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Full text of "Expansion of Medical Facilities and Services in North Carolina - Two Decades of Progress: A Summary of the Activities of the North Carolina Medical Care Commission, July 1, 1947 - June 30, 1967 and Reports for the Biennia July 1, 1963 - June 30, 1965, July 1, 1965 - June 30, 1967"

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na State Library 

aleigh 

The Expansion 
of n. 

Medical 
Facilities 
and 

Services 


in f\Jor±H Cetrolirta. 

Two Decades of Progress 


A Summary 
of" the Act/'vit/es 
of thte 

North Carolina 

Medical 

Care 

Commission 

1947-1967 

and 

Reports for the 
Biennia 

1963-1965 / 1965-1967 


























Digitized by the Internet Archive 
in 2019 with funding from 
State Library of North Carolina 


https://archive.org/details/expansionofmedicOOnort 


THE EXPANSION OF MEDICAL FACILITIES AND SERVICES 
IN NORTH CAROLINA—TWO DECADES OF PROGRESS 


A SUMMARY OF THE ACTIVITIES OF 
THE NORTH CAROLINA MEDICAL CARE COMMISSION 
JULY 1 ? 1947 - JUNE 30, 1967 

and 

REPORTS FOR THE BIENNIA 
JULY 1, 1963 - JUNE 30, 1965 
JULY 1,1965-JUNE 30, 1967 



December 1, 1967 

THE NORTH CAROLINA MEDICAL CARE COMMISSION 
437 North Harrington Street 
Raleigh, North Carolina 



LETTER OF TRANSMITTAL 


To His Excellency, DAN K. MOORE 
Governor of North Carolina 
Raleigh. North Carolina 

Sir: 

The Medical Care Commission and Advisory Council present herewith the 
report of the activities of this department for the period July 1, 1963—June 30, 
1967. including selected summaries of information covering prior years to indicate 
the State's overall progress in developing medical facilities and programs since 
the inauguration of the Commission in 1945. 

Respectfully submitted. 


EDWIN N. BROWER. SR. 
Chairman 


CONTENTS 

Page 

Letter of Transmittal to the Governor . 2 

Members of the Medical Care Commission . 4 

Members of the State Advisory Council . 6 

Administrative and Secretarial Staffs . 7 

Background and Goals. g 

Recent Legislation . 9 

New Personnel. 10 

Section 1 —Planning and Construction of Medical Facilities 

Including Maps and Tables of Information . II 

Section II—The Hospital Licensing Program . 55 

Section III—Education Loans for Medical and Related Studies . 58 












THE NORTH CAROLINA MEDICAL CARE COMMISSION SERVING DURING THE BIENNIA 1963 - 1965 ; 1965-1967 


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5 


Mr. Clifton M. Craig succeeded Mr. R. Eugene Brown as State Commissioner of Public 
Welfare in December, 1966. 



MEMBERS 

State Advisory Council 

Serving During the Biennia 1963-1965; 1965-1967 


Member 


Address 


Term 

Expiration 


Dr. W. T. Armstrong 1 
Mr. Charles R. Cannon 1 
Dr. W. Ralph Deaton. Jr. 1 
Mrs. Virginia Foglia 2 
Mrs. Carrie T. Phelps 
Mr. James P. Richardson 1 


Rocky Mount 

Concord 

Greensboro 

Albemarle 

Creswell 

Charlotte 


June 30. 1969 
June 30, 1969 
June 30. 1969 
June 30, 1965 
June 30. 1969 
June 30. 1969 


1 Reappointed 1965 

2 Mrs. Carrie T Phelps succeeded Mrs. Virginia Foglia 


6 



ADMINISTRATIVE STAFF 

June 30, 1967 


Name 

William F. Henderson 
I. O. Wilkerson, Jr. 

O. Wade Avant, Jr. 

Ruth W. Hathaway 

Bruce K. Jones 

Ray F. Lefler 

Mrs. Elizabeth S. Mason 

A. C. Penny 

Mrs. Janet M. Proctor 

C. W. Sanders, Jr. 

John W. Sherman 
June Sherrill 
Conrad M. Taylor 
Donald M. Watson 


Position 

Executive Secretary 
Assistant Executive Secretary 

Hospital Consultant 
Administrative Officer 
Consulting Architect 
Hospital Consultant 
Hospital Nursing Consultant 
Business Officer 
Administrative Officer 
Hospital Consultant 
Consulting Engineer 
Medical Records Librarian 
Consulting Architect 
Consulting Engineer 


SECRETARIAL STAFF 

Mrs. Sue M. Jones 
Mrs. Emogene K. Massey 
Mrs. Elsie C. Olmstead 
Mrs. Linda R. Parker 
Mrs. Carolyn F. Sutton 


7 


BACKGROUND AND GOALS 


It was the intent of the legislation creating the Medical Care Commission in 
1945 (General Statutes Chapter 131, Articles 13 and 13A) to set up a state agency 
to specialize in the planning, financing and construction of medical facilities 
throughout North Carolina and in the standardization of hospitals particularly, 
and to study ways and means of staffing the State's expanding medical programs. 


Through the years, the Commission has developed a close relationship with the 
state's community hospitals and is thought of as the agency technically staffed 
and oriented to advise with hospitals on their specialized requirements. 


The Commission is composed of twenty members. Three are nominated by the 
State Medical Society, one by the State Pharmaceutical Association, one by the 
North Carolina Nurses' Association, one by the State Hospital Association and one 
by The Duke Endowment. These nominations are subject to the approval of the 
Governor. In addition, eleven members, one of which by law must be a dentist, 
are appointed by the Governor directly so as to fairly represent agriculture, 
industry, labor and other appropriate consumer interests and groups in North 
Carolina. The State Health Director and the State Commissioner of Public Welfare 
are ex-officio members. The Commission regularly meets each quarter and addi¬ 
tional meetings are held when necessary. 


