Re­mem­ber­ing Jack Crow­ley and the doc­tor’s com­mit­tee

Wil­liam O’Fla­herty writes about ef­forts to re­open the med­i­cal prac­tice on Con­cep­tion Bay’s north shore

The Compass - - OPINION - BY­WILLIAM O’FLA­HERTY

“B’y, if I wuz you, I wouldn’t be go­ing out there. They haven’t been able to keep a doc­tor in that place for years. There’s hardly a cent on the whole shore.”

Thus spoke one of the up­per crust mem­bers of the pro­vin­cial Dep­tart­ment of Health when I told him I was con­sid­er­ing go­ing to prac­tise in the Western Bay med­i­cal dis­trict. That area had been with­out a doc­tor for two years and more, in spite of the fact that there was a doc­tor’s res­i­dence and clinic there for a ridicu­lously low rental price, and a very needy pop­u­la­tion.

The of­fi­cial pub­lic pol­icy of the Health depart­ment at the time was one of good wishes and ver­bal en­cour­age­ment to­ward sup­ply­ing a physi­cian to the prac­tice, but in terms of con­crete ac­tion there was lit­tle or none. Af­ter all, there was a hos­pi­tal 20 miles down the shore in Old Per­li­can, and another one 20 miles up the shore in Car­bon­ear, so why bother a lot about that place in be­tween?

The prac­tice there had been rec­og­nized as a med­i­cal en­tity long be­fore the two hos­pi­tals ex­isted, ex­tend­ing as it did for a dis­tance of 20 miles all along the North Shore, from Spout Cove to Job’s Cove, a well-pop­u­lated re­gion of 12 com­mu­ni­ties, each one blend­ing ge­o­graph­i­cally into the other, and, at that time with a pop­u­la­tion grow­ing as the lo­cal fish­ery ex­panded into the har­vest­ing of species be­yond the tra­di­tional cod and salmon fish­ery.

Out­ports re­ceived crumbs

Many peo­ple there were un­happy with the lack of lo­cal med­i­cal care; Jack Crow­ley from Ochre Pit Cove was one of them. He was un­happy with the fact that the out­ports, like Western Bay, were get­ting the crumbs of the largesse meted out to the vast med­i­cal es­tab­lish­ment in St. John’s.

Dr. Wil­liam O’Fla­herty

He was a re­tired teacher who had spent his life teach­ing in out-of-the­way com­mu­ni­ties and was well ac­quainted with the bu­reau­cracy and shenani­gans of gov­ern­ment. He had long rec­og­nized that the “voice of the peo­ple” — as he called it — de­ter­mined the fate of those in gov­ern­ment, and when a ”Yes “was needed, he re­fused to ac­cept a “No” for an an­swer.

He or­ga­nized, or should I say, “res­ur­rected” a doc­tor’s com­mit­tee to can­vas the pop­u­lace to de­ter­mine if they were agree­able to fi­nance the ex­penses of the Western Bay med­i­cal prac­tice (it should be re­mem­bered that this time pe­riod was the mid 1960s and Cana­dian gov­ern­ment funded Medi­care was not yet a re­al­ity, but merely a con­cept in the mak­ing).

It soon be­came ap­par­ent, from the sur­vey con­ducted, that the peo­ple were, for the most part, in favour of fi­nan­cial sup­port for the re­open­ing of the clinic.

Mean­while, back in St. John’s, I ap­proached au­thor­i­ties at the higher ech­e­lon of the Dep­tart­ment of Health and stated, yet again, my in­ter­est in the po­si­tion in Western Bay. I met with the deputy min­is­ter, Dr. Leonard Miller, one of the stars of the Small­wood em­pire, a meet­ing that will rest in my mind for­ever. There he sat, be­hind a grand var­nished oak desk, look­ing crit­i­cally, at least ini­tially, down his well ap­pointed nose at the bay­man from Long Beach.

“You got more on your minds, I hear, out there,” he said, “be­sides cod traps and salmon nets; is that so, doc­tor?”

He con­cluded the state­ment with a bit of a smile, which was barely al­lowed to es­cape the dour look on his face.

I re­lated to the good man that the lo­cal peo­ple were will­ing to con­trib­ute funds to restart the clinic, and per­haps the depart­ment should con­sider match­ing them, dol­lar for dol­lar. Our meet­ing ended, with no agree­ment, but no dis­agree­ment ei­ther.

An im­pec­ca­ble char­ac­ter

Not long af­ter­wards — I have no doubt be­cause of ef­forts of Jack Crow­ley — a very en­cour­ag­ing let­ter was re­ceived and there was hope for a sat­is­fac­tory con­tract to re­open the clinic.

