Duke Health Seeks State Approval for $6.4M Cost Overrun on Cary Surgery Facility

Duke University Health System, Inc. has filed a Certificate of Need application with state regulators seeking approval for a $6.4 million cost overrun on its planned GI endoscopy ambulatory surgical facility, Duke GI at Green Level, slated for Cary. The filing has triggered a public comment period, though specific dates for that window have not yet been announced.

The application lands against a backdrop of tight regulatory scrutiny across Wake County. In February, the North Carolina Department of Health and Human Services Division of Health Service Regulation approved just 267 of the 644 hospital beds requested by county health systems, approving less than half of what hospitals sought. Regulators also rejected a request to build a new hospital outright.

Duke's own expansion bids illustrate that tension directly. While NCDHHS approved 52 additional beds at Duke Raleigh Hospital at a cost of $29 million, that figure represented roughly half of the 101 beds Duke had requested. More significantly, regulators denied Duke's request to add 120 beds to its future West Cary hospital, a project estimated at about $1.2 billion and scheduled to open in 2027.

WakeMed faced a similarly mixed outcome. The system's main Raleigh campus won approval to add 164 acute care beds at a cost of just under $430 million, with a completion target of October 2032. But regulators denied requests for 25 additional acute care beds at WakeMed North Hospital, a $28 million project with a projected October 2029 completion, and 78 acute care beds at a new hospital under construction in Garner, estimated at $272.5 million with an October 2028 completion date. A separate 2024 WakeMed proposal for a standalone 36-bed acute care hospital with a single operating room, expected to cost $286.9 million and open by October 2029, was also denied.

The North Carolina CON law that governs all these decisions prohibits health care providers from acquiring certain medical equipment or developing new services, facilities, or beds without prior NCDHHS approval. According to the agency, the law is designed to restrict unnecessary increases in health care costs and limit unnecessary health services and facilities based on geographic, demographic, and economic considerations.

For the Duke GI at Green Level project specifically, the reasons behind the $6.4 million cost increase have not been disclosed in publicly available materials. The filing date and the exact schedule and submission process for the public comment period have also not been confirmed. Residents with questions about participating in the comment process should contact the NCDHHS Division of Health Service Regulation directly for details on how and when to weigh in on the application.