Relationship between Valdez and Harborview residents
Criticism of the institution
The lobbying against the institution
Management structure at Harborview
Harborview residents leaving the institution
What happened to Harborview after it was shut down
Managing Harborview for most of his career
Greatest satisfaction from working at Harborview
Things he's been doing since retiring in '99
Recreational activities for the clients in Valdez
Separate units for disabilities
Clients taught skills for independent living
City of Valdez benefitted from Harborview
Dealing with criticism from families
Harborview viewed negatively by Alaskans
PAT LANDO: So I psychologically said, you know --
KAREN BREWSTER: When Harborview closed, you didn't go into --
PAT LANDO: The chapter is over. The book is closed. I'm not going to talk about it anymore. I did what I thought was -- I thought I did all right. I thought I did, you know, I -- KAREN BREWSTER: It sounded like -- it sounds like you fought very hard to keep it open? PAT LANDO: We did and that was my little -- and I did it for honorable -- honorable reasons, you know. I didn't -- I did not do that at the risk of the clients. I did it I think in looking at the holistic way, I guess I was trying to look at the big picture of, you know, the fact that we had a great staff and it was a shame to -- to basically fire -- so the last three years I spent basically letting everybody go, you know, systematically. KAREN BREWSTER: I think there is a perception that because you fought to keep it open you were against home care treatment. PAT LANDO: Oh, no, no -- that's -- see that's what -- that's BS, you know. We -- we promoted it. We are the ones that first started it. We -- as I mentioned that was our first thing was to move folks out. We did it on our own before we even -- so we were the first ones to advocate for it and we worked with them. We did more -- we brought them -- we used to bring them down from Hope Cottage and they could spend time learning. We actually taught -- taught them some things, you know. They could come down and learn some of our -- we -- we were ahead of the curve in so many ways. We had some, you know, we had some things going that they hadn't, you know, they hadn't even thought about. And so we were a resource to other people if they wanted to take advantage of it, so. So no, no it became a good guy - bad guy kind thing and it was from the onset. The good guys were the -- the nonprofits. We were the -- the institutions are always the bad guys and we could never defend ourselves. They could always, you know, I was always told to keep my mouth shut, in those words. You know, we've gone to public meetings and we were not allowed to defend ourselves. Fortunately, they could never get the goods on us and I'll tell you -- even though there was one incident that I won't even get into that was really bad. Over all those years we never had one family or consumer complaint. Now that's pretty good. So that made me feel -- I had families that were absolutely adamant that they did not want their family member up to Hope Cottages or some place where they had no control of what went on in those homes. And as I mentioned to you before, we never had a suit, which I felt good about. We never had a, you know, usually institutions are -- were ripe for suits, you know. I mean families loved to sue a state institution. Never had a suit by a family member or a guardian. The only suit I ever had was against me and that was for firing an employee that refused to work and that was two years after the place was closed. And they dragged me into court over that and it was two years later on a phony -- phony deal. But that was strictly a personnel matter and so that was, you know, I guess if I had anything to say, not many people can say that they are, you know, run institution given what we were dealing with that didn't have -- cause I went to enough -- not a lot, but I did go to a few superintendent meetings with these big institutions, but that's all they ever talked about that they were getting sued personally. The institution was being sued for all kinds of, you know, you know, malpractice, mistreatment, abuse, whatever so that's all that consumed them and many of them didn't last very long because they were basically run off -- run out of them. So the good news about being in Valdez, you didn't get that kind of, you know, we had oversight believe me. The Juneau group always coming down here and the surveyors were here all the time. So we had oversight but we didn't have the kind of constant day-to-date scrutiny. We had -- we -- family members were allowed to come any time. We used to have them come down. It was difficult and again that was the problem of Valdez. KAREN BREWSTER: Yeah, that was one of my questions.
PAT LANDO: That was always the problem --
KAREN BREWSTER: How much contact was there with the family --
PAT LANDO: Valdez is a conundrum, if that's a word for you, in terms of it's always difficult to get in and out of here. And wintertime is impossible and oftentimes and for visitation purposes it's tough for families. Although the fact that most of our families were in the Bush, they wouldn't have come visited if they were in Anchorage anyways. Some did go out in the villages. Now there was some -- I've lost track, you know, of -- but they tried to get programs in the villages and they did probably succeed in a number of villages. The other player that was really important was a guy named Todd Risley. Did that name every come up to you?
KAREN BREWSTER: Um-hm.
PAT LANDO: Well Todd -- KAREN BREWSTER: I was going to ask you about that.
PAT LANDO: Todd was the guru. He was the, you know, he had the classic beard and he was the, you know, the philosopher and he was the mentor of the prof -- of the nonprofits and he also became medical division director at one point. KAREN BREWSTER: Well, he had some theory about zone -- zone -- a way of treating with zone areas or something? PAT LANDO: Yeah. He had -- he had -- he was a brilliant kind of guy and he set the philosophy for how to set up community programming and so he -- he also came down and helped us with things early on, too. But he basically was the one that set the philosophical structure for how to work on, you know, getting programs out -- developing home-based programs and then the other piece of the puzzle was when they got the Medicaid Waiver passed and that was a big one because that allowed federal money to flow into the -- into the nonprofits. That was the turning point because then they could divert money from the institution into community programs, you know, and that was a big one because that - that's -- that really jump started that whole process, which is well along. And I haven't kept track of it in the last ten years. I had some good former employees I know that were -- that came -- that worked themselves up into the echelon. I don't know if you -- Rebecca Hilgendorf. Does not name ring a -- Rebecca was a great gal. She was our director of resident services and then she moved on to be one of the regional supervisors of all the, you know, the care centers, you know, the home-based care centers and she was quite a powerhouse. But yeah she was a great -- KAREN BREWSTER: So for the residents at Harborview, the type of care they got here versus what they would get when they went back home, which do you think served them better? PAT LANDO: Good question. I had people as of yesterday come up and say I'm so damn mad, and this is here all these years, I see things going on in town here that I think is terrible. We have the Frontier -- we have some local -- these people are drugies. They're -- they came out (inaudible) and I just shrugged it off, but they said I, you now, these people are, you know, are being taken care by blah, blah, blah, blah and so I can't -- I can't speak of that. I don't know what's going on in the last 10, 12 years, but I do get some feedback from people that say what's going on isn't what it is all supposed to be. KAREN BREWSTER: But when you were with Harborview and you were transferring people back into their communities --
PAT LANDO: We would like to think that what went on was better. That they got, you know, the real -- I mean we had people -- I know two -- in fact, I see them in the swimming pool every day. They were paying people like fifty grand a year to take care of a client in their own home, big money. And then they'd rebuild the house. They'd redo the bathroom and make it, you know, accessible and so, you know, there -- then we have at least, I don't know how many are in town, but I'm guessing at least a dozen or more ex-Harborview clients are still in town. A few of them have passed away. KAREN BREWSTER: They stayed here?
PAT LANDO: Stayed here.
KAREN BREWSTER: They didn't go back to their home --
PAT LANDO: No, they stayed here and I see them today. In fact, the ones I see in the swimming pool every -- every week. KAREN BREWSTER: That's interesting that -- do you know why they chose to stay and not go back --
PAT LANDO: No family.
KAREN BREWSTER: Okay. PAT LANDO: And I can tell you that some families do not want them back and that's the bitter, you know, they don't -- they're not -- they don't -- they've been estranged for so many years, they don't want them back. They may have -- they may have been deceased, but I know for a fact a couple families went to the governor's office when I tried to pressure them, will you consider being a guardian for your child, they didn't want to be -- they didn't -- it was gone. It was -- they had, you know, I think there was something in their minds that they -- they did not want to deal with it and so it's a lot to do with being the -- you know, how the philosophy of it and then the actuality of it, you know, there's some --
KAREN BREWSTER: Right, well that's what I was gonna ask you.
PAT LANDO: There's some disparity of it, you know. And there's a grandiosity to the -- to some of these folks and I call them left wingers, you know, that are out there thinking that this -- they've got -- they're closer to God because they're doing these wonderful things. And I think they are doing some wonderful things, but I think some of it is the part that they -- the accountability part is the one that's, you know, who knows what goes on in -- in these private homes and I think for the most part they're done well, but I'm -- I cannot speak to it as I have not been around it for a long time. But it's not sometimes as -- as great as what you might think. It may be -- may be wonderful, but I get mixed -- I have had mixed messages from people that have been, you know, in the -- but they certainly have made the transition, you know, and as you know the shutting down institutions have been going on for a long time. KAREN BREWSTER: Right. It was a philosophical change.
PAT LANDO: It gets started out in New York. The famous big suit in New York. It started with the Kennedy's. I could tell you a little story. Eunice Shriver came off a boat one day here in Valdez and walked in our back door. How does that grab you, huh? KAREN BREWSTER: Yeah.
PAT LANDO: As you know she is the one that started Special Olympics, you know.
KAREN BREWSTER: Right.
PAT LANDO: And I got a call saying well we got Eunice Shriver here at the Harborview. We had Walter Cronkite come through here during the oil spill days. That was another chapter that was interesting for somebody. Because of that we went through the same kind of craziness during the oil spill that we went through --
KAREN BREWSTER: Oh, right.
PAT LANDO: During the oil. I mean it was wild, wild. I mean thousands and thousands people came in and, of course, employees left, you know, not all but the most (inaudible).
KAREN BREWSTER: Yeah I forgot Harborview was still operating. PAT LANDO: Oh, yeah, yeah, it was -- I mean it was a crazy, crazy time. So we weathered that one, too, and again all I can say is that we had a very -- almost all of our department heads stayed with us right up to the bitter end and the people I know well to this day. We had about fifteen folks that retired with me or maybe it was more closer to twenty-five, you know, that were strong, strong people and they kept the place going, you know, and they're the ones that, you know, so that -- it was that kind of a infrastructure of humanity that kept the place stable. So stability I guess and I guess the fact that I hung around may have had something to do with and you kind of got to know everybody and you knew how everything worked and you kept the family together. And that kept things kind of perking along and so that's the -- I guess if you want to think about what I felt good about I guess I felt that I'd -- we took care of people in a I think a pretty humane way and provided a service that wasn't there before. And then, you know, we knew we were becoming archaic and you know we were becoming passé and, you know, we weren't fitting the mold and that's why I wanted to transition to the corrections program, which I thought made some sense. But our dear fathers in town here at least I always thought -- they all said unanimously they wanted this corrections to happen, but it never did. In a passive aggressive way they let it kind of slide away. KAREN BREWSTER: For the residents who came from Morningside to Harborview with Lynette McCoy.
PAT LANDO: Yeah. KAREN BREWSTER: How did they transition? Morningside, sort of, is described as being more open and gardens they could walk around versus Harborside -- Harborview in that time was fairly restrictive? PAT LANDO: I can't --
KAREN BREWSTER: Do you know how they adjusted?
