DOCUMENT NO. NCHH-111

NORTH CAROLINA HISTORY OF HEALTH DIGITAL COLLECTION Summary of the Activities of the North Carolina Medical Care Commission and Reports [1947-1967] DOCUMENT NO. NCHH-111 http://hsl.lib.unc.edu/specialcollections/nchealthhistory

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The Expansion of Medical Facilities and Services in r\jor-±hi CaroiinsL Two Decades of Progress ECWED NOV 5 1966 NffiMRS ii of thig Activities oi^ the North Carolina Medical Care Commission and Reports for the Biennia 1963-1965 / 1965-1967

THE EXPANSION OF MEDICAL FACILITIES AND SERVICES IN NORTH CAROLINA TWO DECADES OF PROGRESS THE NORTH CAROLINA MEDICAL CARE COMMISSION JULY 1, 1947 - JUNE 30, 1967 and REPORTS FOR THE BIENNIA JULY 1, 1963 - JUNE 30, 1965 December 1, 1967 THE NORTH CAROLINA MEDICAL CARE COMMISSION 437 North Harrington Street Raleigh, North Carolina 4 <l

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 8 Recent Legislation 9 New Personnel 10 Section I Planning and Construction of Medical Facilities Including Maps and Tables of Information 11 Section II The Hospital Licensing Program 55 Section HI Education Loans for Medical and Related Studies 58

MEMBERS THE NORTH CAROLINA MEDICAL CARE COMMISSION SERVING DURING THE BIENNIA 1963-1965; 1965-1967 Term Member Address Representation Expiration Mr. Edwin N. Brower, Sr. 1 Chairman Hope Mills At Large June 30, 1968 Mr. Agnew H. Bahnson, Sr. 1 Vice-Chairman Winston-Salem At Large June 30, 1964 Mr. Marshall I. Pickens Vice-Chairman Charlotte The Duke Endowment June 30, 1969 Dr. J. Street Brewer Roseboro N. C. Medical Society June 30,1969 Mr. Paul W. Bumbarger, Jr. Hickory At Large June 30, 1968 Dr. George L. Carrington Burlington At Large June 30, 1967 Dr. H. Royster Chamblee 2 Raleigh At Large June 30, 1967 Mr. J. B. Clemence Salisbury At Large June 30, 1970 Mr. E. C. Daniel 5 Zebulon N. C. Pharmaceutical Assoc. June 30, 1966 Mrs. Margaret B. Dolan Chapel Hill N. C. Nurses' Association June 30, 1970 Mr. Sample B. Forbus 3 Durham N. C. Hospital Association June 30, 1964 Dr. Powell G. Fox Raleigh N. C. Medical Society June 30, 1967 Mr. Ernest J. House Marion At Large June 30, 1967 Mr. Thomas R. Howerton Wilson N. C. Hospital Association June 30, 1968 Dr. William D. James Hamlet At Large June 30, 1969 Dr. Harry L. Johnson 6 Elkin N. C. Medical Society June 30, 1966 Mr. J. B. Lee 4 Whiteville At Large June 30, 1965 Mr. H. C. McAllister 5 Chapel Hill N. C. Pharmaceutical Assoc. June 30, 1970 Dr. Hugh F. McManus, Jr. 6 Raleigh N. C. Medical Society June 30, 1970 Mr. B. Lee Mootz 3 Winston-Salem N. C. Hospital Association June 30, 1968 Mr. Dwight W. Quinn 4 Kannapolis At Large June 30, 1965 Dr. James J. Richardson 7 Laurinburg At Large June 30, 1965 Dr. William Raney Stanford Durham At Large June 30, 1968 Mr. John C. Whitaker 4 Winston-Salem At Large June 30, 1969 Dr. Paul F. Whitaker Kinston At Large June 30, 1969 Mr. Carl P. Worley,Jr. 7 Selma At Large June 30, 1969

EX-OFFICIO MEMBERS Mr. R.Eugene Brown 9 Mr. Clifton M. Craig 9 Dr. J. W. R. Norton 8 Dr. Jacob Koomen, Jr. Raleigh Raleigh Raleigh Raleigh State Commissioner of Public Welfare State Commissioner of Public Welfare State Health Director State Health Director 'The term of Mr. Agnew H. Bahnson, Sr. expired June 30, 1964; Mr. Edwin N. Brower, Sr. was appointed in December, 1964 to succeed him. 2 Dr. H. Royster Chamblee resigned in April, 1962; he was reappointed in August, 1963. 3 The term of Mr. Sample B. Forbus expired June 30, 1964; Mr. B. Lee Mootz was appointed in August, 1964 to succeed him. Mr. Mootz resigned in December, 1964; Mr. Thomas R. Howerton was appointed in September, 1965 to succeed him. 4 Mr. J. B. Lee resigned in September, 1963; Mr. Dwight W. Quinn was appointed to succeed him. Mr. Quinn's term expired June 30, 1965; he was succeeded by Mr. John C. Whitaker. 5 Mr. H. C. McAllister succeeded Mr. E. C. Daniel. 6 Dr. Hugh F. McManus, Jr. succeeded Dr. Harry L. Johnson. 7 Mr. Carl P. Worley, Jr. succeeded Dr. James J. Richardson. 8 Dr. Jacob Koomen, Jr. succeeded Dr. J. W. R. Norton as State Health Director in January, 1966. 9 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 Btennia 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 2 1 Reappointed 1965 Mrs. Carrie T. Phelps succeeded Mrs. Virginia Foglia 6

ADMINISTRATIVE June 30, 1967 STAFF Name William F. Henderson 1. 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

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 additional 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: S 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 rehabilitation 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 th.? 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.

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. 1 138 permitted transfer from the Department 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 statelicensed 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 two 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 construction 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 deficiencies, 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 11.5% 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 51 1 % 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 rehabilitation 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 1 1

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 advantages of total air conditioning, recovery rooms, physical therapy and enlargement 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, ajump 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 accommodations 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 program, proposals during the biennia reflecting extensive needs of many hospitals for modernization, expansion and replacement developed much beyond the

agency's resources to finance. There are obvious reasons for this accelerated demand. 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 commanding 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 construction 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 appropriations 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 governmentally 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 appropriations to the State for any single fiscal year may not exceed $1 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. 14 (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.)

