Occupational therapy, 1993

Rehabilitation Center, February 1980

Exploring North Carolina Recuperation Barrens

          On a spring day in 1969 Gary Lewis, laboriously rolling his wheelchair along the sidewalk in Greenville, faced a doubtful and depressing future. He was returning from a long stay in a Veterans’ Administration hospital. Since he was merely disabled from an automobile accident that left his legs paralyzed, but was not an alcoholic, not blind, deaf, mentally ill, retarded, or a convicted criminal, there was no place he could go in North Carolina where any public agency would help him prepare himself in any comprehensive way to earn his family’s daily bread. The most he could hope for at the time was a job in a sheltered workshop, where he might frame pictures, refinish furniture, or do someother work for a minimum or sub-minimum wage.

           Before the 1970s, North Carolina possessed several hospital-based units where orthopedists provided physical restoration. Gary had gone through all the orthopedic surgery that would do him any good. He could have found in one of the 16 district offices of the state’s Vocational Rehabilitation Agency—a division established in 1920 in the Department of Public Instruction—a counselor to give him individual counseling, with some support from private physicians and psychologists. There were also 90 cooperative facilities and programs in hospitals, mental health clinics, and sheltered workshops. The cooperative programs ranged from one-man counseling services to large residential units in university and psychiatric hospitals, sanatoriums, correctional facilities, and social service departments. None provided a full spectrum of rehabilitation assistance that would lead Gary back to where he could function as a productive adult.

          In nearby states he could have found his way to the Woodrow Wilson Rehabilitation Center at Fishersville, Virginia, or the West Virginia Rehabilitation Center at Institute, near Charleston. In six other states in the country he could have availed himself of extensive services in diversified centers dedicated to vocational rehabilitation.

          The Smith-Sears Veterans Vocational Rehabilitation Act in 1918 established the first federal vocational rehabilitation program. In 1920, Congress passed the Fess-Smith Civilian Vocational Rehabilitation Act extending the program to non-veterans. Not until Congress amended the Vocational Rehabilitation Act in 1954, authorizing grants to expand programs for people with physical disabilities, did the N.C. Rehabilitation Agency receive limited authority to use its resources for rehabilitation centers. Until the early 1960s, federal funds were very limited, and were used almost entirely to assist individuals. Between 1960 and 1970, federal appropriations for vocational rehabilitation grew from about $50 million to more than $550 million, opening new opportunities to provide service and facilities for disabled persons not previously considered as candidates for rehabilitation. Through 1967, the mentally retarded and mentally ill were given priority, with facilities being set up at all the state operated mental health institutions. Beyond this, about 35 community sheltered workshops were established.

          Following further amendments to the federal Rehabilitation Acts of 1965 and 1968, services were expanded to people suffering from stroke, heart problems, respiratory conditions, nervous system damage, and orthopedic problems. The state Vocational Rehabilitation Agency set up a planning and development section that surveyed the existing rehabilitation facilities, identifying sites in Asheville, Winston-Salem, Chapel Hill, and Durham where programs serving severely physically disabled patients might be expanded. The survey found no substantial rehabilitation programs east of Raleigh.

Following the survey, the agency formed a plan to establish a state-wide system of regional centers expanding the existing facilities and developing additional ones, especially in eastern North Carolina. A two-year study in vocational rehabilitation, completed in December 1968, recommended setting up comprehensive centers to rehabilitate persons suffering from serious multiple disabilities.

          The General Assembly in House Bill 1320, effective July 1, 1969, appropriated funds and requested the State Board of Education to study the state’s needs for comprehensive vocational rehabilitation centers, and to begin planning to set up such centers in chosen locations. These centers were to emphasize medical, psychological, social, and vocational assistance to help persons with physical handicaps live productively in their communities. The board’s final report, with recommendations for designing, locating, and equipping facilities for the handicapped, was to be completed and presented to the governor and the 1971 General Assembly.

          According to the May 19, 1970 Daily Reflector, Eugene R. Keener, state program planning supervisor with the N.C. Division of Vocational Rehabilitation, had already said that a recommendation would be presented to the General Assembly in July in favor of locating a rehabilitation center in Greenville. Goldsboro and Wilson had also bid for location of the center, and both cities offered buildings and building sites. Asheville had offered Thom’s Rehabilitation Hospital, lock, stock, and barrel, for a regional facility.