Pursuant to Federal requirements, the Governor appoints a State Advisory 
Council composed of five members to advise with the Commission on technical 
matters relating especially to the planning and construction of medical facilities. 
The Council meets regularly with the Commission. 


During the biennia, the responsibilities of the Commission were divided into 
three major programs: 


A. Planning and construction of hospitals, public health centers, diagnostic 
and treatment facilities for ambulatory patients, long-term chronic and 
convalescent extended care facilities including nursing homes and re¬ 
habilitation facilities. 

Toward the end of 1965, under the auspices of Public Law 88-164, the 
Medical Care Commission was designated by the Governor to develop in 
cooperation with the State Department of Mental Health, the North 
Carolina Mental Health Council and the North Carolina Council on 
Mental Retardation a statewide plan for the construction of community 
mental health centers and facilities for the mentally retarded. 

B. Licensing of hospitals. The staff of this section also provides consultation 
services to assist hospitals in participating in the Medicare program. 

C. Loans to students enrolled in accredited programs of training in the 
health-related professions. 

8 


RECENT LEGISLATION 


Legislation passed by the General Assembly of 1965 affecting the Commission’s 
programs provided under H. B. 360 Capital Improvement appropriations for 
medical facility construction grants. H. B. 1130 included optometrists in the 
student loan and scholarship program. H. B. 876 furnished construction funds for 
facilities for the mentally retarded. H. B. 1138 permitted transfer from the Depart¬ 
ment of Mental Health to the Commission of $500,000, if needed, as State grants 
for the construction of mental health centers. 

Other primary legislation passed by the 1967 General Assembly affecting the 
health field is summarized below: 

H. B. 1087 appropriated to the State Board of Education funds for the 
training of nurses and dental hygienists in college programs. 

H. B. 532 authorized the issuance of additional hospital construction 
bonds, limited the time within which bonds may be issued and authorized 
the issuance of bond anticipation notes by a hospital district. 

H. B. 683 provided additional legislation authorizing the leasing of 
hospital facilities to nonprofit corporations. 

H. B. 1038 authorized counties to expend non-tax funds to assist state- 
licensed facilities for the mentally retarded, whether publicly or privately 
owned and whether located within or outside of the county making 
available the tax funds. 

S. B. 408 appropriated funds to the Department of Mental Health for the 
construction and operation of tjvo pilot community complexes for the 
mentally retarded. 

S. B. 73 appropriated to the State Board of Education funds for assisting 
hospital-sponsored nursing schools. 

House Resolution 1117 directed the Legislative Research Commission to 
study ways and means of providing more medical doctors for small towns. 


9 


NEW PERSONNEL 


With the inauguration of the two new Federal programs allocating funds to 
the State for the construction of mental health centers and facilities for the 
mentally retarded and as a result of the constantly expanding on-going construc¬ 
tion program for community hospitals, health centers and other projects aided by 
the Hill-Burton Act, the Commission added to its staff a mechanical engineer, a 
hospital nursing consultant, an administrative aide, an additional architect and 
an additional hospital consultant. 

As a result of a contractual agreement entered into by the Commission with 
the State Board of Health to survey hospitals for the purpose of compliance with 
the Conditions of Participation under the Health Insurance for the Aged 
(Medicare) Program and to offer continuing service in areas of serious de¬ 
ficiencies, a medical records librarian consultant was added to the hospital 
licensing section. 

Because of the increasing demands being made upon the chief administrative 
officer and the need for someone to be delegated authority to act for him during 
extended absences from the office, the position of Assistant Executive Secretary 
was created and was filled by Mr. Ira O. Wilkerson, Jr., a long-time staff 
member. 


It should be noted that during the average recent year the Commission has 
been accountable for approximately $10,000,000 in direct appropriations to the 
agency and that its administrative budget during the last year of the biennia 
amounted to $196,000, or 1.8 percent of the total funds budgeted. 


10 




SECTION I 


Planning and Construction of Medical Facilities 

Twenty Years of Building—An Overview 


It is doubtful that any of the State’s social welfare institutions has undergone a 
more dramatic change both in numbers and patterns of sponsorship than have 
hospitals and related medical facilities during the past two decades. 

We have witnessed the complete demise of local tuberculosis facilities in favor 
of regional State-supported institutions. Likewise, emphasis in the past has been 
on the treatment of mental diseases predominantly at State-owned hospitals. 
But toward the end of the biennia, there was an increasing accent on psychiatric 
care at locally sponsored clinics. The change in the pattern and sponsorship of 
general hospital care, however, has been the most revolutionary. 

While the State’s population increased about 47% between 1947 and 1967, 
the number of general and allied hospitals increased 1 1.5% and the number of beds 
increased 115%. The most significant change, however, has probably been in the 
mode of sponsorship of these facilities. Governmentally owned hospitals (state, 
county, city, etc.) increased during this period by 282%; while those facilities 
sponsored by nonprofit associations decreased 30% and the strictly proprietary 
hospitals decreased 24%. County-owned facilities by far show the greatest growth, 
as numerically they have increased during the 20-year span by 511% and the 
number of beds they provided by 1500% ! 

The contour of county ownership of hospitals in North Carolina is unique in 
the country. To support this surge in ownership, 52 different municipalities have 
voted on bond issues to provide capitalization of local facilities. There have been 
86 separate bond issues submitted, of which all but 9 have passed. At the start of 
the Commission’s construction program in 1947, there were 33 counties without 
general hospitals. Twenty years and 216 hospital projects later, there are only 
15 of the 100 counties without a general hospital. 

