Pitt County Memorial Hospital Collection

                                                                     Accreditation Lost and Regained

          Everyone working for an alliance between the school of medicine and Pitt County Memorial Hospital believed that the last barrier had been overcome when Chancellor Leo Jenkins, Vice Chancellor Ed Monroe, and acting dean of the medical school, Dr. Harold Wiggers, went to Chapel Hill to inform the UNC Board of Governors about the affiliation agreement. No one anticipated any problem when, in March 1975, a single site visitor from the Joint Commission on Accreditation of Hospitals (JCAH) had looked over the 21-year old hospital facilities on West Fifth Street.

         The visitor had given no reason to anticipate that there would be any problem with accreditation, usually a routine affair. For that reason, in early June, the hospital administration was stunned to learn that JCAH, later JCAHO or Joint Commission on Accreditation of Healthcare Organizations, had suspended the hospital’s accreditation, citing more than 70 violations of guidelines. Because the site visitor from the JCAH had failed during his visit to indicate disapproval in any way, the decision not to accredit came as a shock to the hospital trustees when they were belatedly informed of it at their meeting June 17. Since the Department of Health Education and Welfare had delegated its survey responsibilities to the JCAH, without accreditation the hospital would receive no Medicare and Medicaid reimbursement, on which its prosperity strongly depended.

          In response to the unexpected suspension, Acting Dean Harold Wiggers wrote to his old acquaintance, Dr. John D. Porterfield, who was chairman of the JCAH at the time. Dr. Wiggers wrote that he had been led to believe that the field representative had not carried out his mission appropriately, and appeared to have developed a vindictive attitude because of what he took to be harassment in the refusal of a few physicians to cooperate with his survey. While Wiggers did not excuse the doctors’ behavior, he did not believe that the hospital should be penalized for the attitudes of a few of its medical staff and vocal physicians from the community.

          He outlined for Dr. Porterfield the progress that had been made toward developing a four-year medical school in Greenville. Withdrawal of accreditation of the hospital would be a catastrophe, threatening recruitment of faculty for the School of Medicine, funding, and accreditation. If the hospital were not re-accredited well before March 1976, the date of the medical school’s accreditation visit, then the entire project would fail.

          Wiggers appealed to Dr. Porterfield to ensure that the hospital’s appeal was given attention quickly and fairly. In the meantime, everything possible would be done to guarantee that the hospital met the commission’s requirements.

          Richardson, the hospital director, indicated that PCMH representatives would contest the decision when they met with commission staff members in Chicago on June 26. When the site visit occurred, Richardson had tried to point out to the JCAH visitor that physical deficiencies at the present hospital were the prime reason for the new multimillion dollar building. He also said completion of the new hospital would remedy many of the problems noted by the site visitor.

          Some 21 of the violations concerned documentation of hospital activities for which there was no record. Richardson said that this indicated the hospital was doing things without record and without compensation for the public’s good. Some of the commission’s recommendation concerned environmental services and the physical condition of the existing hospital. Others dealt with new fire safety codes, which would be met by the new hospital. Eight had to do with governing body bylaws and 28 with revisions of medical staff bylaws. These revisions had been delayed until some of the interrelationships between the PCMH staff and ECU’s faculty could be clarified.

          Chief of Staff Dr. Eric Fearrington found the whole procedure unsatisfactory. He was working with trustee chairman Wilton R. Duke to prepare a presentation to the commission in Chicago the following Thursday afternoon, and commented, “These people don’t care a thing about how we treat our patients. We could kill every one that comes in just as long as we document it correctly. But we have to go through this to get the federal nickel.”

          Trying to sooth public apprehensions, ECU Vice Chancellor for Health Affairs Dr. Edwin W. Monroe, acknowledged the hospital was outdated and overcrowded, saying, “Once this situation is understood clearly by the accrediting authorities, I believe that the preliminary decision, based on only partial understanding by a site visitor, will be changed.”

          As the accreditation battle was being waged, the General Assembly approved the ECU medical school’s appropriation. This funding would permit expanding PCMH to provide space for the medical school’s teaching needs, support an intensive care nursery, and add a building for the medical school departments and administration. Subject to state approval, work was scheduled to begin in May 1976, on a 100-bed tower for the medical school, giving the hospital a total 400-bed capacity. The addition was estimated to cost $12.3 million instead of the $20 million for a separate teaching hospital.

