See also Vignette

BUCK SITTERSON
Retired Vice President, PCMH

February 14, 2000

Interviewer: Beth Nelson

Beth Nelson: You were the Administrator at Robersonville Hospital and you were working towards your Certificate in Hospital Administration at Duke when C. D. Ward called you.

Buck Sitterson: C. D. had just hired Jack Richardson about six months before and the Medicare Program was being put into effect and I was hired as the Office Manager. Mrs. Bell had been the previous Office Manager and she was retiring and they were looking for someone at the time.

Beth Nelson: Would this be somebody primarily with a finance background?

Buck Sitterson: Well, they wanted finance and wanted some new structure in the office. I came in as Office Manager and restructured the office and about the same time Medicaid came in. The county was working on putting in a computer system, which was the old punch-card computer system - first generation computer system. The first thing that we put on was the payroll. Previously the payroll had been done by a clerk in the office with the exception of Mr. Ward's check. He wrote his own check and so consequently we forgot to write in his new check on the computer system. At the same time we were trying to restructure the Business Office. We were trying to think about at least doing the payroll on the computer and trying to implement the Medicare Program all at the same time.

Beth Nelson: How many employees were there at that time?

Buck Sitterson: I'm thinking that there were about 300 employees all together. It may have been less than that.

Beth Nelson: Do you have any idea as to how many doctors would have been on the Medical Staff at that time?

Buck Sitterson: There were about 40. It was about the same time that Dr. Al Ferguson and Dr. Ira Hardy came. Dr. Longino was there because I remember that Dr. Longino used to take referrals from Robersonville. Both he and Dr. Wooten took referrals but it was ahout this time that Ira Hardy and Al Ferguson came. Things were tough back then. We waited every week to get the Medicare check to make the payroll. It was money into the bank and money out of the bank.

Beth Nelson: You waited every week to get the Medicare check before you cut the payroll checks?

Buck Sitterson: Yes, and we paid every two weeks at the time also. We would write checks to vendors and hold them for some time until we could accumulate enough cash but there never was a balance in the bank account.

Beth Nelson: Let me go back to one more thing, I want to go back to your background. I think of the time that I have known you. Your title was changed five or six times. Do you have any idea how many times your title was changed?

Buck Sitterson: Yes, I might give that to you. It was probably about fifteen times. It didn't seem like I could keep a job. As a matter of fact, I think it's written up here on this certificate that they gave me showing the many times that we had a record of.

Beth Nelson: Quite often you had to hold the vendors checks until you had the money and then pay them?

Buck Sitterson: That's right, and at that time our billing system consisted of the two ladies who had typewriters on carts and they would roll to file cabinets and pull the ledgers out and type out a bill. It would take about a year to get through the entire cycle. Anyone who had to go to the hospital received a bill about once a year. Everything was manually done at that time.

Beth Nelson: What do you mean, once a year?

Buck Sitterson: That was all we could do was getting around to all the file cabinets in a year's time for people who owed money to the hospital. If you came to the hospital, it may have taken a year before you got your bill.

Beth Nelson: So, it might be a year before the patient received the first bill?

Buck Sitterson: That's right it could be and the system at that time was that every time you came to the hospital you got a new account so if you had been to the hospital fifteen times there were fifteen different accounts for being in the hospital. I guess the most traumatic thing was when we decided to put the accounts receivable on the computer. We had to consolidate those accounts. The only way we could figure out how to consolidate them at that time with the limited computer system that we had is that we just went through and made a bill for everybody. If you had been there fifteen times you received fifteen statements. We flooded the post office at that time with statements when we started doing that and a lot of people would call and say it has been two years since I have been there but that is the best we could do. It took a year to consolidate all the accounts because sometimes they would come in as John Smith and sometimes it was J. W. Smith and it was all the same person and it probably took us well over a year to two years to get everything consolidated and get control of the accounts so that we could send out statements on a regular basis.

Beth Nelson: Tell me this, you were the Administrator at the hospital in Robersonville, which was certainly a small hospital. What was it that attracted you to that particular environment?