Of the 445 total medical projects aided during the 20-year construction activity, 
62 counties have been provided with 68 all-new general hospitals. The Commission 
has aided in the construction of 91 public health centers, 49 nurses’ residences 
and schools of nursing projects, 21 diagnostic and treatment centers, 15 rehabili¬ 
tation facilities, 34 long-term care projects, 2 projects expanding tuberculosis 
hospitals, 7 projects expanding mental hospitals, 7 mental health centers and 
3 facilities for the mentally retarded. 

The State’s Hill-Burton construction program ranks 1st in the nation in the 
total number of projects and in the number of general hospital projects approved. 
It ranks 7th in the number of beds constructed, 9th in total dollars encumbered 


for capital improvements and 5th in total Federal funds expended. North Carolina 
ranks 6th from the top among the states in the percentage of Federal participation 
in the projects approved under the Hill-Burton Act. 

Just as dramatic has been the change in costs of hospital construction. During 
the first four years of the program, 1948-1952, the costs of all-new hospitals 
averaged $11,000 per bed and $19.00 per square foot. Hospital size during the 
period averaged about 500 square feet per bed. As hospitals recognized the ad¬ 
vantages of total air conditioning, recovery rooms, physical therapy and enlarge¬ 
ment in general of service areas to accommodate the increasing sophistication in 
equipment and services, costs have climbed. From 1953 through 1955, the 
average cost of Commission-aided all-new hospital projects increased to $13,130 
per bed and $23.90 per square foot with attending expansion of average bed-area 
ratio to 545 square feet per bed. Thus, the average per-bed cost increased 19.3%; 
square foot cost, 25.8% and area per bed by 9% over the average for the previous 
four-year period. Between 1956 and 1959, there developed an increasing demand 
for intensive care units and the preference of two-bed accommodations over ward 
beds began to make inroads on design and hence on costs. During this three-year 
span, bed costs jumped to $15,183 per bed (an increase of 15.6%) over the averages 
cited above; square foot costs jumped to $26.46 (an increase of 10.7%) and area per 
bed increased to 578 square feet (an increase of 6%). 

The start of a building boom had a decided impact on costs during the period 
1961-1964 as average costs spurted to $19,010 per bed. or a 25.5% increase over 
costs of the preceding three-year period. Square foot costs rose to $29.12, a 
10.1% increase. This period saw the introduction of more sophisticated service 
systems such as pneumatic tubes and other conveyors installed as labor-saving 
devices and the provision of total environmental control through larger and more 
intricate mechanical systems to accommodate cross-contamination. The square 
foot per-bed ratio increased to 651 square feet over the average for the preceding 
period, a jump of 12.6%. 

The period 1965 through 1967 felt the impact of rising costs thought to be due 
primarily to an increasingly active builder's market and heralded by the preference 
for more private rooms. During this period, the average per-bed cost rose to 
$22,583 over the preceding three years, an increase of 18.8%. Square foot costs 
averaged $31.52, an increase of 8.2%. Hospital size reached an average of 701 
square feet per bed, an increase in area ratio of 6%. During these three years, 
construction costs for remodeling and expansion of existing hospital facilities 
jumped from $4.00 to $5.00 per square foot MORE than for new projects. 
Current planning reflects the demand or need for a larger proportion of accommo¬ 
dations in private rooms and at least one plant now on the drawing board calls 
for all private rooms. The average hospital now in planning in North Carolina 
has 763 square feet per bed and current estimates of average cost are projected at 
$26,400 per bed and $36.00 per square foot. One project currently in the design 
stage is expected to cost $30,000 per bed; another, over $40,000 per bed. While 
the State’s average square foot cost for hospital construction for all-new projects 
has increased on an average of 3% for each of the past five years, the national 
average for this period is 13.6% above North Carolina's project costs. 

Unlike any prior period in the history of the Commission's construction pro¬ 
gram. proposals during the biennia reflecting extensive needs of many hospitals 
for modernization, expansion and replacement developed much beyond the 


12 


agency’s resources to finance. There are obvious reasons for this accelerated de¬ 
mand. In earlier years, the principal needs arose in rural areas where few or no 
hospitals existed and these communities were primarily concerned with small 
facilities of under 100 beds. Thus, most of the meritorious projects could be 
accommodated with appropriations at hand. By contrast, in more recent years, as 
the rural areas were more nearly serviced, regional hospitals in the populous 
communities have become crowded or grown obsolete and have either required 
large expansion projects or replacement entirely. Moreover, many of the larger 
and costlier projects have arisen in counties which previously had not received 
funds under the Commission’s construction program. Because of this fact and the 
great need represented by the proposals, the more urban areas are now command¬ 
ing high priority and are utilizing extensive Federal and State appropriations. As 
examples, since 1958, the Commission has helped develop a new 540-bed hospital 
in Forsyth County at Winston-Salem, a sizable expansion project for the Charlotte 
Memorial Hospital at Charlotte, a new 250-bed hospital at Wilson, a new 200-bed 
facility at Hickory and a new 400-bed hospital at Wilmington—except for 
Charlotte, all being in counties not previously assisted under the Hill-Burton 
program. 

Not only have the larger facilities absorbed more Commission capital but 
inflation has victimized the costs of these more recently developed projects. 