PAT LANDO: Speak to how Morningside was. All I -- my -- what I was told about Morningside was that it was a bit of a jungle, you know. It was old institutional care and I did -- I was never down there so I can't tell you, but it was -- KAREN BREWSTER: But do you know how those residents adjusted from one institution to the next --
PAT LANDO: I would say we didn't -- they did well. I mean the early days were tough because I mean they had -- I know we -- you know, the restraint stuff was going on more than it should've gone because they didn't have -- they didn't know any -- we didn't have any other avenues to -- but when we got into the educational model and we tried to work out of that we gave them, you know, if you don't -- it's like taking care of a -- your pet pooch, you know. If you tie him in a house and you're going to have problems, you know. So if you don't involve them and engage them, you know, you're going to deal with the negative behaviors and that's what happens, you know. And it's true with any kid you take care of or try to raise. If you don't provide outlets and educational or whatever going on they're going to -- they're going to get attention one way or another and they will do it with the most negative thing you can possibly imagine. And we had God knows how many different anomalies of humanity here and genetic flaws. We had a group come down here and spend a week once trying to identify all of the different genetic diagnostic stuff. I mean all the Prader-Willi syndrome. I mean all these different strange genetic things are, you know, they just -- they spent going through their books trying to identify -- what we really didn't get into was a lot of the alcohol syndrome stuff because that was not really known much about, but you can bet that from the villages there was a lot of that going on. A lot -- the other thing that was going on that no one really talked about much was a lot of the close incest type stuff that could have gone on in the villages. We know that occurred in some of these villages. St. Paul Island and the Pribilof Islands and those, we -- you know, some strange, you know, things came out of the -- of those kind of unions and. But, yeah there was lots of stuff that went on that -- a lot of closed head injuries we dealt with later on and that was mostly in the dementia unit, but we had some folks that came in that... KAREN BREWSTER: We talked about the families that may or may not have visited and may or may not have wanted their children back with them. For the children here, how did they adjust to being away from their families? Is that a problem? PAT LANDO: Well and I -- given what I remember and know, they were estranged for so many -- for so long I don't think it made a difference. The other thing you should know is that the first population here was as I think I already said was quite high functioning and I mean the group that came up from Baby Louise Haven were extremely low. I'm talking very low. I'm talking functioning less than two years of age. Major disabilities. No -- none verbal, none mobile, I mean really -- and a lot of them we were able to get back, you know, they were laying in kind of pen-like -- when I went down there I remember that. They weren't, you know, they weren't allowed to walk. So we -- the first thing we did was get them, you know, trying to get them mobile and get them walking and we had special wheelchairs. So we tried to get, you know, get into that and some of them were able to get them on their feet, but for the most part they were really low level functioning. I mean we're talking IQ if you want to get into IQ stuff, you know, probably be the low 20's, you know, developmentally very, very low. KAREN BREWSTER: Right, so they weren't aware as you say, (inaudible) --
PAT LANDO: No, no.
KAREN BREWSTER: But later years when -- when children from villages might have been brought here --
PAT LANDO: There wasn't --
KAREN BREWSTER: Directly, once you were an all Alaska facility. PAT LANDO: Admissions were always controlled -- often, you know, the greater bulk of them did come in from Morningside. We did have groups, you know, not groups -- more individuals that came from API that were most of the time they were dual diagnosed, you know, they had a mental health label on them and then they had a developmentally disability label on them. And they were usually a handful to deal with. So they -- we often got those referrals from API. API wasn't particularly a model of any good things. I've been around API. I'm sure maybe it is much better than it used to be, but in the early days they were strictly the old psychiatric -- medicate them up. First thing we did with our clients and I can tell you almost to the one, they had them so medicated up that they were zombiefied and we used to take -- it was the first thing we would do is wean them off all their medications and we'd find out -- we used to get people in there that, I mean, they couldn't walk, talk or and we would get them off their medications and the lights would come on and we, you know, we had remarkable changes. Then we'd get them out of here. We would move them out. I remember a guy from Fort Yukon that came in here. He would -- he didn't talk for six months and all of a sudden after taking him off all those meds, we got him back and he -- we got him back to a provider in Anchorage, you know. So the more docs, unfortunately, you get around the more medication you got. That's a given. And the more docs you see the more meds you get on and the more and that's -- you call about treatment -- psychiatric treatment is a bit of a joke as far as I'm concerned, has been forever. Treatment is getting them pills and doing what? Providing some counseling whatever, but it's been overblown. But we used to see a lot of those and that may have changed some, but generally they were overmedicated just because it was easier for the staff. KAREN BREWSTER: When you got new patients, not from API, but just, you know, from a community or some place, were they voluntary or were they brought to you? PAT LANDO: Yeah, they were -- yeah, no, no, they were a -- done voluntary. We may have -- I was thinking back a lot -- there could have been a few commitments. But, certainly admissions were very fil -- were very slow even -- even during the heyday because we had a very fixed population and they usually were often screened through API. But, yeah, we did have some families that brought them down, but during that time Hope Cottages was really going, you know, and they -- things were happening up there. So there was some alternatives that weren't there before. KAREN BREWSTER: I was just going to say there was a reputation, true or not I don't know, that people were brought by the state against their will into an institution. PAT LANDO: Early on that was true. I think I told you they used to ship them out to Morningside and that was -- I think I told you the inside, outside or Morningside was the big -- was the -- was a catch phrase, you know. I mean if you were acting a little crazy or a little loony, you end up getting put on an airplane and dragged out of state and that was true -- KAREN BREWSTER: And that wasn't the case for Harborview?
PAT LANDO: No, not at all. We never took anybody against their will. And again particularly because I was cognizant of that. I worked in a psychiatric facility before, you know, I went through the commitment stuff and I knew all about the commitment rules. So we, in fact, I don't think it was possible to commit someone to Harborview given when we changed our designation we were no longer under that same -- we would not fall into the same mental health laws as the old -- see the umbrella was we were classified I think initially similar to API. Under the old -- we changed that to a -- to our -- when we became, you now, accredited. That was you had to be very clear that, you know, admissions were done. You had to have a guardian and go through a whole admission process which covered all of this kind of thing so you couldn't take anybody unless you really made sure they were appropriate, that they met some criteria and were, you know, the level of care that we were at. Intermediate care is very -- very distinctive. Full nurse -- full scale nursing care is a whole separate bag, you know. If you're full medical, you have to have a pretty solid medical diagnosis done or fall into skilled nursing and we did not provide skilled nursing. So the ICFMR thing was quite distinctively spelled out and it would have precluded, at least in my memory, to anyone being committed down here, you know, so. KAREN BREWSTER: And then, what about the City of Valdez and its community here, how was the relationship between the people of Valdez and Harborview? You said they were alot of employees but -- PAT LANDO: They would cut off their arm to have it back, let me tell you that. We -- the budget, not only the budget but it was -- the town embraced and that's a good word to throw around -- embraced the, you know, the -- our clients went to every possible thing in town. I mean every fricking, you know, thing that happens at the Civic Center. We have this great big Civic Center or the ball games or whatever, you know, they were welcomed and there was always Harborview clients and residents that went to every activity in town. They used to go shopping all the time. In fact, the poor lady that's trying to keep her store open -- I mean I think it probably made a difference. Each client had X amount of dollars to spend each month, you know, there was personal needs accounts and they would -- we would go down and they would buy stuff at the stores for themselves, you know, their personal clothing and stuff. So there was a lot of money spent here in the local community. That has hurt a lot of people. Our budget up -- was up in the eight million dollar range at one time. That money was spent all here because as you probably know your budget -- about ninety percent of your budget is all personnel. And people for the most part they do go to Anchorage, but most of their money is spent here in town. So that was a big chunk of change that was spent locally here that was no longer there and then the clients' interactions, you know. So peop -- we -- I can't even think of an incident where a client was mistreated or not well received because everybody knew everybody. Everybody had family that worked there, you know. It was all -- everybody was in bed with each other and in that way the town is kind of incestuous in that way. You know, and it can be a downer because you can't get away from them, but there is that intimacy that comes with the way the town is so tight knit. KAREN BREWSTER: And you think that was a benefit to the residents?
PAT LANDO: Oh, of course. I mean if you can go down the street and people aren't going to, you know, sneer at you or treat you like you're some kind of a -- you know, people were used to seeing the, you know, some of them had all kinds of anomalies and, you know, weren't particularly attractive and some -- but they -- I don't think I ever had a complaint about anyone ever being -- so all I can say is the town was always receptive to our people. You know, -- they -- for economic reasons, but I think there also was the personal reasons, I mean, they got to know the clients. We opened up the store, which is still there today. The Second Time Around Store that Eva Dunning took over -- the Frontiers -- Frontier Services offer. Anyway, it was a -- we had the clients work there and they still work there today. Where we -- it was the Second Time Around Store where the clients worked there and they had them -- KAREN BREWSTER: I also heard that there were families that maybe brought Harborview residents home, into their homes. Did that happen? PAT LANDO: I'm sure it did, you know, and they had them over for visits, you know, took them home for visits. They got very close to them. I mean these people were taking care of them 24 hours a day, you know, and for years on end they became very -- so, yeah, there was a lot of that. And then some of them became, you know, when things started to separate out, they became, you know -- I know one -- at least one or two that opened up, you know, their private homes and became, you know, they actually got a contract with the state for services you know. And they'd get paid X amount of dollars to take care of the client on a 24 hour basis, which is a tough, tough duty, but they do that respite built into that. But there's a lot of our people did. Most of our staff moved away, you know, left little by little, retired and pulled up stakes and we still have a few people around town I see, but a lot of them did leave. But all I can say is over the -- if you talk to anybody in town about Harborview, unless I'm mistaken, they'll tell you it's the best thing that ever happened to Valdez and the clients, you know, were treated well and I think no one can ever dispute that. I would have heard about it believe me. KAREN BREWSTER: Were there certain -- we talked before there was that debate of institutional versus home care within the state education and Harborview was criticized. PAT LANDO: Oh, it always -- sure. You're always criticized for that just because you are what you are, you know. Institutions are inherently evil, you know and I -- the problem is and I think you're seeing if you know and you probably know, some or one thing about this, but they deinstitutionalize all these big state hospitals. You know where they ended up don't you? Well they ended up in prison. I forget how many -- now your prisons are full of what? What percent of mentally ill people are in prisons right now or on the streets or dead? So there was, you know, there's been some rethinking about that and if you go into the bigger cities where they have deinstitutionalized people, you'll find these are the street -- the street people that are sitting in the gutters or they're locked up. And that's happened in a lot of big cities, as you know if you've been around the world a little bit and I have. But, so yeah it hasn't been as, you know, I think it's -- it's probably been the right thing to do but I think there in some ways people have seconded guessed that maybe we've gone too far in this thing. That there has to be a -- some kind of safety net somewhere. The standard joke was, you know, you send them to API you know what happens? They're back on the street two days later. Yeah, I have enough people that are sent up there for six different times and they evaluate them and put them back on the street until they kill themselves or something happens to them. KAREN BREWSTER: Or get picked up again.
