Growth

Faced with the hospital’s increasing effectiveness, by the beginning of 1979, even some of the piedmont opponents of locating an academic medical center in Greenville were beginning to admit that the project was succeeding. The Pitt County Memorial Hospital had evolved from being a community-oriented local hospital to a regional medical center serving 29 counties.

The Raleigh News & Observer on February 18, 1979, described one of the noteworthy kinds of change that had occurred in eastern North Carolina. A doctor in Tarboro, about 25 miles from Greenville, sent a three pound premature baby with respiratory problems by ambulance to PCMH, about 45 minutes away. The baby was taken immediately to the neonatal intensive care unit in the hospital, where there was the most current equipment and trained personnel. The nursery’s specialized care increased the chances that its small patients could not only survive but also survive without damage.

The usually antagonistic newspaper commented, “A few years ago, the child would have been transported in the opposite direction because the nearest facilities for high-risk infants were located in the piedmont. Crucial time was spent in travel instead of treatment.”

Hospital Director Richardson concurred, saying that eastern North Carolina patients did not have to go to distant medical centers as they had in the past.

Generous local funding made it possible for the hospital to become a regional medical center, providing a well-equipped facility and highly skilled people. The affiliation agreement with the ECU medical school was an added advantage in the hospital’s development. That agreement, considered by some members of the Liaison Committee on Medical Education to be an ideal model, had clearly defined the roles that each of the two institutions would play. The hospital furnished traditional patient care and a location in which the medical faculty could provide superior training for medical students and residents, as well as contribute their skills to the treatment of patients.

The hospital’s influence expanded throughout eastern North Carolina. Richardson said that about 42 percent of the hospital’s beds were given over to patients from outside Pitt County. This did not place an excessive burden on county residents because state funding of services related to teaching helped to offset the costs. He also argued that the growth of PCMH did not harm other area hospitals. Most patients preferred to use their local facility whenever they could obtain necessary treatment there. Most referrals to PCMH would have been made in any case, to avoid the lost time, stress, and expense in travel to distant facilities.

The emergency room was one facility that was used heavily by patients not only from Pitt County, but from the surrounding area. In August 1977, Dr. Howard Gradis, Pitt County Memorial’s director of emergency services, told the Daily Reflector that the hospital’s emergency room staff was inadequate for the demands made on it, although it included four emergency physicians (one always on duty), 15 registered nurses (at least three of whom were on duty at all times) and 9 emergency medical technicians (two on duty at all times). He noted that the emergency area had six acute trauma beds, six examining rooms, a fracture room, and a cardiac room, all fully equipped. Help was on the way, however, with the expansion scheduled to be complete in October. After the expansion, the emergency area would have an enlarged waiting room and a six-bed observation ward.

In October, groundbreaking ceremonies were held for a 33-bed neonatal intensive care unit to be added to PCMH for the specialized treatment of high-risk newborns. This would bring the bed count at the hospital to 403 when the unit opened on July 1, 1978. Dr. Jon Tingelstad, chief of pediatrics, announced that Dr. Verbena Sugg would direct the special nursery’s activities, with the support of several Greenville pediatricians, including Drs. Earl Trevathan, Ben Shappley, Edward Davis, Michael Bramley, and Samuel Pepkowitz.

On November 22, 1981, the new bed tower was dedicated, a testament to the hospital’s increasing importance to the region. However, the hospital’s transition from community hospital to regional hospital was not free from growing pains. In 1982, PCMH faced a financial emergency. Richardson confirmed plans to increase room rates from the current rate of $125 per day to between $150 and $180. Three days later, he informed the hospital staff that, except for registered nurses, no employees would receive the usual October cost of living raises. There were several causes for the deficit. The transition to higher levels of service as the hospital increased secondary and tertiary care generated additional expenses. There were changes in the Medicaid reimbursement level that could create a shortfall estimated at more than $2 million. The cost of drugs and other patient supplies was expected to add another $2 million plus. To add a new radiology technology area, improve the laboratories, and complete the expansion to 569 beds would call for capital expenditures of $3.2 million.

