Time Lines: Progressive Leaps and Bounds
The past history of the Prince Albert Community Clinic is endowed with dedicated efforts of people of Prince Albert and area people who believed in practical and desirable methods of providing health services. Among the archives of the Health Center are Board minutes, letters, personal notes and newspaper clippings that enrich the story of the center from its beginning to the present day.
During the provincial Medicare Dispute, on June 2nd, 1962, the vision began with a Health Association incorporated under the Co-operative Act of Saskatchewan.
The Holmes Block, corner of 8th St. and 2nd Ave, Prince Albert was renovated to house four doctors. Patient services began on July 3rd, 1962. Dr. Orville Hjertaas and Dr. Allen Adelman provided services. The first patient was Mr. Fayerman Sr. Assisting the physicians was Vera LeDrew R.N. who stayed with the center for 14 years.
Officially on July 24, 1962 the Medicare dispute was settled.
By the fall of 1962, the center had a staff of ten. One member of the staff was a Registered Nurse/Social worker, Jeanette Mossing. In one of her reports she wrote ‘’ In the concept of health care today, we consider the whole person. Therefore, not only is the best medical care essential, But assistance with other emotional, mental social, and economic factors which also may have a bearing on a person’s health must be considered’’. In 1963, Miss. Mossing had 2050 patient visits. It is safe to say the center was the first in Prince Albert and possibly Canada to provide the services of a Clinic Case Worker in a physician office setting. This was an indication of the direction the center would be taking in providing health care services and is evident in the center 50 years later.
The 1963 and 1964 years were a flurry of activity. The bigger vision was unfolding as excavations began at 110 8th St. East and the newly named Prince Albert Co-operative Health Center was coming into being. Officially the opening of the center was June 20th, 1964.
The archives provided the trivia information that the secretaries made the grand sum of $150.00 a month, the parking spots were $3.00 per month and the first personnel policies were drafted.
In November of 1964, Canwood Clinic opened with Dr. Ed Blenkinsop. This dedicated physician served the community with medical and pharmaceutical care for forty years until his retirement in 1994.
By May of 1965 there were thirteen Co-operative Health Centres in Saskatchewan. Unfortunately, the first facility closure occurred in December of 1965. This trend continued until in 2012 there are only four centers who continue to provide services.
Committed to the enhancement of services, in 1965 the first Visioning Workshop was held with the Board, Physicians and Staff attending. These Visioning Workshops have continued over the years bringing forth many new ideas on ways and methods of enhancing the delivery of health care dependent on the perceived needs and wants of the community and center members. The first workshop led to the organization of an Education Committee and a Ladies Auxiliary. Founding members of the Ladies Auxiliary were Mrs. mary MacDonald, Mrs. Thompson, Mrs. Kulik, Mrs. Apps, and Mrs. Bell. The Auxiliary has evolved into our present day Co-operative Health Center Volunteers. Over the years they have financially and physically supported and enhanced many programs at the center.
A center Newsletter was first published in 1970, edited by Joan Parker and Dale Stanley. Forty years later, this publication continues.
Education and user involvement have always been an important function of the center. In 1971, a’’ Symposium on Health Care’’ was presented, a public forum in 1973 “ Meeting Community Health Needs of the Elderly, Low Income and Young’’. In 1987 there was a public forum on Medicare and a conference on Health Care. In 1991 A wellness conference ‘‘Mind, Body and Spirit ‘’, and in 1992 a ‘’ Task Force on Family Violence ‘’.
Center staff organized and presented many workshops over the years. A few of these were: Diabetic Education for Children, Program of Food Costing, Nutritional Counseling for Overweight, Smoking Cessation, Breast Self Examination, Life and Fitness Evaluation, Body Image, Anger Management, Assertiveness Classes for Women, Eating Disorders, Farm Stress for Women, Relaxation Techniques, Endometriosis, Children’s Health Fair, Teen Health Fair, Emotional Abuse, Arthritis Classes. These are but a few workshops that have been held over the years. As community needs are assessed, more workshops are organized and presented.
