[TAPE 1, SIDE A]

[START OF TAPE 1, SIDE A]

JAMES SLADE:

Earlier, North Carolina would supplement black students to go out of the state. When I applied to medical school, it was 1952. At that time, I also applied for out of state funds, because North Carolina was just beginning to accept black students. In fact, there was only one black student accepted before I was. Before I was notified whether I had received any out of state funds, I had been accepted at UNC. I did get an offer to go out of state, to Meharry Medical College in Tennessee, but I turned it down. I think shortly after that they discontinued that program.

KAREN KRUSE THOMAS:

What made you choose UNC over Meharry?

JAMES SLADE:

I could say it was closer to home, but not really. When you're young, you don't mind challenging things. I felt that I could do as good a job as those guys at Duke and Carolina and other places. It was a challenge. I applied to about five medical schools, and got accepted to two. Even if I had gotten some funds to go to Meharry, I didn't really want to accept it on that basis. It was supposed to be for when you couldn't go to medical school in North Carolina, yet they were willing to give it to me to go out of the state, which I felt wasn't the way it should have been done, so I turned it down and went to UNC.

At UNC, things were pretty good. There were a few instances. There were only two of us at the time. The other student was named Edward Diggs, he was two years ahead of me. He helped me over some of the ropes and things. Some of the guys in my class would come over and study with me, so it wasn't that bad. There was one professor who thought blacks were inferior. I will say that in his grading he was fair, so he didn't carry that over into his classroom. The only weak spot in training at Chapel Hill was in OB, because they wouldn't allow the black students to do deliveries, except on black patients, and there weren't very many black patients in OB at Chapel Hill. Even so, I learned obstetrics, even though that wasn't what I wanted to do. I did OK academically, but from the practical standpoint, it was limited.

KAREN KRUSE THOMAS:

That professor that you mentioned, was it generally known that he thought blacks were inferior?

JAMES SLADE:

He would write in the school paper, he didn't try to keep it secret.

KAREN KRUSE THOMAS:

Was there ever any kind of personal competition between you?

JAMES SLADE:

In the classroom, if you hadn't read the article in the school paper, you wouldn't have known it. He was fair, he didn't try to bring that into the classroom at all. He graded you on what you did, so I didn't feel that was a handicap at all. Aside from weakness in obstetrics, everything else was pretty straightforward, and pediatrics was great. I eventually went into pediatrics.

KAREN KRUSE THOMAS:

How did you get interested in pediatrics?

JAMES SLADE:

It really began in medical school, because you were not limited in any way on the pediatrics floor. The residents were good, and the head of the department was nice, so you had a full range. It seemed like I could

---

Page 2

understand the things we were dealing with. It really began in my third year clinical service. Not that the other services weren't all right, but there was no discrimination in pediatrics. You had one ward, and where you were located depended on which sickness you had.

KAREN KRUSE THOMAS:

Do you think there's anything about pediatrics itself that made it that way?

JAMES SLADE:

It's hard to discriminate against children if you've really got a heart. A sick child is touching regardless of what color they are. The fellows who went into pediatrics, if they had prejudice, they probably lost it along the way. But they did not demonstrate it from what I could determine. That was back in the '50s. From there, it was really the beginning of my love for pediatrics. The other services weren't as open as pediatrics was. The classmates were fine, we got along OK and didn't have any problem. I will say that all of the professors were open-minded. They didn't bend over backward, but they didn't try to hinder you at all.

One of the things that really surprised me, and they could have easily left it off, was that I was accepted into the honor society my senior year. I didn't know it existed! I had never heard of the Alpha Omega Alpha honor society. They did induct me into that, and they didn't have to do that, because I didn't know anything about it. They could have easily kept me out of it, but they didn't. So I thought that spoke well for the faculty at Chapel Hill. Experiences were pretty good, except in obstetrics.

I graduated in '57, and went to an internship at the University of Pittsburgh Medical Center. I got married after my internship, and then went into the army for 28 months. After the army, we went out to Los Angeles County Hospital for my residency in pediatrics. We stayed a year and worked out there on the staff, and then I took my boards in pediatrics and came back. We arrived back in North Carolina in September of '64, but we didn't begin practicing until March '65, because there were a lot of things to get straight. This was the days when no hospital guaranteed your salary and provided you an office space, like you have these days. That was foreign. You got out and found your own office. If you needed some money, you borrowed it, and developed your own practice. It took us a while to get the office fixed up straight. But eventually, March 1, 1965, everything was set up, and we got started.

KAREN KRUSE THOMAS:

Was it difficult for you to set up a practice solo? So many people practice in groups now because of the expense.

JAMES SLADE:

It was a little challenging. Nobody helped you out, except your family. My wife and I would go over to Norfolk and buy office equipment and haul it back.

KAREN KRUSE THOMAS:

So Norfolk was the closest place you could get equipment?

JAMES SLADE:

Because we were looking for some that wasn't too expensive. We got some used equipment over there. We didn't have any help from anybody locally, so it took us a while. We dealt with Wayne Drug Company, and he was real nice in letting us have supplies, and Carolina Surgical. They

---

Page 3

would let you have supplies and pay for it later on. My wife was working with me as a nurse, so we were there on time, nine o'clock! I think we had about one patient that morning, and two that afternoon. It was pretty clear that to do pediatrics solely would have been difficult, because we had four children, and the other doctors in town were seeing children. We did see adults from the beginning, but the emphasis has been on children all along. The first year, we managed to stay alive.

KAREN KRUSE THOMAS:

You also did general primary care?

JAMES SLADE:

Yes. I did not do obstetrics, except for a while, I'd follow the ladies until the fifth month, and then I'd turn them over to the guys who were doing OB, but I eventually gave that up. Even though we saw adults, our primary interest was children, and people had a sense of that. If people had a real sick child, they would bring them by, even though I did see adults. Probably '66, the head of the health department in Plymouth County came over, and asked me if I would run the clinics there. I told him yes, and I've been running the clinics in Plymouth since. I started out once a month, and now we do it twice a month, since the late '60s, early '70s. Then Elizabeth City asked me to do theirs, then Hertford [County], and finally Edenton. We've been doing those since then, except Elizabeth City, since they have several pediatricians now. I haven't been doing theirs for seven or eight years.

KAREN KRUSE THOMAS:

When you started practicing in 1965, how many primary care physicians were in this area?

JAMES SLADE:

We only had one specialist, a surgeon, when I started. The medical center had six physicians, and there was Dr. Walker and Dr. Holly, who was about to retire. About seven in primary care, I would say.

KAREN KRUSE THOMAS:

Would you consider this an underserved area at that time? Because for a rural county that's actually pretty good.

JAMES SLADE:

You have to think about a place like Hertford, that had only one. Hertford County is much larger than Chowan County. Edenton has never been declared underserved since I've been in practice. For the size of Chowan County, with about 12,000 population, we had more physicians per population than the surrounding counties, except maybe Elizabeth City.

KAREN KRUSE THOMAS:

Of those physicians, did all of them serve black patients?

JAMES SLADE:

Yes. And there was one black physicians who was in his late eighties when I started practicing. He died shortly thereafter.

KAREN KRUSE THOMAS:

: So after he died, you were the only black physician in the county. Did that continue to be the case?

JAMES SLADE:

Until about two years ago, when we had a psychiatrist come to town. I should qualify that. Since the emergency room has begun to hire physicians, several black physicians serve there.

KAREN KRUSE THOMAS:

Another doctor told me that the physicians in the town would serve on emergency room duty.

JAMES SLADE:

Absolutely. We did that for many years, and that was one of the reasons why I didn't want to move to far away from the hospital. A lot of

---

Page 4

times, we had to see every patient that came in the hospital ourselves, and as soon as you'd get home, they'd call you back to see another one. We finally hired some P.A.s [physician assistants], and we had to pay them ourselves as a staff, we pitched in. Of course, if they made some money, that helped out. Eventually, the hospital began to hire physicians, maybe ten years ago, at least. But we still have to serve as back-up call. If a patient comes into the hospital and doesn't have a physician, and I'm on back-up call, I have to admit them. The hospital doesn't guarantee any funds. You admit them and take care of them, and if they pay you, fine, and if they don't, that's just part of it.

KAREN KRUSE THOMAS:

Were you able to get admitting rights to the Chowan County Hospital?

JAMES SLADE:

Yes, that was no problem. It probably would have been difficult for them to have done anything. What did happen, the black physician who was here, who was close to 90 when I arrived, he was on the hospital staff, but not the emergency room staff. When I applied, the administrator told me that there was a section of Chowan County that if I was on the emergency room staff, I might run into a problem. What happened was, the doctors, who were mostly around my age, didn't like the idea of me coming on staff and not taking the emergency room call. That just meant more work for them. So I was put on emergency room staff with no problem. The interesting thing is, the very section of the county that he thought would be a problem was the first section I had white pediatric patients from. I've never had any problem in the emergency room from patients from any section of the county. He was not up to par in his thinking.

KAREN KRUSE THOMAS:

Since you were the second black student admitted to the UNC Medical School, did you ever have a sense of how you ended up being the one to be accepted? It must have been quite difficult.

