DURHAM - Durham County and Duke University are talking about a deal to indefinitely extend Duke's lease on Durham Regional Hospital.

Citizens will get their chance to talk next month.

"This is not a done deal," County Manager Mike Ruffin said this week. ""There is a lot of work left to be done."

If the deal is done, Duke's present 20-year lease would be extended to 40 years, and automatically renew each year for 40 more until one party says, Stop -- with 40 years' notice. The new lease would replace the current one, which has 10 more years to run.

As long as the lease is in effect, Duke would also make annual payments to Emergency Medical Services and Lincoln Community Health Center, adjusted each year to rise with the Consumer Price Index.

Commissioners' chairwoman Ellen Reckhow said the new arrangement is intended to make sure Durham Regional Hospital remains competitive by encouraging Duke to put its money into modernizing the facility opened in 1976. It's also supposed to ensure a larger funding stream for Lincoln and EMS.

Formally, the community will get to weigh in at a commissioners' meeting either Nov. 10 or Nov. 24.

Informally, citizens will have until the public hearing to let county authorities know what they think.

When it was proposed, in 1997, that Duke Medical Center take over the county-owned hospital, county residents, hospital employees and the medical community raised misgivings about future quality of care, bedside manners and racial equity, as well as the county's say in how the hospital was run.

Some said the "merger" of the hospitals was the most controversial issue in Durham since the impassioned merger of city and county schools in 1992.

Reasons for considering merger were saving money and improving efficiency for both institutions, especially with the cost-cutting pressures from insurance companies in the era of managed care.

Those, though, raised worries about county residents getting "cut-rate" service, the community losing medical services, and Durham physicians' losing access to both hospitals for patient referrals. The issue was complicated further when several for-profit hospital companies and UNC put in their own bids for Regional's management.

Eventually, leasing to Duke won the commissioners' and university's approval. Duke took over July 1, 1998, with Durham County retaining ownership and the right to name the majority of Durham Regional's board, while Duke pays the county $6.8 million a year for the privilege of running the place.

Ruffin doesn't expect the extension to raise the level of concern that arose with the original lease proposal. Since he described the deal to Durham Regional's medical staff, Ruffin said, "They have expressed support."

Deal points

Under the new deal, Duke's lease payment goes up to $3.95 million annually for the first 10 years, then goes down to $1.25 million for the next 12 years. Thereafter, Duke pays nothing for its hospital lease.

However, Duke's annual contribution to EMS goes up to $2.2 million and to Lincoln to $2.85 million. Those payments continue as long as the lease is in force, and their amounts are adjusted for inflation every year.

Lincoln, the community clinic that carries on the name of Durham's black hospital of the segregation era, is "stressed as a facility" by the number of indigent patients it serves, said commissioner Lewis Cheek, who has been part of negotiations on the lease extension.

Durham Regional itself "needs substantial renovation," he said, and the proposed deal is premised on Duke's increasing investment in the hospital.

Duke's 40-year lease would automatically renew itself for a new 40-year term every year, though either the university or the county could terminate the lease with 40 years' notice.

On the subject

The N.C. Nurses Association has bestowed its Hallmarks of Healthy Workplaces award on Duke Medical Center's cardiac intensive care unit. The honor, according to a NCNA statement, recognizes "a positive work environment for registered nurses."

The awards are made twice a year and come with a vase made by a North Carolina potter.

Previous recipients include Durham Regional's post-anesthesia care and endoscopy units and the Halifax Regional Medical Center in Roanoke Rapids.