Esther Deaver — known to many locals as the Bicycle Lady — looked settled in for the evening.
She picked an out-of-the-way spot on the sidewalk fronting a shopping center in Ardmore. The sun had just set, but a soft light lingered and the pavement still radiated heat. She sat down and took her shoes off.
Esther had removed some of her meager belongings from plastic bags and spread them out. A plastic drinking glass, some laundry soap and a rather large magnifying glass sat next to a container of chili, some candy and a bottle of Gatorade — her evening meal.
Recent social media reports had surfaced about the one thing that means the most to her: a pink bicycle with a distinctive banana seat. Throughout the years, that bike — or more accurately, a succession of them — has come to both identify and endear her to thousands in this city.
And now, if shifting Facebook accounts and updates were to be believed, it had gone missing. Some kind soul had already replaced it, bless his (or her) heart, but Esther was still thinking about the old one.
“I haven’t found it yet,” she said. “I’m still looking for it.”
By now, a lot of people know — or think they know — Esther’s story. But sifting truth from the many stories can be an elusive, delicate exercise.
People are genuinely curious, and an overwhelming majority care about her well-being. Many would like to help, but aren’t quite sure the best way.
A handful of efforts through the years, no doubt well-intentioned, have cropped up. A charitable foundation was even set up with the N.C Secretary of State’s office in 2010. But no paperwork has been filed since its articles of incorporation were registered.
Different merchants and store employees in the area she frequents make it a point to check in. Beat cops and hospital workers at Wake Forest Baptist Medical Center keep their eyes open, too. No doubt others stop when they see her to speak or offer a cold drink and a hot meal.
And why wouldn’t they? Though she never asked, Esther has become part of the fabric of the town. Stories about how she got here — as well as a couple unflattering nicknames — have abounded.
One had it that she was a school teacher who’d lost a child and wound up homeless. Another claimed she’d come from a well-to-do family, but had some struggles with mental-health and wound up living in the back of a bread truck.
The part about the bread truck is true. She lived in one parked on McCready Street in the early 1980s.
As for the rest, the short and verified version is that Esther is from Onslow County, never married and never had children. She came to Winston-Salem with a church group — a sister said in 2010 that she was going to sell Bibles — and opted to stay. She gradually lost touch with her family.
“Esther, she needs to be in a home,” said Juanita Peterson, her oldest sister in 2010. “But I don’t think she’ll go. She made her choice, and she can be stubborn.”
Attempts to reach Peterson last week weren’t successful.
Esther is nearly 80 now. Her health isn’t the best, either. She said that her heart sometimes “causes her to go to sleep” but she always wakes up.
“My time in Winston-Salem is about up,” she said.
Social media accounts drove the desire to check in with Esther. Reports surfaced Tuesday on Facebook that some heartless jerk had stolen her bike.
Predictably, that inspired an outpouring of concern for Esther and a tempest of spleen toward the perpetrator — real or imagined. “Who would do such a thing? To her?” asked a passerby at Cloverdale.
Esther said her bike had been taken. A store manager who checks on Esther several times a week posited Friday that she thought it had just been mislaid. The manager asked not to be identified; corporate types could exact a price for speaking without express permission.
Different Facebook posts reported at various times last week that it had been found or possibly replaced.
Whatever the explanation, Esther had with her a new bicycle. Someone had presented her with a new one. “I got it at (Publix),” she said.
It doesn’t yet have her preferred banana seat or high-back sissy bar, but a friend — an owner at Ken’s Bike Shop — is working on that. It’s hard to not want to help when stories circulate about someone victimizing such a kind and guileless soul.
Esther has her difficulties. Obviously. But anyone with a pulse and an ounce of compassion would want to look out for her.
So if you see her, and she’s feeling amenable, say hello. Ask how she is, and if she appears in distress, call authorities. They’ll know what to do.
Esther isn’t getting younger.
We can keep a collective eye out for her without smothering her. We can let her live — the way she chooses. It’s the least we can do.
Wake Forest University will continue to focus on internal Reynolda campus growth in the short term, much as it has since arriving in Winston-Salem in 1956.
However, the university — in particular its Wake Forest Baptist Medical Center arm — will also continue to “be alert to off-campus opportunities that present themselves and make sense,” said Hof Milam, executive vice president at Wake Forest.
“The majority of our growth will be adjacent to campus or in Wake Forest Downtown,” Milam said.
Recent investments in those areas have left the university with plenty on its plate.
For example, surging demand for student housing led Wake Forest to spend $28.42 million in December to buy Deacon Place, which is near the Polo Road campus entrance.
