William O'Flaherty writes about efforts to reopen the medical practice on Conception Bay's north shore
“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.”
© Photo courtesy of University of Prince Edward Island.
Dr. William O'Flaherty
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.
He was a retired teacher who had spent his life teaching in out-of-the-way 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 first 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 paid 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.