by Congress to the tune of $4 million a year until the obligation was settled. But after an initial down payment of $12.8 million in 2010, Swain hasn’t seen a penny since.
The cash settlement was supposed to make right on the long-standing obligation to Swain County citizens. The federal government signed a memorandum of understanding amid great pomp and circumstance in 2010, a ceremony attended by some 200 people at Swain County High School, pledging to reimburse Swain County for the road.
If it’s authorization the park service wants in order to release the $4 million included in this year’s budget, how about that memorandum of understanding, signed by the Secretary of the Department of Interior Ken Salazar, promising to pay it? Winchester said that ought to be good enough.
“Each individual subsequent appropriation does not require a new additional authorization,” Winchester said. “These joint acts by the federal government and by Congress constitute the authorization, recognition, expectation and plan for future payments, if and when they are appropriated.”
Congressman Shuler has been a champion of the cash settlement. He grew up in Swain County and rode his football stardom there and at nearby Tennessee to his congressional seat in Washington.
Shuler had to lobby for the appropriation on two fronts. He worked closely with the Obama Administration to get the $4 million payment included in the National Park Service budget this year, Mitchell said.
He also had to shepherd the line item through Congress to make sure it remained intact during the budget process.
“Rep. Shuler worked closely with House leadership to ensure the $4 million annual payment the President promised and requested as part of the North Shore Road settlement was fully funded in the 2012 Appropriations bill,” Mitchell said.
Shuler is remaining optimistic.
“Rep. Shuler fully expects the National Park Service to fulfill the President’s request and uphold the federal government’s legally-binding obligation to Swain County by making the payment before the end of this year,” Mitchell said.
Mitchell pointed out that the government signed a “legally-binding” memorandum with Swain County.
Even with an ally in Shuler fighting for the cause, the cash settlement seems to have stalled out almost as soon as it was promised. Shuler is now serving his last year in office, however, having announced this winter he would not seek re-election.
Whether Shuler’s successor will fight with the same vigor for the settlement leaves the future of the payments in even greater limbo.
Shuler’s office says he will impress on whoever comes along after him to carry the torch.
“Our office will fully brief the incoming 11th District representative to ensure they have the information and resources they need to follow in Rep. Shuler’s footsteps and continue his leadership and hard-fought efforts on this front,” Mitchell said.
For now, Swain County leaders haven’t gotten actively involved in hunting down the $4 million that allegedly has their name on it somewhere in the National Park Service budget. Instead, they were counting on Shuler to fight that battle for them.
“The money is in the account ready to go but nobody is willing to sign the check,” Swain County Manager Kevin King said, proffering his version of the cash settlement’s status.
But Swain County commissioners might need to start rattling some cages.
“We might have to at some point in the future,” King said.
What is the North Shore Road?
The so-called “Road to Nowhere” is a source of bitter resentment for the people of Swain County. Before it was flooded, the road traveled for more than 30 miles from Bryson City to Tennessee. The route was dotted with homes, farms, schools, churches, cemeteries and general stores of numerous Appalachian settlements going back generations.
When Fontana dam was built in the 1940s, what wasn’t consumed by the rising water of Fontana Lake was folded into the Great Smoky Mountains National Park. Hundreds of people were forced to leave their homes forever.
The federal government promised in writing at the time to rebuild the road, but after pecking away at a dozen or so miles in the 1950s and 1960s, it was abandon due to the exorbitant costs and environmental hurdles of building the remaining 20 or so miles.
It became a symbol of Washington’s failure to keep promises to rural Appalachia. Swain County, after all, had paid to build the road in the first place — and had to keep paying off the construction debt for years after the road didn’t exist anymore.
A deep-seated distrust and disillusionment set in over the intervening decades.
The race for N.C. House of Representatives between two well-known and prominent Waynesville Democrats, Danny Davis and Joe Sam Queen, came down to the wire Tuesday night.
Queen emerged as the top vote getter by only 12 votes. But, Davis said he was not prepared to concede the race. Results are considered “unofficial” on election night and are not certified for another two or three days, after the county election boards are able to verify provisional ballots, a process that can result in a shuffling of few votes here and there.
“Twelve votes is just too close,” Davis said Tuesday night. “I want to wait until we know more about these other ballots.”
Davis spent 26 years as a District Court judge in the seven western counties, what he calls a “front row seat” on the issues affecting people’s lives. Meanwhile, Queen, an architect with a side business managing a vast inventory of rental property, points to his six years spent in Raleigh as a state senator.
While Queen and Davis are both from Waynesville, the candidates had the most at stake in Jackson County — clearly the largest bloc of Democratic voters compared to much smaller Swain County and the fraction of Haywood that lies in the district.
Queen and Davis both spent the day campaigning in Sylva.
“We had a very pleasant day together at the same precinct all day long in the rain and in the sun. We had good sensible conversation, intermittent with shaking hands and trying to win our share of the votes,” Queen said.
Queen said Democratic voters were torn, witnessed by the close vote.
“We are both well-known, well-like Democrats with significant records of public service and loyal constituents,” Queen said.
Queen has been a state senator representing Haywood County but has never been on the ballot in Jackson.
Queen campaigned actively in Jackson County, attending community functions and hosting meet-and-greet receptions with voters.
“Jackson County is half the district, and it was new to me, so it was certainly my battle ground,” Queen said.
The winner will run against Mike Clampitt, a Republican from Swain County, come November.
Jackson County has a new county commissioner.
Vicki Greene, a longtime community planner and retired assistant director of the Southwestern Development Commission, clinched the Democratic nomination, which makes her a shoe-in for the Board of Commissioners as there is no Republican opposition running for the seat in November’s general election.
Greene will take the seat on the board currently held by Commissioner Joe Cowan, who decided not to seek re-election.
Stacy Buchanan, a former Jackson County commissioner, ran against Greene in the primary, but Greene walked away from the race with 60 percent of the vote.
“I look forward to working with all the folks of Jackson County to make this the best possible Jackson,” Greene said.
For three decades, Greene has worked as a resource for local governments and community leaders in the seven western counties. She is skilled in the art of consensus building and translating brainstorming sessions into tangible results
“Good communication is more about listening than talking,” Greene said. “For somebody to win, somebody else doesn’t have to lose.”
Another “Greene-ism” she tries to live by — “Do I want to be right or do I want to do right?” — is one she didn’t learn until she was about 50.
Greene’s top priority as a commissioner and biggest challenge facing the county is economic development. To say that Jackson County has not been proactive on the economic development stage is an understatement.
“When the unemployment rate was only 4 or 5 percent seven years ago, it was not as obvious that Jackson County needed a strong economic development strategy,” Greene said.
But, unemployment is now at 11 percent.
Greene said she wants to ensure that Jackson County continues progressive approach to managing growth and development, which includes strong subdivision and steep slope ordinances to protect the quality of life in Jackson County. She does not believe development regulations hamper growth and development.
“It is about seeking balance between the two,” Greene said.
There is a chance an unaffiliated candidate will try to get on the ballot for the November election, but to do so, a candidate would have to gather approximately 1,400 signatures.
As predicted, North Carolina voters ushered in a constitutional ban on same-sex marriage and civil unions in Tuesday’s primary election, joining a flood of states to pass constitutional amendments banning same-sex marriage in recent years. Missouri was the first in 2004. This week, North Carolina became the 35th state to do so.
Statewide, the ban was passed by a 61-39 percent margin. The margin was slightly higher in Haywood, Jackson, Macon and Swain, with 70-30 percent margin.
Turnout was higher than normal for a primary election, driven in large part by Amendment One. Many voters showed up uninterested in voting for anything but that. In primaries, voters have to pick either a Democratic or Republican ballot when voting. Precinct workers reported many voters coming into the polls, when asked which party ballot they wanted to cast, simply answered “whichever ballot has marriage amendment on it.”
Religious beliefs clearly played a major role in those who voted for the ban on same-sex marriage.
Carlene James of Canton said her pastor at Center Pigeon Baptist Church has preached about it for the past two Sundays. And like so many churches all over the state, the signboard out front has been dedicated to the message “vote for the marriage amendment.”
“I think marriage is for one man and one woman, not two men or two women,” James said as she was leaving the polls Tuesday.
As the election results show, the idea of gay marriage is a concept that society as a whole has not accepted.
“I think that is the way it should be,” Richard Meyer, 28, of Sylva, said of his vote in favor of the ban.
Denise Gibson of Lake Junaluska fears same-sex marriage goes against God.
“I feel like history tends to repeat itself. In the Bible, Sodom and Gomorrah were destroyed because of gay marriage and I am worried we are heading that way,” Gibson said after voting in Waynesville Tuesday.
But, Francine Popular of Waynesville, a Roman Catholic, said she believe God loves everyone. Religion aside, she questioned the role of government in dictating people’s personal relationships.
“People say we don’t want the government in our lives, so why do we want the government to control people’s marriages — who they love and who they don’t?” Popular asked.
The live-and-let-live viewpoint was shared by many who voted against the amendment.
“If two people love each other and they want to start a family, who am I to stand in their way?” Korey Ramsey, 41, said on his way out of the polls in Sylva Tuesday.
Some who voted against the constitutional amendment out of fear it would have implications beyond gay couples and sends the wrong message about the state.
“It is really black and white, but we don’t live in a black and white world,” said Lauren Bishop of Waynesville on her way out of the polls Tuesday. “I think it would be more harmful than helpful, especially bringing businesses into the area.”
Reporter Caitlin Bowling contributed to this story.
A political impasse over live dealers and table games at Harrah’s Cherokee Casino has been resolved, but the tribe still has some heavy lifting to go before it can close the deal.
The Eastern Band of Cherokee Indians needs the blessing of both the governor and state lawmakers to add live dealers and table games. The tribe offered to give up a cut of gross gaming revenue to win the needed support.
While Gov. Beverly Perdue and Republican leaders in the General Assembly had agreed in theory to live dealers last fall, they had locked horns on a seemingly obscure sticking point. Perdue wanted the state’s cut of casino revenue to go directly to schools, bypassing the General Assembly. That way, lawmakers couldn’t be tempted to tap the money for other uses.
Republican leaders, however, said casino revenue couldn’t legally be put in a lockbox and earmarked for future years. One set of lawmakers today can’t impose mandates on how future lawmakers can spend money. It’s up to members of each General Assembly to craft the state budget each year as they see fit, regardless of instructions left behind by previous lawmakers.
For its part, the tribe preferred that the state’s cut of casino revenue be directed to education as well.
Sen. Jim Davis, R-Franklin, said it was admirable of the tribe to choose such a worthy cause for casino revenue, but it’s simply not possible to make those kind of promises.
“I think it is totally appropriate for the Eastern Band to express their wishes for where the money goes, but the General Assembly cannot determine for future General Assemblies where money goes,” said Davis, the state representative for the seven western counties, including Cherokee.
Based on letters written between the Republican leadership in the General Assembly and Perdue in recent months, each blamed the other for holding up Cherokee’s live dealers. The dispute underscored a longstanding source of acrimony between Perdue and her Republican counterparts over education funding.
It appears Perdue eventually gave in, according to a recent version of the live gaming deal.
New language in the proposed deal acknowledges the wishes of the governor and the tribe to see the state’s cut of casino revenue go to schools. But it likewise acknowledges that “the General Assembly is not bound” to spend the money for education. It will simply go into the state’s general fund instead.
Perdue seems to have extracted a promise that at least for the next couple of years, however, the casino money will go to education. But there are no guarantees after that.
“Gov. Perdue believes that the state’s revenue from the new compact should be used for education, and we are confident that will be the case for at least the next two years,” according to a statement from Chris Mackey, Perdue’s press secretary.
Other hurdles not yet cleared
While one logjam has been broken, the tribe still faces a challenge in mustering the necessary support to pass the General Assembly.
The tribe is actively lobbying to get the number of votes needed to bring bona fide live dealers and table games to the casino. On the Senate side, things are looking good, according to Davis.
“I think we have the votes in the Senate. I have been working really hard to get those,” Davis said.
It appears to be much closer in the House of Representatives, however — perhaps too close to call right now.
“Some people were concerned it might be another Las Vegas,” Davis said. “There are some people who have real ethical principles against gambling.”