Buck Sitterson: I think it was the challenge. Mr. Ward and Mr. Richardson both told me that there was no structure in the office at all as far as controls and it was just a challenge in going in and setting it up. There were very few systems, as we know systems today, in the office. I think it was the challenge and the chance for advancement. I took a cut in pay to go there, probably about 10% as I was making $8 - $10 thousand per year then. This was the first year. I remembered Kenneth coming and he had given me some idea of what to expect when I came to Greenville so it wasn't a complete shock. Anyway, once we got the cash receivables on cash flow did improve some but we were still using manual billing for everything. We would manually make a statement and then that would be sent down to the courthouse to the computer system and is key punched into the computer system so there was no interface between the computer and us. I guess I remember one of the funny stories at that my is that my office backed up against C. D. Ward's office and he and I needed to talk a lot and there was a closet in the corner of his office that backed up to my office and we cleaned out the closet and knocked out the wall and we could pass back through into each other's offices. The first time we had done that, he had never taken the word "closet" off of his door and he had Kenneth Dews and a group in there one day and he needed something and he called for me to come in and I walked out of the closet and at that time Kenneth had not seen what we had done and he really got a big laugh out of me walking out of the closet. I think C. D. told them he just sort of kept me in there and when he needed me he just called out for me.

Beth Nelson: Tell me, there was some story and I think Kenneth might have been the one who told me, having to do with a toilet that you had to unstop. Maybe you were the Administrator on call or something.

Buck Sitterson: That was in Robersonville. I have told this story many times but it is a true story. I had just been in Robersonville and at that time I was not the Administrator, I was the lab and xray technician and had not been there very long. I had some of my friends over one day and at that time we didn't even have a blood transfusion program so we had to use local donors and we had a bad wreck the week before and I was bragging to my friends on how we had called in some local people and had drawn some blood from them and saved a life. About that time I received a call from the hospital, which sounded like a real panic call, and they needed me down there right away, the nurse did who was probably the only nurse on duty at the time, and of course I took my friends down to show them just what I could do in action. When we got down there we realized that there was no ambulance outside or anything and that there was just a toilet which had overflowed and water was running down the hall. I was the only person she could think of to contact.

We had a lot of experiences like that in Greenville. We had a commode that was in the administrative bathroom and C. D. Ward, for some reason, if you didn't know how to push a handle down and get out of the way, sometimes when the water pressure was real high it would back up. I had seen him come out many times wiping of. He would call Walter Dail who was the maintenance supervisor. When I came to the hospital there was Walter Dail and he used to tell me a story about when he would hire C. D. and Walter did maintenance for the school system, and C. D. was a teacher, I believe. He would hire C. D. in the summer to supplement his income by painting schools. Then the turnaround was that when C. D. became the Administrator of the Hospital he hired Walter as the maintenance supervisor and he was there for years and years. At that time the maintenance shop was down in the basement of the old hospital.

Beth Nelson: C. D. Retired before he passed away, didn't he?

Buck Sitterson: Yes, he retired and moved to Myrtle Beach.

Beth Nelson: Jack Richardson was just there a year or two before C. D. stepped aside?

Buck Sitterson: I think it was about three or four years. Yes, because Rick Gilstrap had come in during that same time too. At one time there was C. D., Jack, Rick and myself.

Beth Nelson: I didn't seem to remember Rick being there that early.

Buck Sitterson: Rick Gilstrap was there for about fifteen years.

Beth Nelson: I was thinking in my mind that Rick was there for about four to six years. John Stillerman, one of our administrative residents, is interviewing Rick for this too.

Buck Sitterson: I feel, unless I am mistaken, C. D. was not there long but I feel that if Rick wasn't there when C.D. was there it wasn't but about six month's difference at the most. Mr. Ward was a character. At that time there was an Administrator in Washington and they were always from the same old school. Back then you used to go to something called District VI, which is still ongoing, and in this day in time you wouldn't believe some of the discussions that went on in those meetings. It was like discussions on raising nursing salaries for the year. The Administrator from Rocky Mount or the Administrator from Kinston would say they were going to go up ten cents an hour but that's all I'm going and everyone would agree to stick to ten cents an hour. Then they would discuss room rates and agree they were going to go up on them and they would decide to go up twenty cents but they would tell C. D. that it was his time to announce it first. That was the system that they had and they would take turns to be first so that Greenville would be first to announce the room rates increase in one year and let Rocky Mount announce their nursing increase rates and the following year they would flip flop and the system worked. Nobody got lambasted every year.

