Duke and Durham: A Matter of Trust

By SYLVESTER MONROE

Angela Baldwin and her son Tyrece, 6, are in the waiting room of Lincoln Community Health Center. They have come for Tyrece's school physical exam and immunizations. In Durham only six months, Baldwin is glad to have Lincoln Community in her neighborhood. "We didn't know where to take Tyrece," she says. "We happened to drive by the center one day, and so we came here. They took us right in."

Duke Med is grateful too. It is affiliated with the center, which is only a few miles from its main hospital, and much prefers to handle such routine checkups here rather than in its own high-priced facilities. Lincoln Community is one of dozens of affiliations and joint ventures that Duke has with local medical facilities spread throughout the 27-county region targeted as its turf. Serving 29,000 registered patients, who made 102,000 visits last year, Lincoln is a gleaming example of Duke's community outreach at work.

Not always is a hand extended by Duke so welcome in Durham. Earlier this year, when Duke announced plans to acquire Durham Regional Hospital and nearby Raleigh Community Hospital, many in the area were suspicious of its motives. They feared, not without cause, that Duke was trying to take complete control of health care in the region by buying up all the competition. A major worry was that Duke would then jack up prices, as any monopoly would.

At the first public hearing on the Duke-Durham Regional merger, held in a black church, city councilman Howard Clement, an African American, voiced a widely shared concern when he stood up and asked, "Can we trust Duke?" It was, and is, the big question, Clement believes, "and the jury is still out."

For people of color in Durham, Duke is more than just the hospital; it is "a white university hidebound by Southern tradition," as Clement puts it. Like most members of the town's minority community, Clement never wanted to go to Duke Hospital because it was viewed as a place where "they experimented on you." In 1968, when he was badly bruised in a head-on car collision, Clement screamed at the ambulance driver, "Don't take me to Duke! I don't want to go to Duke!"

Terry Sanford, Duke University's president from 1969 to 1982, tried to build bridges between town and gown. He was the first Duke president to go to city hall, and on Sunday mornings he brought people from Durham to the campus for breakfast meetings. Duke's current president, Nan Keohane, has reached out even further. Since arriving in 1993, she has opened a Duke University office in downtown Durham and helped establish clinics in five city schools. Although the public University of North Carolina receives the bulk of government funding for indigent care in the city, Duke and Durham Regional Hospital together provide 90% of that care. "I don't think they've always gotten the credit for what they do in the community," says Dr. Evelyn D. Schmidt, executive director of Lincoln Community Health Center.

Dr. Gary Stiles, who runs Duke's Health Systems Network Development program, openly acknowledges that Duke's motives are more than just magnanimity. "We live in a very competitive market here. We either help people and catch them where we can, or we kiss them goodbye." So Duke goes out to Lumberton and Laurinburg, screens patients and transfers the sicker ones back to Duke, where they or their insurers will pay for them to get well. Duke also collaborates with community organizations in other cost-saving joint ventures, such as a child-abuse-prevention center, a teenage-pregnancy-prevention program and safe-kids fairs.

Still, wary Durham residents are worried about Duke's ever expanding tentacles. The acquisition, completed in July, has caused some hard feelings among Durham Regional's staff physicians. They fear it will destroy Durham Regional's identity as the comfortable community hospital--and cut into their private practices. "The structure [of the partnership] has been developed, but we don't know how it is going to work," says Dr. Stuart Manning, president of the Durham Regional medical staff.

Duke leaders say they're committed to maintaining the special character of DRH and the other facilities Duke acquires. "We depend on the community hospital," says Malcolm W. Isley, director of DUMC Affiliations, Duke's liaison with its growing empire. "We go out of business if the local community hospital goes out of business."

But the ultimate test of Duke's affiliations and joint ventures is how patients in the communities it moves into feel about the care they receive. Angela Baldwin says Lincoln Community did a good job on Tyrece, and she plans to come back. That's good news for Duke, because even when hospitals buy each other up in big-dollar deals, medical practices are built one patient at a time.

--By Sylvester Monroe