JAMES SLADE:

At that time, you applied to medical school with all your credentials, and then you had to go down for an interview before they would accept you. I had an advantage, because I had already been accepted into Meharry. When I went down, I wasn't "I've just got to get in," that kind of attitude. We interviewed and the fellow asked me, "Why do you want to come here?" And I said, "It's close to home, and it's cheaper." He told me, "We've got ten slots open, and 25 applicants." And that's the way we left it. I wasn't all that worried, because I'd already gotten accepted, and if they turned me down, it wouldn't be that big a deal. But they did accept me.

It's a good time to get into things when you're young, because you don't think of all the possibilities that can go wrong. I had done OK up to that point, of course, it was all in black schools. Some of the fellows were very friendly. We never had any arguments at the table. There were four of us to a cadaver at the anatomy table, and we worked together. The only thing they didn't want you to do was learn too much, and make it difficult for them to learn, doing your dissection ahead of class. We had no real basic problems there.

The first exam we had in anatomy, I think it was histology, I made a "D." So that told me I had to study differently than the way I had been. That was the

---

Page 5

last "D" I made. That would have been true if I'd been at Meharry or anywhere, you have to learn how to study in medical school. It's different from regular college.

KAREN KRUSE THOMAS:

During the time your were in medical school, and I've asked other people I've talked to who went to UNC this same question, did you ever have a sense that some of the outside events like the 1954 Brown vs. Board decision, or the Montgomery Bus Boycott, those very publicized civil rights activitiesߞdid you ever think that those things were going to impact medicine?

JAMES SLADE:

It was the end of my freshman year when Brown vs. Board went through. You knew it was happening, but you wondered if it was ever going to reach down to a place like Edenton. Of course, eventually it did. That's one of the nice things about Chapel Hill. We went in, and the law students were in under court order. But the medical school, there was no court order, not even for the first one, they just did it on their own. Since the law students had gone in under court order, the medical staff was wise that they should go ahead and not have to go through all that. The medical school didn't want a lot of publicity from having to be forced to take students in. Diggs went in with no problem, and when I went through, there was no write-up or publicity. I never went to the newspaper to tell them I'd been accepted, I just told my family and the people at the college who had sent my references in. We didn't make it a big event.

One of the nice things, I used to work for a family in Greensboro. The man I worked for was well to do. He had gone to the University of North Carolina. He told me once, by the time you get to go to medical school, the University will be taking blacks. He was willing for me to go to the same school he went to. He made provision for me to borrow some money to go for the first year. Britt Armfield. He helped me get a loan for about 900 dollars. That was a big help to get started. I didn't have to pay him back until I got out, and I paid him back when I went into the army. Just before I got ready to go to medical school, he developed cancer. He had asked me to come by and help with his illness. You don't see it too much now, but they actually did the embalming right there in the home. So I helped with that, and helped the family until it was time for me to go to medical school. That atmosphere sent me off to a good start. The people at Chapel Hill, the Dean was nice. There weren't too many barriers, except book money, you had to try to get that.

KAREN KRUSE THOMAS:

Had you ever thought you might go outside the South for medical school?

JAMES SLADE:

I had applied to Boston, University of Chicago, one other outside the South. I really wanted to go to Boston, because I'd heard a lot about it, but I'd never been there before. But I didn't get accepted there.

KAREN KRUSE THOMAS:

Were you surprised when you got into UNC?

JAMES SLADE:

It wasn't as much of a surprise as it might have been, because Diggs had already been accepted, and Mr. Armfield had told me I probably would get accepted. It came as a pleasant surprise, but they had had me come down for an interview.

KAREN KRUSE THOMAS:

When you went away to Pittsburgh and California to do your training, was it hard to come back to North Carolina? Did you ever want to go somewhere else where there might be more opportunity?

JAMES SLADE:

When I went to the University of Pittsburgh, that was my first time out of North Carolina as far as education. All of my training from kindergarten through medical school had been in North Carolina, so I figured it was time to go somewhere else. I didn't go there to stay, I went for my training. Then, after I got married and went into the army, I didn't really go to California with the idea of staying there. By the time we got through with the training, all four of my kids had been born. So she didn't want the kids to stay away from their grandparents. She wasn't opposed to coming back at that time. I always wanted to practice in an area where there was a need. At that time, there was only one pediatrician in northeastern North Carolina, Dr. Harrell in Elizabeth City. I felt with the training I had, I would be able to offer something to the area. When I was ready to practice, Edenton still had no pediatrician. The need was here, so I that was the basic reason. I didn't go there to stay, so it wasn't that hard to leave. The weather was nice. I've had people who have tried to talk about going elsewhere since we've been here, but I never had any real desire to go anywhere else, because the need has never gotten away, the need is still here. It's not as strong now as when I first started, because a lot of the guys coming out now in family practice receive a fair amount of training in pediatrics. At that time, most of the fellows in family practice had just taken a rotation during their internship, some of them had done some residency training, but not necessarily. When I came to Chowan Hospital, we weren't doing intravenous infusions in children. Maybe some were done in a crisis, but if a child had a real serious problem, they had to send him away. That was one of the things I felt reasonably competent in, especially in children with diarrhea, meningitis, severe pneumonia.

We had some rather interesting cases over the years. I'll give the local doctors credit, particularly one of them. If he had a problem with a child, and he didn't feel comfortable, he would call me in. There were no race barriers there. Eventually, all of the doctors would refer. They didn't do a lot of referring, but they did at times, usually the real difficult cases. Didn't get no referrals for bread and butter cases, like tonsillitis or ear infections! But you did get referrals for meningitis. One of the most interesting ones was a child eighteen days old. He called and said he had a child in cardiac decompensation, that means it's in congestive heart failure. He had a heartbeat of 241, his breathing was 80 to 90, and his liver had begun to enlarge. This was the only time I can remember when the nurse was a little too slow for me. I got the medication myself, drew it out, and gave it to the child, because the child was so sick. By the next morning the child was out of heart failure. We found out later that it had Wolf-Parkinson-White syndrome. We continued to treat this child until it was two years old, and I got to thinking, maybe we ought to send this child to Chapel Hill, to make sure we'd been treating for the correct thing. Sure enough, it was. The child is grown

---

Page 7

and has children of his own, now. That was one of the most fascinating cases we had. So I really felt we were making a difference among children.

KAREN KRUSE THOMAS:

It sounds as if you treated a variety of black and white patients. Were most of them able to pay a fee, or did you take care of indigent cases?

JAMES SLADE:

A lot of patients we took care of free. I started practicing before the days of Medicaid and Medicare. We never turned anyone away because of inability to pay. In fact, we didn't even ask them to pay until we had already treated them. A lot of them told us, "see you next week."

KAREN KRUSE THOMAS:

What did you charge for an office visit to start out?

JAMES SLADE:

An office visit was four dollars, and if we did a urinalysis, it was an extra dollar. If we did a complete [workup] in the hospital on the day of admission, it was ten dollars, and five dollars for taking care of them in the hospital for a day.

KAREN KRUSE THOMAS:

So was that within the reach of most people to pay?

JAMES SLADE:

No. One time, I started figuring up how much money was on the books, and I got up to $18,000 and quit. That was a long time ago, so it was quite a bit then. I never worried about it, we did the best we could. Once Medicare and Medicaid came in, at least you got something.

KAREN KRUSE THOMAS:

Before those two programs came in, can you give a general estimate of about what percent of your patients were paying versus non-paying, or not fully able to pay?

JAMES SLADE:

I would guess about 50 percent. It was a large percentage that did not pay, particularly the ones that went into the hospital. Many of the patients that went into the hospital, we never got anything on.

KAREN KRUSE THOMAS:

Was that hospital subsidized by the county or the state?

JAMES SLADE:

Chowan is a county hospital. But the subsidy never went to the physicians. The hospital might have gotten money for indigent care, but never the physician. You treated them, but never received pay for it, if the patient didn't pay you or didn't have insurance.

KAREN KRUSE THOMAS:

Along those lines, what were some of the changes you saw from the beginning of your practice until now in the kind of economic status people had? Did you have a lot of poor farmers or people who worked in industry? And what were the major health problems when you started practicing, and have those changed over time?

JAMES SLADE:

In pediatrics, one of the major things we saw a fair amount of was severe diarrhea, dehydration. I would say in the last 15 or 20 years, that has dropped off dramatically. I haven't seen a child with severe dehydration in 15 or 20 years. I think part of that is due to the fact that these people have Medicaid, so when the child get the least little bit sick, they take them to the emergency room. With the advent of stuff like Pedialyte Oral, electrolyte solutions that are readily available have made a difference. They

---

Page 8

would come in, and their eyes would be sunken back, and their skins stands up when you pinch it, and you've got to get them IV fluids right awayߞI just don't see that.

In terms of adults, you don't see as severe pneumonia. By the time you see them, it's patchy pneumonia, as opposed to whole lobe consolidation. If you get pneumonia, it's at an earlier stage than it was back in the '60s. Hypertension is about the sameߞyou still see a lot of that. It's hard to change the dietary habits of people. They'll come in the office and say, "Doc, I've been off my diet," and you can tell it by checking the blood pressure. That is one of the major areas, particularly among the black population, that still needs a lot of work. It will probably be the next generation.

KAREN KRUSE THOMAS:

About what percentage of your office patients were black?

JAMES SLADE:

Probably 80 to 90 percent. We always have seen whites, and most of our white patients have been children. But we do see a few adults who insist on coming. Word of mouth gets around, if you treat a child and he gets better, they spread the word.