          A new building would have to be built in Greenville, but the justification for locating a regional rehabilitation center in Greenville was solid. It satisfied all the criteria the committee had set up: central location in eastern North Carolina; a nearby large hospital, which Pitt County Memorial Hospital would be once its new construction was completed; existing rehabilitation manpower and training programs for such manpower; local organizations to provide financial and personnel support; a four-year university, with a medical school proposed for biennium 1971-73, and the potential for being barrier-free; a local community college; existing rehabilitation facilities, such as the Alcoholic Rehabilitation Center established in Pitt County in 1965; and a local sheltered workshop. The rehabilitation counseling, occupational therapy, speech pathology and audiology, psychology, nursing, sociology, and anthropology, medical technology, physical therapy, social work, and other training programs available at ECU were further points that favored locating the center in Greenville.

          ECU administration announced in May 1970 that the university might provide some funds if the hospital bond issue passed, to ensure access to community facilities for teaching. The Division of Vocational Rehabilitation might help, and there might be funds from other private and public sources. Donations, grants, or other funding would decrease the $9 million in bonds that would have to be sold.

          Despite the early recommendation of the vocational rehabilitation division’s assistant director, there were still many barriers – political, financial, and architectural – to be eliminated.

          When the study and report were issued, they emphasized the center’s comprehensive nature. It would be an environment in which people from different health professions would interact with disabled persons, giving them the assistance they needed to achieve fully productive lives in their communities.

          Because there was no comprehensive vocational rehabilitation center in the state, the Division of Vocational Rehabilitation staff and a 24-member State Advisory Committee on Rehabilitation Facilities created to carry out the study visited the best centers in some other states, and consulted with governmental and voluntary agency leaders.

Irrigating the Desert

          Dr. Edwin H. Martinat, an orthopedic surgeon from Bowman-Gray medical school, was named committee chairman. Two committee members were appointed from Greenville: Sheldon C. Downes, Ed. D., coordinator of rehabilitation counselor education in the ECU School of Education; and Edwin W. Monroe, M. D., dean of the ECU School of Allied Health Professions. The other 21 members were from Asheville, Butner, Chapel Hill, Charlotte, Durham, Fayetteville, Goldsboro, Laurinburg, Raleigh, Wilson, and Winston-Salem.

          In Greenville, interested persons formed the Rehabilitation Center Committtee in late 1970 and early 1971 to support locating a regional rehabilitation center in the city. The committee members included H. E.(“Sonny”) Lowry, who was chairman, Sheldon Downes, George Hamilton, Joe Pou, William Speight, Ralph Steele, and Richard Wells. The local medical community was represented by Drs. Earl Trevathan, James F. Bowman, Sellars Crisp, Al Ferguson, Ira Hardy, Monroe (later replaced by Ronald Thiele), Allen Taylor, and John Wooten. Members of the local committee met with R. T. “Capt. Tim” Brinn of the ECU Regional Development Institute to document, in a 72-page brochure, Greenville’s case for establishing a regional rehabilitation center in Pitt County. The main text included facsimiles of letters from officials, community organizations, businessmen and professionals supporting the concept of the rehabilitation center. The committee raised enough money to print individualized, named copies of the book to present to local supporters, Gov. Robert W. Scott, and all the legislators who would act on the eventual location of the center.

          Bill Speight, Pitt County attorney, went to the governor’s office along with other members of the committee. He found Scott unsmiling and not very friendly, and when he presented him with Greenville’s plan, the governor said, “You people in Greenville just got approved for a medical school. What more do you want?”

          It must be added that Gov. Scott shifted to a more favorable position after Greenville’s rehab center proponents combined with those from Fayetteville in their joint campaign. In the meantime, state Senators J. J. Harrington, John Hensley, Kenneth Royall, and Vernon White, and state Representatives Sam Bundy and Horton Rountree had spoken to him about the economic and other advantages of having a vocational rehabilitation center in Greenville. The governor wrote on June 3, 1971 to Vernon Cox, chairman of the Pitt County Commissioners, “Please be assured of my concern for such a worthy program, and my sincere hope that, if sufficient funds are found to be available, the appropriations bill for these centers can be ratified. I feel the humanitarian and economic benefits of the two rehabilitation facilities for the east, advanced planning for a state rehabilitation institute at Chapel Hill, and rehabilitation counseling units for general hospital patients in western, central, and eastern North Carolina deserve full consideration by the 1971 General Assembly.”

          On June 7, Dr. Ira Hardy, as spokesman for the Greenville committee, visited Douglas Herring, State Board of Education chairman, and presented arguments to the board for Greenville as the ideal location for a center.

          The main question discussed at the start was whether or not there should be a single central location, like the Woodrow Wilson Rehabilitation Center in Virginia, the West Virginia Rehabilitation Center, and the Warm Springs Foundation in Georgia, or regional centers placed strategically across the state. The committee decided in favor of multiple regional centers.