One of those is Rep. Ray Rapp, D-Mars Hill, who has been torn over the issue.
Rapp is against gambling for the social ills it causes. For some, gambling is simply a form of entertainment and recreation. But for others, it is an addiction.
Rapp voted against the state lottery several years ago and has been public enemy number one against the video gambling and video sweepstakes industry, leading the charge to outlaw the digital gambling terminals.
“Many of the people who are playing these games have little or no disposable income. They are taking away from their family’s basic needs, food and housing money, to gamble,” Rapp said.
Rapp had resigned himself to the casino’s presence in Cherokee and was willing to support the addition of live dealers there — but only there.
“If they were going to stay in those confines of the existing campus, I would be fine. They already have gambling there, so I could support that,” Rapp said.
But the deal brokered with the state would have allowed live dealers at any new casinos built by the tribe in the future on other tribally-held lands in Jackson, Swain, Graham or Cherokee counties.
“This wasn’t permitting it in place, but was allowing an expansion,” Rapp said. “That brought me up short.”
Specifically, Rapp was concerned about a tribally-owned tract of land near Andrews that is being eyed by the tribe for a small-scale casino — something less than a full-fledged casino but something slightly more than a bingo hall.
There has been movement to amend the language in the compact with the state to limit live dealers to gambling facilities on land held by the tribe prior to the mid-1980s — not tracts it has added to trust lands in more recent years. But that still may be too much of a blank slate for some legislators. If the vote was held today, it’s not clear how the final count would come down.
“It will be a very, very close vote in the House with both Republicans and Democrats voting against it,” Rapp said.
Davis said lawmakers might be a little more flexible after this week’s primary election is behind them.
Davis said while he personally doesn’t gamble, his Libertarian streak doesn’t think the government should over-regulate and limit free enterprise. He also is eager for the economic boost live dealers may bring.
“I think we need to do everything we can to enhance the economic climate in the western part of the state,” Davis said.
Harrah’s Cherokee Casino currently is limited to video-based gambling. The tribe has touted the economic impact of adding bonafide table games and real cards.
It would attract more guests — those of a different caliber and demographic than its core base of players today — which in turn will mean 400 more jobs and an economic boost for all of WNC.
It will also mean more money for the tribe, which uses casino proceeds to fund social programs, education, health care and other services for tribal members, as well as a twice-annual personal check for each of the 14,000 members of the tribe.
Years in the making
It took years of lobbying and negotiations for the tribe to get to this point. In an historic agreement signed with Perdue last November, the tribe agreed to give up a cut of its revenue from the new table games — on a sliding scale starting at 4 percent and maxing out at 8 percent over the next 30 years. In exchange, the state would allow real dealers and a guarantee that no other casinos would be allowed to encroach on its core territory, namely anywhere west of Interstate 26.
Perdue’s office is putting a positive spin on the prospects of passing the measure before she leaves office in November.
“We are comfortable that all of the issues around the agreement will be settled in time for the General Assembly to pass the appropriate legislation this year,” Mackey said in a statement.
Evergreen Packaging has reached a partial settlement with environmental groups over pollution from the Canton paper mill in the Pigeon River.
Environmental groups had challenged the mill’s pollution permit, claiming that the standards weren’t tight enough. There were two bones of contention: how warm the river gets and the dark color the river takes on due to the mill’s discharges.
The portion of the suit dealing with temperature fluctuations to the river has been settled. Initially, the mill was permitted to raise the temperature of the river by 15 degrees Fahrenheit with its discharges, as measured at a monitoring point about half a mile downstream.
The limit was based on a monthly average, however, so spikes much higher were acceptable as along as it evened out over the course of a month to stay within the acceptable 15 degrees.
Now, the mill has agreed to an additional temperature criteria based on a weekly average. The river cannot exceed a maximum temperature of 89 degrees in summer or 84 degrees in the winter based on a weekly average, under the terms of the new settlement.
That is largely within the temperature confines the mill adheres to already.
“This agreement largely validates what was already a good permit ... the result of a good process,” Blue Ridge Plant Manager Dane Griswold said in a statement. “Having this issue settled means we can continue to provide jobs for hundreds of Western North Carolina families, continue to meet the needs of our customers and ensure the quality of the Pigeon River continues to improve.”
Hope Taylor, the director of Clean Water for North Carolina, said the temperature standard is still too lax in her book.
“We would have liked to go far enough to have a true mountain cold water stream downstream of the mill,” Taylor said.
But moving the mill toward a weekly average instead of a monthly average is still progress, said Taylor, who has been wrangling with the Canton paper mill over water quality issues for more than a decade.
Taylor said in some instances water in excess of 100 degrees Fahrenheit has been discharged into the river by the mill. For monitoring purposes, however, the river’s temperature is taken about half a mile downstream of the discharge point, after the hotter water has mixed with the rest of the river.
The lawsuit was filed by Southern Environmental Law Center on behalf of several groups: the Western North Carolina Alliance, Clean Water for North Carolina, the Tennessee Chapter of the Sierra Club, Tennessee Scenic Rivers Association, Cocke County, Tenn., and Clean Water Expected for East Tennessee.
The paper mill sucks roughly 29 million gallons a day out of the river and uses it in a myriad of aspects of the paper making process — from cooling coal-fired boilers to flushing chemicals through wood pulp — and then dumps it back in the river again.
The settlement was reached “without any admission of liability” on Evergreen’s part, the agreement makes a point of noting.
Too dark? You decide
Another area environmental groups contested in the suit is how dark the river’s color should be. Discharges from the mill darken the color of the river. The state considers this purely an aesthetic issue, governed by a subjective standard. Whether the river is too dark is in the eye of the beholder.
The state has wagered that the color of the river is acceptable, and the mill no longer needs regulation on this front. Environmental groups argued the river is still too dark, however.
To resolve the issue, the mill will soon undertake a public perception study. A random panel will be asked to size up the color of the river upstream and downstream of the mill.
The environmental groups have agreed to table their concerns over color pending the outcome of the study. In the meantime, Taylor said her organization is riding herd on the protocols for how the study will be carried out to ensure it is done fairly.
“Blue Ridge Paper is paying for the consultants who are coming in to do this study, so you have to assume they would bias the study,” Taylor said. “There is a way to really manipulate the way the study goes.”
For example, the mill initially proposed taking the panel to view downstream portions of the river first where the water is darker due to the discharges, then to the upstream portions where the water is clear. But the color contrast of the river downstream would likely be more striking if viewed the other way around — seeing the clear stretch first then the darker stretch, Taylor said. So she proposed a different methodology: splitting the panel into two groups in terms of viewing order.
“We said, ‘No, you have to have to have half of them go one way and half go the other way,’” Taylor said.
Taylor also wants to ensure the panel doesn’t have anyone on it who works at the mill, or whose family members work at the mill. She is also scrutinizing the way the questions will be phrased and the spectrum of multiple-choice answers.
Mike Cohen, a spokesperson for the Canton mill, said the issue of color is primarily aesthetic, thus the subjective standard is appropriate.
But Taylor believes there are underlying ecological concerns from the color of the river.
“We see that color as evidence of the chemical soup coming into the river,” Taylor said. Some of those compounds could be toxic, said Taylor, even though the state doesn’t currently classify them as toxic.
Even on the basis of aesthetics, the color is still a black mark against the mill, according to the lawsuit.
“We believe the dark color makes the river less desirable for fishing, rafting and wading than other, less polluted rivers nearby,” said Daniel Boone of Tennessee Scenic Rivers Association in a press statement.
Taylor said the mill should not deprive the public from being able to use and enjoy the river as a resource.
Whether the public is indeed bothered by the river’s color — based on the opinions of the random panel that is selected — will be borne out by the study in coming months, with the results finalized in early 2013.
The parties in the suit will then revisit the issue of color. The mill hopes the study will resolve the concerns and the rest of the suit can be dismissed, according to a statement by the mill.
Permit, take III
The environmental standards in the mill’s water pollution permit have already been tightened once compared to what the state initially suggested. The state was sent back to the drawing board once by the Environmental Protection Agency, which intervened in the pollution permit two years ago.
The state had initially recommended looser temperature criteria. The state also deemed the mill had already done enough to improve the color in the river, and that the color discharges were now acceptable and no longer needed regulating through a permit.
But the EPA called for tighter limits, telling the state to tighten up temperature fluctuations. Under the state’s original permit, the mill would have been allowed to raise the river’s temperature by as much as 25 degrees Fahrenheit downstream of the mill based on a monthly average, but the EPA reined it in to only 15 degrees warmer.
The EPA also wasn’t convinced color was no longer an issue. The study to determine whether color was within acceptable levels was a result of the EPA stepping in, Taylor said. The EPA also wanted tougher monitoring requirements on dioxins and fish tissue testing.
The permit was approved by the state two years ago in May 2010. Technically, the permits are up for review every five years.
“It is pretty much a continual process,” said Cohen, the mill spokesperson.
In reality, it is often longer between permits. Before the new one was adopted in 2010, the last one before that dated to 2001. The mill operated under an extension of that 2001 permit for four years while a new one was being worked out.
The river downstream from the mill is far cleaner today than anytime in the mill’s 100-year history. The Pigeon River was once so polluted few fish species could survive and it was unsafe for people to swim in.
During the 1990s, the mill embarked on a $300 million environmental overhaul, spurred partly by expensive class action lawsuits.
The biggest environmental victory of the 1990s was getting the mill to drastically reduced dioxin, the most toxic chemical discharged into the river. The final health advisory against eating fish caught downstream of the mill was lifted in 2005. Fish once wiped out by the mill’s pollution are being reintroduced in a joint effort between the mill and state wildlife and environmental agencies.
But environmentalists and downstream communities want the mill to make further improvements. But instead, it seems progress has plateaued.
Marty Stamey, like any county manager, takes pride in crafting a water-tight budget: one that squares up the minutia of how many reams of computer paper and tanks of gas county employees will use on one side of the ledger with property tax and sales tax flowing in on the other.
But no matter how persnickety Stamey is in his forecasts, there is one irksome line that’s simply a roll of the dice. So he just crosses his fingers, gives it his best guess and hopes like heck a jail inmate won’t need open heart surgery.
Whether it’s a simple cavity or a serious brain aneurism, any medical ailment that befalls inmates while awaiting trial lands on the county’s tab. Even medications inmates are on, whether its insulin for diabetes or blood pressure medicine, are filled courtesy of Haywood County taxpayers.
Haywood isn’t alone. All counties are saddled with what Stamey called perhaps the “most unpredictable” area of the budget.
The county will spend around $230,000 in medical costs for inmates in the current budget year. Most of that is for hospital bills and visits to specialists, for everything from X-rays to dental work. But, the sum also includes an in-house nurse, a retainer for an on-call doctor and prescription meds.
The costs and hassle of managing inmates’ medical needs has become so complicated, however, the county has decided to outsource the job to a private firm.
The firm, Southern Health Partners, manages medical care for inmates at 190 jails and prisons in 13 states. Half of North Carolina’s 100 counties contract with the firm.
Haywood County will pay the company $134,000 a year for basic medical care to inmates. The contract isn’t all-inclusive, however. It mostly includes nurse and physician services provided at the jail, such as health assessments and dispensing daily medications taken by inmates.
The fee only covers the first $30,000 in hospital bills, visits to specialists and medications. Anything more than that, the county will still have to pay for.
The county has earmarked another $70,000 in its budget for that, so when it comes to the total cost of providing medical care for inmates, the county is budgeting $205,000 —compared to $234,000 now — a small net savings.
Regardless, it’s worth it simply not to deal with it, said Haywood Sheriff Bobby Suttles.
“Even if it is a wash or is a little bit more, it is still a good deal in the long run,” Suttles said.
The county still faces a potential legal liability if something goes wrong with the medical care provided to an inmate. The county currently faces a lawsuit from the family of a female inmate who died. She was rushed to the hospital after collapsing, but the family blames the jail for not paying closer attention to her condition and failing to take action sooner.
Contracting with a firm to handle medical care won’t absolve the county from being targeted by such suits, but the firm would at least be named in the suit along with the county as a co-defendant.
“The whole point of this is to get our risk down and our performance up,” said Julie Davis, the county finance officer.
