October 9, 1979 Ed Monroe Vice-Chancellor of Health Affairs East Carolina University Greenville, NC 27834 Dr. Monroe: Enclosed ár a transcript of the interview that we held on September 12 in Raleigh. I think that the interview is quite good, especially considering how little warning you had about it. I have tried to render the interview as it is recorded. Yuu hay have some objections to the wording or want to express yourself differently. Please feel free to change what ever you want to. And also, add anything that you think would add more depth to the interview. Miter you have made any corrections or additions, please send me the corrected version, and then I will have it typed up in a final draft and submit it to you for your final approval. I enjoyed talking to you very much and of course admire both your and the Senator's role in bringing about the medical program at ECU. I am enclosing a self-addressed emyelope for your convenience. Very truly yours, Pete Daniel Oral History Interview with Ed Monroe. September 12, 1979. Raleigh, North Carolina. By: Pete Daniel MONROE: Doing it off the cuff like this is a little bit difficult, because your memory tends to fail as you get older. When I went to East Carolina, part time in January 1968, Senator Morgan's interest and role in the development of the medical school was already well under way. He was in the state Senate back in the early sixties until he ran for Attorney General. He was chairman of the Board of Trustees at East Carolina during the last couple of terms he was in the state Senate. My recollection of those early years of the effort to start a medical school is somewhat vague and not based on direct personal involvement. The first effort I heard about was in either late 1963 or early '64, when Dr. Jenkins brought to Senator Morgan and to the board the idea that a two-year medical school would be a good development for the state of North Carolina. After, I assume, some discussion and study, a decision was made to pursue that development, and a bill was introduced in the Legislature, I think in the '65 session. MONROE 2 DANIEL: Did Senator Morgan introduce that? MONROE: Senator Morgan and I believe Senator Walter Jones, who was in the state Senate then and a number of other eastern senators co-signed it. I think the effort met immediate resistance from the existing medical education establishment in the state in the same sense that UNC's effort to move their two-year school to four-year school back in the late '40s met resistance from Duke and Bowman Gray, the establishment back in those days. But they were able to get a bill through the Senate and the House that authorized East Carolina to plan and develop a two-year medical school, but the opponents were able to get an amendment attached to that bill which produced some real problems. The amendment said that if the school were not established and accredited within sixteen months after the bill was passed, that the question of the development of the school would revert to the North Carolina Board of Higher Education, which was the state agency responsible for coordinating higher education efforts on the part of the state. I think the proponents were so overjoyed at their success in getting the idea across and winning against the state power structure, because it was fought bitterly by not only the medical establishment but also by the major MONROE 3 political figures in North Carolina, like the Governor's office, for instance, that they did not recognize the hazards of the amendment at the time that it was offered. Planning took place; it was obviously impossible to have an accredited school within sixteen months. So the question did revert to the Board of Higher Education. The Board of Higher Education did agree, however, because of all of the scrutiny related to the medical school question, did agree that some strengthening of the academic programs at East Carolina was not only desirable but necessary. With the help of the legislature, East Carolina was able to get money to build a new science building for the basic science departments, get more faculty in the sciences, and was able to get approval and very token money to start the allied health school. And that's when I went to East Carolina; it would be in the early '68 time frame, to be the Dean of the to-be-organized school of allied health. DANIEL: Could you go back and fill in your background before that? MONROE: Yes. I'm a native of North Carolina, born in Laurinburg, went to college at Davidson, went to Medical school at Chapel Hill when it was a two-year medical school, transferred to the University of Pennsylvania for MONROE 4 the last two years of medical school, headed back South, stopped in Richmond to intern a year at the Medical College of Virginia Hospital, and went through a residency in internal medicine at Chapel Hill, starting the residency when the four-year school opened its first class of third-year students, and the new hospital, N.C. Memorial Hospital, opened to start treating patients in the summer of 1952. After completing a residency in medicine, I moved to Greenville and went into private practice and stayed in private practice in internal medicine until I went over to East Carolina in early 1968. The Allied Health School moved steadily along under Governor Scott, from '68 to '72. We were able to get some money for a building; we were able to get new program money and able to get programs started in a lot of health-related disciplines like physical therapy, occupational therapy, environmental health, medical technology, medical records sciences, speech and hearing disciplines, rehabili- tation counseling. The college already had a nursing school that Senator Morgan had been very instrumental in helping get started in 1959 and 1960. So part of my job was to coordinate the existing health-related programs, nursing, and develop the new programs in allied health and continue laying the foundation MONROE 5 for the development of the medical school. Meanwhile, Dr. Jenkins and Senator Morgan and the other trustees were pushing very hard for change in the classification of the institution from a college to a university. That got started in the early sixties and was an unrelenting effort until 1967 when the General Assembly, after a lot of back room politicking that I am not personally familiar with, agreed to a name change from East Carolina College to