The airport, AHEC, Bacon and "sick children"

Twin stories in this morning's CH News from Mark Schultz on the front page: "UNC Pledges Cooperation on Airport" and inside:  "UNC Gave State Airport Bill Language."   Kudos (or the candy of choice) to Schultz for digging away at the behind-closed-doors stuff - e.g., just who from the Univ. was talking to the legislature, seeking the eminent domain provision, etc.; and kudos for going after some actual numbers.  Would expect, however, that assurances of cooperation will be received by citizens with the usual and appropriate skepticism - keep those cards and letters coming...

Three irksome aspects of the stories, at least for me: 

A. The attrition theme - the persistent suggestion that AHEC participants will opt out if they don't like airport location.

First, it's usually departments and divisions that are the participants, not individual staff members.  Those departments/divisions operate according to the institutions' mission, and if Duke or UNC are committed to outreach via AHEC, any single person wouldn't usually be able to opt out on his/her own say-so. 

Second, the time differences between getting from UNC or Duke Medical center to RDU vs. HWA or an OC airport are, at best, arguable - and have been the subject of a number of conflicting studies and assertions.  Certainly getting from Duke to an OC airport would seem to take longer than going down the Durham Freeway to RDU.  But as is repeatedly pointed out, for the vast majority of AHEC's customary trips - which are not life-hanging-in-the-balance - a 10-20 min. difference (assuming even that much difference) isn't likely to bring a dept. or a division to pulling their staff out of AHEC programs.  They build into their staff time budget a half-day or a day total, whatever it takes including transit time.

B. The "save the sick children" theme.

Bacon told Schultz that 60% of the AHEC flights were for clinic visits and claimed that (Schultz's wording, not direct quote)  "the most common reason for clinic visits was so specialists such as pediatric cardiologists could see children in areas where those specialists aren't available."   Next, a direct quote from Bacon: "These are pretty sick kids who are being seen in these clinics."

(As an aside, note that this means that 40% of the AHEC flights are for non-clinical purposes.)

First, as noted in the article, not all of the clinic visits are made using the MedAir planes.  We don't know how many of these sick children are being visited by staff using ground transport. And we don't know what numbers actually add up to this "most common" purpose of AHEC trips.

Second, Bacon implies that the largest demand is in pediatrics. It's certainly true that pediatric subspecialties go begging in America's health care system, and NC has a shortage like other states'. However, we don't have any actual numbers here, for one thing.  And. . . 

Third, this smacks suspiciously of the melodrama seen in the general-aviation PR blitz-campaigns to keep HWA open - targeting legislators and the media with letters describing mortally ill children being whisked away by air to UNC hospitals where their lives were saved.

Let me say this as emphatically as possible: No one wants sick children to have the best possible care more than I do - as we all do.  However, implying that failure to build an airport in rural OC or keep HWA/IGX operating in CH will threaten their well-being, and that such a failure means we don't care about sick children?  That's both misleading and insulting. 

If critically ill children need time-sensitive care, ambulances and hospital helicopters will most probably be used.  If chronically ill children need consults from pediatric subspecialists, AHEC is one way to get them there; and 10 or 20 extra minutes either way would not be the pivotal determinant in that choice.

C. The vanishing-RDU-option theme - the persistent dodging of the choice to move AHEC to RDU as best and final option:

The 8th paragraph (of 10) in the cover story reads: "A 2005 consultant's report ranked a site in White Cross in southwestern Orange County as the top location, after Raleigh-Durham International Airport, for housing UNC-CH's medical fleet once Horace Williams Airport closes for construction of the Carolina North satellite campus." 

The last line of the Inside story is a quote from Bacon: "'If some of the faculty decided it's not worth the hassle to drive to RDU or wherever [see Irk A - Attrition theme, above], I think we would see some drop off,' he said. 'Until it actually happens it's all theoretical.'" 

