By Jim Hight and June Nessler
For 40 years Richard Ricklefs was a country doctor in the Klamath-Trinity Mountains who broke as many traditions as he created.
A white man who married a Hoopa woman, he encouraged Indian healers to help treat his patients. He let whole families help with childbirths in an era when most hospitals wouldn't even let fathers into the delivery room. A visionary organizer, he recruited hundreds of people in Hoopa, Willow Creek, Burnt Ranch and other mountain communities to join a consumer-owned medical service in the 1950s.
People all across the United States became aware of his work in 1959 when he was a guest on the popular "This Is Your Life" TV show. His appearance drew nearly $100,000 in donations for the cooperative hospital he wanted to create in Hoopa; then local politics twisted his beloved concept into something he couldn't support. Shaking off the loss, he founded his own HMO-like practice.
The story of Ricklefs' service to Hoopa and the Klamath-Trinity Valley began on an autumn day in 1934 when the 17-year-old Midwesterner came to visit his brother who had started a school in Hoopa. He fell in love with the area at once and began working as a tutor to his brother's students. Within a few months he'd also fallen for young Elsie Gardner. [see end of article for more information about Elsie Gardner]
Meeting as teenagers, Richard and Elsie courted for seven years before they married. Early in their relationship they decided they would both become doctors, a plan motivated as much by necessity as by their desire to serve.
"The question in the '30s was 'How are you going to make a living?'" says Ricklefs. "We wanted to live in Hoopa, we knew, and there were no jobs here, not even manual labor. We figured we'd better get trained in something that was needed, so we decided on medical school."
They both were accepted into a pre-med program at UC Berkeley, but after two years Elsie had to drop out. A brain tumor had been plaguing her with headaches for years and she was losing her sight. Eventually surgery relieved her symptoms.
It was 1941 when Richard graduated, and like every other young man in America, his career plans were put on hold by the war. He qualified for civilian public service as a "conscientious objector," and the couple went to work at a state mental hospital in Connecticut. It was a primitive, brutal place, but along with other COs working there, the Ricklefs "inaugurated a lot of changes. We took patients out of restraints and tried to learn about mental health."
After his discharge in 1946, Ricklefs earned more credits at Berkeley, then was accepted at Hahnemann Medical School in Philadelphia. It was there that Richard and Elsie began to be influenced by the ideals of cooperative organizations.
"We'd been acquainted with some Quakers in California, and they had a co-op boarding house in Philadelphia. We lived there about a year and became Quakers."
Among the Quakers they met were other medical students who were enthusiastic about the work of Dr. Michael Shadid, a Lebanese-American who had organized a cooperative hospital in Oklahoma. They read and discussed a book by Shadid. And as they returned to the West in 1951, they had begun to think that a cooperative medical service was exactly what the Hoopa area needed.
After a year in San Francisco where Richard completed an internship and Elsie worked as a teacher, they resettled permanently in Hoopa.
With Elsie as his nurse, bookkeeper and all-around assistant, Ricklefs began seeing patients. As the only medical provider in the region aside from the inconsistent Bureau of Indian Affairs medical service, people in medical need sought him out. Most of them signed up for prepaid membership in a system that would become familiar decades later as an HMO.
He charged $25 per year for a family, $35 for those living outside of Hoopa proper. Within a year he had signed up 250 families. How could he support himself and Elsie and run a medical business on what must have amounted to $6,000 or $7,000 per year? Ricklefs chuckles:
"You don't know how things were in 1952. There's been a lot of inflation since then."
But he and Elsie were also very frugal; and they lived and operated their clinic on land given them by Elsie's family.
Practicing medicine high up in the Coast Range in those years was often a risky, difficult adventure. During the floods of December 1955, bridges washed out, cutting off Hoopa from Willow Creek, and isolating the entire area. But babies wouldn't wait for good weather, and Ricklefs rode out many a night with an anxious husband to attend to a woman in labor.
Crossing the swollen Trinity meant dodging logs and debris that could easily swamp a boat, sending its occupants to certain death. In one tragic incident, several people drowned when the ferry to Willow Creek was wrecked by a log. The very next day, with the flood waters still raging, Ricklefs received one of his emergency calls.
"A woman was having a baby on the other side of the river," he remembers. "Her husband came to get me and the ferry wasn't fixed yet. So we got another boat. I had a big flashlight with me and as we got in the boat, he said 'Shoot your light across and see if you can see any logs coming down.'" The pair made it across and a healthy baby was delivered.
Sometimes getting the doctor to a woman in labor took the combined efforts of many people.
"We once were called to deliver a baby in Burnt Ranch. There were a lot of slides across the road. The man that came after me drove as far as we could go, then stopped at the first slide. I got out, walked over the slide and met another car, which drove me to the next slide. We had to cross three of four slides that way to get there It was a breach delivery, but a perfectly normal baby."
In the 1950s there wasn't a regular ambulance service in the Trinity-Klamath area, so Ricklefs was often called upon to ride out with rescuers to help accident victims. And on the mountain roads, reaching the victim of a car or truck accident often meant a trip down steep terrain suspended from a cable.