East Carolina University. But as part of the acquiring enough votes to get that through some additional institutions had to be offered the same opportunity. Schools like Greensboro A & T, North Carolina A & T in Greensboro; North Carolina Central, Western Carolina, Appalachian State, all got university status as a result of the push to get East Carolina designated as a university. Back to the medical school issue. Briefly, as part of the name change of the institution, some very skillful legislators were able to get the authorization to plan a medical school extended under the bill to change the name of the institution. Most of the people who were voting on the name change were not aware that they were continuing the authorization to plan the medical school. That turned out to be a very fortuitous happening. The MONROE 6 Board of Higher Education, under Governor Scott's chairmanship, agreed to continuing to plan a two-year medical school after the Legislature appropriated $375,000 to spend from 1967 through fiscal year '68-'69 for a planning effort. Using that money we were able to recruit a medical educator, Dr. Wallace Wooles from the Medical College of Virginia Department of Pharmacology, to direct a planning effort. He was able to recruit a few basic science medical faculty members. Through 1970 the planning effort culminated in a plan being presented to the Board of Higher Education and to the accrediting authority for medical schools, the liaison committee on medical education, for a two-year medical school. There were all kinds of problems associated with implementing that plan. The accrediting review which occurred in the late summer of 1970 was a very positive report but pointed out two major deficiencies. One, the school had no operating budget, and two, the whole question of two-year medical schools in the United States had changed from a national theme of more two-year medical schools to produce students to fill empty slots in the last two years of existing four-year schools. All this had changed to a, we need no more two-year medical schools because curriculum changes had made it possible MONROE 7 for students to transfer easily from a two-year school to a four-year school. This report, then, with those reservations was presented to the Board of Higher Education, who were aware of, under Governor Scott's leadership, aware of the increasing desire of the people for more doctors, the increasing politics of the question, and were really in a quandry as to what to do. They could not bring themselves to recommend a four-year medical school; they could not bring themselves to do nothing. So they worked out a compromise called a one-year program in medical education under the auspices of the other state medical school in North Carolina, the University of North Carolina at Chapel Hill. They directed Chapel Hill and East Carolina to go into partnership to plan and implement the first year medical education program at East Carolina with the commitment of Chapel Hill to take all the students into their second year at Chapel Hill. East Carolina had a choice--take this and view it as a start, or tell the state that, no, we want no part of it. And East Carolina decided to use it as a start. So, those directed plans between the two institutions were pursued, the program was structured, the first students were admitted in the fall of '72, twenty North Carolinians, MONROE 8 into the first year program at East Carolina. That program operated for three years, taught a total of sixty North Carolina students, all of whom transferred successfully to Chapel Hill, completed their degree requirements, and the last class graduated in the spring of '78, from Chapel Hill. During all this time, Senator Morgan, as chairman of the Board of Trustees, still through the time he resigned to run for the Senate, I think in '73, worked very hard to move all of this along--joined President Jenkins in making speeches, used all of his influence that he could, first with Governor Scott, with other political figures in the state and in the General Assembly, and was very intimately involved in it. After the one-year program had been in operation for one year, East Carolina requested the agency that replaced the Board of Higher Education, called the University of North Carolina Board of Governors, to authorize the implementation of the second year. The Board of Governors appointed a committee to study that question, known as the Jordan Committee because the chairman was a member of the board named Robert Jordan, who is now in the State Senate. The committee made several recommendations back MONROE 9 to the Board of Governors, which were adopted by the Board of Governors. One, that the state needed more doctors, and the immediate pay-off in an approach to this would be to expand the school at Chapel Hill, and they recommended this and recommended the money required to do it, that Duke and Bowman Gray needed to be encouraged to take more North Carolinians into medical school, and they started an incentive program for paying those schools several thousand dollars a year for each North Carolinian they would admit, that the state may need another four-year medical school but it required more study and that a team of out-of-state consultants should be employed by the Board of Governors on this question. That was all done. The consultants were employed and spent six months listening to people across North Carolina express their opinions pro and con, not only about does North Carolina need more doctors but does North Carolina need another medical school; what else does North Carolina need to do to get more doctors and to get more doctors where they are needed and the disciplines they are needed in. The upshot of that report was that the one-year program was not a viable entity, that two-year schools were not viable entities, that the state needed to decide finally whether it was going to develop a medical school or not, that they personally thought it was unwise, that the state needed more doctors, that the fledgling MONROE 10 area health education center program should be expanded and not rely on federal money but the state should put an enormous amount of money in it, etc. This was all done. Meanwhile, the Legislature was doing its medical manpower study on its own, under a committee chaired by Representative Huskins and Senator Billy Mills. The essence of their report was