Beth Nelson: That was back in the days before we did a wage assessment of competing hospitals. It's such a scientific thing now.

Buck Sitterson: Wage assessment in Greenville was that we would all sit down, Jean Owens, myself and several other people would all sit down and we had cards that had everyone's name on them and we would get to "Beth Nelson" and we would say that they thought Beth had done a pretty good job this year and Jean would say yes and the most we would give her was a twenty cent raise and then we would discuss negative things such as being late for work a few time sand decide to cut it back to fifteen cents and that was our scientific method of how we decided on how much of a raise the people got and we would go through the cards and if you had been late too much you would be cut back pretty quick and this was before the time that anti-trust was initiated.

Room rates back then were increased by perhaps a dollar, which was a big increase. Everything was based on an RN salary. If it was $3.75 an hour then everyone else was below that. Of course, we did know about compression back then and we always tried to keep the gap between RN salaries and everyone else about the same. If RNs got a five-cent increase everybody else would probably get a compression increase, not necessarily five cents but percentage wise they would get an increase. That is how we used to decide all of this.

That was the scientific method we had. I'm not sure we ever had a structured method until Charlie Fennessy was hired. We may have had one for certain groups of people but it was tight. We were looking for any way in the world that we could cut back and Jean Owens, who was the Director of Nursing, at that time came up with the idea.

Beth Nelson: On a sad note, when EastCare crashed, please talk about your role in dealing with that. I think you and Dave McRae made a trip down to the site of the crash.

Buck Sitterson: Charles Mayo and I went to the site. We had to deal with the FAA after that. Of course, that is something we will never forget. Someone had to go and identify the bodies before they would take them out of the craft. These were people we knew very well.

Beth, I don't know how far you want to go back but I can remember when I first went to Greenville there were separate waiting rooms for the black and white. This was in 1968 and the white entrance to the hospital was on a level where you would drive up and walk in but the black entrance was around to the back and you had to go up steps to walk in. We shut down what was called the "colored waiting room" at that time. We used it as an office after we closed it down.

Beth Nelson: How was that decision arrived at?

Buck Sitterson: That was not a decision that was made locally or by any hospital. In order to qualify for Medicare all those separate facilities had to be done away with prior to Medicare approving the hospital.

Beth Nelson: Was that a controversial decision in the area? Did the black people feel like they were being displaced, or did they think it was good?

Buck Sitterson: No, I don't think so. I just think it was just one of those things. It was quietly done and I don't ever remember it being an issue.

Beth Nelson: Tell me about the fight for the bond issue. I have heard Jack Richardson tell about being shouted down in public hearings and told that the hospital would be a white elephant and be empty and that he was going to bankrupt the county. I am also trying to get with Joe Pou and interview him. What do you remember about those kinds of things?

Buck Sitterson: I think I have some of those things in my possession. I will look for them. Of course, the decision at that time was, first of all, I can remember was that we were going to have a medical school which was going to be a two-year medical school and that they were going to add on to the existing hospital on Fifth Street. The plans were already being developed and it was going to be a four or five story building built right out in the middle of the parking lot at the hospital. That was going to be the addition for the medical school.

I remember very well Mr. Ward, myself, Mr. Bill Speight and maybe Kenneth Dews and Charles Gaskins, going to Raleigh one day to talk further about that expansion and there was fellow named Mr. Bill Hennessy who was with the Medical Care Commission. He was the Chairman of the Medical Care Commission, which gave the approval to expand hospitals. You explained to the Commission what you were going to do. This was not the first meeting but something had happened that nobody ever knew about, but anyway, we had not been in the meeting more than thirty minutes when he said that his Committee was not going to approve any expansion for the hospital. He said it would not be the thing to do and we would never be able to grow to what he thought our potential is going to be. He further stated we would never have enough parking. He stated that the Medical Care Commission was telling us that in order to do what we want to do we would have to start a new building. I can remember the sick feeling that everyone had. We had a good building. It was a brick building that was very adequate that needed expanding but it was equivalent of coming to the taxpayers of Pitt County today and telling them that we had outgrown the hospital and wanted to build a new one. I remember riding back to Greenville that day and nobody said anything because nobody wanted to come home and be the one to tell the news. I have all the documents right here calling for a new hospital and new site which I will let you borrow for further reference.