          The various committee members vigorously represented their own areas’ interests. Dr. John McCain was staunchly in favor of locating a center at the unused Eastern North Carolina Sanatorium in Wilson, a state-owned 160-170-bed hospital. He was supported in the endeavor by Rufus Swain of Wilson County Technical Institute, who also spoke about Atlantic Christian College with its B. A. programs in nursing, medical technology, and deaf education.

          Dr. Robert Brashear, Jr., from UNC School of Medicine’s Division of Orthopedic Surgery and Robert A. Lassiter, Ph. D., of the School of Education at UNC, declared firmly, although they were not quite prepared to define the exact site, that Chapel Hill deserved most of all to be the location of a state rehabilitation institute, since it was so centrally located, had the UNC and Duke University medical schools to draw on—failing to mention that the sole rehabilitation facility at Chapel Hill was a single ward in Memorial Hospital, or that the campus was nowhere near barrier-free. Moreover, Ferebee Taylor, UNC chancellor, had ruled that the university had already made adequate arrangements for handicapped students, would not alter its admission policy in any way as a concession to handicapped applicants, nor spoil its beautiful campus by providing ramps and other facilities for the handicapped.

          Members of the rehabilitation advisory committee, accompanied by Dr. George Hamilton, Larry Snyder, and Sheldon Downes from ECU, visited the campus of the University of Illinois campus in Champaign, IL, which was a pioneer, having been barrier-free since the 1950s; the Rancho Los Amigos Hospital in Downey, CA, and Casa Colina Hospital for Rehabilitation Medicine, in Pomona, CA; Craig Rehabilitation Hospital in Denver, CO; and four other centers in Pennsylvania, Virginia, and West Virginia. On the basis of these visits, and advice from their administrators, medical directors, and staff, and other experts on rehabilitation facilities, the advisory committee developed an “Ideal Model for a Comprehensive Statewide System of Rehabilitation Services for the Physically Disabled in North Carolina.”

          The ideal model, presented in the committee’s final report, included a variety of rehabilitation services at the local, regional, and state levels:

          1. Locally, there should be hospital rehabilitation units, mobile hospital units, and vocational rehabilitation    evaluation and service centers where district offices already existed.
          2. Regionally, comprehensive vocational rehabilitation centers should be set up in conjunction with large     general, acute hospitals, to deal with patients for whom local facilities were insufficient.
          3. To serve the entire state, there should be a state rehabilitation institute to serve physically handicapped               persons for whom regional facilities would be inadequate, and a state rehabilitation center for the deaf.

          Public hearings were mounted in Asheville, Charlotte, Durham, Greensboro, Greenville, and Raleigh during November 1970. There was one curious and unexplained incident. The tapes made on the several recorders at the Greenville hearing could not be transcribed because all were blank. It was as if the hearing had never occurred.

          In Raleigh on January 7, 1971 presentations were made by Fayetteville, Pinehurst, Greenville, and Wilson.

          After all the hearings and presentations, a consultant was brought in from the University of Virginia in Charlottesville to provide unbiased outside advice on the decision where to locate the center. Since there were no transcripts of the public hearing in Greenville, he took the statement of John McCain, chairman of the Central Coastal Plain Health Planning Council located in Wilson, as definitive for eastern North Carolina, and recommended that the center be located there.

          The situation was seen by the Greenville group to be at an acute stage. They had to do something to retrieve their preeminent position. They sought a political answer. At the time the General Assembly members from the Fayetteville area were more influential than those from the Pitt County area. Committee members approached the Fayetteville representatives and suggested that they combine their forces. “If you support us, we’ll support you,” they said, to ensure that regional centers were located in both Fayetteville and Greenville.

A Regional Rehabilitation Center for Greenville

          The alliance succeeded, and the final report of the State Board of Education proposed that two regional centers should be established in Fayetteville and Greenville, funded through a combination of federal, state, and local funds. Drawing on Vocational Rehabilitation and Hill-Burton funds, the federal participation for new construction could be as much as 61 percent. The remaining 39 percent would include 24 percent state funds and 15 percent local funds. The regional centers would operate through their local county governments, with the state sharing in their cost on the same basis as that for funding regional mental health facilities.

          The community components of the centers, operating in affiliated universities, community colleges, and sheltered workshops, would involve removing architectural barriers and employing special project staff. Federal Vocational Rehabilitation funds could be used for barrier removal at technical institutes and community colleges. Staff costs, which would amount to about 65 to 70 percent of the operating budget, would be funded by colleges and universities, using local and state funds, by technical institutes and communities colleges, utilizing funds matched with federal vocational education funds, and by sheltered workshops using existing staff or, if needed, additional staff paid from vocational rehabilitation funds.