The firm should deliver a higher standard of medical care and expertise. That will hopefully translate to fewer trips to the hospital as the staff brought in by the firm will be able to more confidently handle health care needs.
Stamey said the firm will do a better job determining when an inmate truly needs to go to the hospital.
“Sometimes they probably don’t need to go, but to be on the safe side, we probably send them on to the hospital,” Suttles said.
Jailers also will get training on how to handle medical needs when faced with them.
There could be other hidden savings as well. Any inmate going for medical care has to be accompanied 24-7 by a deputy. When a deputy is taken off his regular assignment to escort an inmate to the hospital, a back-up deputy is called in to cover the hole.
“That’s running me into money,” Suttles said. “I think in the long run it’s going to save.”
Being able to provide more health care at the jail instead of sending the inmates out for care is where the $30,000 in hoped-for savings would come in. Also, helping to save money on hospital bills for inmates is a new health care network for jails, formed under the N.C. Sheriffs’ Association.
Currently, the county has to pay the out-of-pocket rate when taking inmates to the hospital or to see specialists. Under the Inmate Medical Costs Management Plan through the state sheriffs’ association, the county would be eligible for a discounted rate, much like the discounted rate insurance companies are able to negotiate.
There’s roughly 75 inmates bunked up in Haywood’s jail any given night. Some are there serving short sentences, like a week-long stint for DUI convictions. But, most have only been charged with a crime and are still awaiting trial.
If convicted, they are sent off to state prison to serve their time and are no longer a health care liability for the county. If they aren’t violent or considered a flight risk, and they get out on bond while awaiting trial, they likewise aren’t the county’s problem.
It seems to Suttles like more inmates than ever are on medications now or have health problems. Buncombe, Transylvania, Henderson and McDowell counties all contract with the same firm.
MedWest leaders are struggling to hold a fledgling joint hospital venture together in the wake of recent physician turmoil, but there’s likely no easy fix for the identity crisis faced by Jackson County’s medical community.
Fearing the sanctity of Harris hospital is on the line, a group of Jackson County doctors went public two weeks ago with a litany of concerns. They aren’t alone. Doctors everywhere are desperate for solid ground, but instead have been caught up in the competitive turf wars playing out between hospitals.
Both MedWest-Harris and MedWest-Haywood have seen a troubling loss of patients to Mission Hospital in Asheville in recent years. Harris lost 10 percent of its in-patient business in just five years, most of it to Mission. Haywood lost 6 percent.
Indeed, both hospitals hoped the MedWest joint venture two years ago would shore up that erosion of patients. Both, however, seemed to have different ideas of how that would play out on the ground.
Was there enough business for both to stay the size they were, or would one ultimately evolve into the big kid on the block — and if so, who?
SEE ALSO: Jackson doctors fear underdog status in MedWest venture
“Is there enough to go around for two? I don’t know the answer to that,” said Dr. Waverly Green, a pulmonologist at Harris.
It’s a troubling proposition for doctors who have married their livelihoods to a particular hospital — from building up their practice to raising their families here — to have their careers hinge on forces outside their control.
“It is challenging to know who is going to remain standing,” said Miriam Schwarz, the director of the Western Carolina Medical Society, a trade group for doctors in the region. “I think this jockeying for position is in response to the current climate.”
Schwarz said the “tumultuous times” have put everyone on edge.
“In this time of uncertainty, what we are witnessing across the country is heightened worries, anxieties and concerns about how health care will be delivered in the future,” Schwarz said.
Big kid on the block
When the MedWest venture was formed two years ago, Jackson’s medical community had little to fear from its neighbor.
“There has historically been very little market overlap,” said Steve Heatherly, the president of Harris.
Fewer than 5 percent of patients from Jackson migrated to neighboring Haywood or vice-versa.
“We said, ‘We’ve got enough to do, they’ve got enough to do and that’s the way it should be,” said Dr. Earl Haddock, a cardiologist at Harris for 22 years.
The result: two neighboring medical communities, largely happy to serve their own patient base and competing very little amongst each other.
“We’ve always had a collegial relationship. It has never been a competitive thing. They took care of their county and we took care of ours,” said Dr. Randy Savell, a gastroenterologist at Harris.
Haywood clearly had the tougher row to hoe, however. Just 25 minutes from Asheville, it was all-too-easy for patients who subscribed to the “bigger is better” theory to opt for Mission.
“It would be hard to survive in Mission’s shadow like that,” Green admitted.
Harris, however, had been largely spared from the specter of Mission. For decades, Harris acted as a net, capturing patients from the more rural counties to its south and west. It was far enough away that patients would only go to Mission if they really needed to, not just because they could.
And compared to the smaller, more rural counties around it, Jackson had a leg up simply by having a hospital at all.
“A lot of people west of here would stop at Harris because the roads to Asheville were bad, and there was at least a specialist here,” said Dr. Joe Hurt, a retired pathologist who helped build up Jackson’s medical community in the late-1970s and early ‘80s.
As a result, it had grown much bigger — both in the size of the hospital and the breadth of its doctors — than it ever could have been if drawing from just Jackson County’s population.
Patients from Swain, Macon and Graham counties plus the Cherokee Reservation accounted for nearly 50 percent of Harris’ total in-patient business. Only 45 percent of its in-patient volume comes from Jackson itself, according to market share data collected by the state.
Desperate times
It’s quite likely that Jackson’s medical community saw itself as poised to emerge as the epicenter of MedWest.
Not only did Haywood have the geographic conundrum of Mission to grapple with, it was still trying to rebound from a damaged reputation after failing federal inspections in 2008. It was an unfortunate turn of events blamed more on bureaucracy and bad leadership than a reflection of its health care, but a PR crisis nonetheless.
But, there were other forces at play. Chiefly, Harris was no longer immune to the siphoning effect of Mission.
While losing patients to Mission was a long-standing struggle for Haywood, Harris was not used to fighting that battle, and the hospital for the first time found its bottom line in jeopardy.
Harris is now in its third round of layoffs in four years. A wing of the hospital has been closed simply because there aren’t enough patients to fill it. Cash on hand had been dwindling, and finances got so bad the hospital could barely keep up with bills it owed, from medical supplies to the Red Cross blood bank.
Fear that it could now lose patients to Haywood — if suspicions are true that Haywood has been anointed as the flagship of MedWest — proved too much for Jackson doctors to bear. It’s entire model had been thrown into uncertainty, and a sense of panic set it.
“What Carolinas did was put us in competition with Haywood inside MedWest. Harris has to keep every patient it can to survive itself,” said Dr. Bob Adams, a hospitalist at Harris for 36 years who has decided to leave the hospital.
Not everyone shares that view, however.
“I certainly don’t get a sense of significant friction between the two,” said Steve Heatherly, the president of Harris.
For its part, the Haywood medical community doesn’t feel that way either.
“There is no friction, no competition,” said Dr. Marvin Brauer, the chief of staff at Haywood and a hospitalist there.
But, Brauer does think the two neighboring medical communities could do more to bridge the county line between them.
Every hospital has regular monthly meetings of its doctors. Since uniting under the MedWest venture, the doctors in Haywood and Jackson had not taken steps to hold periodic joint meetings of both hospitals, something that may change now.
“I think we should start to try to integrate the medical staffs even more,” Brauer said.
Circling the wagons
MedWest leadership sees one way out: buckle down and reclaim market share it has lost to Mission.
“The whole goal for us to join together was to take back some of the market share in our communities,” Dr. Chris Catterson, an orthopedist at Haywood, said.
That alone could solve everything.
“If we were each getting a reasonable market share, about 70 percent, there would be no problems,” Brauer said. That would mark about a 10 percent gain over the market share they have now.
Dr. Richard Lauve, a national health care industry consultant and analyst, questioned whether the strategy jives with the unstoppable reality that health care is consolidating.
“You can’t win back market share in a consolidating marketplace. A growth strategy is not one that wins,” said Lauve, with L&A Consulting based in Louisiana.
Granted, community hospitals have arguable advantages that resonate with patients, even when going head-to-head against the big guy next door.
“These are neighbors taking care of neighbors. The services are closer. You don’t have the cattle call mentality you get at the bigger facilities. Those are all advantages you can work to improve your position,” Lauve said. “But, they don’t move 10 percentage points of market share.”
That said, from a purely objective view, something has to give, Lauve said. Lauve was recently a guest speaker at a roundtable hosted by the Western Carolina Medical Society, attended by doctors and hospital CEOs from a dozen or so counties in the region.
Lauve’s answer was short and sweet when asked whether both Haywood and Harris could keep up their historical model: “No.”
Two mirror-image hospitals of that size simply can’t exist in neighboring rural communities 20 miles apart.
“You can’t repeat services that close together and make them both work,” Lauve said. “One of them will either fail completely and the other survive — or they need to sit down and make decisions about what makes sense for each community to have.”
In Lauve’s view, it’s time for those tough choices. And that might mean each hospital won’t have everything it had before.
“It is a political process — the interaction of human beings trying to figure out how to divide a pie,” Lauve said.
Fold or draw?
That’s one reason some Jackson doctors believe the right thing for their community is to get out and get out now. If one of the two hospitals is destined to get smaller, why keep heading down a path that is setting up their hospital to shrink?
Adams fears that die has already been cast.
“Harris devolves, and Haywood grows. It is not that they have anything against Harris. (Carolinas HealthCare) has an interested in right-sizing their components,” said Adams.
But, Jackson doctors say any strategy to make Haywood the new net to capture health care business from the rural western counties is flawed, because of the same long-standing geographic conundrum Haywood has always struggled under.
“You aren’t going to get most of the people in Western North Carolina to stop 25 miles short of Asheville to go to Haywood,” Hurt said. Once in the car and on the road, they’ll go the extra miles, he said.
Adams said it would take years to change the historical patterns of patients. If their own community hospital can’t do it, they will just go to Mission rather than the community hospital in another county, which patients would see as merely a lateral move.
“It is not a suburb of Atlanta or Charleston or Charlotte where a whole bunch of people who are moving in from somewhere else without a history or tradition can be influenced by marketing where to go,” Adams said.
In recent months, Adams and a group of Jackson doctors have advocated walking away from MedWest and instead partnering with Mission.
A mercenary stance perhaps, but they hope Harris would be built up by Mission as a go-to hospital for the western counties, a catch-all for health care from the rural west.
Adams said he understands why Haywood’s medical community would see Mission as simply too close for comfort.
“I think the medical community in Haywood County would be very concerned about Mission because I think they would feel more threatened,” Adams said. “Clearly, because of the proximity, it is a bigger concern for the Haywood community than for Harris.”
But, Jackson should look out for Jackson first, he said.
“For each hospital and each community who is the best partner for that individual community? I think that the communities may have different perspectives about that,” Adams said.
Not all Jackson County doctors are sold on Adams’ line of thinking, however. Several voiced their trepidation toward Mission at a hospital-wide meeting of Harris doctors in January. Adams’ camp had called on their fellow doctors at the meeting to send a message up the chain to Harris’ board of directors: they were unsatisfied with MedWest and wanted to vet Mission as a prospective new partner.
A few doctors were not swayed, however.
“The people who voted against it were concerned about their perception of Mission’s behaviors over the past 20 years where they had been aggressive and wanted everything to come to Asheville,” Adams said. But,“We felt that Mission’s attitude had changed significantly.”
The game-changer, in Adams view, is the new CEO who took over at Mission two years ago, Ron Paulus.
The former CEO, Joe Demore, was seen as an empire builder, one who was interested in grabbing up smaller hospitals in Mission’s net to promote an Asheville-centric model. Demore was ultimately forced out after a vote of no confidence by doctors practicing at Mission.
When Paulus came on board, he immediately began touting a collaborative regional view of health care, with small community hospitals across Western North Carolina working together under one system.
Paulus maintains Mission doesn’t want to compete with the smaller hospitals but genuinely wants to let them keep their own patients except when Mission’s services are truly needed.
The claim has been taken with a grain of salt, however, particularly in Haywood where there’s evidence of Mission planting its own doctors in Haywood’s backyard to steal patients. Mission has also made offers to buy out existing doctors’ practices in Haywood.
Adams said MedWest is so obsessed with competing against Mission — even paranoid — that patients’ interests aren’t being put first.
“At some point the region has to decide whether they want a competitive or collaborative health care system,” Adams said.
