See also Vignette

DONALD TUCKER, M.D.
Retired Cardiologist

October 16, 2000

Interviewer: Beth Nelson

Beth Nelson: Let's start with a little bit of your background, your education and what brought you to Pitt County and what made you choose to practice here instead of other places.

Don Tucker: Well, I was born in Greenville and I left Greenville in 1951 to go to Duke, I actually went to medical school in Atlanta in 1954 and I graduated from medical school at Duke in 1958. Then in 1959 I got a BS Degree in Medicine and then I interned at Duke and that was 1958 and 1959 and then in 1959 and 1960 I was in New York at Cornell Medical Center-New York Hospital. Then I came back to Duke. I finished my residency and my fellowship in Cardiology in 1960 and 1962. Then in 1962 and 1964 I was in the Navy and was in charge of the Cardio-Pulmonary Catheterization Lab at the Naval Hospital in Portsmouth. Then I came here in 1964 and weighed going back to Duke and teaching medicine and I decided that I really wanted to go into practice so I came and then joined the Medical Arts Center with Dr. Winstead and Dr. Fred Irons and Dr. Deyton and Dr. Clement. Dr.Bartlett was an internist and died and then shortly after I came, maybe a year, we broke into separate specialties and everybody went out towards the hospital and worked at Quadrangle and Fred Irons and I shared an office out there until Fred went to East Carolina University as a physician in charge of health services over at ECU. At that time Dr. Thiele came in and joined me and then after that Dr. Ramsdell and then Dr. Ferguson and that group grew after that and we needed bigger offices so we also relocated into what is their central building now.

Beth Nelson: I guess that was the beginning of specialization.

Don Tucker: Yes, that was the beginning of what is now Physicians East which was Quadrangle Internal Medicine. In gastroenterology we had Dr. Newton and Dr. Dellasega and we had cardiology in Dr. Privette and in catheterization, and we had hematology and Dr. Ramsdell and then we had nephrology with Dr. Ferguson and Dr. Ferguson left us to start the Hemodialysis Program and then after that we had oncology and expanded into pulmonary medicine with Dr. Shaw which has grown. Then we had our first outreach over at Winterville and then we opened the Urgent Care Center on Fire Tower Road and then we started a practice in Grifton so we had Winterville, Grifton, Fire Tower. Then just before Drs. Deyton and Clement retired we started talking and before the three of us retired we merged the other practice in with Quadrangle and became Physicians East and after we had Greenville Women's and Pitt Surgical.

Beth Nelson: There's no telling how many doctors there are over at Physicians East now.

Don Tucker: I would guess that there are now more than fifty. I am not sure but probably fifty or more. It is remarkable and actually this is something that I didn't expect to happen, it just happened. I never envisioned the practice would be that large. I think the community and the environment was right for multispecialty practices and we were trying to reduce expenses and give a better product and by combining services was what this was for and ultimately the development of Physicians East. It is better to have all of your services grouped into one building and then you are able to have your own management.

I think the hospital is probably not going to like this but I think there was concern by people in private practice about the hospital's relationship with the medical school. The feeling was that private practice could be left out in this relationship and that the larger the mass of private physicians in one group the better it could speak out to a common cause. We wanted to maintain some sort of autonomy and have some kind of leverage in whatever the hospital and medical school may ultimately do. As you probably know, there has been some strain between the private community and the hospital/medical school alliance because sometimes private physicians have not felt that they were being represented in the big scheme of things. Most people give credit for the growth in the medical community in Greenville to the medical school which I think is unfair and unfortunate. It misrepresents the fact that before the medical school ever arrived Dr. Hardy was here with neurosurgery and we had an excellent orthopedic group with Dr. Wooten and we had Dr. White with one of the premier eye programs in the State, the urologists that were here, the radiology program. The hospital and the medical school had never tried to compete with that.