Not to be left out are the support groups that were presented initially at the center : Prenatal Classes for Unwed Mothers, Parents without Partners,
Compassionate Friends, Chronic Fatigue, Alzheimer’s, Concerns for Employee Rights, Families of Homosexuals are a few of the groups.
Expansion had always been a part of the vision and in 1968 a second story was completed. Ten years later, in October of 1978, a third expansion occurred adding another ground level and basement area. Interior redesigning and reassigning space has continued in the ensuing years as new programs and needs are recognized and implemented.
In 1973, recognizing the problems of transportation for those in need,
the physicians purchased the first van for the center. in 1974 the van was equipped to enable wheelchair accessibility. In subsequent years, when van replacement was required, the Volunteers have diligently raised the funding necessary. The provision of Center owned transport for medical care, at no cost to the user, is also a first in the province.
There were many ‘‘firsts’’ that the center can take pride in. In 1973, an outreach program with a surgical nurse at Waskesiu National Park for the summer months. In 1990 the beginning of the Native Community Health Worker Program. The Iskwew program ( Women Helping Women) , a support program for abused women. Affirmative Action/Employment Equity Program , the first health care setting plan developed in Saskatchewan.
In 1972, when Global Budgeting method of payment was introduced by the Government, the center was chosen for the trial.
In the fifty years the Co-operative Health Center has been in existence there have been many changes to the physical building and to the staff who provide services. From manual to electric typewriters in 1974 to computers in 1988, the center has continued to be in the forefront of changing needs to provide optimum care. The Health Center will continue in providing high quality care in partnership with the community respecting the Vision, Values and Mission they have embraced for fifty years.
Retirement Report to Board: O.K.Hjertaas
The Prince Albert Co-operative Health Centre is now 20 years old. It came into being as a direct result of the struggle to introduce Medicare in Saskatchewan and Canada. Once that goal was achieved, it widened its efforts to attempt to deliver more health positive services in the community, and to promote more patient interest and responsibility in their own health care. These latter objectives have by no means been achieved.
Much of the early history of our Center has already been lost,. It is probably appropriate that, as I come to retirement, I should try to set down in print some of my experiences and memories, as one who had an intimate role in the life to date of our Center.
I was born, without benefit of medical help, on a farm near Wauchope, Saskatchewan in 1917. Neighborliness and co-operation were the accepted ways of life, and permitted us to survive the drought and depression of the 1930’s. How my parents found the money to send me to University is still a mystery. Janitor work in the university buildings, summer employment at the University, plus some small scholarships helped to complete the student years.
Just as I graduated in medicine, and my wife-to-be graduated in nursing, she postponed our marriage for a year by developing tuberculosis, and going to Ninette Sanatorium. Exactly a week before our next attempt at marriage, it was my turn to go. I went as a patient to Ft Qu’Appelle Sanatorium for a year. The absolutely free, and excellent care, that we received at Taxpayers’ expense, probably saved our lives, and undoubtedly influenced our future thinking about how health care should be delivered.
I came to Prince Albert in 1946 as a founding member of the Prince Albert Clinic, and worked that group for 16 years. In those early years, before roads were good and before cars were universal, we attempted to take our medical services to the rural people. To that end, I travelled each week, for ten or more years, to the villages of Debden and Canwood.
The friendships that resulted among these rural patients, so like farm neighbors at Wauchope, have enriched my life and endure to this day. They also led eventually to the formation of a Community Clinic in Canwood.
The hysterical reaction of the Saskatchewan medical profession of that day, to the introduction of provincial medicare, infected my partners. When I refused to go on strike, or to absent myself from the City for the duration of the strike, that partnership dissolved. It became apparent that when all the medical offices in Saskatchewan locked their doors on July 1, 1962 the only doctor in Prince Albert who was not on strike would be without an office in which to practice. A group of interested citizens and patients, including Mrs. Mary MacDonald, and Mr. Ted Bowerman, conceived the idea of a Community Clinic and asked me to participate. We evolved the idea of a co-operatively owned facility that would provide office space, lab facilities and all the equipment, etc., that a group of doctors would need to deliver services. We agreed that in return for the use of these facilities, we the doctor-providers of service, would enter into a partnership with the consumer-patients and owners of the facility – to the end that their health care needs would be met within the spirit of the new Saskatchewan Medicare Act. The doctors, in theory, could bring to the Clinic their medical skills without the necessity of heavy financial outlays or commitments. A board reflecting this partnership was established.
