Watch "Death on the Bakken Shale," Fault Lines' investigation into why North Dakota's worker fatality rate is so high. It airs Monday, January 12, at 9 pm Eastern time/6 pm Pacific on Al Jazeera America. | Click here to find Al Jazeera in your area.
Dr. Gary Ramage is a physician who has lived in Watford City, North Dakota, for 20 years. When he first arrived in the area, it was a farming and ranching community. Some of its fewer than 1,500 residents had wealth tied up in their land and the livestock they raised. “Land rich, cash poor or cow rich, cash poor,” as Ramage told Fault Lines.
Today, thanks to an oil boom that began six years ago, the town’s population has more than doubled. Land in western North Dakota that once cost a few hundred dollars per acre is now going for hundreds of times more. Some of Ramage’s friends are collecting royalty checks totaling $80,000 every two weeks for letting oil companies drill on their property. The boomtown economy has trickled down to the businesses that support the new drilling operations, like convenience stores, where Ramage said clerks are paid $17 per hour with benefits, even though the state’s minimum wage is only $7.25.
But there are other consequences to the oil boom: The people of Watford City, the largest town in McKenzie County, which is near the center of the new gold rush, say their cost of living now includes a so-called “Bakken surcharge”—named after the Bakken shale that companies are fracking for its crude. They incur higher prices for groceries and other goods and services than others in the state and those in neighboring states. Ironically, they even pay more for gas.
Another consequence is that Ramage’s caseload at McKenzie County Hospital has also picked up significantly. The influx of new, unskilled workers taking on relatively dangerous industrial jobs resulted in a sharp rise in accidents and injuries in the region. In fact, North Dakota’s oil and gas operations have the highest fatality rate in the industry nationwide.
Fault Lines spoke with Ramage about Watford City’s transformation and the human cost of the rush to tap the Bakken shale. An edited and condensed transcript of that conversation follows:
Fault Lines: What was this place like 10 years ago?
Dr. Ramage: When I first arrived here, it was 1,250 people in town. That was it. It was Highway 85 in and out, going north and south, and Highway 23 going east. I was seeing a half a patient per day in the emergency room. So I'd see 15 patients in the emergency room in a month.
What kind of issues was the town facing back then?
We had a lot of people emigrate from our community and, ultimately, our numbers dwindled quite significantly. We went from 1,250 to about 1,500 or 1,700 and then down. And we were losing a lot of our young people. The running joke was that the last person to leave Watford City should turn off the lights. And we were close.
That actually happened to a lot of small towns up here. They just died out. What happened when the oil came?
I don't think a lot of people saw this coming. The people who really noticed that oil was beginning to be speculated were people who owned the hotels and restaurants. They were seeing the land men come in. And then the people who were working in the clerk of courts where the land men were doing their research for what minerals were available.
Then all of the sudden the ranchers and farmers started being approached by land men wanting to purchase some of their mineral rights. And next thing you know, there's a few wells going out. And then next thing you know, everybody is talking about it and how much they got for their minerals and how much somebody else got for their minerals.
All of the town sort of morphed into this bustling sort of little mini-metropolis, and people started to come in. We had the initial oil companies come in and we had the ancillary services come in—it was the people with the trailers, the food trailers and then support for the oil field. They just grew and grew and grew to what it is now.
When guys come in with major injuries from the oil rigs, do they have company guys with them sometimes?
They do. For the most part, a safety officer either phones me or accompanies in the injured worker.
How does that work out, your relationship with that person? What do they do?
They're fine. They're fine. They explain to me what their job is, and we tried to work within, you know, the parameter. I do what I do, you know, for everybody, irrespective of what comes in. Medicine is medicine. And I render the treatment.
But when we do the paperwork, each company will have different things that they need to have done. And some companies will mandatorily have their employee alcohol tested and drug tested, so we work with that. We have people here who can alcohol test and drug test. Sometimes they'll need to have forms filled out for prescription medications, if they require prescription medications. Sometimes they will have forms filled out for safety for things that are specific to that company. But I file a worker safety form for every injured person unless they decline.
I assume they must do alcohol and drug testing out there as well, they are not just doing it after someone has an accident? Are they?
They, the companies, are responsible to alcohol and drug test their own employees. ... There's been lots of cases where we've had people who have come through here who are positive for either alcohol or drugs and are working for oil field companies involved in accidents.
Does the company or company guy ever try to influence you to code things a certain way?
No. That hasn't been my experience. I've worked pretty closely with the safety officers. And sometimes they will ask, if at all possible, could I not prescribe a prescription narcotic or can I not prescribe a prescription medication for their worker, if I felt that it was within a reasonable parameter.
Is that weird to have a company guy not to give a certain prescription to a patient?
If it adversely affects their company, in terms of their insurance premium, if it adversely affects their company in some way ...
But were I in pain, and I found out my producer talked to the doctor and said don't give him that pain med, I would be like, “Wait, I thought I had a secret relationship, a one-on-one between my doctor and I on what I needed.”
That has happened.
And as a doctor, how do you respond to that?
I usually do what I feel is necessary, you know. And a lot of times, there will be a grey area where a patient certainly could get by with an anti-inflammatory instead of a low grade narcotic. And I would discuss that with the patient first. But I can understand where the safety officers are coming from in that respect as well.