History: 1960s - The Beginning of Medical Specialization

Achievements in outer space, tragic assassinations, unprecedented social changes, the Vietnam War, and anti-establishent sentiments all marked the turbulent sixties. In the health care arena, the concept of Medicare was introduced and, for the first time, concern was expressed over rising health care costs and utilizarion of hospital resources.

At Windham, the Greer Wing had opened by 1960 creating a 145 bed hospital. The subsequent expansion and renovation program brought additional changes. A modern operating room, a recovery room, central supply and a t)harmacy were new features that were long overdue. An intensive care unit (ICU) was opened and l:rederick Beardsley, M.D. and Ann Martin, R.N. took the lead in developing policies and procedures that would assure its proper utilization and operation. Dr. Maurer, Chief of Staff, described the ICU as "part of a progressive care plan that adjusts intensity of care to the needs of the sick individual This [plan] should eventually include facilities for convalescence and rehabilitation."

In I963, Windham's Board of Trustees established a Planning and Development Committee. Its purpose was to review the 20 year Master Plan written in 1958 and to find solutions to the ever-increasing demands for more space, staff and equipment. The continuing bed shortage, along with inadequate space for emergency services, radiology, laboratory, pharmacy and other developing ancillary services were pressing concerns.

Early in their deliberations, committee members entered into discussions with the "Hatch Trustees" who were overseeing funds left by George Hatch in memory of his parents, Jonathan and Alma Armstrong Hatch. The intent of the trust was to provide a maternity or convalescent hospital within the community.

The will of George Hatch, dated July 26, 1924, was filed upon his death in 1938. Legal complications arising from specific terms of the bequest delayed action for many years. In 1954, the Hatch trustees planned to build a 25 bed convalescent hospital and bought land that was part of the Vanderman property. Later, as the 1958 expansion plans of Windham progressed, the Hatch trustees reconsidered and proposed a joint venture with Windham Hospital. They finally decided to donate the land to Windham and sought permission from the courts to blend the Hatch will with the hospital's development program. This proposal was not viewed favorably by the courts at the time. On June 23, 1964, a consultant, AnthonyJ. J. Rourke, M.D., was successful in obtaining a decree from the court confirming that a convalescent and rehabilitative care facility connected to Windham Hospital would satisfy the intent of the will.

Thus the Hatch unit was built with money from the Hatch trust at a cost of $598,000, adding 14000 additional square feet to the facility that was now formally called the Windham Communicy Memorial Hospital, Inc. and the hatch Hospital Corp.

The Hatch Hospital memorial wing was Oemcated on September 30, 1967 and opened the next day. Its twelve rooms contained 30 adult beds, and the new unit included a Physical Therapy department, a day room and a patio. Furnishings, space and equipment were designed for the handicapped or wheel-bound patient.

Physical Therapy, now with new space, equiplnent and a full complement of personnel, reported a workload increase of 72 % the first year. Medical supervision was provided by Thomas Hines, M.D. of Yale-New Haven Hospital and Director of Gaylord Hospital. Eventually, Windham's Chief of Orthopaedics assumed accountability for Mmdical direction of this department.

The opening of Hatch relieved the bed shortage. Windham was now a 175 bed hospital. However, the needs of the ancillary service departments were not yet addressed, which meant planning would continue for some time.

By now, Windham had twenty-seven active medical staff members and plans for additional recruitment, welcoming: Millard Amdur, M.D., George Becker, M.D., Frank Bird, M.D., Raymond Bopp, M.D., William Ellzey, M.D., Robert Gillcash, M.D., Morton Glasser, M.D., Donald Glugover, M.D., Gerard Lawrence, M.D., Nelly Nepomuceno, M.D., Carl Peterson, M.D., Blake Prescott, M.D., Gertrude Rucker, M.D., Melvin Sandier, M.D. and Joseph Shaw, M.D. to the community.

The medical staff once again revised their bylaws, leading to greater organization of the important mission they carry out within the hospital. The roles of Chief of Staff and President of the Medical Staff were combined into one position. The Exccutive Committee began to function as a medical board, acting on behalf of the mcdical staff between their quartcrly meetings. This structure continues today and allows the medical staff to perform its primary function, the care of patients, while maintaining an advisory capacity to the Board and Administration.