PAT LANDO: Picked up again. So it's, you know, the revolving door of, you know -- or they commit a crime and then they lock them up. So there is no, you know, nirvana, you know. So there's the daydreamers and then there's the reality people, you know, that you kind of sort of the -- so I used to be more I guess in the middle of trying to balance the two sides knowing that I wouldn't want to be locked up in an institution. I wouldn't stay a day, so I walked away from my back surgery with my IV in my hand and said I'm going moose hunting. That's the truth. KAREN BREWSTER: I want to go back a little bit to the transition period where you're talking about the fighting with the nonprofits and all of the feuds -- PAT LANDO: I wouldn't call it fighting. I would just say we -- we would just have to take the brunt of the attack, you know. KAREN BREWSTER: The governor's special council and that whole time period --
PAT LANDO: The governor's council for -- yes, they were a very, very active group that they were the -- they were the -- kind of the -- spearheaded most of the activity. And they were very, very vocal and they were very strong lobbyists and they were always -- KAREN BREWSTER: Did you have allies? Because you've sort of talked about you're the opposition, did you have allies, too? PAT LANDO: The allies were the parents. I used to have families on their nickel would fly down to Juneau, on their own and they wanted to hear, of course, but these people were damn mad that they were, you know, they said my kid -- I like the way my kid is being taken care of and I don't trust that what you guys are going to do is going to be any better. And I know I can think of some family that off the top of my head -- they could be gone by now but they used to come down and testify, but they never got much attention because they didn't really want that to be -- to be heard of. It was very, you know, it was very controlled and it was hard to find -- and I personally was told to keep my mouth shut, you know. KAREN BREWSTER: By the -- whom?
PAT LANDO: By my superiors because if you didn't play -- play the game -- the game was if you don't -- if you're not playing the game with the nonprofits, you don't have a job. Those are all appointees down there. KAREN BREWSTER: Well, that -- that makes me think about the management structure of Harborview. It was a state institution.
PAT LANDO: Correct. KAREN BREWSTER: And so you reported to whom?
PAT LANDO: I reported -- well --
KAREN BREWSTER: That position --
PAT LANDO: To various people and that didn't bounce well.
KAREN BREWSTER: The position, the head of the Department of Mental Health? PAT LANDO: No, well they created a position of -- actually they had the Division of the Medical Director of Mental Health Division, Director of Mental Health, was probably Dr. Schrader, you mentioned. KAREN BREWSTER: At some point it was Dr. Schrader --
PAT LANDO: Yeah he was early on. He was in there for about ten years, but after that they went through every year they had a new medical director. They created a position that was Bob Gregovich who was in there for years, Dr. Robert Gregovich, great guy, liked to -- liked to be called doctor because he had a Ph.D. behind his name. I'm sorry Bob if you listen to that, but we used to always kid him about Dr. Bob. Anyways, but yeah he was -- they actually created a position for -- to be in charge of Developmental Disabilities because the mental health was soled consumed with API. API were -- always dominated everything they did. So they actually created a -- I forget what they actually called the position, but so Harbor -- so I was responsible to the -- to the coordinator of Developmental Services. KAREN BREWSTER: For the State Division of Mental Health and Social Services?
PAT LANDO: Division of Mental Health, yes.
KAREN BREWSTER: Which is under Health --
PAT LANDO: Which is under Health and Social Services.
KAREN BREWSTER: Okay. PAT LANDO: There was a time when for whatever reason it could have been with Margaret Lowe -- Margaret Lowe became commissioner at one time.
KAREN BREWSTER: Yes, she was. PAT LANDO: And I actually was responsible directly to her for a while.
KAREN BREWSTER: Okay. PAT LANDO: (Inaudible) to the commissioner and then the next step is the governor, I guess. So they a lot of -- there was a lot of change and then Bob came down with I think his own medical condition and retired and I think Mike Renfro came in for a number of years. And I don't what happened after that, but there was lots of comings and goings of people down there and we just kind of did our own thing and tried to -- so, yes, I'm -- we had to -- KAREN BREWSTER: You were part of the state bureaucracy --
PAT LANDO: We had to be, yes, unfortunately. And unfortunately our biggest problem was the bureaucracy. I'll tell you how bad it got. You know I had complete line authority for years, you know, I don't know how many years. I could hire, fire, whatever and then little by little because the bureaucracy grew in Juneau so -- and to my estimate it was a joke, you know. I think they had 50 people when I left down there that you could hardly do anything without having someone down there sign off on a piece of paper. The worse it ever got they put a commissioner in there who happened to be a lieutenant colonel out of the Air Force, who happened to be also black and he -- we used to have to fill out 14 pages of EEO stuff in order to hire an aide and we were at a point we had to have aides we had to get them on -- on the line and, you know, and he'd had to personally have them go through his desk to make sure we had dutifully covered all the, you know, EEO requirements to make sure that we had covered -- you had to get preferential consideration to the ethnic issues which I thought -- now you're taking my toys away. So that -- so that was the worse as it got and he didn't last more than about a year. But truly the bureaucracy grew in Juneau to the point where our functioning, the field office was able -- and then when they put in the computers, the computer world came on board. I mean that was another, you know, whole bunch of employees that could sit there and play with their -- their computer. KAREN BREWSTER: So that made it worse?
PAT LANDO: I would say that it didn't make it any better. They thought -- everyone thought that this computer stuff was going to be and I, of course, have my own biases about that, but the fact is that it did take away from the efficiency of your operation, you know. My mode of operating was always to delegate. You know you get good people in and then you give them the authority to do what they need to do. You don't micromanage from down in Juneau where they don't even, you know, they might come by once a year and everyone wants to be boss, you know, and you want to be a boss because they create their own jobs. At least that's how I saw it. They'd come in there and I have a job now and now I have to get -- pull in all this stuff so that I have a job because I have to approve this, this and this and this and that makes me boss. And that's what went on Juneau. And that happens in all bureaucracies. I don't know if you've ever read -- there's an interesting book called When -- When in Doubt, Mumble.
KAREN BREWSTER: No.
PAT LANDO: And so it's a critique on how bureaucracies don't function.
KAREN BREWSTER: Right. PAT LANDO: And it's the old Peter Principle stuff, you know, where everything kind of floats to the top. Crap has a way of floating to the top.
KAREN BREWSTER: Right. PAT LANDO: And that's some interesting stuff because I used to, you know, used to sit and kind of say well these crazy guys were telling us how to run business and I, you know, I had to put up with it, but I didn't like it. And it did take away -- and that is why I mentioned my Wyoming experience here last year when I could actually go down and talk to a field person who had -- KAREN BREWSTER: And your frustrations with that bureaucracy did that affect the residents and the services they were getting? PAT LANDO: Sure because, you know, when you couldn't hire an aide, you know -- to wait for someone to sign off on something in Juneau what do you do? You have to put somebody to work overtime, which increases the costs. I mean when we had -- we were -- during oil times -- oil spill times and during the -- we were going through -- I mean it was crazy. I mean we're talking people were quitting, you know -- KAREN BREWSTER: Because they could make --
PAT LANDO: They could walk over and get a hundred thousand dollar job, you know, and we were paying good money, but not -- we couldn't compete with those numbers. You had to get people on the line and you could not sacrifice, you know, you had to have people there to take care of clients 24 hours a day and you couldn't wait for someone to approve it down in Juneau. And the personnel system in particular is -- is I'm sure it's not any better. I mean it's -- you know it's mired and you call for the registry and then you have to clear the registry and then you have to go through all the red -- it's all these different steps in order to hire somebody and we don't have time to do that. We need to get them on line and get on with it, you know. So the state system in itself, I always found that a bit of a -- it wasn't -- the clients weren't the problem it was the system that was the problem. So my job was how do you outsmart the system and I -- there's certain ways you do that, you know, and oftentimes it's by getting to know the right person down there and often it would be a secretary or, you know, the right person that you could call that would walk a piece of paper through. KAREN BREWSTER: So for the bureaucrats they may not have been particularly fond of you if you were trying to buck the system all the time? PAT LANDO: Probably not. I really didn't probably give a damn actually, huh? And I was able to survive. I didn't get fired so that was good news, so. KAREN BREWSTER: Well, as your population went down at Harborview and you had trouble hiring staff, did you have to cut the services to the residents like no more -- PAT LANDO: Well, that was the balancing act, see. You -- you have to maintain your accreditation. And your accreditation requires that you have all these players in place. KAREN BREWSTER: And all the programs.
PAT LANDO: You have to have a nurse on every shift. You have to, you know, a certain ratio. You have to have all the program stuff has got to be going on. In the meantime, you're being "held your feet to the fire" -- that's a Dick Brandton word by the way. Dick was good on throwing out things. He also liked "dead babies in the street". That's the only way -- that was his -- I never forget that. He said the only way you get the bureaucracy to move is if there are "dead babies in the street" and that -- that was the one I always remembered. If you have to create a crisis in order for the bureaucracy to move and I always -- I always threw that one out when I could. So yes, that was a balancing act between -- between keeping your accreditation going and then trying to get the bureaucracy to -- to provide, you know, what you needed to do the job. So you reach a point where you can't do that. I mean you reach that tipping point. And, you know, and that and the numbers start to eat you up and then finally I say whatever year that was. I think -- they gave us a three year time frame to basically move out, you know, X amount of staff. You know, and yeah it was a pro -- we did it in a programmed way in which we X amount, so we cut the units down less and less, but you still had a great big overhead because I mean my God you had all this other stuff that had to be there, you know, so. KAREN BREWSTER: And all the residents got moved out how?
PAT LANDO: Systemically. We had -- they --
KAREN BREWSTER: To where? PAT LANDO: Yeah, they had a plan and they would struggle like hell to get them out at a certain time, but yeah, there was -- it was orchestrated to have X amount out by so, you know, by such and such a time, which put pressure on the nonprofits to come up with, you know, programs and they had to get, you know, find homes and they had to buy homes up there or get staff and do all that stuff. So that took like three years at least to get that occurred. And we worked with it. We didn't fight it. You know, we knew that this was the way it was going to happen so we were -- I can say that we did it despite the fact that we were able -- everyone was losing their job. We did it I think with the clients' interest in mind, you know. We actually went up there and sent staff up there, helped them, you know, get oriented to the clients so that the clients, you know, they weren't getting somebody that didn't know all their little idiosyncrasies. So yeah we, you know, I think we did it honorably even though we knew that it was our own demise. So, I mean, I think we did a -- we did a pretty admirable job of working with them with the process. All the time I was hoping that we could get a, you know, an alternate population, but -- KAREN BREWSTER: And now you said that the buildings were torn down, is that what you said? PAT LANDO: They -- it became an albatross. They continued to operate the community hospital, but then they had this whole big vestigial organ. There's a good word for you, huh? An organ that serves no function, hanging there, but that organ costs a lot of money because the building was huge to keep going, even though it was shut down. They did move into some of the offices. A certain group in town really got on the bandwagon to build a new hospital even though it's a bit crazy, but they did and if you go by it, it's a beautiful building. So they actually built a brand new hospital and then they had a -- and I was -- KAREN BREWSTER: On the site of where the old one was? PAT LANDO: Right next to it and that is run by Providence now and it's a very beautiful place and they have I mentioned to you the long-term program there that's -- that's very expensive, and -- but it carries the place. And then they were left with this huge structure and then I think there was -- I was actually gone during that time where they were arguing about who's going to be responsible for it. The city said well we're not going to pay to have it torn down and I think the state appropriated -- I think it was almost like two million dollars to tear the place down. So it was like, literarily a fortress. It was built to be there. It was -- the cement in that place was -- I mean -- KAREN BREWSTER: And what's happened to that property now? PAT LANDO: It looks like hell. If you go over there today you'll see this big expansive land. We used to have -- at one time it was -- looked really nice. We had beautiful lawns. We had a -- we had a farm in the back where we actually a farm -- a little farming thing we had going on. We had a little bit of artistic thing that was built. I don't know if you were around when we had to have a percent for art.