"Usually a tow truck in Willow Creek would be called," he remembers, sitting near the fire in the living room of the modest house on the east bank of the Trinity where he and Elsie have lived for 30 years.
"The truck had a long cable, and at the end of it we'd attach a basket made of wire netting. Then I'd get in the basket and they'd lower me down the slope."
After riding down in the basket, "I'd give the man a shot for his pain, then put him in the basket. I'd ride back up hanging onto the outside. Today the ambulance drivers do all that."
Ricklefs started out in private practice, but he was quickly drawn into the leadership of a community-run health association. It started in the summer of 1953 when the BIA announced it would close its hospital in Hoopa.
Hoopa Indians and non-Indians came together to form the Klamath-Trinity Health Association. Ricklefs merged his practice with the association and became manager of the health service, which was consumer-owned in the cooperative model he believed in. Meanwhile, the all-volunteer board of directors began raising money to build its own hospital.
The group's first estimate of costs was about $300,000. Federal and state government money was available, but an additional $50,000 would have to be raised. Each small community in the area formed an auxiliary to help with fund raising: bake sales, variety shows, dances, barbecues, raffles. People from Eureka and Arcata made donations. The Ricklefs themselves were one of the largest individual contributors.
Eventually the association raised the needed funds and the hospital was built in 1959. However, no sooner had the huge opening ceremony ended did the celebrants have to face the fact that they needed more money to operate the hospital. Those funds came from far-away sources that were tapped through the new medium of television.
A member of the Hoopa Tribal Council, Pete Masten, knew someone who knew someone who booked guests on the popular "This Is Your Life" TV series. The story of Ricklefs' leadership in the crusade for a locally owned hospital appealed to the producers, and host Ralph Edwards agreed to book him.
The challenge was to get Ricklefs to Hollywood without his being aware that he was to be the main guest on the program. Incredibly, as close as the community was to him, no one divulged the secret as he and Elsie left for Hollywood, ostensibly to meet with a wealthy person who wanted to make a large donation to the Klamath-Trinity Hospital.
When he and Elsie arrived for the meeting, they were told that it had been postponed; to compensate for the inconvenience, they were taken to see a live television performance of "This Is Your Life."
Seated in the audience, Dr. and Mrs. Ricklefs were approached by Ralph Edwards. Before he understood what was happening, Ricklefs was brought before a nationwide audience.
The show was testimony to Ricklefs' remarkable life of public service and dedication to the people of his community. Grateful people whose lives he had touched appeared one after another to extol his character, his medical skill and his dedication to their well-being. At the conclusion of the show, Edwards explained to the audience that money was needed to operate the Klamath-Trinity Hospital, and he gave the address.
In the next few weeks viewers responded to the appeal by donating more than $97,000. "Sacks of mail arrived every day for weeks," remembers June Knight, one of the association stalwarts. "Children around the country sent dimes and nickels and some people sent as much as $50. We were even willed money which we got years later."
But as volunteers gathered for the immense task of writing thank-you letters, the seeds were already sown for what would be one of Ricklefs' greatest disappointments.
Behind his back a campaign had been mounted by some of the association board members to ditch the collective concept and make the hospital a traditional private operation. The enemies of the co-op used red-baiting tactics to discredit Ricklefs and his ideas.
"They called me a Communist," he remembers. "Never to my face but behind my back. Friends of mine let me know what was being said. And in those days that was about as far as you could go to discredit someone."
He says that the board members opposing the co-op were primarily business owners afraid the concept of collective ownership would spread and affect their livelihood. "They didn't want cooperative grocery stores or cooperative timber companies (taking away their business)."
Working in the new hospital and throughout the countryside, Ricklefs was too busy to organize support to save the co-op. "I didn't have time to do the political work (that would have been necessary), talking to people, encouraging them to get involved."
After serving for several months as hospital administrator, Ricklefs read the writing on the wall and resigned. "They made it difficult for me and I got out."
After that, he took a rare vacation in San Francisco with Elsie and her parents. "After we'd settled our nerves, we came back and I opened my own practice." That was 1960, and Ricklefs continued to practice in Hoopa until 1972, when he left for several years to practice among Native Americans in Alaska. Then he practiced locum tenens - substituting for local doctors - around the state before returning to Hoopa in 1979. He retired his local practice in 1987, but practiced locum tenens in other locations until 1993.
The hospital was operated independently until the mid-'60s, when it was taken over by the county. The county stopped supporting it in 1981, after Proposition 13 cutbacks. The health association turned it over to one private operator after another, the last of which went bankrupt in 1986.
After that blow, the health association joined efforts with the Hoopa Tribal Council, which created the Hoopa Health Association. It operates a clinic, which is now being upgraded to a "rural acute care facility," to provide emergency care and short-term inpatient stays, as well as a higher level of outpatient care.
