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General News · 7th November 2010
Ralph Nursall
THE HEALTH CENTRE STORY

CONSTITUTION OF THE CORTES COMMUNITY HEALTH ASSOCIATION

The name of the Society is the Cortes Community Health Association

The purposes of the Society are:

1. To offer medical health and related support services to the general public.

2. To do all such things as are incidental and ancillary to the attainment of the foregoing purposes of the Society.

July 20, 2004.

mandate (noun): an order given to a person, organization, etc. to carry out a certain task. Canadian Oxford Dictionary (Second Edition 2004).

“To do all such things...” appears to be the “mandate” claimed by the CCHA Board of Directors (2010). According to the CCHA Board Update (Cortes Tideline, 31 August 2010) “The mandate of the Association is to operate and maintain the clinic for the benefit of the Cortes community, and to ensure continuity of medical services. Our obligation is to the Cortes community, not to any particular practitioner.” It has never been explained who voiced or approved this “mandate”. The arrogation of power by the Board of Directors without reference to the membership, or reporting to the membership, has been astonishing.

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Cortes Islanders enjoyed and benefitted from more than a decade of remarkable medical care from much-admired Dr Kirstie Overhill. The culmination of that attention and respect was the construction of the Cortes Island Health Centre, which came about largely through island efforts to provide our doctor with facilities appropriate to current and future needs. Funds were obtained by means of voluntary fund-raising and formal grant application, with signs erected to illustrate progress in acquiring funds, and community get-togethers to encourage generosity. The Cortes Island Seniors Society (CISS), then known as the Cortes Island Seniors Building Society(CISBS)) entered into an Agency Agreement with the CCHA to expedite money handling and to permit federal tax credit to donors, until the CCHA achieved its own credit status. Furthermore, the CISBS volunteered space on the property it owned along Beasley Road, and undertook survey requirements for access, boundaries, water supply, power and septic facilities, in preparation for use of a portion of its property by the CCHA, and agreed joint use of amenities with development of the Seniors’ Village. The Health Centre was designed and built in greater part with local skills and labour. A significant part of that was voluntary. Dr Overhill was much involved in planning and design. It was a glorious and happy day when our doctor was able to take her practice to the new building for which she had worked so steadily! The community and she had accomplished a wonderful transformation. What pride we had!

The Health Centre building is owned by the CISS, but is furnished and equipped by the CCHA. The Seniors, in arranging use of its property, and determined to make use of the Health Centre as easy and practicable as possible, gave an easement for access to the property to the CCHA, and set the lease fee to the building at $100.00 per annum. That skimpy price raised some eyebrows, but the Seniors, well-satisfied with the medical care being provided, wanted its community organization to be as free of unnecessary costs as possible. Cortes Island now had a level of care second to no other island community of equivalent size or remoteness. And it got better, as the Dr Overhill and VIHA organized additional services. Whether in the cramped, makeshift quarters in Manson’s Hall, where sometimes we had to line up out in the corridor, or in the bright, spacious, efficient, community-built Health Centre, we had a decade of thoughtful, careful, personal, effective attention from our family practitioner. We thrived on it!

Unbeknownst to most Islanders, there were some difficulties developing. When Dr Overhill first came to Cortes, she was supported by VIHA with funds sufficient to support her clinical operation as well as with her salary, standard practice for doctors in remote locations. Dr Overhill, with her husband, John Macdonald, maintained a limited company to manage these monies. With the establishment of the Health Centre, the CCHA took a more active role in the management of health care, as it increased its societal responsibilities (e.g. taking on charitable status, so it could directly handle donations and grants, previously done for it by the Seniors), and was entrusted with the management of the Health Centre building. At that point there began to be disagreements about the distribution of costs, between the management of Overhill Ltd., and the CCHA. Suddenly, there were two entities which considered themselves responsible for health care on Cortes Island! Something in health care got lost in the reportedly raucous meetings between them, as both claimed priority in management. This difference, serious, but certainly not tectonic, was certainly negotiable.