          Nearly a month later, the UNC Board of Governors accepted a committee recommendation on spending cuts in response to the General Assembly’s budget reductions. It also withheld the $13 million appropriated to provide teaching facilities in PCMH until an acceptable affiliation agreement had been reached and approved by all concerned parties. Also, the board stipulated that the hospital must gain renewal of its accreditation and approval by the state hospital planning authorities for the additional construction.

          In the midst of the turmoil, Dr. William E. Laupus began his tenure as dean of the ECU medical school on July 1, 1975. Earlier in the year, Laupus, chairman of the Department of Pediatrics at the Medical College of Virginia, had come to Greenville as a consultant on teaching facilities. He and two other consultants had recommended that ECU should not build a separate hospital, but work out an affiliation agreement with PCMH.

          While Laupus was at ECU, Dr. Wallace Wooles, director of medical sciences, who had worked with him in Virginia, suggested that he should apply for the deanship of the medical school. He had just completed working on a major project at the Medical College of Virginia–an addition to the MCV Hospital, and he thought that his contributions to MCV had probably reached their peak. If he hoped to accomplish much more, he needed to go elsewhere. So, he submitted his name for consideration by the search committee, and was chosen to be the new dean.

          Although he was not to begin working full time until August 1, Laupus was already spending time in Greenville, becoming oriented to the situation. He responded pacifically to the Board of Governors’ actions, saying he considered the action taken by the board “exactly what we expected, quite routine. It’s just a matter of following procedure and not releasing the funds until everything is in order. We’re proceeding on all three requirements and will be ready whenever they choose to meet. This will be up to Dr. Friday, I believe.”

          PCMH won a first victory in the campaign for re-accreditation on July 24, when Richardson announced that the hospital had been given a provisional one-year accreditation from the JCAH. Accreditation was usually granted for two years, but the full term was withheld because of deficiencies in the physical plant, which would be eliminated when the new building was completed in 1976, and because of revisions being made in the medical staff bylaws to prepare for affiliation with the medical school.

          With accreditation problems solved at least temporarily, the Governor’s Advisory Council on Health Planning gave preliminary approval on September 15 to a $7.6 million construction and renovation project at PCMH to provide clinical facilities and space for the ECU medical school. The final decision was left to the Comprehensive Health Planning Agency of the Human Resources Department. The planned construction would give the hospital 88,000 square feet of additional space, including clinical laboratories, X-ray facilities, emergency operating rooms, and the 100-bed tower.

          At a public hearing in Greenville, no one appeared to present opposing arguments, an unusual event for a project of its size, said Lawrence Burwell, chief of the agency. He saw no problem with the request, and barring objections, he anticipated approval before deadline at the end of September.

          As one obstacle after another fell, an old bugaboo reappeared. On September 16, 1975, Laupus requested that the school be given 50 percent representation on the PCMH Board of Trustees’ Executive Board. The trustees informally rejected his request. Laupus said the Liaison Committee on Medical Education had demanded such representation, and asked hospital board members to reserve judgment until the matter could be discussed at length. He promised to send Dr. Fearrington, chief of staff at the hospital, a copy of the LCME report calling for the 50 percent representation, which could not be made public.

          Fearrington responded, “Apprehension is running high in the county that this hospital will be taken over by the medical school.” Mrs. Bancroft Moseley, a member of the hospital board said, “The people of Pitt County do not want this, and we are their representatives.” Dr. John Wooten said he considered the LCME demand a “rather arbitrary one. I don’t see how they can say that the medical school will succeed if they have 50 percent representation on the hospital executive committee and will not if they have less. And I wonder if it would stand up in court if it were to be contested.”

          Dr. Fearrington concluded that he believed the university faction should convince their people to accept “the affiliation agreement we worked so hard and long on.”

          Ironically, as local tensions resurfaced, other barriers fell away. The Comprehensive Health Planning Section of the Department of Human Resources on September 23 ruled that expansion of clinical facilities to accommodate the medical school at ECU could go ahead. The approval did not include expansion of the hospital’s bed capacity, the agency said. This issue would have to be considered in a separate request.