KAREN BREWSTER: Yep. PAT LANDO: Okay. We had a guy from California build this thing that still is kind of there. It was a mound that had some I don't know what his brainstorm was, but anyway the grounds looked very nice and we spent a lot of time making the place look very presentable. And the place was always clean and the place never smelled. If you have ever walked in institutions, even nursing homes, the first thing that hits you is the smell. You know, urine has a way of saturating everything and you can always -- they always call it the smell test. If you have been around institutions, you walk in you can always tell if the place has been well kept up just by the odor you get and our place never smelled or if it did, it was not a very -- and so we had a great housekeeping staff and we were very -- so anyway we took great pride in keeping the place up. So now it's kind of sad that it's just an empty lot and the building was, you know, again it was the way it was designed it was very, very expensive to maintain. KAREN BREWSTER: I want to go back a little bit to you personally and Harborview is a big part of your career and what that has meant to you, working there? PAT LANDO: Well, I would like to forget most of it even though I had, you know, I met a lot of good friends and God I still have contact with many, many people that I've known. I think I should have left a lot sooner, you know, in terms of my own career because I think I stuck around too long, but things happened, you know. Kids grew up. Kids were in college, you know, pretty soon you have to pay for college stuff, you know and everything kind of stair cased in and then they started -- then they started throwing out early retirement packages, you know, that occurred for numbers of years and they kept kind of baiting you to stick in the system. I did not want to go to Juneau. I did not want to go to Anchorage and I did not want to go to Fairbanks, although I did apply for a job up in Fairbanks. So I kind of reached a point where it was kind of either jump ship now or wait and get and then I felt a certain obligation I think even though I think towards the end I knew I should move, I felt I should probably be there and kind of help as long as I put the place together, in my own way I thought I should be there to take it apart. So it was kind of a funny feeling, you know, of spending all that time building up a staff and then basically tearing it all apart. So that was kind of a downer, you know, in that sense and that part of it I still remember is -- I remember turning lights out, New Year's Eve walking through that place and turning lights out, you know. So how did you spend, you know -- what I'd do, I spent 30 -- 28 years walking these crazy halls and then to shut the joint down was kind of sad, so. KAREN BREWSTER: Well I think it might be a stressful job running --
PAT LANDO: Stress --
KAREN BREWSTER: A facility like that and how that would affect home life and personally? PAT LANDO: Valdez has its own stress levels. That's why they call it Val disease, you know. Huh? Read some of the old Gold Rush poems. You know there's a certain -- their being sequestered in a certain area like Valdez has a certain, you know, psychological thing that goes on. But yeah it's -- the stress was more from staff than clients for sure. You know, keeping the staff happy, keeping little bickering's and -- that go on. Dealing with a hundred and some women, how does that sound? Huh? At one point I told you we were down to two males in the whole building and women at times, you know, can be a little bit difficult. You get them together and they somehow. And I'm not being sexist but I know -- women take direction from men better, as you probably know or don't know, then women directing other women. That may be -- you know, I don't know if you buy into it or not, but I used to somehow able to get through that. I often amaze myself that I didn't get, you know, God knows you come in in the morning and then someone having bad days and you know you have all these people to deal with, you know. So yeah, you had your bad days, but overall there was more good days than bad ones, so. KAREN BREWSTER: So, yeah, what gave you the greatest joy or greatest satisfaction from working there? PAT LANDO: I think, as I already said, I think the fact that we could sit back and say we did good things to people for the most part. I'm sure we did some disservice to people, but I think we did, you know, provide a good services given what we had going on. And we treated people I think with some respect and dignity and I think I treated the staff with that same respect and I don't think you could have a staff that would say otherwise. So that part of it, you know, I think I was fair with everybody, probably too easy with some people. I would let some people get off the hook that I shouldn't have but it was hard to fire people unless they really did some terrible things, you know, you had to -- KAREN BREWSTER: It sounds like you -- yeah, you were very close to the staff. What about with the residents? Did you get to know the residents?
PAT LANDO: Probably not as close. I'm not the warm and fuzzy kind of guy, as you probably could pick up, although I have my side so I know, you know, I don't go around squeezing and hugging kids and things too well even my own, but no, every day I was down there. I mean I walked the halls. I mean I was -- as I say most people in my position were out in the going to meetings. They all loved to go to meetings, you know. Call someone in Juneau. I'm sure you work at the university. They love to sit around meetings. That's all they do is sit in meetings. I can tell you I was in the halls every day, every unit, every day. So, you know, I was in touch with them in that respect and I knew all the clients, of course. I knew all their families, but in terms of, you know, my, you know, I wasn't out playing games with them and that kind of stuff, but I definitely was in touch with what was going on. I mean there is nothing I didn't miss. I read thousands of records. Every day I reviewed all the records every day. We used to get 24 hour reports and all the records were sitting there. I helped put all the medical records together when we first got there. We had no record system to speak of. So we actually put in -- I actually went and bought the damn things myself. And we actually put, you know, where you basically break out all the different departmental stuff, you know, and we had no really good recordkeeping until we put it together. So I was, you know, I wasn't estranged from the clients. I -- I, you know, I was there and that again was the part of -- the Valdez had the good and bad of it, you know. You were basically stuck here. If you were in some other place, you wouldn't be here. You'd be down having lunch with some group thing and running around the town and going to Seattle for some convention or -- because that's what they do and I know it's -- that's what -- I didn't make that many ventures away from town here, except for my own personal stuff that I would do. KAREN BREWSTER: And so Harborview shut down in '99, you said?
PAT LANDO: Yeah, yeah.
KAREN BREWSTER: What have you been doing since you retired?
PAT LANDO: I've become a care provider. KAREN BREWSTER: You retired from your career?
PAT LANDO: No, I went -- I'm also a taxidermist and I'm sure you'd love to see my taxidermy shop. I'm sure I got a whole bunch -- and I have hunted all over the world and I've done lots of -- lots of stuff that I shouldn't probably have done, but -- and I still do it even though my -- but interestingly I've come full circle, my poor little mother sat in that room right back there for five years and she was, you know, she came up here and broke her arm the first day she was here and that was the end of the story. And I was the only next of kin that she had, so I -- I, you know, I -- it was a long five years and you know I can -- and this house is very small and she was a very tenacious lady and very -- anyways, I was for the last five years I was a care provider. And you know the story, I, you know, at the very end I had to bring her out of state to find -- to find care. KAREN BREWSTER: So you didn't continue in social work?
PAT LANDO: No, I toyed with it and my wife said why don't you go out and do something, you know, because I still had I think a few -- a few things to offer. KAREN BREWSTER: You said you were fairly young, so --
PAT LANDO: Fifty-five, yeah. KAREN BREWSTER: But you chose not to go --
PAT LANDO: I chose to be lazy. Actually I chose to, we -- we went off to Montana and we made trips to check on our mothers. We had two mothers still alive and my wife's mother. We spent time commuting -- commuting back and forth for two years until her mother passed away. Then we came back here and then my mother came up and that was the end of story. So five years of that has been and I literally was here trapped in this house. I shouldn't say that on camera, but at times that's basically the way -- way it was. KAREN BREWSTER: We've covered a lot. I know you had made some notes of your own. Have we covered all of that? PAT LANDO: No, I basically scribbled some of the vernacular that I forgot about, you know some of the -- some of the titles and stuff and all of which I've touched on, you know. I just wrote down the different, you know, we had certain acronyms for, you know. KAREN BREWSTER: I just wanted to make sure we covered everything?
PAT LANDO: No, no, no, I just wanted to -- I forgot, you know. KAREN BREWSTER: Well, actually one other question that occurs to me now in terms of your residents and the things they did in getting out of the facility and you mentioned they went to school and recreational opportunities. Valdez is this amazing place. Did they go on field trips? Did they go and do activities? PAT LANDO: I think I mentioned it, yeah, they were out doing stuff all the time. You know, we had at least two or three different rec therapists and part of their deal was, you know, they had their a whole itinerary and one was the shopping thing. They'd go down to whatever was going on in town they would participate in. They'd be at every movie or civic activity. I don't know if you've seen our big Civic Center. We got a Civic Center for the size of a town of 50,000, you know and there's lots of -- KAREN BREWSTER: You mentioned the farm. Did they have a garden? PAT LANDO: We had a garden. We had animals. We had a whole bunch of stuff in the back that was kind of neat that was -- we had a barn. We had a -- and I just actually I was going through some stuff the other day and I was throwing stuff away, pictures of our farm back there that was -- but yeah, we grew and the kids would go out there and the whole idea Eva Dunning, who now is head of the Frontier Services here in town, she helped pioneer that farm. But I thought it was -- I think it was my brainstorm initially, but anyways we thought -- I said it would be great to have something for the kids to go out and do --
KAREN BREWSTER: Right. PAT LANDO: And monkey around outside and you have to work with the snow conditions, but yeah, it was -- we had pigs, we had goats, we had chickens. I think -- we had a big garden they'd play with and you know and they'd go out and monkey around. KAREN BREWSTER: Were the residents physically able to do things --
PAT LANDO: Some were --
KAREN BREWSTER: Like skiing or hiking or things like that, fishing? PAT LANDO: They -- fishing big time, right in the back yard here.
KAREN BREWSTER: Okay.
PAT LANDO: Bob Bassett, who owned this house, in the summertime this was a Shangri-La. He'd go out the back here and catch more fish off the dock here than I mean literally there are thousands of salmon come in here. So the kids used to come out here and fish. Some weren't, you know, obviously it depends on the level of functioning. You know some were able to do it and some were not, but I got -- all I can tell you is that they probably got more involvement here than they would -- everyone says oh how great it is to be up in Anchorage. You go out in Anchorage you get hit by a car, you know. Here they can go downtown, you can walk around and stumble around and we have a bicycle path, you know and you can actually get around and do some things that you can't go in big cities. I can take my dog out for a walk. I can do things here that-- KAREN BREWSTER: But when the residents left the Harborview facility, were they -- could they go out on their own and walk the beach or they were supervised or how did that -- PAT LANDO: In other places?
KAREN BREWSTER: No, here. In Harborview, if a resident wanted to go shopping or --
PAT LANDO: Right.
KAREN BREWSTER: Or wanted to go for a walk? PAT LANDO: Would they have to be, yeah.
KAREN BREWSTER: They were supervised.
PAT LANDO: Oh, of course, of course. There was -- and I say the higher functioning ones we moved out very soon on our own before hand. So what I'm saying what we were left with were the folks that were really impaired. We -- the dementia unit now is a little different. Now we had a really mixed bag in the dementia unit. I mean there was some folks that were -- we had several closed head injury people, automobile accidents and stuff that were very combative and then you know we dealt with that. There was some -- KAREN BREWSTER: How did -- how did you handle those patients with the developmentally disabled?