I guess the next crisis that I remember are before we moved to the new hospital. We really ran short of funds. This was probably before we started building the new hospital and I remember we were so short of funds that I called a representative at Blue Cross who I knew and asked them that if I brought some claims up to their office would they process the claims and write us a check that day. And they did. I took a briefcase full of claims to Durham and at that time our relationship with them was so great that they stopped what they were doing and assigned some people to our claims. We went out to lunch and when I came back to Greenville that evening I had a check in my pocket. That's how tight we were on money. I think the check was for somewhere around $20,000. As I remember, when Dave McRae first took over as President, we didn't have enough money to meet the payroll. We went out to borrow money and that is when we found out we couldn't borrow anything.

Beth Nelson: That was right after Christmas and they were looking at withholding paychecks. That was a problem with the computer that there was some problem with our computer system. Kathy Barger and I have talked about this. I had always had the sense that the problem was a computer glitch on the part of Blue Cross. I remember they notified us in November that they would not be able to pay us for several months into the future. My sense was that it was their fault but Kathy was telling me no that there was some computer interface we could not achieve in order for them to process. We worked for several months. Back then Blue Cross would have been 35% or 36% of our business. Back at that time when you had to drive to Durham, what percent of our business would Blue Cross have been?

Buck Sitterson: When I am saying Blue Cross, I am talking about them as an intermediary for Medicare so they were processing Medicare claims and not private individual claims. I am not sure the percentage has changed that much over the years.

Beth Nelson: Would you say that these were not claims that Blue Cross was in arrears in paying us, these claims you were walking in the door with.

Buck Sitterson: That's right. They had not seen these claims at all. We were so desperate for money that from the time we would file claims to get the check back it was taking fifteen days. Back then you put all the claims in the mail. Everything was processed by hand. We were so desperate that we didn't have any choice but to do this.

Beth Nelson: Back then, how long did $15,000 go payroll wise?

Buck Sitterson: It would carry us for a pay period.

Beth Nelson: I guess the employees probably had no sense of how desperate things were financially.

Buck Sitterson: No, they did not.

Beth Nelson: I was talking to several folks about why it was that way and talking to Kenneth Dews he said it was just that way all over. Money in Greenville in general was in short supply and people really didn't have a good idea of what the situation was.

Buck Sitterson: I think it was during a period of when there was a recession going on and at that time we said we wouldn't want to alarm our employees to the fact that they may not get a paycheck. In looking at some of the material I have, there is a question and answer section in here. When we had the bond issue a decision was made pretty early on to hire a professional consultant to come in and direction this whole operation. We had just used him in Martin County because we had just had a bond issue there for building the Martin General Hospital and it was called Ketchum. I had just recommended Ketchum to them and somebody else had also heard about them.

Beth Nelson: Is that the same Ketchum that helped us with fund raising when we did the Capital Campaign?

Buck Sitterson: I'll bet it is the same company. They came in pretty much and directed the whole bond issue all the way through. I don't think hospital money was used to pay Ketchum.

Beth Nelson: Who would you say was the toughest sale on the bond issue? I'm sure you spoke to a number of different groups and lobbied every which way. What group would you say was the toughest to get to come around to the hospital's way of thinking?

Buck Sitterson: I'm not so sure. I don't think it was the rank and file. I think it could have been the large property owners in the county. They were concerned about taxes being increased. I remember after the bond issue was over with and we decided then that we were going to buy a piece of land and we were going to buy 100 acres. I remember a county commissioner coming to me telling me at the time that to buy the area were looking at between Stantonsburg and Fifth was a very bad mistake. We didn't need that much land and it was just going to cost a lot of money to keep the weeds cut down on that piece of land. We also wanted to get a loan as soon as possible for this.

