What piqued your interest this year? We review what stories grabbed peoples’ attention, got passed around and shared widely.

By NC Health News Staff

1. Medicare cuts off Wake Forest Baptist University Medical Center after lab errors

In March, the federal Centers for Medicare and Medicaid Services sent Wake Forest Baptist Medical Center a notice that the facility was in “immediate jeopardy” of losing federal Medicare reimbursements as a result of problems in the diagnostic lab operated by the hospital. The hospital was cut off in late March, and then quickly created a plan to fix those problems lest it potentially lose tens, if not hundreds of millions of dollars in annual revenue.

Shows an older blonde woman smiling at the camera
Vickie Murphy has had almost constant pain since having tissue excised from our mouth after being diagnosed with cancer by a pathologist at Wake Forest Baptist Medical Center. Photo courtesy: Murphy family.

“Last fall, Wake Forest Baptist Medical Center became aware of deficiencies in its pathology quality monitoring process, which led to a change in diagnosis requiring a change in management for 10 of our patients,” the hospital said in a statement. “We promptly notified all patients affected, as well as the physicians who cared for them. We have completed a review of hundreds of similar cases to satisfy ourselves that there are no other patients who have been affected.”

This announcement signaled a several months-long processundertaken by Wake Forest Baptist that resulted in thousands of case files being reviewed.

Eventually, the hospital “determined that most, if not all, of the misdiagnoses centered on a single individual who is no longer with Wake Forest Baptist,” a hospital statement said. Wake Forest Baptist said it also made changes to its lab processes, equipment and training to address the issue.

The errors were reported by hospital employees through the medical center’s Safety Starts Here program and subsequently reported to regulators.

Our coverage included reviewing the case of a patient who was misdiagnosed with cancer of the mouth. Her unnecessary treatment left her with pain and numbness.

2. Hurricane Florence coverage

Hurricane Florence, which blew ashore in North Carolina as a Category 1 storm Sept. 14, was a long, slow, wet slog that was one of the biggest stories of the year across the state. For the folks affected it was more than a story, it was their lives. Response and recovery from the storm is sure to extend through 2019 and beyond.

Farm building flooded in aftermath of Hurricane Florence in Wayne County, NC near Seven Springs.
Flooded properties, such as this barn, on the county line between Wayne and Lenoir Counties, across the river from Seven Springs, are only starting to emerge from floodwaters this week. Photo credit: Elizabeth Page

NC Health News published more than 30 stories overall, starting with the lead-up to the storm, including reviewing hospital preparation, what senior living facilities needed to think about as they got ready and the need for people to pre-fill their medications in anticipation of closed pharmacies.

During the long storm, we followed how the state’s Department of Health and Human Services was taking a new approach to hurricane response, and even though our staff members lost power and some experienced flooding, we kept up a steady stream of tweets, Facebook posts and short reports. We even profiled a delightful 103-year-old evacuee from Wilmington.

All of NC Health News staff contributed to our coverage, including our development director Elizabeth Page, who flew with her pilot husband to deliver food and medical supplies to communities isolated by flooding. Along the way, she got a taste of reporting, snapping photos from the air and on the ground, and interviewing people who were recovering from the storm.

In Florence’s aftermath, we monitored how medical relief teams helped survivors, how mental health workers continuously staffed the phones to help their clients through the crisis, and how the storm affected the health of people in the seafood industry. We also broke the story that more than half of the North Carolinians killed during Florence were over the age of 70.

Our public service story on the availability of disaster-SNAP benefits got the most traffic of any of our Florence stories, reflecting the intense interest in the storm and recovery efforts.