After the opening of the new operating room, the hospital had three full-time anesthesiologists, Samuel Dodd, M.D., William Grillo, M.D. and Sawyer Medbury, M.D. In 1963, Dr. Medbury took a position in Massachusetts and Dr. Grillo succeeded him as Chief of Anesthesiology. Arturo Diaz, M.D. joined the department, but did not remain long. In 1968, Peter Calise, M.D. arrived as the third anesthesiologist and later became chief of the service when Dr. Grillo retired in 1985.

In his first report of 1963, Dr. Grillo discussed the successful experiences using fluothane anesthesia, as well as the introduction of two new anesthetic agents, Fluormor and penthrane. In 1964, Dr. Grillo reported: "The new Bennett anesthesia ventilator was donated to the hospital by the Masonic Society for the Greater Willimantic Area. This machine provides life saving advantages to patients undergoing major surgery because it does such an excellent job of controlling respirations." Prior to this, the anesthesiologist controlled respirations by hand.

The cardiac service continued to grow. State and national heart associations began placing emphasis on community education and public awareness concerning treatment of cardiac problems. Windham sent nurses to train at the St. Raphael's program in order to prepare them for the opening of our Coronary Care Unit. Equipment for cardiac monitoring was installed and Windham opened a Pacemaker Clinic.

The laboratory had found a new home with the opening of the Greer Wing. The single room Lab of 1933 was contained in 140 square feet; the new lab now had 6,000 square feet of space.

Dr. Rosenberg gained some assistance with the arrival of Fred Doyle, M.D., Windham's second full-time pathologist, in November, 1964. James Cornish, Ph.D. was hired in June, 1965 to develop the School of Certified Lab Assistants. Ed Recor became chemist in 1962, following Leo Denauk, and Carl Murdock became the first laboratory assistant.

The following accomplishments are noted in Laboratory reports throughout the 1960's:
· strong and steady statistical increases;
· standardization and improvement of procedures with introduction of new tests;
· institution and refinement of quality control measures;
· participation in hospital and community screening programs; and
· cytology testing for the American Cancer Society.

Sometimes when we look back it is difficult to believe what we "lived with." In Radiology, concerns about equipment and space were so paramount that appearances were often overlooked. Peggy Herbert,wife of a Windham radiologist, took a special interest in the perceptions of patients and families. Over one weekend she worked long hours and spruced up the waiting room. Her efforts not only greatly improved the area for patients and their families, but brightened the spirits of employees, as well.

During these years, radiologists were seen walking around wearing "red glasses" which helped their eyes accommodate to differing situations. This practice disappeared with the advent of the image amplifier. Dr. Herbert reported that the image amplifier worked so well that he hesitated to use the old standard fluoroscopy unit and requested a second amplifier. This was installed in1965 and provided TV viewing so that several physicians could view examinations simultaneously.

The early darkroom will be best remembered by Mr. Gawlas, who worked in boots to avoid the consequences caused by water leaks in the area.

Notwithstauding certain encumbrances of the times, Radiology moved forward, acquiring new equipment and kept current as technology rapidly advanced. The many new pieces of equipment purchased included a rapid fire cassette changer (the first of many gifts from the Lauter Foundation and the Greer family); an image amplifier, equipment which intensified an image 3,000 times, gave more detail yet lower radiation exposure (a gift of the Brand Foundation); an Amplatz injector, which enabled radiologists to do more aortograms and arteriograms at much less risk to the patient; and a Polaroid ten-second radiographic processing unit in the operating suite which reduced by as much as 30 minutes the time a patient remained under anesthesia in certain operative cases. The department also acquired a new Paki automatic film processing machine. This unit sped up the processing of films which could now be developed, fixed, washed and dried in seven minutes compared to two and one half hours previously. The unit processed up to 200 films per hour, a considerable increase over the manual method. In 1964, the first magazine loader in use in New England was added to this processor. It fed film into the machine automatically, eliminating one of the bottlenecks in the department.