The consumer representation on the board has always provided a deep interest and involvement in health positive and preventative programs for our patients. Our doctors, basically trained in curative medicine, have had difficulty in understanding the consumer interest in the various preventive and health positive programs we have proposed. Our provincial government has been even more reluctant to lend such support. The names of the people who had the vision and the pioneering spirit to act on the first, the provisional, board of our Clinic were as follows:
• George R. Bowerman
• Neil McLeod
• Glen Thompson
• Mary MacDonald
• Jean Yockey
• Harry Apps
The Prince Albert Community Clinic opened its doors on July2, 1962 at 101-8th Street East. Volunteers, carpenters and television crews from all over North America mingled with the patients as we struggled to meet the needs of the rush of humanity. We were fortunate to have a Dr. Harold Wise from the Kaiser Hospital System in California – (later to head up a huge health care system in New York City), and a Dr. Allan Adelman, later to become Associate Professor in Medicine at University of Toronto, came out to join me and help get the Clinic going.
The Saskatchewan hospitals, public and private, aided and abetted the provincial medical profession during the strike. For example, a doctor from Town A would be shifted to Town B, and be given instant hospital privileges. A doctor from Town B would be sent to Town C, etc., etc. This game of shuffle worked to our advantage in that both Dr. Wise and Dr. Adelman obtained immediate full hospital privileges. Within a week or two , however, the local medical profession, even though they had withdrawn their services, had met in a downtown doctor’s office, and again changed the hospital rules. The local hospital boards slavishly enforced them. Now a new doctor wishing to give services in Prince Albert had to appear before a Credentials Committee of doctors (who had withdrawn their services), and produce acceptable letters of reference to obtain even the most limited privileges. No longer was it accepted that my personal assumption of full responsibility was sufficient to secure hospital privileges for new doctors joining our staff. The medical opposition – at their convenience – decided when our new doctors would be supervised and observed, and what hospital privileges they would be given. For many years after the strike, the opposition doctors of this City were still allowed, by the local hospital boards, to change and enforce hospital privilege rules in such a way as to obstruct and delay our Clinic’s ability to meet the health needs of our patients. To this day I do not know how our patients had the courage and the faith to stay with us in the face of these attempts to discredit our abilities. The rules, and regulations and bylaws of the hospitals, that were applied to our early doctors, were not put into print till years after the strike was over.
In addition, a determined effort was made to remove my hospital privileges. On two different occasions, I received, by special delivery, at about 2 o’clock in the afternoon, letters from the Victoria Union Hospital, ordering me to appear that same evening at 7:00 p.m. before special committees in the hospital board room, to show cause why my hospital privileges should not be removed.
The first evening I appeared with my lawyer, his assistant and her tape -recorder, plus Mr. W. Berezowsky, M.L.A. and hospital board member. The doctors ordered them all out of the room, and when they refused to leave – the doctors left. On the second occasion, only my lawyer accompanied me. He advised the committee doctors of the letter of the law, and they left. One of my most bitter memories of the entire strike, and the early years that followed, was the role the Prince Albert hospitals played.
When i think back to those terrible days in July 1962, I am still nearly overwhelmed. If the local profession had succeed in driving me out, The health Center would have failed, but also you can imagine the difficulties that I would have had, to ever again obtain hospital privileges anywhere in Canada or the United States. To this day I believe that my medical life was at stake in that struggle.
I want to tell you one more story to try to illustrate just how ridiculously supposed adults can behave. I had two ladies admitted to hospital with miscarriages. Both were bleeding. Both needed to be scraped. I had no anesthetist, and no other doctor in the City would give an anesthetic for me. I therefore turned these ladies over to the doctors’ emergency committee.