3. Medicaid Managed Care: Who’s in the running for contracts with the state

One of the biggest state health policy stories of 2018 was the fate of North Carolina’s Medicaid program which will transform from the legacy fee-for-service program to one run by managed care companies in the coming year. At the beginning of the year, lots of details were lacking, including whether the state would impose a work requirement for beneficiaries to access insurance.

shows NC with the 100 counties divided by region into six regions for Medicaid bidders
Under the new Medicaid plan, commercial managed care companies will bid to cover patients statewide, while local “provider-led entities” will bid on covering all the patients in one of six regions. Map courtesy: NC DHHS

Health and Human Services Sec. Mandy Cohen and her team worked on updating the waiver application they submitted to the federal Centers for Medicare and Medicaid Services for services for most adults and children. However, the plans for services for people with severe and persistent mental health problems remain up in the air.

For DHHS, much of the year was spent waiting for CMS to approve that waiver, but details on the plans began to emerge in late summer when the state issued its request for proposals to managed care providers. Several months later, those proposals had been submitted and legislators and state health regulators got their first looks at which companies are bidding for business. The waiver was approved in October and the following month, Cohen provided more details to lawmakers and the public at a General Assembly hearing.

In February, the DHHS will announce which of the eight interested companies and provider-led groups will provide services, Cohen said.  Contracts could amount to as much as $30 billion over the next five years, the largest procurements in the state health department’s history.

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4. STD rates bump up in NC

information about drug-resistant Gonorrhea, more than 820,000 cases per year.
N. gonorrhoeae
causes gonorrhea, a sexually transmitted
disease that can result in discharge and inflammation. Image courtesy CDC

Despite historically low pregnancy rates among teens and fewer young people having early sex,, teens and people in their early 20s are still contracting sexually transmitted diseases in North Carolina.

In fact, North Carolina has some of the highest rates of chlamydia, gonorrhea and syphilis in the U.S. according to recent data from the Centers for Disease Control and Prevention.

This story was actually published in late 2017 but had sustained interest through the early part of the year.

5. New psychiatric urgent care clinic slowly gains patients

Close to two decades after North Carolina “reformed” the state’s mental health system, throwing the system into almost constant turmoil, finally, new modes of care are starting to emerge. 2017 saw the creation of a behavioral health urgent care center in Durham; a place for people with mental health issues to go if anxiety is ramping up, or they run out of psychiatric medications or if depression is weighing too heavily.

Shows a woman behind a reception desk talking to a man with his back to the camera.
Carolina Outreach clinic director Marissa Holsten said receptionists are an important part of the team, most of the reception staff are studying social work. “The first person clients encounter has to be someone who has dedication or desire to be in this field because it’s very difficult and they’ve got to have that dedication and be on all the time and be warm and comforting no matter what just happened,” Holsten said. Photo credit: Rose Hoban

Alliance Behavioral Healthcare, the state-funded managed care organization that covers Durham, Wake, Cumberland and Johnston Counties, tapped a group of therapists in Durham, asking them to create the clinic, located on 15-501, south of downtown. They created the only facility of its kind in the state.

“The community identified a gap there between people who couldn’t make their regular appointments to see their psychiatrist or therapist, or go to the emergency room or theDurham Recovery Response Center,” said Tim Brooks, the CEO of Carolina Outreach, which is running the behavioral health urgent care.

“It’s clear there was this group of people who weren’t getting exactly what they needed and we’ve been able to fill that niche.”

After a year in business, the center was getting close to hitting its targets on patients and treatment.

NC Health News also covered the creation of several crisis care centers for children in Asheville and Charlotte that opened this year.

6. Fate of most Duke Energy coal ash still uncertain

Photo shows two men peering closely at a map
Sean Neale of Duke Energy, right, listens as Jim Michel poses a question about risks of water contamination at the Allen Steam Plant outside Belmont. Photo credit: Catherine Clabby.

In 2017, the fate of Duke Energy-generated coal ash stored at large waste impoundments around the state was one of our biggest environmental health stories, especially as some families remain unable to drink water from their nearby wells.

In 2018, environmental advocates focused much of their attention on the Cape Fear River, where industrial chemicals have befouled that waterway. However, the problems with coal ash continue to concern many property owners and local officials, with many details left unclearas to how that problem will be resolved.