---Updated: OK, I missed this so edited later to add the following from last paragraph of the cover story: "He [Thorp] holds out the possibility that the Medair fleet could remain at RDU if a new airport does not become available . . . " ---

There are SO many reasons why moving AHEC Medical Flight operations to RDU is the best option, but it's constantly ignored or an afterthought for everyone except conscientious letter-writers and bloggers. Indeed, until and unless there's a move to RDU, it is "all theoretical"; but that doesn't stop airport proponents from using the threat to secure an OC airport more for general aviation use than for AHEC's.



Comments the UNC PR machine is cranking up. It sounded to me as if Holden Thorpe was softening his stance, although he did not appear to answer the BoCC questions (maybe he did but the answers were not in the article). OTOH it does sound like he is saying "OK County; Zone me an Airport and we'll think about it". I share your implied concern that this could be a tactic. I have seen negotiation like this were parties is whipsawed between a "good cop/bad cop" press releases, until you have no meaningful stance to pin them on. If this is the case, I hope the media does not fall for it.The university and legislatures ability to pretend RDU is not there brings cognitive dissonance to extraordinary new levels. It's an outstanding exercise in denial. The case for airport economics has never been weaker and it is getting worse. There is an abundance of capacity, there is terrific territorial overlap already with 4 regional and two International airports close by. I doubt a credible economic case could ever be made.The case for AHEC is weakened by the fact that many doctors go from home to the airport so proximity to UNC is not as much of an issue as Bacon (what happened to Roper and Fitzgerald?!?!) would imply. The "save the sick children" theme is tired and actually pretty pathetic given that the "Fostering Successful Academic-Community Partnerships for Health Workforce Development" presentation that he gave to the Professional Science Associates on June 23 2008 did not make reference to AHEC air operations, but made a point of emphasizing distance learning.,%20Thomas,%20All%20Grantee%20Mtg%20-.pptThis is all couched in the fact that AHEC air operation would not suffer and IMO would be even cushier. When the move AHEC air operations to RDU, they will have their own hanger, no hassle with the TSA, living quarters, parking, probably car service, in other words treated like Saudi Royal family. What *exactly* is the problem? Which one of the mucky-mucks got dissed at RDU. and why can't they get over it?

Thanks - that PowerPt presentation (text-heavy, a model of how not to use ppt) gives an exhaustive picture of AHEC's missions and operations - a little hard to follow but definitely centered on education and training (education in clinical setting), with the only reference to flight possibly in the "logistical support" phrasing.(not sure what you're asking re: what happened to Roper and Fitzgerald - Roper is Dean of Med. sch. - and on a number of other boards of directors; Bacon is head of AHEC, Kevin Fitzgerald is a finance/administration administrator) 

.....reference was, that earlier Roper and Fitzgerald seemed to be the front men for this effort, suddenly it seems to be Tom Bacon. Did the project get kicked back downstairs? (....he asked hopefully)Agreed on the abusage of powerpoint, Steve Jobs he is not.I agree with the mission of AHEC and support it. The work they do is important and necessary. I think that AHEC is best supported using exactly the same emphasis Bacon does in these presentations. I just don't get why AHEC needs its own airport.(just kidding about the Steve Jobs reference, Tom. I am no Steve Jobs either)

The continued claim that the time difference is 10-20 minutes between an OC airport and RDU is not universally accepted. From everything I've been told, it's more frequently 1-2 hours from leaving Chapel Hill to actual take off. I don't know if either claim is accurate or how often either scenario occurs so personally, I don't believe either side of the story at this point.Also, I have done some checking into the issue of physician time. First, I found that for most AHEC continuing education activities, UNC staff (nurses, health educators, etc.) travel by car. The ones using HWA are the top specialists, the ones who don't have many counterparts here or anywhere else in the state; the ones who make very large salaries. For the most part though, their trips are not emergencies.  However, their consulting time is expensive to the hospital (lost income) and the state (salary). Any time traveling is also time they don't spend consulting on cases, not just at the destination but also here at UNC. So the total costs for their time are health related as well as financial. Finally, if we really want to understand this situation, it seems to me that we need to see a cost breakout on operating MedAir, a proposed local airport, and RDU.