We had one of the outstanding radiology programs in the whole State so this was a growing vital medical community before the medical school ever arrived. Did the medical school accelerate growth? Yes, but it's a little bit irritating to hear people say to look what Greenville has become which is a medical center-a medical center with a medical school and certainly the two have complemented each other but most people who were here before the medical school arrived will tell you that this was a premier medical community long before the medical school had arrived and the medical school probably had benefited as much as the private community from the fact that there was this strong core of private physicians here when the medical school was founded. Primarily, a lot of teaching was done by private physicians because the medical school had limited staff and with time that has changed.

Beth Nelson: In 1964 when you came here, the hospital was relatively new at that point. It was thirteen years old.

Don Tucker: At that time, as I started to tell you earlier, we had about twenty-five physicians on the staff and it was an obligation to have hospital staff privileges and one of the obligations was that you had to cover the Emergency Room from 7:00 p.m. until 7:00 a.m. the following day. It was a burden because a lot of physicians had no training in minor surgery and trauma and so you would be there from 7:00 p.m. to 7:00 a.m. the next morning triaging and treating things that came in and you wanted to try to avoid having surgeons and pediatricians come in because you knew they worked all day and so you were sometimes feeling compelled to extend yourself beyond your area of confidence or comfort and treat patients. It was difficult because you worked all day. Then you were at the hospital and you worked all night and slept very little. The next day there was no system there where most practicing physicians took the day off. You worked the day, you worked the night and then you had the next day, all day, in your office. You ended up working like this about once every twenty-five days. We slept in the hospital and originally they put a little trailer outside the Emergency Room and the Emergency Room duty officer would stay and be confined to the trailer. You would go back and forth into the hospital and they couldn't afford to give a doctor a hospital bed because they were at such a premium. That was very difficult for practicing physicians and, of course, now there is full-time Emergency Room coverage. The Emergency Room was not as busy then as it is now but still you could not get much sleep, particularly on Saturday or Sunday nights.

Beth Nelson: It would be like that every twenty-five nights?

Don Tucker: About every twenty-five days you spent a night in the Emergency Room and you were required to do that to join and have staff privileges and for most people that was a burden and undesirable duty. It was a chore.

Beth Nelson: It seems that was pretty common though among hospitals before hospital-based emergency physicians came in.

Don Tucker: Well, I would say it was pretty much the norm, I guess. Of course in medical centers you had residents who did that but not in a community hospital. Even in those days we were more effective than say Tarboro and Rocky Mount or Washington and a lot of those patients would end up in the Pitt Emergency Room to be seen because we had neurosurgery and we had other specialists.

Beth Nelson: What drew you here? I know that being from here was certainly a factor, but with the kind of training you had you probably could have gone anywhere in the Country.

Don Tucker: Probably could have but I just had the feeling that I wanted to be in a rather small community which Greenville was then. There was a good cross-section of specialty physicians and I could do hands-on primary care cardiology. I just felt like, I mean I had written a number of papers while I was at Duke and when I was in the Navy. I decided I wanted to be in private practice and I thought I was probably better suited to deal with people than I was with medical students, house staff and the academic side of cardiology. I liked Greenville and I was really attached to Greenville because this is where I had grown up and had gone to school. I had a lot of family here and then a lot of the people who were doctors here I had known through the years, I was comfortable coming back.

Beth Nelson: I guess in 1964, was there talk at that point about the school of medicine? Was that the start of talks?

Don Tucker: It was a little bit later than that. Dr. Jenkins and them had been talking about it, I can't remember, but I think it was probably in the late sixties when he began to campaign for a medical school. There was some opposition in the private community with good reason and I think there was a lot of work on the Affiliation Agreement with a lot of input by the private community to insure that private practice would never be excluded from or privileges at the hospital. That the door would always be open to people in private practice and there was concern that they might eventually close the hospital staff so that it would be difficult if you had a private group bringing in additional people. It appears the problem was just paranoia.

Beth Nelson: But you liked being in Greenville, you had chosen to start your practice here, you built your practice.

Don Tucker: You wanted to be sure that you could be competitive and I think the practice has been competitive and I am sure that in the community one aspect of medicine complements the other. Dr. Longino was here and he probably was one of the great all-time surgeons ever to practice in Greenville.

Beth Nelson: I think a lot of people talk about him. He could bring a lot of physicians to the table to discuss issues.