What might look like collaboration to Mission might look like undermining local health care to others, however.
Ultimately, the board of directors for both Harris and the MedWest system have thrown their support behind the current model.
“The boards have essentially said the organization of MedWest is the structure they are committed to at this time,” Heatherly said.
Haywood doctors agree it is the best route forward.
“We think the best thing for our communties is to be under one umbrella serving our communities of Haywood, Jackson and Swain,” said Dr. Chris Catterson, a Haywood orthopedist.
What now?
While the call by Jackson doctors to withdraw from MedWest seems like a shot across the bow to their neighbors in Haywood, Jackson doctors said they didn’t intend it that way. They aren’t questioning the quality or caliber of health care at Haywood’s hospital or by Haywood doctors.
Simply, they don’t think Carolinas HealthCare — the major hospital network managing MedWest — truly has their best interest at heart. Carolinas, as the new variable in the equation, has born much of the criticism from the group of Jackson doctors.
Carolinas has 34 hospitals in its network. Some it owns outright. Others, as with MedWest, pay Carolinas an annual fee for its management services and the benefit of being part of a larger system.
Carolinas’ interest in MedWest goes beyond that annual fee, however.
The more patients it represents, the more leverage it has when bargaining for better reimbursement rates from insurance companies and the federal Medicare and Medicaid programs. Those reimbursements have been dwindling, and what insurance and Medicare are willing to pay often no longer cover the actual cost of providing the health care. Ultimately, that’s the driver in the consolidation of healthcare and jockeying for market share.
“They are playing the corporate practice of medicine,” Adams said. “I don’t want to be a pawn in somebody else’s power struggle and be used as a widget in a big business’ plan for their benefit.”
But that’s the reality, said Lauve, the health care industry analyst. Things won’t go back to the way they were.
“Be a part of the change instead of resisting or ignoring it,” Lauve said, encouraging physicians to engage in the process.
“If you believe the fundamental driving forces are not going to go away, the peaceful coexistence of yesteryear is not an option. You are ignoring the elephant in the room. You are saying ‘I just want to get in another five years until I retire,’” Lauve said.
There’s two strategies left: compete head-to-head or collaborate.
“If you compete, one loses and one wins, but even the winner is worse off five years later than all the systems you compare it to that chose to collaborate,” Lauve said, citing a case study by the Voluntary Hospital Association.
Or, “You can figure out a way to collaborate and be part of the system that rationalizes how care is delivered,” Lauve said.
Miriam Schwarz with the Western Carolina Medical Society said physicians would much rather be taking care of patients but have found themselves trapped in a microcosm of a much larger national debate.
“I think the fact that physicians are so isolated and don’t have the opportunity to communicate across county lines, that has exacerbated the polarization that has been created by the institutions,” Schwarz said. “All they know is what their institutions are telling them but haven’t talked to their counterparts to get the whole story.”
Schwarz said physicians across the region need to come together — rise above it all so to speak — and work collaboratively, something the Western Carolina Medical Society hopes to serve as the mechanism for.
Previously, the organization was known as the Buncombe County Medical Society, but a year ago, it changed its name to reflect its regional mission. It has 900 members, with 125 now from outside Buncombe County.
“One of the goals we have as a regional medical society is to cultivate physician-to-physician dialogue in a safe setting,” Schwarz said. “Hopefully, physicians can put aside the politics and institutional affiliations and the pressures that are put upon them by those institutions and really focus on excellent patient care.”
Two months ago, doctors from more than a dozen hospitals in the region came together for an all-day summit at a country club in Haywood County in hopes of bridging the divide. Schwarz said it gave her hope.
“When they are sitting across the table from each other, the posturing that happens when people are really afraid or concerns about how to practice medicine in this chaotic world melt away,” Schwarz said.
When a team of moving men showed up in the surgery suite of MedWest-Harris two years ago and rolled a specialized spinal surgery table out the door, down the hallway and into a truck, acting on orders to haul the half-million operating table back over the mountain to the hospital in Haywood County, news that Harris’ equipment was being raided by its sister hospital on the other side of the mountain spread like wildfire through the halls of doctors’ offices in Jackson County.
“That was one of the first inklings we had that Haywood was going to get preferential treatment,” said Dr. Randy Savell, a Gastrointerologist at Harris. “‘We’re taking from you and giving to your big brother.’ That’s how it came across.”
The hospitals in Haywood and Jackson were a mere three months in to a joint venture at the time. The premise: working together the two hospitals would be stronger than going it alone.
But, stripping the spine table from Harris’ operating room quickly became a large-than-life symbol of the struggle for Jackson County doctors to hang on to their autonomy under the new MedWest banner.
SEE ALSO: Caught in the crosshairs: Doctors struggle for footing in a shifting health care landscape
“That was a big dust up,” said Dr. Waverly Green, a pulmonologist at Harris. But he didn’t immediately climb on the anti-MedWest train.
“I think it hit different people at different times,” Green said. “Over the first year, it was like ‘Are they really trying to slight us and build up Haywood?’ Or are we perceiving a chain of events that way because of our own set of goggles we were viewing this from?”
From a different set of goggles, moving the spine table made sense. Harris didn’t do spinal surgery. It had no spinal specialists. Instead, neurosurgeons from Mission Hospital in Asheville would travel to Harris twice a month to see patients. If they needed surgery, the patient was almost always sent to Asheville — and Mission raked in the billing for the highly-lucrative procedures.
The spine tabled purchased by Harris aimed to change that, hoping that the right equipment in-house would convince the Asheville doctors not to merely hold office hours in Jackson County but to perform the big-bucks surgeries there as well. In reality, however, less than two dozen spinal surgeries were actually performed at Harris in a year.
Jump to Haywood, where two spine specialists had built a reputable practice during the previous five years. They performed 50 to 60 back surgeries a month.
After the joint venture, it only made sense to quit sending patients and money out the door to Mission and instead keep the business in the MedWest house. So the spinal surgery table was moved to Haywood where the equipment would be put to better use.
But for Harris, it cut off any budding aspiration that it, too, could perform spinal surgeries with regularity one day, not only for the revenue but to serve patients locally.
“That was a major product line we were trying to develop,” said Dr. Gilbert Robinson, an anesthesiologist with Harris for 10 years. “We were doing very valuable services for the community and they quit.”
To Jackson doctors, it begged the larger question: was Harris being set up as an ancillary hospital to Haywood?
For its part, the Haywood medical community does not perceive an underlying tug of war with Jackson but instead sees itself as equal partners.
“We want to have a great relationship with Sylva,” said Dr. Chris Catterson, an orthopedist in Haywood. “We want to help the whole system. That was our goal: to get bigger, to become more financially sound, and to grow. We want all of our hospitals to be successful. That is our goal for the future.”
Musical beds
While moving the spine table to Haywood became a metaphor for the issue, there were other perceived slights as well.
Faced with dwindling patient count, Harris had closed one wing of the hospital about three years ago, cutting down on staff and overhead to reflect the number of patients it was actually serving. But during spikes, when there were suddenly more patients on its doorstep than the reduced staff could care for, Harris had to turn them away.
Dr. Earl Haddock, a longtime cardiologist at Harris, said hospitals should be in the business of treating patients, not turning them away, especially in light of financial struggles at Harris.
“When someone calls to admit a patient, there’s two things you can say and that is ‘Yes, sir,’ or ‘Yes, ma’am.’ Not ‘We don’t have any beds,’” Haddock said.
In reality, Harris had the beds but had maxed out its nurse-to-patient ratio for the night.
“There was no ability to flex. They had cut the staff back to the point they couldn’t take another admission,” Green said.
Meanwhile, it seemed Haywood always had plenty of beds, and the business was sent over the mountain.
While unfortunate, MedWest didn’t intentionally undersize staff at Harris so it could then divert patients to Haywood, according to Steve Heatherly, the president of Harris.
“Are there times when you get an influx of patients at a moment in time and don’t have the staff to handle it? Of course, that is an issue for every hospital,” Heatherly said. “There probably were times when patients were diverted from here to Haywood, and also patients diverted from Haywood to here due to availability of staff or physicians, but that is not part of any master plan.”
Harris now has a contingency plan in place to ramp up staff when need be.
All in the referrals
Allegations of ulterior motives aside, there’s an inescapable fact: Haywood’s medical community offers certain services Harris doesn’t. That was the case even before the MedWest venture.
• One of those areas is spine surgery.
• Another is advanced cardiology services, particularly diagnostic heart catheterizations. The procedure is advanced, but two heart specialists in Haywood perform them routinely. Harris doesn’t.
• A third service line Haywood has but Harris doesn’t is certain types of interventional radiology.
Historically, Harris referred patients needing any of these to Mission.
“People who were sick but not sick enough to need Mission we would handle. Anything we couldn’t handle, we would send to Mission,” said Green, a doctor at Harris.
Under MedWest, however, the question was raised: why not send them to Haywood?
“It was, ‘We don’t want you sending this to Mission if we can keep it in the system,’” Green said.
Legally, hospitals can’t tell doctors where to refer patients. They can ask, suggest and perhaps even gently implore, but they cannot strong-arm doctors into referring patients to a particular hospital or advanced specialist.
MedWest administration indeed asked Jackson doctors to give referrals to Haywood. According to some doctors, MedWest administration went a step further by tracking the referral patterns of their physicians, keeping spread sheets on the number and type of patients a particular doctor referred to Mission for things that could have been treated in system.
On the surface, it rightfully should be the administrator’s business to know where his corporation was losing market share and figure out ways to get it back. Jackson doctors, however, saw it as further evidence they were being asked to help prop up Haywood.
The Haywood doctors likewise asked their counterparts in Jackson — colleague to colleague — to send patients to them if it was something they could treat.
It’s possible the Jackson medical community couldn’t accept the notion that Haywood doctors could treat patients Harris couldn’t, and subconsciously, that’s why they bucked the idea.
That is not the case, however, according to Jackson doctors.
“If we are going to be true to our patients we want them to get the best they can get,” Savell said
Simply put, specialists at Mission do more of the procedures, and in the highly rare event something went wrong, the patient was closer to the emergency intervention they would need. And besides, after refering to Mission for years, they were simply used to working with the particular doctors on the other end of that radiology report or heart diagnosis.
Lonely at the top
As Jackson County doctors began scrutinizing management, attempting to detect whether favoritism was at play, it didn’t help that Jackson’s own CEO was let go when MedWest formed, and the staff at Harris began answering to the CEO from Haywood, Mike Poore. Poore had been promoted to oversee all hospitals under the MedWest system — both Haywood, Harris and Swain. Poore’s finance officer, chief operating officer and chief nursing officer from Haywood also took the reins over the entire system.
Poore’s home base was clearly Haywood, but he regularly made the 25-minute trip over Balsam to work from Harris, parking himself behind the desk of Harris’ departed CEO.
Accounts differ on exactly how much Poore and the other top leaders from Haywood actually made it over to Harris. Some say Poore was there at least two days a week. Whether its was merely their perception, Jackson doctors felt like they were being managed from afar, relegated to the status of a satellite hospital.
“All of a sudden we were saying ‘Gee, where is our representation here?’ The concept was ‘We’ll all be one big happy family, but that medical model didn’t work,’” Haddock said.
Likely, Poore was there more than they realized, based on accounts from one former employee who worked in a nearby office, but as far as Jackson doctors were concerned, their administration wing at Harris seemed empty more often than not. More than merely being irked by it, however, it actually made a difference on the ground, they said.
“If the person you need to ask a question of are in another county and have shown themselves to be unresponsive or aggressive, you don’t seek out help,” Savell said.
Push back from the Jackson medical community ultimately led to Poore being stripped of his position as CEO over MedWest and over Harris in February. Harris was given its own president, namely Steve Heatherly, who had served in various leadership roles, including chief operating officer, chief finance officer and chief strategist for Harris during the past 15 years.
Jackson doctors have responded well to Heatherly’s new leadership role and largely say they have confidence in him to help turn things around. Even Dr. Bob Adams, a spokesman for the disgruntled Jackson doctors, has given Heatherly his blessing.
“I think the WestCare board and Steve Heatherly are doing their best to work with medical staff now,” Adams said.