KAREN KRUSE THOMAS:

Have you seen economic conditions change in this area, and has that affected your practice?

JAMES SLADE:

I think economic conditions have improved for a large group of people. But what has primarily made the difference in medical care is Medicaid and Medicare. Other doctors might see more paying patients, but I see a tremendous number of Medicaid and Medicare patients. These people are getting better care, particularly with Medicaid, since you can take it anywhereߞdrugstore, hospital, doctor's office, not so much with Medicare. Particularly when you've got a large number of single parents. Without Medicaid, they don't have a good source of income, so that makes a difference. That has been a real boon. There has been industry coming into the area, but I'm not so sure that has impacted particularly the black community that much. Some, yes. But I think from a health standpoint, it's been those two programs that have really made a difference. A lot of times you'll see a child in your office who needs to go to the hospital. A lot of times the mother doesn't have the means to go, and will try to treat them outside, and keep them away until almost the last minute, until they're so much sicker. Now they don't mind bringing them in earlier, because they know there's a means of reimbursing.

KAREN KRUSE THOMAS:

Earlier in your practice, do you remember some of the ways people would try to treat themselves to avoid going to the doctor?

JAMES SLADE:

We had grandmother's remedies! [Laughter] They have Tylenol, and sometimes by the time they get to you with an ear infection, the ear is draining. But that began to fade out with Medicaid, around 1970. You still see some trying to treat themselves, but most of them don't hesitate to come in.

KAREN KRUSE THOMAS:

So you didn't encounter that much fear of doctors even early in your practice?

JAMES SLADE:

No. The thing that has surprised me over the years, there's been a black physician present in Edenton for a good while, with Dr. Holly who preceded me. He started his practice I guess back in the '30s or late '20s. At one time, there were three black physicians practicing in Chowan County, Dr. Hine, Dr. Capott, and Dr. Holly, that's years back. The presence of black physicians in the county is nothing new.

KAREN KRUSE THOMAS:

But why do you think there were more a long time ago than there were all the time you were the only black physician?

JAMES SLADE:

A long time ago, a lot of the physicians were dedicated to coming back to their home, to practice in the area they grew up in. Those three doctors' roots were in this area. When I got out of medical school, I didn't have any debts, except $900. I went into the army, and paid it off, $100 a month. Now you've got doctors coming out with debts of up to $80,000, depending on where they go to school. When you've got that kind of debt on you, it's very difficult to go back to a small town and try to set up a solo practice. When I went to college, we paid as we went along. So I think that has made a difference with all these doctors who want to go somewhere they can get into a group and have an immediate income. I didn't have that pressure. By the time I got out of the army, I had paid my loan off, had a little bit saved, my car was paid forߞthe one out there sitting in the yard! [Laughter] We had four kids, and didn't owe any money on them, since a few were born while I was in the service. Financially, we didn't have a big burden on us like these guys coming out now. The difference is that now, the hospital is willing to supplement physicians' income. That was nonexistent when I came. The one black physician who is in town now came on that basis, with the hospital supplementing her income. They're no longer doing that now, but that's what got her here, she didn't come because Edenton was such a nice place. It's very difficult to recruit physicians unless you've got a reasonable amount of income. They want to be guaranteed a certain salary if you take them into your practice, and I'm not in a position to do that.

KAREN KRUSE THOMAS:

Do you think that's partly the result of a change in medical ethics, and do you think it had anything to do with black physicians being trained outside historically black institutions like Meharry?

[TAPE 1, SIDE B]

[START OF TAPE 1, SIDE B]

JAMES SLADE:

Black physicians can pretty much go anywhere in the country, and have no real problems getting onto hospital staffs. As time has moved on, hospital staffs have opened up to black physicians in the larger places, although some maybe not as readily as others. Probably, that's part of the reason why black physicians don't think about going back home, because they have these other opportunities available to them. A lot of them become friends with white physicians, and in big cities, maybe even go into practice with them, which is something that years ago wasn't heard of. You might have had multi-specialty groups, but you didn't have multi-ethnic groups, which is no longer the case. I think all of these opportunities, plus the pressure of economics, makes it difficult, unless you get an unusually dedicated one who wants to come back to a smaller town. Even the ones who are dedicated, the pressure of finances can weaken that dedication. It's hard to pay off a $90,000 loan unless you're getting some definite income.

KAREN KRUSE THOMAS:

Do you think medical school used to intentionally instill a certain kind of medical ethics that would encourage someone like you to go back to Edenton, for instance?

JAMES SLADE:

I think perhaps, but in some ways, they're trying to do it now. One thing that sounds good, but I'm not sure how great it really isߞyou never heard about money in medical school. You learned how to practice medicine, and economics was not really a factor. When you got into practice, you had to learn how to set it up on your own. You learned a little about practicing medicine in the community, but none of the mechanics of running an office. When you came out, you made a lot of errors, and you didn't run it very efficiently, which made it difficult. Solo practice is pretty well becoming a thing of the past, although there are still a few brave souls. I think the medical schools are now beginning to talk more about finance, especially with managed care coming on the scene. But years ago you just didn't hear about it. We didn't even have much on legal medicine. Our idea was to practice the best type of medicine that we could, giving every patient the best that we could give them. When I started practice, it never dawned on me to have malpractice insurance. I practiced for five years without it, until one of my fellow physicians told me I might better get it. We were trained to consider our patient first and foremost, and they're trying to get back to that, somewhat. By the same token, it's hard sometimes to give your patient the best if you don't have a sufficient income. More so now than years ago, because you didn't have all the instruments and ways of doing things you have now. With all the technological advances, computers and all, it's more difficult to practice that kind of medicine. You've got to consider finance, otherwise you're going to be out of business.

KAREN KRUSE THOMAS:

Do you remember anyone in your medical training who really modeled that idea of considering patients first?

JAMES SLADE:

I would say Dr. John Sessions, who's still at Chapel Hill. He taught me physical diagnosis, and that to me is the basis of the practice. If

---

Page 11

you don't know how to examine the patient and give a good history, you're going to miss about 80 percent of your diagnosis. Sure, you get some from the laboratory, but he taught us really good ways of doing that. That's something I use every day. He's one of the physicians who I remember what he taught me.

KAREN KRUSE THOMAS:

Do you remember the Simkins vs. Cone case at all?

JAMES SLADE:

No.

KAREN KRUSE THOMAS:

It was a 1963 case that desegregated the federal Hill-Burton hospital construction program. It seems like a pretty important case, but no doctor I've asked so far has ever heard of it.

JAMES SLADE:

I can tell you what I do remember. I think this hospital was built with Hill-Burton funds. When I came here, I had no problem getting on the staff, but the black patients were on one ward, and the white patients were on another.

KAREN KRUSE THOMAS:

That was in '65?

JAMES SLADE:

Yes. Let me qualify that a little bit. They didn't stay segregated. If they had a bad patient that cried or hollered all night, you know what ward they went on. One guess! [Laughter]

CATHERINE SLADE:

They really had a wing or end, they weren't on the same ward.

JAMES SLADE:

If they had one of the noisy white patients disturbing people, suddenly integration was OK. [Laughter] I'm not saying they did it every week, but it did occur. But when Medicare came along, that cut it out. Because Medicare would not allow any hospital to segregate on the basis of race if they were going to receive Medicare funds. Hill-Burton might have played into that, too.

CATHERINE SLADE:

Was that when the built the hospital with all private rooms?

JAMES SLADE:

That was in 1970. That was after Medicare.

KAREN KRUSE THOMAS:

So do you remember when Chowan County Hospital completely stopped assigning patients on the basis of race?

JAMES SLADE:

I think it was when Medicare came in, because they needed the money.

KAREN KRUSE THOMAS:

This court case was in '63, and then Medicare was passed in '65, so they came right together.

JAMES SLADE:

I started practicing in '65, but by '66, it had changedߞthat practice was no longer in vogue. [Laughter] And has not been practiced since.

From the nursing standpoint, did they try to limit the black nurses?

CATHERINE SLADE:

They were not in supervisory positions, even though they were qualified. May I address some of the things that he's said?

KAREN KRUSE THOMAS:

I'd love for you to!

CATHERINE SLADE:

You were asking him about problems when he went to medical school, and he said he never had any real problems and they seemed to accept him. I think that was because he was a good student. He had something that they needed, and that's why the students would come and study with him. You

---

Page 12

don't go and study with someone who doesn't have anything to offer. He was in the dormitory, was it just two of you on that floor?

JAMES SLADE:

At one time there were three, because there were two black law students.

CATHERINE SLADE:

Two black law students and one black medical student had one whole floor in the dormitory! On the other halls, they were three in a room.

JAMES SLADE:

It's hard to complain about that, though!

CATHERINE SLADE:

You were also asking about why many doctors didn't come back to Edenton, and why he came back to North Carolina after he was away. Although he could go to many other places, he is not the type of person who's looking for big city lights or any of those things. He's very happy and comfortable and pleased right here in Edenton, because it offers everything he needs or wants. As far as some of the cases he has treated, now with us getting a little older, it's not infrequent that we'll meet someone, and we won't have any idea who they are, and they'll say, "You saved my child's life." I remember before his office was ready, they were still working on it and we had moved back to North Carolina, there was a child that was struck by a car. We both came to the hospital with this child, and started to Virginia with the child, to try to get him to a neurologist at another hospital.