At their meeting on August 17, the trustees approved a budget of $77.5 million for submission to the Pitt County commissioners. Room rates, which generated 42 percent of revenue, were being increased to $160 a day, effective at the beginning of the new fiscal year on October 1. The county commissioners approved without objection the budget presented by the hospital board.

PCMH still had a way to go in the transition from a county hospital, serving mainly as an acute care facility for a small area, to being an academic hospital and regional referral center. Richardson commented that the years of development had not been easy ones. “They have been ones of constant expansion and phenomenal growth in our programs and facilities. We are still Greenville’s community hospital, but we have now taken on the responsibility of serving the people of eastern North Carolina as a regional referral medical center.”

Long-range Planning

The need for space for support services had left many other activities severely compromised, especially healthcare. Many existing programs needed strengthening, and new programs being planned, such as transplant and open heart surgery, would strain facilities even further. The hospital and medical school leaders decided that they needed an orderly plan of development for improving and expanding support programs.

Responding to this need, PCMH trustees voted on December 21, 1982, to adopt the first phase of a Long-Range Facilities Plan to enlarge the hospital on its present site to as many as 900 beds by 1995. An architectural firm presented the plan to the board. The emergency and non-acute psychiatric beds would be increased and the surgery and radiology areas enlarged at a cost of about $5.3 million. X-ray would expand into the existing emergency area after the new addition was finished. The psychiatry section of the project would begin before the surgery, emergency, and radiology portions, which were scheduled to begin in the summer of 1983.

The trustees authorized $540,500 to finish studies of the plan and prepare architectural and engineering drawings, and to retain local architects to design modifications leading to the next step in the proposed expansion, meeting certificate of need designation of 569 beds. The hospital had on hand about $3.8 million for Phase I.

At their next meeting, on January 18, 1983, the hospital board of trustees received a report that contracts had been awarded for the $5.2 million radiation therapy center to be constructed between the hospital and the medical school’s Brody Medical Sciences Building.

In a separate action, the trustees voted to name the new administration-education building for county Commissioner Charles Gaskins and Trustee Henry Leslie.

Handling Emergencies

Area medical personnel continued to prove their value to the region. In a mock disaster staged on October 21, 1982, Pitt County rescue squads moved 53 people from the site of a mock disaster to PCMH in 2 hours and 9 minutes. The purpose of the exercise was to test the preparedness of emergency service personnel to meet an actual disaster. The scenario was built around a sham explosion at a rock concert. Two doctors and a nurse arrived at the scene in 33 minutes, to help decide which patients most urgently needed treatment. The Eastern Pines Fire Department responded with a truck, and both Winterville and Simpson fire departments sent personnel.

Curious spectators blocked the road and obstructed access of the rescue workers and their vehicles to the area where the “victims”—nursing students from Pitt Community College—were located. Joyner appealed to local residents not to go to the scene of a disaster because traffic hampered rescue efforts. He said, nevertheless, that the entire mock disaster was one of the best drills they had had, with more people transported than ever before. It was a timely means of preparation for a series of events that would soon test the medical center’s emergency response.

The grim and urgent need for a sophisticated emergency department and trauma center was demonstrated in 1983. An explosion in the city’s Village Green Apartments on March 2, caused by a leaking liquid propane gas tank supplying a clothes dryer, demolished 11 apartments. It killed an ECU student and injured 12 others. Seven students were admitted to PCMH emergency department for treatment and observation. Three others were treated and released.

Two students, Rick Murray and Stuart Sloan, living in an apartment on the top floor of a building only a few yards from the one in which the explosion occurred, were covered by broken glass from the blast. Sloan told a reporter from the Daily Reflector that they had heard a girl screaming under the wreckage as they ran down the stairs. They pulled her from the rubble. “Rick grabbed her and handed her to me, and I carried her down the hill,” Sloan said. “Her apartment just collapsed around her. She was kind of shaky.” He reported that she was bleeding from a cut on her head.

Sloan, from Jacksonville, NC, thought a tornado had struck. He smelled gas in some areas, but saw no sign of fire. Murray added that the force of the blast “just about blew me out of bed.”