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 connection 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 Health 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 Commission, 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 1, 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

$30,000 O T3 O O $25,000 % RISE OVER PRECEDING PERIOD 105% 19.3% 15.6% 25.5% 18.8% 0) CD $20,000 n ao < O $15,000.. \V-^;.";V.'v.V''. $10,000 M 'L :-. V'-o-.'r.'!. V. I&J $40.00 % RISE OVER PRECEDING PERIOD 65.9% $35.00 25.8% 10.7% 10.1 % 8.2% o U -D O CJ CO > < CD Q_ $30.00 $25.00 $20.00 ;} V V t&i&smesa ; $15.00 '» -.'.. -/ '..v c : '..y-c-i. -V..'j'-V'vS' i. i»»i ' 11 1,. I'III Vim j CD "D Q. O i *- (D u_ a. cr 5 800 700 600 % RISE OVER PRECEDING PERIOD 40% 9% 6% 12.6% 6%..... ;. :!: :) ' ':'!'; < m 500 : V p V.. ' -.r 1948-52 1953-55 1956-59 1961-64 1965-67 Period of Years TRENDS IN COSTS* OF ALL-NEW GENERAL HOSPITAL PROJECTS DEVELOPED UNDER T H E HILL-BURTON PROGRAM IN NORTH CAROLINA 1948-1967 * cost shown are total hospital cost excluding site cost 17

TABLE l-a Data on Projects Approved During the Fiscal July 1, 1963 - June 30, 1964 Year Federal State Local Project Address Type Beds Total Cost Share Share Share Branch Cherokee County Health Center Andrews <N) Health Center 40,000.00 22,000.00 10,640.00 7,360.00 Washington County Hospital Plymouth APW (A) Hospital SF 32,529.10 17,891.00 5,725.12 8,912.98 Catawba County Hospital Hickory (N) Hospital 200(G) 3,600,000.00 1,980,000.00 ;: -0-1,620,000.00 Watauga County Hospital Boone (N) Hospital 80(G) 1,440,000.00 792,000.00 100,000.00 548,000.00 Columbus County Hospital Whiteville (A) Hospital 12(G) 500,000.00 275,000.00 100,000.00 125,000.00 34(LTC) Davie County Hospital Mocksville (A) Hospital 29(G) 720,000.00 396,000.00 77,760.00 246,240.00 Caldwell Memorial Hospital Lenoir (A) Hospital 35(G) 839,000.00 461,450.00 76,349.00 301,201.00 N. C. Memorial Hospital Diagnostic and Treatment Center (A) Diag. and Chapel Hill Treat. 7,500,000.00 2,487,375.00* -0-5,012,625.00 Maryfield Convalescent Home High Point (N) Nursing Home 50(LTC) 607,000.00 333,850.00-0- 273,150.00 Forsyth Memorial Hospital Chronic Care Unit Winston-Salem (N) Chronic 64(LTC) 786,500.00 432,575.00-0- 353,925.00

Pender Memorial Hospital Burgaw Alexander Children's Center Charlotte Johnston Memorial Hospital Diagnostic and Treatment Center Smithfield Union Memorial Hospital Long-Term Chronic and Convalescent Unit Monroe (A) (A) (A) (N) Hospital Rehab. Diag. and Treat. CHRONIC 19(G) 36( Rehab. 78(LTC) 680.000.00 855,000.00 I (.5,748.45 810,000.00 374,000.00 100,000.00 552,586.50* -0-91,161.65-0- 445,500.00 100,000.00 206,000.00 302,413.50 74,586.80 264.500.00 Total 1963-1964 14 Projects 375(G) 18,575,777.55 8,661,389.15 570,474.12 9,343,914.28 226(LTC) 36( Rehab.) 637 * Although committed to project, did not come out ot one year's allotment. A Addition to existing facility N All-new facility G General beds Rehab. Rehabilitation beds LTC Chronic disease and nursing home beds APW Federal funds appropriated under Accelerated Public Works program (no Hill-Burton funds involved)

TABLE IB Data on Projects Approved During the Fiscal July 1, 1964 - June 30,1965 Year Federal State Local Project Address Type Beds Total Cost Share Share Share Carteret County Hospital Morehead City (N) Hospital 100(G) 1,800,000.00 990,000.00 100,000.00 710,000.00 Betsy Johnson Memorial Hospital Dunn (N) Hospital 115(G) 2,070,000.00-0-* 100,000.00 1,970,000.00 Franklin Memorial Hospital Louisburg (A) Hospital 25(G) 900,000.00 495,000.00 7 1,208.00 333,792.00 Annie Penn Memorial Hospital Reidsville (A) Hospital 32(G) 1,214,000.00 667,700.00 51,084.00 495,216.00 Cleveland Memorial Hospital Shelby (A) Hospital 79(G) 3,277,000.00 1,802,350.00* 71,208.00 1,403,442.00 Memorial Mission Hospital Asheville (A) Hospital SF 370,000.00 203,500.00-0- 166,500.01- Memorial Mission Hospital Asheville (A) Hospital (36)(LTC) 388,000.00 213,400.00-0- 174,600.00 Cornelia Nixon Davis Nursing Home Wilmington (N) Nursing Home 70(LTC) 840,000.00 462,000.00-0- 378,000.00 Hatteras Medical Center Physician's Hatteras (N) Clinic 8(G) 125,000.00-0- 93,750.00 31,250.00 Guilford County Nursing Home (Equip. ) Nursing Home Greensboro (only ) 96(LTC) 1 10,000.00 60,500.00-0- 49,500.00 Rowan Memorial Hospital Salisbury (A) Hospital 34(G) 3,275,380.00 1,801,459.00* -0-1,473,921.00

Rowan Memorial Hospital Salisbury (A) Hospital (48)(LTC) 614,620.00 338,041.00-0- 276,579.00 Highlands-Cashiers Hospital Highlands (A) Hospital 20(LTC) 267,000.00 146,850.00 70,488.00 49,662.00 Total 1964-1965 13 Projects 477(G) 15,251,000.00 7,180,800.00 557,738.00 7,512,462.00 (84)186(LTC) 663 Total for Biennium 27 Projects 852(G) 33,826,777.55 15,842,189.15 1,128,212.12 16,856,376.28 (84)412(LTC) 36(Rehab.) 1,300 * Federal share tentatively assigned to Rowan Memorial Hospital. * Although committed to project, did not come out of one year's allotment. A Addition to existing facility N All-new facility Q General beds l.tc Chronic disease and nursing home beds SF Service facilities only

TABLE l-c Data on Projects Approved During the Fiscal July 1, 1965 - June 30, 1966 Federal State Local Project Address Type Beds Total Cost Share Share Share Orange County Health Center Hillsborough (N) Health Center 100,000.00 55,000.00-0- 45,000.00 Bertie County Health Center Windsor (N) Health Center 77,000.00 42,350.00-0- 34,650.00 Grace Hospital Morganton (N) Hospital 160(G) 2,880,000.00 1,584,000.00* -0-1,296,000.00 Wayne Co. Memorial Hospital Goldsboro (N) Hospital 350(G) 6,300,000.00 3,000,000.00* -0-3,300,000.00 Cape Fear Valley Hospital Fayetteville (A) Hospital 78(LTC) 4,821,000.00 2,000,000.00* -0-2,821,000.00 108(G) Sampson Co. Memorial Hospital Clinton (A) Hospital 36(LTC) 1,682,502.00 925,376.00-0- 757,126.00 8(G) Beaufort County Hospital Washington (A) Hospital 22(LTC) 1,570,000.00 863,500.00-0- 706,500.00 44(G) Southeastern General Hospital Lumberton (A) Hospital D&T 687,755.00 233,467.00-0- 454,288.00 Blowing Rock Hospital Blowing Rock (A) Hospital 76(LTC) 912,000.00 501,600.00 100,000.00 310,400.00 Valdese General Hospital Valdese (A) Hospital D&T 155,000.00 85,250.00-0- 69,750.00 Lincoln County Hospital Lincolnton (N) Hospital 100(G) 1,800,000.00 990,000.00-0- 810,000.00 Southeastern General Hospital Lumberton (A) Hospital 80(LTC) 960,000.00 528,000.00 100,000.00 332,000.00 Year