Volume of Construction 


As previously mentioned, the demand for hospital facilities and other health 
buildings is unprecedented. Federal appropriations to the Commission for con¬ 
struction of all types of medical facilities during the last biennium 1965-1967 
amounted to $23.5 million, an increase of 17.4% over the biennium 1963-1965. 
For the biennia 1963-1967, total Federal appropriations amounted to $43.6 
million, an increase of 31% over the prior four-year period while State appropria¬ 
tions during the last biennium 1965-1967 were 89.3% less than those for the 
biennium 1963-1965. 

The Commission approved 35 projects involving 1,787 beds and costing $44 
million during the last biennium 1965-1967, an increase of 29.6% in number of 
projects, 37.5% in number of beds and 30.8% in dollar volume over the 1963-1965 
biennium. Bids were taken on 33 projects at a cost of $52 million during 1965- 
1967, an increase of 6% in number of projects and 16% in dollar volume over the 
prior two-year period 1963-1965. 

Between 1963 and 1965, general hospital beds increased from 17,712 to 18,703 
and by 1967 to 20,396, an increase of 15% during the last two biennia. 


Important Policy Revisions 


During the biennia, the Commission adopted several policies that have had 
important bearings upon the development of construction projects. These are 
summarized below: 


13 


Supporting Tax Levies 


Traditionally, the Commission has recommended that in governmental^ 
sponsored hospital projects where bonds are voted for capital purposes there be 
submitted a proposal to authorize a tax levy to provide funds for underwriting 
operating deficits. While most bond issues have been favorably approved by the 
voters, there have been several instances in recent years where the supportive tax 
levy was turned down. Fearing that local facilities will lack the resources to finance 
opening expenses and operating deficits to be expected while the new hospital is 
becoming established, the Commission now requires that a tax levy sufficient to 
generate funds to bridge the gap between patient and other revenues and operating 
costs be passed in connection with the bond issue supplying matching funds for 
construction purposes. Municipally owned projects will henceforth not be approved 
for Commission participation unless tax levies are authorized. Applicants 
representing nonprofit corporations have traditionally been required to place in 
escrow sufficient funds to guarantee operating needs not covered by patient 
income. 

Priorities and Fund Limitations 

As project costs increased and as the rise in utilization of hospital facilities 
continued to create demand for expansion of existing institutions, it became 
apparent that the limited Federal funds to which the State is entitled would not 
be sufficient to finance all high priority proposals on the same basis that has 
prevailed in the past. In 1965, it became apparent that the cost of expected new 
applications that could use funds for general hospital and health center projects 
would require at least $10 million of Federal money in the succeeding fiscal year 
to which would be added about $2 million covering Final installments on previously 
approved projects. 

Notwithstanding this pressure on the Commission, it was felt that the rate 
of 55% of participation with Federal funds then prevailing should not be reduced 
as such would tend to hurt the economically disadvantaged areas. On the other 
hand, it was apparent that a ceiling must be adopted so that all of the funds 
would not be allocated to just a few large, costly projects. Accordingly, the 
following positions were adopted as a means of aiding as many projects as 
possible on an equitable basis to permit the program to retain its statewide status: 

1. Priority is given to applications of comparable need from service 
areas which have been assisted less recently. The number and frequency 
of projects previously aided by the Commission are to be taken into 
consideration also in determining the priority of the service area. 

2. The maximum Federal allocation to an applicant from the appropria¬ 
tions to the State for any single fiscal year may not exceed $ I million. 

3. The total Federal funds to an applicant for alteration and expansion 
of existing facilities may not exceed $2 million. 

4. The total Federal funds to an applicant for the construction of an 
all-new facility may not exceed $3 million. 

(Because of the limited State supplementary funds available in recent 
biennia, the Commission for several years has established a ceiling 
of $100,000 of State funds for any one project.) 

14 


5. Combined commitments for approved projects against future Federal 
allocations to the State may not exceed $3 million in any one fiscal 
year’s appropriation for general purposes and may not exceed $2 million 
in any one fiscal year’s appropriation for long-term care and diagnostic 
and treatment center projects combined and that projects requiring 
funding from more than one year’s Federal allocations will be deferred 
until these maximums are reduced to the extent additional proposals 
can be considered. 

6 . Participation will be restricted to costs of basic facilities and features 
applying to the actual needs of the patients, and participation will be 
excluded from those features intended primarily to altering the 
appearance of buildings. 


Long-Range and Areawide Planning of Medical Facilities 


The preceding overview of project costs and accelerating demand for medical 
facilities demonstrates the urgency of more careful planning. For many years, 
the Commission has required each sponsor to develop long-range plans in connec¬ 
tion with each project submitted for Federal and State grants. More recently, 
it has insisted that communities in which multiple medical facilities are located 
coordinate their planning so that each institution can more efficiently serve 
the public and reduce the duplication and costs of both construction and 
operation. 

During the biennia, the Commission became eligible to assign Federal grants 
to assist areawide health planning councils in developing a more coordinated 
community hospital program. Grants totaling $73,000 were made to the Flealth 
Planning Council for Central North Carolina at Durham to plan for medical 
facilities in Durham, Orange and Wake counties, and the Citizens Planning 
Council of Forsyth County. Similar planning agencies were developed in 
Asheville and in Charlotte but these did not request Federal planning grants. 
Toward the latter part of the biennia, other health planning entities were created in 
Western North Carolina under the auspices of other Federal programs, notably, 
the State of Franklin Health Council embracing Cherokee, Clay, Graham, Jackson, 
Macon and Swain counties and the Regional Health Council of Eastern Appalachia 
to serve Burke, Caldwell and McDowell counties. 