The gated community, which opened in the spring of 2017, consists of 146,448 square feet in six buildings containing 328 beds, including fully furnished four-bedroom suites and five townhouses in 1,500- and 1,800-square-foot options.
Donna McGalliard, dean of residence life and housing, said plans are for Deacon Place to be 100 percent occupied by Wake Forest students starting in the fall.
“We’re currently in a 10 percent growth in undergraduate enrollment, or from about 4,800 to about 5,350,” Milam said.
“We’re optimistic that Deacon Place will meet our short-term needs with student enrollment given the three-year residency requirement.”
Wake Forest’s participation in the ambitious $200 million Whitaker Park renovation, the former center of R.J. Reynolds Tobacco Co.’s manufacturing operations, is another example of how the university plans to assist, but not lead, another project.
In April of 2017, Reynolds donated a total of 120 acres, 1.7 million square feet of space, in 13 buildings for a planned mixed-use campus.
The recipient is the Whitaker Park Development Authority Inc., a nonprofit corporation created in 2011 by Winston-Salem Business Inc., the Winston-Salem Alliance and Wake Forest.
The goal is making the campus a magnet for manufacturing, industrial, warehousing and distribution operations, but also possibly retail and residential, said Bob Leak Jr., president of Winston-Salem Business, which will market the campus.
The main development to date is Cook Medical’s decision in June to move its local operations and 650 employees into Whitaker Park by late 2021 or early 2022. Renovation work is set to begin in late 2019.
The company said it is making a $55 million capital investment toward renovating 600,000 square feet and the potential for 50 new jobs. It has been made eligible for up to $4.8 million in local incentives.
Whitaker Park, at its production peak, had more than 2,000 employees, many of whom ate breakfast, lunch or dinner at several nearby diners along Deacon Boulevard and University Parkway.
Wake Forest announced in 2008 plans to redevelop 67 acres along those streets with the feel of a village, featuring stores, offices, residences and restaurants. The goal was investing more than $25 million in the project.
The move appeared feasible given the village would be within walking distance of BB&T Field, then-Ernie Shore Field and Joel Coliseum.
However, the first attempt with restaurants on the Deacon Village campus met with failure by May 2010 when three new and one pre-existing restaurant closed.
The Deacon Boulevard area is somewhat of a tough market for attracting diners, particularly after the closing of Whitaker Park for good in 2012, said Ray Collins, president of Collins Commercial Properties Inc.
The area is not close to a lot of homes, where people can go around the corner for a bite to eat, nor is it a Hanes Mall Boulevard-type area that is a magnet for people seven days a week, Collins said. Another problem is that most of the restaurant sites aren’t highly visible from nearby thoroughfares.
Milam acknowledged as much when he said the university “couldn’t have acquired the properties at a worse time for commercial real estate.”
“We’re going to patiently stay in a holding pattern as Whitaker Park takes off with Cook Medical and other tenants. We think Whitaker Park could provide a boost, but the real catalyst will be creating more jobs and attracting more visitors and fans to our athletic facilities.”
Milam said the university and the Whitaker Park authority believe there is opportunity to convert some of the buildings into residential apartments that could serve individuals working at Whitaker Park or those who need moderate-priced housing.
Wake Forest Innovation Quarter has been ranked by Preservation NC as the largest historic redevelopment project of its kind in the state, as well as among the largest involving major innovation districts in the country.
Counting the $65 million Bailey Power Plant renovations, the Link Apartments mixed-use project, $106 million Wake Forest BioTech Place, $75 million Inmar Inc. headquarters, and $60 million Plant 64 apartment complex, there has been more than $300 million in capital investment represented within the research park.
Milam said that while the university and Wake Forest Innovation Quarter are connected at the hip, they have distinct enough missions that they are not overly dependent on each other.
“The Innovation Quarter represents an opportunity to start something new in an urban setting, and we have had promising success to date,” Hilam said.
“We can attract students, such as those interested in engineering, because of the offering within the downtown campus.
“We also have additional space for our graduate school programs to accommodate growth.”
Terry Williams, chief strategy officer for Wake Forest Baptist, said there are a few buildings that Wexford and the innovation quarter could refurbish for new or relocating businesses.
Williams said he is encouraged by House Bill 399, which would give state historic rehabilitation tax credits at least a 10-year extension to 2030, as well as a slight increase in the expense cap. The bill cleared the House on June 6 by 113-5 vote, but has not been heard in the Senate.
The Republican-written 2019-21 state budget compromise proposal includes extending the historic-rehabilitation tax-credit deadline dates to Jan. 1, 2024, for any current project and Jan. 1, 2032, for any projects undertaken after Jan. 1, 2024.
Those tax credits have been instrumental in several revitalization projects in downtown Winston-Salem, with a combined capital investment value of more than $700 million.