Their emergency doctor, a different one each day, visited these ladies, but refused to operate. I, of course, clandestinely checked each day to see how they were doing. One evening I found one of the husbands sitting by his wife’s bedside with tears streaming down his face. His wife was continuing to bleed day after day. The nurse was not allowed to tell him the name of the emergency doctor for the day. Nothing was being done. The next day, a Saturday, an anesthetist arrived to join our group. Very early on Sunday morning these two ladies transferred themselves back from the emergency service, to my care. We took them to the operating room, and with Ted Bowerman, a big man by any measurement, patrolling the corridor outside the operating room, we did the necessary surgery, and both ladies did very well. Only in retrospect can we see the immature humor of the entire episode. At the time, the situation for all of us, especially the two ladies, was deadly serious.
A doctors’ strike is not a pleasant thing. The public is rarely, if ever, aware of the pressures that can be applied to any doctor who openly fails to agree with his medical colleagues. The pressure that can be applied to ill patients is also horrendous, whether that illness be physical, as for example miscarriage bleeding, or emotional, such as the threat of a withdrawal of services.
If the political opposition, the Chambers of Commerce and their mouthpieces, the press and the electronics media, add their forces, a good deal of pressure instead can be built up.
It is my personal opinion that the Saskatchewan medical profession allowed itself and its members, to be used by the political and mercenary reactionary forces of that day. This did not make the battle any less vicious or bitter. One of the most evil parts of the doctors’ strike was the emotional torture inflicted on our five children, all of who were in either the local public school or high school systems. On my behalf they were subjected to vicious abuse, called dirty scabs and communists and worse. My wife had phone calls threatening the safety of our children. To this day some of my children refuse to talk of anything to do with medicare.
At the Clinic, however, the work load was overwhelming. A constant rush of patients always needed help and care. I made two trips to England to recruit more doctors. These newcomers were regularly given firm lectures on how the Saskatchewan Medical Association viewed our Clinic when they applied for their licenses to practice. Once they arrived in Prince Albert the local profession took further delight in telling them tales about our’’Communist Clinic’’ and the third rate association into which they had unfortunately been ‘conned’. A number of doctors were unable to withstand this pressure, and left. Some promising, young, and well qualified Canadian graduates were also persuaded to change their minds and withdrew their applications to work with us.
By 1963 our work load was crowding us out of our original space. We purchased the land at the present site, and arranged a sod turning ceremony. On the appointed day we found all our billboard signs defaced and mutilated.
Construction proceeded. In 1964, the first level and basement of the east portion were completed and opened. In 1967, the top floor of that portion was added. In 1979, the west extension of our Clinic was opened.
I believe that our doctors and staff, working in our excellent facilities, have always provided curative services second to none for the patients coming to our doors. Let me try to tell something of our struggles in the preventive and health positive fields. As early as 1962, 1% of the net earnings of the Clinic was earmarked ‘’for medical education, local research, and the provision of those services designed to actively promote good health”. We hired our first nurse case worker, Miss Jeanette Mossing, in September 1962. She was with us for at least three years. During these same early years we were able to experience the benefits of having a dietitian on our staff when we hired a broken-hearted girl who managed to recover her own health through helping our patients with their nutritional needs.
For the first 10 years of our existence the entire income of the Clinic was the fee-for-service earnings of our doctors. Every patient that our nurse case worker, and our dietitian, kept away from our doctors, reduced our income. When we then also had to pay their salaries – insult was added to injury. The fact that the Health Centre had no income other than the doctors’ fee-for-service earnings, permitted the providers of service to exercise a rather overwhelming influence in the partnership between providers and consumers. Preventive programs, as a result, have always been underfunded and under-emphasized.