Modernization of Medical Facilities 


During fiscal 1964-1965, Federal funds were allocated for the first time 
specifically to assist medical facilities to modernize their physical plants as 
a means of continuing the use of older buildings by increasing their optimum 
safety and efficiency. In order for the State to qualify for these special grants, 
the Commission was required to inventory all of the hospital buildings in the 
State and to furnish data to the Public Health Service showing those elements 
pointing up obsolescence. As a result of this inventory, North Carolina has been 
able to receive additional Federal funds specifically to modernize existing health 
facilities. 


15 


Mental Health Centers and Facilities for the Mentally Retarded 


Federal funds became available during the biennia under Public Law 88-164 to 
provide for the construction of mental health centers and facilities for the mentally 
retarded. The State Department of Mental Health developed a statewide plan for 
the construction of mental health centers which divided the State into catchment 
areas, in most instances consisting of several counties for planning purposes, 
as under the Federal formula facilities must serve a population of not less than 
75,000. Under a mutually developed arrangement, the State Department of Mental 
Health approves the operating programs of the centers and then the proposal 
is referred to the Medical Care Commission for processing the construction 
application and architectural and engineering studies. The Commission adopted the 
formula allowing Federal participation to the extent of 63% of approvable project 
costs; 22% with State funds, or a maximum of $50,000 to any one project; and 15% 
with local funds. The local authorities are responsible for furnishing the site. 

The North Carolina Mental Health Council, at the invitation of the Commis¬ 
sion. appointed an advisory committee to assist in recommending projects under 
the program. Slowness in developing Federal guidelines for the program resulted 
in a delay in developing construction projects during the biennia. However, as of 
June 30, 1967, two mental health center projects were under construction and 
five others were approved for construction to commence after July I, 1967. 

The North Carolina Council on Mental Retardation in a similar manner has 
prepared a state plan for building facilities for the mentally retarded under the 
Federal program. An advisory committee composed of representatives from the 
Council was created to assist the Commission in reviewing building proposals for 
these much-needed projects. The same rates of participation were authorized as 
for mental health centers. At the end of the biennia, three projects had been 
approved for construction. Bids for these are expected to be taken after July I, 
1967. 


16 


Avg. Sq. Ft. per Avg. Sq. Ft. Cost Avg. Bed Cost 

Bed for Period for Period for Period 


$30,000 


$25,000 


$20,000 


$15,000 


$10,000 


% RISE OVER PRECEDING PERIOD 

1 05 % 





'< ' '' - 


18.8% 






ffilHii 





800 


700 


600 


500 


% RISE OVER PRECEDING PERIOD 

40% 

9% 

6 % 

12.6% 

6% 








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1948-52 1353-55 1956-53 1961-64 1965-67 


Period of Years 


TRENDS IN COSTS* OF ALL-NEW GENERAL HOSPITAL 
PROJECTS DEVELOPED UNDER THE HILL-BURTON PROGRAM 
IN NORTH CAROLINA 1948-1967 


* cost shown are total hospital cost excluding site cost 


17 































TABLE I-A 

Data on Projects Approved During the Fiscal Year 
July 1, 1963 - June 30, 1964 


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19 




TABLE l-B 

Data on Projects Approved During the Fiscal Year 
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Federal share tentatively assigned to Rowan Memorial Hospital. 

Although committed to project, did not come out ot one year’s allotment. 

—Addition to existing facility N—All-new facility G—General beds 

C—Chronic disease and nursing home beds SF—Service facilities only 






TABLE l-C 

Data on Projects Approved During the Fiscal Year 
July 1, 1965 - June 30, 1966 



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A—Addition to existing facility N—All-new facility G—General beds LTC—Chronic disease and nursing home beds. 

Psy.—Psychiatric beds 





TABLE l-D 

Data on Projects Approved During the Fiscal Year 
July 1, 1966 - June 30, 1967 


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* Although committed to project, did not come out of one year’s allotment. 

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Psy.—Psychiatric beds 







TABLE 11-A 

Data on Projects for Which Bids Were Taken During the Fiscal Year 
July 1, 1963 - June 30, 1964 


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Health Centers 

Cherokee County Branch Health Center N Cherokee 39,843.44 21,843.93 10,564.52 7,434.99 


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SF—Service facilities only * Conversion of nurses’ residence 

APW—Federal funds appropriated under Accelerated Public Works program (no Hill-Burton funds involved) 





Data on Projects for Which Bids Were Taken During the Fiscal Year 
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Data on Projects for Which Bids Were Taken During the Fiscal Year 
July 1, 1965 - June 30, 1966 



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SF - Service Facilities only 





Data on Projects for Which Bids Were Taken During the Fiscal Year 
July 1, 1966 - June 30, 1967 



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Diagnostic and Treatment Centers 

Charlotte Memorial Hospital A Mecklenburg 1,670,000.00 782,465.00 -0- 887,535.00 

N. C. Memorial Hospital A Orange 10,240,679.00 2,487,375.00 -0- 7,753,304.00 

Sampson Co. Memorial Hospital A _ Sampson _512,495.72 249,892.00 -0- 262,603.72 


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Total 33 Construction Projects from 

July 1, 1965 -June 30, 1967 52,430,411.36 19,583,203.55 628,180.00 32,219,027.81 





Federal Allotments to North Carolina for the Construction of Medical Facilities 


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Allotments for Chronic Disease Facilities and Nursing Homes are now combined in a single category “Long-Term Care Facilities 
Includes funds used to construct interchangeable beds in acute sections of general hospitals. 