          University and county authorities moved ahead. On October 31, 1975, the UNC Board of Governors approved by a 23-6 vote the 20-year affiliation agreement between the ECU School of Medicine and Pitt County Memorial Hospital. The board agreed to release $4.8 million to expand facilities of the 315-bed hospital, and to reserve $3.8 million to add a 100-bed tower later. Pitt County Manager Reginald Gray said the hospital trustees and the Pitt County Board of Commissioners had already tentatively approved the agreement, but still had to give formal approval.

          President William C. Friday said that the signing of the final version of the agreement by UNC and PCMH concluded all major pending business as far as the Board of Governors was concerned, in terms of allocating funds and getting the construction project under way for the medical school.

          Laupus, replying in a telephone interview to the strong objections to affiliation voiced by George Watts Hill, Sr., an influential board of governors member from Durham, said there were “lots of checks and balances” in the agreement, and that he was confident it would protect the state’s investment in the hospital. He said that the agreement relied on the good faith of both university and county officials. “I don’t think America got where it is by people not being willing to risk some things on faith,” he said. He also said that the medical school’s having only 40 percent representation on the board of directors of the hospital, which Hill disapproved, would be balanced by being able to designate the chairmen of the medical school’s clinical departments as heads of staff in the respective clinical areas of the hospital.

          Hill had objected that medical school faculty might, because of regulations about state salaries, be paid considerably less than their colleagues from the community who were appointed by the hospital board of trustees. He had also complained about the agreement for ECU to pay all educational costs, because it would be impossible to separate them from treatment costs. Laupus agreed that some points still required clarification but said problems could be resolved by negotiation.

          Hill claimed that affiliation was likely to raise costs for patients, which at the time was only $48 a day at PCMH, where at Duke and North Carolina Memorial it was about $200 a day, and at Watts Hospital in Durham $110 a day. In rebuttal, Laupus said, “I don’t think costs will increase anything on that order at all, because (the hospital) is going to be in a completely different milieu (from those mentioned by Hill).”

          In December, the hospital board authorized Freeman-White Associates to work with the medical school architects to make necessary changes in working drawings for the alterations in the hospital building. The modifications were not to delay the December 1976 opening date for the hospital.

          On February 27, 1976, the UNC Board of Governors recommended 14 persons for appointment to the Board of Trustees of Pitt County Memorial Hospital. The trustees were expected to name the state representatives as well as two additional county appointees at the meeting of the Pitt County commissioners on the following Monday. The appointments were to be for staggered terms.

          The hospital board had 19 members before the new appointments and they raised the board’s size to 35, with 60 percent local and 40 percent state representation.

          The Board of Governors recommended:
                G. Henry Leslie, Greenville, Burroughs-Wellcome plant manager;
                James T. Cheatham, Greenville attorney;
                Raleigh Carver, Elizabeth City, chairman of the Pasquotank County Board of Commissioners;
                Bill Neal, a Roanoke Rapids businessman;
                Nancy Norwood, Goldsboro;
                Louis Renn, Jacksonville, real estate agent and chairman, Onslow County Board of Commissioners;
                Dean Rich, Raleigh, NCNB eastern region trust officer;
                William R. Roberson, Washington, former member of NC House of Representatives, chairman of the                 board of WITN-TV;
                Norfleet Sugg, Pinetops, executive of Planters Bank and Trust Company of Rocky Mount;
                Hal H. Tanner, Sr., Goldsboro, publisher of the Goldsboro News Argus;
                Martha Walston, Wilson, member of the Wilson city council;
                Dr. Charles Watts, Durham, medical director of North Carolina Mutual Insurance Co.;
                Dr. Jesse Williams, Fayetteville, director of the Cumberland County Health Department;
                Mrs. Donald Diechman, New Bern auto dealer.

          With their conflicts behind them, PCMH and ECU School of Medicine solidified their partnership. With hierarchical issues put to rest, the realities of administering their joint venture set in right away, in the form of financial issues.

          “We are working to locate the money for what we need in terms of equipment for the new hospital,” hospital Director Richardson said. He said that an additional $700,000 had been put into the budget. Hall, the hospital’s construction manager, had learned recently from the Medical Care Commission that $250,000 must be committed to the rehabilitation center. More than $600,000 was still needed. The biggest problem was equipment for the X-ray department. Dr. Laupus asked the hospital administration for a list of the items needed and a statement of how they would each relate to the teaching function of the hospital. Medical school funds might be used if the purchases could be shown to support teaching.