Remember that some of those docs are traveling from Duke.  I too question whether reports of 1-2 hrs. waiting at RDU are exceptional or routine, and I agree that the studies haven't seemed to be adequately thorough or objective (depends on who commissioned or did them and why). [Edited - re: T&B report - not sure it was timing things door-to-door and not just UNC-to-RDU]The question of cost of the docs' time is problematic, too.  If they take time from their Duke or UNC patients to serve patients elsewhere, I don't know that it should be considered a "loss" overall.  Duke and UNC are willingly part of the AHEC program and know the trade-offs. Quibbles about transit time implies that the nearer the patients, the more they are worth the trouble to see them - a slippery slope and contrary to the point of AHEC. Otherwise, aside from the uncomfortable juxtaposition of the altruistic "save sick kids" theme with less altruistic warnings about time and costs, there is the issue of who is paying for what here, which indeed is not always clear. If it's a pivotal consideration, then who actually is out of pocket for the top-earning physicians time in transit?  Taxpayers?  Hospitals or universities?  The physicians themselves?  Or should it be considered cost-of-doing-AHEC-business?Along that line, if those really needing MedAir transport are primarily some top specialists, that raises a question about having as many as six planes.  It also suggests that, for those few irreplaceable docs with exceptionally expensive time valuation, there might be specifiic arrangements made - with outsourced helicopter transport or with RDU - that would be less expensive than building a whole new airport (or even maintaining the old one). But thanks, Terri, for adding what you've learned re: AHEC operations.

At the risk of duct-tape muzzling, I cannot stop repeating that AHEC's mission does not include MedAir transport.  AHEC doesn't fly sick children, cancer patients, or accident victims anywhere.  With the exception of accident victims, sick patients definitely benefit from various AHEC docs' expertise -- much of it highly specialized.  But the AHEC planes and personnel are not ambulances.  This airport debate is too loaded without such lofty claims.  I'm  starting to wonder if Chancellor Thorpe is sufficiently worded up on the AHEC mandate and AHEC funding.  It's a system-wide educational offering, period. Perhaps the language implies otherwise.  

The assumption in so many discussions about AHEC is that the value of the providers time and the value of a few university dollars trumps any other considerations. We are talking about wrecking a rural community & its ecology in exchange for a few bucks & a little time-shaving for some folks' trips.Let's have some balance. You'd think these AHEC providers were the sole carriers of the Secrets of the Universe and nothing should be spared to protect them and their mission. If airport proponents want to make the bogus argument that poor sick kids will get no care if there is no stand-alone airport in Orange County because the doctors won't visit them, then let's put those doctors on a stage and ask them if they care so little for those poor, sick children that a little incovenience in the form of slightly longer travel times would stop them from helping. Apparently they are such arrogant, self-centered people that they'd let poor, sick kids suffer instead of sucking it up for the greater good of the larger community and doing what everyone always should do when things change - adapt. It hardly brings a tear to my eye that our community could be ruined so a few hypocritical whiners don't experience some minor inconvenience. 

True community involvement would involve going to the basic issues/problems to be addressed, and letting the community help figure out how to handle/solve them.  For example, one need is to get AHEC people to outlying state areas as efficiently as possible.  One way to do that is with a new airport, another is with a limo service out to RDU.  A limo service could solve the problem, as the physicians could have a nice ride during which to work (dictating notes, writing their papers, doing email...phoning, etc.  These would be high end limos, with all the extras!)  Let's tease out costs of the limo service.  They could be calculated on a  per mile basis, or on an equipment plus labor plus expenses basis.  I'll do the latter, in a very rough, preliminary way.  Say we had 5 limos, at a cost of 100,000 per year.  (That's 5  limos bought at $100,000 each, every 5 years; including insurance, etc.)  Now we staff the limos....5 drivers at, say $50,000 per year each, including overhead (retirement, etc.).  That's $100,000 plus $250,000, or $350,000 per year.   Say the limos each cost 15 cents a mile for gas, and each limo makes 10 round trips a day to the airport, at 25 miles each way.  Taking one limo out for service, driver vacation, etc., that's 4 limos x 10 trips x 50 miles per trip x 0.15 dollars/mile x 365 days a year, or $109,500 per year.  Call it $100,000 a year.  So, now we can run limos back and forth to the airport, 40 trips a day for a year for about $450,000 a year.  (This seems like way more AHEC trips than we have today, but let's include limo trips for dignitaries, and the like.)  The new airport would cost...was it $50 Million?  Subtracting $2 million for the hangar at RDU, the WeaverGuy limo service could run for 106 years!!!...longer than we've had human flight...on $48 Million.  Of course, this is a rough number.  Expenses will go up with inflation (but the $48 Million could be invested to cover inflation), and one could consider just running the limo service off the interest from putting the $48 Million in the bank: at only 2% interest, one would have $960,000 a year, enough to run the WeaverGuy limo service well into the future.