JAMES SLADE:

They didn't have helicopter service.

CATHERINE SLADE:

The child died before we could get there. Some of the people felt that he was being over heroic, trying to save the child, and felt like you should just let him go. We felt that we should try to get him someplace where he could be helped. As far as diabetics, he has had some very, very sick, almost dying, diabetics. I can think of a couple of them, they were children. You don't see as many bad diabetics now.

JAMES SLADE:

There was one girl, she was already in the coma. She had a pH around six, which is way up.

CATHERINE SLADE:

He treated a boy with meningitis in the first or second grade. They were used to sending meningitis patients away, and he treated this six year old fellow. He was real sick, and it got real touchy at times. It was difficult for him [Dr. Slade], because he had come from a big medical center and teaching hospital with people who he could consult with. I feel that one of the reasons we don't see as many sick peopleߞI used to work with EIC, and we had family planning clinics, and I would help in the health department. With EIC, I would visit in a lot of the homes, and one of the problems would be transportation. That's not as much of a problem. Education was a problem. With TV and clinics and all these things, people now don't let their children get as sick. They don't still keep them home without recognizing that they should get them to the doctor. We used to see a lot of babies who had not had their shots, and they would say it was a problem with transportation, plus taking off from work. The husband might have to take off work if the wife couldn't drive. That was a problem.

KAREN KRUSE THOMAS:

These sick children that you used to see more of, what kind of background were they coming from?

CATHERINE SLADE:

I think they were coming from people who were low-income and uneducated.

JAMES SLADE:

Not all of them, though.

KAREN KRUSE THOMAS:

Were they isolated in rural areas, or why were they uneducated?

JAMES SLADE:

Some of them, it was like parent like child. A lot of the parents didn't make it through fourth grade, and the children would drop out too, especially with single parents. Some of the sick ones we saw came from relatively well to do families, like the diabetics.

CATHERINE SLADE:

Some of that was becauseߞI don't know if they just didn't recognize it, or what it was, but they had gotten pretty low. Some of them had gone to other doctors. A lot of the tests and things that they do now more frequently, they didn't do them with children back then. I don't think doctors routinely would check blood.

JAMES SLADE:

We did urine tests, primarily. We didn't do blood sugar, because you didn't have office glucometers when we started out. We could do hemoglobins in the office, and urinalysis. We had the dextrose test, but it wasn't very reliable.

CATHERINE SLADE:

It just wasn't something they automatically did, like using x-rays to find pneumonia. A lot of them didn't do chest x-rays.

JAMES SLADE:

We had to really battle sometimes to get chest x-rays. I was getting chest x-rays day and night, and they weren't used to going x-rays here at night too much. They did it, but they fussed.

KAREN KRUSE THOMAS:

Did you have an x-ray machine in your office?

JAMES SLADE:

No, we had to take them to the hospital. They had a lab there, but it wasn't open after hours. I had to read my own x-rays at night, because the radiologist only came once a week. I remember one lady in particular who wasn't all that happy about doing an x-ray. She did it, but didn't her husband call afterward?

CATHERINE SLADE:

We don't know who called, but somebody called in the middle of the night and threatened him.

JAMES SLADE:

We didn't let that stop us. The person who didn't want to do the x-ray finally did it, and the next thing I knew, she had her children down at the office! [Laughter]

KAREN KRUSE THOMAS:

The radiologist only came once a week?

JAMES SLADE:

At first, only on Thursdays. All the x-rays had to stay until he got there. We read our own, but the official reading was done only once a week. Now we're a long ways from that, we've got our own radiologist. But that's the way it was when I first got here. He did the G.I. series and barium enemas, and read all the x-rays that had accumulated from the previous Thursday. We read them ourselves, and got to where we could read them pretty good.

One thing I didn't tell about at Chapel Hill, it was a minor point but interesting, in the dining room at the University, there was no discrimination, if you had your money! But at the hospital cafeteria, Diggs who was ahead of me had said that it was OK to eat in there. So I went in, and I could tell the girls who

---

Page 14

were serving weren't sure whether to serve me or not. I didn't want them to get in trouble, so I left and checked it out. I went in the second time, and they fixed my plate. When I got to the cashier, they said I would have to sit over in the corner. I started toward the corner, but I sat down midway.

KAREN KRUSE THOMAS:

Just made the corner a little bigger!

JAMES SLADE:

Yeah! What made it so nice, was that my classmates came over and sat down with me, one of the two girls in the class and some of the fellas. That ended that, after the cashier looked over.

CATHERINE SLADE:

He had said to me that Diggs was a fair-skinned black, so they weren't used to having anyone as black as he was. [Laughter]

JAMES SLADE:

My dad told me, "One thing about you, when you get there, there won't be no doubt about you!" [Laughter] One day in the cafeteria at the TB clinic where we used to eat, these guys said, "If he's going to eat in there, I'm not going to eat in there." And I said, "Well, they won't eat in here todayߞI'm going to eat in here!" When you're young, you're a little braver.

CATHERINE SLADE:

I think another thing that has helped him is that they didn't feel threatened as far as the girls were concerned, because he was not one who was making eyes at the girls. He was more concerned with his work. [Laughter]

JAMES SLADE:

No time for that!

KAREN KRUSE THOMAS:

Did you join the county medical society when you came here?

JAMES SLADE:

No, I didn't. It's not that I couldn't, but again, it was the money. Plus, the medical staff of the hospital met, and there wasn't but one doctor in Perquimans County at the time, so the county medical society was almost one in the same. We benefited from it if someone came to lecture, so there wasn't any pressing need to join.

KAREN KRUSE THOMAS:

Do you know anything about the Old North State Medical Society?

JAMES SLADE:

Yes. I never joined the Old North State Medical Society, but I did join the local group of dentists and pharmacists and doctors who all got together. They don't keep separate. It was a part of the Old North State, but it was also part of the other [professional groups].

KAREN KRUSE THOMAS:

Do you know how long that society continued to exist, does it still exist?

CATHERINE SLADE:

I think so, we still get mail from them.

KAREN KRUSE THOMAS:

Did they ever merge with the North Carolina State Medical Society?

JAMES SLADE:

No, they're still not merged. Some people belong to both.

KAREN KRUSE THOMAS:

Did you ever try to join the North Carolina State Medical Society?

JAMES SLADE:

Noߞthat was more money than the Old North State! [Laughter]

KAREN KRUSE THOMAS:

So joining the North Carolina Medical Society wasn't a priority for you.

JAMES SLADE:

No, not at all, not in the least.

KAREN KRUSE THOMAS:

How about the AMA?

JAMES SLADE:

No, same thing. Once you go so long without belonging to them, it becomes more of a challenge, since you've done without them that long.

CATHERINE SLADE:

I'm not sure what the advantages are to belonging to them, except being able to socialize.

JAMES SLADE:

The social part is part of it, because if you just attend the scientific part, most of the time, there's not much advantage.

KAREN KRUSE THOMAS:

One advantage, though, I had heard that the North Carolina Medical Society had the power to appoint members to certain state boards, there were positions that black physicians were barred from because they weren't in the state medical society.

JAMES SLADE:

The board of medical examiners I suspect might be that way.

KAREN KRUSE THOMAS:

But I read that you were the medical examiner of Chowan County, so there was no problem with that?

JAMES SLADE:

What happened there was that Dr. Wright was the medical examiner, and he wanted help, so he asked me about becoming one. Sure enough, when I got in it, he got out. I guess I was medical examiner by myself for about 20 years. Finally one of the other doctors in town became one. Now we have four, which is good. We used to attend meetings up at Chapel Hill.

KAREN KRUSE THOMAS:

What does the medical examiner do?

JAMES SLADE:

Anyone who dies accidentally or is poisoned, any suspicious death, you have to go investigate. It's what the coroner used to do, but we don't have a coroner system in North Carolina anymore. You don't necessarily always have to do an autopsy, but you have to determine the cause of death.

KAREN KRUSE THOMAS:

One thing we haven't covered is your public health experience. What was it like to practice in those public health clinics when you first started in '66?

JAMES SLADE:

Initially, when we began to do those public health clinics, they were state-funded. Now they pay you something like $20 an hour. Initially, we saw fairly sick children. Many times, I would have to refer a child from the clinic to the hospital. One thing I always tried to do was not refer them to myself. But a lot of times they wound up seeing meߞif they come to you, you have no choice. We tried to be careful not to refer patients to yourself. Initially, practically 100 percent of the children we saw were black. With the advent of Medicaid, and the passage of time, we began to see more white children come into the clinics. Now, it's still more black than white, but it's not unusual to have white children in the clinics these days.

KAREN KRUSE THOMAS:

Why do you think that changed?

JAMES SLADE:

I suspect part of it was because of school desegregation, since they had to go to school together.

KAREN KRUSE THOMAS:

So you think it became more acceptable to go to a public health clinic after school desegregation?

JAMES SLADE:

I think so, because it's not that there weren't poor whites, but they either did without care or some of the white doctors saw them. As time went on, it became no longer a problem. Even in the public health clinics, though, you had very few black nurses. I can only remember one or two. The children who come are less ill. You very seldom see a premature baby in the clinics anymore. I have seen babies around three pounds in public health clinicsߞyou don't see that anymore. I think again, it's because hospitalization is not a problem for these children. The midwives were very active in those early years, and they're not that active now.