Morehead Memorial Hospital Leaksville Western Carolina University Mental Health Center Cullowhee Western Carolina University Facility for the Mentally Retarded Cullowhee (A) (N) (N) Hospital Mental Health Center Mental Retard. 50(LTC) 600,000.00 213,090.00 266,678.00 330,000.00 35,400.00 34,246.70-0- 68,007.14-0- 234,600.00 78,843.30 98,670.86 Cape Fear Valley Hospital Mental Health Center Fayetteville Alamance Co. Mental Health Center Burlington (A) (N) Hospital Mental Health Center 3 KPsy.),294,000.00 269,140.35 815,220.00 50,000.00 167,245.95 50.000.00 428,780.00 51.894.40 Facility for the Mentally Retarded N. C. Board of Juvenile Correction Butner Duke University Medical Center Durham Wilson County Mental Health Ctr. Wilson (A) (A) (N) Mental Retard. Rehab. Mental Health Center 504,054.00 656,000.00 76,000.00 317,554.00-0- 335,000.00-0- 10,880.00 38,720.00 86,500.00 321,000.00 26,400.00 Total 1965-1966 20 Projects 770(G) 25,924,219.35 13,186,696.79 374,120.00 12,363,402.56 342(LTC) 3 l(psy.) 1 143 * Although committed to project, did not come out of one year's allotment. A Addition to existing facility N All-new facility G General beds Psy. Psychiatric beds LTC Chronic disease and nursing home beds.

t J 4- TABLE ID Data on Projects Approved During the Fiscal July 1, 1966 - June 30, 1967 Year Project Address Type Beds Total Cost Federal Share State Share Local Share Nash County Hospital Rocky Mount Anson County Hospital Wadesboro Duplin General Hospital Kenansville Swain County Hospital Bryson City Edgecombe General Hospital Tarboro Wilkes General Hospital North Wilkesboro Onslow County Health Center Jacksonville Charlotte Memorial Hospital Charlotte Mountain Sanitarium and Hospital Fletcher Chatham Hospital SilerCity Duke University Medical Center Durham (N) (A) (A) (A) (A) (A) (N) (A) (A) (A) (A) Hospital Hospital Hospital Hospital Hospital Hospital Health Center Hospital Hospital Hospital Hospital 300(G) 13(G) 30(LTC) 50(G) 20(G) 12(G) 34(LTC) 30(G) 3()(LTC) D&T 50(LTC) 30(LTC) Rehab. 5,454,545.45 3,()00,0()0.00* -0-,818,182.00 1,000,000.00-0- 1,647,272.00 778,000.00 1,555,000.00 1,568,000.00 132,000.00 1,422,664.00 600,000.00 739,190.00 971,522.00 906,000.00 427,900.00 855,250.00 862,400.00 72,600.00 782,465.00 330,000.00 406,554.00 612,059.00-0- -0- -0- -0- -0- -0-25,200.00 6,974.00-0- 2,454,545.45 818,182.00 741,272.00 350,100.00 699,750.00 705,600.00 59,400.00 640,199.00 244,800.00 315,662.00 359,463.00

Charlotte-Mecklenburg Mental Health Center Charlotte Moore Memorial Hospital Mental Health Center Pinehurst Southeastern General Hospital Mental Health Center Lumberton Eastern Carolina Sheltered Workshop and Vocational Rehabilitation Center Greenville (N) (A) (A) (N) Mental Health Center Hospital Hospital Mental Retard. 20( Psy.) 25(Psy.),261,920.00 542,968.00 550,000.00 284,705.71 795,009.00 50,000.00 342,069.84 50,000.00 346,500.00 50,000.00 179,364.60 50,000.00 416,91 1.00 150,898.16 153,500.00 55,341.1 I Total 1966-1967 15 Projects 425(G) 19,325,969.16 10,918,171.44 242,174.00 8,165,623.72 174(LTC) 45(PSY.) 644 Total for Biennium 35 Projects 1195(G) 44,250,188.5 1 24,104,868.23 616,294.00 20,529,026.28 516(LTC) 76(Psy.) 1787 * Although committed to project, did not come out of one year's allotment A Addition to existing facility N All-new facility Psy. Psychiatric beds G General beds LTC Chronic disease and nursing home beds

TABLE ll-a Data on Projects for Which Bids Were Taken During the Fiscal July 1, 1963 - June 30, 1964 Year New or Number Federal State Local Name of Project Addition of Beds County Total Cost Share Share Share General Hospitals Alleghany County Memorial Hospital A 15 Alleghany 230,460.38 126,500.00 65,090.00 38,870.38 Chas. A. Cannon, Jr. Mem. Hospital A SF Avery 120,286.12 79,200.00 20,760.00 20,326.12 Caldwell Memorial Hospital A 35 Caldwell 1,074,759.00 461,450.00 76,349.00 536,960.00 Columbus County Hospital A 46 Colu mbus 605,399.96 275,000.00 100,000.00 230,399.96 Duke University Hospital - APW A SF Durham 518,156.88 272,735.00-0- 245,421.88 L. Richardson Memorial Hospital N 185 Guilford 2,700,000.00 1,485,000.00-0- 1,215,000.00 Johnston Memorial Hospital A 34 Johnston 1,276,810.13 621,500.00-0- 655,310.13 New Hanover Memorial Hospital N 404 New Hanover 9,249,579.87 4,000,000.00-0- 5,249,579.87 Scotland Memorial Hospital A 27 Scotland 1,648,000.00 906,400.00-0- 741,600.00 Maria Parham Hospital - APW N 100 Vance 2,184,288.00 990,000.00 100,000.00 1,094,288.00 Washington County Hospital - APW A SF Washington 37,362.26 17,891.00 5,725.12 13,746.14 Subtotal 1 1 Projects 846 19,645,102.60 9,235,676.00 367,924.12 10,041,502.48 Diagnostic and Treatment Centers Duke University Hospital A Durham 4,1 18,283.00 654,635.00-0- 3,463,648.00 Johnston Memorial Hospital A Johnston 165,748.45 91,161.65-0- 74,586.80 Subtotal 2 Projects 4,284,031.45 745,796.65-0- 3,538,234.80

Health Centers Cherokee County Branch Health Center N Cherokee 39,843.44 21,843.93 10,564.52 7,434.99 Long-Term Care Facilities Chowan Hosp. Chronic and Conv. Unit A* Huntersville Hosp. Chronic Disease Unit A Person Co. Mem. Hosp. Chronic and Conv. Unit A Union Mem. Hosp. Chronic and Conv. Unit N 15 17 23 66 Chowan Mecklenburg Person Union 93,965.09 867,425.45 226,727.54 810,000.00 49,500.00 18,000.00 26,465.09 464,750.00-0- 402,675.4:. 108,350.00 40,188.00 445,500.00 100,000.00 78,189.54 264,500.00 Subtotal 4 Projects 121,998,1 18.08,068,100.00 158,188.00 771,830.08 Rehabilitation Facilities Greensboro Cerebral Palsy Ting. Ctr. Guilford 280,827.00 181,498.49-0- 99,328.51 Total 19 Projects 26,247,922.57 I 1,252,915.07 536,676.64 14,458,330.86 SF Service facilities only ' Conversion of nurses' residence APW Federal funds appropriated under Accelerated Public Works program (no Hill-Burton funds Involved)