PAT LANDO: Well we -- they --
KAREN BREWSTER: Were they in a separate unit? PAT LANDO: They dealt with them as a separate entity, you know. There wasn't too much -- there wasn't too much comingling with that, you know. There was -- there may have been some, you know, but for the most part it was done separately because they were adults and they were, you know, different -- different things going on with them. KAREN BREWSTER: Do you remember what years -- you said it was near the end? PAT LANDO: Yeah, it was in the late -- I should know that. I would guess in the late 80's or mid-80's, '85, '86 something like that maybe. It was called the Sourdough Unit and we had -- we had wonderful things with some. We -- there was a fellow that -- have you been on the Glenn Highway a lot, haven't you, the -- what's the -- the King Mountain Lodge right there, the fellow that built that? The fellow that built the first house on Nancy Lake. He ended up down here because the Pioneer Home couldn't manage him. Great guy. Great family and, you know, he shouldn't have been down here, but they couldn't -- they bounced him out and so some of these really combative guys, you know, and there's a stage in Alzheimer's, you know, where you go through that combative stage. We had the behavioral tools because we had been doing that kind of stuff for so long we were able to deal with that behavior much better than they could in the nursing homes threw up their hands. They don't know what to do. All they can do is medicate him. They don't have -- they often don't have the tools to deal -- they don't have the behavioral background. So our whole emphasis was for so many years was that the educational mode. I mean everything. The school, the college stuff, all the con -- everything we had was based on modifying behaviors, you know, and dealing with that kind of stuff, you know, so it all came naturally. KAREN BREWSTER: And were the residents taught life skills for independent living? PAT LANDO: Yeah. I think as -- and particularly in the OT department they had -- we had our own kitchen down there. And Shannon -- Shannon Irish is head of the rehab services over in the new hospital. She heads up the whole rehab department. She is a doll and she came in and she used to have a kid -- and Mary Melborn (phonetic) anyway two really nice gals, very smart. They had a kitchen thing where they'd teach them cooking skills and they were trying to get them ready to maybe get out and do some on their -- they wouldn't be on their own but they may be in a different setting. So that was as I mentioned to you our -- in the facility the way it was originally set up was -- even over at the other hos -- or at the other school they had as setup over there for teaching some of those skills. They had kitchen facilities. Again that building was designed for the Harborview clients, so it had very specific things, including a very exotic hydrotherapy pool that was a huge expense, you know, because of all the muscular problems and all the mobility problems that these folks have. KAREN BREWSTER: And what was the reaction? Did all that money being spent for these few number of people --
PAT LANDO: Well --
KAREN BREWSTER: And then, had to close, I mean, not close but -- PAT LANDO: The wisdom of it and I was -- the fact and my good friend George Makowski (phonetic) was -- they knew that the time would come when we'd have to convert it so when they built it, they built it with the eye that they could convert it over. So now it's a full, you know, the elementary school was closed. The old elementary school became the college, okay and then the Herman Hutchins School became a full-time elementary school. And so you know and even though the population has gone down, its -- you know, it was converted easily over to a -- KAREN BREWSTER: From a political perspective it has been criticized that that was -- the City of Valdez --
PAT LANDO: A ploy?
KAREN BREWSTER: Kind of took advantage? PAT LANDO: Well, it could have been. It could have been a real -- I -- at the time we thought it was -- it made sense. I think -- I don't know how the money came. I think there was some Mental Health money that may have been put into that. The school did get criticized, I can tell you, early on because they were counting our students as full-time students and getting money for that. And the fact of the matter was, early on they were only getting an hour or two and that was, you know, that was pretty shaky. That was brought to their attention big time, you know, we -- I remember that was a long time ago but we said this is -- you guys are making money off of our clients.
KAREN BREWSTER: Right. PAT LANDO: So that really spurred them to go into a full time, so they actually had a full day of school, but the school bus used to come over. We had a ramp set up for them. They'd go on that school bus and they would go off. They'd be over there from nine o'clock until whatever two o'clock in the afternoon. So they did get a full day of school, but initially yeah there was some shaky times when they were counting them as full-time students and were getting reimbursed for that so. But that was way, way early on and that was -- that came up as an issue at the time. Sarah -- that's just me. KAREN BREWSTER: This is my last question.
PAT LANDO: Okay. KAREN BREWSTER: Would be, you know, we talked about Harborview met all this criticism for a certain time, you know, families may have felt their children were or were not being taken care of, how did you deal with that criticism personally? PAT LANDO: Well first of all, families did not feel that way. I think I already said it a couple of times. I don't think I ever had a family member make a formal complaint nor did they ever come -- call me up and make a formal complaint. We had one very bad incident and I won't even get into it, but it was a bad one. A bad assault of a client and the mother that, that -- she was one of the most vocal parent that we had and she could have taken us to the cleaners and she did not. I was -- always to this day I said my God she could have taken us to, you know, and this guy got caught in the act of an assault thing -- KAREN BREWSTER: One resident to another resident?
PAT LANDO: Yes -- no, it was staff.
KAREN BREWSTER: Okay. PAT LANDO: And it hit -- it hit the -- that was probably the worse of the days as far, you know, had the newspaper out here from Anchorage and oh God they were all over me, yeah. But this woman and she was so vocal and she was on the Governor's Council, but she never -- she took that in stride and I'm not sure why, you know. And she, you know, we took the guy to court and he ended up in jail and everything. But yeah, she could've really made a thing of it and -- because it was, you know, a miscarriage, this guy did some terrible things to this kid, but she did not, you know, she could have really gone with it and she could have got an attorney. I mean that was the lowest point of any major incident other than that, I can -- we had very few issues. We had one other concern that I -- we fired three guys, four guys over some abusive kind of stuff and that hit the fan. And they somehow got reinstated even though we went through a whole bunch of stuff including a court thing. But yeah, given the thousands of folks we dealt with, that's a pretty good record, you know, in terms of incidents, you know. So I was lucky in that way, you know. I think we kept on top of it and so. But that's, you know, those were two things that I think of and those were bad days and when those things hit the fan, you know, you got a lot of attention. KAREN BREWSTER: Yeah and that's what I said within Alaska there's a sentiment of negatively towards Harborview whether that's correct or not. There's a bit of that bias. PAT LANDO: Yeah and I don't why. First of all, you should understand and you may already understand this. Valdez is considered to be the rich kids on the block. People are mad as hell that this oil money is coming in here. When our kids go play basketball, mine surely did around the state, you know. They used to get booed, you know, because they, you know, these kids came out and the money that these people are making across the bay is crazy. I mean they're making money as doctors money -- they're making $180,000 for sitting watching dials over there. So the town is -- has got, you know, has always got the reputation of being the rich kid on the block and so that has something to do with it and you know, and I think I used to pick that up when our kids would play ball, you know. Here comes the cocky kids from Valdez, you know, they think that they're on top of the world. But when things were, you know, when money was flowing and everything was going so that has something to do with it. That has something to do with it. You can't fight the other part of it. The other part is, you know, its engrained in the whole philosophy that institutions are inherent -- I think I've already said -- are inherently evil institution. We are the, you know, and that's the fact of the matter is we were not a bad institution and I think we were about as good -- if you have to be an institution, we were as good as they come. And I think that's and I don't think you could find anyone that could tell you otherwise. KAREN BREWSTER: Well I think that's a great place to stop and unless --
PAT LANDO: And that's the truth.
KAREN BREWSTER: Okay. So do you have anything else we -- I haven't asked about?
PAT LANDO: No. That's -- I think we've covered more than you probably wanted to cover.
KAREN BREWSTER: Okay, great, thank you very much.
Pat Lando was interviewed on April 29, 2012 by Karen Brewster and Marla Statscewich in Valdez, Alaska. From 1972-1999, Pat Lando worked at the Harborview facility for the developmentally disabled in Valdez, Alaska. He was superintendent from 1976-1999, when Harborview closed and he retired. Harborview was originally opened around 1961 with some of the residents transferred from Morningside Hospital in Portland, Oregon. The buildings were destroyed in the 1964 Earthquake and a newly rebuilt facility was opened in 1967. In this interview, Pat provides an overview history of the facility, the services provided, the facility organization and staff, and the controversy over institutional versus community and home-based care of people with developmental disabilities. He discusses residents coming from Morningside Hospital accompanied by nurse Lynette McCoy who then worked at Harborview for ten years. He talks about the relationship between Harborview and the town of Valdez and between residents and their families, working with the state's administration, type of care provided, effect on residents, and the fight to keep Harborview open. Part two of this interview.
Click to section:
Moving to Alaska to work at Harborview in Valdez
Harborview Memorial Hospital
Morningside Hospital in Portland, Oregon.
Patients coming up to Harborview from Oregon
First patients arrived in Valdez in the early 60's
Alaska Psychiatric Institute was a screening agent for Harborview
Original population at Harborview
Appointed guardians for the clients of Harborview
Lynette McCoy, previous superintentant
Harborview was Bill Egan's gift to his hometown
Medicaid Waiver Program
Original delivery of services
Film called "The Salmonberry Story" about a camp the clients helped build
Change in philosphy from medical to educational model
Variety of services brought to Valdez
Hermon Hutchens Special School and educating clients
Building the school wasn't popular in Juneau
Constant threat of shutting down Harborview
Recruiting new staff
Becoming the superintendent
Prince William Sound Community College degree in Developmental Disabilities
Staff relationship with eachother
Physical description of the Harborview facility
Ratio of staff to resident
Renovation of the building
Effect of model change on the employees
In-service training and the dementia unit
Expense of Harborview as clients began to move out
Tried to convert Harborview into a corrections facility
KAREN BREWSTER: Well, we're on. Okay, I'm Karen Brewster and here in Valdez with Pat Lando. PAT LANDO: Lando, that's a good French name for you, huh, except it's spelled differently. KAREN BREWSTER: And today is April 29, 2012 and this is for the Mental Health Trust History Project. Thank you, Pat for letting us come -- interrupt your Sunday. PAT LANDO: I'm missing church because of you, you know, so we're both going to go to hell.
KAREN BREWSTER: Okay.
PAT LANDO: Okay. KAREN BREWSTER: Good, we'll meet you there. Before we get into the Harborview story, I just want to start a little bit with some of your personal background. Where you were born, where you came from? PAT LANDO: Okay. I'm from Minnesota and went to the St. Thomas College. My only claim to fame is I went with Vince Lombardi, Jr.'s son, so that was a -- that square-headed guy sat in front of me for four years, so -- but at the time was -- anyway. Then I went -- had a Masters Degree up in Canada at the University of Manitoba. KAREN BREWSTER: In what subject? PAT LANDO: In social work. And then I worked in a variety of settings from you name it to -- in state hospital setting in Minnesota to a private residential treatment center for adolescents to foster care to adoption stuff up in northern Minnesota. I worked in Canada in several settings up there. And then I decided I needed to go to Alaska and broke my parents' heart and took the only grandkids they had and we came up here in '72. So I had a variety of experiences prior to coming up here and I had a job offer that was basically to be the first social worker of the Harborview Institution and -- KAREN BREWSTER: Was that something you applied for? PAT LANDO: I applied for and they were looking for somebody -- back in those days a MSW was hard to come by and hard to recruit any professionals up in Alaska and so a little bit of -- I don't want to get off on a rant here, but my original application was on that airplane, the only airplane Alaska Airlines that crashed -- in Juneau. KAREN BREWSTER: Oh, right.