          The next obstacle came from the national accrediting agency. The Liaison Committee on Medical Education informed UNC President Friday in April 1976 that the facilities planned at the new PCMH for the ECU medical school might not be adequate. The school might have to develop cooperative arrangements with other hospitals to provide satisfactory clinical material for even a 24-member inaugural class.

          ECU immediately responded to the LCME reservations. Chancellor Jenkins said that Dr. Laupus was developing affiliation plans with other hospitals in the area to supplement the affiliation with the new Pitt County Memorial Hospital. He and his faculty believed there would be ample clinical cases to teach medical students and residents.

          The report of the two LCME officials who visited the school in March 1976, had been positive, Jenkins said, clearly indicating the medical school was on track. They intended to continue to work vigorously toward the goal of enrolling the first students in the coming academic year.

          In October, 1975, the UNC Board of Governors agreed to release $4.8 million to expand facilities of the 315-bed hospital and hold back a $3.8 million reserve to add a 100-bed tower to the hospital when the beds were needed. In April 1976, the PCMH trustees announced a meeting to express dissatisfaction with the recommendation to reserve the construction money. The board invited Pitt County’s four representatives in the legislature, and as many representatives as possible from neighboring counties.

          Board member Dr. Lee West said, “Pressures are coming from other areas of the state to withdraw the whole $43 million allocated for the medical school.”

          The chief of the hospital medical staff, Dr. Fearrington, said, “It is my understanding that, according to North Carolina law, one legislature cannot obligate another for any funds. So, once the money is taken away, there’s nothing that says it’s got to be put back. I don’t want to see the people of Pitt County left holding the bag when the rooms they’re building now are quickly filled and more are needed.”

           Board member Norfleet Sugg of Pinetops said, “It disturbs me that the eastern North Carolina members of the Advisory Budget Commission, which has proposed this withdrawal, have been so passive about the whole thing. They say the money is needed for other things, but what’s more important than health care? We’ve got to start building a case for a strong political fight, if that’s what it takes, and apparently it is.”

          Richardson announced on April 23 that the hospital board would ask UNC officials to designate funding for the teaching addition as a top priority project in 1977. The addition was necessary to implement the affiliation agreement adopted by UNC and the hospital, under which the hospital would provide resources for the medical school’s teaching. The space, to be added above the front entrance to the hospital, modifying the central portion of the building, would have space for X-ray, laboratories, conference rooms and offices for medical school departments and individual physicians. The three-story addition was completed and put into use in August 1977, in time for the medical school’s first class of students to occupy it.

          Richardson reported to the county commissioners on August 2, 1976, that it might be Easter before the new hospital would be ready to receive patients. Work on the $4 million addition to provide clinical facilities to the ECU medical school could delay the opening past the December target date. Hall, construction manager for the project, said finishing work was “coming along fine,” but some of it was behind schedule.

          Richardson also filed notice with the Department of Human Resources of the hospital’s intention to purchase equipment for computerized tomographic scanning (CT or CAT scanning) at an estimated cost of $640,000. The equipment was to be used by clinicians at both the hospital and the medical school.

           In the months before the completion of the teaching space, wrangling between the hospital and UNC Board of Governors continued. On February 11, 1977, the Board of Governors’ planning committee approved ten changes to the ECU-PCMH affiliation agreement that the hospital staff had requested.

          Board member William A. Johnson was concerned about an amendment that gave the medical staff executive committee veto power over any duplication of hospital services. Dr. Laupus told the committee the question had no practical importance, because the medical school would not want to duplicate hospital services. He also said that the medical staff of the hospital would take it personally if the amendment about duplicating services were turned down. The planning committee approved the amendment, but gave the veto power to the chairman, not the full medical staff executive committee.

          The planning committee also had reservations about a change saying the university could not impose any requirements that would restrict practices that met accreditation standards, because they were concerned this provision would lock the medical school into low standards. The rule, Laupus said, would apply only to members of the medical staff who were not on the medical school faculty and he did not anticipate its causing problems for the school.

          Hill objected to all the changes, because he said the university was compromising too much.
The amendments were to go back to the PCMH board of trustees for a vote on the changes made by the planning committee, and return to the UNC governors for final approval.

