By Rob Zapple| For StarNews Media

Late Friday afternoon, officials released a 160-page agreement detailing the final terms for selling county-owned New Hanover Regional Medical Center to Novant, a private, non-profit health-care system based in Winston-Salem.

Well over a year after a possible sale was announced, important questions remain. Though there are many, here are 10 essential questions I believe must be addressed before the county moves forward with the proposed $1.5 billion sale.

1. Why are local taxpayers giving Novant $200 million?

The agreement requires the county to pay $200 million to go toward future benefits for current NHRMC employees. Once the sale closes, those workers will be employed by Novant and will have no direct connection to the government of New Hanover County. If Novant buys NHRMC, it becomes responsible for all aspects of ownership. If compensation for employees needs to be enhanced, that is the responsibility of Novant, not of New Hanover County taxpayers.

2. Why is NHRMC negotiating a sale of county assets?

NHRMC is not a county agency. It is a nonprofit organization that leases facilities and other assets from the county to operate a healthcare system. The land, buildings, equipment, and cash reserves all are owned by the county. The sale is a deal between New Hanover County and Novant Health. Why has NHRMC and its executive team played such an outsized role in advocating for a sale and negotiating an agreement? Who is advocating for the citizens of New Hanover County?

3. When will UNC partnership begin?

After Novant brought on UNC Medical School as a partner in the proposal, there has been extensive discussion about its role, including increasing graduate education at NHRMC and establishing a UNC Medical School branch here. Although the agreement specifies a financial commitment, there is no timeframe, meaning theres no guarantee when any of the new programs/services will begin or if they will happen at all.

4. Who will control $1.25 billion?

Of the $1.5 billion sale proceeds, $1.25 billion will be used to establish a nonprofit community foundation. The initial board members who will oversee the foundation must be identified in the final agreement and made public prior to the final vote. The diversity and regional representation of this board are of great interest to the public. Residents of New Hanover County have the right to know who will be managing the fund and how the proceeds from investments it earns will be used.

5. Will Novant have undue influence?

Under the agreement, a new local board will be established to oversee NHRMC. Appointments to the board will be subject to the approval of the larger Novant Health corporate board. One duty of the local board will be to appoint six of the 11 members of the Community Foundations board -- a group that will control $1.25 billion of New Hanover County taxpayers money. Since the Novant Board must ratify all nominations to the local board, it effectively has majority control of the new Community Foundation. Why would we give Novant Health, a Winston-Salem based private corporation, that much influence? How do we guarantee local interests are protected?

6. Why is NHRMCs strategic plan not public?

The majority of the financial commitments made by Novant are based on the nearly $2 billion NHRMC officials say is needed to fund initiatives in the plan. The public, however, has not been allowed to see it. This plan has been in the works for three years. There likely are areas that need to be updated or even removed, possibly changing important financial elements of any sale. Are we sure the price is accurate? Why not redact details on competitive health-care activities as allowed by state law and make the plan public?

7. Why is local control not an option?

NHRMC is a nonprofit corporation. It operates the health-care system, but the county owns the assets and appoints NHRMCs board. That makes NHRMC a component unit of New Hanover County and means it is subject to state laws that tie its hands in certain cases, such as expanding into other counties. But if the county were to transfer all assets to NHRMC and get out of the hospital business, an independent NHRMC could combine its cash and reserves -- estimated at $550 million -- and focus on a revised strategic plan. It could negotiate directly with UNC School of Medicine and UNC Health on expanding that partnership, grow at a slower pace, live within its means, and serve the needs exclusively of Southeastern North Carolina, not the needs of Novants three-state region.

8. What if Novant changes hands?

The current language in the Letter of Intent allows Novant Health to sell NHRMC at any time without approval of the new local Hospital Board, if Novant merges or is acquired by another entity. After ten years, Novant Health has the unrestricted right to sell any or all of NHRMC assets to any other healthcare system without the approval of the local Hospital Board. A sale or merger of NHRMC to another healthcare system would mean the contractual guarantees Novant Health is providing to New Hanover County could be renegotiated by a new Owner.

9. Medicaid expansion would change everything

What happens if the legislature passes Medicaid expansion? With the upcoming election, it is a possibility. That would pump billions of health-care dollars into North Carolina and provide a major financial shot in the arm for NHRMC. Why are we rushing to finalize a sale in October when something will take place a few weeks later that could dramatically change NHRMCs financial outlook? Wouldnt waiting until after Nov. 3 to see if the political landscape changes be the responsible thing to do?

10. The timing is bad

Why are we rushing to sell NHRMC at this time? The possibility of a sale was announced in July 2018. Since that time, our nation has become gripped by an unprecedented health crisis and periods of civil unrest. We face extraordinary challenges on many fronts. No homeowner would sell their house in the middle of a hurricane. Why are we selling our countys most valuable asset in the middle of a national crisis?

Why we need to wait

I want to be absolutely clear. I am not opposed in principle to selling NHRMC to Novant Health. There is much in the proposal to like, including the financial windfall, which, if governed wisely and inclusively, could be transformational for our community. But it is an incredibly complex transaction with many interwoven and moving parts. We need to spend as much time as is necessary to thoroughly -- and publicly -- address some very important issues that remain. We need an agreement that the entire community can embrace.

If in six months we reach a deal that's in the overall best interest of county residents, I will support it. But we are not there yet. This is perhaps the most consequential decision in the countys history. We have to get it right.

Rob Zapple serves on the New Hanover County Board of Commissioners.

Read more:
OPINION, Rob Zapple: 10 reasons we don't have all the facts needed to vote on NHRMC sale - StarNewsOnline.com