“Historic and job creation tax credits can mobilize additional activities in the quarter for those looking to relocate here,” Williams said.
“We had a 10-year plan for building out existing space, and we’re close to occupying all of that space.
“The next three years will be about attracting new companies in traditional and digital health care,” Williams said. “As we do, we’ll be considering the space needs and options.”
Williams said Wake Forest Baptist “will continue to have conversations about growing through mergers and acquisitions.”
The open-ended nature of negotiating a potential medical partnership between Wake Forest and Atrium Health has raised concerns about the local future of Wake Forest Baptist and its medical school.
The groups announced April 9 that they have signed a memorandum of understanding “to create a next-generation academic health-care system.”
Highlighted in the potential partnership is the opening of a second Wake Forest School of Medicine campus in Charlotte — a long-sought goal by Atrium officials and Charlotte civic and elected officials.
“The goal is that upon signing a definitive agreement together, Atrium Health, Wake Forest Baptist Health and Wake Forest University will immediately convene a team to start the work of bringing a modern, innovative, cost-effective and sustainable top-20 school of medicine to the Charlotte area,” the groups said in a question-and-answer posting.
However, the groups have not ruled out a much larger collaboration during their period of exclusive negotiations.
“At this initial stage of memorandum of understanding, we have not defined the details for final structure for the relationship,” Wake Forest Baptist spokeswoman Paula Faria said.
“We have confirmed that both boards and management teams will remain in place. The medical school main campus will remain in Winston-Salem in the future.”
Wake Forest took the same approach with its recent acquisition of the neighboring Winston-Salem First properties.
In late January, Wake Forest reached an agreement to buy the church and its school. Under that agreement, the church will be allowed to stay at the location for at least three years while it searches for a new site.
It was announced April 5 that Winston Salem Christian School will remain at its current location at 3730 University Parkway for the 2019-20 school year, welcome news for families worried that the school would have to leave the site at the end of this academic year.
The school plans to renovate Woodland Baptist Church’s former location on North Patterson Avenue and move in by August 2020.
Gaining ownership of the Winston-Salem First properties became warranted as the university plows through on-campus projects that have yielded plenty of economic spillover, particularly from the 10-year, $625 million renovation initiative that began in June 2016.
Those projects include: the opening of the Sutton Center, an extension of Reynolds Gymnasium; McCreary Field House, an indoor practice center for student-athletes; a building adjacent to Worrell Professional Center for the health and exercise science department; and renovations in the law school, including a central commons.
Wake Forest said it has spent more than $210 million with local and regional construction companies and architecture firms.
Besides hiring local businesses to assist with the projects, the renovation squeeze led Wake Forest to need temporary, or what Milam calls “swing space,” to place faculty and student offices and operations.
“As we renovate, we will move faculty into the Winston-Salem First space,” Milam said. “We already had access to its parking. It’s just become more directly available now.”
Milam said Wake Forest would prefer to be a tenant off-campus rather than a buyer, “to help provide a boost to the other economic development efforts of others.”
The deadline for hospitals to sign up for the State Health Plan’s new reimbursement contracts expired at midnight Sunday with no officially announced takers.
A financial reimbursement game of chicken commenced in October when State Treasurer Dale Folwell launched his attempt to move the SHP to a government pricing model tied to Medicare rates.
Folwell’s Clear Pricing Project would move the SHP away from a commercial-based payment model. Folwell said Thursday the contract deadline was firm with no planned expansions.
On Sunday, Folwell said that at least three hospitals, which he declined to name, requested additional information Friday. He said he identifies providers once Blue Cross Blue Shield of N.C. — which administers the SHP — confirms signed contracts.
With the deadline expiring, more than 720,000 state employees and their dependents and retirees who haven’t qualified for Medicare and their dependents may be considered as out-of-network with their local hospital and affiliated medical providers, starting Jan. 1.
However, for SHP participants, their decision-making process begins in early fall when they chose which providers they want for 2020 coverage.
Novant Health Inc. and Cone Health’s latest public comments on the reimbursement plan, made on Thursday, were that they were still reviewing it. Wake Forest Baptist Medical Center has not commented on its stance.
Novant said “it is our understanding that State Health Plan members will have an opportunity to verify provider’s network status after July 1, and before their open enrollment (for 2020) begins on Sept. 29.”
The N.C. Healthcare Association said in a statement that “we cannot advise our members on contractual matters or speak for them when it comes to the new contracts. As far as we know, none of the hospitals in the state have agreed to participate.”
Folwell said Sunday that the NCHA “has said repeatedly that no hospitals will ever sign on to reference-based pricing.”