that the state did need another medical school, and of the two opinions, the legislative opinion carried the day. Listening to that opinion, the UNC Board of Governors decided that they should recommend to the legislature that it approve and fund the development of a four-year medical school. That was presented in the '75 session, and the decision was made, and the initial funds were appropriated, and things have moved forward from there. That's a capsule summary. DANIEL: There was a lot of politics. MONROE: A whole lot of politics. DANIEL: You mentioned a while ago that you and several other people probably did most of the behind the scenes work. MONROE: Staff work. DANIEL: Staff work? Do you have any recollections about any high points of that or depressing times when you were trying to implement all these measures? MONROE 11 MONROE: One of the problems is that as time goes by you tend to forget the bad times. Yes, there were a lot of times when people would get discouraged. People doing the staff work would get discouraged, people who were doing the sort of public comment in keeping the question before the public would get discouraged. I'm sure Senator Morgan got discouraged, periodically. But I guess the most discouraging times were when the Board of Higher Education in early 1971 decided not to recommend the development of a traditional two-year school as a start to a four-year school but instead recommended a one-year program. We had no input into that decision whatsoever. DANIEL: Did you think that maybe that any kind of start, though, would eventually wear down the opposition into seeing that a four-year school would be beneficial? MONROE: I though that was true. I'm not sure that faced with the flush of disappointment at that point in time that President Jenkins and Senator Morgan thought that was true. I believe that Senator Morgan thought it was true more than President Jenkins did. I think President Jenkins was discouraged enough at that time, and had been contending with the question since 1963, that he was tempted to say to hell with all of it. I think another discouraging period was when the panel of consultants employed by the Board of Governors MONROE 12 came out with their report. We knew the report was going to be pretty negative from East Carolina's vantage point, but we were not aware of the strategy of making such a state-wide splash about the report. Governor Holshouser was in as governor. He was totally opposed to the development of the medical school, and he allowed his office to get heavily involved in orchestrating the announcement of the report and the publicity surrounding it. We went through a period of several months of really totally inappropriate media review of the question and of the strengths of East Carolina University and of the motives of the people behind the push. DANIEL: What was the time difference between the release of the consultants report and the legislature's decision to go ahead with it? MONROE: The consultants' report was released in either September or October of 1973; the medical manpower House-Senate joint commission of the Legislature issued their report in January of 1974. DANIEL: And all during that time the press was dwelling on the question? MONROE: Yes. DANIEL: Well, how did the press react when the second report came out? MONROE: It depends on where the press was located. If it was a Piedmont press or metropolitan press, they tended MONROE 13 to downplay the legislative commission's report. The small town newspapers across the state generally supported the findings of the legislative commission. What the legislative commission said is that North Carolina has a severe chronic shortage of doctors, and it's not doing enough. There are too many kids from North Carolina who want to go to medical school, who are qualified, and who cannot get in an existing school, etc. So what the manpower commission recommended and what ended up after a whole lot of intensive work by the proponents and opponents in the Legislature and outside the Legislature was an appropriations bill that passed the joint appropria- tions committee late in February 1974 that did not say develop a four-year school. What it did was instruct the Board of Governors to proceed with the expansion of medical education at East Carolina, to add the second year at East Carolina, to increase the size of the enrollment in the program at East Carolina, to work toward the establish- ment of a clinical base at Greenville to help in the training of third and fourth year students and house officers, residents, and appropriated some money to begin that effort. I guess the point of all that is that was interpreted by the majority of the membership of the Board of Governors as a clear signal to move things ahead rather than stopping everything. That's why, I think, the Board of Governors in MONROE 14 the fall of '74, then recommended back to the Legislature the fact that a four-year school was the only way to go and directed, the bill that was introduced, directed the development of a four-year school. DANIEL: Who were the main opponents, calling names, who were the main opponents of any medical school at East Carolina? MONROE: Well, the initial opponents were the leadership of the state medical society, most of whom were in the Piedmont, the deans and major administrators of the three medical schools in the state, particularly the medical school at Chapel Hill. What I call the blue crowd in North Carolina, and I don't say that in a derogatory fashion, the people who love Chapel Hill and what it means to them and what it means to the state of North Carolina. Most of them viewed this move as a threat to the integrity of the strength and quality of the University of North Carolina at Chapel Hill and its medical school. They saw a pie of resources from the state, and they didn't feel it was right for another institution to be brash enough to come along and grab a piece of that pie. I think those were the major motivations behind their opposition. MONROE 15 Some of it was personal, some of it was directed toward Leo Jenkins. DANIEL: I understand from having grown up in Eastern North Carolina and read the newspapers that he did create a lot of opposition. I've never understood the basis of it. MONROE: Well, a lot of it was his style, his way of bringing an issue to the attention of people was to present it in a way that it created attention, to