PAT LANDO: Do you remember that, back --
KAREN BREWSTER: Yeah. PAT LANDO: My application was on that and so I, you know, I should have been here several years before that, but I -- everything got lost and then that's apparently what happened. So that was kind of a fun little twist of fate. But then I reapplied and showed up here in a pickup truck and, you know, and it was hardly a place. We didn't have a bed to sleep in and Valdez was a very humble place. Seven hundred people, 800 people. Fortunately, the Harborview had its own housing, which was a crucial part of the puzzle because there was no housing for anybody. So we had a neat housing complex that we were able to get an apartment because without housing you didn't have employees. So that's how it all began and I was in my late 20's. KAREN BREWSTER: And you were already married with children? PAT LANDO: Married with children, dragged them up there and they said what am I doing up here in godforsaken Valdez. But it was very simple times. No TV. Housing was strictly trailers for the most part. KAREN BREWSTER: 'Cause this wasn't long after the earthquake? PAT LANDO: The earthquake in '64. The house, you know, as you know the old town was moved four miles to the current place of, you know, on higher ground and the real piece of the puzzle was, you know, this was Bill Egan's hometown and he was the governor at that time. And he, you know, opened up the Harborview Memorial Hospital and that was the name of it. And that was, you know, there was no hospital and the hospital was destroyed over in Old Town. And so that was an interesting thing. Here you had a state operated city hospital, you know, and it was curious when they have a patient would come in, they'd have to shut down and then the nurse would run over and open up the hospital to take care of the patient. There was one doctor in town. An interesting fellow named Dr. Shunk (phonetic) from Wyoming who was past his prime and we won't get into some of the details of that, but the nurses basically ran the hospital, and Dr. Shunk would come in when he was -- had all of his faculties together, and he used to take care of business. But we had some very powerful nurses back in those days and Lynette McCoy was certainly one of them. She was the director at the time. KAREN BREWSTER: Yeah, tell me about that. That was -- Morningside was closing down. PAT LANDO: Morningside, yes. The Morningside Hospital in Portland and I was not there, but I -- Lynette came up -- Lynette and Helen Nye were the two parties that came up here and before that the medical director of that facility was also -- came up and I think he only spent about a year here and then Lynette took over as the superintendent. But that was a bit of a -- as I remem -- as I was told it was the classic institutional mess, you know. I mean it was in terms of level of care -- KAREN BREWSTER: That -- what Morningside? PAT LANDO: Morningside and the -- the what really happened over those years during territorial days as I understood, you know, they were shipping -- everybody got shipped out to Morningside Hospital. And I'm talking kids, three, four, five year old kids all under the old statutes, under the old Mental Health Statute, the old commitment laws. It was modeled after the Oregon Commitment Laws. So you had basically kids that were, you know, had disabilities, some of them were marginally disabled, you know, with maybe a seizure disorder. And they were being put in with adult psychiatric patients. And, you know, you talk about a bad mix. And the conditions as I was told were very poor. And if you weren't disturbed, you were after you spent time in Morningside, because these kids were, you know, these were often kids from the villages. We had many, many of -- seventy percent of our population was from the villages. These good hearted nurses would go up and pluck them out of these villages and put them on an airplane and ship them down to Morningside Hospital. And God knows, you know, what they were exposed to and some of them that I met early on were, you know, hardly impaired in terms of their mental retardation, but they had all kinds of other behavioral problems associated with just the environment that they were in in Morningside, so -- KAREN BREWSTER: So do you know why -- when Lynette McCoy and Helen Nye and they brought those children here to Valdez, and when they did? PAT LANDO: The original group came up in -- right after in '67 and then -- KAREN BREWSTER: So they brought them to -- PAT LANDO: They brought a group up. They flew them up here. One of my first assignments was to -- I chartered an airplane, a twin engine airplane, and we went down there and we went to -- the other place that they went to was called Baby Louise Haven. And I went there and visited and those kids are basically in big cage-like, you know, enclosures and there was certainly no active treatment going on. You know, it was basically custodial care. And I visited down there. They were in Salem, Oregon. So that was one of my first little jobs was to put that altogether and we brought up another I'm guessing 40 to 50 patients. And we weren't calling them patients, we called them residents. We brought them up and I remember landing. That was before we even had a runway out here. We just had a gravel strip out here and it was pretty rudimentary things, but we brought the -- so at that point, probably not very much after I was there, we had up to 120 some people at Harborview. So that was a pretty good chunk of humanity, you know. So -- KAREN BREWSTER: But that first group that McCoy brought, that was before the Harborview facility was built, you say -- PAT LANDO: Okay, now -- she wasn't party to that -- and that was a little piece of history. And, in fact, I remember the -- I sent that to the archives actually. The head -- actually the title was "First Mental Health Patients Arrive in Alaska."
KAREN BREWSTER: Uh-huh. PAT LANDO: And they went to the nursing home in Old Valdez. And I'm guessing it was like 12 or 16 of them came up from Morningside. And then when the earthquake happened -- KAREN BREWSTER: So do you know when that happened -- what -- PAT LANDO: That was '61 as I remember and this is I'm flashing back, you know, 40 years here, but I just remember -- I have a good memory. That's one thing I have that's still intact, but I remember the article and when I shut down the joint we went through all the archive stuff and I sent things I thought were pertinent for historical reasons to Juneau. And I remember that jumped out at me and I was told that that was, you know, that had occurred. KAREN BREWSTER: Do you know why they brought them here? PAT LANDO: Good question. I don't know how that was done. KAREN BREWSTER: Or who -- and that wasn't McCoy? PAT LANDO: No, no, no, that was before Lynette.
KAREN BREWSTER: Okay. PAT LANDO: And I don't know who pioneered that, but all I know is it didn't last very long because the earthquake happened and then at that point API was built, the Alaska Psychiatric Institute was built and then they had to -- I mean everyone had to evacuate and they moved those clients up to API. And then a lot of them probably filtered back down to Harborview after that. KAREN BREWSTER: Actually, that was one of my questions -- where did -- PAT LANDO: Yeah, and so many of them filtered from API. API became a screening agent for a lot of the clients because again they were mixing and matching people were in a, you know, in a psychiatric facility that shouldn't have been in there. And then API actually had a unit, as I remember, of -- for developmentally disabled people, but there again there was no active treatment. It was strictly under the old medical model, you know, and -- So we brought them back down to Harborview so we often, you know, that was a screening thing that they would send them down to us and we would, you know, proceed from there. KAREN BREWSTER: That was my question about the first ones because originally the Harborview Nursing Home was built in -- well it was remodeled in '60 to '63. PAT LANDO: Okay. KAREN BREWSTER: And then the earthquake was '64 and so those people went to API? PAT LANDO: Right. KAREN BREWSTER: API had already been built, okay. PAT LANDO: API was -- had to have been built within a couple of years before -- I don't know exactly the date of API --
KAREN BREWSTER: I can't remember either.
PAT LANDO: -- was built, but it has to be somewhere -- KAREN BREWSTER: Somewhere in there.
PAT LANDO: In '63, '60, yeah. KAREN BREWSTER: It was rght after statehood, I think --
PAT LANDO: Right.
KAREN BREWSTER: -- it was started.
PAT LANDO: Yeah, yeah. KAREN BREWSTER: And so then those res -- after the new Harborview was built in '67, those residents were brought back here or --
PAT LANDO: Correct.
KAREN BREWSTER: Okay. PAT LANDO: I don't know how many -- we used to, you know, there was a constant referral process that went on, you know. They would do their diagnostic stuff and then think that they'd be more appropriate for Harborview and so they, you know, they would send them down. The original population that we saw at Harborview were very high functioning. These folks were really a mixed bag of, you know, talking about mixed diagnoses, you know, of mental illness and oftentimes it started out with a seizure disorder and then it developed into other behavioral things and psychiatric issues, so they were a real mixed bag of problems. A lot of them we -- we -- weren't properly diagnosed. In those days, God knows how many were alcohol syndrome related and again many came from the villages and their prenatal care was always, you know, an issue. God knows, you know, the conditions they came from and there were lots of strange feelings amongst the Native people about disabilities. You know, they were often, you know, treated very poorly because of their -- there was some kind of voodoo kinds of mentality, you know, about seizure disorder, for example. And so many, many of our people had seizure disorders and that frightened the locals and they would then be ostracized from the villages. So that was -- because I found that out firsthand. Another little thing that I did, interestingly we chartered the only plane in town and I took six clients and we flew them from here all the way up to the villages, and I brought them home before they even talked about de-institutionalizing. These were very high functioning clients, and brought them back to the villages in Dillingham and Qwethluk and Nome and we flew, you know, actually Dave Kennedy was the only air service in town, Kennedy Air Service. We chartered his airplane and took them all. I brought a great big camera, you know, this big old camera thing must have weighed 60 pounds and I was going and it went to hell on me the first village we got into. But I wanted, you know, kind of revisit what they were going into and how they were being received by the families. KAREN BREWSTER: What year was that? PAT LANDO: That was probably in '74, yeah. KAREN BREWSTER: How did you arrange that? Did you contact the families? PAT LANDO: Oh, yeah and that was part of my -- we, you know, we were pretty savvy at that point. We knew these people, you know. They were often young adults that didn't need to be here and we contacted them and tried to make provisions. The -- what wasn't there, of course, was Special Services. I mean these villages at that time and still now, you know, the services aren't up there. If you've worked in Barrow, you know about what I'm talking about. The other thing we found out later on was that many of these people do not want them back in their home. There was a whole idea once you're gone out of sight, out of mind, you know, and I found that out the hard way when I tried to get folks to, you know, rethink taking kids back in the villages because there wasn't services there and often there wasn't -- the people didn't want them. The other thing I found out even some very prominent people in Anchorage, which I won't even get into, had family members down in Morningside and Baby Louise and they did not want them back in Alaska. They wanted them gone and, you know, when I approached them I met with a lot of resistance because I met with all of them. The other thing that was really of astounding and which it's a wonder someone didn't sue somebody. All these people were down and these kids were down, you know, under the old statutes. None of them had guardians. None of them had guardian ad litem's. They were down there on what authority? Who knows. But, you know, in terms of disservice how would you liked to have had your child pulled out of a village, shipped to Morningside Hospital, put in that kind of environment, which I guess would be very bad and -- and so again one of my first jobs was to get guardians appointed for all of the clients, because they were basically in a limbo status. Many of them, you know, were sent down there as, you know, when they are three and four years old and I -- now they were 18. We would have them at Harborview by what authority? I mean it was really a -- so I spent a whole bunch of time trying to get the attorney general's office to get guardians appointed for these people. And it took me a couple of years. And then I, of course, the first people I went to was the families.
KAREN BREWSTER: Uh-huh. PAT LANDO: Do you want to become the guardians? And many of them did not want to become the guardians. So then we had public, you know, people -- what do you call them the certain officials? I'm trying to think of some of the people that were actually signed as guardians, guardian ad litem type things that were -- KAREN BREWSTER: Like a social worker? PAT LANDO: Right, you know, there was a number of them that took down that responsibility. Public guardians is what I am trying to think about. The public guardians, the Office of Public Guardians is what I'm thinking about. KAREN BREWSTER: So when you took those people back to the villages, those six people you're talking about, what was the reception from the --
PAT LANDO: I -- KAREN BREWSTER: -- community and their families? PAT LANDO: You know, it was -- it was -- it was one of these -- back in those days you kind of did what you wanted to do, you know. We didn't have a lot of oversight. It was, you know, Lynette and I guess we talked about and she says I think these people need to be back home and let's do it, you know. We didn't have to -- we didn't have to have permission from somebody in Juneau. KAREN BREWSTER: Uh-huh. PAT LANDO: And I really like to make that point because we -- we -- life was a little different, you know. We could make decisions. We -- I think sound decisions without having somebody sitting down in Juneau giving us permission to do everything. We had full line authority to do pretty much what we thought was in the best interest of the clients. And I think we for the most part did the right thing by them. That changed dramatically, particularly when we got into the Medicaid stuff. Someone came along with the brainstorm, and probably rightly so that we needed to get into the Medicaid business. And with that came all the regulatory stuff. And Lynette left in '76 because she didn't want to be party to having people tell her what to do. And she didn't want anyone from Juneau telling her what to do and she wouldn't. If they came down, I could tell you some interesting stories. She'd crush them. You know they'd come in with their little suits and ties and she would literally, you know, it was quite a way she had -- KAREN BREWSTER: It sounds like she was quite a strong willed woman. PAT LANDO: She was a more than a strong willed -- She was an old Army nurse and she had a -- she had the smile of Bill Buckley. You know Bill Buckley, the famous -- you've heard of Buckley. He wrote lots of books.