Dr. Tucker: You know he had the training and he did communicate well with people and he was not one that put up with a bunch of nonsense. You know, it was all business with Frank. He built that terrific surgical practice and Dr. Vick came and Dr. Carter and Dr. Hale.

Beth Nelson: Let's talk about what you think the hospital has meant to Greenville, Pitt County and the region from a standpoint of what it had to offer when you first came here to what it is now.

Don Tucker: It probably was an advantage to the citizens of Pitt County but it is somewhat of a tax burden and expense. We tried very hard, again this won't be popular with the hospital, but there was a group of us, Dr. Longino included, who tried very hard to get a CON for a private hospital. Most of us felt like the individual citizens of Pitt County would be served better by having a choice. As you know, there are a lot of built-in costs associated with having a university teaching hospital. Anybody that would argue otherwise is, I think, misleading the public. If you go in with triple pneumonia, you're also paying for a neonatal unit, you're paying for the cardiovascular surgical unit; you're paying for the ER trauma. I haven't seen the books in a long while. I was on the Board at one time. All of that is factored into your daily bed cost. We felt that there was a better way, a simpler way, and a less expensive way to provide eighty-five percent of the care that the average citizens of Greenville and Pitt County need. So, obviously it was to the medical school's advantage to enlarge and encompass a big region and to do that you have to bring services in that are specialized.

Anyway, we didn't get that. The medical school and the hospital opposed our CON so obviously if you have a private hospital you got to siphon off some of the patients that are necessary to support the losing services that exist at a teaching hospital. Without the medical school and the enlarged hospital, would Physicians East be as large as it is now? Probably not. Sure, we have attracted some physicians because of the medical school here and they had some interest in teaching. Sure, as things have evolved most of
those people don't teach anymore as the medical school has enough faculty except in certain areas and the majority of the teaching is provided by full-time ECU people.

People used to have to go to Duke, Birmingham; we sent patients to a lot of different places for cardiac procedures and now I think Dr. Chitwood has got probably the premier cardiovascular surgeons in the Country and that is the edge. If you have to travel somewhere to have a bypass procedure and your family has to be displaced and you have children, it is a big advantage to be able to have that done here where the family can go back and forth to home and so that has been a plus and I know there are other services that are equally as important that are now in Greenville and Pitt County so there have been many positives to offset some of the negatives.

Beth Nelson: I want to go back to what you were talking about, about Dr. Chitwood's having a premier program. If he was here he would, and I have heard him say this any number of times, he would probably be quick to tell you that one reason for his success has been the fact that there was a strong cardiology community that essentially sent him patients and that helped make his program.

Don Tucker: Dr. Chitwood's philosophy was a little different than some of the other people that had come with the medical school. He knew that he needed to have a good working relationship with the private physicians in the area and the cardiologists and the primary care physicians, because he knew that initially most of his patients were going to come from outside the medical school. But his Dad was in private practice for years and he was very loyal to private practice. He respected physicians in private practice. He had been familiar with what his Dad had done in private practice so it was more than just, that he needed to have this relationship in order for his program to succeed, I think he generally liked people in private practice and I think Dr. Chitwood does great with private practice, so he went out of his way to create a trust between private physicians and his program. In many instances there was some concern by private physicians that maybe the hospital wasn't being fair and that they were being more partial to the medical school, but Chitwood seemed to be an advocate for private practice. I think he was probably more so than anybody else with his philosophy for bonding between private community and the medical school.

It was very fortunate for the medical school when they hired him and it was a loss when he left and he very good for the hospital and the medical school and the private community when he came back Not many people had enjoyed the admiration and respect and had been accepted in the private community in the way he was. Dr. Laupus was and Dr. Laupus also recognized the importance of having a good partnership between private physicians, the community and the medical school.

Beth Nelson: Absolutely and that was probably one of the hallmarks of his administration I would say. Now, let's go back to the private hospital concept. Looking back on your years of practice here and the way things have evolved, in hindsight are you glad that you didn't start a competing hospital?