CATHERINE SLADE:

Also, they have programs in the health departments now where they provide formula.

KAREN KRUSE THOMAS:

When did that start?

JAMES SLADE:

It probably began in the early '70s. We used to have milk and formula in the office. In addition to the public health clinics, I also work in the migrant clinics. It's still through the public health department, but it's a different division.

KAREN KRUSE THOMAS:

When did this area start getting a lot of migrants in, and when did those clinics start?

JAMES SLADE:

It might have started before my time. It was well established in '66 when we started going over there. They would have probably 500 migrants or more in the area.

KAREN KRUSE THOMAS:

Were those migrants African American at that time?

JAMES SLADE:

Yes. No Hispanics back in the late '60s, early '70s. Occasionally you would see a Caucasian, not very often but once in a while. Most of the clinics were held in Pasquotank County, we'd have to drive over there. A lot of times, they were busy. There were two physicians when I started, one other physician and myself, and sometimes my wife would work with us. We would both work until one or two o'clock in the morning before we got through, and we weren't just sitting around chatting, either.

KAREN KRUSE THOMAS:

What were some of the problems that y'all saw that were specific to migrants?

JAMES SLADE:

A lot of epilepsy. Occasionally, we'd find tuberculosis. Part of the epilepsy problem was due to lifestyle. There's a lot of alcohol consumed among the migrants, I guess that's part of the socio-economic status, and the pressures and all that. Hypertension, diabetes, although not necessarily insulin-dependent. A lot of rashes. With the diabetics, a lot of times you'd see foot ulcers. Occasionally, you may run into someone with a cardiac problem, but hypertension was the biggest thing. Sometimes some of the ladies would be pregnant and we'd take care of the newborns. That's what I'd like, when we had a baby to look after. Makes you feel more at home.

KAREN KRUSE THOMAS:

You mentioned midwives a minute ago. What were some of your experiences with the midwives? Were most midwives at that time black?

JAMES SLADE:

All the ones I knew were black. In Plymouth, particularly, they had midwives, because one lady in the clinic worked as an aide, but she was also a midwife. You'd see these children in the clinic, three or four pounds, and you'd think they should be in the hospital, but they were doing pretty good. Chowan County has not had a lot of midwives in recent times, because the physicians that did deliveries weren't all that enthusiastic about midwives. They had a project in the early '90s with a couple of midwives at Chowan Hospital. They stayed about six months, and then kind of petered out. These particular ones, I think one of them made an error, and that didn't go over too good. With Medicaid, they have access to the physicians, and unless they've got a real good rapport with the midwife, they prefer to go to the physicians. For many years, we didn't have any midwives in Chowan County, and the physicians did all of the deliveries. We had four obstetricians, but one has retired. When I started out, all the physicians in town, except for myself, were doing deliveries. With the advent of malpractice suits, and increasing rates for malpractice insurance, all the physicians except those who are strictly OB/GYN have ceased to do deliveries. No primary care physicians except OB/GYNs now do deliveries, where all the family practitioners were doing them before. When it got to be $18,000 for malpractice insurance and you didn't do but one delivery, it became financially noncompetitive.

KAREN KRUSE THOMAS:

You say there were quite a few midwives when you first came?

JAMES SLADE:

Maybe not "quite a few," mostly in Washington County, not in Chowan County.

KAREN KRUSE THOMAS:

Do you have a sense of why midwifery died out?

JAMES SLADE:

Two reasons. She mentioned transportationߞif these ladies can get in the rescue squad and be in Chowan County or Washington County Hospital. But Washington County has not had the medical coverage that Chowan County has. We now have three OB/GYNs who do deliveries, and are fully board certified, whereas Washington County only had one, and they lost that one. We see a lot of people from Washington County who come to Chowan County for deliveries. So transportation is no problem now. They had a choice of staying home with the midwife, but if they got in trouble they'd have to go to a physician anyway. Now, I think midwives have to have so much certification.

KAREN KRUSE THOMAS:

Had those midwives when you came in been through certification courses?

JAMES SLADE:

I don't think soߞif there was any such thing at that time. Did they even have certified nurses aides at that time?

CATHERINE SLADE:

No.

JAMES SLADE:

Maybe their grandmother taught them, but certification came later.

KAREN KRUSE THOMAS:

I know a long time ago, especially in rural areas where doctors couldn't get out to people, a lot of people of both races did deliver with midwives. It seems to me from what I've read that midwifery became

---

Page 18

more and more a black profession, and that mainly black women were using them. Do you know when or why that happened?

JAMES SLADE:

I've never known a white midwife.

CATHERINE SLADE:

There was that lady who was going to go to schoolߞdid she go?

JAMES SLADE:

I think she finally decided to be a lawyer! She was an RN that used to work in the public health clinic, and she decided she wanted to be a midwife.

CATHERINE SLADE:

One reason people used midwives was because they didn't have to pay as much money. It probably was easier to get her than to get a physician.

JAMES SLADE:

Once they have one or two successes, that's all they need.

KAREN KRUSE THOMAS:

You had mentioned what a big impact Medicare and Medicaid had. Some physicians I talked to were hesitant to take those, and had a lot of concerns about socialized medicine. It sounds like you started taking them right away?

JAMES SLADE:

I was practicing before they existed, and we saw all the patients who came to be seen. We didn't turn anybody away. In fact, sometimes we went out of our way to treat people in their homes. We used to make housecalls frequently, and sometimes she'd come along with me and start an I.V. right in the house. If we knew then what we know now, we could have started home health care! [Laughter] We'd have been real pioneers, we just didn't get paid for it. That was part of our practice. You take care of them for free, or you take care of them for pay. If you're going to take care of them for free, it's certainly no opposition to take care of them for pay. Another thing, these people that have Medicaid need to be seen. If you're going to not see them because they've got Medicaid, and they don't have the money to pay, then they're not going to be seen, and they're going to suffer. And then they get worse and show up in the emergency room. Chowan County has a policy that nobody gets turned away from the emergency room. If you're on back-up call, you're going to have to take care of them then, and then they're in worse shape. To me, it never made much sense not to treat people because they had Medicaid. Because I've come from a background where I treated them when they didn't have anything.

[TAPE 2, SIDE A]

[START OF TAPE 2, SIDE A]

JAMES SLADE:

As far as the amount of socialized medicine, that's never been a big thing among African-American physicians, as it has among non-African-American physicians.

KAREN KRUSE THOMAS:

Why do you think that's true?

JAMES SLADE:

When you look at blacks as a whole, group things seem to mean a little more to them, like in terms of the church. That's one of the institutions that's really meaningful to blacks, it's not just a club, it's more of a family gathering, although they don't always act that way. White physicians can go to the country club and play in the golf tournament on Sunday morning, or whenever it is, whereas the black physician, I know some now who go on the golf course, but back when I was coming along, you probably couldn't find half a dozen black physicians in the country that played golf, particularly in the South. The church was the uniting force, and its a social gathering place. Helping somebody in groups has never been a threat, so I think that's one reason why black physicians have never been threatened by so-called socialized medicine. You don't turn anybody down anyway, or it's a lot more difficult for the black physician to turn away the poor people, particularly the blacks.

CATHERINE SLADE:

Another thing, you find very few rich people in the black race. Most of them might have been in the same situation at one time, until a better opportunity came along. So they know what it's like.

JAMES SLADE:

Also, if the black physician starts turning away his own people, he gets into all sorts of trouble. He's not going to attract a lot of non-blacks just because he turns away blacks, and he puts himself in a bad position with his own race, because people say, "Now he's a big shot, he won't even see us." Basically, he's taught not to reject his own.

CATHERINE SLADE:

It's a loyalty thing. As I think about it, I can remember hearing people get very upset with him. If he didn't have time to make a housecall or do something they wanted him to do, they would go over to a white doctor who they know wasn't going to go on a house call. But because [Dr. Slade] wouldn't do everything they wanted him to do, they were going to go to someone else. They expect more of you.

KAREN KRUSE THOMAS:

The patient would go to the other doctor to punish you, even though they wouldn't get any better service with that doctor?

CATHERINE SLADE:

They're not getting any better service, they just didn't like it if you turned them down and wouldn't make a house call.

JAMES SLADE:

But they're going to get out of the house to see the other doctor, because he's not going to make no house call, either! By the same token, they're also more loyal. I have patients who will wait in that office for three or four hours before I get to see them.

CATHERINE SLADE:

Maybe they give more, but they expect more.

JAMES SLADE:

It amazes me, by and large. Maybe a few white patients would wait, but most of them, if I'm not there close to on time, they take off.

---

Page 20

Which is their right to do so. I call and have my nurse tell them I'm going to be late, and they won't move.

KAREN KRUSE THOMAS:

Some of the doctors I've talked to have said that Medicaid and Medicare were all right to begin with, and the government pretty much gave you full reimbursement, but as time went on, there was less reimbursement and more paperwork, and that really made them hesitant to keep accepting those patients. What's your opinion on that?