stir up opposition in order to keep the issue alive. I think he got a great deal of personal enjoyment out of the process. DANIEL: Could you reflect more specifically on what Senator Morgan did and maybe your relationship with him to add a little bit to the demension of his role in this struggle? MONROE: I'm sure that he was, I know for a fact, that he was a great leader in the efforts to improve and expand the institution. During his tenure on the Board of Trustees, and I assume even before that, he was particularly meaningful and tremendously helpful in the medical school issue which I became personally involved with starting in '68. For two reasons. One is he was only recently out of the state Senate and still had a lot of friends in the Legislature and he was able to sue those contacts in his own appropriate way. He was Attorney General. He was close to the Governor, MONROE 16 from '68 to '72, Scott; from '72 until he was elected to the Senate, the U.S. Senate, he was the leading name Democrat under the first Republican governor the state had had in seventy-five years. So he was able to use that position. For instance, he would get invited to give a speech, and he didn't hesitate to seize those opportunities to bring the medical need question position, position shortage question, and the East Carolina issue, before the people. I remember one occasion when Wally Wooles and I were invited by him to go with him to speak to the UNC Faculty Club in Chapel Hill. The chancellor at Chapel Hill was there, the dean of the med school was there, probably better than two hundred UNC Chapel Hill faculty members from all disciplines, several of the Chapel Hill trustees, people like Watts Hill, Sr., Victor Bryant, Sr., and what Robert did was hit them head on for about thirty minutes. They didn't all agree with him, but they respected him and they respected his opinion and I think through that kind of process where he had an aopportunity he was, in addition to everything else he was doing, he was able to put the question in a somewhat better perspective for some of the opponents to consider. I think it helped to quiet down some of their vigorous opposition. I'm sure it was a very difficult time for him during all those years. He had a lot of other things he needed MONROE 17 to use his time and energy for other than fighting the medical school fight, but he never hesitated. And I'm not just blowing smoke at him. I don't have anything to gain by currying his favor. He is a friend of mine, but I got to know him in a different kind of way in this stuggle through the late '60s and early '70s and I just have a tremendous amount of respect for what he was able to do. DANIEL: Did you plan strategy with him? MONROE: Yes, we did. When he was in the Attorney General's office, Wally Wooles and I, either together or individually, seemed to be in that office taking his time and energy at least twice a month. And he always made himself available. We kept him informed; he tried to give us some advice and direction. It was just a very interesting period. DANIEL: Other people I've interviewed from his childhood talked about how tenacious he was in different things such as in court, how tenacious he could be with a witness. Did you notice this tenacity in this sustained fight for a medical school, an unyielding way he would go about it? MONROE: Yes, he was willing to listen to anybody, but he made his mind up early in this game. Nobody who tried to talk him out of it was ever successful. I think for two reasons. One, he is tenacious. And I think he second reason is, he really studied the facts of the issue and felt that none of the opponents had any better answers than the one he was MONROE 18 in favor of. It wasn't just loyalty to East Carolina. He was very vigorous in his support for the expansion of the school at Chapel Hill, for the increase enrollment of North Carolinians at Duke and Bowman Gray. The notion that there was some grand scheme behind this whole issue, that there were strategists working day and night plotting devious routes to a goal, that's totally erroneous. I think the major reason that we were successful is because the vast majority of the people in the state were convinced that there was a shortage of doctors and that there was a need for another medical school. The vast majority of people in the eastern part of the state knew for a fact that they had problems, and this was what they saw as the most reasonable solution to the problem. Just working from that base with the amount of publicity statewide, the involvement of various lay organizations across the state, more than counterbalanced any professional opposition either from the medical profession itself in the Piedmont or from the leadership of the medical education efforts of the other three campuses. DANIEL: Were there any political alliances that grew out of this? That is, I'm sure that it couldn't have been done without a lot more support than just eastern North Carolina. Were there parts of western North Carolina, or some rural-urban, or just what kind of alliances did come from this? MONROE 19 MONROE: I think the alliances that were behind the effort in the Legislature were to some degree rural versus urban. Obviously Democrat versus Republican, although we were able to get quite a few of the Republican delegation on our side in spite of Mr. Holshouser's opposition and active efforts to keep them from going over to our side. Some of that was due to personal relationships that they had with their voters back home or, I should say political relationships rather than personal, some of their personal relations with people like Robert Morgan, and because of the involvement of people like Senator Helms. DANIEL: Now how was he involved? MONROE: He was the director of programming at WRAL TV in Raleigh before he ran for the Senate. He felt very strongly that the East Carolina side should be given a hearing by the media in this area of the state, and he made the time available for people like Senator Morgan and President Jenkins to be interviewed. After he was elected to the Senate, he got involved because he felt that he should use his position in what ever way he could to help. He called on his Republi- can friends and his conservative friends to get behind the issue and push it. One of the interesting things that he did after the panel of consultants' big media splash in the fall of '73 was to write a letter that was run as a rather large MONROE 20 displayed advertisement in quite a few newspapers across the state expressing his opposition to their negative findings and his support for the development of the school. Of course there are certain political spinoffs that accrue to one's benefit if you take a position on an issue that you feel the vast majority of the people are in favor of. Oral History Interview with Ed Monroe. September 12, 1979, Raleigh, North Carolina. By Pete Daniel, 1.