“Reference-based pricing is intended to provide transparency in provider rates by indexing fees to a published schedule.”
The SHP contract has become one of the two main hot-button health-care issues in the state alongside the potential for expanding Medicaid coverage to between 450,000 and 650,000 North Carolinians.
The SHP contract dispute appears just as rigid on both sides as Democratic Gov. Roy Cooper and Republican legislative leaders are over the state budget bill, which does not contain Medicaid expansion and was vetoed by Cooper Friday.
It raises the question of which dispute will be resolved first, the state budget and Medicaid expansion, or the SHP reimbursement contracts.
“Perhaps the health care providers continue to hold out hope for legislative action to reverse Treasurer Folwell’s position,” said Mitch Kokai, senior policy analyst with Libertarian think tank John Locke Foundation.
The treasurer has the authority to decide on reimbursement cuts, but legislation could take that away from Folwell.
House Bill 184, which would halt Folwell’s initiative for at least a year in favor of a legislative study report, cleared the state House by a 75-36 vote April 3.
It has yet to be acted upon in the Senate since being sent to the Rules and Operations committee April 4. Senate leader Phil Berger, R-Rockingham, signaled last week he has no desire to address HB184.
“I see no quick resolution to this dispute or to the battle over Medicaid expansion,” Kokai said.
If the typical contract negotiations between private health insurers and hospitals are any indication, the out-of-network status could linger for weeks or months before an agreement is reached.
Private health insurers vs. hospitals contract disputes have often gotten heated, including filing lawsuits, as part of negotiating strategies.
“It looks increasingly as if (the hospitals and providers) will need to sign on to his plan or challenge it in court — if they believe they can make a case,” Kokai said.
The SHP is the largest buyer of medical and pharmaceutical services in North Carolina, spending $3.2 billion in 2017.
Folwell’s proposal would allow the SHP to begin paying about 61,000 providers based on a percentage above current Medicare rates, along with an additional and adjustable profit margin estimated at 82%.
“From our perspective, NCHA is deeply concerned that the Clear Pricing Project is not what the name suggests,” the group said.
“Instead, the planned changes could catastrophically alter health-care delivery in North Carolina and put state employees, retirees and their families’ in-network access to high quality health-care and financial well-being at risk.”
The SHP plans to phase the rate changes in over a two-year period. First-year rates are projected to produce $196 million in savings, and another $62 million in year two.
The state Insurance Department gave final approval May 6 to the contracts.
According to a WRAL report last week, the SHP currently has about 15,000 contracts in place.
The new plan has at least 640 signed contracts, representing at least 15,000 providers. The contract has been available since May 13.
On Thursday, ECU Physicians signed the contract. It is the medical practice of Brody School of Medicine at East Carolina University.
On June 24, EmergeOrtho and OrthoCarolina signed the contracts.
EmergeOrtho is one of the largest physician-owned orthopedic practices in North Carolina with more than 140 physicians, 130 advanced practice practitioners and 165 physical and occupational therapists. It has 50 office locations throughout 21 counties, as well as orthopedic urgent care services across the state.
OrthoCarolina is one of the nation’s leading independent academic orthopedics practices with more than 300 providers. The practice has 31 office locations.
Other notable participants to date include: MinuteClinic facilities in CVS Pharmacy and Target stores; Rehabilitation Associates Networks; and the Community Care Physician Network, which represents 2,500 primary care clinicians.
Forsyth County Health Department signed the contract Thursday as a small provider through the SHP for clinics, dental and pharmacy.
Folwell, the SHP and the NCHA each claims the other side has not been willing to engage in earnest negotiations.
Dr. Michael Waldrum, the NCHA’s chairman and chief executive of Vidant Health in Greenville, has questioned the wisdom and timing of Folwell’s proposal, including to legislators.
He said the state health care system is bracing for the full impact of the latest phase of Medicaid waiver transformation between now and February.
However, the transformation could be affected by funding necessary for the rollout being unavailable as part of a potential delayed state budget after July 1.
“There’s a better way to do this, and we stand ready to help the State Health Plan with providing better quality care at lower cost,” Waldrum said.
Folwell said the NCHA “has neither stood up, showed up or spoke up about how to increase transparency and lower health-care costs.”
Folwell said the SHP will provide increased reimbursement payments to most independent primary care physicians, behavioral health specialists and many rural hospitals.
“If achieved, a 15% reduction in charges from hospitals, doctors and clinics would be quite significant,” said Mark Hall, a law and public health professor at Wake Forest University and a national health-care expert.
“I expect that these providers would be under a good deal of pressure to comply since most are unlikely to want to be dropped from the network that serves state employees ... for being too expensive.”