On April 18, scarcely a month after the tragic explosion, a school bus overturned, injuring five students from Wahl-Coates Elementary School. Director of Emergency Services Jack Allison went immediately to the scene, after arranging for first-shift personnel to stay after hours to help second-shift workers. He led the triaging of the children. Seven of the 65 children in the accident were sent immediately by emergency vehicle for treatment. Police cars, private vehicles, or emergency vehicles took others in. A secondary treatment center was set up in the Ambulatory Medical/Surgical Unit manned by Dr. Walter Pories and a group of surgical residents and nurses.

The disaster alert continued until 4:50 PM, with treatment continuing into the evening. More than 30 doctors responded to the disaster call.

Dr. Allison said, “No one could have predicted that we’d have another disaster so soon after the March 2 apartment house explosion. These events have really given us opportunity to look to our capabilities to provide emergency care for disaster victims. We see we’re doing a good job, and we see ways we can improve.”

Improvements made in plans for the hospital and local safety personnel were all too timely, as nature dealt a cruel blow to the community when the tornadoes of 1984 ravaged the area. The staff of Pitt County Memorial Hospital was prepared for its emergency role, and faced with the tornado disaster, reacted with order and precision.

Another Emergency

Writer Germaine Greer said , “Perhaps catastrophe is the natural human environment, and even though we spend a good deal of energy trying to get away from it, we are programmed for survival amid catastrophe.” One might amend this to say that perhaps catastrophe is what a hospital is programmed for. No amount of planning for disasters can make such programming more than a tentative blueprint for the unexpected, unpredictable events that happen.

The precariousness of the hospital’s water supply and the importance of a way to maintain an adequate water supply in an emergency were underscored on February 15, 1994, when a 10-inch water main ruptured near the intersection of Memorial Drive and N.C. Highway 33, and interrupted the water supply to PCMH from about 7:15 a.m. to about 1 p.m. It was necessary to shut down a 36-inch water line so that utility workers could repair the broken one. Repairs were completed by about 12:30 p.m., after which the water mains had to be flushed out to remove any sediment that had collected in them.

The hospital normally used about 200-300 gallons of water a minute, and around 8:00 a.m. almost ran out. More than 20 tankers from fire departments in Pitt, Edgecombe and Greene counties began bringing water to pump at a rate of a thousand gallons or more per minute into the hospital system, and by 10:30, according to Ralph Hall, vice president for facilities management, were still pumping in several hundred gallons a minute. During the six hours or so before the main was restored, the tankers had brought an estimated 330,000 gallons of water from Bell Arthur Water Corp. mains about 8 miles west of Greenville.

Once more, the hospital’s disaster plan proved effective. Hospital operations were not seriously curtailed, though it was inconvenient not to be able to flush commodes; and faculty, staff, and students had to be asked to limit their water use. Some elective surgery was postponed because of the low water pressure, but there was no interference with patient care, and no urgent operations were affected.

EastCare

Another measure of PCMH’s success in the mid 1980’s was the resounding response to the EastCare helicopter service. On December 18, 1984, the hospital board of trustees had budgeted $754,119 and authorized the administration to set up a helicopter ambulance service. Faster treatment in critical situations would improve the chances of living rather than dying for people whom the helicopter brought in. The service could not only bring critically ill and injured persons to the hospital, but also carry specialized medical personnel to where persons in need were located. The helicopter ambulance would serve 1.2 million persons in 29 eastern North Carolina counties, an area largely neglected in terms of both transportation and healthcare resources.

The public was invited to come and look at the EastCare helicopter and meet its crew members on June 30, 1985, following a dedication ceremony held in the PCMH auditorium. By the Wednesday before the formal dedication, the helicopter had been in operation for nearly three months and had already made 101 flights since its first one—about twice as many as anticipated. Mike McGinnis, the chief flight nurse, felt that the heavy volume was the result of a high level of need for the service, and of the cooperation given by the residents of the 34 eastern North Carolina counties it served. EastCare had transported patients from more than 20 hospitals and clinics in the region.

Linda Crisp of Beaufort County testified to the value of access to an air ambulance. “My little girl very well might not be alive if it weren’t for the EastCare people,” she declared. An automobile had struck her nine-year-old daughter, Sandy Woolard, and when she was brought to the Beaufort County Hospital in Washington had no pulse. After the doctor there restored breathing and ordered X-rays, he called EastCare. The helicopter arrived in about 10 minutes. By the time her mother drove to PCMH, the surgeons were already at work on Sandy’s injuries. Mrs. Crisp said that during the entire month and a day of Sandy’s hospital stay, the EastCare crew stayed in touch and kept her informed about all that was being done.