         Laupus said in an interview on February 17 that the verbal changes made by the planning committee were not major, and that he and others were pleased the agreement had “held up so well.” He was gratified that the dean of another medical school anticipating affiliation with an existing hospital had asked for a copy of the ECU-PCMH agreement, after being referred by an accrediting agency that found the agreement a model one.

                                                                     An Academic Medical Center

          On March 27, 1977, Governor James B. Hunt, Jr., was the keynote speaker for the dedication of the new Pitt Memorial Hospital. Director Richardson estimated that about 400 people showed up for the dedication, and more than 10,000 people toured the building Saturday and Sunday afternoons. UNC President Friday was present, along with key UNC vice presidents and members of the UNC Board of Governors and Board of Trustees. ECU trustees and many other notables also attended.

          In the next few months, the fledgling medical center was given a higher funding status within the UNC system. In April the Joint Appropriations Subcommittee on Education gave first priority to $9 million in operating funds for the ECU medical school. In addition, $3.82 million for construction of a bed tower at the new PCMH was also given first priority.

          The new hospital admitted its first patients in April. With the accreditation of the School of Medicine as a four-year medical school in the same month, a regional medical center was born. At its opening, the hospital had over 100 physicians and dentists on the medical staff, 200 nurses, and 850 support staff. There were 24 beds in the medical and surgical intensive care units, the latest monitoring and therapeutic equipment, and 10 operating rooms in the surgical suite located at the hub of the hospital. The business office was fully computerized, and computers monitored the hospital’s air conditioning, heating, energy consumption, and bed status. The entire facility was connected by a pneumatic tube system for transport of reports and records. The dietary department was equipped to prepare 7,000 meals each day.

          There were still some deficiencies to manage. Hall recalled that before new furniture and equipment for the patient rooms could be purchased, the money began to run out. Richardson and the trustees hustled about trying to get together enough money to put new beds and other furniture at least on the first floor. After they had exhausted all the resources they could identify, they still lacked the furnishings for 18 rooms. Robert Monk was present at a discussion between Hall, Richardson and some other board members. He asked how much money was needed, and Hall told him about $18,000. Monk said he would take care of that, and he sent a check for that amount so that they could have all new furniture on the first floor. On the second and third floors they had to settle for taking the beds out of the old hospital, cleaning them up and painting them.

          The only capital improvement money for buildings at ECU in the 1977-79 state budget announced in June 1977, was $3.82 million for the additional bed tower at PCMH. The total cost of the project was $5.5 million. When it was finished, it would add 138 beds, bringing the hospital’s capacity to 556 beds. On the first floor of the tower would be surgical sub-specialties such as orthopedics; pediatrics would be located on the second floor, and the third floor would house additional clinical space. The teaching addition, a three-story construction across the front of the hospital, was put into use to accommodate the charter class of 28 students, admitted to the four–year medical school on Monday, August 22, 1977.

          This first class reported to the main ECU campus for orientation, and on Tuesday classes began . The school had received 350 applications, 280 of them North Carolinians. Of the 28 students admitted, all were residents of North Carolina who had expressed interest in family practice or other primary care fields, and also in practicing in the state after their graduation. Five members of the charter class were minority students.

          The admission requirements were quite conventional for a medical school, apart from the emphasis on interest in primary care, and the limitation to North Carolina residents. In its decisions, the committee considered grade point average, Medical College Admissions Test scores, and letters of recommendation from college faculty members and friends. Each applicant also submitted an essay explaining why he or she wished to study medicine, and was interviewed by two separate committee members.

          The interviewers considered the applicants’ personalities and what the admissions committee foresaw as the student’s ultimate impact on medical practice, whether they would remain to practice in North Carolina and what were their attachments to the state. Attachments might include relatives living in the state, or whether spouses were from North Carolina. Every reasonable attempt was made to find students who appeared likely to remain in the state when they started their practices.

          The admissions committee also emphasized extracurricular collegiate activities and employment experience. One medical school staff group worked with counselors in high schools, junior colleges, and community colleges to recruit promising students.

          There were many bitter memories clinging to the opening of the new medical school. In spite of these the occasion was an opportunity to celebrate. The names of the charter class of medical students were listed in the Daily Reflector. The newspapers of the state were brimming with news articles and editorials, with both the Associated Press and United Press International carrying the story. Hometown papers carried stories about most of the students entering the medical school.