A new x-ray therapy machine, providing both deep and superficial therapy was installed. X-ray therapy continued as a service until 1973. By that time the major medical centers had invested heavily in new techniques and Windham felt referral to these areas would be more appropriate for its patients.

To temporarily solve the space problem, the radiologists received approval to move the cystoscopy room to the operating suite. Two permanently mounted tubes in Room 4 assured the performance of certain types of general surgical cases with more ideal x-ray guidance. The vacated room in the x-ray department was used immediately to house the Franklin skull unit. The Franklin unit enabled the radiologist to obtain more accurate and detailed films of the head and neck. Radiology workload was steadily increasing; statistics demonstrated almost a 50% increase between 1960 (10,486 examinations) to 1966 (15,116 examinations).

Recognizing the value of training our own technologists, both for supply and quality, Windham opened a School of Radiology Technology on September14, 1964. With the second class that started in September, 1965, we were training four first-year and three second year students. The program was 24 months long. After completing all academic work and clinical practice, each student took the registration examination adntinistered by the American Registry of Radiology technicians. The Windhain program has continually produced high quality graduates who have won state and regional awards on a regular basis.

Meanwhile, there were several personnel changes in this department, Ivor P. Smyth, M.D. became the hospital's second radiologist in 1961. Miss Taylor transferred to the Medical Records department while Judith Wheeler, Alta Baker and Flo Charest joined the clerical staff in Radiology. Thomas Danehy left to work for the TB Control Section of the State Department of Health and was replaced by Sheldon Dyer, one of our students. Mr. Dyer became Chief Technician and later Technical Director of the Radiology Department.

It would seem that each area of the hospital was advancing rapidly and introducing the newest concepts in their own specialty. In the early 60's, Windham became the first hospital in the United States to administer Rhogam for Rh negative women. Dr. Sandler recalls it had just been approved by the FDA when he had a problem case. Johnson and Johnson Company in New Jersey wre contacted and they air-shipped a supply of Rogham to Bradley Airport. Frank Ritchie, the Assistant Administrator, picked it up and brought it to Windham for immediate use.

Although the number of births continued to be reasonably high, the length of obstetrical stay decreased. By 1964, a normal maternity case remained in the hospital four days and the newborn five days. The length of stay continued to decrease and by 1966 the occupancy rate of the maternity unit was 37%. Declining maternity occupancy rates were occurring in hospitals throughout the state. In response, regulations were passed allowing "clean surgical" cases to be admitted to maternity units. Windham developed a program consistent with state guidelines and received early approval from the State Department of Health.

Under the department of Nursing, a trial series of "mother classes" began and were very successful. At this time natural childbirth was preferred by most patients; fathers were allowed in the delivery room; and tours of the maternity unit were offered to help the new family feel comfortable during the birthing experience.

The Pediatric census continued to climb well into the 1960's. The average occupancy rate was 69%, but there were seasonal highs and lows. The average length of stay for children was 3.8-4 days. Pediatrics accommodated children of various ages and sizes. Keeping equipment on hand that fit properly created occasional challenges for Head Nurse, Muriel Korvell, R.N. The layout of the unit made it difficult to segregate surgical and medical patients and infants from older children. Responding to these concerns, Barbara Kane, R.N., M.S.N. Director of Nursing, asked Tina DiMaggio, a consultant from the University of Massachusetts, to survey the pediatric unit and make recommendations on the design of a new unit, equipment needs and policies.

During this time, Dr. Anderson was Chief of Pediatrics (1962 - 1975). He and Dr. Nepomuceno, who arrived in 1962, served the entire pediatric community.

The Emergency Room continued to be staffed by registered nurses. Private physicians were available and responded when called. The medical staff had an on-call schedule in place, assuring twenty-four hour coverage. The Yale surgical resident provided much assistance in the emergency room, but the first significant change occurred when arrangements were made in 1967 to have doctors from the Groton naval base provide night and weekend coverage.

The Dental Staff was responding to more emergencies at the hospital. In 1964 they saw 45 patients, 11 of whom had fractured jaws. By 1967 the emergency room had installed a dental chair and x-ray unit to better serve patients with these needs.