But, some doctors fear that the move is temporary and that once the Jackson medical community has been placated, Carolinas will return to the ultimate game plan: creating one flagship hospital with the other relegated to a supporting role.
“What does that mean three years or five years from now under MedWest?” Adams asked. “No one will ask the strategic question. Where are we going, how are we getting there and what does it mean?”
Meanwhile, Poore has resigned completely, announcing in early April that he would step down from his role. He has already landed a new job as a hospital administrator in Texas.
The Haywood medical community was dismayed by the news, believing Poore had done a good job and put the hospital on a trajectory for success and primed for a turn-around.
Since Poore’s departure, Carolinas has sent in its own John Young, the vice president of its western region, in a acting role as the CEO of MedWest. Young said few hospital affiliations are seamless.
“To bring different cultures together is always very difficult,” Young said. “But as sticky and difficult as these times are, we know that we will get through it. Organizations do work through these issues.”
When Dr. Bob Adams walked into a hospital-wide meeting of Jackson County doctors in early January, he believed he had finally mustered the critical mass to demand action, action that so far had been elusive despite a year of working internally to bring change.
But, he made a fatal miscalculation. The message doctors would ultimately send up the chain that night to the WestCare board of directors would be rejected.
Some doctors had become disillusioned with the Charlotte-based management firm that had been at the helm of the MedWest venture since its inception two years ago. They voted 31 to 3 to ask the board of directors to go to Mission Hospital, hear what it had to say and consider whether it would be a better partner.
It’s rare for the majority of doctors at a hospital to make a formal and pointed request to their board of directors. The issue had been escalating for months by then, and as the community would later learn, had not yet reached its climax.
A core group of concerned doctors began meeting in early 2010, discussing their perception of problems at Harris, which was struggling financially and had lost 10 percent of its inpatient business to Mission. Initially, they took their issues up directly with MedWest CEO Mike Poore. Unsatisfied, however, they opened a line of communication with the hospital board of directors, sitting down with key members in one-on-one meetings.
SEE ALSO: Carolinas affiliation catalyst for doc's departure
By summer, however, the airing of concerns became a standing topic at the monthly meetings of all the Harris’ physicians, marked by a heated exchange or two with Poore before the roomful of doctors.
Eventually, Poore knighted the core group of concerned doctors with an official title — the “kitchen cabinet” committee — in an apparent attempt to address the issues.
Meanwhile, doctors ramped up their line of communication with the hospital board, a rather brazen move to go over Poore’s head.
“We go in and sit down and talk and start expressing our concerns directly to the board,” said Dr. Randy Savell, a long-time gastroenterologist at Harris. “They were surprised. They suggested they had no idea how things were.”
The meetings with the board continued for several weeks, and while the board members were willing listeners, the doctors couldn’t spur them to take action.
“We never got anywhere, but they were being very surprised and shocked and concerned,” Savell said.
Some in the core group oscillated between caring about the management structure and just going back to doing what they did best: caring for patients.
“After a while, you get worn out. You get tired of fighting,” said Dr. Earl Haddock, a pulmonologist at Harris.
Two of the doctors in the “kitchen cabinet” had been on the hospital board themselves but had resigned earlier that year after growing disenchanted.
“The thing that struck me is nobody asks questions,” Dr. Waverly Green said of why he resigned from the board. “If it was a place where there would be honest discussion and be about the future of the hospital, I am happy to be a part of that. but I am not going to sit in a room and rubber stamp things that to me make no sense.”
Between a rock and a hard place
The group of concerned doctors decided to take matters into their own hands. In December, some of them drove to Asheville for a behind-the-scenes meeting with the CEO of Mission, Ron Paulus. It was a renegade move, unauthorized by the rest of the medical community at large, but they liked what they heard.
So in early January, they called a meeting of all the doctors under WestCare and asked them to take a stand. Discussion dragged on for more than an hour.
Getting out of the MedWest partnership wasn’t an easy proposition. There was an escape clause built in at the three-year mark, but it could only be exercised by a three-fourths majority of the MedWest board, which was comprised equally of seven members each from WestCare — comprised of Harris and Swain hospitals — and Haywood Regional.
But, there was a little-known loophole. A clause in the MedWest contract allowed either side to pull out if the financial viability of one of the partners was at risk. It just so happened there was bad financial trouble brewing next door in Haywood. The Haywood hospital was running so low on cash, word on the street was it might not be able to make payroll.
To solve the short-term cash flow crunch, Haywood had gone up the chain to Carolinas for an emergency loan. Harris, however, was being asked to co-sign for the loan, putting its own revenue stream on the hook should Haywood default.
In realty, Harris would never be asked to cough up the money. Haywood’s revenue stream — about $100 million annually — along with all its equipment and its hospital building were also on the hook as collateral and would be tapped first before Harris would ever have to ante up. Essentially, there was more than $250 million guaranteeing a $10 million loan.
But, Carolinas was outside its comfort zone. This marked the first time it had ever loaned money to any of the 34 hospitals it manages. So it wanted the kitchen sink as collateral.
The Jackson doctors theorized the financial straits at Haywood were grave enough to exploit the loophole and engage in talks with Mission.
Little did the doctors know, however, that the WestCare board faced a grave choice — co-sign the loan to help bail out Haywood or comply with their own doctors’ request to meet with Mission. Doing both, it turned out, would not be an option. There was a catch to the loan with Carolinas. As long as MedWest owed Carolinas, the hospitals were prohibited from negotiating with a new partner.
Business-wise, it made sense. Carolinas didn’t want to prop up MedWest only to have it walk away still owing money. But to the unhappy physicians, it played out like a game of Mousetrap — and they were the ones sitting under the cage.
Harris board backs Carolinas
The WestCare board ultimately had faith in the MedWest venture and co-signed Haywood’s loan.
“We believe the future is bright for all three hospitals, even though the challenges are many. It is time to look forward, assuring the full potential of MedWest-Haywood, MedWest-Harris and MedWest-Swain is realized,” the MedWest board said in a statement this week. “Is this a short-term process? No, it is not. It will take months of hard work. But, we are confident in the expertise of our medical staffs and in the skill and dedication of all our employees.”
The doctors, however, felt ignored in their pleas to consider other options.
“We said ‘We aren’t telling you to dump Carolinas.’ We are just saying go talk to Mission and see if we made the best choice,” said Dr. Waverly Green, a pulmonologist at Harris. “Two days later, they signed documents that tied us up even tighter to Carolinas. That told me the board didn’t want input from the medical staff.”
One of the board members, Bob Carpenter, resigned from the board a few days later in a show of solidarity with the doctors.
“The bottom line is our hospital is in serious shape, and our trustees need to be looking at alternatives,” Carpenter said. “The community needs to keep pressure on the board to seek alternatives and do the right thing for this community.”
It turns out Harris was not merely hamstrung by Haywood’s loan. Harris was beholden to Carolinas for its own financial security as well. Carolinas had pulled strings to help Harris out of a pinch over an outstanding $15 million loan with BB&T, dating back to hospital construction projects a decade ago. Under terms of the loan, BB&T required Harris to have 75 days cash on hand.
Last year, Harris wasn’t able to maintain that balance and dipped below the cash-on-hand threshold that BB&T required. Carolinas tapped its relationships in banking circles, essentially putting in a good word for Harris, and convinced BB&T to temporarily relax its cash-on-hand requirement.
Harris currently has 56 days of cash-on-hand instead of the mandated 75. If Harris sent Carolinas packing, it could jeopardize the leniency BB&T had extended on the loan terms.
The door had been closed on any escape hatch Harris may have had, Savell said.
To be clear, the concerned doctors don’t believe in a conspiracy by Carolinas to make the hospitals financially dependent as a way of keeping MedWest intact. Adams thinks Carolinas just wasn’t paying close enough attention to the day-to-day operations, which after all is the expertise Carolinas was supposed to be providing in exchange for its management fee.
“They would never have allowed them to spend what they spent at Haywood without having the resources to back it up,” Adams said. “They would never have allowed Harris to be run in the ground even if that was a planned maneuver because it created a huge backlash. You don’t poison the components.”
John Young, a vice-president for Carolinas’ western hospitals, said that Carolinas doesn’t tell MedWest what to do — it’s the other way around.
“We work for the local boards. We have no control mechanism,” Young said.
A unique community of physicians
It’s rare to find physicians and hospital management in lockstep on everything. Now, however, the WestCare board must find a way to rebuild the fractured relationship with physicians.
“For every member of the medical staff that has talked to the board, to walk away feeling like nothing was going to be done was a difficult thing for us,” said Dr. Earl Haddock, a cardiologist at Harris.
It marked a departure from an amicable relationship the Jackson medical community had always had with its board of trustees.
“There was never any adversarial relationship. It was collaborative across the spectrum. We all worked together for the same goals. I think the thing that has been particularly uncomfortable for the medical community in these last two to three years is that relationship no longer applies,” Adams said.
A saying by a patriarch of the Harris medical community has been reverberating in Jackson County for nearly 40 years, handed down through practices and still preached to new recruits today.
“Sylva is where you can practice contemporary medicine in the old-fashioned style,” so the saying goes. It was coined by Bill Aldis, an internal medicine specialist who came to Harris in the mid-1970s.
Aldis was part of a dynamic trio of upstart internal medicine specialists who sought out Sylva after medical school as a place to make their mark, perhaps even a social experiment of sorts. Their mission: to take a rural hospital with a smattering of primary doctors and see how far they could take it.
“They were at John Hopkins together and decided they were going to find a place where they could make an impact,” said Dr. Joe Hurt, a retired pathologist who came to Harris in 1978. Hurt came partly because he was impressed by the three young internists who had thrown themselves headlong into building up a rural medical institution.
“There was a tremendous amount of potential,” Hurt said.
The energy was infectious. Each new specialist who came on board joined the recruiting crusade, putting their best foot forward as a medical community to build up their own ranks in partnership with the hospital.
“A lot of the recruiting parties and events were actually held at my house,” Hurt said. “Some of the contracts between partners were worked out at my house.”
In the decade from 1975 to 1985, the number of doctors practicing in Jackson County more than doubled, bringing in the county’s first orthopedists, pathologists, radiologists and surgeons. More by fate than design, the community attracted a certain breed of physician — those who didn’t care about the lack of a country club or golf course, Hurt said.
Those early efforts set Harris on a track that still persists.
“Harris has had a long-standing tradition of attracting very good physicians. Part of the attraction was for a small hospital, this had an exceptional medical staff. Well-trained physicians, very community-oriented. There was a rapport between the physicians and community that didn’t exist elsewhere. The hospital just had a very good reputation,” Green said.
All still support local hospital
There’s one thing both sides in the debate agree on: keep going to your local hospital.
“In terms of the services, we can and should provide in our local hospitals, we are as good as anyone in the country,” the MedWest board of directors said in a statement this week.
Undermining Harris is indeed the last thing those speaking out want to do.
“There are those who felt the community deserved to know. Hopefully, there will be enough of a outcry to have an impact,” Savell said.
But, the 2,000 employees of MedWest in Haywood, Jackson and Swain counties have surely felt the sting of the negative publicity during the past week.
“I care for every single patient with every ounce of my being,” said Heather Sheppard, a nurse at Harris and director of ICU. “I stand by the care that we deliver to every single patient at Harris.”
In Haywood County, a letter was signed by 29 doctors this week reinforcing their strength and resolve to provide excellent health care.
“We believe and have substantial data to corroborate that the care at Haywood hospital is, like the care at Harris hospital, something the community can take great pride in,” the letter states.
Dr. Joe Hurt, a retired pathologist at Harris, said going public was clearly a last resort for Adams after months of working through internal channels that got him nowhere.
“I don’t think any of them wished ill against the hospital,” said Hurt.
Savell agreed that’s not what this struggle is about.
“Good care is still there. Good people are still there,” Savell said.
Even those who have publicly stood beside Adams plan to stick with Harris to the end.
“I love what I do. I love the patients. I love the hospital, and by golly, we provide excellent care, and we want to get back to that,” Haddock added.
When the Med-West venture was coined two years ago, the premise was an easy sell. Together the hospitals would be stronger than going it alone.
Both Harris and Haywood hospitals had witnessed a troubling loss of patients to Mission — a loss so troubling in fact neither hospital could afford to continue as it was. They faced a cold, hard reality: turn the course, and fast, or they would be faced with financial insolvency.