Today, at 79 - and three years into his retirement - Ricklefs is as convinced as ever that the cooperative model would have worked if it had gotten a start in 1960. "I think the hospital (founded by the Klamath-Trinity Health Association) would still be there if had been run cooperatively. It's a concept that can work. It was so successful during the 1950s in our community health service."
As an example of how well co-ops can work, he points to the North Coast Co-op, which operates grocery stores in Arcata and Eureka, as well as a bakery and trucking outfit. "You have to believe in it (to make it work). If you have a lot of people who are not for it, you're in trouble."
While Ricklefs wasn't successful in creating cooperative ownership of health care in Hoopa, he was successful in another radical health care innovation: mingling American Indian medicine with modern scientific medicine.
While the healing rituals and herbal medicines used by the Hoopa and other California tribes have declined since the 1860s when the reservations were established, they're still practiced. From his earliest days in Hoopa, Ricklefs observed the healing power of these ancient ways; as a physician, he encouraged their use alongside modern methods.
"Sometimes it's difficult to bridge the gap between modern medicine and Native American, but it can be done," he said.
He participated in healing ceremonies that involved extended families and neighbors.
"One meeting was led by a doctor from a tribe in the Midwest it was a group healing session at the gym. There were a couple of hundred people there and about 10 patients. The people who weren't patients would help with singing, supporting the woman who was leading it. I wasn't in charge, by any means, but I'd helped to arrange it."
Working with the tribal health clinic, Ricklefs sponsored a weekly seminar on American Indian medicine for tribal employees. "We had shamans as guest lecturers, usually women. We went out on field trips and learned to identify and gather medicines."
Another tradition he bucked - for the good of his patients - was the prevailing idea that the closest a husband should be to his wife's childbirth was the waiting room.
"In Humboldt County in the early 1960s, no hospital would allow husbands to be in the delivery room with their wives," he remembers. "It was so bad in Eureka that some HSU students padlocked themselves to the delivery table (to be with their wives). Then the hospitals got chain cutters so they could get them out."
Ricklefs ascribes the practice to "fears that (the fathers) would faint and have an accident and sue the hospital or bring in bacteria. There were all kinds of excuses, but most obstetricians just didn't want anyone in there to watch."
His reputation as the doctor who didn't mind company in the birthing room spread, and he had labor and delivery business from throughout the county, particularly Arcata. Not only would he allow husbands to participate in deliveries, many of which were performed in homes, he encouraged the whole family to be there.
"There's a lot of learning that goes on. It's good for the family to be there to sympathize with the mother and rub her back," says Ricklefs. "It involves getting (a family member) over the hurdle of having a baby. That's what I call family medicine."
With the social changes beginning in the '60s, obstetricians became more open to family participation. "Some of those hard-shelled (obstetricians) resisted for a long time, but it's all changed now. Hospitals even have delivery suites to accommodate the family."
The Ricklefs have no children, but any errand to the post office or weekend gathering can be an occasion for the doctor to come face to face with someone he brought into the world.
"I'll often run into people who say, 'Remember when you delivered me?' 'Well, who are you?' I have to ask. I don't even know all my own grandnieces and grandnephews. I've got about 90 or 100 of them. I delivered a lot of them and delivered a lot of their mothers and fathers."
Indeed, when Ricklefs tells his stories, several generations parade by in the space of a couple hours. As he speaks, it's easy to imagine him on a small motorboat, aiming a flashlight into the dark, storm-tossed waters of the Trinity to spot a rushing log that might keep him from tending to a woman in labor; or gripping his medical bag as he clambers over wet, mud slides on Highway 299; or bucking himself up to return to private practice after losing the community-run hospital he'd dreamed of and labored toward for a half-dozen years.
But Dr. Ricklefs wouldn't have much patience with such romantic imagery. He'd want to change the subject to something important, like how families can help an ailing member recover faster, or what HMOs ought to do to provide real preventive medicine, or how madrone leaves can be prepared to help heal an abrasion.
"If those of us in medicine could emulate him in some small degree, then we would have fulfilled a purpose," says Dr. Jose Sanchez, medical director of the Hoopa Health Center.
This story was a joint project between staff writer Jim Hight and June Nessler. Nessler, a retired teacher who lives in Fortuna and once lived in Hoopa, first proposed the story and did much of the research.
Elsie Gardner Ricklefs shared her husband Richard's dream of becoming a doctor and practicing in Hoopa. But illness kept her from finishing college. In her 20s, the tumor that caused her headaches was removed, but she struggled with ill health for many years.
In spite of these burdens, she supported her husband through medical school working as a teacher. She was his assistant and business manager for two years. After the practice expanded, she went on to teach again and to become chair of the Hoopa Tribal Council, serving in the 1950s and again in the 1980s.
Elsie Ricklefs says she used her position "to preserve the cultural heritage of our people." She worked to protect timber and fisheries for their economic value and because of their centrality to her people's culture and religion.
"We have one Creator who made this Earth and gave it to our people ... with instructions about how to take care of it and of one another," she says.