Apparently the Directors of the CCHA could not bend to thoughtful consideration and discussion of antagonistic ideas. Despite pleas for discussion, including mediated negotiation, and protests that there were no outstanding issues between the doctor and the CCHA, nothing happened. There was a six-month period of backs turned and conversation avoided. There is no record of anybody on one side talking to anyone on the other. It was different out on the street, where Islanders were anxiously awaiting Dr Overhill’s return from sick leave. CCHA Board Meeting Minutes (28 July, 2010) note that three representatives of VIHA met with four board Directors that morning; it was reported that VIHA had sent a letter to Dr Overhill, offering a position on Cortes if she regains her licence to practise, and if she has a contract with CCHA to practise in the Cortes Community Health Centre. Furthermore, “VIHA feels that if a physician gives up their practice due to illness, they can expect to be offered their practice back when they are well again.” It seems to me that VIHA understands doctors and communities rather better than the CCHA Board does. I understand that Dr Overhill had regained her licence to practise, and only the Board’s unwillingness to engage in discussion and negotiation (why? why? why?) led to the closure of Dr Overhill’s practice.

All of us know that there are battles with repressed resentments, petty jealousies, perceived indignities, even outright dislike, but six months of failure to talk about differences of opinion on who pays for what, and how to maintain health care in a mature and diverse community should not lead to the events of July 28, 2010, in which seven members of a 12-member Board of Directors minuted the following: “The CCHA will respond with a letter to VIHA. The letter will state that at the July 28th meeting of the CCHA, it was the unanimous decision of the Board not to offer to lease the Health Centre to Dr. Overhill. The Board does not feel that Dr. Overhill will conform to the new financial and administrative model that the Health Centre is now operating under and the Board has no reasonable confidence a contract with Dr. Overhill will be fulfilled.”

This minute gives 7 out of 12 members of the Board responsibility for unanimity, at a meeting which was not of the CCHA, as stated, but only of a portion of the Board. The minute then presumes and attributes future non-compliance by Dr Overhill of contracts. The Board supports this by its recorded statement, in the same minutes, that “The CCHA feels that Dr. Overhill closed her practice due to a financial dispute with VIHA which was a clear breach of contract.” This in direct contradiction to a VIHA statement in a letter to a concerned Cortes Islander (D. G. Blackie, Corporate Director, Medical Affairs, VIHA, e-mail, 20 November, 2009 to ___twincomm.ca) which stated “When Dr. Overhill first made us aware of the onset of her health issues, VIHA worked closely with her to immediately hire a temporary locum doctor to replace her while he was away.” This letter has been seen by the Board. I did say to a Director, in correspond-ence, “...why was the Board so disturbed by a ‘breach of contract’ between Overhill and VIHA? Surely VIHA has the capacity to deal with its contracts.” The arguments brought up by the Board are distressingly specious.

It is not known who has maintained these minutes. Contrary to the requirements of the Society Act BC and the CCHA Bylaws, the CCHA Board of Directors has not appointed a Secretary to its Executive. The functions of the Board Secretary include correspondence and minutes. What is much more dismaying and disturbing is that, according to the Board minutes of July 28 (see above) the “unanimous decision ... not to offer” use of the Health Centre to Dr Overhill did not come forward to the Executive as a formal motion, seconded, discussed, and passed, but seemed to spring, full-formed, like Pallas Athena, from Zeus’ brow. The Board acts like gods! Apparently, there are no rules of order in place, nothing to ensure responsibility, regularity in procedure, or formal recording of operations. The perceived rightness of actions does not preclude the need to proceed in orderly fashion, to keep records properly, and to maintain correspondence and co-operation with the members of the association. Those simple steps provide the substance of an organization’s history, and its best defence, if disagreement should arise.

We are told nothing of who brought the substance of the letter to the Board (i.e. who made the motion, if such there was) the discussion that it engendered, whether or not here was any hesitation or realization of the consequences of the letter among the seven, nor even how unanimity was achieved among the remainder of the Board. Never was it suggested that the membership of the CCHA be brought into the discussion, to try to determine what level of desire there was among members for change in the island’s medical service. Nor is there ever any suggestion of attempted solution of the problems of administration by mediated negotiation. The ultimate, and probably worst consequence of the Board’s inability to keep records while failing to resolve a problem that sorely vexed some Board members (from whom contagion spread) is that now only the selective memories of involved participants are available for detail. This story will become ever more obscure with time!

Meanwhile, a reputation has been crumbled, a livelihood lost, a community has been deprived of care it found ample and comforting, and 10 years of experience of our care has been thrown away. A community, once bound together in the pride of its accomplishments in providing for its doctor, and pleased with the attention and service returned, is now discomfitted, confused, part saddened, part angry, and left out of any sense of participation in matters of health care.

And all that was needed was some disciplined, mediated talk!

Ralph Nursall