Indeed, both hospitals hoped the MedWest joint venture would shore up the erosion of patients to Mission. Both, however, seemed to have different ideas of how that would play out on the ground.
Was there enough business for both to stay the size they were, or would one ultimately evolve into the big kid on the block under the MedWest umbrella — and if so, who?
Before the merger, and even now, Haywood and Harris competed very little. Fewer than 5 percent of patients from Jackson migrated to neighboring Haywood or vice-versa.
But with the future of their medical community on the line, 1 percent here and there suddenly seemed to matter quite a lot.
While the call by some Jackson doctors to withdraw from MedWest seems like a shot across the bow to their neighbors in Haywood, Jackson doctors said they didn’t intend it that way. They aren’t questioning the quality or caliber of health care at Haywood’s hospital or by Haywood doctors. Instead, it seems desperation amidst a shifting health care landscape has seized the day.
Next week: Read more about the specific concerns raised by Jackson doctors, an analysis of hospital market share, a snap shot of finances, and philosophical view points on the MedWest venture.
Four long-time physicians in Jackson County are leaving C.J. Harris hospital after becoming disenchanted with the direction of MedWest — and even more so with Carolinas HealthCare System, a giant network of 34 hospitals that MedWest is affiliated with.
Dr. Bob Adams, a hospitalist who is leaving Harris after 36 years, fears Carolinas plans to build up Haywood as a flagship to compete with Mission. He didn’t like where that would lead.
“Harris devolves and Haywood grows,” Adams postulated. “They are playing the corporate practice of medicine. I don’t want to be a pawn in somebody else’s power struggle and be used as a widget in a big business’ plan for their benefit.”
The president of Harris, Steve Heatherly, laments the loss of the four doctors — and the circumstances.
“It is unusual in the history of this organization to have physicians leave because they were not satisfied with the strategic direction,” Heatherly said.
Making matters worse, another seven doctors in the Jackson-Swain medical community have either already left or plan to leave — for a total loss of 11.
“It is unusual to have that level of turn over,” Heatherly said, even though only four of the 11 actually chalk up their departure to “dissatisfaction with the hospital.”
Lessening the blow somewhat, seven new doctors are moving to Jackson and Swain in coming months. They had already been recruited and were intended to bolster the physician ranks.
Now, however, the hospital will see a net loss instead of gain and a gap in a few key specialties.
Dozens of doctors, of course, aren’t going anywhere.
“We must not forget that we still have an extremely skilled and dedicated medical staff of nearly 230 physicians who are choosing to stay in our communities and work in our hospitals to take care of our patients,” Dr. Robin Matthews, an ob-gyn in Haywood County who chairs the Physician Leadership Council of MedWest.
Many of the 2,000 employees of MedWest have rallied to their hospitals’ defense during the past week.
“The hard decision is to stay here and fight for this place to succeed,” said Dr. Casey Prenger, the medical director of the hospitalist group at Harris. “We believe in our hospital and our community, and it is our privilege and honor to take care of you.”
There are huge challenges, however, facing Heatherly and MedWest: hold MedWest together, turn the corner financially, recapture market share from Mission, quell the doctor uprising, and recruit new doctors to fill the holes.
Resolving to make a stand
For the group of Jackson County doctors who went public with their concerns last week, the decision wasn’t an easy one nor was it taken lightly.
“They aren’t trying to hurt anything. They are trying to fix something,” said Dr. Gilbert Robinson, an anesthesiologist at Harris for 10 years.
Even those who spoke out aren’t certain now was the right time, or if it will do any good.
But, the ball was in Adams’ court. When he decided to go public, the core group who had been fighting alongside him during the past year to bring about change internally weren’t going to leave him on a limb by himself, so they reached out and grabbed on as well.
“I decided I wanted to let the community know what was happening to their hospital. The only thing that is going to change is if the community starts standing up for itself to Carolinas and the WestCare board,” said Dr. Waverly Green, a pulmonologist at Harris who is leaving as well.
Adams hopes the issues he raised aren’t construed as a parting shot or chalked up to sour grapes.
“They are portraying those of us who had concerns and discomfort about where we are as being disgruntled and outliers,” Adams said.
But in fact, hospital administration has gone out of its way to praise Adams and the others who are leaving.
“It is regrettable. They will be missed in this community. They are outstanding physicians who have provided years of service to this community,” Heatherly said.
Even doctors in neighboring Haywood, who rightfully have reason to be miffed by Adams’ shot across the bow at MedWest-Haywood, have been complimentary.
“He is a great doctor and wonderful human being. I just happen to disagree with them completely,” said Dr. Marvin Brauer, chief of staff at MedWest-Haywood and a hospitalist like Adams.
While Adams will soon be gone, others who support him will still practice at Harris and will continue carrying the torch to fix perceived problems.
SEE ALSO: Doctors take a stand out of fear for Medwest-Harris' future
Some of them are even on Harris’ payroll. Technically, the entity they are speaking out against writes their paychecks, putting them in an uncomfortable position at best, a vulnerable one at worst. Normally, few doctors would be willing to take a career gamble like that.
The difference at Harris likely comes down to their new president, Steve Heatherly. Heatherly has been with Harris since the 1990s, part of that time as a physician liaison and serving in a variety of vice president roles and as chief operating officer.
In hopes of quelling dissension among Jackson doctors, Heatherly was promoted two months ago as the president of Harris. It gave Jackson doctors one of their own at the helm — rather than the previous hierarchy where they answered to a single CEO for the entire MedWest venture, Mike Poore, who they were acutely aware hailed from Haywood and still had his base office there.
Jackson doctors have hope that Heatherly will help right the ship.
“I believe Steve is at the place he needs to be to help turn WestCare around, due to his experience and background and skill set. I don’t know of anyone else that would be better at this point in time,” said Bob Carpenter, a former MedWest board member from Sylva who resigned in January over the same issues troubling the doctors.
Even Adams agreed.
“I think the WestCare board and Steve Heatherly are doing their best to work with medical staff now,” Adams said.
Many doctors — even those who are in near lockstep with Adams’ pointed assessment of the MedWest landscape — wish he had given Heatherly more time to fix things before going public.
Dr. Randy Savell, a gastroenterologist doctor at Harris, said Heatherly faces a difficult future.
“He is between a rock and a hard place,” Savell said.
Heatherly’s boss is technically Carolinas, and he answers to them daily. But, he must also answer to the hospital board of directors, all the while winning the good graces of nurses and doctors by proving he will address their concerns.
The road ahead
Heatherly doesn’t downplay the reality that a hospital lives and dies by its doctors. If the doctors are good, people will get their health care locally.
“That leads to more volume through the hospital, which helps solve the business dilemma,” Heatherly said.
That business dilemma — dire financial straits for both Harris and Haywood — looms large in the debate.
Harris has lost more than 10 percent of its in-patient business to Mission Hospital during the past five years.
As a result, Harris is struggling financially and has been losing money for at least three years. It’s now in its third round of layoffs in four years.
“Our hospitals must confront the fundamental business reality that expenses cannot continue to be greater than revenue,” Heatherly said.
If the financial picture was rosier, the paranoia among Jackson doctors that Carolinas is trying to siphon its patients off to Haywood could simply melt away.
For now, Heatherly is stuck in a Catch 22. Rather than shrink, Harris must find a way to regain the market share lost to Mission.
“No organization can cut its way to prosperity, especially not a hospital, where quality patient care is our business. ‘Thrive-ability’ will happen when more patients come through our doors to see our brilliant doctors and caring staff,” Heatherly said.
Harris’ financial problems are largely because it lost several doctors back in 2006 and 2007, Heatherly said. When patients needed a doctor’s appointment, they were forced to look elsewhere and ended up walking right into the open, waiting arms of Mission in Asheville.
Heatherly, who started at Harris in the 1990s, had taken a hiatus for a few years to work for a physician management firm. When he came back to Harris in ?, job No. 1 was recruiting physicians to fill the void.
“The organization was having trouble recruiting physicians to replenish the supply to the local community, and it created a constrained access,” Heatherly said.
In 2008 and 2009, WestCare brought in 10 new doctors. It also bought out several private practices in order to put existing doctors on the hospital’s payroll — reflective of a national trend by doctors who increasingly prefer to work directly for a hospital rather than run their own private practices.
Those moves came at a financial cost, but Heatherly said the influx of doctors stopped the bleeding of market share. Unfortunately, it hasn’t come back up yet either.
“Now that we’ve had success in rebuilding our medical staff, we need more patients from our local communities using our local hospitals. Only then can we expect more positive financial results,” Heatherly said.
Heatherly’s belief in doctors as a core business strategy for the hospital seems genuine. He stresses it even when discussing other topics, like when the long-awaited renovations to Harris’ emergency room will be re-started.
“As we move forward, we have to assess that we have the right medical staff in place to offer ongoing appropriate access to care, and then those opportunities to evaluate facility expansion will be driven by the ability to generate sustained financial results,” Heatherly said.
Heatherly was speaking off the cuff, not reading from a prepared statement. But, his hospital administrator’s version of Alan Greenspan’s famous Greenspeak can be boiled down this way: doctors must be shored up first, which will bring back patients, which will bring back money.
Despite rumors that cuts at Tuscola High School in Waynesville could reduce the number of advanced courses, academically gifted students will have just as many courses to chose from next school year.
Tuscola will lose five teaching positions, which is likely what fueled the buzz among students that fewer honors courses would be offered. Parents mounted a campaign imploring the school not to cut the number of upper level classes.
School administrators say this was never the case, however.
“I think there has been some misinformation, and it just spread like wildfire,” said Stephanie Goodwin, an assistant principal at Tuscola.
To combat the rumors, the school even scheduled a mass pre-recorded phone call to parents. Robocalls are usually used by the school system to share information on everything from snow days to school-wide testing. This one assured parents there would be no cuts to advanced course offerings next year.
Kim Turpin was among the parents who voiced concerns after hearing the school was reassessing both the number and variety of upper level courses it offered. Her daughter is eyeing Stanford but to get in she would need plenty of Advanced Placement courses — essentially university-level courses that count toward the students’ college course credits.
“If you have smart kids, why wouldn’t you feed your smart kids?” asked Turpin. “They need to provide courses so they can go out in the world and be competitive.
Turpin said it is also important for the overall reputation of the school system.
“Anyone you are wanting to attract as a professional in your community, they are going to be looking at your school system,” Turpin said.
Tuscola is offering Advanced Placement, or AP courses, in four areas this year. Next school year, two new subjects will be added — so in essence there are more AP courses being offered next year, both in the variety and sheer number.
Every January, Tuscola High School surveys students to see what AP courses they are interested in for the coming school year. The line-up is built accordingly.
“Student interest drives our schedule for those upper classes,” Goodwin said. “The only way we reduce the number is if we don’t have student interest.”
Unfortunately, if there aren’t enough students interested in a particular AP course to comprise a full class, the school can’t offer it.
“There has been a reduction of funds the last two or three years in the public schools and you have to get the most bang for your buck,” said Danny Miller, the high school curriculum supervisor for Haywood County Schools. “If you had only five or six kids interested in a course, whether it is AP or say business law, it is hard to take a teacher’s block of time and dedicate it to that.”
That is the case with some AP courses, such as AP Physics and AP World History, which only have a handful of students express interest each year, so the course is offered online only.
Haywood County has roughly 2,000 students at its two high schools. While Tuscola High School historically has been larger than Pisgah, reallocation in recent years has led to a reduction in the number of students at Tuscola and an increase at Pisgah. That in turn led to Tuscola needing fewer teachers.
“Our class sizes will be larger next year,” said Tuscola Principal Dale McDonald.
The teachers taken away from Tuscola have not been added to Pisgah, however.
Despite the loss of teachers in the schools, students won’t be left without enough classes to fill their school day.
“Even with the massive cuts, we’ve had I can’t imagine that high-performing students won’t have plenty of honors or AP course offerings,” Bill Nolte, the assistant superintendant of Haywood County Schools, said. “The capacity to offer the courses has not changed.”
The students still have to be taught, and so a teacher standing in front of a particular class can just as easily teach an honors curriculum for an allotted class, according to Nolte.