More than 100 other persons who suffered injuries or had other medical emergencies had reason to be grateful for EastCare’s presence in eastern North Carolina. For example, the helicopter showed its worth when, on May 31, a school bus in Greene County had a wreck in which a number of children were injured. One of them, Shawanna Albritton, suffered a serious head injury, and was flown to PCMH for treatment. One flight nurse stayed at the bus and worked with other children who had been injured, while one flight nurse and an emergency medical technician with experience in Vietnam accompanied Shawanna.

The service was valuable not only for its timeliness, but for the skills that the EastCare staff possessed. The nine flight nurses were all experienced in an emergency department or in intensive care nursing, and some in both. Mary Jo Bankhead, Alena Bramble, Dolly Bryan, Pam Demaree, Betty Harris, Brenda Hurdle, John Nelson and Cindy Raisor, like McGinnis, the chief nurse, were highly skilled, and could also receive direction by radio from the PCMH emergency room physicians. They also won the hearts of patients and families by making visits while their patients were recovering in the hospital.

In addition to the nurses and emergency medicine technicians, three pilots were assigned by the company furnishing the helicopter: Willie Dykes, Perry Reynolds, and Sam Ewing. Joe Belschner was assigned to keep the principal aircraft and its backup in good working order. Joan Hadder ran the office, and the hospital emergency department provided dispatchers. At every hour of every day crews were on duty, including two of the nine flight nurses. Whenever they were not needed in emergency situations, the nurses were on hand to work in the emergency department and the critical care unit as their duties permitted.

Emergency Services

The medical center’s development brought an impressive array of medical sub-specialties to Greenville that had never before been available in eastern North Carolina. Many of these capabilities increased the number of patients brought in for emergency or trauma-related care. Pressure on the Emergency Department’s facilities necessitated a major expansion and renovation project.

The project was completed by January 1985, and on the afternoon of Sunday, January 27th, an open house was held to mark the opening of the new Emergency Department and Trauma Center. The new center replaced the existing emergency department, increasing the area from 11,600 to 18,912 square feet, and the beds from 25 to 45. The center was the first phase of a $9 million project to add 38,000 square feet to hospital space, part of the long-range development plan. The entire plan was being paid for out of patient revenues, without calling on Pitt County for financial support.

The former emergency department space was renovated over the next six months to accommodate expanded surgery and radiology departments. The expansion in emergency facilities and adding the helicopter ambulance service would make it possible for the service to apply by midsummer for state designation as a Level I Trauma Center, on the same level with the services at Duke University Medical Center, Memorial Hospital in Chapel Hill, and Baptist Hospital in Winston-Salem. The emergency medical services officials would visit PCMH in the fall to confirm the classification.

In November 1985, Pitt Memorial became a Level I Regional Trauma Center, joining the select group of hospitals in North Carolina that had been given that designation. All were affiliated with medical schools. Dr. Jack Allison said that the high level of service required to qualify for Level I would ensure that eastern North Carolina residents had better trauma care than they had ever before received in the region. The center also featured a quick-service clinic for non-critical patients. The emergency staff’s intention was to do away with long waits and within 45 minutes to begin treatment of any patient who came in.

Dr. Paul Cunningham, director of the trauma center and assistant professor of surgery at the ECU School of Medicine, described the special resources necessary to qualify for Level I status. Among these was a computerized trauma registry that provided statistics about the varieties of traumas that occur in the area. Most of the approximately 150,000 persons who died from trauma in the United States each year were victims of motor vehicle accidents, shootings, falls, drownings, poisonings, or fires. The registry gave a preliminary indication that in rural eastern North Carolina more injuries were related to motor vehicle accidents than in urban areas and more had unsatisfactory outcomes, Cunningham said.