Our Board has changed so many times over the years. At the time that I went to work at the hospital, the Board itself was made up people from geographic areas and these people were
throughout the whole county and these people were not necessarily picked for their business experience but more or less for influence in the community. I remember my first Board meeting I went to request to buy a new xray machine I think which was about $6,000 and we needed a new lawnmower. I presented the xray machine first and there were almost no questions asked at all and we got approval to buy the xray machine. When I got to the lawnmower, there were many questions and they wanted to know how many cylinders the engine had in it, how it was wired, etc. I remember it was a lesson that I learned the hard way. I didn't get the lawnmower approved that night. I had to come back the next month with horsepower of the engine, the cubic displacement of the engine and the complete cut of the blades. Once I presented that they said it was ok. As I said, the xray machine was $6,000 and the lawnmower about $250.

Beth Nelson: If you go and make a list from your perspective, who would be the giant in the development of the medical center over the years? Who were the true leaders in that overall process?

Buck Sitterson: I would have to say Jack Richardson and Dean Laupus. Then you would have Wilton Duke, Charles Gaskins, and Mr. Bill Speight.

Beth Nelson: A lot of people have had incredible things to say about Mr. Speight. What about physicians?

Buck Sitterson: You know, it is interesting to remember but I am not sure the physicians were for the medical school at that time. There were some that were definitely not for the medical school. Most of them were going to wait and see. But you have to realize that we had a lot of young physicians move to Greenville I'm not so sure they didn't see the medical school as competition being a little bit of a problem for them. I guess Eric Fearrington was very vocal against the medical school. He is one I remember being more concerned and at that particular time I believe Ed Monroe and Eric Fearrington were partners in a practice together. This was before Ed became Dean of the School of Allied Health. I'm sure that Dr. Jenkins played a big part in his role. It's hard to begin to name everyone. Once you start you don't know when to stop.

Beth Nelson: It's like with the Joe Pou fellow, if I hadn't asked that question of Kenneth. I might not have ever heard thought of him. Everybody I have talked to said that he really took on quite a task and that he was the right man at the right time. He swayed a lot of votes with the rural community and big landowners.

Buck Sitterson: Absolutely. He was probably the most respected person in the community overall at that point in time. Read some of the material I am giving you and you can read all about it. This is some of Jack Richardson's material. I recognize it as he did his own typing at that time. None of us had a secretary for the first four or five years. We had to do our own work. There are some good questions asked and answered in this material. It talks about Joe Pou in this material. One of the things I do remember is that when Bill Hennessy talked about the hospital and had a big meeting, he pretty much committed $2 million at that time to go to the new building and that was the Medicare Hill Burton commitment at that time.

Beth Nelson: That would have been a big part of the cost of the $9 million.

Buck Sitterson: At that time we were talking about $9 million. It was $11 before we concluded.

Beth Nelson: What about some other physicians? Other folks have mentioned Dr. Longino, being one who could really bring all the physicians together and get agreement.

Buck Sitterson: I think at the time all of this was taking place that ifwe were going to make a pyramid of new physicians with Dr. Longino would have been right at the top. Dr. Longino demanded respect, in one respect he was just the type of person who if he asked all the physicians to jump in line and march they would line up and march. He was just that type of a physician. I knew Dr. Longino before we ever came to Greenville because he was such a good physician. I can remember back then if we sent a patient from Robersonville to Greenville for Dr. Longino to operate on, before he ever left the operating room he would call one of the three doctors in Robersonville to inform him. Back then we were such a close-knit community people were in and out of the hospital all the time asking questions of what was happening to their friend or family over in the operating room. He wanted the doctors to know first of the outcome. I am sure that he had the respect of referrals and had the courtesy with the referrals that our present doctors don't have now to go back to referring physicians to let them know as soon as possible what the outcome was.

