UNC Health and Duke Health are embroiled in a battle to build a new hospital in Durham County, a fast-growing region where Duke has a strong medical foothold. UNC Health appears to be winning slowly, with UNC-Research Triangle Park — a $371.3 million dollar facility — potentially coming online in late 2032.
In 2021, the NC Department of Health and Human Services found a need for 40 additional hospital beds in Durham County after looking at the exceptionally high utilization of existing hospitals there, namely Duke Regional Hospital and Duke University Hospital.
Though Duke demonstrated the need for additional beds in Durham County, DHHS can select any health system to meet the need near RTP, provided the organization fills out a convincing application.
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DHHS conditionally approved UNC Health to build a 40-bed hospital to fill that need in 2021, while denying Duke’s application. The same thing happened the next year, after DHHS found a need for an additional 34 beds in 2022.
North Carolina’s administrative law judge ruled that UNC’s proposed hospital at RTP had greater geographical accessibility than Duke’s existing one, and would also serve to increase market competition in the area’s health care industry.
Duke argues that it would be cheaper and faster for it to add these beds than for UNC to build an entirely new facility in RTP. UNC argues that awarding these beds to Duke may result in the unnecessary duplication of services and increased medical costs, which is what DHHS’s Certificate of Need process is specifically designed to avoid.
Duke Hospital appealed both the 2021 and the 2022 decision, and those appeals are still underway. UNC’s chosen site for UNC-RTP would violate zoning laws, Duke argues. Duke also brings up that UNC Chapel Hill was cited for multiple counts of “immediate jeopardy-level deficiencies” in 2022.
“We are reviewing the agency findings and evaluating our options,” a Duke Health official told Carolina Public Press in an email.
This year, DHHS once again found a need for an additional 38 hospital beds in what DHHS is calling the Durham/Caswell/Warren service area. Once again, UNC Health was approved, while Duke was denied. Duke — or any other health system — has until Oct. 28 to file an appeal.
“That would ultimately result in a 112-bed hospital, assuming we prevail in the appeals of all three phases,” UNC Health spokesperson Alan Wolf told CPP.
“UNC Health went through a similar appeals process before we were allowed to build a 50-bed community hospital in Holly Springs,” Wolf said. “That hospital opened three years ago, after more than a decade going through the CON and appeals process, followed by design and construction.”
That hospital — UNC Health Rex-Holly Springs — is in southern Wake County, adjacent to Durham. Both counties have seen massive population growth in recent years.
“Since UNC Health Rex Holly Springs Hospital opened three years ago, it’s become a major asset for that fast-growing region,” Wolf said.
Since UNC Health Rex opened in 2021, more than 80,000 people have been treated in the emergency department, doctors have performed more than 8,000 surgeries and delivered more than 2,100 babies.
The need for another new hospital shows just how fast the Triangle region is growing, with substantial growth coming in and around RTP itself. Durham County has seen 6% growth in just six years.
“The factors driving population growth in Durham are great quality of life, great access to education, a great job market and a much lower cost of living than where we’re pulling people from,” Matt Gladdek, vice president of economic development at the Greater Durham Chamber of Commerce, told CPP.
The Triangle region graduates more than 40,000 students each year, and due to the rising cost of living in other US metropolitan areas, an increasing number of those graduates are staying in the region, according to Gladdek.
A great number of these graduates are in the medical field, providing ample workforce for a new hospital. In 2023 alone, Research Triangle schools — Duke University, UNC Chapel Hill, and NC State University — graduated 316 doctors, 529 public health professionals, and 752 registered nurses. Most people moving to the area are young and educated.
“We are already served by many great hospitals including Duke Health and UNC Health, proactively expanding capacity before there is a public demand to keep up with growth is always important,” Gladdek said.
“Duke Health and UNC Health are both fantastic options for local residents. We trust that DHHS are the experts in deciding what is the most efficient and effective way to ensure we have the needed hospital beds to meet the needs of our growing population.”
In addition to the turf war at RTP, the two health systems are also fighting over the state’s Certificate of Need office for a 50-bed community hospital in Wake Forest in northeastern Wake County. DHHS was set to conduct a public hearing Thursday to hear competing proposals. A decision is expected next year.
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