In 1972 we entered into a global budget agreement with the government. We agreed that our doctors should be paid the provincial average of their professional peers, and that our staff should be paid at the same ratio as their hospital peers. I believe that this funding arrangement would permit our board to introduce a wide variety of preventive and health positive measures. I allowed myself to be misled by our government’s verbose propaganda about their interest in, and support for, preventive health care. In addition, I naively believed our government’s statements about decentralizing control over the delivery of health services. In my opinion, subsequent events have proved I could not have been more wrong. Ever since going on global budget, our board has begged and struggled and fought for money to institute and support health positive programs. If I can borrow a few words from Murray Dobbins’ book, I believe that our N.D.P. government has inherited from the C.C.F. the “boundless self-righteousness”, and the “paternalistic refusal to listen to the people or believe them capable of progress”.
Our Community Clinic is the only clinic in Prince Albert that must obtain permission from the government to hire an additional doctor. The Minister explained to me that he is responsible for us, but that the other Prince Albert clinics are free enterprisers, and beyond his control. Try as I might, I am unable to see the logic of this bureaucratic flatulence.
Despite lack of government support, a certain amount of progress has been made. We managed to retain and even expand our nursing services in the community. Thousands of hospital bed days have been saved. Many patients have been permitted to live out their days in the familiar and loved settings of their own homes. Our doctors and clients alike have come to depend on their family health worker service.
Our experience with a social worker – a program that had great success at the Saskatoon Clinic – failed here in Prince Albert. We then sought assistance in developing health positive programs for our patients and members, and hired Mr. John Hewitt as a Program Development Officer. This proved an excellent choice. With the aid of a Program Development Committee of staff and users, a statement of philosophy was drafted as follows:
“We believe that good health is not only the absence of
disease or infirmity, but also a state of complete physical,
emotional, social and spiritual well-being.”
and we set ourselves the following objectives:
1. To provide quality health services in keeping with our health philosophy.
2. To promote health care that is responsive to human needs.
3. To promote health education directed toward adopting good health practices.
4. To promote and maintain independence with dignity.
5. To provide access to health and social services operating in the community.
6. To commit ourselves to work with other community resources in providing good health.
7. To be involved with health research at the local level.
Down through the years, the Program Development Officer, and this committee have been able to stimulate, assist and participate in many health positive projects.
Our Health Centre volunteers are an outstanding example. In our early years the Federal government assisted with funding to hire a Volunteers Co-ordinator for a demonstration project. While we had a co-ordinator, our volunteers regularly provided annually 15,000 hours of free labour to make possible some fifty to sixty thousand hours of health positive recreational activity for our senior and handicapped patients. As a sideline they have raised over $65,000 to buy medical equipment for the Centre, and have thus helped alleviate our chronic underfunding from Regina. Even the co-ordinator position is no longer funded, and of course the volunteers program is suffering and failing to achieve its potential.
Our Program Development Committee has been able to get Federal funding to run research summer programs to help us define, and meet, the health needs of our elderly.
In the community we have been able to participate in, and stimulate, such heath positive projects as “TRAC” which, amongst man other things, has brought the S.C.C.C.A, buses for the handicapped to Prince Albert. We have been involved in the Mobile Crisis Unit, the Cancer Support Group, and the P.A. Council on Alcohol and Drug Abuse, where once again John Hewitt was instrumental in obtaining Federal funding. When John Hewitt left for Winnipeg we advertised for a new Program Development Officer. All of our staff had the opportunity to apply. As I look back at the tremendous and demanding work load of this position, I think the board was fortunate indeed, in selecting from the many applicants, Mrs. Thora Wiggens. Her devotion, determination and hard work have contributed in no small way to our health positive progress.
At present we are operating physical fitness classes for the elderly and teaching cardiopulmonary resuscitation. One of our greatest needs is for a full-time health educator, to teach our diabetics how to cope, to teach our hypertensives, our arthritics, our cardiac cases, etc., etc., how to live with their diseases, and how to prevent further illness. We simply are not doing anything approaching an adequate job in either preventing illness or promoting health. Our problem is lack of funds, and an inability to convince government of the obvious support for, and merit of, our preventive health programs.