Kathy Bailey, manager of the trauma center’s outreach programs, who had been an emergency medical technician and a head nurse in the hospital’s neurosurgical intensive care unit, said that it was possible to do a great deal to prevent trauma. One important part of the trauma center’s service was the effort to prevent injuries by educating the public. Her office offered programs on prevention of injury in the home, industry, and on the highways. Along with Dr. Herb Garrison, she also administered a seatbelt safety program actively involving hospital employees, who spoke in support of seatbelt use to civic and professional groups and schools throughout the eastern region.

TraumaCare, a support group for trauma patients, was set up to give opportunities for patients recovering from serious injuries, along with their families, to meet with people who were in a similar situation.
Cunningham said that the achievement of Level I status had indicated a decision made throughout all units in PCMH to provide the best possible care to trauma victims. Each month about 100 people who had been injured were being admitted to the hospital through the center, which provided its specialized care to 29 counties in the area
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The commitment was to provide a variety of specialized resources. Twenty-four-hour staffing in the emergency department had been there from the start, as had anesthesiology service, operating rooms, the immediate availability of surgeons, and intensive care units for injured patients. Others were added or expanded: a trauma research program, a training program for physicians, nurses, and support staff; and a system for evaluating the quality of care. Cunningham said that it was impossible to maintain a high level of quality in the service without the trauma registry that permitted tracking patient outcomes.

The location of the EastCare helicopter ambulance service at the hospital was important, since about half of the trauma victims came from outside Pitt County. Essential also were EastCare’s connections with hospitals and emergency medical services in neighboring counties.

Problems and progress in solving them continued in emergency services. In August, 1992, Dr. Charles Willson, PCMH chief of staff, announced that a new program, “Fastrack,” was being inaugurated as part of the nighttime operation of the hospital’s emergency room. It would eliminate many of the long waits for patients, waiting caused mostly by the necessity of treating trauma and other serious cases as soon as possible. Patients with colds, rashes, or minor injuries occasionally had to wait several hours for treatment. Beginning in October, such patients would be routed into the Family Practice Center from 6 p. m. until midnight, seven days a week. The plan was to expand the hours later. The Family Practice Center was ordinarily used for clinics only during the daytime.

Heart Surgery

In the 29 easternmost counties of North Carolina, the death rate from diseases of the heart was 316 per million in 1997. At the same time, in the US as a whole the death rate from heart diseases was 272 per million. Along with a need for more internists specializing in heart conditions, there was an inordinate need for cardiac surgeons in PCMH’s service area.

At its December 1982 meeting, the hospital board had approved submitting a certificate of need for a cardiac surgery program, which would cost about $400,000. Cardiac surgery was available nowhere in the eastern part of North Carolina. It was offered only at Duke, Chapel Hill, and Bowman Gray, and at some large hospitals in Greensboro, Raleigh, Asheville, and Charlotte. By the time the project was completed, two operating rooms dedicated to heart surgery, a cardiac intensive care unit, and specialized equipment would bring the total invested in the heart program to more than $1.03 million.

PCMH and the ECU School of Medicine announced on July 6, 1984 that the Certificate of Need had been approved, and the hospital would begin open-heart surgery later in the month. The cardiac surgery program would be led by Dr. W. Randolph Chitwood, Jr., who had recently completed a 10-year residency program at Duke University School of Medicine. Chitwood came from “a family of country doctors” in Wytheville, VA., and took his MD at the University of Virginia before joining the surgical program at Duke University School of Medicine. During his last year at Duke he was the teaching scholar in cardiac and thoracic surgery.

Chitwood said that his team would begin at once performing coronary artery bypass surgery, and estimated they would do 125 operations during the first year of the program. A second cardiac surgeon was to join the program after the first year, and Chitwood expected they would perform at least 300 procedures yearly within three years.

The two operating rooms for cardiac surgery were to be added in the expansion of the surgery, emergency, and radiology departments, and the first floor of the hospital’s north patient tower renovated to serve as the cardiac intensive care unit, with six intensive, six intermediate, and six general care beds. The equipment for open-heart surgery and patient monitoring would be the best available, including a heart-lung machine and an intra-aortic balloon pump.