Let me throw another thought into your mix Weaver Guy. What would 50 million dollars do invested into I-40 so that EVERYONE  could get to the airport faster or just get through the RTP area faster?  What would 50 million dollars do invested into the infrastructure at RDU so that all the planes could take off faster?   Doesn't 50 million dollars have more value to the state and still help AHEC invested in I-40 and RDU upgrades  rather than a rural airport with one main user?  I'm still not understanding why the OC airport is so necessary.  I am just not getting it.   

In fact, the $50 Million would better go toward the light rail system, to include the airport on the route.  We need fewer roads, not more, and not road improvements, and it will be a shame if the new stimulus funds are used for new roads (yes, fix the bridges, but forget new roads).  NC DOT can be turned around towards public transportation, trains, and the like.  I used the limo service example as but one clear alternative that is in fact doable and affordable, and which AHEC and others likely would be fine with, yet UNC has made no form possible for putting such things fully on the table for discussion and decision-making by all the stakeholders.  They just went ahead and decided to commission an airport study (at what cost) before getting the right stakeholders (County commissioners, etc.) to buy in to that approach.  The WeaverGuy limo service would cost far less than I proposed, given current AHEC needs, as well.

Limos are nice, but if I remember correctly, the complaint about added time by using RDU has to do with delays to actual take-off (in addition to traffic congestion getting to the airport, which would affect limos as much as anything else).  Also, for some destinations, such as Fayetteville, which is reachable in about 90 min., there's a plane-equals-car travel time threshhold.  Light rail is a great idea and I'm all for it, esp. to RDU; but I suspect the time to get it approved and built will exceed the time involved in most other solutions to the AHEC/MedAir/airport problem.

Sadly, you're right about how far off light rail is, although it might not be that far if Orange, Durham, and Wake all adopted the proposed STAC recommendations (ie a local half-cent sales tax for public transportation in the three counties).  Without a new funding source we are about $250 Million or so dollars away from having a light rail system - Patrick M correct me if that number is notably incorrect.  In any case, AHEC is not the sort of problem light rail would solve.

Mark, Priscilla:I think the earliest we could get light rail, under the best of circumstances, would be 8-10 years, and that would be pushing it.  Mark, regarding funding, the 1/2 cents sales tax would cover (if levied across the region) about half (approximately $1 billion) the cost of the Special Transit Advisory Commission's recommendations for a regional transit system.  This system would include enhanced regional bus service, a well-developed system of local bus service (circulators) and a rail (right now leaning toward light) system extending from Chapel Hill to North Raleigh.  And yes, it would go to the Airport!!

Mark, the $250 million is about right for the portion of light rail that would be in Orange County.  Our latest estimate on the full cost of linking UNC Hospital to Downtown Durham near the new bus and rail stations there is in the $735 to $780 million range.  Some of the upheaval in financial markets could move those numbers down (cheaper concrete and steel, perhaps) or up (general inflation due to the Fed increasing money supply, perhaps) but these are our best estimates right now. 