For many years it has been my practice to ask the computer in Regina to supply me with the figures for our total patient load, our total hospital admissions, and our total hospital days. From the annual Medicare Reports, and the Saskatchewan Hospital Services Plan reports, I can get total costs, etc. The comparisons are quite interesting. For example, in 1980 we attended 18,578 different patients at our Health Centre. From the annual reports we know that the provincial average medicare cost per patient was $111.32. The average hospital cost per patient was $419.20. The average 18,578 patients therefore cost the government $9,856,000.
In actual fact our total clinic budget in 1980 was $2,195,011. Our total Prince Albert hospital costs for our patients was $2,370 361.80 so our total costs were $4,569,372. The cost to our government and the provincial taxpayers for the health services that we provide here in Prince Albert to our 18, 578 patients was $5,286 257.00 less than the average Saskatchewan cost. In spite of this, our clinic is chronically underfunded. And we have to get permission from Regina to hire each additional doctor. The late, great Jim Brady, patient, philosopher and Indian-Metis leader expresses my thoughts when he said:
“No political party in the history of Canada has been so vicious to
its friends and so kind to its enemies.”
In the narrative, my own memories and emotions have tended to exaggerate by role. I want the board to know that from Day One until 1972, when our survival was under constant threat, it was the staff who came with me and who, equally with me pioneered in this venture, that made the clinic run efficiently and effectively. i think they may often have worried about where we were going, and whether we could survive, Mrs. Fran Mackie and Mr. Ed Emms are still with us. Corre Barentson we lost, to my deepest sorrow. Joanne Christiansen and Shirley Carson married and left. The faith, and the loyalty, and the friendship of these people has contributed greatly to the stability and success of this Center. When our new building was erected, our man of all trades, Steve Blocka, joined us. No clinic has ever been blessed with a better or more faithful employee and friend. It would be impossible for me to pay tribute to all of the staff who have worked with us in the past twenty years. Suffice it is to say that I believe that no one has been favored by a better staff than I.
Many doctors have come and gone. I mentioned Dr. Adelman and Dr. Wise, who managed to keep me nearly sane in 1962. Of our present doctors, Dr. H. A. Martinson, Dr. E. I. Blenkinsop, Dr. D. B. Wilkinson and Dr. G. Z. Shenouda came in 1964. Dr. S.A. Shukoor came in 1966.
Dr. A. R. Zaidan came in 1969. Dr. D.M.Bekolay came in 1970.
Dr.M.D.G. Thomasse came in 1972. Dr. D. G. Junor and Dr. D. J. Crawford came in 1973. Dr. B.R.W. Vickers came in 1975. Dr.B.J.Hookenson came in 1976. Dr. R. J. Unsworth came in 1977. Dr. Jack I.M. Urton came in 1978. Dr. F. B. DePadua and Dr. K. Lee came in 1981 and Dr. J.Cross came in 1982.
Now what of the future? The Provincial Health Regions have demonstrated what they can do to prevent illness. The Provincial Home Care Regions will undoubtedly make a great contribution in the future. But we have demonstrated the tremendous savings in hospital costs that a well organized and equipped ambulatory care center such as ours can achieve. Those of us who work here Know that we are just scratching the surface of our potential for prevention and health positive programs. I believe that an active, curative, ambulatory care center such as ours offers an ideal opportunity to devise and implement further preventative services. It is highly improbable that such programs could be introduced in a fee-for-service delivery system. Even in our salaried system the passive inertia of cure-trained physicians will have to be overcome just as it was with our family health worker service. There is now some indication that the Federal government may be interested in funding such new projects. Perhaps at some future date a provincial government may also become interested but the record makes this doubtful.
As I retire I want to express my most sincere thanks to all of the board members, past and present, who have given so generously of their time and talents in an effort to make our Center a success. I wish to thank many patients who gave me their trust, and loyalty through the years. By all of these my life has been greatly enriched.
April 14,1982 O.K.Hjertaas, M.D.
Duly transcribed verbatim from notes by Dr. O.K.Hjertaas