TABLE MB Data on Projects for Which Bids Were Taken During the Fiscal Year July 1, 1964 - June 30, 1965 New or Number Federal State Local Name of Project Addition of Beds County Total Cost Share Share Share General Hospitals Carteret County Hospital N 100 Carteret 2,137,200.00 990,000.00 100,000.00 1,047,200.00 Catawba Memorial Hospital N 202 Catawba 5,901,822.55 1,980,000.00-0- 3,921,822.55 Cleveland Memorial Hospital A 131 Cleveland 3,404,126.00 1,500,000.00 71,208.00 1,832,918.00 Hatteras Medical Center N 8 Dare 126,760.00-0- 93,750.00 33,010.00 Davie County Hospital A 29 Davie 772,466.12 396,000.00 77,760.00 298,706.12 Pender Memorial Hospital A 14 Pender 840,812.32 374,000.00 100,000.00 366,812.32 Watauga County Hospital N 82 Watauga 1,728,731.00 792,000.00 100,000.00 836,731.00 Subtotal 7 Projects 566 14,91 1,917.99 6,032,000.00 542,718.00 8,337,199.99 Long-Term Care Facilities Forsyth Mem. Hosp. LTC Unit N 60 Forsyth 1,032,500.00 432,575.00-0- 599,925.00 Guilford County Nursing Home Equip, only 96 Guilford 109,403.21 60,171.76-0- 49,231.45 Maryfield Convalescent Home N 60 Guilford 784,574.75 333,850.00-0- 450,724.75 Cornelia Nixon Davis Nursing Home N 87 New Hanover 1,127,480.46 462,000.00-0- 665,480.46 Subtotal 4 Projects 303 3,053,958.42 1,288,596.76-0- 1,765,361.66 Rehabilitation Facilities Alexander Children's Center N 36 Mecklenburg 904,168.00 552,586.50-0- 351,581.50 Total 12 Projects Total 3 1 Construction Projects from July 1, 1963 - June 30, 1965 18,870,044.41 7,873,183.26 542,7 18.00 10,454,143.15 45,1 17,966.98 19,126,098.33 1,079,394.64 24,912,474.01

TABLE ll-c Data on Projects for Which Bids Were Taken During the Fiscal July 1, 1965 - June 30, 1966 Year New or Number Federal State Local Name of Project Addition of Beds County Total Cost Share Share Share General Hospitals Memorial Mission Hospital of Western North Carolina A SF Buncombe 436,897.00 203,500.00-0- 233,397.00 Franklin Memorial Hospital A 30 Franklin 987,459.03 495,000.00 71,208.00 421,251.03 Rowan Memorial Hospital A 66 Rowan 3,875,506.43 1,801,459.00-0- 2,074,047.43 Annie Penn Memorial Hospital A 49 Rockingham 1,287,238.97 667,700.00 51,084.00 568,454.97 Subtotal 4 Projects 145 6,587,101.43 3,167,659.00 122,292.00 3,297,150.43 Long-Term Care Facilities Memorial Mission Hospital of Western North Carolina A 32 Buncombe 433,566.00 263,400.00-0- 170,166.00 Highlands-Cashiers Hospital A 19 Macon 327,992.86 146,850.00 70,488.00 1 10,654.86 Rowan Memorial Hospital A 64 Rowan 663,576.34 338,041.00-0- 325,535.34 Subtotal 3 Projects 1 15 1,425,135.20 748,291.00 70,488.00 606,356.20 Diagnostic and Treatment Centers Southeastern General Hospital A Robeson 861,944.3 1 233,467.00-0- 628,477.3 1 Valdese General Hospital A Burke 167,866.00 85,250.00-0- 82,616.00 Subtotal 2 Projects 1,029,810.31 318,717.00-0- 711,093.31 Total 9 Projects SF - Service Facilities only 260 9,042,046.94 4,234,667.00 192,780.00 4,614,599.94

TABLE ll-d Data on Projects for Which Bids Were Taken During the Fiscal Year July 1, 1966 - June 30, 1967 New or Number Federal State Local Name of Project Addition of Beds County Total Cost Share Share Share General Hospitals Beaufort County Hospital A 41 Beaufort 1,584,924.68 698,500.00-0- 886,424.68 Cape Fear Valley Hospital A 1 16 Cumberland 4,669,702.90 1,500,000.00-0- 3,169,702.90 Betsy Johnson Mem. Hospital N 1 17 Harnett 2,457,215.72 1,138,500.00 100,000.00 1,218,715.72 Lincoln County Hospital N 100 Lincoln 2,099,847.00 990,000.00-0- 1,109,847.00 Sampson Co. Memorial Hospital A SF Sampson 391,071.39 203,923.00-0- 187,148.39 Swain County Hospital A 20 Swain 896,775.00 622,400.00-0- 274,375.00 Wayne Co. Memorial Hospital N 264 Wayne 6,303,999.45 1,505,000.00-0- 4,798,999.45 Anson County Hospital A 13 Anson 1,228,602.72 594,476.00-0- 634,126.72 Subtotal 8 Projects 671 19,632,138.86 7,252,799.00 100,000.00 12,279,339.86 Long-Term Care Facilities Beaufort County Hospital A 22 Beaufort 330,732.25 165,000.00-0- 165,732.25 Cape Fear Valley Hospital A 78 Cumberland 1,725,097.92 500,000.00-0- 1,225,097.92 Southeastern General Hospital A 80 Robeson 979,065.63 528,000.00 100,000.00 351,065.63 Morehead Memorial Hospital A 50 Rockingham 1,127,699.28 330,000.00 35,400.00 762,299.28 Sampson Co. Memorial Hospital A 36 Sampson 1,072,677.34 471,561.00-0- 601,1 16.34 Blowing Rock Hospital A 76 Watauga 1,346,363.83 551,600.00 100,000.00 694,763.83 Wayne Co. Memorial Hospital N 75 Wayne 1,696,000.55 495,000.00-0- 1,201,000.55 Anson County Hospital A 30 Anson 776,150.98 405,524.00-0- 370,626.98 Subtotal 8 Projects 447 9,053,787.78 3,446,685.00 235,400.00 5,371,702.78

Diagnostic and Treatment Centers Charlotte Memorial Hospital N. C. Memorial Hospital Sampson Co. Memorial Hospital A A A Mecklenburg Orange Sampson 1,670,000.00 10,240,679.00 512,495.72 782,465.00 2,487.375.00 249,892.00-0- -0- -0-887,535.00 7,753,304.00 262,603.72 Subtotal 3 Projects 12,423,174.72 3,5 19,732.00-0- 8,903,442.72 Rehabilitation Facilities Duke University Medical Center Du rham 778,000.00 23 1,241.06-0- 546.758.94 Public Health Centers Bertie County Health Center Orange County Health Center N N Bertie Orange 95,036.90 21.854.85 42.350.00 55.000.00-0- -0-52,686.90 66,854.85 Subtotal 2 Projects 216.89 1.75 97,350.00-0- I 19.541.75 Mental Health Centers Alamance Co. Mental Health Center Cape Fear Valley Hospital Mental Health Center N A 31 Alamance Cumberland 269.140.35 1,015,230.96 167,245.95 50.000.00 633.483.54 50,000.00 51,894.40 33 1.747.42 Subtotal 2 Projects 31 1,284,371.31 800,729.49 100,000.00 383,641.82 Total 24 Projects I 149 43,388,364.42 15.348.536.55 435.400.00 27.604.427.87 Total 33 Construction Projects from July I, 1965 - June 30, 1967 52,430.41 1.36 19.583,203.55 628.180.00 32,2 19,027.8 I

