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Features Health & Wellness State grants extension on dialysis center petition

Along with letters by residents describing the hardships of commuting multiple times every week to dialysis centers outside the county, during his testimony last week, Commissioner Beale also submitted photos like the one above taken by a dialysis patient while driving over Cowee Mountain for a dialysis appoint last winter during one of the frequent snow storms.Commissioner gives testimony at Medical Facilities public hearing in Asheville

Last week, Macon County received an extension granting it extra time to complete a petition seeking special needs consideration from the state for a dialysis center. Many residents of Macon County who require dialysis for kidney disease must travel across Cowee Mountain into Jackson County to access the nearest facility offering such treatment.

In recent months, citizens and local officials have mounted an effort to seek special consideration to establish a center in the county. The State Health Coordinating Committee, the body charged with making determinations of need for healthcare facilities throughout the state, publishes its findings in the twice annual State Medical Facilities Plan.

On Friday, county commissioner Ronnie Beale made a presentation before members of the committee at a public hearing in Asheville. In his testimony, he informed the committee that the county has 34 known residents who must travel to Jackson County to receive dialysis at this time. Beale noted that there are other residents in southern areas of the county who travel south across the Georgia line for treatment at a facility in Clayton. In addition, the county also has as many as 9,000 second homes, nearly doubling the population with seasonal residents, many of whom are of retirement age and more prone to kidney conditions which require dialysis.

In making determinations of need, the state generally requires that a county demonstrate a projected need for at least 10 dialysis stations to serve 32 patients. These patients should live more than 30 miles from the nearest dialysis facility. According to the most recent Semiannual Dialysis Report issued July 1, the state recorded 23 residents of Macon County were receiving dialysis treatment as of Dec. 31, 2010, and many of these may live within the the 30 mile radius from the nearest facility in Sylva.

Beale told the committee, however, that because of the extreme climate conditions and mountainous terrain, the 60 miles round-trip represents much more of a challenge for the county's residents than it does for patients in other areas of the state. “The distance is much more time consuming and difficult than driving on Interstate 40,” Beale wrote in his prepared comments.

Citing the state's own principle of basic access, Beale noted that barriers of time and distance are especially critical to rural areas and small communities that are distant from comprehensive urban medical facilities, arguing that such communities merit special consideration. “We can't compete with the urban areas of the state,” he said, “and the only way we meet the needs of our citizens is to ask for special consideration.”

In addition to his remarks, Beale submitted several documents demonstrating need and support for a dialysis center in the county, including a recent resolution passed unanimously by the Macon County Board of Commissioners and a map showing that, of the seven counties in the state which do not have a dialysis center, six are in Western North Carolina and two – Clay County and Graham County – share borders with Macon County.

“We can't compete with the urban areas of the state...and the only way we meet the needs of our citizens is to ask for special consideration.” – Commissioner Ronnie Beale, in comments during last week’s public hearing of the State Medical Facitilies PlanBeale also submitted several letters from residents, explaining in detail the problems they encounter traveling at all hours of the day and in extreme weather conditions to receive critical dialysis treatment. Some must keep up the treatment indefinitely. All must travel at least three days a week for the treatment.

One letter from the family of an 84-yearold woman, Gladys Hannah Wright, described the hardship of traveling 53 miles roundtrip to the Sylva Dialysis Center in Jackson County and back three days a week. According to the letter, Wright is currently scheduled to be at each appointment at 7:30 in morning, requiring her to rise on those days at 5:45 a.m. in order to check her blood sugar levels, take medications, prepare her arm for the treatment (which requires it to be numbed and wrapped in plastic), eat breakfast and pack for a full morning of treatment from which she will not arrive back until after noon. The letter also notes that Wright suffers from other ailments common for a woman her age, including diabetes and poor mobility due to hip replacement.

To make the appointment, Wright's family members must arrange to drop her off and pick her up every day. “The trips have caused a financial strain on our family due to gas prices and family members missing work,” reads the letter. “We consider ourselves lucky to have many family members who can take off from work or school and work around our schedules to make her comfortable on the long trip to and from Sylva. Some patients have only one person to take them and wait for them, or they have to rely on public transportation or even drive themselves.”

Besides the the inconvenience of the trip, the letter notes the journey can be treacherous in winter months, requiring four trips across Cowee Mountain for each appointment, at least 12 trips a week. “During the winter months, we have to arrange so that someone with a four-wheel drive vehicle takes her and picks her up,” says the letter, which had attached photos of the woman and her daughter waiting in the dark last winter for an ambulance and a wrecker to clear the scene of an accident that happened due to icy conditions before they could cross the mountain on their way to an appointment. “Driving across that mountain in the winter was very terrifying for her and for us,” the letter says.

The letter also notes that in the summer months the center experiences higher levels of usage from seasonal residents. Recently, Wright was asked to change her appointment time to 5 a.m. each day which would have required leaving her home by at least 4:15 a.m.

“This is life support for her – it is not a choice,” says the family. “Macon County dialysis patients need and deserve to have a nearby dialysis center in Franklin.”

According to Beale, the testimony he gave was well-received by the committee members, at least one of whom has since contacted him to say he will support a special consideration of need for the county. Beale insists it is well deserved, stressing that the mountain area is unique.

“We're living in a different place than the metropolitan areas,” he said again on Wednesday. “And it's not like these people have a choice – it's either do it or die.”

The petition extension will allow the board of commissioners to approve the complete petition package at its next regular meeting on Aug. 9. Beale says he anticipates unanimous approval by the board before the petition is forwarded on to the State Facilities Coordinating Committee.


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