That's one of the big problems we have now. We hear that a physician can refer a patient to Greenville and the patient can be back home and it would be three weeks and the patient would come in for a follow up visit to the doctor and the doctor had not heard anything from the physician in Greenville about what had happened to his patient. There were a lot of referred patients who didn't want to go back to their regular physician but wanted to establish with a physician in Greenville. At that point in time medicine in eastern North Carolina was beginning to suffer because of doctor shortages so if the patient could establish a relationship with a physician specialist they wanted to go ahead and get that. I think more that the patients didn't want to go back rather than the physicians trying to keep them in Greenville. I'm sure the patients came back for several visits. The physicians in the outreach communities saw it as losing the patient.

Beth Nelson: One of the key things that is going to be in the book is some of the details that people remember.

Buck Sitterson: In here they are talking about the night of the tornado in 1984. I believe the impression I had at that time was how well that everyone worked together for common cause. We put in systems that night that were not even in our plan and one of the systems that I remember we put in is that we moved all of the family members of the patients that were in the waiting room to the cafeteria and began to feed them donuts and pizza. We also had limited OR space and were right in the middle of renovation at that time.

Beth Nelson: Because of that they were having to do some minor types of surgery out in the hall rather than operate in the operating room which would have been ideal. These people were in such desperate circumstances and I just wanted to confirm that. Also they talked about operation on people without anesthesia because we just didn't have the capability to do that without the operating room.

Buck Sitterson: I don't remember that. When we were talking about operating out in the hall, I think we were talking about minor procedures like cut downs to get into veins. I don't think that there were any major procedures done in the hall or all over the hospital and I don't remember but, of course, it certainly could have been done.

Beth Nelson: I understand there were about 140 some people come through the ED that night in a span of about 2-1/2 hours.

Buck Sitterson: Right. I also remember we set up a temporary morgue that night in the storeroom. I remember we quickly ran out of space in the morgue. If you know, the morgue at that time used to be down at that end of the hall where the storeroom was located. This was across from the cafeteria down at the end of the hall.

Beth Nelson: We had nine people die in Pitt County that night. I don't know if all of those bodies were brought to us.

Buck Sitterson: I do think they were all brought to us. I remember we sure ran out of space that night very quickly and had to set up the temporary morgue and a temporary viewing area in which family members could come in if they described a victim. That is how we identified a victim.

Beth Nelson: What else can you remember about that night? The things I remember are the fact that we really struggled to get staff back into the hospital. We were calling back everyone we could think of. The problem was that trees and brush blocked the roads.

Buck Sitterson: I remember that the medical staff responded, most being local. I don't remember a shortage that night. I do remember that everybody was pushed pretty much to the limit but everything got done that night.

Beth Nelson: Is there anything else you can remember? I remember looking out the door of the ED and as far as you could see down the road there were rescue squads lined up.

Buck Sitterson: I guess that the thing came in through Ayden, skipped over, had gone back down and lifted back up again and nobody at that time knew exactly how widespread the whole thing was until the next morning.

Beth Nelson: Tell me something about what you see as being the challenges at the hospital.

Buck Sitterson: I think that orderly growth, of course, would be. I doubt that we will see the growth that we saw for the first ten, fifteen or twenty years that I was there. I think the growth is going to slow down now and I think the delivery of health care is going to be offered in a different way. Inpatient is probably going to be there. Outpatient procedures will be different. Everything has changed too much. When I remember coming to Greenville in 1968 and you did a cataract procedure, it was like fourteen days that the patient was in the hospital. I think that for about seven days they had their head sandbagged and they couldn't move their head. It was a long time. Check with Dr. Bill Monroe. There were just so many procedures that we did that the recovery period was just so long. Now, of course, with the minimally invasive surgeries that we do it is just so amazing - a gall bladder operation was a major procedure back then and now there are no tubes.

I can also remember when we had weeks when we would take tonsils out and they would always try to do it like the Tuesday or Wednesday before Thanksgiving. You could just about shut the OR down as that is the day they were going to take tonsils out so the kids could recover and be back in school at least Monday or Tuesday of the following week. It was a big deal and they would block out big schedule time in the OR based on holidays. They would do twenty-five or thirty patients in that one day. I can see all that changing now. I see procedures to be less invasive and recovery time much shorter. People just don't go to hospitals unless they are really sick in this day and time.