TABLE lll-a Federal Allotments to North Carolina for the Construction of Medical Facilities Long-Term Hospitals, Care Facilities Health Diagnostic Community Facilities Total Centers, and Chronic Rehabili Accelerated Mental for the Federal Nurses' Treatment Disease Nursing tation Public Planning Health Mentally Year Allotment Residences Centers Facilities Homes Facilities Works Grants Centers Retarded Appalachian Funds 1947-1948 3,429,016 3,429,016 1948-1949 3,413,486 3,413,486 1949-1950 6,414,042 6,414,042 1950-1951 3,620,615 3,620,615 1951-1952 3,715,001 3,715,001 1952-1953 3,379,249 3,379,249 1953-1954 2,877,889 2,877,889 1954-1955 4,016,253 3,321,1 17 205,095 205,095 142,473 142,473 1955-1956 4,656,299 3,949,179 208,707 208,707 144,853 144,853 1956-1957 5,270,126 4,564,698 208,188 208,188 144,526 144,526 1957-1958 5,033,778 4,334,784 206,177 206,177 143,320 143,320 1958-1959 7,953,263 6,576,271 261,073 261,073 427,423 427,423 1959-1960 7,787,383 6,436,503 256,774 256,774 418,666 418,666 1960-1961 7,630,942 6,308,032 251,425 251,425 410,030 410,030 1961-1962 8,693,299 6,284,490 563,082 817,223 752,087 276,417 1962-1963 9,155,057 6,257,134 813,635 813,635 813,635 406,818 50,200 1963-1964 10,120,902 5,934,767 771,374 771,374 771.374 385,687 1,486,326 1964-1965 9,925,442 5,909,362 765,109 1,530,569* 382,030-0- 16,215 1,050,372 271,785 1965-1966 1 1,578,508 5,343,285 680,941 2,649,937* 369,608-0- 44,805 1,498,962 352,524 1966-1967 1 1,953,263 5,144,148 738,273 2,645,424* 368,236-0- 12,059 1,491,856 430,665 Totals 130,623,813 97,213,068 5,929,853 14,993,988* 4,020,087 1,536,526 73,079 4,04 1,190 1,054,974 * 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 Year Total Appropriation Hospitals Health Centers Nurses' Residences Long-Term Community Care Mental Health Mental 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 3.4 13,486 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- I960 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 1964-1965 1,000,000 500,000 1965-1966 95.342 1966-1967 1 17.813 300,000 300.000 200,000 200.000 95,342 I 17,813 Totals 20,540,127 19.326.972 600,000 400.000 213,155 33

4- TABLE IV Summary of Costs of Projects on Which Bids Were Received July 1, 1947 Through June 30, 1967 Number of Fiscal Year Projects Total Cost Average Percent Commission Federal Share State Share Local Share Participation July 1, 1947 to June 30, 1948 5 1,5 14.527.34 July 1, 1948 to June 30, 1949 21 12.357.754.83 July 1, 1949 to June 30, 1950 21 16.57 1.746.63 July 1, 1950 to June 30, 195 1 38 14,445,121.32 July 1, 195 1 to June 30, 1952 17 1 1,899,900.24 July 1, 1952 to June 30, 1953 32 6,792,633.78 July 1, 1953 to June 30, 1954 30 5,220,479.4 1 July 1, 1954 to June 30, 1955 26 9,461,329.84 July 1, 1955 to June 30, 1956 29 9,001,1 13.99 July 1, 1956 to June 30, 1957 21 6,144,468.46 July 1, 1957 to June 30, 1958 29 16,448,981.23 July 1, 1958 to June 30, 1959 20 18,288,330.44 July 1, 1959 to June 30, I960 19 8,385,7 17.26 July 1, 1960 to June 30, 1961 21 18,639,394.91 July 1, 1961 to June 30, 1962 1 1 12,009,054.22 July 1, 1962 to June 30, 1963 20 17,397,145.13 July 1, 1963 to June 30, 1964 19 27,041,658.41 July 1, 1964 to June 30, 1965 12 19,762,289.45 July 1, 1965 to June 30, 1966 9 9,042,046.94 July 1, 1966 to June 30, 1967 24 43,388,364.42 496,675.79 379,555.92 638,295.63 57.9 3,958,297.09 3,457,242.78 4,942,214.96 60.0 4,584,486.79 2,729,172.76 9,258,087.08 44.1 5,915,290.64 3,01 1,679.24 5,518,151.44 6 1.8 4,679,549.5 1 1.416,064.20 5,804,286.53 5 1.2 2,251,058.36 2,282,728.44 2,258,846.98 66.7 2,239,630.15 1,041,435.7 1 1,939,413.55 62.8 2,949,041.10 899,465.35 5,612,823.39 40.7 4,331,53 1.01 888,619.62 3,780,963.36 58.0 2,972,487.43 388,076.28 2,783,904.75 54.7 7,810,529.53 1.146,230.87 7,492,220.83 54.5 10,494,220.18 1 15,920.27 7,678,189.99 58.0 4,458,550.44 207,270.09 3,719,896.73 55.6 8,100,357.86 250,082.64 10,288,954.41 44.8 6,392,759.61 8,401.00 5,607,893.61 53.3 8,819,531.92 55,140.56 8,522,472.65 51.0 1 1,252,332.14 536,676.64 15,252,649.63 43.6 8,265,621.33 542,718.00 10,953,950.12 44.6 4,234,667.00 192,780.00 4,614,599.94 49.0 15,348,536.55* 435,400.00 27,604,427.87 36.4 Total 424 283,812,058.25 I 19,555,154.43 19,984,660.37 144,272,243.45 49.2

Average 21.2 14,190,602.91 5,977,757.72 999,233.02 7,213,6 12.17 Approved projects for which bids will be taken after July I, 1967 21 23,188,647.15 9,179.494.28 * 280,894.00 13,728,258.87 Total all projects approved July I, 1947 to June 30, 1967 445 307,000,705.40 128,734,648.71 20,265,554.37 158,000,502.32 * Federal share does not include $1,000,000 tentatively pledged to Wayne Memorial Hospital and $2,000,000 to Nash County Hospital from subsequent years Federal allotments.