JAMES SLADE:

There are two factors here. One, physicians' prices have jumped quite a bit. Naturally, if you're charging $20 or $25 for an office visit, and next year you jump up to $35, and the following year you jump up to $45, and finally you get up to $50, Medicare is not going to jump along with you. When you're charging $50 for an office visit and Medicare is only paying you $25, that looks bad. But our office rates started off lower, and right now, we're up to $25 for an office visit, and Medicaid pays it all. From our standpoint, Medicaid is doing good, but if I charge $50 or $75 for an office visit, then it looks bad. Of course, I'm not saying they're not justified in increasing their fees, but that's part of the problem. Maybe they've increased them because they've brought more people into the office, or bought more computers. And the same thing with the hospital. I think a urinalysis in the hospital runs about $30, and in our office, it's $10.

KAREN KRUSE THOMAS:

Why are you able to do it cheaperߞyou can do it at a third of the cost, why is that?

JAMES SLADE:

I don't pay my people that do it as much as the hospital does. They have to have trained technicians. I train the girls that do it myself, and they do it just as good. Then of course, the hospital has more fancy equipment, and that's part of why they charge more. Even though I charge $10 for a urinalysis, Medicaid will only pay me about $5 or $6. But that's what they do.

KAREN KRUSE THOMAS:

Especially as a solo practitioner, have you had a hard time with paperwork? A lot of doctors say they've had to hire a full-time person just to do the paperwork.

JAMES SLADE:

We have a lot of paperwork, but I guess it depends on how you organize it. The girls I have now, as I see the patients, they start on the paperwork. By the time the patient's out of the office, their Medicaid blank is all filled out. We've got a computer, but haven't started doing it by computer yet, but we hope to soon. I can understand a lot of doctors, if they have a large volume, then there's extra paperwork to be done. If they run it through the computer, then they have to train somebody on the computer. But better to have the paperwork increase, and have the green paperwork increase along with it! [Laughter]

KAREN KRUSE THOMAS:

When did you hire an office assistant?

JAMES SLADE:

From the beginning. My wife worked with me for the first three years, and then another lady worked for me for 24 years, and she was the only one in the office. Once in a while, we'd have someone else come in.

KAREN KRUSE THOMAS:

So you've always had an office assistant, but have you really had to increase the number of people you've hired for paperwork?

JAMES SLADE:

Not really.

CATHERINE SLADE:

You have two people in the office now, where for twenty-some years, you only had one. One thing is, through the years, he has lost money because of not getting his issuances and Medicaid in on time. He was not able to see that maybe it would pay him to hire someone extra. He has not really concentrated as much as he should have [Laughter] on the money part of it. Through the years, if the patient would tell him they didn't have the money, he would say, "That's all right, don't worry about it." I don't know if it helped him or not, because I think they needed to know their responsibilities, and not expect certain things. A lot of times, I think it's something from our background that we're not supposed to put anything before taking care of the patient. That's something that both doctors and nurses feel. You might feel guilty if you think about the money too muchߞthat's the way the old nurses and doctors were. I don't know about now, whether that's a problem. I think maybe our house would have been painted, and we would have had landscaping, and we would have been able to help our children more in their education. They all got it, but it didn't come easy. Things probably could have been a little different.

JAMES SLADE:

Then they think you're rich even though you ain't. [Laughter]

CATHERINE SLADE:

No matter how much you have, everybody thinks doctors are rich. I tell him all the time, I wish I could visit the president, or write an article, to let them know that all doctors are not rich. A lot of times, you're working so hard, and then have to borrow money for income tax, because so many of the things are not deductible that we spent our money forߞa lot of it was education. When our children were young, child care was not deductible, but we had to get someone to take care of the children. Then after that, it became deductible. We sent all of our children to academy and college, and helped them the best we could in graduate school, and none of that was deductible. At one time, the interest on the loans was deductible, but now they've even taken that. The middleman like us, you make too much to get anything, but you don't get enough to live the way people think you are living.

KAREN KRUSE THOMAS:

Some people have suggested to me that doctors who used to provide charity care for free, perhaps the allocated a certain amount of their practice for charity care and did things like public health clinics, but when Medicaid and Medicare came in, they disrupted that charity care system.

JAMES SLADE:

I don't see that, because the same patients you were giving the charity care now have Medicaid.

KAREN KRUSE THOMAS:

So doctors are getting paid to give care that they used to give for free.

JAMES SLADE:

That's the way I see it. Unless it was the type of patient who if they didn't have money, you didn't see them. In the larger cities, you might

---

Page 22

send them to the charity clinic. But in Chowan County, you're it. You may send them to another doctor, but that's not going to go over too good. Either you treat them, or they don't get treated. If you send them to the hospital, years ago, if you were on call, you'd have to go out there to treat them, or the other doctors had to treat them, and that doesn't look good if you're refusing to see a patient and tell them to go to the emergency room. You didn't have the option of sending the patient to charity care unless you were willing to give it. Because there was nobody else to give it.

CATHERINE SLADE:

I don't know if this is charity or not, but still, the doctors do team physicals for the school for free.

JAMES SLADE:

For the baby clinics, the state pays a certain amount per hour, but when you consider the time you put into it, you could do a lot better in your office. It's quasi-charity, it's not a hundred percent free.

KAREN KRUSE THOMAS:

Do you think black physicians in the period you've been practicing have been more likely to do public health work, and have had a larger part of their income come from public sources, rather than relying completely on a private practice?

JAMES SLADE:

When it comes to the income, you don't get a lot of your income from public service. I would say probably in the range of 20 percent, if that much. We certainly couldn't live off the money we get from the public health clinic and the migrant clinic. In a year's time, even now, it's less than $15,000 put together. So it's a small portion of your income, the only thing about it is that it's fixed. By the same token, if you can't make the clinic, you don't get the income. Going to Plymouth, it takes about 40 minutes one way. So that's an hour and a half that I'm on the road, but they don't really pay that travel, and it comes in the middle of the day, when you could be doing other things. While it's not completely free, you're not being rewarded as you could be if you were seeing private patients in your office. In and hour and a half traveling on the road, you could see patients, as well as the time you're over there. It is a service, although there's some compensation.

KAREN KRUSE THOMAS:

When you were first approached about doing a public health clinic, was that something you'd always intended to do anyway, or were you surprised?

JAMES SLADE:

I'd never even thought about it, to tell you the truth. But when Dr. MacDowell from the Plymouth health department came over, and I don't know how he learned I'd been trained in pediatrics, and approached me about running the clinics, there was not reason not to do it, because I wasn't all that busy. So I told him yes. I never planned to do that, but when it came available, I hadn't planned to turn it down, either. The thing I loved about it, it was strictly pediatrics. This was the one time of the month I could count on doing nothing but pediatrics, so I enjoyed that.

KAREN KRUSE THOMAS:

I think that's most of the questions I had. Do you have any general comments about changes you've seen in medicine in your lifetime?

JAMES SLADE:

One of the first changes that came about, group practice had already started before I got into medicine. As a child growing up, all the doctors in Edenton were solo. We didn't even have a hospital until about '46, when they started at the base. This is the fiftieth year for Chowan Hospital, so they must have opened in '47. I've seen Chowan County become a leader in health care. When I started off, physicians were solo. In the late '40s, we had a Marine air base here. When it closed down after the war, some of the physicians and community leaders approached the Navy to allow them to utilize the infirmary. So they had a hospital at the base.

We didn't have a hospital locally. If you got sick and had to go to the hospital, you went to Elizabeth City, and if you were really sick, you went to Norfolk. They got together in the early '50s and built Chowan Hospital, a 35-bed hospital. Some of the physicians organized themselves into a group at the Chowan Medical Center, maybe five or six, in the early '50s. When I came to practice in '65, it was well organized, and they had their building. There were about two physicians in solo practice. Chowan Hospital in 1970 expanded to a 60-bed facility. The hospital over the years has continued to upgrade. They built a 40-bed unit for extended care, which brought it up to about 100 beds. They've added on a 20-bed psych unit, and renovated the emergency room, and now we're building an ambulatory care center. So one of the things I've seen over the years is that both the in-patient and out-patient facilities of the hospital have continued to progress, even though the size of the town is about the same. Edenton's slogan is that it's both historic and progressive, and that's been true in health care.

From the physicians standpoint, we've grown in numbers. Now we have an OB/GYN center with four physicians. Before reached the stage it's at now, a physician pulled out from Chowan Medical Center, and started this OB center, and then we had a doctor come in and start an opthamology center. We've had surgeons come inߞthere was only one when I came here, and now we have three general surgeons and an opthamologist. Just as the hospital has grown, the physicians have multiplied and brought in more specialties. When I came, we had only one specialist, a surgeon, and a radiologist who came once a week. Since 1982, we've had a hospital-based radiologist. So there's been an upgrade, healthwise. Along with this, the nurses have become better trained. Now we have a lady administrator, which is a new change. The hospital has gotten into the business of recruiting physicians, which was totally unheard of. As the trends have changed across the nation, it may not have been as fast in Chowan County, but it's been replicated here to a degree. The hospital has affiliated with other places like Pitt, so physicians will come in to hold cardiology clinics, GI and pulmonology. Many of the specialties represented at Greenville [where the Eastern Carolina University School of Medicine is located] also come up here to Chowan County to give their services. We have our own CAT scan, which was a big thing when it first started in a place like Edenton.

KAREN KRUSE THOMAS:

When did they bring that in?

