Commissioners get schooled

The Sampson County Board of Commissioners got an in-depth look at the Health Department, Department of Social Services and Sampson Regional Medical Center during a special meeting on Tuesday afternoon. Called “an information-only workshop,” the meeting didn’t contain any specific budget requests from the agencies, but rather was an overview of how each works and the services they provide.

Health Department

Public Health Director Wanda Robinson started things off, explaining that the county’s Board of Health is made up of 11 members appointed by the county commissioners, and must include physicians, pharmacists, the county manager and county attorney.

The Health Department has 44 staff members, including nurses, lab technicians, case managers, social workers and multiple interpreters, Robinson said. A medical director and pharmacist are also required to be part of the department.

She also shared information about Health Department services, which include child health services, exams, lab work, immunizations and referrals.

“We do have pertussis going around Sampson County in the schools and the day cares,” Robinson shared. “That’s where Public Health comes into play. We are the people that go out and investigate those cases, and tell folks what they need to do to stop the spread of diseases.”

Immunizations are not just for children, she added.

The Health Department also provides family planning and maternal health services, which are mandated by the state. “We provide those services to indigent people in our county who do not have Medicare or Medicaid,” she explained. “We probably have about 100 pregnant ladies receiving our services right now. What’s important is that we only have one OB/GYN in our county.”

“There are no county contributions,” Robinson pointed out. “We have other funding sources. We do get funding from the United Way.”

WIC is managed through the Health Department, not Social Services, she said. “They do bring millions into our county,” she said.

Uninsured individuals make up 52 percent of the population, Robinson said. The Health Department offers a sliding fee scale for the uninsured, based on the household income and family size.

Environmental Health is also under the Health Department umbrella, which includes regulating food and lodging within the county. There are over 150 restaurants in Sampson County, Robinson said, and health inspectors must visit each site at least twice a year.

Interim County Manager Jeffrey Hudson asked about the biggest challenges facing the Health Department over the coming years, to which Robinson replied, “Funding. So far, we are good; we are not seeing any reductions.”

The department also strives to reduce infant mortality rates within the county, and recruitment and retention are also big challenges.

Department of Social Services (DSS)

Perhaps the largest county department, DSS covers a wide variety of services in Sampson County. “North Carolina has a federally mandated, state supervised and county administrated program,” explained Sampson County DSS Director Patty Santos. “Our mission statement is to enhance the quality of life for our residents by promoting self-sufficiency, preventing maltreatment and providing supportive services.”

Child Protective Services (CPS) is a major portion of what the DSS does. That includes child abuse or neglect, which nine staff members investigate and respond to. Sometimes, the children have to be removed from the home, and foster care is also under the banner of CPS.

Rhonda Matthews shared information about the foster care program in the county, saying that there are currently 111 children in foster care, but only 11-13 homes available in the county. As a result, foster children from Sampson County may end up all over the state, she said.

Adult Services Program Manager Carrie Phillips provided information about services available, which include abuse, neglect, and personal and financial exploitation of adults. “Our evaluations include talking with the adult privately,” she explained. “We talk with collaterals, we obtain medical records, we gather all this information to try to make a determination on whether or not somebody is meeting our criteria.”

Social workers provide protection for adults in the county. Sometimes, a guardian is appointed if the person cannot protect themselves against abuse, neglect or exploitation.

The economic services provided by DSS include Medicaid, Work First, emergency assistance, child care subsidies, child support, EBT (food and nutrition), low-income energy assistance (LIEAP) and non-emergency transportation.

Commissioner Chip Crumpler asked what happens if someone receives Medicaid when they are actually not qualified. Brandy Jones spoke about that, saying that errors can happen, but DSS will take the necessary steps to correct any misqualifications.

“They go through a year-long, even before they do cases by themselves, we do double parties,” Jones explained. “They are with a supervisor. They go through extensive training with their supervisor. We go through their cases for a year before they’re allowed to do applications on their own. If we do see an error, we’re going to fix that error before Medicaid is even authorized.”

Santos said that overall, challenges for the agency include: high caseload, staff feeling inadequately trained, staff safety and staff turnover. DSS has taken steps to reduce workers’ caseloads, increase training and has an on-site security guard for safety. While turnover was high in 2022, Santos said the turnover percentage has decreased since then. Projected turnover for 2025 is about 10 percent, she added.

Sampson Regional Medical Center (SRMC)

SRMC Chief Financial Officer Jerry Heinzman talked about the challenges facing the hospital, No.1 of which is that it’s a rural community. “Staffing becomes a problem,” he said. “Our starting salary at SRMC is as high as any Raleigh hospital.”

However, he said that many medical professionals would rather be in a more urban community. There is very little turnover in Sampson County, however.

“Another thing that affects rural hospitals is our reimbursement rates,” Heinzman added, saying that Sampson County has the lowest rate in North Carolina. Hospitals that have reclassified with larger healthcare systems tend to get higher reimbursement rates, he explained.

About 65 percent of the hospital’s business is through Medicare or Medicaid, Heinzman shared. “On top of that 65, seven percent in 2024 was self-pay. Self-pay is no pay. For every self-pay dollar that comes in the door, the hospital’s average is 5 cents.”

Based on the current guidelines, SRMC provides charity care to families that are at 350 percent of the poverty level.

“It’s an ongoing battle to get paid by commercial insurance,” Heinzman said. “The reality is, we have to fight for every dollar of commercial insurance that we get.”

SRMC is licensed for 146 beds, shared Chief Medical Officer Dr. Shawn Howerton, adding that on an annual basis, the hospital accredits 130-150 physicians a year. In the past two years, SRMC has recruited 43 providers. “In the last two years, we’ve had a 74 percent retention rate,” he stated. In addition, 53 percent of the hospital’s physicians reside in Sampson County.

“We are training physicians locally,” Dr. Howerton said. “Less than 2 percent of residency programs are rural. We’re one of them.”

Since the primary care residency started, the hospital has hired 10 primary care physicians, which Dr. Howerton called “huge.”

SRMC has recently added a new primary care provider in the Spivey’s Corner area and dialysis. “We do pick and choose very carefully the services we provide to stay afloat,” Heinzman said.

As far as the numbers of patients seen at SRMC, Heinzman said volumes have not returned to pre-Covid levels. “Costs continue to rise,” he stated. “Our hospital costs from 2023 to 2024 increased 7 percent. The majority is in salaries and benefits.”

Though volumes are down, the emergency department still sees 30,000 patients a year. “Part of the issue is access to primary care,” he said. Outpatient volume has been steady, and the hospital sees about 2,500 admissions a year.

Surgery cases numbered 4,000; the hospital performed about 8,800 CT scans, 2,200 MRIs, and 27,272 physical therapy sessions. The hospital also saw about 31,000 primary care visits.

“I did see some things that I hope you will share with our community,” said Commission Chair Allen McLamb. “I do thank you for what you do for our community.”