TABLE V Summary Showing Construction Status of Medical Facilities Projects Approved Under Public Health Service Act (Title VI) and Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 as of June 30, 1967 Total All Projects 445 Total Cost $ 307,000,705.40 Federal Share State Share Local Share $ 128,734,648.71 (41.9) 20,265,554.37 ( 6.6) 158,000,502.32 (51.5) Total All Projs. General Hospitals Acute LTC Nursing Homes T.B. Mental Rehab. D&T Health Centers Nurses' Res. Community Mental Health Centers Mental Retardation No. Projs. 445 216 1 30 4 2 7 15 21 91 49 (2,999) 7 3 No. Beds 14,422 12,354 588 (954)2 491 100 647 166 76

Number Projects Total Federal Share Local Share Cost State-owned Projects Completed Projects Under Construction Projects in Planning Stage 20 $ 384 40 21 16,831,187.88 $ 5,406,075.64 $ 1 1,425,1 12.24 Total Number Current Projects 61 Total Cost Current Projects $ 104,485,939.66 Betsy Johnson (General and Modernization) included as one project in biennium ending June 30. 1964. Wayne Memorial (General, Modernization and LTC) included as two projects in biennium ending June 30, 1967. Denotes beds constructed with Federal funds for long-term care facilities and planned architecturally to be used interchangeably for acute and chronic purposes as required by demand. Figures in parenthesis ( ) are included in the acute bed count.

TABLE VI Projects Currently Under Construction June 30, 1967 Project No. of Federal State Local Number County Name of Project Beds Total Cost Share Share Share General Hospitals NC-433A Anson Anson Co. Hospital 13 1,228,602.72 594,476.00-0- 634,126.72 NC-424A Beaufort Beaufort Co. Hospital 41 1,584,924.68 698,500.00-0- 886,424.68 NC-412A Buncombe Memorial Mission Hospital of Western North Carolina SF 436,897.00 203,500.00-0- 233,397.00 NC-350 Carteret Carteret Co. Hospital 100 2,265,924.99 990,000.00 100,000.00 1,175,924.99 NC-398 Catawba Catawba Co. Hospital 202 5,901,822.55 1,980,000.00-0- 3,921,822.55 NC-411 Cleveland Cleveland Mem. Hospital 138 3,763,558.00 1,802,350.00 71,208.00 1,890,000.00 NC-422A Cumberland Cape Fear Valley Hospital 1 16 4,669,702.90 1,500,000.00-0- 3,169,702.90 NC-409 Franklin Franklin Mem. Hospital 30 987,459.03 495,000.00 7 1,208.00 421,251.03 NC-408A&B Harnett Betsy Johnson Mem. Hosp. 1 17 2,457,215.72 1,138,500.00 100,000.00 1,218,715.72 NC-383A Johnston Johnston Mem. Hospital 34 1,276,810.13 621,500.00-0- 655,310.13 NC-428 Lincoln Lincoln Co. Hospital 100 2,099,847.00 990,000.00-0- 1,109,847.00 NC-378 New Hanover New Hanover Co. Hospital 404 9,249,579.87 4,000,000.00-0- 5,249,579.87 NC-410 Rockingham Annie Penn Mem. Hospital 49 1,287,238.97 667,700.00 51,084.00 568,454.97 NC-416A Rowan Rowan Mem. Hospital 66 3,875,506.43 1,801,459.00-0- 2,074,047.43 NC-423A Sampson Sampson Co. Hospital SF 391,071.39 203,923.00-0- 187,148.39 NC-434 Swain Swain Co. Hospital 20 896,775.00 194,500.00' -0-274,375.00 427,900.00 NC-399 Watauga Watauga Co. Hospital 91 1,796,423.13 50,000.00' 100,000.00 854,423.13 NC-421A&C Wayne Wayne Co. Mem. Hospital 264 6,303,999.45 1,505,000.00-0- 4,798,999.45 Subtotal 18 Projects 1785 50,473,358.96 20,656,308.00 493,500.00 29,323,550.96

Facilities NC-433B Anson Anson Co. Hospital 30 776,150.98 405,524.00-0- 370,626.98 NC-424B Beaufort Beaufort Co. Hospital 330,732.25 165,000.00-0- 165,732.25 NC-412B Buncombe Memorial Mission Hospital of Western North Carolina 36 433,566.00 50,000.00' -0-170,166.00 213,400.00 NC-422B Cumberland Cape Fear Valley Hospital 78 1,725,097.92 500,000.00-0- 1.225,097.92 NC-429 Robeson Southeastern Gen. Hospital 80 979,065.63 528,000.00 100,000.00 351,065.63 NC-430 Rockingham Morehead Mem. Hospital 50 1,127,699.28 330,000.00 35,400.00 762,299.28 NC-416B Rowan Rowan Mem. Hospital 64 663,576.34 338,041.00-0- 325,535.34 NC-423B Sampson Sampson Co. Hospital 36 1,072,677.34 471,561.00-0- 601,1 16.34 NC-426 Watauga Blowing Rock Hospital 76 1,346,363.83 50,000.00' 100,000.00 694,763.83 501,600.00 NC-421B Wayne Wayne Co. Mem. Hospital 75 1,696,000.55 495,000.00-0- 1,201,000.55 Subtotal 10 Projects 547 10,150,930.12 4,048,126.00 235,400.00 5,867,404.12 Public Health Centers NC-419 Bertie Bertie Co. Health Center 95,036.90 42,350.00-0- 52,686.90 NC-418 Orange Orange Co. Health Center 121,854.85 55,000.00-0- 66,854.85 Subtotal 2 Projects 216,891.75 97,350.00 0-1 19,541.75 Community Mental Health Centers NC-MH-3 Alamance Alamance Co. Mental Health Or. 269,140.35 167,245.95 50,000.00 51,894.40 NC-MH-2 Cumberland Cape Fear Valley Hospital Mental Health Center 31 1,015,230.96 633,483.54 50,000.00 331,747.42 Subtotal 2 Projects 31 1,284,371.3 1 800.729,49 100,000.00 383,641.82 Special funds provided under Appalachian Regional Development Act.

TABLE VI (Continued) Projects Currently Under June 30, 1967 Construction Project Number County Name of Project No. of Beds Total Cost Federal Share State Share Local Share Diagnostic or Treatment Centers NC-427 NC-386 NC-383B NC-439 NC-425 NC-423C Burke Durham Johnston Mecklenburg Robeson Sampson Valdese Gen. Hospital Duke University Med. Center Johnston Co. Hospital Charlotte Memorial Hospital Southeastern Gen. Hospital Sampson Co. Mem. Hospital 167,866.00 4,775,006.89 165,748,45 1,670,000.00 861,944.31 512,495.72 85,250.00 654,635.00 91,161.65 782,465.00 233,467.00 249,892.00-0- -0- -0- -0- -0- -0-82,616.00 4,120,371.89 74,586.80 887,535.00 628,477.31 262,603.72 Subtotal 6 Projects 8,153,061.37 2,096.870.65-0- 6,056,190.72 Rehabilitation Facilities NC-431 Durham Duke University Med. Center 778,000.00 231,241.06-0- 546,7^8.94 State-Owned NC-403 Orange N. C. Memorial Hospital D&T 0,240,679.00 2,487,375.00-0- 7,753,304.00 Total 40 Projects Under Construction 2363 81,297,292.51 30,418,000.20 828,900.00 50,050,392.3