JAMES SLADE:

Back in the '80s. We recently put in an $800,000 state of the art unit. They have nuclear medicine, and the hospital has become computerized. We're upgrading, but not as fast as some other places. It's been very progressive. In terms of relations between hospital personnel, things have improved. When I first came here, we never even heard about the hospital ball until it was over. [Laughter] We're free to go now. Last year, I became vice-chief of staff, and this year I'm chief of staff. Race has no longer kept physicians from taking positions, so that's progress. Overall, I think the changes have been many. I don't know what's coming with managed care. It hasn't impacted this area as strongly as other areas, but it probably will down the road. Especially if Medicare and Medicaid decide to go managed care, I doubt any of the physicians can survive without those patients. Certainly Chowan Hospital would be in terrible shape. This is a retirement community now, and a lot of them have Medicare.

KAREN KRUSE THOMAS:

You've been talking about what sounds like serious growth in the health care system. How has that been funded? Has the area economy grown and helped to fund that?

JAMES SLADE:

A while back, Chowan Hospital went through a series of administrators, and at one point, we were in the red. Then they had Sun Health manage the hospital, supply the administrator, and they began to improve and get into the black. After a while, they felt they no longer needed it, so they got rid of it. One thing they have done that has improved the financial base is that they haven't just stuck with in-patient care, because that's beginning to dwindle. They've gone into home health, and Chowan Hospital has its own home health unit. Their bottom line has been positive ever since I was on the finance committee. So that has been a source of income. They've started outpatient clinics with doctors from Greenville. The orthopedic physician brings patients to the hospital that weren't being operated on here, and that increases the hospital's bottom line. The hospital hasn't just depended on in-patient care, they've gone into the clinics, the CAT scan was a big purchase, but it's paid for itself. We've begun to offer many services locally that people used to have to go out of the area to receive. They've incorporated people from the community who are knowledgeable in finances, so they've made some smart moves in investments. They refinanced their bonds, so it's almost like getting the CAT scan free. [Laughter] It's been a cooperative effort among the community, the administration, the nursing and physician staff. Once the got into the black, they remained in the black. The one thing we've had a problem with is the psychiatric unit. But it hasn't been enough of a drain to affect the rest of the hospital. They don't turn away anybody who needs the service, and a lot of people who need it have substance abuse problems, and don't have any money. So you're taking care of patients who can't afford to pay, and yet you can't afford to turn them away.

KAREN KRUSE THOMAS:

I have been looking into what some have called the unintended consequences of desegregation. Some people I've talked to in Wilson said that it really improved care for African Americans to have a

---

Page 25

desegregated hospital, but that there were some things that were lost. When you lost a hospital like Mercy with an all-black staff, that offered a lot of opportunities for black physicians, black doctors had difficulty getting admitting rights, and there were no black doctors in Wilson within a few years after Mercy closed. Can you comment on the things that might have been lost in the transition?

JAMES SLADE:

My wife could tell you more about Wilson, because that's her home. Chowan never had the same situation, because after desegregation, the situation with blacks being on one wing ended. But I would think that the problem with Mercy Hospital, and black hospitals in general, is that they've had problems getting enough money to function. Because their patient load is primarily low income, they can't stay in the black, and they can't offer the services they need to in order to keep current. That's a problem. And if you don't have the state of the art equipment, patients are going to go elsewhere if they can. There are a few black hospitals that have been successful, but now there are less than a dozen, and some of those are in trouble. Lincoln Hospital in Durham is gone, so is Good Shepherd in New BernߞI did my externship there.

KAREN KRUSE THOMAS:

Despite these tremendous changes with the civil rights movement, and Medicare and Medicaid, and a lot of the things we've been talking about, there are still, at least statistically, racial differences in things such as infant mortality.

JAMES SLADE:

There is still a difference. One thing that contributes to infant mortality is teen pregnancy and nutritional status. That's a problem that probably won't be solved with the present generation. Hopefully, down the line, if we can't solve the problem of teen pregnancy, at least we'll diminish it, and that's going to take a lot of help from a lot of different areas. The schools, the churches, and society in general. I think part of the problem there is employment. They see a lot of blacks unemployed, and a lot of times they say, "What's the use of going to college if I'm not going to be able to get a job?" A lot of times when you get frustrated, you do things that don't make a lot of sense. They have low self-esteem, and perhaps getting pregnant gives them a certain status. It's not a very wise way of looking at it. So until we solve some of these wider social problems such as employment, and giving people more hope when they're young. It's going to take a lot of networking together to get this generation straightened out. Hopefully there are some bright spots on the horizon, but it's going to be a while before the health status of black is on par with whites. It's going to have to come from within the black race itself. It takes a while when you've been pressed down to rise back up, even when the pressure's no longer there.

Things like sports have a great impact, but sometimes it gets overplayed. There's nothing wrong with basketball and football stars, but the average student can't be that. We need to learn to aim at something that's just as important, but maybe not as visible. I think that falls back on the parents.

KAREN KRUSE THOMAS:

Do you think that the institutions that used to encourage blacks to solve these problems, like the black churches and schools

---

Page 26

and hospitals, even thought they were the results of segregation, they were resources and sources of strength. Do you think that has changed now?

JAMES SLADE:

One of the sad things that's happened in integrated schools is that a lot of black leaders fell by the wayside and got pushed out of the system. It's just a fact of life that to some degree, you tend to relate to people who look more like you. When you go to a convention, you find the ladies go where the other ladies are, and the men bunch together. The same thing with race, maybe not quite as much. If the black students only see white leaders in positions of importance, they won't aspire to that type of position, because they don't have a role model. Overall, integration was good and gave us a lot of advantages, but somewhere along the line, we lost some of the things that segregation did offer, and how to implement them into the system. Historically black colleges are still needed, because it's hard to take a predominantly white institution, and get enough black role models in important places to make a real difference. The white professor of English doesn't want to give up his job, if he's been there 15 or 20 years, so that the black students can have a role model in the English department. In the predominantly black school, he has that. But if you had enough role models, at least percentage wise, that would inspire the students.

KAREN KRUSE THOMAS:

I just couldn't understand, at first, how there could be three black doctors in Wilson in the '50s, and none left by the late '70s.

CATHERINE SLADE:

I think they're interested in going someplace else, particularly the younger ones. They find out what the rest of the world is like, and they can go.

JAMES SLADE:

That's what integration has made it possible for them to do.

CATHERINE SLADE:

After they've gotten educated, they find out that it's not as much race as whether you can afford it. So they're freer to go places.

JAMES SLADE:

A lot of times, even non-white doctors come to Edenton not for the love of their heart, but because the hospital's going to guarantee them a certain salary. And the water and the lifestyle. If they had to open their office and make their money day by day without any guarantee, they wouldn't be here. And with managed care, it's going to be very difficult for doctors to go into private practice. Hospital are eagerly buying up practices. Doctors can get rid of the overhead, since the hospitals assume all that.

CATHERINE SLADE:

They can have time off, because the hospital takes care of that. There are advantages.

JAMES SLADE:

The disadvantage is, if your performance is not what they want, they can let you off. In your own office, nobody's going to fire you, but nobody's going to hire you, either. But Chowan County is unusual, to find a town this size with the health facilities that we have.

KAREN KRUSE THOMAS:

Can you think of things that have made health care in northeastern North Carolina different than in other parts of the state?

[TAPE 2, SIDE B]

[START OF TAPE 2, SIDE B]

JAMES SLADE:

For some reason, the history of Edenton has been a little bit more progressive. The country started in the east, and this was one of the first areas that was settled. The people who started these areas weren't poor, and took pride in their architecture. A lot of these doctors, not necessarily black ones, built these tremendous homes. A lot of the people were willing to put their money into structures that could be seen. This idea of bigness being a sign of progressiveness has spilled over into health care, and pride is a part of it, too. They feel they're just as important as any other area, especially in Edenton. One of the signers of the Declaration of Independence came from here, and the ladies in Edenton had tea parties, just like in Boston. This sort of thing has been passed down. Edenton was the capital of North Carolina at one time. They pride themselves in their preservation of history.

KAREN KRUSE THOMAS:

It sounds like Chowan County is atypical of eastern North Carolina in a lot of ways.

JAMES SLADE:

Yeah, it is. There have been a fair number of people who were pretty rich years back.

KAREN KRUSE THOMAS:

I've been to the area around Wilson, and just to look at Edenton, it looks like there's more wealth here than in other parts of eastern North Carolina.

JAMES SLADE:

These people formed their own historical societies. At least in the predominantly white community, there's some money. The farmers are pretty well to do.

KAREN KRUSE THOMAS:

A lot of people have said there's been a crisis in agriculture, and that spilled over into more health problems, especially with migrant workers.

JAMES SLADE:

Edenton has been spared a lot of the migrant workers. They're mostly in Perquimans County, and back in Pasquotank and Washington counties. There's a few in Chowan County, but not a lot. They harvest cabbage and potatoes mainly. The hospital board has a lot of people on it who are very influential in the community. They don't want to be on something that's a failure. So they tend to support progressive ideas, as long as the financial means are there. Once Chowan Hospital got out of the red, they've really been innovative.

CATHERINE SLADE:

Part of it is that the hospital has improved a lot and has met the standards, and it's not necessary to send a lot of the things that you used to send away. When we began practicing pediatrics, we were able to keep a lot of people here. Other doctors who had sent children away began to refer them to me, or would call me in to consult. This sort of thing builds up, and some of them learned to do it on their own.

CATHERINE SLADE:

We didn't have an internist.