Chitwood’s surgery team would involve from the beginning three persons with whom he had been associated at Duke: a head nurse for cardiac care, a head cardiac operating room nurse, and a heart-lung machine operator with 15 years’ experience in cardiac surgery. Others to be included would be a nurse clinician to do patient education, and Chitwood’s assistant, who would be a surgery resident at PCMH. Chitwood was scheduled to teach general surgery residents and develop a cardiac research laboratory.
An open house with public tours of the new cardiac surgery unit and videotapes of an open-heart operation was held at PCMH on February 17, 1985. Hospital President Richardson said that for the first time since the hospital was established, an operating room was opened for inspection by the public. Operating Room 12, which was dedicated exclusively to heart surgery, was set up just as it was during an operation. This operating room was equipped with specialized instruments and equipment required for cardiac surgery. A special feature was the heart-lung machine that provided patients undergoing surgical procedures with oxygenated blood.
The cardiac intensive care unit, where patients were taken following surgery for recovery under the eyes of nurses and physicians, was also open to visitors.

During the six months after the cardiac surgery unit opened, 92 patients from 21 eastern counties had gone through heart surgery at PCMH, surpassing earlier projections. In addition, a second cardiac surgeon had been recruited. Of the patients, 69 were men, 14 were women, and 9 were children. The most frequent operation had been coronary artery bypass grafts, with 25 percent of the operations being to replace heart valves or to correct defects.

In the fall of 1984, percutaneous transluminal coronary angioplasty had been added to the treatments performed for coronary artery disease. For some heart patients, it was an alternative to more drastic coronary artery bypass surgery, making it possible to postpone that operation, often for several years. Angioplasty usually required only about three days of hospitalization, and the patient could often resume normal activities in five days. The procedure cost usually about $5,000 at that time, where bypass surgery would cost as much as $30,000.

In the angioplasty procedure, a guiding catheter was inserted, usually into the femoral artery in the patient’s groin, and threaded up to the heart, past the blockage in a coronary artery. Then, a second, thinner catheter with an inflatable portion near its end was run through the guiding catheter to the blockage. A dye was injected to enable the physician to observe the artery on a fluoroscope. The balloon portion was then inflated to break up the fatty plaques obstructing the blood flow to the heart muscle.

The procedure was performed by a physician, with the patient awake, but could not be instituted at PCMH until the advent of cardiac surgery. Dr. Douglas Privette, a cardiologist practicing privately in Greenville, said that angiography could be carried out only with a cardiac team present, since about one patient in 20 had to go directly from the catheterization laboratory into surgery. “In rare instances,” he said, “the lesion we’re attempting to unblock closes up completely and then the patient must be maintained artificially until a surgeon can unblock the vital artery.”

Dr. Randolph Chitwood said, “Coronary angiography is a very appropriate and useful adjunct to our cardiac surgery program here.” Having the procedure along with the use of streptokinase to break up coronary blockages meant that PCMH could offer patients in the region everything they might receive anywhere for treating coronary artery disease.

On the arrival of Dr. Erle H. Austin III in July 1985, a new congenital heart surgery service was added at PCMH. Dr. Austin, who had recently completed a 10-year residency in cardiothoracic surgery at Duke, was a graduate of the Harvard Medical School. His main task would be dealing with heart defects that could usually be repaired only if the operation was done in childhood.

The board of trustees in the next month approved purchasing an open-heart pump to equip a second operating room. The second cardiac surgeon had performed 40 open-heart procedures, most of them on children.

In January 1988, Dr. Chitwood left ECU to head the cardiac surgery program at the University of Kentucky in Lexington and to be associate director of the Kentucky Heart Institute. He returned to the PCMH in October 1989. In his new appointment, he would be professor of surgery, chief of cardiac surgery and vice chairman for faculty affairs of the Department of Surgery. He returned with an agreement that a Heart Center would be built in Greenville, along with a residency program in cardiac surgery.

The hospital’s success in the region now seemed irrefutable. The medical staff included 276 physicians, 612 full-time registered nurses and 103 part-time registered nurses. During July, there were 1,918 admissions to the hospital, at an average cost of $497.50 per day. Two hundred and twenty-four babies were delivered that month.

In addition to the cardiac surgery program, with its up-to-the-minute equipment, skilled staff, and adequate operating rooms for open-heart surgery, two new departments had been instituted. These were a Department of Physical Medicine and Rehabilitation and a Department of Radiation Oncology. School of Medicine.