Windham opened a mental health clinic in January, 1963 with funds provided by the State Department of Mental Health. Under the guidance of Medical Director Joseph Shaw, M.D., and his associate, W. Richard Newman, psychiatric social worker, this out-patient service developed rapidly. A. child psychiatrist joined the staff. Hours were expanded and more space was provided at the "White House". In addition to patient evaluation and treatment, services included consultations with school principals, the VNA and social workers in the area. Community education was provided at Eastern Connecticut State College. The staff was involved with activities of the Mental Health Regional Planning Commission, as well as the development of the Windham Area Conmmnity Action Program (WACAP) and Project ASK.

In 1968, Millard Amdur, M.D. arrived, opened a private practice and succeeded Dr. Shaw as Medical Director of the Mental Health Clinic. The clinic continued to serve the community into the late 70's when it faced serious budget restrictions. At that time Windham reluctantly transferred sponsorship of the clinic to Natchaug Hospital.

On April 1, 1960, Frank Ritchie was hired as the first registered pharmacist, coming to Windham from the Master's program at the University of Connecticut. After renovations following the Greer addition were completed, a new pharmacy opened on January 7, 1961. It was located on the third floor. With this move the hospital created a new multiple patient drug requisition, a new narcotic system and began prepackaging medications. With a registered pharmacist on site, compounding of medications was now possible.

One year later, Mr. Ritchie was appointed Assistant Administrator. Lee Stenberg, Marie Graham, Joseph Cerreto, Andre LaCombe and Robert Theriault followed him as Chief Pharmacists, a position later to be called Director of Pharmacy Services.

An Electroencephalogram (EEG) service was postponed due to lack of space, trained technical staff and medical supervision. The 1967 Annual Appeal provided funds for equipment, other problems were addressed and in 1968 EEG was offered as a diagnostic service at the hospital.

Florence Grant had volunteered five years of her time planning and organizing a new medical library. When it opened in 1961, the President of the Medical Staff commented: "We owe a debt of gffratitude to Miss Grant for services freely given, which are priceless and could not be duplicated." The medical staff and the hospital honored Miss Grant by naming the library the Florence A. Grant Medical Library. Upon the urging of Miss Grant the new library served all members of the hospital family--doctors, dentists, nurses, technical and administrative staff. The library was well designed, beautifully organized and attractively decorated. It became a showcase for visiting physicians and staff. Librarians that served after Miss Grant included Eleauor Sherman, Beulah Patterson and Doris Pekarski.

In Medical Records the patient's chart grew as increasing numhers of x-rays, lab tests, consultant reports and other documentation became necessary. Space for storage presented a problem and microfilming of records was introduced.

Activity in the Medical Records area is summed up in this excerpt from the 1964 Annual Report: "The importance of medical records to a modern hospital cas easily be seen by a visit to this busy department. The work load increases with census, doctors are dictating more, reports of records are more often being called for: All this has put some strain on our filing space, microfilming program and dictating and copying equipment. For efficiency, a color coding system was instituted, and, in line with national and state recommendations, the newer, broader International Coding System was adopted, requiring a recoding of all records."

Some may remember the weekend dictating system of the early 1960's-three Edison voicewriter machines attached in tandem. The Maintenance Department checked them daily and changed discs when necessary. Administration even went so far as to provide a "light connection" to the discs so that when a red light flashed at the switchboard (much like a fire alarm) the switchboard operator would call Maintenance to change the discs.

Other alarm systems were found at the switchboard. Warnings for fire, low pressure alerts for oxygen and suction, malfunctioning temperature controls in the blood bank, and interruptions in security were all monitored by the telephone operators, Helen Rydowski, Mildred Kurdzo and Loretta MacNamara. At this time Windham had a two board PBX (200E series) which was then considered very modern. It accommodated five trunk lines for incoming calls and two for out going calls. All calls, including those within the hospital, went through the operator.

The mid to late 1960's ushered in an era of national health care cost control and regulation. Medicare was introduced at this time and with it came numerous regulations.