-&r-&ena r Rut MONROE: DoingAoff the cuff like this is a little bit difficult, because your memory tends to fail as you get older. When I went to East Carolina, ;Dart time in January 1968, Senator Morgan's intere: =and roll in the development of the medical schc,,)1 was already wea under way. He was in `he state c.,r1.-.te back early sixties untii he ran for Attorney General. He was chairman cf the Board of Trustees at East Carolina during the last couple of terms he was in the state Senate. My recollection of those early years of the effort to start a medical school is somewhat vague and not based on direct personal involvement. The first effort I heard about was in either late 1963 or early '64, when Dr. Jenkins brought to Senator Morgan and to the board the idea that a two-year medical school would be a good development for the state of North Carolina. After, I assume, some discussion and study, a decision was made to pursue that development, and a bill was introduced in the Legislature, I think in the '65 session. DANIEL: Did Senator Morgan introduce that? MONROE: Senator Morgan and I believe Senator Walter Jones, who was in the state Senate then and a number of other eastern senators co-signed it. I think the effort met immediate resistance from the existing medical education establishment in the state in the same sense that UNC's effort to move their two-year school to folr-year school back in the late 140s met resistance from Duke and Bowman Gray, the establishment back in those days. But they were able to get a bill through the Senate and the House that authorized East Carolina to plan and develop a two-year medical school, but the opponents were able to get an amendment attached to that bill which produced some real problems. The amendment said that if the school were not established and accredited within sixteen months after the bill was passed, that the question of the development of the school would revert to the North Carolina Board of Higher Education, which was the state agency responsible for coordinating higher education efforts on the part of the state. I think the proponents were so overjoyed at their success in getting the idea across and winning against the state power structure, because it was fought bitterly by not only the medical establishment but also by the major political figures in North Carolina, like the Governor's office, for instance, that they did not recognize the hazards of the amendment at the time that it was offered. Planning took place; it was obviously impossible to have an accredited school within sixteen months. So the question did revert to the Board of Higher Education. The Board of Higher Education in essence did nothing with it; the Board of AEducation did agree, however, because of all of the scrutiny related to the medical school question, did agree that some strengthening of the academic programs at East Carolina was not only desirable but necessary. With the help of the legislature, East Carolina was able to get money to build a new science building for the basic science departments, get more faculty in the sciences, and was able to get approval and very token money to start the allied health school. And that's when I went to East Carolina; it would be in the early '68 time frame, to be the Dean of the to-be-organized school of allied health. DANIEL: Could you go back and fill in your background before that? MONROE: Yes. I'm a native of North Carolina, born in Laurinburg, went to college at Davidson, went to medical school at Chapel Hill when it was a two-year medical school, transferred to the University of Pennsylvania for the last two years of medical school, headed back South, stopped in Richmond to intern a year at the Medical College of Virginia Hospital, and went through a residency in internal medicine at Chapel Hill, starting • the residency when the four-year school opened its first class of third-year students, and the new hospital, N.C. Memorial Hospital, opened to start treating patients in the summer of 1952. After completing a residency in medicine, i moved to Greenville and went into private practice and stayed in private practice in internal medicine until I went over to East Carolina in early 1968. The Allied Health School moved steadily along under Governor Scott, from '68 to '72. We were able to get some mony for building; we were able to get new program money and able to get programs started in a lot of health-related disciplines like physical therapy, occupational therapy, environmental health, medical technology, medical records sciences, speech and hearing disciplines, rehabilitation counseling. The college already had a nursing school that Senator Morgan had been very instrumental in helping get started in 1959 and 1960. So part of my job was to coordinate the existing health-related programs, nursing, and develop the new programs in allied health and continue laying the foundation for the development of the medical school. Meanwhile, Dr. Jenkins and Senator Morgan and the other trustees were pushing very hard for change in the classification of the institution from a college to a university. That got started in the early sixties and was an unrelenting effort until 1967 when the General Assembly, after a lot of hack room politicking that I am not personally familiar with, agreed to a name change from East Carolina College to East Carolina University. But as part of the acquiring enough votes to get that through some additional institutions had to be offered the same opportunity. Schools like Greensboro A & T, North Carolina A & T in Greensboro; North Carolina Central, ',:estern Carolina, Appalachian State, all got university status as a result of the push to get East Carolina designated as a university. Back to the medical school issue. briefly, as part of the name change of the institution, some very skillful legislators were able to get the authorization to