TABLE lll-B 


State Appropriations to the Commission for the Construction of Medical Facilities 



Total 

Hospitals 

Long-Term 

Community 


Year 

Health Centers 

Care 

Mental Health 

Mental 

Appropriation 

Nurses’ Residences 

Facilities 

Facilities 

Retardation 

1947-1948 

3,125,000 

3,125,000 




1948-1949 

3,125,000 

3,125,000 




1949-1950 

3,413,486 

3,413,486 




1950-1951 

3,413,486 

3,413,486 




1951-1952 

1,000,000 

1,000,000 




1952-1953 

1,000,000 

1,000,000 




1953-1954 

1,000,000 

1,000,000 




1954-1955 

1,000,000 

1,000,000 




1955-1956 

-0- 

-0- 




1956-1957 

-0- 

-0- 




1957-1958 

375,000 

375,000 




1958-1959 

375,000 

375,000 




1959-1960 

250,000 

250,000 




1960-1961 

250,000 

250,000 




1961-1962 

-0- 

-0- 




1962-1963 

-0- 

-0- 




1963-1964 

1,000,000 

500,000 

300,000 

200,000 


1964-1965 

1,000,000 

500,000 

300.000 

200,000 


1965-1966 

95,342 



95,342 

1966-1967 

1 17,813 




1 17,813 

Totals 

20,540,127 

19,326,972 

600,000 

400,000 

213,155 


33 




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Summary Showing Construction Status of Medical Facilities Projects Approved 
Under Public Health Service Act (Title VI) and Mental Retardation Facilities 


36 


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Projects Currently Under Construction 
June 30, 1967 


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Special funds provided under Appalachian Regional Development Act. 






Projects Currently Under Construction 
June 30, 1967 



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Total 40 Projects Under Construction 2363 81,297,292.51 30,418,000.20 828,900.00 50,050,392.31 



Projects Currently in Planning Stage 
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July 1, 1967 


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NC-438 Onslow Onslow Co. Health Center 133,811.22 72,600.00 






Projects Currently in Planning Stage 
For Which Bids Will Be Taken After 



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Granville Board of Juvenile Correction 

Mental Retardation Facility 504,054.00 317,554.00 -0- 186,500.00 

Jackson Western Carolina University 

Mental Retardation Facility 322,272.66 168,007.14 -0- 154,265.52 


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SIZE AND LOCATION OF GENERAL AND ALLIED HOSPITALS 

(EXCLUDING MENTAL AND TUBERCULOSIS) 

December 1, 1947 



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SIZE AND LOCATION OF GENERAL AND ALLIED HOSPITALS 
INCLUDING PROJECTS UNDER CONSTRUCTION AND IN PLANNING 
(EXCLUDING MENTAL AND TUBERCULOSIS) 

June 30, 1967 



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400—499 6 4.1 2,646 13.0 + 200.0 + 200.0 

500—Over X 4 2.7 2,962 14.6 + 300.0 + 430.8 













(EXCLUDING MENTAL AND TUBERCULOSIS) 



46 


Counties with no general hospital 








OWNERSHIP OF GENERAL AND ALLIED HOSPITALS 
INCLUDING PROJECTS UNDER CONSTRUCTION AND IN PLANNING 
(EXCLUDING MENTAL AND TUBERCULOSIS) 



47 


TOTAL 146 100.0 20.287 100.0 + 11.5 + 115.2 Counties with no general hospitals 









62 COUNTIES WITH ALL-NEW GENERAL HOSPITALS 
AIDED BY THE COMMISSION 
1947 - 1967 



48 




















LONG - TERM CARE FACILITIES 
CONSTRUCTION PROGRAM 
1947-1967 



49 


Under Construction 





PUBLIC HEALTH CENTERS 
CONSTRUCTION PROGRAM 
1947 - 1967 



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Under Construction 








NURSES’ RESIDENCES — SCHOOLS OF NURSING 
CONSTRUCTION PROGRAMS 
1947 - 1967 



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Completed Nurses’ Residences 







REHABILITATION FACILITIES 
CONSTRUCTION PROGRAM 
1947 - 1967 



52 


DUKE UNIVERSITY MEDICAL CENTER (Durham County) 










COMMUNITY MENTAL HEALTH CENTER 
CONSTRUCTION PROGRAM 
1964 - 1967 ' 



53 


1 Construction Funds Under Public Law 88 - 164 
First Became Available July 1,1964 





FACILITIES FOR THE MENTALLY RETARDED 
CONSTRUCTION PROGRAM 
1964 - 1967 1 



54 


Construction Funds Under Public Law 88 - 164 
First Became Available July 1, 1964 










SECTION II 


THE HOSPITAL LICENSING PROGRAM 


In June 1964, the Commission revised its licensing regulations and procedures 
with the assistance of the Department of Hospital Administration at the Univer¬ 
sity of North Carolina, the Council on Hospital Planning of the North Carolina 
Hospital Association, the State Board of Health, the Fire Marshal’s office of the 
State Insurance Department and the State Board of Pharmacy. The amended 
procedures have been well accepted by hospitals in the State and have received 
national commendation. 

The Commission is continually studying and evaluating licensing standards 
in the light of constantly changing factors that influence hospital design and 
operation. As an example, a study was recently initiated on the use of carpeting in 
hospitals. With the advice of a panel of recognized consultants and specialists, 
the Commission has established specifications restricting usage of carpets and 
defining areas in which their use is acceptable for licensing purposes. 

In April 1966, The State Board of Health contracted with the Medical Care 
Commission to conduct surveys of hospitals not accredited by the Joint Commis¬ 
sion on Accreditation of Hospitals for purposes of determining their eligibility 
for certification as participants in the Federal Health Insurance for the Aged 
Program (Medicare). Approximately 60 surveys of non-accredited hospitals were 
conducted between April and June 30, 1966. Of this group, 45 hospitals are 
currently certified. In addition to the initial surveys, the contract provides for 
follow-up consultation to aid hospitals in retaining certification. 