Don Tucker: No, it should have been started and I think Greenville should have two hospitals. They should have a private community hospital that can take care of the majority of the needs of people in Greenville and Pitt County and then they need a teaching hospital. Of course Duke has bought their regional hospital and that is a good example and then in Raleigh you have got three or four hospitals. I think that there is a simplicity and I am not sure that bigness of size not necessarily determines the quality.

There are obviously some very outstanding programs at the hospital but you could go around the community and talk to people who have had very complicated illnesses that have been managed at the hospital, who would probably tell you that they had a lot they didn't need. They say that the hospital is over-sophisticated for some of the things. If you are going in for an appendectomy or you are going in for a routine delivery or you are going in for a GYN surgery, the theory is that there is has more potential for error and complications in an institution the size that ours now is.

Recently I visited a friend there and I couldn't believe the places that I could wander and other people I saw wandering around and nobody said anything, nobody asked me to show anything. Security is important in this day and time and in a small institution you know everybody who walks in, now you know almost no one who walks in. I think we missed the opportunity to have something that would have been a real jewel for the community.

Beth Nelson: I serve on the State Health Coordinating Council that determines the State Medical Facility Plan every year and the idea of new hospitals is almost unheard of.

Don Tucker: You know what it is, there is so much fear by the existing hospitals that they can't compete. I mean they have developed a layer of expense associated with running a hospital. They shudder at the fact that somebody might come in and run something more efficiently and hire nurses and provide an environment that people would love to work it.

When Physicians East, which was then Quadrangle, applied for a CON to do our endoscopy service we had one opposition and that was the hospital. We spent an additional $50,000 just getting our CON. Even then we got a limited CON which said we had to open our books to the hospital and be sure that we weren't pricing at a level that was lower than what we agreed we would price it at and when then we could add a third OR. You know, it is all about money and competition and they sure don't want any more CT scanners. They don't want any more radiation therapists. It is just a monopoly. Sure, I get good care at the hospital and, hopefully, having been a physician and having had a relationship, somebody will look after me when I go over there. But I think that there are problems that go with a large teaching hospital.

You have probably heard this before but there is a lot of stress right now among surgeons in Greenville because they have to take trauma call. Taking trauma call means that a physician in New Bern can get up and get called if there is a patient in the Emergency Room that has possible torn ligaments in the ankle, he doesn't have to go in and see him. He can send him over to Greenville to the Trauma Center and what does that mean. That means that Dr. Wooten and Dr. Williams and all those orthopedists have to take trauma call. It is hard to recruit people when they know they are going to be on trauma call because it requires a lot of time and a lot of loss of sleep and compensation is not always assured. There is a lot of conflict and friction right now in the community because of the trauma. Trauma is crucial for a medical school's program but it has caused a lot of problems for people in private practice; neurosurgeons, orthopedic surgeons, urologists and nobody is addressing that. It will eventually force people into early retirement, in my opinion.

Beth Nelson: Do you think it will have more of an impact with the groups that don't have a residency program to back them up? If there was a residency program in orthopedic surgery or neurosurgery would it help?

Don Tucker: Sure it would be a lot less of a burden, it definitely would, and you know with the residency program would come university neurosurgeons and university orthopedists and I am sure in time that they still want that.

Don Tucker: The financial growth, you know, you spend large sums of money, particularly to expand as in Tarboro and its about HMOs and surely you are not making money there. I think Duke is just divesting themselves of their HMO after a huge loss. They probably made some financial errors but I think they have had an unusually large economic growth because they are in a region that they were able to out compete some of the hospitals in neighboring towns. I guess that is an advantage. I'm sure you have heard that about Kinston and New Bern don't necessarily appreciate all the competition that is current in Greenville.

Beth Nelson: Yes, absolutely, and they are very vocal about it.

Don Tucker: You know, the larger you are doesn't necessarily mean that you are looked on in a positive way. I don't know specifically how the relationship is with administrators here and neighboring hospitals but I think it is not real warm.

Beth Nelson: I think it varies from facility to facility. I think New Bern and Kinston have, as always, been a little bit standoffish with us but some of the other hospitals we have fond relationships with.