plan a medical school extended under the bill to change the name of the institution. Most of the people who were voting on the name change were not aware that they were continuing the authorization to plan the medical school. That turned out to be a very fortuitous happening. The Board of Higher Education, under Governor Scott's chairmanship, agreed to continuing to plan a two-year medical school after the Legislature appropriated $375,000 to spend from 1967 through fiscal year '68-'69 for a planning effort. Using that money we were able to recruit a medical educator, Dr. Wallace Wooles from the 74edical College of Virginia Department of Pharmacology, to direct a planning effort. he was able to recruit a few basic science medical faculty members. Through 1970 the planning effort culminated in a plan being presented to the Board of Higher Education and to the accrediting authority for medical schools, the liaison committee on medical education, for• a two-year medical school. There were all kinds of problems associated with implementing that plan. The accrediting review which occurred in the late summer of 1970 was a very positive report but pointed out two major deficiencies. One, the school had no operating budget, and two, the whole question of two-year medical schools in the United States had changed from a national theme of more two-year medical schools to produce students to fill empty slots in the last two years of existing four-year schools. All this had changed to a, we need no more two-year mecical schools because curriculum changes had made it impossible for students to transfer easily from a two-year school to a four-year school. This report, then, with those reservations was presented to the Board of Higher Education, who were aware of, under Governor• Scott's leadership, aware of the increasing desire of the people for more doctors, the increasing politics of the question, and were really in a quandry as to what to do. They could not bring themselves to recommend a four-year medical school; they could not bring themselves to do nothing. So they worked out a compromise called a one-year program in medical education under the auspices of the other state medical school in North Carolina, the University of North Carolina at Chapel Hill. They directed Chapel Hill and East Carolina to go into partnership to plan and implement the first year medical education program a,e'East Carolina with the commitment of Chapel hill to take all the students into their second4ear at Chapel Hill. East Carolina mad a choice--take this and view it as a start, or tell the state that, no, we wantiVo part of it. And East Carolina decided to use it as a start. So, those directed plans between the two institutions were pursued, the program was structured, the first students were admitted in the fall of '72, twenty North Carolinians, into the first year program at East Carolina. That program operated for three years, taught a total of sixty North Carolina students, all of whom transferred successfully to Chapel Hill, completed their degree requirements, and the last class graduated in the spring of '78, from Chapel Hill. During all this time, Senator Morgan, as chairman of the Board of Trustees, still through the time he resigned to run for the Senate, I think in '73, worked very hard to move all of this along--joined President Jenkins in making 14-ect speeches, used all of his influence s„eLhe could, first with Governor Scott, with other political figures in the state and in the General Assembly, and was very intimately involved in it. After the one-year program had been in operation for one year, East Carolina requested the agency that replaced the Board of Higher Education, called the University of North Carolina Board of Governors, to authorize the implementation of the second year. The Board of Governors appointed a committee to study that question, known as the Jordan Committeey/because the chairman was a member of the board named Robert Jordan, who is now in the State Senate. The committee made several recommendations back to the Board of Governors, which were adopted by the Board of Governors. One, that the state needed more doctors, and the immediate pay-off in an approach to this would be to expand the school at Chapel Hill, and they recommended this and recommended the money required tc do it, that Duke and Bowman Gray needed to be encouraged to take more North Carolinians into medical school, and they started an incentive program for paying those schools several thousand dollars a year for each North Carolinian they would admit, that the state may need another four-year medical school but it required n,A more study and,,a team of out-of-state consultants should be employed the Board of Governors on this ouestion. That was all done. The consultants were employed and spent six months listening to people across North Carolina express their opinions pro and con, not only about does North Carolina need more doctors but does North Carolina need another medical school; what else does North Carolina need to do to get more doctors and to get more doctors where they are needed and the disciplines they are needed in. The upshot of that report was that the one-year program was not a viable entity, that two-year schools were not viable entities, that the state needed to decide finally whether it was going to develop a medical school or not,that they personally thought •rha it was unwise, the state needed more doctors, that the fledgling area health education center program should be expanded and not rely on federal money but the state should put an enormous amount of money in it, etc. This was all done. Meanwhile, the Legislature was doing its medical . manpower study on its own, under a committee chaired by Representative Huskins and Senator Billy Mills. The essence of their reort was that the state did need another medical school, and of the two opinions, the legislative opinion carried the day. Listening to that opinion, the UNC Board of Governors decided that they should recommend to the legislature that it approve and fund the development of a four-year medical school. That was presented in the '75 session, and the decision was made,- and the initial funds were appropriated, and things have moved forward from there. That's a capsule summary. DANIEL: There was a lot of politics. MONROE: A whole lot of politics. DANIEL: You mentioned a while ago that