KAREN BREWSTER: Oh, William Buckley. PAT LANDO: William Buckley. KAREN BREWSTER: Yeah, yeah, yeah. PAT LANDO: She had that same smile as William Buckley and she could sit back in a chair and she could just crush them. And I was always amused by it, because they'd come down and she would basically say that isn't the way we're going to do it here, you know. That was before Unions.
KAREN BREWSTER: Uh-huh. PAT LANDO: It was when central office had about ten people, and most of them could care less about Harborview. KAREN BREWSTER: And she was -- Lynette McCoy had been a nurse at Morningside -- PAT LANDO: She was at Morningside and then before that she was a nurse in the Army -- Army nurse, so -- KAREN BREWSTER: In Korea, you said? PAT LANDO: Yeah, and she was a psychiatric nurse because she -- me and her were talking about having to deal with the soldiers, you know, and the psychiatric, you know. And they didn't have the equipment. They didn't even have the medications, you know. I think Thorazine was the only thing they had on -- had going in those days. KAREN BREWSTER: But so she -- she came up here to Harborview with patients or residents from Morningside as part of the transfer? PAT LANDO: Right. And I don't know at what point she came in and then they came in. It had to have been very close together because the place opened up in sixty what - I'd say sixty -- KAREN BREWSTER: Sixty-seven. PAT LANDO: Sixty-seven. And I remember seeing pictures of the big -- they had a big ceremonial whatever going on and they had lots of -- I'm sure the governor was there and they had a lot of celebrities there and it was a big deal because the town needed -- needed it, you know, probably. And I think at the time the clients needed it too -- the clients that were out there in Morningside. KAREN BREWSTER: But Morningside was closing? PAT LANDO: Yeah, so there was a, you know, there was a rush and at that time the economy in Valdez was gone. We, you know, the port was gone. This was a major port for Alaska, and that port ended up going to Anchorage. So the -- there was very little going on in terms of the economy. So between Harborview and the Highway Department, Department of Transportation had a -- quite a group of engineers, and those two entities kept the town going. KAREN BREWSTER: Do you know why Harborview was placed here in Valdez? PAT LANDO: Well, I'm telling you it was Bill Egan's gift to his home town. And that's how it was always perceived. And that's how I always talked about it. You know, he's -- his town -- his hometown was in, you know, had been destroyed and he knew the economy was gone, and it was extremely unpopular, believe me. KAREN BREWSTER: What building Harborview here?
PAT LANDO: Yes. KAREN BREWSTER: Why?
PAT LANDO: The ARC -- the Association for Retired Citizens up in Anchorage. They went livid, and they -- that stuck in the craw of the Anchorage group from the very beginnings to the very end. They were absolutely -- and there was some that they never -- they never forgot about that and it was the driving force. The first thing I heard when I walked in the door. Well, they're going to be closing Harborview and that was in '72.
KAREN BREWSTER: Seventy-two. PAT LANDO: Don't expect that this will be here very long. KAREN BREWSTER: And when did it close? PAT LANDO: It closed in '99. I literally turned off the lights. I stayed until the very end and I, you know, and there was some things that happened in between that I -- Kim and I, and time went on and we -- anyway there's a lot of things that kind of came into place, but, you know, you know the Medicaid Waiver that came in. As you probably know the Medicaid waiver that diverted funds over to the nonprofits to the, you know, to the -- KAREN BREWSTER: No, I don't know. PAT LANDO: Okay. Well, the Waiver Program was really a big step. It took a long time to get in place. Basically, it took money that would -- you know, the only way you could get federal money is to have them institutionalized, you know. And the Medicaid money that came into Harborview was very important to the -- to the budget, the Mental Health budget. We brought in three or four million dollars every year. Our budget at one point was up to 8 million dollars, so it was a hunk of change that came into town. Half of that was, you know, federal match monies. I can't play with my toys?
KAREN BREWSTER: No.
PAT LANDO: Okay. KAREN BREWSTER: No. It makes too much noise. PAT LANDO: But anyway that was -- that was a big one and -- and the fact that we became certified as a Medicaid provider was a big step because that opened the door for the funding. And it also opened the door for major changes in philosophy and delivery of service. KAREN BREWSTER: Wow. Well, why don't we step back a sec -- then what was the original philosophy of delivery of service? PAT LANDO: The original service -- because the folks that ran the place were medical nurses. The place was full of nurses. They did it more of the -- remember "One Flew Over" [The Cuckoo's Nest] don't you?
KAREN BREWSTER: Uh-huh. PAT LANDO: Okay, well it had that kind of mentality. It was -- but it was a benign kind of "One Flew Over" believe me, but it was controlled.
KAREN BREWSTER: Uh-huh. PAT LANDO: You know you control them, you medicate them, you restrain them, you -- you, but it was done in a loving way, I'll tell you that. Lynette was strong handed and the philosophy was strong handed, but the clients were not mistreated, although I can harken back to some of the restraint policies that would not be acceptable today. Some of the people we had were really difficult to handle and they didn't have the -- the repertoire if you will of medications that we have today, you know. So there was some restraint stuff that was probably una -- you know, very unacceptable now. KAREN BREWSTER: Such as? PAT LANDO: Talking about leather restraints, you know. Four point leather restraints and it was, you know, these people were -- some pretty difficult people. I mean they would be physically abusive to themselves and others. I'm talking -- you ever been in an adult psychiatric facility? KAREN BREWSTER: Not personally, no. PAT LANDO: Well, I have and I, you know, you're talking about people who are going to gouge your eyes out, you know, I mean. And you're talking about physically, you know, safeguarding yourself and others and -- KAREN BREWSTER: And Harborview had those types of -- PAT LANDO: We had some of those folks, some very difficult ones, very tough ones. So that, you know, the model at that point was we had -- we had a large number of nurses. They had a recreation department and another little interesting piece of the puzzle was we had a recreational camp out here just past the house called The Salmonberry Camp. It was built by the -- clients actually helped build it. And it took them several years and it was 80 acres. It was developed into a camp and they used to live out there in the summertime and they made a movie of it.
KAREN BREWSTER: Yeah. PAT LANDO: Called The Salmonberry Story.
KAREN BREWSTER: I think I've heard of that.
PAT LANDO: And it was a really neat movie to watch and it is some place in the archives. MARLA STATSCEWICH: It's -- the library has it at UAF. We have a copy of that. PAT LANDO: So that was built by -- up there and now it's the -- the city just turned it into a ski -- ski hill. But anyways there was programming going on, but -- but the overall philo -- you know, philosophy of treatment was medical. So we went from the medical model, if you will, to the educational model and the -- when you became accredited under the ICFMR label. KAREN BREWSTER: What does that stand for?
PAT LANDO: It's Intermediate Care Facilities for the Mentally Retarded I think is what the title. It was a, you know, then there's skilled nursing. There's a whole bunch of levels of Medicaid care, but this was -- then we got into the regulatory stuff that was overwhelming. Overwhelming to the point were we had I don't know how many nurses quit on us because they just didn't want to get into that bag and we literally reclassified every position in the house. We changed nurses from nurses into unit supervisors. I'm going to have to do something with my critter out there I see. But anyway we -- we changed their whole world, but it was for the better and we went into individualized treatment programs for the clients. KAREN BREWSTER: What do you -- give me an example of individ -- PAT LANDO: Well, it was a multi-disciplined, you know, the multi-disciplinary approach to -- to providing services. We had a, you know, the other thing I did or tried to do, I built a team and I recruited all over. I mean I brought in the first physical therapist to town, the first occupational therapist. I brought in some great rec therapists. I -- we had the first psychologist. We had on contract the Langdon Clinic, for example. We had contracts with a whole bunch of docs from Fairbanks. Dr. Kinn, used to own the clinic in town here originally. KAREN BREWSTER: I don't know.
PAT LANDO: Well, William Kinn is from Fairbanks. He was an ophthalmologist and all of his docs, this was their playground, but they also provided services for our clients and for the town and so they were all on contract. We had ENT [Ear, Nose, Throat], ophthalmology, all the specialty services, orthopedics. So we had a, you know, that all came down to down here.
The other great piece of the puzzle was the school district. And our -- it took a while, but the City of Valdez built a special school and it's still there today called the Hermon Hutchens Special School and it's now converted over to the elementary, but that whole half of that building and it was a beautiful building and it still is, was designed for Harborview clients. So all of our people went to school every day on a school bus. They came -- the school bus came, our staff would go with them over to school. They had six Special Ed teachers at least and speech therapists, a hydropool and you name it. It was top of the line and they went over there for a full day of school, which was a remarkable, you know, change, you know, we got them out of the institution. They went over to school and it was pretty neat and -- and, of course, the school got their funding off of it, you know, because they could count them as a student, but they did get some special grant money to build the Hermon Hutchens School, which is still there today and it is the elementary school. KAREN BREWSTER: So before that special school was built --
PAT LANDO: We had --
KAREN BREWSTER: Were the students of Harborview educated? PAT LANDO: Yes. We -- before that was built we had the teachers come over here and we actually had some -- some -- some buildings put in there. They were temporary buildings. They were built and the teachers actually -- and the upstairs -- well, Harborview was a very big complex, eighty some thousand square feet, okay, a very large building. That building was meant to be here a hundred years. It was -- it was eight foot of concrete above, below and is the only approved bomb shelter in town. It was built to be here forever. It was built by the Army Corps of Engineers and there was an annex part of that building and -- which was a gymnasium and then upstairs was a whole other area which was school and then we had a school down there. So we actually had our own school in-house and this is all flashing back in my distant mind. So we had the teachers actually there and so the kids would go off to school right in the same building. And then when we got into this -- the big -- the big picture was to get this -- the Hermon Hutchens thing going on and that -- a good friend of mine George Mycowski (phonetic) and Hermon Hutchens were both administrators at the time and they -- we remember we had to go down and petition the folks in Juneau for that money to build that school and it wasn't real popular because they didn't want money to go for that purpose. Plus, you know, anything we did that was construed as sealing the fate of the Harborview Complex never sat well with a lot of people, well Margaret Lowe, for example. KAREN BREWSTER: And why was that?