Projects Currently in Planning For Which Bids Will Be Taken July 1, 1967 Stage After Project No. of Federal State Local Number County Name of Project Beds Total Cost Share Share Share General Hospitals NC-420 Burke Grace Hospital 160 3,510,000.00 1,584,000.00-0- 1,926,000.00 NC-441A Chatham Chatham Hospital SF 333,028.79 181,725.00-0- 151,303.79 NC-436 Duplin Duplin Gen. Hospital 50 2,156,000.00 906,000.00-0- 1,250,000.00 NC-435A Edgecombe Edgecombe Gen. Hospital 38 955,000.00 525.250.00-0- 429,750.00 NC-432A Nash Nash Co. Hospital 220 5,809,1 16.10 144,229.00-0- 5.664,887.10 NC-437A Wilkes Wilkes Gen. Hospital 30 1,073,723.17 689.400.00-0- 384,323.17 Subtotal 6 Projects 498 13,836,868.06 4,030,604.00-0- 9,806,264.06 Long-Term Care Facilities NC-44IB Chatham Chatham Hospital 30 412,33 1.21 224,829.00 16,974.00 170,528.21 NC-435B Edgecombe Edgecombe Gen. Hospital 34 600,000.00 330,000.00-0- 270,000.00 NC-440 Henderson Mountain Sanitarium and Hospital 50 675,870.00 330.000.00 25,200.00 320,670.00 NC-432B Nash Nash Co. Hospital 80 1,993.883.90 855.771.00-0- 1.138,1 12.90 NC-437B Wilkes Wilkes Gen. Hospital 30 664.945.05 330.000.00-0- 334.945.05 Subtotal 5 Projects 224 4,347,030.16 2,070,600.00 42,174.00 2,234,256.16 Public Health Centers NC-438 Onslow Onslow Co. Health Center 133,8 11.22 72.600.00-0- 61,21 1.22

TABLE VII (Continued) Projects Currently in Planning For Which Bids Will Be Taken July 1, 1967 Stage After Project Number County Name of Project No. of Beds Total Cost Federal Share State Share Local Share Community Mental Health Centers NC-MH-I NC-MH-6 NC-MH-7 NC-MH-5 Jackson Mecklenburg Moore Robeson Western Carolina Univ. Mental Health Center Mecklenburg County Mental Health Center Moore Mem. Hospital Mental Health Center Southeastern Gen. Hosp. 20 257,495.34 1,261,920.00 542,968.00 134,246.70-0- 795,009.00 50,000.00 342,069.84 50.000.00 123,248.64 416.91 1.00 150,898.16 NC-MH-4 Wilson Mental Health Center Wilson Co. Mental Health Center 25 550,000.00 176.000.00 346,500.00 50,000.00 I 10.880.00 38,720.00 153,500.00 26,400.00 Subtotal 5 Projects 45 2,788,383,34 1,728,705.54 188,720.00 870,957.80

Mental Retardation Facilities 504,054.00 322,272.66 284,705.71 3 17,554.00 168,007.14 179,364.60 NC-MR-2 Granville Board of Juvenile Correction Mental Retardation Facility NC-MR-I Jackson Western Carolina University Mental Retardation Facility NC-MR-3 Pitt E. Carolina Sheltered Workshop -0- -0-50,000.00 186,500.00 I 54,265.52 55,341.1 1 Subtotal 3 Projects 1,11 1,032.37 664,925.74 50,000.00 396,106.63 Rehabilitation Facilities NC-442 Durham Duke Univ. Medical Center 971,522.00 612.059.00-0- 359,463.00 Total 2 1 Projects 767 23,188,647.15 9,179,494.28 280,894.00 13,728,258.87 4-

SIZE AND LOCATION OF GENERAL AND ALLIED HOSPITALS (EXCLUDING MENTAL AND TUBERCULOSIS) DECEMBER 1, 1947 / V 0 / / AINLL *s~j * * * Y% I \ Y//ss////A / V #0 \ - i. X. W o ' v N m M W, * X v c t u l n a / > SMMM / T ^ «/ >'. /LL.^ W I- J R~* / - - F V - ^ ^ LEGEND Facilities Beds No o«beds Symbol No. Per Cent No Per Cent 16 49 63 48.1 2,005 21.3 50 74 o 35 26.7 2.068 21.9 75 99 A 12 9.2 1.029 10.9 100 149 10 7.6 1.138 12.1 150_ 199 4 3.0 665 7.1 200 299 mm 3 2.3 776 8.2 300 399 o 1.8 304 3.2 400 499 2 1.5 883 9.4 500 Over Z 1.8 558 5.9 NOTE: Does not include facilities of 15 beds or less V/S/S/SS, Counties with no general hospital TOTAL 131 100.0 9.426 100.0

SIZE AND LOCATION OF GENERAL AND ALLIED HOSPITALS INCLUDING PROJECTS UNDER CONSTRUCTION AND IN PLANNING (EXCLUDING MENTAL AND TUBERCULOSIS) June 30, 1967 ^ X R 1 T 7. o 0 i-x I \ / k / W o V - 7 0 ~~' ; " \ ~_ ^ ' NT7U"..u. / I I " LEGEND Facilities Per Cent of Change 1947 1967 No of Beds Symbol No Per Cent No Per Cent No of Facilities No of Beds 16 49 41 28.1 1.420 7.0 34.9 29.2 50 74 o 17 1 1.7 990 4.9 5 14 52.1 75 99 IK 12.3 1.568 7.7 + 50.0 52.4 100 149 26 17.8 3.1 13 15.3 + 160.0 173.5 5(>_ 199 16 1 1 0 2.733 13.5 + 300.0 + 3 1 1.0 200 299 T? 12 8.2 2.772 13.7 300.0 + 257.2 300 399 O 6 4.1 2.083 10.3 + 500.0 + 585.2 400 499 6 4 1 2.646 13.0 + 200.0 + 200.0 500 Over X 4 2.7 2.962 14.6 + H)0 ii + 430.8 NOTE: Does not include facilities of 15 beds or less W//////M Counties with no general hospital 4^ TOTAL 146 100.0 20.287 100.0 + 1 1.5 1 15.2

as OWNERSHIP OF GENERAL AND ALLIED HOSPITALS (EXCLUDING MENTAL AND TUBERCULOSIS) December 1, 1947 City City - County State County Nonprofit Assoc. Proprietary Authority Symbol O C A X At Beds No. Per Cent 523 5.6 284 3.0 160 1.7 503 5.3 7,323 77.7 633 6.7 TOTAL 31 100.0 9.426 100.0 NOTE: Does not include facilities of 15 beds or less Counties with no general hospital

OWNERSHIP OF GENERAL AND ALLIED HOSPITALS INCLUDING PROJECTS UNDER CONSTRUCTION AND IN PLANNING (EXCLUDING MENTAL AND TUBERCULOSIS) June 30, 1967 "7" ) X N'"""'" / x x v J o 1 \ x j.., j V >">~i " -L_ \ *X»> - rtj V / A I MCHIHM > 1 A. A A AA / " LEGEND 4^ --4 Facilities Beds Per Cent of Change 1947-1967 Symbol No Per Cent No Per Cent No. of Facilities No. of Beds City O 3 2.1 427 2.1 0.0 _ 18.3 City - County c 1.7 42 2 75.0 _ 85.2 State A 3 2.1 622 3.1 + 200.0 + 288.7 County 55 37.6 8.146 40.2 + 5 11.1 1.5 19.5 Nonprofit Assoc. X 65 44.5 9.294 45.8 30.1 + 26.9 Proprietary 16 10.9 783 3.8 23.8 + " 3 7 Authority 3 2.1 973 4.8 TOTAL 146 100.0 20.287 100.0 + I 1.5 + 1 15.2 NOTE: Does not include facilities of 15 beds or less Counties with no general hospitals