you and several other people probably did most of the behind the scenes work. MONROE: Staff work. DANIEL: Staff work. Do you have any recollections about any high points of that or depressing times when you were trying to implement all these measures? - `- MONROE: One of the problems is that as time goes by you tend to forget the bad times. Yes, there were a lot of times when people would get discouraged. People doing the staff work would get discouraged,' people whc were doing the sort of public comment in keeping the auestion before the public would get discouraged. I'm sure Senator Morgan got discouraged, periodically. But I guess the most discouraging times were when the Board of Higher Education in early 1971 decided not to recommend the development of a traditional two-year school as a start to a four-year school but instead recommended a one-year program. We had no input into that decision whatsoever. DANIEL: Did you think that maybe that any kind of start, though, would eventually wear down the opposition into seeing that a four-year school would be beneficial? MONROE: I thought that was true. I'm not sure that faced with the flush of disappointment at that point in time that President Jenkins and Senator Morgan thought that was true. I believe that Senator Morgan thought it was true more than President Jenkins did. I think President Jenkins was discouraged enough at that time, and had been contending with the question since 1963, that he was tempted to say to hell with all of it. I think another• discouraging period was when the panel of consultants employed by the Board of Governors came out with their report. We knew the report was going to be pretty negative from East Carolina's vantage point, but we were not aware of the strategy of making such a state-wide splash about the report. Governor Holshouser was in as governor. He was totally opposed to the development of the medical school, and he allowed his office to get heavily involved in orchestrating the announcement of the report and the publicity surrounding it. We went through a period of several months of really totally inappropriate media review of the question and of the strengths of East Carolina University and of the motives of the people behind the push. DANIEL: What was the time difference between the release of the consultants report and the legislature's decision to go ahead with it? MONROE: The consultants' report was released in either• September or October of 1973; the medical manpower House-Senate joint commission of the Legislature issued their report in January of 1974. DANIEL: And all during that time the press was dwelling on the Question? MONROE: Yes. DANIEL: Well, how did the press react when the second report came out? MONROE: It depends on where the press was located. If it was a Piedmont press or metropolitan press, they tended to downplay the legislative commission's report. The small town newspapers across the state generally supported the findings of the legislative commission. What the legislative commission said is that North Carolina has a severe chronic shortage of doctors, and it's not doing enough. There are too many kids from North Carolina who want to go to medical school, who are auailfied) and who cannot get in an existing school, etc. So what the manpower commission recommended and what ended up after a whole lot of intensive work by the proponents and opponents in the Legislature and outside the Legislature was an appropriations bill that passed the joint appropria- tions committee late in February 1974 that did not say develop a four-year school. What it did was instruct the Board of Governors to proceed with the expansion of medical education at East Carolina? to add the second year at East Carolina, to increase the size of the enrollment in the program at East Carolina, to work toward the establish- ment of a clinical base at Greenville to help in the training of third and fourth year students and house officers, residents, and appropriated some money to begin that effort. I guess the point of all that is that was interpreted by the majority of the membership of the Board of Governors as a clear signal to move things ahead rather than stopping everything. That's why, I think, the Board of Governors in the fall of '74, then recommended back to the Legislature the fact that a four•-year school was the only way to go and directed,the bill that was introduced directedthe development of a four-year school. DANIEL: Who were the main opponents, calling names, who were the main opponents of any medical school at East Carolina? MONROE: Well, the initial opponents were the leadership of the state medical society, most of whom were in the Piedmont, the deans and major administrators of the three medical schools in the state, particularly the medical school at Chapel Hill. What I call the blue crowd in North Carolina, and I don't say that in a derogatory fashion, the people who love Chapel Hill and what it means to them and what it means to the state of North Carolina. Most of them viewed this move as a threat to the integrity of the strength and quality of the University of North Carolina at Chapel Hill and its medical school. They saw a Pie of resources from the state, from the federal govern- ment, for quality education and for medical education that was limited in its dimensions, and they didn't feel it was right for another institution to be brash enough to come along and grab a piece of that pie. I think those were the major motivations behind their opposition. Some of it was personal, some of it was directed toward Leo Jenkins. DANIEL: I understand from having grown up in eastern North Carolina and read the newspapers that he did create a lot of cpposition. I've never understood the basis of it. MONROE: Well, a lot of it was his style, his way of bringing an issue to the attention of people was to present it in a way that it created attention, to stir up opposition in order to keep the issue alive. I think he got a great deal of personal enjoyment out of the process. DANIEL: Could you reflect more specifically on what Senator Morgan did and maybe your relationship with him to add a little bit to the dimension of his role in this struggle? MONROE: I'm sure that he was, I know for a fact, that he was a great leader in the efforts to imporove and expand the institution. During his tenure on the Board of Trustees, and I assume even before