GREENVILLE - No one envisioned a sprawling medical center in Greenville when East Carolina University began its quest for a medical school 40 years ago.

Back then, Greenville was a quiet college town with a booming tobacco market and a small county hospital. Local doctors took turns working nights to make sure someone was on call at the emergency room.

But through the years, the medical school has transformed Pitt County Memorial Hospital and the surrounding area. Not only did the school boost health care in Greenville -- now there are about 500 doctors and 1,200 nurses on the hospital staff alone -- but it also fostered a far-reaching regional health care system serving 1.2 million people in 29 counties.

Once the focus of long-running opposition from the state's higher education and medical establishment, the school is now benefitting from cooperation between former rivals ECU and UNC-Chapel Hill that is fueling even more growth in Greenville, state and local officials say.

With tobacco's decline and the slow extinction of small-town hospitals, this latest development boom underscores the medical complex's role as both a primary economic engine and the prime source of high-end medical care for rural counties that are hard-pressed to attract and keep doctors, particularly specialists.

"If you took East Carolina University -- and especially the medical school -- out of the east we would look like a developing nation," said former U.S. Sen. Robert Morgan, an ECU graduate and longtime political supporter.

The medical complex on the west side of the city is already a bustling mix of university facilities and those of Pitt County Memorial Hospital, a 761-bed facility that is the university's main teaching hospital. Towering nearby is ECU's Brody Medical Sciences Building.

Joining the skyline is a six-story, $150 million tower, part of the new East Carolina Heart Institute, which will soon add 120 more beds. A separate four-story building behind the hospital will house offices and labs for cardiologists, surgeons and scientists as well as outpatient clinics. And nearby, construction is just getting under way on ECU's new dental school.

The scope of facilities and services surprises even the most ardent ECU supporters. They sought a medical school simply to boost the number of doctors in rural communities. Instead, the hospital has become one of the area's largest employers, with 6,300 employees and an annual payroll of $344 million.

The hospital has grown from a building worth $12 million in the mid-1970s to an $800 million facility with $600 million in expansion projects planned. About 33,000 patients are admitted annually, and the hospital serves about 266,000 outpatients. More than 3,000 babies are born at Pitt each year.

Bitter fight for respect

Morgan, then a state senator, was on the front lines in the early legislative struggles of the 1960s, when ECU sought approval for a medical school. The idea was widely regarded as a pipe dream by an upstart teacher training school.

Opposition was formidable. Officials and supporters of the existing state-supported medical school at the UNC-CH argued that it would be better to expand UNC or private medical schools. Others wanted a medical school in Charlotte. Critics charged that a new school would be unnecessary and expensive.

Study commissions agreed with critics. Major state newspapers, including The News & Observer and Charlotte Observer, weighed in with editorials and cartoons opposing the new school. Much of this criticism targeted the late Leo Jenkins, the feisty ex-Marine who led ECU for 18 years.

"It was bitter," recalled Dr. Edwin Monroe of Greenville, a retired ECU vice chancellor.

Monroe, who was a physician in Greenville before joining the school in 1968, said he entered the fray because not enough was being done for underserved areas, including Eastern North Carolina. Others offered counterproposals after ECU began pushing, he said.

But partisans and politicians, tapping regional pride and resentment against rival schools, built a coalition that prevailed by the 1970s. The legislature authorized a medical school as well as other programs aimed at the physician shortage. The first four-year class of 28 students enrolled in 1977. ECU was graduating physicians by 1981.

Rivalry subdued

Despite a history of rivalry, officials at ECU and UNC-CH say they are now working together on projects to improve health care, especially in rural areas. ECU is building a new dental school while UNC expands its existing dental school.

In December, officials of ECU's Brody School of Medicine and its Leo W. Jenkins Cancer Center, UNC-CH and its Lineberger Comprehensive Cancer Center in Chapel Hill, and the UNC system signed a memorandum of understanding to work together on cancer care.

The schools are even working together on medical school expansion. The UNC Board of Governors earlier this month endorsed a $450 million plan to expand medical education at the state's two public medical schools.

House Speaker Joe Hackney of Chapel Hill, who attended the groundbreaking for the ECU Dental School last month, said ECU receives widespread support because of its accomplishments.

"The folks across the state have paid attention to what the Brody School of Medicine has done," he said.

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