At the end of the last biennium, there were 146 hospitals certified for participa¬ 
tion in the Medicare program, this number including both accredited and non- 
accredited hospitals and representing 19,117 beds. Of the available hospital beds 
in the State, 97% are certified for Medicare purposes. 

Many of the hospitals surveyed need guidance in maintaining adequate medical 
records. As a means of furnishing this assistance, the Commission employed a 
registered medical record librarian in March 1967. An additional nurse is to be 
employed to assist hospitals with their nursing problems. 

A need was indicated in 1963 for the State Board of Pharmacy to develop and 
promulgate rules and regulations applying to hospital pharmacy registration and 
for the Board and the Commission to clarify and coordinate their respective 
responsibilities in upgrading drug administration and distribution practices in 
licensed hospitals. It was concluded that hospitals which were compounding and/ 
or dispensing medications as defined by G. S. 90-75 must secure the services of a 
pharmacist to supervise the drug services to enable the hospital to register its 
pharmacy in accordance with State statutes. The regulations as presently drawn 


55 


permit the issuance of a “limited service permit," allowing smaller hospitals 
not needing the services of a full-time pharmacist to comply with statutory 
requirements. Procedures were mutually agreed upon whereby the Commission 
will conduct the pharmacy surveys and provide the Board of Pharmacy reports on 
findings. The Board then will work with the hospitals in obtaining registration. 

At the same time, a plan of assistance to develop and improve hospital pharmacy 
service in North Carolina was jointly sponsored by the North Carolina Association 
of Hospital Pharmacists, the North Carolina Board of Pharmacy, the North 
Carolina Pharmaceutical Association, the North Carolina Hospital Association 
and the Medical Care Commission with the cooperation of the School of Pharmacy 
at Chapel Hill. A pharmacist was employed to head the assistance program. As a 
result of all of these efforts and the excellent cooperation of the hospitals, the 
number of registered pharmacies in licensed hospitals has increased from 37 in 
1963 to 80 at the end of the last biennium. 

Pursuant to legislation enacted in 1963, the Commission strengthened its sur¬ 
veillance program for hospital X-ray facilities. The majority of the surveys are 
conducted by the Commission’s staff. However, reports of surveys made by 
qualified physicists are acceptable to the Commission for licensing purposes. As 
of June 1967, instrumentation surveys had been completed on all hospitals except 
those that were surveyed by radiation physicists. 

As of January 1967, there were 150 hospitals in the State that were eligible to 
be considered for accreditation by the Joint Commission on Accreditation of 
Hospitals. Among this number, 1 1 1 were actually accredited representing 74% of all 
of the hospitals and 88% of eligible beds. This high percentage of hospitals meeting 
the Joint Commission's requirements has made it easier for the majority of the 
hospitals to meet Medicare requirements. 

The following summarizes statistically hospitals by capacity and medical type: 


Licensed Hospitals by Bed Capacity 
(December 31, 1966) 


Size by Beds 

Number 

3-15 

13 

16-30 

1 1 

31-50 

40 

51-75 

19 

76-100 

20 

101-150 

22 

151-200 

14 

201-300 

1 1 

301-400 

6 

401-up 

9 


165 


Beds 

Average 
No. of Beds 

1 1 1 

8.5 

251 

22.8 

1,696 

42.4 

1,264 

66.5 

1.837 

91.8 

2,71 1 

123.2 

2,437 

174.1 

2.620 

238.2 

2,071 

345.2 

4,646 

516.2 


19,648 119.1 


56 



Licensed Hospitals by Medical Type 


General . 141 

Mental . 0 

Tuberculosis . 4 

Rehabilitation . 4 

Maternity . 0 

Pediatric . I 

Eye, Ear, Nose, Throat. 2 

Physician’s Clinic. 12 

Chronic Disease . 1 

Following is a summary of patient service data of licensed hospitals for the 
year ended September 30, 1966: 

A. Percentage of occupancy . 73.70 

B. Average length of stay . 7.77 

C. Total patients discharged (deaths included). 780,876 

Less newborn discharged . 81,680 

Total less newborn . 699,196 

D. Total patient days . 5,648,751 

Less newborn days . 362,143 

Total less newborn . 5,286,608 

E. Total outpatient visits . 2,032,389 

Organized clinic visits . 1,215,814 

Emergency room . 816,575 

F. Employees per patient per day (excluding newborn days) . . . 2.57 

G. Total surgical procedures: 

Major . 1 15,615 

Minor . 199,820 

H. Number of Medical Inpatients . 234,349 

I. Number of Pediatric Inpatients (14 years and under) . 80,757 

J. Number of Maternity and Gynecological Inpatients . 141,642 

K. Number of Other Inpatients . 59,620 

L. Deaths (stillbirths excluded). 19,213 

M. Number of Autopsies . 4,507 


57 






























SECTION III 


EDUCATIONAL LOANS 
FOR MEDICAL AND RELATED STUDIES 


Twenty-two years ago North Carolina inaugurated a plan through which 
it hoped to supply more family doctors to the more rural communities. The 
need continues, yet the urgency for manpower exists in other health fields and 
areas as well. Cognizant of a sweeping problem, the 1965 General Assembly 
passed legislation consolidating and unifying all previous laws applying to this 
loan program and further structured H.B. 478 so as to provide more flexibility 
in administration of the program. The new law was designed to stimulate 
more financially needy state residents to enter or continue in medical and related 
studies and to provide their services to areas of critical shortages in return for 
the financial assistance made available by these loans for their professional 
education. 