          The estimated total cost for constructing and equipping a regional rehabilitation center in Greenville would be about $1.8 million, and estimated annual operating costs would be $1.25 million.
It was essential for the ECU campus to be barrier free. The first phase of removing architectural obstacles on the campus was estimated by the Division of Vocational Rehabilitation to cost $50,000, and they were prepared to furnish $40,000. ECU administrators were no more unified than usual. Jim Lowry, director of Buildings and Grounds, resisted any architectural changes to improve access to campus facilities. Dr. Downes, representing the Greenville committee, approached Cliff Moore, the university’s financial manager. Moore told him that there were no funds to pay for barrier removal.

          To stop here would have left the project dead in the water, so Downes went to President Jenkins and explained the situation. All the work that the committee had done would be lost if the essential requirement to remove all architectural barriers were not satisfied. It did not hurt that Downes, who was a Marine as was Jenkins, could talk the talk and walk the walk. Jenkins responded positively, saying that the issue was bigger than just the regional center. The university’s goal was to serve all the people in the region, and it would be inexcusable if physically handicapped students were prevented from attending classes and other university functions.

          He made a telephone call to Moore, and the $10,000 was immediately available. Several months later, following a 20 percent/80 percent formula, the university provided another $10,000 to match an additional $40,000 to complete removing architectural barriers. Even with the funds available, it was only through the strong support of the university engineer, Larry Snyder, who for the necessary length of time managed to circumvent the interference of Jim Lowry, his supervisor, that the required changes in campus accessibility were brought about.

          The 1971 General Assembly authorized $1.9 million to construct the rehabilitation center at PCMH to open around Easter 1977. The section of the hospital containing the center would become the final center in a system of five regional centers and one state institute. With the system’s completion, anyone in the state would be able to begin rehabilitation care within 75 to 100 miles of home.
On October 11, 1971, the Pitt County commissioners passed a resolution to expand the hospital by establishing a Regional Rehabilitation Center as part of the new PCMH. The commissioners promised $881,000 toward constructing the 55-bed rehabilitation center, the balance to be provided from federal and state rehabilitation grants.

          The ground-breaking ceremony to inaugurate construction of the new Pitt County Memorial Hospital was held on Thursday, February 14, 1974, Valentine’s Day. The facility on Stantonsburg Road was to include a 315-bed acute care hospital and a 55-bed regional rehabilitation center, and was scheduled for completion in September 1977. R.L. “Bob” Martin, chairman of the county commissioners, said the new facility would tie in with developing the ECU medical school.

          Dr. Edgar T. Beddingfield, Jr., a Wilson physician who was very active in campaigning for the medical school at ECU, spoke on January 7, 1971, to the final Raleigh meeting before the State Board of Education. After reviewing the reasons why Wilson should be the site for a regional center rather than Greenville, he said, “In closing, I must confess that in observing your current and perhaps justified predilection for the Greenville location, I feel a bit like the ever-faithful but rejected lover, who on seeing his girl friend cast him aside and go on to a new relationship with another man, told her plaintively, ‘Honey, I still love you just the same. If this new affair that you have become involved in doesn’t work out, come on back—I’ll be waiting.’ So, Ladies and Gentlemen, if the limitations of funds available, or other factors throw a roadblock in the development of the facility at any other site than Wilson, we want to remind you that we will be there waiting and ready to go at your pleasure. Thank you very much.”

           By 1995, 12 rehabilitation centers for the physically disabled had been established, including those in Fayetteville and Greenville. The others were in Asheville, Charlotte, Winston-Salem (the John C. Whitaker Regional Rehabilitation Center and the Rehabilitation Center at North Carolina Baptist Hospital), Greensboro, Raleigh, Hickory, Chapel Hill, Durham, and Wilmington.

The First Three Directors

          The first director of the Regional Rehabilitation Center was Dave McRae, who came from Raleigh, where he was directing a nursing home and attending graduate school. It was an inside joke among some PCMH staff that McRae had been Jack Richardson’s second choice for the position. Richardson had in mind a man who came from eastern North Carolina, but was persuaded that he needed someone with more of a professional background than his favorite candidate.

          McRae started in March 1976 as associate director for rehabilitation. Like the other executives at PCMH at the time, he found himself doing whatever had to be done. The challenges were great, but the situation was conducive to learning a great deal about the hospital’s operation, as problems and crises arose and had to be met. During the 13 years he spent in administration, he had six or seven different jobs, and had become familiar with virtually every area of managing the hospital.