As the medical staff introduced the concept of "utilization management," emphasis was placed on control of emergency admissions, length of stay, severity of illness and intensity of treatment. Utilization Review programs, sponsored jointly by administration and the medical staff, were later introduced in hospitals. From a 1969 report we extract the following definition of the meaning of this new medical staff concern:

A search to discover and use new, different and less expensive ways of delivering health care led Windham Hospital to review its policy on admissions and the use of hospital facilities. This has had a resounding and measurable effect upon the hospital's patient care systems and economy.

At Windham, utilization means viewing the total hospital as a community health center with inpatient bed care one part of this operation, and that to be used only for the intensely sick patient. Utilization aims to assign diagnosis and treatment to the proper level and place for giving it. During a review of an admission request, the question is posed: 'What will be done for the patient that could not be done elsewhere, just as well or perhaps better and less expensively, for him?'

Utilization does not seek to limit care for general hospital patients, but, for reasons of manpower shortages, state and federal legislation requirements and inflation, seeks to slow down the growth of general hospital bed usage by encouraging the use of and making provisions for other alternatives for health care.

With the introduction of utilization management, attitudes concerning the appropriate use of hospitals changed. Admissions dropped, as did patient lengths of stay. Windham began to seek more and improved ways in which the patient could be serviced in the ambulatory care setting. Patients were discharged sooner, but often required attention of the visiting nurse or continuing care in a skilled nursing facility.

In the late 60's, amid rising hospital costs, the State funded a demonstration project at Windham Hospital, providing a Health Services Coordinator to work with physicians to develop patient discharge plans and form liaisons with nursing homes and area VNAs. The purpose of these efforts was to speed patient discharge while assuring that all continuing care needs were met. This role blended well with the new emphasis that was being placed on utilization management. The individual involved in the start up of this new program was Helen Litwak, R.N. Her efforts were so successful that she was hired by Windham and her program served as a model for other hospitals in the State.

With social pressure for cost containment increasing, the financial contributions of the Auxiliary became even more important. On several occasions, a variety show, "The Willi-Mantics" was produced with Auxiliary members, hospital personnel, physicians and community members cooperating in an entertainment production of unique interest and financial benefit.

The Auxiliary's impressive gift to assist in construction of the Greer Wing was later exceeded by pledges of $100,000 for pediatric renovations, $100,000 for air conditioning on the medical and surgical floors and subsequent gifts in the 70's and 80's.

The Art Committee arranged paintings and exhibits throughout the hospital each month. Since 1968, over 166 pictures were donated to the "Pictures for Patients Project" to brighten hospital rooms, corridors and offices. Each year, a number of paintings were sold and a percentage of the profits were retained to help make possible whatever project was current at the time.

The Junior Auxiliary fully resumed activities in 1959. The Library Cart which brought reading material to patients was their initial project. Later, they worked in the Coffee Shop, Pediatrics, Central Sterile Supply, the Business Office and helped deliver flowers and mail to patients.

In an annual report, Mr. Ogrean made the following comment about the funds raised and hours volunteered by the Auxiliary: "There is hardly a service or department that has not benefited by the Auxiliary throughout the years. Our Auxiliarians, nearly 800 of them, have shown since 1933 their willingness to take part in all the hospital's projects. They have, using a staggering variety of ways and means, raised money, lobbied, and provided invaluable public support. They have rallied around the hospital whenever called upon. Certainly we would not be the hospital we are today without those who served yesterday and those who serve today."

Through the years, no other body of people has done so much to mold the character of Windham Hospital as the Board of Trustees. As community leaders, they have taken particular interest in preserving the mission of the hospital.

When some who are Trustees or Trustees Emeritus were asked to reflect upon their Board experience, they offered these comments: "We functioned as a whole Board - all decisions were made there"; "The committee structure and use of the Vice President to chair important committees worked very well"; "We had a close relationship with the doctors"; "Society has so many demands for volunteer service, it is difficult to attract good Board members; "Too much documentation and regulation can be negative. It can stifle determination and creativity"; "The Board never became politicized--we functioned as full representatives of the whole community"; "The Board functions best as a local representation."