Important factors are being missed.  The limo service would save time getting to and from one's car and to and from parking at RDU, while giving people a comfortable place to sit and work while in transit.  It will be a desk substitute.  The limo is of course parked right outside the hospital (or South Building, or both).  The riders also could sit in the limo at the airport until just prior to the plane going out on a runway, and then get to the plane, or sit comfortably at the general avaition has a restaurant.  Another factor is that RDU, being one of the highest levels of airports, has better systems for handling inclement weather than would the smaller, regiona, albeit big-moneyed one being considered.  The limo service could be put in place rather quickly and at least tried!  That would give time to get the light rail going, putting the 10's of millions of dollars into that instead of a regional airport. Another obvious factor is that there's no money right now, and we may see that continue for a decade or more.  UNC departments are all having to cut their budgets by...2% I believe.  Tax revenues are falling.  Numerous industrial facilities are either closing, or ramping back.  It would be a cost-saving measure to go to the limo service, in any event.  Where's the money for this airport going to come from? Thorpe misses the point, it seems.  His letter to the County Commissioners implies that an airport is a fait acomplis, and now he is willing to work with them, with invoking imminent domain as a final option, which will not be necessary if they just go along and do the zoning things necessary for an airport..  The problem is that the stakeholders did not get to help decide that an airport is necessary at all.  Only after that would one start talking about siting an airport.

as you point out.....takeoff and landing delays are congestion related and similar to highway delays. If you leave 10 minutes early you can save a half hour. I think these numbers are "worst case" and a minor scheduling adjustment would make delays much less.Light rail is a "would be nice" in this case. My understanding is most AHEC doctors leave right from home in the morning and likely come from places where light rail will not reach.OTOH a high speed rail link might make a certain amount of AHEC flights unnecessary. If you want to see a major bun fight, pit rail against air travel. I remember when American Airlines lobbying killed a perfectly justified and economical high speed rail link between Dallas and Houston.

All this presupposes the move to RDU, which I continue to believe is a chimeric if not vanishing option, on the table primarily as a place-holder until more shakes out of the various attendant issues - CN and the OC airport plan foremost.  I can't believe that the current economic crisis for both state and University isn't going to freeze things right where they are now for the foreseeable future - and that includes keeping HWA open and tabling RDU plans, which to my knowledge are still only on paper.

According to Bruce Runberg, Head of Facility Planning, they have put the plans to build the temporary AHEC hanger on indefinite hold. He told me that maybe next year sometime they might resume the process.Is this exactly what they say it is - just a repercussion of the economic downturn - or does it also suit their purposes not to let AHEC get comfortable at RDU?

"Is this exactly what they say it is - just a repercussion of the economic downturn - or does it also suit their purposes not to let AHEC get comfortable at RDU?"

 You can ask the chancellor directly at his blogsite:

In light of this not-at-all surprising information, I've revisited my "handicapping" blog entry and revised my guess at the odds upward for keeping HWA.   I think the current economic crisis has to have reduced the ... er ... lift for a new airport in OC anytime soon. 


the economy makes it doable, then I would hold the Chancellor to what he said in his letter to the BOCC:

Thorp reiterates his previous statement that no site for an airport has been chosen. He also suggests that moving the Law School will result in the closing of Horace Williams, triggering a temporary move of UNC Health Care’s MedAir to Raleigh-Durham International, adding, “If and when a new airport is available, we will relocate MedAir.”

Note that no site has been selected and the words, "if and when."  Also know that the authority will probably not be organized until February at the earlist, and it will be a while before they identify sites. So when will a new Law School appear?  Giving the economic situation, who knows, but I would bet on later over sooner?So Priscilla, we get to keep our airport for a while longer and MarkM and TBlake will have to wait to get the one that they believe is going to be their neighbor, wherever that turns out to be!In the spirit of the recent election, "From my window I can see HWA!"

in Thorp's new comment that has been a debate about whether he is saying to the BoCC "zone me an airport location" or "zone me out of an airport entirely" either way he seems to be saying "zone me out of this decision".As far as breaking ground on CN goes, I think federal block grants to the state could well accelerate CN more than the economy slowing it. We shall see.

Funny that Peds Cardiology is mentioned as a priority for AHEC.  UNC Peds Cardiology has satellite clinics in Cary, WakeMed, Greensboro and Rutherfordton, with consults in Fayetteville and New Hanover.  As far as I'm aware (and I work in Pediatrics), all of the docs travel by car on their scheduled clinic days.

You could contact Dr. Bill Henry, Division Chief, for the true travel story.


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