7. Family ties keep one rural OB-GYN practicing in Eastern NC, despite challenges

doctor in white coat looks at the camera while holding a little baby in a onesie
OB-GYN Lindsay Stevenson. Photo courtesy: Samantha Merritt

Our reporter Taylor Knopf travels around the state documenting the state of health care access and provision of services in distant parts of North Carolina. Sometimes, she meets unique people who are making their own contribution to rural care, such as this Elizabeth City obstetrician who practices in the town where his father and brother still run the local pharmacy.

8. The science of hog farm odors

As lawsuits around large-scale hog farms played out through 2018, NC Health News carried a unique story on the science behind quantifying smell and how it is being used in court as a key part of the plaintiffs’ case against neighboring farms.

photo of a roadside sign that reads: STop complaining or put down the bacon
Here is one sign supporting hog farmers seen in Kenansville, the county seat of Duplin County, one of the largest pork-producing counties in the country. Photo credit: Rose Hoban

Scientists are using DNA analysis to find a fecal indicator bacterium they’re calling Pig2Bac. Researchers have identified multiple of these biomarkers in human and animal feces to track their presence in water.

When hunting for the bacteria, scientists look for specific strings of their DNA. During testimony, Shane Rogers of Clarkson University submitted citations of four peerreviewed studies that found Pig2Bac to have 100 percent specificity as a pig fecal biomarker. One of the studies used Pig2Bac to detect evidence of pig feces in unnamed streams near hog farm spraying fields in Eastern North Carolina.

9. BCBSNC says most of its ACA plans will be cheaper in 2019

Similar to Mark Twain, reports of the death of the Affordable Care Act remain exaggerated and premature. Despite tweaks made to the law by Congress (eliminating the individual mandate to purchase insurance) and the Trump Administration (which allowed for the establishment of association health plans, among other administrative tweaks), premiums for most of North Carolina’s ACA plans were cheaper for people seeking to purchase insurance for the coming year.

10. Hundreds of N.C. doctors say they’ve stopped prescribing opioids

graph shows number of overdose deaths rising more slowly
In last year’s state action plan, the state Department of Health and Human Services’ goal was to reduce the growth of opioid overdose deaths.

In 2017, DHHS Sec. Mandy Cohen unveiled an action plan to reduce the rate of death from opioid overdoses, which included planning for overdose deaths to have leveled off. But by mid-2018, the rate of deaths had increased, surpassing projected number of deaths for the year 2021 in 2018.

Part of the effort to curb opioid deaths has included new guidelines for physicians and other prescribers on how to work with their patients on taking opioid pain relievers. In addition, the STOP Act makes it harder for providers to dole out as many of the pills.

In response, however, it’s become clear that many physicians have stopped prescribing opioids altogether, according to an investigation by Taylor Knopf. This has made it more difficult for pain patients to get the relief they need, in a crisis that unfolds one person at a time.

Bonus:

N.C.’s shortage of autism therapists leaves some on Medicaid waiting months, even years

shows a little girl sitting on a bed in a cheerful room, she's smiling and looks playful
Adison Cole started being able to verbalize once she started receiving applied behavioral analysis therapy. Photo courtesy Donna Dworak

In 2015, advocates pushed a bill through the legislature that required insurance companies to cover expensive — but extremely effective — therapies for children with autism. Within a year of implementation, we started hearing from parents that they were having difficulty accessing the therapies, or that once they paid out of pocket for them that insurers were denying their claims, which sometimes ran into the tens of thousands of dollars.

An original NC Health News investigation found that both privately and publicly insured children were having difficulty accessing the treatments, in part because of a lack of therapists trained to provide the care.

After our stories ran, the policy shifted. DHHS pushed the state’s mental health managed care providers to start providing services to Medicaid children.

Our reporter, Sarah Ovaska-Few, did a follow-up story a few months later recounting that one of the little girls she’d reported on was finally getting the therapy and that for the first time in her life, she was able to say “Bye bye” to her grandmother as she got on the bus to go to her appointments.