          The approach to rehabilitation at the PCMH center was unique in that it not only made facilities more easily available, but provided complete patient care, dealing with the real problems faced by the disabled. Through being near the patients’ homes and families, it could make a difference in their feelings, how they viewed the world, and their motivation to learn what they needed in order to function. As McRae said, “Because of the extent of their problems, you don’t treat just the patient. Rehabilitation involves being ‘into’ the community.”

          The center mobilized an entire community to help disabled people learn to function in real life, not separating the person for long periods of time from his home and people.

          McRae directed the rehabilitation center until Deborah Davis, after working for him for several years, assumed the position. She joined his staff after working in materials services, in the basement of the Fifth Street hospital. She was also still in graduate school. Her first task was to prepare for CARF to review the rehabilitation operation with an eye to accreditation. It took about a year to get ready for the accreditation review. During that period and for a time afterward, Mrs. Davis worked to complete her masters in business administration.

          She also worked with McRae after he moved to the Human Resosurces division, then taking on clinical services, and gradually moving into overseeing daily operations. In 1990 she was senior vice president with responsibility for the entire operation of PCMH – patient services, clinical operations, support services, and facilities. “Everything for the daily operations for PCMH reports, through an executive staff member, to me,” she said.

          After Mrs. Davis, Martha M. Dixon became the rehabilitation center’s director. She had been employed in the center in 1977 as its first speech and language pathologist. The next year, she became the manager of the Department of Speech Language Pathology and Audiology at the hospital, a position she held for several years. Then she took on responsibility for rehabilitations services as a senior manager, administrator, and assistant vice president for the Regional Rehabilitation Center. In January 1997, she became the vice president of general services for PCMH.

          On its 20th anniversary, September 16, 1997, the Regional Rehabilitation Center at PCMH opened its new aquatic therapy pool with a dedication ceremony and an open house to which the public was invited. The $1.6 million pool had been envisioned since the center opened. It had been designed and built after surveying 12 other aquatic therapy facilities across the country. The Greenville Service League supported the pool’s construction with a $300,000 gift.

          The pool’s water temperature would be kept between 90 and 94 degrees, and the air temperature inside the building that housed the pool 2 to 3 degrees warmer than the water.

          There were recreational, physical, and occupational therapists on the Rehabilitation Center staff who would lead aquatic therapy. Having the pool allowed them to expand the swim therapy program that had been carried on at the Greenville Aquatics and Fitness Center pool. Being able to use the rehabilitation center pool would help both outpatients and inpatients with complications resulting from stroke, spinal cord injuries, traumatic brain injuries, and arthritis.

          In April, 1999, the Commission for the Accreditation of Rehabilitation Facilities granted the Regional Rehabilitation Center at PCMH, along with the center’s six specialized rehabilitation programs, a three year re-accreditation. The most recent previous accreditation had been in 1995. The center was evaluated on its comprehensive inpatient rehabilitation program and vocational evaluation services, as well as on its specialty programs in pediatric, brain injury, and spinal cord injury rehabilitation. The center’s speech-language pathology and audiology services were accredited also by the American Speech-Language-Hearing Association as part of the CARF survey process.

          The rehabilitation center was commended for communication among staff, physicians, and administrators, for its patient satisfaction level, the expertness of its staff and medical staff, and its facilities, particularly the aquatic therapy pool. Areas needing improvement were arranging information in order of priority, managing outcomes, and streamlining daily patient care documentation.

          Dr. Phillip Bryant, the center’s medical director and chairman of the Physical Medicine and Rehabilitation department at the ECU medical school, said surveys were valuable in judging how the rehab center stood in relation to established benchmarks. He said, “It allows us to get a better understanding of standards we should be achieving and helps us continue our pursuit of excellence in rehabilitation.”

          Gary Lewis, more than 50 years old in 2000, has made great progress since he left the VA Hospital. He was fortunate to obtain work in the sheltered workshop in Pitt County, and when the Regional Rehabilitation Center opened he began therapy for his disabled legs and learned office skills. He works as office manager for an engineering firm in Greenville and attends ViQuest Center, where the University Health Systems carries on its wellness programs, twice a week. There he exercises in the pool, is given physical therapy, and uses the cardiovascular and training equipment to benefit his heart and upper body. As evidence of the center’s impact, people like Gary can live in Greenville, while receiving comprehensive rehabilitation services and lifelong help in keeping well, without having to leave home.