I signed the con­tract. It brought me back to my roots on the Shore, and away from St. John’s. Mind you, it had its re­stric­tive clauses, that agree­ment, no­tably this one: “The med­i­cal health of­fi­cer … shall not leave the area of his med­i­cal prac­tice dur­ing the pe­riod of this con­tract (one year), ex­cept … hav­ing ob­tained pre­vi­ous leave from the depart­ment …”

Back on the Shore, Jack Crow­ley and his com­mit­tee set to work. Each com­mu­nity had ap­pointed a mem­ber who col­lected $12 per fam­ily per year and $6 per year for sin­gle able bod­ied adults over 21. The pooled fund, han­dled by Mr. Crow­ley, a man of im­pec­ca­ble char­ac­ter, was the source of a monthly salary to me.

The clinic was far from ideal. In fact, it fit­ted the “bare bones” de­scrip­tion, con­sist­ing of a small wait­ing room and a “surgery,” as they called it in those days. There was no pro­vi­sion or room for sec­re­tar­ial help, no fil­ing cab­i­nets, and most of the med­i­cal in­stru­ments were seized up or rusted from long lack of use.

Alas, if my mem­ory serves me prop­erly, the only in­stru­ments that were in good con­di­tion were an ar­ray of den­tal for­ceps used for pulling teeth. Th­ese were of no use to me or to my pa­tients since I had had no den­tal train­ing (as did no mem­ber of my class) in my time at McGill.

The f irst cou­ple of monthly salaries, and be­yond, were used to pur­chase proper med­i­cal in­stru­ments and equip­ment; no help was forth­com­ing from the Depart­ment of Health.

A med­i­cal dilemma

The med­i­cal com­mit­tee had its rules and reg­u­la­tions bind­ing on me as well as on every­body else. Once the yearly fees were p a i d the fam­ily/per­son was con­sid­ered to be “on the books.” Only in the gravest emer­gency was I, the med­i­cal of­fi­cer, to treat any­body who was not on the books.

That rule, of course, left me with a dilemma, since de­nial of med­i­cal care based on in­abil­ity to pay is now un­eth­i­cal, and was just as un­eth­i­cal then. The rule was that, when con­fronted with a non-payer, I was sup­posed to col­lect the full yearly fee and de­liver same to the com­mit­tee. I found this sit­u­a­tion dif­fi­cult, in­deed un­ac­cept­able, es­pe­cially when con­fronted with an ill child whose par­ents were not on the books.

It boiled down, in the long run, that I never re­fused med­i­cal care to any­body based on in­abil­ity to pay, though I did, rarely, crit­i­cize an in­di­vid­ual for not pay­ing.

Most peo­ple were “on the books.” Some were not, and the rea­sons given for that state of af­fairs were le­gion. Most of the non-pay­ers sim­ply said that they couldn’t af­ford the cost; and in­deed, I feel, in many cases, that to be true. There were oth­ers who felt that, since they were on “wel­fare” the gov­ern­ment was re­spon­si­ble for their med­i­cal ex­penses. Af­ter all, their med­i­ca­tions were cov­ered by the “wel­fare depart­ment,” so why not this ex­pense as well?

One such in­di­vid­ual, he hav­ing been on wel­fare for years, stated he was “on the gov­ern­ment, all the way.” Another, a fit young man who worked on a trawler, came in with a se­vere strep­to­coc­cal sore throat. I noted that his fin­gers were brown from cig­a­rette smok­ing. As I wrote out a pre­scrip­tion for peni­cillin I asked him how come he could af­ford to smoke cig­a­rettes, but couldn’t pay 50 cents a month to his doc­tor. His an­swer was: “Doc­tor, b’y, a fella got to have a smoke.’’

One per­son, a dis­tant rel­a­tive liv­ing in the area, re­fused to pay as a mat­ter of prin­ci­ple. He felt that one’s ex­is­tence on earth gave him a right to free med­i­cal care, and, not only that, the at­tend­ing physi­cian had an ab­so­lute obli­ga­tion to look af­ter him. One other per­son, a lady from down the shore, said she wasn’t go­ing to pay since “doc­tors are all mil­lion­aires.” And I was one of them.

There are bad times, in our mem­ory trove, and there are good times. Most of mine are good ones.

I hope the ma­jor­ity of my pa­tients feel the same way.

— Dr. Wil­liam O’Fla­herty is au­thor of a best-sell­ing mem­oir

en­ti­tled “Tom­cats and House Calls: Mem­oir of a Coun­try Doc­tor.” He worked a 40-year ca­reer as a coun­try doc­tor in New­found­land and New Brunswick. He was the coun­try doc­tor in Western Bay, on the north shore of Con­cep­tion Bay, from 1967 to 1989, and was born in the tiny fish­ing vil­lage of Long Beach, at the lower end North­ern Bay. He writes

from Monc­ton, NB.

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