This editorial was originally published on Cardinal & Pine.
Across eastern NC, emergency care services aren’t always easy to come by and often require long wait times or distant drives. The consequences can be devastating.
By: Dylan Rhoney
For more than 70 years, anytime someone got sick in Martin County, really sick, they knew they had a hospital nearby they could go to. A place they could go for emergency and specialty care.
But after Martin General Hospital closed in 2023, the community lost a literal lifesaver. For lifelong Martin County resident and current county manager, Drew Batts, the loss of the hospital is personal.
Batts’ friend was rushed to the hospital last year after she stopped breathing in her sleep. She lived close to the former site of the hospital, but had to be transferred a half hour away to neighboring Bertie County, and then to Greenville, where she died two days later.
Batts wonders what might’ve happened if the local hospital was still open and if care hadn’t been delayed.
“I would like to have seen what the alternative could have been,” he said.
Martin General Hospital opened its doors in the town of Williamston in 1950 and for seven decades, it served the county’s 21,000-plus residents. Two and a half years after the hospital closed, residents and local leaders are still feeling the aftershocks, and, like Batts, pondering what-ifs.
“If my mother was having a situation, she would be two minutes from the hospital. But now, she’ll be at least 25 minutes from any facility,” Batts said.
Dr. Samuel Dail, a New Bern-based primary care doctor who also treats patients at the local urgent care, says it’s important to get treated at a hospital as soon as possible in the event of an emergency.
“If you’re having severe crushing chest pain, severe shortness of breath, it’s critical that you get access to care quickly.”
A community fighting for more emergency services
Beyond the hospital closure, Martin is the only one of North Carolina’s 100 counties without an on-staff paramedic, Batts said. For lifelong resident Paul Roberson, having a paramedic is essential and the lack of one may literally be costing lives.
“Studies across the world show that paramedics save lives when it comes to strokes and heart attacks,” Roberson said.
Nationwide, rural communities like Martin County suffer from a higher rate of preventable heart disease and strokes. While there are EMS services available countywide, paramedics can provide more advanced care faster than EMTs. Paramedics are required to have 800 hours of training to become certified, while EMTs train for just 130 hours. In the field, paramedics are trained to administer medications, including for a cardiac event, as well as provide a patient an IV for fluids.
Susan Curtis, a former ER nurse who worked for decades in what is now Blue Ridge Regional Hospital in Spruce Pine, echoed Dr. Dail’s sentiment.
“The longer you delay care, the more likely you are to have a worsening of the condition… heart attack and strokes, we know the sooner they get in to ultimate treatment, whether it’s the cath lab or whether it’s getting the medications to reopen those blood vessels—the longer it takes you to get to that point, the more likelihood of permanent damage to the heart muscle,” she said.
Having a paramedic wouldn’t make up for the loss of Martin General, but Batts said it would provide an extra layer of protection for members of the community facing a medical crisis.
The issue is the cost.
“There is a heavy expense to implement paramedics. You’re looking somewhere in the neighborhood of $1.4 million to implement a paramedic around the clock. The way that works, we can’t just have a paramedic five days a week, we’ve got to have a paramedic on-call 24/7,” he said.
The county’s total budget for 2025 was $46.6 million, meaning a paramedic would account for 3% of the total yearly expense.
Roberson believes getting paramedic services to the community is essential.
“We need that service here because people are dying from lack of healthcare. It’s really a healthcare desert. You’ve got a few small family practitioners here, and a pediatrician, and that’s it,” he said.
Even the community’s urgent care abruptly closed in January, and has since re-opened as a virtual clinic with no in-house doctors. Before it closed, Roberson cut his foot on a piece of glass last year and drove himself to the urgent care. If that happened now, he’d have to go elsewhere.
“A doctor virtually can’t sew up my wound, obviously,” he said.
The next closest hospital is in neighboring Beaufort County, and Roberson knows he wouldn’t have been able to drive there with an injured foot.
“I could not have driven myself to Beaufort and made it,” he said. “I drove myself to that urgent care.”
Accessing specialty care can be a challenge
The lack of emergency options in rural eastern North Carolina is compounded by the absence of another kind of care: specialty care.
Unlike primary care, specialty care is focused solely on a specific area of medicine, and includes doctors such as cardiologists, who focus on heart related issues, as well as oncologists that treat and prevent cancers.
In urban areas of the US, there are 263 specialist doctors per 100,000 people, compared to just 30 per 100,000 people in rural communities.
This lack of specialty care in rural regions often leads to more emergency medical episodes—that lack the infrastructure to treat them. So doctors do their best to make sure their patients get the care they need, even if it’s far away.