These comments reflect the thoughts of Albert Snoke, M.D. who, in his book HOSPITALS HEALTH AND PEOPLE, commented on the importance of the Board:

The voluntary hospital, with its responsible community Board of Directors, has been a major factor in the development of American health systems. Recognizing that the health world will continue to change, undoubtedly become more complex and costly, as diagnostic and treatment procedures, multiply, the acute care hospital will continue to be of fundamental importance. A local, representative hospital Board--as my experience in Connecticut showed me--can be a powerful influence in preserving consideration of the patients.

When asked what makes a good Board member, Mr. Ogrean replied: "A person who will listen and receive information, who will seek to become an expert in the health care field, who will take the time to be responsible for analyzing recommendations and alternatives, and who will make decisions."

Mr. Ogrean worked closely with the Board of Trustees. He added the attendance of the Assistant Administrator and Controller to monthly Board meetings in order to bring their expertise directly to members.

According to Mr. Ogrean, the role of the Administrator had changed significantly from earlier years. By the 60's, the administrator was expected to he active, to inform, educate and make recommendations to the Board on health care issues, especially hospital trends and changes, He was expected to understand issues, coordinate efforts with the medical staff and be a visible spokesman and interpreter for the hospital. Once again referring to Dr. Snoke's book, the role of the "new" Administrator is described as follows:

The Chief Executive Officer is now also the 'Executive Vice President or President of the Board in most hospitals while the Chairman of the Board is a community representative.

The emphasis upon titles and upon a more formal, corporate approach is not a matter of self-aggrandizement or higher salaries, but a logical reaction to the changing status of the hospital. Hospitals are big business; frequently they are the major industry in their community. The CEO has great responsibility from the operational point of view, and to this must be added his or her unique responsibility for the care of the patient and for the role of the hospital in community health. These organizational changes are basically good for management of the institution, but they lead, of course, to the next logical development--multihospital corporations, consortia and partnerships. Obvious dangers of this trend are increased emphasis on form and structure, marketing, competition and the bottom line--with a corresponding loss of interest in the welfare of the patient.

The Administrator has unique assets that position him well in the role of facilitator. Knowledge of healthcare issues and problems throughout the hospital and the community, the ability to implement suggestions that cut across departmental lines and the influence and authority that accompanies the position of chief administrative officer are characteristics that are necessary to effect change.

However, the Administrator has a primary responsibility to develop a comprehensive system and corporate structure to carry out the legal and moral duties of the hospital to care for its patients. Again, we quote from Dr. Snoke, "The CEO can delegate experts to deal with operational and fiscal matters; the medical, nursing and social service staff can take care of individual patients; but he or she is the only person who is in the position to see these activities as a whole and who has the authority to bring these groups together to ensure the best possible care. This fact should be uppermost in the minds of a Board of a hospital or health corporation when it chooses a Chief Executive Officer."

Mr. Ogrean had become an authority on state and regional purchasing activity. He was chairman of the Administrative Conference at the Connecticut Hospital Association in the 1960's and provided leadership in this area. From 1962-1967 he served on the Board of Directors of the hospital bureau of New York, a national group purchasing outfit and participated in numerous conferences at the New England Hospital Assembly.

Purchasing had become, and remains, a large complex industrial procurement department. By 1968, John Hudak, Purchasing Agent, operated this important hospital function.

In the 1960's, hospitals debated the value of contracted services. Mr. Ogrean, in a presentation at a New England Hospital Assembly seminar, said: "Contractual services are neither good nor bad, effective or not so effective. The decision...to use them is individualistic and based on the advantages at a given point in time and under certain circumstances." That such services would benefit Windham during the 60's was the motivation that led to contractual services in three areas of the hospital--housekeeping, laundry and dietary.

After the retirement of Helen Battey there was a lack of qualified housekeeping supervisors in the area. A contract was signed with Servicemaster, while also signing a contract to provide laundry service. Laundry equipment had not been replaced since 1933. Rather than buying new equipment, it was felt that the money could be better spent on other programs. A dietary contract was signed with Seilers after the retirement of Dorothy Moxon and shortly after the resignation of Helene Jensen. Properly selected and supervised by Administration, these contracted services served Windham well for a period of time.