Don Tucker: Have we turned around Belhaven? I don't know. I don't see any numbers anymore but I know we sent a lot of people down to Belhaven to try to rescue that little hospital. A lot of what we do is for our good. I mean, you know we want a feeder hospital, we want a feeder community, so we will give money in order to develop a referral line or referral base and that's marketing. Those are just some of the things that are occurring today that are foreign to my generation. I mean I went into medicine not to make a fortune but to provide a service that was essential to improve the welfare for your community and a quality of life for the people and to develop personal relationships that would be of benefit for both the physician and the patient.

You could have your patient come in and confide in you but I think they are so busy that you try to come in and in ten or fifteen minutes talk about something that is important to you but your physician may feel it has no particular bearing on your medical complaint and you have to try to find an ear for that sort of thing. Nobody wants to spend time talking to the patient to try to find out how the patient feels. Sadly, this is one of the things that are of concern. People who are going to require a lot of medical care; it does concern me but I am not sure I would be comfortable in the hands of a lot of the doctors that are being trained now taking care of me because they don't see the patient and they don't see the patient's needs as they are so technologically oriented. The hospital is operating the robot. Medicine is not as personalized as it was and a hospital is not as personalized as it was, and I think it is a big challenge for the future. Somebody better try to train people to look at patient's needs and not rely so much on the computers.

Beth Nelson: As you look back over the years that you have been here, can you identify some people who you would say have been major contributors to the hospital's success?

Don Tucker: Sure, I would put Woodrow Wooten down, Kenneth Dews; I think Jack Richardson did a great job when he was here; C. D. Ward did a good job.

Beth Nelson: Talk a bit about C. D. Ward.

Don Tucker: Mr. Ward was a friendly person. If you went into Mr. Ward's office you felt like that you were important and that he would listen to you. Generally he responded to the staff needs in a very timely way. Being an administrator in a hospital in those days there were not as many people as there are now. You passed by his office and you could always walk in. How many people can pass by the administrator's office today and drop in. There are probably not many. I also just want to say that where the offices are is not where the patients are.

Jack Richardson used to walk the halls and come over to the offices. The current administration has done that too, I don't mean to say anything about it, but I am sure they don't have the time because there are certainly more physicians. If you have got a complaint you are probably going to be in his office. There is a difference in twenty-five on the staff and the people you have now and there was more socialization between the medical community and the support staff of technicians, administrators and even from the physicians. The Medical Society is poorly attended now. When I was here we would eat in the basement of the Episcopal Church and went over to the hospital and we got together and there were eighteen to twenty-five people who sat around tables and you really understood the problems of the people that you were working with. Today you can't do that.

Beth Nelson: We do have a hard time getting a presence at those quarterly meetings.

Don Tucker: Back to the list of people; Kenneth Dews I mentioned, Ira Hardy is extremely important, Frank Longino was extremely important.

Beth Nelson: Where did you stand on the privatization issue?

Don Tucker: I wasn't around when that was being considered. I think as a county citizen you hate to see this happen. The hospital paid a sum of money and I'm not sure that I have seen any numbers. I'm sure the hospital has paid off any monies that it could to be able to be privatized.

When I was on the board I saw a lot of things that bothered me because with the county relationship all the trustees were political, the trustees were on without regard to qualifications and I didn't think a lot of the people that were serving on the board were really qualified. They served there because they had been loyal to this commissioner and that commissioner. I thought it would probably stop the hospital from going forward with the politics and so I was in favor, but reluctantly in favor, and I thought it was a necessity for the hospital to grow and be able to innovate and not to be encumbered by regulations on health care needs, so I thought it was a good thing.

I do want to see the hospital stay healthy but I want to see a cross section of confident physicians that I can use as resources if I had medical problems so I would like to see our community continue to attract and be able to retain them. It concerns me when I see people leaving Greenville for one reason or another; people are complaining about some of the things that are happening at the hospital, some of the things that are happening between the medical school and the hospital and private practice but I realize that there is not much I can do about it.

Beth Nelson: It's good not to have to worry about those things on a day to day basis.

Don Tucker: It is nice.