Two years later, as of June 30, 1967, the Medical Care Commission had 
processed over 55% more applications than for all the previous 20 years of the 
program’s existence, and over 130% more applications than for the prior 
biennium. The fields of pharmacy, nursing, medical technology and dentistry 
represent the most notable increases. Medicine showed almot 100% increase over 
the 1963-65 biennium, but was the same as the 1961-63 biennium. Social work 
remained the same and nurse anesthesia dropped 25%. The new fields of study 
approved in June, 1965 (i. e., psychology, dietetics, medical records library 
science, medical recreation, optometry and physical therapy) all had loan re¬ 
cipients with physical therapy leading the group in number of applications 
approved with six recipients. 

By December 1, 1966, well over 600 recipients had attended 32 different 
colleges or universities and 26 hospital schools. Students, now having a free 
choice of schools, have been scattered in schools over 15 states. Thirty-four 
different North Carolina educational institutions have enrollees under the 
program. 

The rate of attrition has dropped from 12.6% at the end of the 1963-65 
biennium to 10.5% as of June 30, 1967. There were 7 withdrawals 1 in nursing and 
I academic failure. Pharmacy had no academic failures. 

The true effectiveness to the State of the $650,000 encumbered over the last 
two years to assist students in completing their training will be difficult to assess 
for some time. Although there are more recipients practicing in pharmacy, 
nursing, nurse anesthesia and medical technology than there were on June 30. 
1965, there was a decline of practitioners in medicine and dentistry. The field of 
medicine has 56% fewer practitioners than at the end of both previous bienniums; 
the decrease for dentistry was only 2 students, or 13.8%. The current program is 
not designed to attract those interested in medical specializations unsuited to 


1 Changed major field of study—2 students; left North Carolina due to marriage—3 students; 
and financial and/or personal reasons—2 students. 


58 



areas of service approved by the Commission, nor for those interested specifically 
in urban locations, but it must be recognized that over the long period of training 
many will be motivated to goals other than those which will qualify under this 
program. Likewise, the attractive interest rates of 2% and 4% prevailing for notes 
executed prior to June, 1965 may have been an enticement to borrow regardless 
of the service commitment which could be altered. 

The nursing field recorded a 300% increase in practitioners in June, 1965 over 
1963 and a 75% gain in 1967 over 1965. It is encouraging to observe that 70-80 
nursing students are potential candidates to give service to the State in the next 
biennium, a tremendous increase over the current 20 nursing recipients who are 
in practice. Instead of the 35% increase for "in practice” recipients in all fields as 
shown for the biennium ended June 30, 1967, the Medical Care Commission 
predicts at least a 100% jump in services rendered to the State by loan recipients 
during the next two years. There were no failures on North Carolina Board 
examinations for nurses among the baccalaureate graduates and less than a 10% 
failure rate for “first-takers” for diploma and associate degree recipients. 

Based on a study completed in 1966, of the 625 recipients who had been 
provided assistance from the program only 20.4% returned to their home county 
to practice. This represented 41 out of 100 counties. By field of study, pharmacy 
and nurse anesthesia were the only areas where over 50% of the students returned 
to their home county to give service in accordance with their loan agreements. 
Medicine was one of the lowest of all fields with 23.1%. Figures are based only 
on students who were eligible to practice and do not include those who were 
involved in some additional phase of their training and/or military service. 

The changes adopted by the Medical Care Commission during the last 
biennium are: 

1. July 6, 1966: Funds are available for a registered nurse attending a 
baccalaureate program for a fraction of a year if needed to complete 
final requirements for a baccalaureate degree. To be considered for 
less than a full year’s loan, a student must have (a) received a Com¬ 
mission loan for the previous academic year of study and (b) enrolled 
as a full-time student for not less than one full term or semester of 
study. 

2. February 16, 1967: A student who has been admitted to or is in 
satisfactory standing in a baccalaureate program with a major field of 
study designated as eligible for funds by the Medical Care Commission 
would be eligible to make application for assistance in the sophomore 
year. A student will not be eligible for assistance in the freshman year 
of a collegiate program or in a first year of the diploma program for 
nurses. This applies to nursing, medical records library science, medical 
technology, physical therapy, occupational therapy, dietetics, and dental 
hygiene. 


59 


FINANCIAL STATISTICS 


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Active accounts submitted to the Attorney General's Office for collection when the Medical Care Commission is unsuccessful in its negotiations with the 
recipients and sureties to their notes. 





STATUS OF RECIPIENTS WHO HAVE COMPLETED PRESCRIBED TRAINING 




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SUMMARY OF APPLICATIONS APPROVED 

Educational Loan Program 
1945-June 30, 1967 


Increase or Decrease 
1945-67 over 1945-65 


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O' 

PC 

PC — 

DC DC 
— PC 

+ 

, A3o|OqoAsd 

leoiuiio 

<y> 

1 

1 


i 

1 

1 


New Students Approved: 

1965-67 Biennium 5 

1963-65 Biennium 0 

Increase or Decrease 
over 1963-65 Biennium 

Number of Recipients 5 

Percentage + 100 


Total Number of 

Students Approved 

In Practice 

Completed Practice 
Obligation 

Enrolled in School 

Academic Failures 

Withdrew from School 
and/or Program 

Postgraduate or 

Military Service 

Failed to Comply with 
Practice Obligation 


62 


New programs adopted June 18, 1965. No applications have been received for occupational therapy, Master's of Public Health (physicians only) or dental hygiene 






































STATE LIBRARY OF NORTH CAROLINA 



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