4- oc 62 COUNTIES WITH ALL-NEW GENERAL HOSPITALS AIDED BY THE COMMISSION 1947-1967 LEGEND ^ Completed Facilities Facilities Under Construction Facilities In Planning

LONG - TERM CARE FACILITIES CONSTRUCTION PROGRAM 1947-1967 In Planning Under Construction Completed Facilities

PUBLIC HEALTH CENTERS CONSTRUCTION PROGRAM 1947-1967 LEGEND In Planning Under Construction Completed Facilities

NURSES' RESIDENCES SCHOOLS OF NURSING CONSTRUCTION PROGRAMS 1947-1967 LEGEND Completed Nurses' Residences Completed Schools Of Nursing

to REHABILITATION FACILITIES CONSTRUCTION PROGRAM 1947-1967 DUKE UNIVERSITY MEDICAL CENTER (Durham County) A Under Construction (3 Completed Facilities

- - U..» I _ J U M N I U U * m m W L J. L... I. R G - J U.... K -..I... J,.1 II W B i m i i Ml - COMMUNITY MENTAL HEALTH CENTER CONSTRUCTION PROGRAM 1964-1967 1 d OF Project Includes Psychiatric Beds (In Planning) Project Includes Psychiatric Beds (Under Construction) 1 Construction Funds Under Public Law 88-164 First Became Available July 1,1964

FACILITIES FOR THE MENTALLY RETARDED CONSTRUCTION PROGRAM 1964-1967 1 ) TII ' *[ "~1 1 f 1 T~\ P\V; J ' j RR"1 - I O / > ' - V '-^ Sr ^ V J,0.,,,. I I I / F\ J» \S V-- r \.V> \ V ~ " R L " " ; 1 ' I -1 r- J - / """ J J t - _/-^\ V c - \ / V, (... -\! I, \ X k t Z... o. >- -> H T-'~- L.. \ v _L r - J ^~ > -V 0. / V, 0 R < J.J ~ y s~ - J v / > I > / v / / r.u~ L-* 1 * ' 1- J««F\.^...o.. V j r. _1 ^ / 1 J - 1 v -... V? V " ^ 1 n " " " 1 ^.._< ^ v v s I w ^ >^ ao«rioa / 11 AM* \ / \ LEGEND \ - R o In Planning < ( Under Construction 1 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 University 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 Commission 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 participation in the Medicare program, this number including both accredited and nonaccredited 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 surveillance 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, I 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 Beds Average No. of Beds 3-15 16-30 31-50 51-75 76-100 101-150 151-200 201-300 301-400 401-up 13 11 40 19 20 22 14 I 1 6 9 I 1 1 251 1,696 1,264 1,837 2.71 1 2,437 2,620 2,071 4,646 8.5 22.8 42.4 66.5 91.8 123.2 174.1 238.2 345.2 516.2 165 19,648 1 19.1 56

Licensed Hospitals by Medical Type General 141 Mental 0 Tuberculosis 4 Rehabilitation 4 Maternity 0 Pediatric 1 Eye, Ear, Nose, Throat 2 Physician's Clinic 12 Chronic Disease I 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 115,615 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 recipients 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 1 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 1 58 Changed major field of study 2 students; left North Carolina due to marriage 3 students; and financial and/or personal reasons 2 students.

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 Commission 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

S FINANCIAL STATISTICS Educational Loan Fund 1945-63 1945-65 1945-67 Total Appropriation 1,200,000.00 1,355,500.00 1,485,500.00 Interest Collected on Loans 48,996.26 75,305.00 93,782.57 Total Assets 1,248,996.26 1,430,805.00 1,579,282.57 Total Expenditures (Loans) 1,020,523.89 1,318,073.89 1,796,601.90 Loans Repaid (Principal) 323,773.96 519,508.5 1 673,536.27 Loans Cancelled by Satisfactory Service 28,417.00 69,414.85 251,978.68 Total Loans Outstanding (Notes Receivable) 668,332.93 729,150.53 871,086.95 Cash Balance 552,246.33 632,239.62 456,216.94 Less: Encumbrances to Complete Education of Students Already Approved 191,358.00 172,033.00 309,676.00 Unencumbered Balance for Financing New Loan Applications 360,888.33 460,206.62 146,540.94 June 30, 1963 June 30, 1965 June 30,196 Delinquency Percentage 1 1.8% 1.2%.9% 1 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' Educational Loan Program j Category 1945-June 30, 1961 1945-June 30, 1963 1945-June 30, 1965 1945-June 30, 1967 Number of Recipients Percentage of Total Available Number of Recipients Percentage of Total Available Number of Recipients Percentage of Total Available Number of Recipients Percentage of Total Available In Practice 47 68.1 59 38.8 71 31.5 96 28.3 Completed Practice 13 18.8 57 37.5 97 43.1 146 43.0 Unable to Practice in Accordance with 1 Loan Agreement 9 13.0 36 23.7 57 25.3 97 28.7 TOTAL j 69 99.9 152 100.0 225 99.9 339 I00.0 Includes mandatory military service.

SUMMARY OF APPLICATIONS APPROVED Educational Loan Program N> 1945-June 30, 1967 Clinical Psychology 1 Dentistry Dietetics 1 Medical Record Library Science 1 Medical Recreation 1 Medicine Medical Technology Nurse Anesthesia Nursing Optometry 1 Pharmacy Physical Therapy 1 Social Work June 30, 1967 Grand Total June 30, 1965 Increase or Decrease 1945-67 over 1945-65 Number of Recipients % Total Number of Students Approved 5 107 1 3 1 199 28 47 166 1 32 6 45 641 41 1 230 + 55.9 In Practice 12 2 1 16 10 24 20 -> 1 K 96 71 25 + 35.2 Completed Practice Obligation 29 <>2 5 20 4 26 146 97 49 + 50.5 Enrolled in School 4 37 1 1 3 1 8 16 78 1 10 5 1 193 87 106 + 122.0 Academic Failures 5 4 8 9 28 23 5 + 21.7 Withdrew from School and/or Program 2 8 3 15 6 5 39 29 10 + 34.5 Postgraduate or Military Service 9 in 31 1 1 42. 4 7 5 10.6 Failed to Comply with Practice Obligation 1 13 47 3 3 24 1. 5 97 57 40 + 70.1 New Students Approved: 1965-67 Biennium 5 1963-65 Biennium 0 31 13 1 0 3 0 1 0 25 13 2 1 7 20 27 93 26 1 0 13 1 6 0 10 10 Total 230 97 Increase or Decrease over 1963-65 Biennium: Number of Recipients 5 Percentage + 100 IK + 138.4 1 + 100 3 + 100 1 4-100 12 + 92.3 14 + 200 7 + 25.2 bl + 250 1 + 100 12 + 1,200 6 + 100 133 + 137.1 1 New programs adopted June 18, 1965. No applications have been received for occupational therapy, Master's of Public Health (physicians only) or dental hygiene