Dail says that while he tries to do all he can for patients, he does have to refer them to specialty care doctors in some cases.
“I really try to maximize what I can do, but there are some things that absolutely need specialist care, surgical care,” he told Cardinal & Pine.
While New Bern does have specialists, such as rheumatologists, the wait can be upwards of six months—if there’s an appointment available at all.
A trip from New Bern to Raleigh takes two hours each way, and for some of Dail’s patients in neighboring Pamlico County, that drive could be even longer. But Dail believes it’s important patients see a specialist when it’s needed.
“There are some prescriptions and management of conditions that should be handled by a specialist, rather than a primary care physician. There are pretty big barriers to good care, and access to care that is critical. There are some things we can’t do locally,” he said.
For elderly patients, driving longer distances for care can be difficult. Eighty-three-year-old Irene Johnson of rural Halifax County says she needs to be driven to longer appointments. Before her insurance allowed her to find a closer doctor, a visit with her cardiologist at Wake Med in Raleigh was a two-hour roundtrip journey.
“My granddaughter always took me to Raleigh,” Johnson said. “I have missed some [appointments] because I didn’t have anybody to take me.”
More money and new thinking is required
Dail believes training new doctors in rural communities like the one he grew up in and serves today will help boost medical services in rural North Carolina.
“There’s consistent evidence that shows that people that train in the community are much more likely to stay in that community,” he said.
Eastern North Carolina faces both primary and specialty care shortages, and 13 counties in the region are without a hospital. Dail says Eastern Carolina University’s Brody School of Medicine has prevented the region from being even more of a medical desert.
ECU ranks in the top 10% for graduates practicing in-state, and 44% of the school’s graduates are placed in residency in North Carolina, including Dail.
Still, of the 402 residency programs statewide, only 10 are located in rural areas.
Dail acknowledges the difficulty in recruiting doctors to more rural communities.
“Unless somebody has grown up in a similar community, some of the bigger cities, bigger metropolitan areas are more appealing to folks to move to. We know that folks born and raised in the area are more likely to come back and train in the area,” he said.
Recruiting rural residents into medical programs is a challenge as well. Just 5% of all medical students come from a rural area.
For Hyun Namkoong, Down Home NC’s Statewide Healthcare Campaign Strategist, part of the problem is that healthcare is approached from a profit-first standpoint in the US.
“Our healthcare system is built on making profit. And that is really hard to do in impoverished, rural parts of the state,” she said. “That part of the state is just not having the same kind of economic growth, it’s experiencing a lot of population decline, and when you couple that with folks not wanting to move in and invest in a community that doesn’t even have a hospital or a primary care clinic, this is when people’s options really dwindle.”
North Carolina’s delayed budget could revive Martin General
Since last summer, the Republican-led General Assembly has been unable to pass a state budget. Martin County’s effort to reopen its hospital could hinge on its passage.
Williamston Town Commissioner David Richmond, whose district includes the now-closed Martin General Hospital, says his community deserves the same level of health care as any other.
“Healthcare is a basic human right,” Richmond said. “When we don’t even have a hospital, we need to be priority number one.”
ECU Health is attempting to take over the Martin General site and reopen the facility as an emergency-only, outpatient hospital. It would be the first of its kind in North Carolina and would provide essential emergency care to a community in need.
Batts said ECU is asking for $70 million from the state to reopen Martin General, while at the same time building a new facility to ultimately replace the old one. The university is also asking for $150 million to add a 100-bed tower to the ECU facility in Beaufort County, according to Batts.
Batts says he and other officials with the county recently met with Speaker of the House Destin Hall (R- Caldwell County) to garner support for the regional effort.
“The impression that I got from Speaker Hall was that he is a proponent. He is in support of what we are trying to do,” Batts said.
WUNC’s Collin Campbell recently reported that a budget may not pass until April, but if it includes the funding for the ECU-backed project, Batts believes things could move forward quickly.
“The biggest obstacle right now is knowing whether or not we’re going to get the funding,” Batts said. “Once you see that funding come through, I really think it will take off like wildfire.”
This story is part of Cardinal & Pine’s “Bad Medicine” series, a wide-ranging look at how new federal healthcare policies threaten to overwhelm already overwhelmed doctors and nurses, widen health disparities in rural areas, and make North Carolinians sicker.
To view more stories, tap here.
Dylan Rhoney is an App State grad from Morganton who is passionate about travel, politics, history, and all things North Carolina. He lives in Raleigh.
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