While the number and variety of AP classes are based on student interest, the school also vets students to ensure they are eligible for the courses.
“You have to recognize this is a college-level class while you are in high school,” Goodwin said.
Even for honors courses, students have to qualify. The application process is based on a combination of test scores, grades in the current academic year and teacher evaluations. For honors English courses, students have to take a tailor-made test to get in. Based on those results, there will be only two honors English courses for sophomores at Tuscola next year compared to three this year.
While parents have expressed concerns that the testing has weeded out the number of students eligible for honors English, Nolte said it is important to make sure students end up in the appropriate level course at the beginning of the school year.
“Otherwise they will want out of the course midway through, and there won’t be a regular English course to jump to,” Nolte said.
Dr. Kristen Hammet, a veterinarian in Waynesville, has been an advocate of offering advanced courses in high school.
“We do need to offer the kids courses; they need to be able to get in top level schools,” said Hammet. “If these kids can’t compete, they can’t get into the Dukes and the Princetons and Davidsons.”
But, it’s more than that, Hammet said. She sees academically gifted students as a special-needs group. They crave a challenge that, if unmet, can leave them floudering and can lead to them checking out intellectually.
“These kids need these courses,” Hammet said. “It has been shown that if the gifted and intellectually and academically gifted kids are not offered courses that meet their challenge, they are at greater risk of dropping out, or become more depressed and more suicidal.”
A group of Jackson County doctors say they want out of the two-year-old partnership with the hospital in Haywood County and instead would like to look toward Mission Hospital in Asheville as a future partner.
There have been murmurings for months that Jackson County doctors are dissatisfied with the pseudo-merger with the hospital in neighboring Haywood and might want out. But this week marked the first time a group of doctors went public.
“There is a common element of frustration with day-to-day operations, and concern about the financial viability of the hospitals,” said Bob Adams, the chief hospitalist at MedWest-Harris hospital.
Adams, backed by six other doctors, appeared at the Jackson County commissioners meeting Monday to get his message out.
Though the doctors say they ardently support Harris hospital, they are dissatisfied with the MedWest joint venture that united Haywood Regional, Harris and Swain County hospitals under a single umbrella. At the same time, the new MedWest entity signed on with Carolinas HealthCare, a network of 34 hospitals based in Charlotte.
Many doctors in Jackson and Swain now say that was a mistake — and that they don’t trust Carolinas or their own board of directors.
“MedWest is failing and needs to be dissolved. Carolinas is not an acceptable partner,” Adams said. “Mission is the only partner acceptable to the communities west of Balsam.”
Some doctors in Jackson County believe Harris has not fared well in the MedWest joint venture.
Harris is struggling financially. It has seen an outmigration of patients. Doctors, too, are leaving.
Adams said he is one of eight physicians leaving Jackson and Swain counties in coming months. The community already faces a doctor shortage, a factor partly to blame for the loss of market share in recent years.
Doctors in Jackson County also feel that the Haywood hospital is being groomed to become the flagship of the MedWest venture. They fear patients once cared for locally at Harris will be gradually siphoned to Haywood. They also feel Haywood has gotten a greater share of resources. A long-promised new emergency room remains on the back burner in Jackson — meanwhile Haywood used up MedWest’s borrowing ability by taking out a $10 million line of credit to stem a cash flow shortage.
Whether real or perceived, the Jackson medical community has long prided itself on its reputation and didn’t take kindly to the thought of their beloved local institution declining. That, along with a strong independent streak, has doctors questioning the corporate relationship they now find themselves in as culturally incompatible.
“It is clear to me that the hospital that I joined 10 years ago no longer exists, and is unlikely to rise again from its current ashes,” said Dr. Waverly Green, who is leaving the community in a few months. “I am saddened that it has come to this, and ultimately, I think the community as a whole will be left paying the price.”
Adams and Green both blamed Carolinas HealthCare System as duplicitous in bringing about Harris’ plight.
Adams said he does not trust Carolinas to look out for the interests of their local Jackson County hospital.
They say Carolinas pushed Haywood and Jackson together to advance their own long terms interests — namely to mount a competitive front in WNC against Mission, Adams said
After corralling the trio of hospitals under MedWest, Carolinas then began setting the stage for Haywood to be the lead player with Harris and Swain in supporting roles.
“Carolinas wants everything to funnel past us to Haywood and stop them from going to Mission,” Green said.
“It was Haywood-centric all along,” agreed Bob Carpenter, a former board member for WestCare and MedWest.
Carpenter resigned in a show of solidarity with the medical community.
In particular, though, Carpenter believed the board had not been given ample time to consider signing off on $10 million loan documents that encumber the entire MedWest venture for money borrowed by Haywood. Carpenter said board members were called into an emergency meeting in January and asked to sign documents they had not even had a chance to read.
“They said we had to do it to save the MedWest system,” Carpenter said.
Haywood allegedly didn’t have the funds to make payroll and needed the credit immediately.
The Jackson County medical community appealed to the management of MedWest and Carolinas as well as the hospital board of directors several times during the past six months to no avail.
“I realized we were being shut out,” Green said.
Adams has worked at Harris for 36 years and does not take lightly the decision to come forward with his views.
“Some people thought it may do more harm than good and may be more destructive,” Adams said. “A group of the physicians believe the information needs to be made public and our whole intent is to allow the community to make a decision to look further into what is going on and make their own decisions.”
A movement to rein in the dominance of Mission Hospital in Western North Carolina’s healthcare landscape has hit a critical juncture.
A legislative committee studying whether smaller hospitals are suffering from aggressive, monopoly-like tactics by Mission will unveil its recommendations this week. Based on a preliminary report, the committee will recommend new restrictions to help level the playing field for Mission’s competitors.
But, there is early indication the recommendations won’t garner the necessary support in the General Assembly.
To pass, it would need the support of heavy-hitter Sen. Tom Apodaca, R-Hendersonville, who chairs the Senate rules committee. Apodaca has told fellow legislators he won’t support it.
“The senator assured me it would be dead on arrival in the Senate,” said Rep. Ray Rapp, D-Mars Hill.
Without Apodaca’s backing, new restrictions on Mission have “zero” chance of passing, according to Sen. Jim Davis, R-Franklin, even though Davis himself personally supports them.
Another nail in the coffin: Sen. Martin Nesbitt, D-Asheville, doesn’t support new restrictions either. Between Apodaca and Nesbitt — the two senators who represent territory at the heart of the Mission Hospital debate — it’s unlikely senators from other parts of the state would feel strongly enough to go over their heads and push it through anyway.
Smaller hospitals and doctors in the region are fearful that Mission is exploiting monopoly-like power to gobble up market share, causing the slow-but-steady decline of smaller community hospitals by eroding their patient base.
But while Mission’s competitors lobbied for more restrictions, Mission was lobbying for fewer restrictions. It currently is subject to anti-trust oversight dating back to the merger of Asheville’s only two hospitals in the 1990s.
Mission claims those existing regulations handcuff its ability to navigate the rapidly changing dynamics of healthcare and should be lifted.
“It has been 16 years. There has to be a way of gracefully ending this,” said Ron Paulus, CEO of Mission.
The upshot, however: neither may get what they want. If lawmakers buck committee recommendations and decide to leave well enough alone, the status quo will stay in place.
“If it ain’t broke, don’t fix it,” Rapp said.
Rapp said the state shouldn’t do something that could hurt Mission’s role as a life-saving hospital in the region.
“The health and well-being of our citizens should be first and foremost,” Rapp said. “ We can’t put our premier health care institution in jeopardy.”
But, Davis said Mission’s unfair advantage is jeopardizing smaller hospitals.
“I just don’t want any hospital to be preyed upon by a large hospital,” Davis said.
Davis said the anti-trust oversight Mission is subject to was put in place for a reason.
“Whenever you endorse a monopoly, whatever government body blesses that, has an obligation to keep an eye on them,” Davis said.
Paulus said Mission has a critical responsibility in the region as the largest and only tertiary care institution. “I hope you don’t need us but I want to be here if you do,” Paulus said.
It’s doubly hard given the demographics: poorer, sicker, older and less insured.
“The issue is how do we care for the patients in our region when the demographics are so much worse,” Paulus said.
Mission wants to work collaboratively with all the hospitals and doctors in the region toward that goal rather than get bogged down in turf battles no one can afford to wage, Paulus said.
The state committee considering whether to strengthen or weakened the anti-trust regulations governing Mission released preliminary recommendations last month.
Among them: a buffer zone that would stop Mission from setting up certain types of clinics within 10 miles of an existing hospital and a cap on the percentage of doctors Mission can employ in a community.
In Haywood County, MedWest-Haywood hospital has been in a race with Mission to buyout private doctors’ practices and put physicians on the hospital’s payroll as in-house employees.
The trend of doctors working directly under a hospital instead of private practice is a national one, driven largely by economics. Doctors have been getting squeezed by declining insurance and Medicare reimbursements and see employment under a hospital as an easier route.
The fear, however, is that whichever hospital employs doctors can control where they send their patients.
“If Mission buys a practice, the default for that practice would be to send those patients to Mission Hospital, and I am concerned about how all these little hospitals in the western part of the state will survive if that happens,” Davis said. “I don’t think anyone wants our community hospitals to become emergency clinics that feed to Mission Hospital.”
Paulus countered that Mission would not dictate which hospital a doctor should admit and refer patients to.
Nonetheless, Mission’s competitors would like to see limits on how many doctors it can employ in surrounding counties. Currently, Mission’s anti-trust regulations cap the number of doctors it can directly employ in Buncombe County to 30 percent, but there are no caps for other counties.
Fishing for physicians
Mission has come under fire for courting physicians in Haywood County. Mission has also set up a competing medical office complex in Haywood.
But, Paulus said Mission’s motives in extending employment offers to Haywood doctors are not sinister.
“The goal is not to have a single monolithic hospital in the middle of Asheville,” Paulus said, adding “it would never work, parking is terrible.”
Paulus said WNC has historically not been able to recruit enough doctors to serve the population.
“The ratio of doctors to population is well below the state and national average,” Paulus said.
Their salaries here are lower because of the higher number of poor, uninsured patients. By employing doctors, hospitals essentially subsidize their practices to get them to stay here.
Mission simply wants to ensure a stable of doctors for the region, he said.
“Our core concern is the ablity to attract and retain quality physicians in the community,” Paulus said.
Haywood doctors who are critical of Mission for its forrays in their home territory questioned why, if Mission’s goal was building the physician base, did it try to buy exisiting practices that are already here.
Paulus said the existing practices are the best route for recruiting more doctors.
“It is much easier to recruit into an existing group than create a new group,” Paulus said.
MedWest-Haywood got particularly irked, however, when Mission tried to court Mountain Medical Associates, a key practice in Haywood County with eight doctors across four critical specialties.
Realizing it had stepped on an ant hill, Mission actually withdrew its offer to Mountain Medical Associates, Paulus said. Before doing so, it extended an olive branch inviting MedWest-Haywood to form a three-way partnership with the practice and the two hospitals working together. That way MedWest-Haywood wouldn’t have to shoulder the entire financial burden of adding all the doctors to its payroll, Paulus said.
Paulus said the offer attempted to “reset the playing field and get past old emotions” between Haywood and Mission, but the opportunity was squandered.
Whether perception or reality, MedWest-Haywood had to counter Mission’s offers to buy local physician practices, despite not really having the money to do so.
“They in a sense have been forced into a bidding war with Mission for their own doctors and have had to pay more for those physicians as a result,” Fields said.
That was partly to blame for landing the MedWest-Haywood in a financial quagmire. It barely had enough cash on hand to make payroll and had to get an emergency line of credit to bail it out of a cash flow crunch.
But, those who defend the move say it was critical.
“If you don’t have physicians in your community pushing people toward your hospital, you aren’t going to have a hospital in your community,” said Kirk Kirkpatrick, a Waynesville attorney and Haywood County commissioner who has been active in hospital affairs.
Kirkpatrick said billboards for Mission in Haywood County are a testament that Mission is actively going after patients in Haywood County and trying to pull them away from MedWest-Haywood hospital.
