By By BETTY MITCHELL GRAY
Staff Writer 
Some five years ago after Dr. James Manning finished his medical studies in Charleston, S.C., he and his wife, both North Carolina natives, decided to return to their home state. They considered several locations — including Edenton, New Bern and Washington — where he could work as a hospitalist, a doctor whose practice is hospital-based. 
“In the end, we liked Washington the best,” he said.
One of the things that attracted Manning to Washington is that Beaufort County Hospital, now Beaufort County Medical Center, was a stand-alone, independent hospital, not one in a group of health-care providers, he said. 
As he considers the future of the hospital, he believes it may be time to sacrifice that independence to ensure the future of a vibrant medical community and good health care for the people of Beaufort County and the surrounding area.
“I would like for us to remain independent, but I have not seen anyone put forth a plan that would allow us to maintain, as an independent hospital, the same quality of care that we now have,” he said. “And I worry that we are not going to cut our way to prosperity.” 
Urologist Michael Crawford, who came to Washington more than 20 years ago, agreed with Manning’s assessment.
“All of us would love to see things stay the same,” he said. “And if only the economic downturn were to blame, the hospital could ride it out. But the future of medicine in the United States is that is going to be tough for small hospitals to survive.
“To keep a hospital in Beaufort County, we may have to give up some autonomy,” he said.
After recording a profit of almost $600,000 in 2008, Beaufort Regional Health System suffered an economic downturn in 2009, recording an operating loss of about $1.5 million and a decline of net assets at the end of the year of about $1.3 million, according to a recent system financial statement.
In response, the system’s Board of Commissioners implemented a plan of cost-cutting measures and revenue enhancements. The board also contracted with HealthCare Appraisers Inc. of Florida to conduct a search for possible merger partners. As of last week, 11 systems — including nonprofit systems University Health Systems of Eastern Carolina and New Hanover Health Network — have expressed interest in receiving more information from Beaufort County Medical Center about a possible merger.
Manning and Crawford are two of a reportedly growing number of local doctors who fear that additional cuts made in an effort to keep the hospital independent will adversely affect the quality of patient care and, therefore, lead to an exodus of qualified doctors.
They are two of five local doctors who agreed to discuss the issue of a possible merger in interviews with the Daily News.
“We have resisted this change for a long time — longer than most. That’s a reflection that the administration has been doing a good job,” Manning said.
“There are a lot of things going well at Beaufort County Medical Center. We need to make sure the bottom line is taken care of so we can keep doing those things well,” he said.
This question — whether to merge the local hospital with a larger entity or remain independent — is “probably the most important issue that has come before the hospital in the last 25 years,” said Dr. Thomas Penders, hospital chief of staff. 
Penders, a psychiatrist, came to Beaufort County about six years ago. He is employed by the hospital and oversees in-patient psychiatric care, crisis care and maintains a small private practice, among other responsibilities.
In his position as chief of staff, Penders oversees some 267 doctors cleared to work at the hospital — about 50 of whom maintain an active practice in Beaufort County. 
“Our role is to focus on what’s good for patient care,” he said.
Further cost cuts in an effort to maintain the hospital’s independence will have “a devastating effect on quality of care,” he said.
“If you start cutting, you can’t determine what that effect will be,” he said. 
Penders believes it’s time for the local hospital to merge with a larger system.
“From a quality of care standpoint, there would be tremendous advantages to having a broader relationship with a teaching facility,” he said. 
He said “the vast majority” of doctors agree. He said a smaller number favor trying to remain independent.
Some doctors, Penders said, believe they don’t yet have enough information about a possible merger to make an informed decision.
To that end, local doctors are scheduled to discuss the hospital’s future with the system’s Board of Commissioners on Thursday.
The Daily News contacted several local doctors seeking their opinions about a possible merger of the hospital with another health-care entity.
Among those who agreed to talk about the issue was pediatrician Russel Cook. Cook serves as chief of pediatrics for the hospital, but his medical practice is independent of it.
Since joining the practice of Drs. Dave Tayloe and Frank Stallings some 30 years ago, Cook has seen many changes in medicine in eastern North Carolina — the advent of managed care, advances in medicine requiring more capital investment by smaller hospitals and the rise of a regional teaching hospital in Greenville that is equipped to handle more serious cases.
But it was the recent economic downturn that has brought the discussion of merger to “an acute situation,” he said.
“Ultimately, the best thing would be for us to be a part of a larger system.” he said.
“We’re at the point where if we try to stay independent we’re going to make things worse,” he said.
A recent audit of the health system’s finances by Dixon Hughes of Raleigh has indicated that the local hospital’s physical plant is older than other hospitals its size.
To date, the local hospital has done a good job of trying to keep up with medical advances and capital improvements but many needs are looming, according to obstetrician and Beaufort County native Rachel McCarter. Her practice, Obstetrics and Gynecology of Washington, is under the umbrella of the medical center.
She is among those who see a growing list of construction and renovation needs at the hospital and, if the hospital remains independent, little money to fund those needs.
“I understand everybody’s concern, but at the same time, I see patient rooms that need updating, I see patient bathrooms that need remodeling, I see a small emergency room that is overcrowded,” she said.
She and others who agreed to discuss the issue believe that a larger health-care provider will have the resources to make these improvements. 
Said Penders: “Nobody will bring us a sack of money, but they will make judicious improvements.”