Public relations had been handled by Administration up until 1966. At that time Mr. Ogrean presented a proposal to the Board to establish a Public Relations Department. The Board authorized a part-time position to begin, in order to evaluate the new service and to introduce the cost into the budget gradually.

Pat Dye, trained in journalism and with public relations experience at St. Elizabeth Hospital and Lafayette Home and Hospital in Indiana, joined the staff. Her work was so good and the first year so successful that the position soon expanded to full-time. Ms. Dye remembers that her first "big special" was the opening of the Hatch unit.

The diligence of Maintenance paid off during the Blackout of November 9, 1965. Suddenly, without warning, around 5:00 p.m. the entire East Coast lost power; lights were out everywhere. Within seconds Windham Hospital's emergency power system was activated. Lights all over the hospital were on. The critical areas--ICU, operating room, emergency room, delivery room, lab, radiology, heating plant, pharmacy and kitchen were functioning.

1966 is referred to as the year of the "minor development program", using $115,000 on maintenance

and capital expenditures. The original elevator was renovated; a second elevator was added in the Greer Wing; a boiler and a 10,000 gallon fuel storage tank were installed. These developments were in addition to the cystoscopy project in the operating suite and renovation of the old physical therapy area for additional Emergency Room space.

The next few years brought hosts of upkeep and repairs common to an aging physical plant. A preventative maintenance program was instituted to prevent breakdowns, thus reducing unanticipated costs.

By 1966, the charge per patient day was $38.38. Windham was one of only five hospitals in Connecticut that kept below the $40.00 per day margin. In 1968, charges had risen to $45.60 per day while 33 other hospitals in the State listed amounts ranging from $48.65 to $80.79.

As third party payments, or insurance coverage, became the norm, patients and families were not as aware of charges nor as concerned. Unpaid balances, or the self-pay portions related to hospitalization and outpatient care, were not acknowledged quickly. Those without health insurance needed credit and time to pay their hospital bill. Towns struggled over accepting "indigent cases" and considerable sums were tied up in town judgment.

As hospital costs rose, these uncontrolled sums--Accounts Receivable--grew. Occasionally, the hospital had to borrow money to meet payroll and pay bills. The norm for Accounts Receivable became 60-75 days or 2-3 times that of other businesses and had a direct effect on Accounts Payable. "Money in" ran parallel to "money out."

When Anthony Pepe succeeded Arlene Sayers in 1960, his title changed from Chief Accountant to Controller, indicating increasing responsibilities. In 1965, John Peck succeeded Mr. Pepe as Controller, coining from previous positions at other area hospitals.

By 1966, medical and surgical bed occupancy was the highest in the hospital's history, recorded at 95.5%. Ancillary service growth was up sharply. Patient days were straining capacity and the waiting list had grown from 97 to 180 people. From the annual report we read: "Space shortages became more apparent this year as the demands of laboratory, x-ray, classroom, business office, medical records, dietary department and storage forced imaginative, ingenious use of space never planned and poorly suited for active functioning. Space needs for supporting services thus become more understandable. Since it takes from 2-5 years to move from ideas to construction and use, we need to move along as rapidly as possible in our planning work."

The teamwork exercised by Windham Hospital was remarkably successful. The Planning and Development Committee, working with the architectural firm of York & Sawyer, drew up an expansion plan addressing the pressing needs in the Emergency Room, Radiology, Laboratory, Pharmacy and other out-patient and support services.

The 1960's may be summed up as years of growth in medical care and service, all of which required trained personnel and new equipment. Among those services initiated were Intravenous Therapy, Medical Library, Nutrition Teaching, Recovery Room, Intensive Care Unit, Laboratory Automation, Pharmacy Service, Mental Health Clinic, Utilization Review, Occupational Therapy, Electroencephalography, School of Radiological Technology, full-time cytology coverage, Physiatry and Rehabilitative Health Service Coordinator, Community Laboratory Services, Acute Surgical Care Room, and Central Sterile Supply.