JAMES SLADE:

Now it's pretty well financially stable. The retirement community is growing, and some blacks who had moved to New York are coming back here to retire. The fact that the hospital is here is a real bonus. When you've got money, you can grow. The hospital can offer specialists a good

---

Page 28

package, and once they're successful, they go on their own, and the hospital can hire someone else. We don't have a lot of infighting.

KAREN KRUSE THOMAS:

Has the hospital had a hard time recruiting physicians to come here? Because in Wilson, they told me that potential doctors said they didn't want to practice in their county because there were too many social problems.

JAMES SLADE:

Some physicians have decided not to stay. Nobody wants to work solo these days. We'd like to bring in a urologist, but no urologist wants to come in and work by himself. The hospital will pay a recruiting group $18,000 to look for a physician until they find one. The rationale is, if they get one physician in here, all he has to do is admit 20 patients, and you can hardly get out of the hospital for less than a thousand dollars, sometimes five or ten, depending on the condition, so the hospital gets its money back.

Even if you get a new physician in the same specialty, the ones that are here keep seeing patients, and the new one starts seeing patients. I'm sure if you had enough, you'd run out of patients, but it seems as if the more physicians you get, the more patients there are to be seen. If we were just depending on Chowan County, we'd probably be in serious trouble. But we draw from Tyrell, Washington, and even some from Perquimans, Pasquotank, Gates, and Bertie counties. Even though Bertie County is much larger and has had a hospital for longer than Chowan, their hospital has kind of gone down. Some of our physicians actually go over there to help them. If they have a serious case there, they'll bring it to Chowan Hospital. The physicians who come tend to stay, and attract new physicians. Since I've been in practice, I don't remember ever having a clash. There were two different groups, but one was too ambitious, and worked itself right on out of town. [Laughter] Got in trouble with Medicaid, so that took care of them. By and large, that was an aberration.

CATHERINE SLADE:

One thing you said about physicians in Wilson and social problems, it's so frequent on the news that you'll hear bad things that happen in Wilson. Edenton is a much smaller place, but other than the daycare scandal that was here, it doesn't seem like you really see us in the news all the time. But you really do hear Wilson.

KAREN KRUSE THOMAS:

Not just Wilson, but a lot of eastern North Carolina communities have problems with poverty, drug trafficking. I'm very interested in what has caused some of the problems, and possibly getting into public policy.

JAMES SLADE:

In Chowan County, there's cohesion among the various groups, and you don't see a lot of infighting. We just had our joint commission survey, and one of the things they commented on was how unusual it was for the chairman of the board and the county commissioner to come to some of the meetings to support the hospital.

KAREN KRUSE THOMAS:

And it's hard to know what fosters that, what makes one community cohesive, and another have a lot of infighting.

JAMES SLADE:

When they had the daycare episode in the '80s, it split the community. But last year a team from Oprah called my office and said they

---

Page 29

wanted to interview me. They came down, and the whole community was interested in Oprah coming to Edenton. It didn't make any difference that they were interviewing a black physician. When they decided to put it on TV, the whole town wanted to know when it was going to be on. That brought the community together.

KAREN KRUSE THOMAS:

What did she interview you about?

JAMES SLADE:

I work with the migrant clinic, and the lady who's head of Rural Health in Raleigh came down to the clinic in Plymouth on a Wednesday night, and then came again to the one in Elizabeth City on Thursday, and she evidently was impressed that I worked both clinics. I think she must have told the Raleigh News and Observer that they should interview me for Tarheel of the Week, I think it was in the November 19 issue. Oprah's people picked that up, and wanted to have me on the show. At the time, Mrs. Clinton had written the book It Takes a Village, and were going to have her on the show, with people who had made a difference in the community, especially with children. I thought my nurse was kidding me when she said Oprah was on the phone. So they filmed me driving my old car to the nursing home and the hospital. Then they invited us to Chicago for the show. I got a lot of complimentary letters from the mayor and different people. That set a good tone for Edenton, especially after the other episode. They thought national recognition was positive. And it didn't make any difference that I was black, they were just glad that somebody from Edenton was represented in a good light. They interviewed people at the hospital, so they got to be a part of it, and some of them got to be on TV.

That's one thing that integration has done, to remove barriers where people can come together. One of the ladies who's head of the clinic at the hospital is black, and they sent her to school to become an LPN. She used to work the emergency room, and now she's head of a clinic. That probably wouldn't have happened if it hadn't been for integration. Overall, it's been more positive than negative.

CATHERINE SLADE:

We're not trying to convince you that things are perfect!

JAMES SLADE:

No, but at least in terms of health care, we offer a lot to the people of the area that they weren't getting 30 or 40 years ago. The thing we have to be careful about now, we're thinking about affiliating with Pitt, so we can't be pushed aside by managed care. That's still in discussion. As long as Medicare and Medicaid didn't go to managed care, we might be able to survive, but if they do, we need to be in on whatever network will maintain our base. If our patients get sent somewhere else, we'll be in trouble.

KAREN KRUSE THOMAS:

When you say that things aren't perfect, what are some of the biggest problems remaining for black health?

JAMES SLADE:

It's getting better in the area of housing, if you have the money you can pretty much live anywhere, but it could certainly be improved. Can you think of any other areas?

CATHERINE SLADE:

I think in hospital personnel, as you said about black role models, that there could be improvement in seeing more blacks in administration and supervisory positions.

JAMES SLADE:

I don't know if they're not applying, or if they're applying and not being accepted. I think that ten years down the road, we'll see improvements. Some of the young people are quietly going about getting their training, and we don't necessarily know about them. I had to speak at the school on medicine, and at least one lady came up and said she wanted to be a pediatrician. It's important for some blacks to remain in roles where they're visible enough to be seen by the young people. If not, they won't have the drive to get into those positions. It's especially important in schools, where the children spend so much of their time. We have a black principal here now, but when I was coming along, the students were separated, and naturally, the head of the school was black. For a while, that vanished, and a lot of the teachers vanished, but now they're beginning to come back. Where blacks had their role models, they suddenly got diluted.

We do have black physicians in the ER, but they're short termers. We could certainly use more. We had one apply for internal medicine, but the internist here at the time wasn't sure he wanted a partner, and he didn't want to go into practice by himself.

CATHERINE SLADE:

Another thing that I think is important is not letting blacks be figureheads. If you're going to put them in a position, let them have the same privileges and rights as that position has stood for in the past.

JAMES SLADE:

I think a lot of times, you've got to get to know an individual before you can trust them. That's one of the main things that segregation did, it kept you from ever getting to know the person. You might know what somebody told you about the race, and then you ascribe the same qualities to everyone in the race, since you didn't know any of them. That's detrimental. If I had to say, let's have it like it was with segregation, or let's have it like it is with integration, I'd say let's have it like it is, and let's try to improve it. I can tell you, it's no fun driving up and down the highway for 800 miles without anywhere to sleep. We went through that when I was in the army. I remember one night, we went through Mississippi, and that was one state I wasn't interested in staying in, period. We saw this one sign that said, "Colored Motel." And we pulled in, because you didn't see many colored motels, and you couldn't stay anyplace else.

KAREN KRUSE THOMAS:

I don't know of anybody who would actually say, let's go back to segregation. But I think some people have started to say, we made these changes and expected certain results, and in some ways, we haven't gotten them yet. And I think health is one of those areas.

JAMES SLADE:

People are slow to change. You can put a person in a position, but unless people have confidence in the person, they're not going to fully trust him. When I first came to town, some of the doctors didn't refer [patients to me], and some of them were brave enough to refer. The ones who referred, and the patients didn't die, then the other ones got up enough courage to refer. It's an ongoing thing. You could bring the best pediatrician in the country to town, but it's going to be a while before people have enough confidence to refer patients to him. And that's not necessarily based on race.

CATHERINE SLADE:

But don't you think that at that time, it was a lot worse.

JAMES SLADE:

They probably would have referred to a white physician, and would also have tried to get him in their group. But if he had preferred to stay out of the group, I'm not sure how many referrals there would have been. You always have to remember that bottom line's important!

CATHERINE SLADE:

We say sometimes, they found out we won't bite. [Laughter]

JAMES SLADE:

I still don't get a lot of referrals. There are two reasons for that. A lot of the fellows coming out of school now are better trained. They offer more at places like Greenville. Take diabetes. When you get a severe diabetic, you send them to a diabetologist. I hadn't ever heard of no diabetologist then. If I get a patient with diabetes, I go ahead and treat them. But some of these fellows, if a patient comes in in a coma, they're ready to ship them to Greenville. When I had that situation, I'd treat them locally. But they're trained to send them out, so naturally, they're not going to ask me to treat them locally, when there's a diabetologist in Greenville that they've been used to referring to in their training program. It seems strange to me, though, to send a child to Greenville to be treated for diabetes. In medicine, your biggest source of referrals is your patients. If you've helped someone, they'll tell someone else. So these guys are better trained. In a three-year residency, they may spend two years in pediatrics, so they learn a lot. Some of the things they're learning now might be more than I learned in my whole residency. The late '60s was when pediatrics began to blossom, with new techniques. But there are those patients who have the confidence that they still want to see a pediatrician, so I'm still seeing new patients.

KAREN KRUSE THOMAS:

You've been really informative, and I really appreciate your time. Was there anything else you wanted to add?