that, he was particularly meaningful and tremendously helpful in the medical school issue which I became personally involved with starting in ti68. For two reasons. One is he was only recently out of the state Senate and still had a lot of friends inlhe Legislature and he was able to use those contacts in his own appropriate way. He was Attorney General. He was close to the Governor, from '68 to '72, Scott; from '72 until he was elected tc the Senate, the U.S. Senate, he was the leading name Democrat under the first Republican governor the state had had in seventy-five years. So he was able to use that position. For instance, he would get invited to give a speech, and he didn't hesitate to seize those opportunities to bring the medical need question position, position shortage question, and the East Carolina issue, before the people. I remember one occasion when Wally Wooles and I were invited by him to go with him to speak to the UNC Faculty Club in Chapel Hill. The chancellor at Chapel Hill was there, the dean of the med school was there, probably better than two hundred UNC Chapel Hill faculty members from all disciplines, several of the Chapel Hill trustees, people like Watts Hill, Sr. Victor Bryant, Sr., and what Robert did was hit them head on for about thirty minutes. They didn't all agree with him, but they respected him and they respected his opinion and I think through that kind of process where he had an opportunity he was, in addition to everything else he was doing, he was Pv-1 able to the question in a somewhat better perspective for some of the opponents to consider. I think it helped to auiet down some of their vigorous opposition. I'm sure it was a very difficult time for him during all those years. He had a lot of other things he needed to use his time and energy for other than fighting the medical school q,..'4+; but he never hesitated. And I'm not just blowing smoke at him. I don't have anything to gain by currying his favor. He is a friend of mine, but I got to know him in a different kind of way in this sturggle through the late '60s and early '70s and I just have a tremendous amount of respect for what he was able to do. DANIEL: Did you plan strategy with him? MONROE: Yes, we did. When he was in the Attorney General's office, Wally Wooles and I, either together or individually, seemed to be in that office taking his time and energy at least twice a month. And he always made himself available. We kept him informed; he tried to give us some advice and direction. It was just a very interesting period. DANIEL: Other people I've interviewed from his childhood talked about how tenacious he was in different things such as in court, how tenacious he could be with a witness. Did you notice this tenacity in this sustained fight for a medical school, an unyielding way he would go about it? MONROE: Yes, he was willing to listen to anybody, but he made his mind up early in this game. Nobody who tried to talk him out of it was ever successful. I think for two reasons. One, he is tanacious. And I think the second reason is, he really studied the facts of the issue and felt that none of the opponents had any better answers than the one he was in favor of. It wasn't just loyalty to East Carolina. He was very vigorucs in his support for the expansion of the school at Chapel Hill, for the increase enrollment of North Carolinians at Duke and Bowman Gray. The notion that there was some grand scheme behind thisrissue, that there were strategists working day and night plotting devious routes to a goal, that's totally erroneous. I think the major reason that we were successful is because the vast majority of the people in the state were convinced that there was a shortage of doctors and that there was a need for another medical school. The vast majority of people in the eastern part of the state knew for a fact that they had problems, and this was what they saw as the most reasonable solution to the Problem. Just working from that base with the amount of publicity statewide, the involvement of various lay organizations across the state, more than counterbalanced any professional opposition either from the procrsS medicalitself in the Piedmont or from the leadership of the medical education efforts of the other three campuses. DANIEL: Were there any political alliances that grew out of this. That is, I'm sure that it couldn't have been done without a lot more support than just eastern North Carolina. Were there Parts of western North Carolina, or some rural-urban, or just what kind of alliances did come from this? MONROE: I think the alliances that were behind the effort in the Legislature were to some, degree rural versus urban. Obviously Democrat/ versus Republica4, although we were able to get cuite a few of the Republican delegation on our side in spite of Mr. Holshouser's opposition and active efforts to keep them from going over to our side. Some of that was due to personal relationships that they had with their voters back home or, I should say political relationships rather than personal, some of their personal relationships with people like Robert Noran, and because of the involvement of people like Senator Helms. DANIEL: Now how was he involved? MONROE: He was the director of programming at WRAL TV in Raleigh before he ran for the Senate. He felt very strongly that the East Carolina side should be given a hearing by the media in this area of the state, and he made the time available for people like Senator Morgan and President Jenkins to be interviewed. After he was elected to the Senate, he got involved because he felt that he should use his position in what ever way he could to help. He called on his Republi- can friends and his conservative friends to get behind the issue and push it. One of the interesting things that he did after the panel of consultants' big media splash in the fall of '73 was to write a letter that was run as a rather large displayed advertisement in ouite a few newspapers across the state expressing his opposition to their negative findings and his support for the development of the school. Of course there are certain political spinoffs that accrue to one's benefit if you take a position on an issue that you feel the vast majority of the people are in favor of. UNITED STATES SENATE U.S.S. WASHINGTON, D.C. 20510 PUBLIC DOCUMENT OFFICIAL BUSINESS Interview. Ed Monroe Sept. 12, 1979. Raleigh NORTH CAROLINA.