How North Dakota’s Oil And Gas Boom Is Straining The State’s Health Care System

Crewmen construct a new gas pipeline near Watford City, North Dakota. (Photo by Matthew Staver, Bloomberg/Getty Images)

The growth of the oil and gas industries in North Dakota has brought an economic boom to the state in recent years — job growth in the oil and gas industry has tripled since 2007, and North Dakota’s overall population has increased 44,000 since 2008. But, as the New York Times reports, it’s also placed a massive new burden on the state’s health care system.

The new jobs have predictably led to a surge in North Dakota’s population. Combined with the unusually dangerous nature of the oil and gas industries, the explosion of new residents to North Dakota is straining the state’s hospitals to their limits. Mackenzie County in North Dakota has shouldered much of the burden with its single, one-story, sixty-year-old hospital with one emergency room. In the last three years, the hospital’s average monthly emergency room visits ballooned from 100 per month to 400:

Over all, ambulance calls in the region increased by about 59 percent from 2006 to 2011, according to Thomas R. Nehring, the director of emergency medical services for the North Dakota Health Department. The number of traumatic injuries reported in the oil patch increased 200 percent from 2007 through the first half of last year, he said.

The 12 medical facilities in western North Dakota saw their combined debt rise by 46 percent over the course of the 2011 and 2012 fiscal years, according to Darrold Bertsch, the president of the state’s Rural Health Association.

Hospitals cannot simply refuse to treat people or raise their rates. Expenses at those 12 facilities increased by 15 percent, Mr. Bertsch added, and nine of them experienced operating losses.

According to the Times report, many of the new patients for the state’s health care system are transient workers who don’t have permanent addresses or health insurance coverage. One of the biggest drivers of hospital debt there is patients providing inaccurate contact information, and then disappearing when it comes time to collect. Average paychecks in the energy sector are growing faster than elsewhere, so it’s not clear if this is an income problem or just a failure of the state’s housing infrastructure to keep up with the massive influx of new residents. Ad-hoc housing has sprung up in camps and even in Walmart parking lots across the state to compensate.

Those infrastructure problems have also created second-order problems for North Dakota’s health care. Street signs and addresses are often nowhere to be found, and paramedics can have a difficult time locating patients. The cramped housing has brought its own health problems and pests, and — as can happen when lots of human beings are thrown into close quarters — sexually transmitted diseases are also on the rise.

And the problems accompanying North Dakota’s boom are a microcosm for the oil and gas industries as a whole: Their annual fatality rate between 2003 and 2008 was 29.1 deaths per 100,000 workers — seven times the rate for all U.S. workers. A single well can require 1,500 trips by semi-trucks, tankers and standard pickups to move oil, water, sand and chemicals, and a third of the industries’ fatalities are associated with the massive amounts of motor vehicle activity. On top of that, companies often pay out rewards for low injury rates, which encourages under-reporting of workers’ compensation claims. In North Dakota itself, companies are allowed to compensate injured workers directly, prompting one lawyer to describe the situation to Grist as “the wild fucking west.”

In Mackenzie County and elsewhere, there are attempts to convoke the local government to impose a new 1-cent sales tax to finance a $55 million expansion of the hospital facility. Gov. Jack Dalrymple (R) is moving to bulk up medical training in the state with a new $68 million medical school building at the University of North Dakota, and $6 million expansion of the nursing program. But for now, the small-town practitioners are largely on their own.