“It is an extremely competitive business, extremely competitive,” Kirkpatrick said. “If you want a hospital in your community that can provide the kind of care you expect then you need to utilize your hospital. If you go over to Mission and you vacate your hospital and don’t utilize it, it won’t be here anymore.”
For more information on both sides of the issue, go to www.wncchoice.com and www.missionfactchecker.com.
Finding a new leader to replace the outgoing MedWest-Haywood President Mike Poore could take months and will be handled by Carolinas HealthCare Network rather than the local hospital board.
Carolinas HealthCare System, a Charlotte-based network of 34 hospitals that MedWest-Haywood joined two years ago, will conduct the search and vet applicants. The MedWest-Haywood board will make the final pick from among two or three finalists.
Finding a replacement who can navigate the complicated structure of MedWest may take time, according to John Young, the vice president for Carolinas HealthCare’s western region.
MedWest-Haywood is one of three hospitals under the MedWest banner, along with MedWest-Harris in Jackson County and MedWest-Swain.
Until recently, Poore had served as the CEO of all three hospitals plus the overarching MedWest partnership — in effect four organizations.
“He has taken on multiple roles in a complicated situation,” said Dr. Benny Sharpton, a member of the Haywood hospital board.
Poore had to balance the wishes of three medical communities, answer to the individual hospital boards plus the joint MedWest board — all the while reporting to his primary boss of Carolina’s HealthCare.
“This is not the place for a new CEO,” Young said.
Earlier this year, however, Poore was reassigned. He was stripped of his CEO status over all of MedWest and pulled back to his former role as president of MedWest-Haywood only.
Meanwhile, MedWest-Harris and Swain were given their own president in Steve Heatherly, who had been in Harris management for 15 years.
The management shuffle was aimed at placating dissention among some Jackson County doctors who felt Harris was not getting the attention it needed from Poore under the new MedWest venture. Harris has been faring worse financially than MedWest-Haywood and had seen a growing loss of patients to Mission, while Haywood’s market share has inched back up.
Failure to fix concerns raised by the Jackson medical community could potentially threaten the MedWest joint venture. When the joint venture was launched, an escape clause was built into the contract at the three-year mark, which comes up next year.
Young said dissolving it would be bad for both hospitals.
“The real issue from my perspective is simply we are better together,” Young said. “When you put the hospitals together, you have enough market share and enough demographics to be able to compete for primary and secondary care with Mission way better than any hospital could by itself.”
The hope is that MedWest-Harris and MedWest-Swain would get more attention under their own CEO than they could have gotten from Poore as CEO of the entire system.
How long the hospitals will remain under separate leadership isn’t clear. Ultimately, there needs to be a CEO over the entire MedWest venture, Young said. Having a president for each hospital plus a top CEO results in a “pretty hefty salary load,” Young said. So ideally, the president of either Haywood or Harris would serve in a dual role as CEO over the whole entity.
But, it is unclear when a return to joint leadership may occur. And, that complicates the hiring of a replacement for Poore.
“This is not the best moment for us to be looking for someone because we have this bifurcated approach,” Young admitted.
Young said there is no easy way to get through this “awkward moment.”
Given the complexities, an interim president will most likely be appointed while a permanent one is found. If the interim leader proves their mettle, they could be asked to stay, however.
“So we need as robust a search for an interim leader as a permanent one,” Young said.
For now, Young will serve in a transitional capacity while a search is conducted for an interim president.
“This organization has had enough change,” said Young.
The president of MedWest-Haywood hospital suddenly stepped down this week after three-and-a-half years on the job.
Mike Poore’s tenure at the helm of MedWest-Haywood was marked by an aggressive strategy to restore a crisis of community confidence, rebuild plummeting finances and compete head-to-head with the much-larger neighboring Mission Hospital in Asheville.
The news that Poore was resigning came as a surprise to the medical community and hospital’s board of directors, who met for two-hours Monday to digest the news.
Dr. Benny Sharpton, a long-time surgeon in Haywood County, said the medical community is going to be disappointed at the loss.
“The medical staff was not only comfortable but optimistic with his leadership,” Sharpton said. “He opened up lines of communication that had been broken it he past. He had an open door policy. Not all CEO’s have good rapport with their medical staff.”
Poore will be best known for rescuing the hospital after a tumultuous period when it failed federal inspections and was forced to essentially shut its doors for four months in 2008. The previous CEO, David Rice, who had become a lightning rod of controversy even prior to that crisis, stepped down and Poore stepped in — not only filling a leadership void but also putting the hospital on a path to recovery.
“Within a relatively short period of time, we had regained the market share we had lost. That is not a small feat,” said Dr. David Markoff, an ophthalmologist in Haywood County. “I have enjoyed working with Mike. I am sorry to see him leaving.”
Poore’s family man persona and regular presence at civic and social functions not only built rapport for the hospital but made him generally well-liked around town as well.
“Mr. Poore is one of the finest men I have ever known,” said Dr. Charles Thomas, an oncologist in Haywood County and a hospital board member. “He has done us a wonderful job. We accepted his resignation with deep regret and lots and lots and lots of thanks and platitudes.”
While Poore’s departure seems amicable, many in the medical community are left asking “why now?”
Poore, 47, does not have another job lined up. Depending on where he goes next, his family may stay in Haywood a while before joining him to avoid being uprooted. His son, a football player for Tuscola High School, will be a senior year next year, while his daughter will be a sophomore. His wife is involved in various community civic groups.
Poore is receiving a severance package but the terms aren’t public for now.
Poore said he will look for another hospital CEO position.
“I am a hospital administrator. That is my animal,” Poore said.
Turn-around man
There wasn’t any detectable tension between Poore and the Haywood medical community or hospital board.
But, Poore technically had another boss as well. He answered to Carolinas HealthCare System, a network of 34 hospitals based in Charlotte that MedWest joined two years ago.
Carolinas didn’t have a problem with his performance either, according to John Young, the vice president for Carolinas HealthCare’s western region who Poore reported to.
“This moment is Mike’s choice. This is not because of anything,” Young said. “It is just a certain period of time when it is time for somebody else to come in.”
By all accounts, Poore was dealt a difficult hand when he took the job.
“We will always remember his great leadership in getting Haywood Regional Medical Center back up and running,” said Fred Alexander, the chairman of the full MedWest board of directors.
With no patients to speak of, the hospital’s cash reserves had plunged so low that it had less than a month of operating revenue left when it reopened its doors. Patients who had turned elsewhere for medical care during the closure had to be lured back. And, the historically robust medical community in Haywood County, which had rallied around the hospital, needed reassurance they still had a future in Haywood County.
“He has worked so hard in the past several years to bring this entity, our hospital, upright again,” said Jean Burton, chair of the MedWest-Haywood board and a Cooperative Service agent in family and consumer sciences. “We were so knocked down a few years ago, and Mike worked tirelessly around the clock and has really stuck to the priorities he set.”
With the crisis in the rearview mirror, Poore led the hospital into a new partnership with neighboring hospitals in Jackson and Swain counties. The three hospitals formed a joint venture under the new MedWest banner. At the same time, MedWest joined the Carolinas HealthCare Network.
“I came to the hospital at a time of transition. We have gone through that transition during the last three-and-a-half years. It is just time for me to move on to other things,” Poore said.
Poore’s tenure isn’t uncharacteristically short for a hospital CEO. While the average time at one hospital for a CEO in North Carolina is longer, nationally it is 3.8 years, Poore said. Poore’s time at Haywood was just under that.
“It is not unusual for that turnover, but especially in a circumstance where you have a transition of bringing two organizations together to form MedWest,” Poore said.
There are always rivalries, even if friendly ones, between neighboring hospitals, Poore said. Bringing together two medical communities to act and think like a single entity can be difficult and challenging, he said.
As is sometimes the case in corporate mergers or turn-arounds, the person to affect change does not stay on as the long-term leader, Young said.
“Mike was the man to move the ball,” Young said of Poore’s role during the past three years.
Poore’s total compensation package was $444,000 a year.
Bumps in the road
Poore’s tenure wasn’t without snags, however. His honeymoon period began to fade in recent months, as the financial recovery initially witnessed under Poore began to backslide.
Despite a workforce reduction of 52 employees last year, MedWest has embarked on another round of cuts — 120 positions will be eliminated by July 1.
“It is what we need to do to right-size our organization with the reality of the revenue coming in today,” Poore said. Poore said MedWest is operating under austerity measures until the tide turns.
The layoffs amount to about 5 percent of the 2,100 employees across MedWest, including all three hospitals plus the 16 doctor practices now owned by MedWest.
In the midst of the financial troubles, MedWest-Haywood has seemingly been on a building and spending spree during the past year — from the very necessary replacement of a broken down generator to the very optional construction of a new surgery center.
In the end, MedWest-Haywood saw its cash-on-hand dip so low it had to turn to Carolinas HealthCare for an emergency $10 million line of credit. It was the first time Carolinas has ever loaned money to any of the 34 hospitals in its network.
While Poore defended the loan as no big deal, as Haywood has no other debt on its books, getting bailed of a cash-flow crunch by Carolinas clearly wasn’t ideal.
The loan was precipitated by a series of unexpected costs. Namely, MedWest-Haywood spent more than $10 million to replace a broken generator, upgrade its electronic medical records system and pay out judgments in two lawsuits dating to the previous administration.
Like Poore, Young characterized MedWest-Haywood as a victim of circumstances. Nonetheless, it revealed just how critical the financial status had become.
Build and they will come
While some costs indeed couldn’t be helped, Poore also oversaw an expansion campaign far more voluntary in nature.
A hospice center, a new surgery center and a new urgent care center are in various stages of construction, costing MedWest-Haywood a total of $2.35 million. The amount put up by the hospital is a fraction of the total cost — the lion’s share was paid for by the non-profit hospital foundation and a private group of physician investors.
MedWest also has new MRIs, a new diagnostic lab and new heart catheterization services.
“The hospital is very well positioned to serve patient needs and to grow and to prosper,” said Dr. Charles Thomas, an oncologist in Haywood County and former chief of staff of the hospital.
Young agreed.
“Mike started us down a track. A lot is already in place,” Young said.
The attention Poore gave to MedWest-Haywood didn’t sit well with some doctors in Jackson County, who felt their hospital was being slighted in favor of making Haywood the flagship of the MedWest system, another bump in the road for Poore in recent months. Disatisfaction among the Jackson medical community led to Poore being replaced as CEO of MedWest-Harris and relegated to being over MedWest-Haywood only.
Perhaps the most expensive piece of Poore’s expansion campaign was buying out several Haywood doctors’ practices. The exact cost of the private transactions are not known, but up-front costs aside, the newly bought doctor’s practices will continue to be a drain on the bottom line for another year or two before turning the corner. The hospital has to foot the bill for salaries, equipment, and overhead before the billing for patients begins to pay off.
While costly and perhaps outside the hospital’s realistic budget, it had to be done, according to Dr. Benny Sharpton, a long-time surgeon.
Mission Hospital in Asheville was courting the same physician practices, and Haywood had to make a competing offer. So Poore acted swiftly despite perhaps not having the money to do so.
“It was done in an extremely short period of time primarily due to outside threats from Mission hospital trying to siphon the loyalty of our doctors off,” Sharpton said. “He took that on in a difficult time. It needed to be done. It had to be done.”
While Poore has taken criticism from some for overspending or failing to enact austerity measures sooner, others disagree. When faced with embattled finances and dwindling market share, MedWest-Haywood had a choice. It could retrench and scale back. Or it could move forward with guns blazing.
Rather than resigning Haywood to being a rural second-fiddle hospital in Mission’s shadow, Poore chose to push Haywood onto a bigger stage.
“He has already laid the foundation,” said Cliff Stovall, a MedWest-Haywood board member. “The person that does all the spade work doesn’t always get to enjoy all the glory.”
The track set in motion by Poore will hopefully continue by the leadership team still in place, said Stovall.
“As much as I hate to see Mike ago, we are glad to have the people he put in place,” said Stovall, a retired army colonel who now works in tax preparation.
Poore assembled a nearly all-new management team for the hospital after he was hired, bringing on board more than a dozen vice presidents and department heads within his first two years.
Poore gives credit to the entire team for the advances that have been made.
“I am so proud of the accomplishments the team has made,” Poore said. “I feel like I am leaving this in good hands on a go-forward basis.”