PAT LANDO: Because it was another piece that was -- that would have to be unraveled if you were to get away from, you know, shut down Harborview, that's -- I mean I heard that word so many times for so many years I, you know, we became very antagonistic towards it. And, you know, to -- to further develop the empire, if you will and to further, you know, would make it more difficult to close it down, so the more money you spent here and so there was some people that didn't see that as -- I remember I'd be sitting down with the Governor's Council for the Gifted and Handicapped, you know, that was the group, you know, and it was mixed group of providers and consumers and it was always -- always antagonistic towards Harborview. Their agenda was from the very onset to shut the doors down here and we certainly didn't fight it in terms of philosophy, you know, but we did fight it for some other reasons. We had our own selfish reasons I suppose, but, you know, we -- we always had to -- to fight the battle to -- to maintain what we did. But the bottom line was we maintained our accreditation for many, many years and we always came out on top. We, you know, we always made the grade, if you will. Every year as you know you get the local -- the state auditors come down and they go and it's always a stressful time when they come and do a state audit. It's like what they do in hospitals, you know. And then the feds would come in. The feds would do an oversight on the state surveyors and that was even more of a pressure because the regs changed each year. There'd be new regulations, you know, and as you know, if you've ever been in the hospital you know they spend more time filling out paperwork than dealing with patients, you know. So that was always a problem. You had to document everything you did, everybody had to have a, you know, individualized program. It was all a lot of behavior modification stuff, a lot of basic psychology, basic positive rewards and, you know, we -- each one was, you know, all beh -- we had a lot of behavioral stuff. We had a -- I say we had several psychologists over the years and they developed the psychology of trying to work on different behaviors. You had to identify behaviors that you're trying to modify and work towards and it was all done and then, of course, we were critiqued on how you did on those individual programs. And again we had multi-disciplinary meetings, you know, and there was a constant interchange between all the disciplines. So we had a lot of players. Then we had, you know, of course we had the local docs on contract and then in that group we had several very, very good doctors that came into town and Dr. Todd and Dr. Embick and some of the other docs in town that have come and gone, but there are some of them Dr. Todd is still here. So they were our primary physicians and they fed into it a lot because there was always medication reviews and, you know, you always had to have a medical point. And we still had a very strong nursing contingency there. We had a director of nurses and we had to have nurses on every shift, but they did not dominate the whole scene, you know, it was all -- they were player of it but they didn't dominate, you know, and that was the difference between a medical model and, you know, and the educational model, or behavioral model or developmental model is basically what it's all about. And it still goes on today I'm sure and so it was a major -- that was a major change in what occurred. KAREN BREWSTER: Now the other staff besides the nursing staff, what kind of staff was there and what kind of training did those people have? PAT LANDO: I think I mentioned to you already we had --
KAREN BREWSTER: You had aides and -- PAT LANDO: We had a whole -- at one point we had -- I'm trying to think of when I first got here I think we had like 160 positions at one time, which was huge we had then, but we also were responsible for housing. We -- I rise -- I ran the state housing. Are you cold? That door would close, if you would. We had a -- then during -- what really made life different was when the oil -- the pipeline was developed. I mean this town when bananas when the oil -- they started laying the line. We had 10,000 guys come into town. Every employee left, every male. I think we were down to about two males in the whole institution. So it was very difficult to keep aides and we went through staff at that time 10 and 15 a week and that was a very hectic, hectic time. But the good news was the unit supervisors, some of the department heads, were -- stayed with us for 20, 25 years, including myself, for whatever it is worth. But we had a very stable structure and these were good people. I mean solid, solid people. Our director of nursing Gail McGee (phonetic) actually is good friends with Lynette McCoy she's -- the PT and OT were gals from Montana that were in their twilight time of their careers. They came up in their sixties and they were both really strong people with a lot of backgrounds in -- one of them unfortunately couldn't pass the PT thing because she had been doing it for 50 years and, you know, and couldn't pass the -- they had to get licensed you know. I remember her trying to -- trying to get them to bend a few things because how do you expect to have someone to pass a test, you know, after 50 years of changes and stuff. The other people, the psychologist people, did have backgrounds, you know, they had Masters in Psychology. And the nurses were all -- we had lots of RN's and so, you know, we had a pretty good mix of -- of people with good backgrounds. When we hired unit supervisors they changed the, you know, the job descriptions were all changed and we wrote up -- basically we wrote up our own individualized job descriptions and requirements. We call them QMRP's - they are qualified mental retardation professionals and again this is all dictated by the regs, which means you had to have a Masters or a degree or at least a BA degree and so many years of experience in developmental disabilities and so it was clearly spelled out and that was always a problem. Recruitment was always a problem. Trying to get qualified people to come to Alaska, to come to Valdez, because if you didn't have one, you'd be -- you'd be in -- you would, you know, you would be in the deficit when it came to, you know, you have your oversight come in and they'd say well you know you're lacking, you don't have a PT or you don't have a, you know, someone with this kind of background. So we would often have to do it by contract. We had a pharmacist on contract. The pharmacy was very important obviously because we had to have overview of meds all the time. We had constant medication reviews. We had contracts with dental hygienists. We had contracts with again I mentioned all the doctors, the specialty docs that used to come down and contract with the clinic. We had Dr. Wolf, you mentioned Dr. Aaron Wolf came down for many years. Dr. Langdon himself used to come down for a few years so -- KAREN BREWSTER: So how did you -- how did you recruit people? PAT LANDO: Any way I could. Make up any story I could. I would get them to think about coming to Alaska. KAREN BREWSTER: Did it work?
PAT LANDO: Not well. I finally did get some. We actually had several good ones after that, but it was very difficult to get them to come up. I hired a psychologist and I remember meeting her. I went all the way to meet her to try to talk her into it because she had a resume that would knock your socks off in terms of background. I mean, she had written more documents and I won't even get into her name because she ended up suing the Alaska Psychiatric Institute because I think she had her own psychiatric agenda and it was very personalized, believe me and she -- after I spent some time with her she left and went up to API and ended up with a long-term issue with API and that did not go away. But anyway that was another story, but, you know, she looked good on paper and she had more background than you could shake a stick at. She was from out on the East Coast, but in terms of her functioning, it didn't work with us and -- KAREN BREWSTER: Now you started in '72. You weren't the director right away were you? PAT LANDO: No, I was a social worker for three years, yeah, three or four years and then Lynette left in April of '76 and somehow I became I guess her -- whatever I did she liked apparently, so she -- she was quite a mentor of mine. And she kind of said I want me to take over the job, which didn't go real well with the folks in Juneau. She told them what she wanted done and that didn't sit well with some people down there. But at the time I was here and I kind of knew what I was doing I guess and had some background. So I -- I kind of took off from there and I was only in my early thirties and I took on a great responsibility and probably wasn't completely well equipped to it, but I did it. KAREN BREWSTER: So that made you the main administrator of the facility? PAT LANDO: I was the superintendent yeah. So, given, you know, in retrospect, you know, I was before my time I guess because I was only like 31 years old and had all these people, particularly and you don't -- you don't tell these old nurses what to do. They don't like to be told what to do by young guys, you know, but, you know, I -- I somehow was able to schmooze my way through it. I never got in trouble, which was amazing. Survived all those years and the key was keeping the secretaries happy. And that's the God's truth. I had some great secretaries and some great -- because they make the world go around. I mean they can do more to -- so if you keep the ladies happy by just being nice and dealing with them as not in any kind of an arrogant way, you know, the -- my whole philosophy was to keep a happy family. Because if the family started fighting -- feuding, care goes out the window and so I -- my whole, I guess modus operandus was to kind of cruise a the unit and I spent a lot of time -- I didn't spend a lot of time traveling like a lot of your administrators love to go off to conventions, you know, and that kind of stuff and they love to do their thing away from -- I spent my time kind of wandering and kind of being part of the group, you know, And so I got to know everybody. The other thing is the town is so intimate that every family in town had people that worked at Harborview. I'm talking about every family. Former legislators, former you name it, they worked at Harborview, so you were very a closely knit group. Everybody knew everybody. I mean it was a -- the problem was that you got too big -- when you had to discipline someone and then you'd see them out in a restaurant or bar scene or whatever, it was very hard to live because it was, you know, it was too -- too close. But literally and it was a great starting off point for so many people. The mid-level employment in Valdez is gone. So every kid that came out of high school had a great little job they could start and they could work their way up through the resident aide. We had a whole series of resident aides and then they could jump into something and they could go off. The other piece of the puzzle that was really neat was the Prince William Sound Community College. They developed a whole curriculum just for Harborview. And they had at least three or four staff and some of them are still here today. Janice Johnson is one. She could tell you all about and they developed a whole curriculum that our aides were required to take and it was all behavioral educational model. So they had to go through this whole repertoire of classes so you weren't thrown in, you know, without having some background, so that was neat. So they -- they partied up with us and -- and all of our aides had to go through that educational process. So that was kind of -- again it was a kind of thing that you could do in this little town because you kind of knew how everything worked and -- KAREN BREWSTER: Didn't they offer a degree in Developmental Disabilities? PAT LANDO: Yes, they did, yeah. They had a -- they actually offered an undergraduate AA degree in Developmental Disabilities. And Janice and a gal named Wendy Weidaman (phonetic) and there was how many -- they had three or four people that were kind of really gung-ho and Janice is here today. KAREN BREWSTER: In terms of the staff getting along with each other, I wonder how did that work with the long-term employees who'd been here under the old nursing model and then these new --
PAT LANDO: Well --
KAREN BREWSTER: Guys coming in with this different --
PAT LANDO: Yeah, yeah.
KAREN BREWSTER: Model. How did that work? PAT LANDO: It -- it -- it didn't work for some. I had some nurses that basically were so threatened by the concept of changing their name. Nurses are very funny people, as you probably know or don't know. Well, I know. They're very, you know, they, you know, they have their own very pointed view and, you know, nurses don't like to be told what to do, except by a doctor, you know. And they don't like, you know, if it's -- it's an assault against their nursing profession or they perceive it as an assault, it can get real sticky. So I had some nurses who got up in arms, you know, and I can't -- I cannot do this. I'm a nurse. You're threatening my license. I cannot do this kind of stuff, because we basically took a nurse position, an RN, and said you are now going to become a unit supervisor. You are going to manage a unit. That's the other part that I should mention to you that Harborview was built like a wheel, okay. The building was a -- had a centerpiece, which was called the, you know, it was an arena if you will and it was -- and each spoke went off. There were six spokes that went off and each of those became -- so we went to the unit system, which again -- KAREN BREWSTER: So each spoke was a unit? PAT LANDO: Each unit, yes. And each unit had a designated name we made up, I think they were all called various things like we -- birds of Alaska I think we called them. We had a ptarmigan unit and we had a -- we had an eider unit. We had a swan unit. We had an eagle unit. Anyway, each one had a supervisor, so that was a way of -- of managing a unit. It's much more difficult, you know, to have a -- if you know anything about how institutions work. If you get someone coming in and try to manage this whole conglomerate you, really -- really difficult. You have, you know, the charge person that comes on, you know, is -- so we found by partializing it out by segments was a much more, you know, better way to manage. So you'd have, you know, 16 clients and so many staff and, of course, maintaining the staff ratio was a very critical part of it. KAREN BREWSTER: What was that ratio? PAT LANDO: We tried to keep it, you know, again this is all dictated by regs. Everything we did was by regs and I -- it was like a one to two ratio, one to three that I remember. I could get a little vague on that, but we had, you know, and that was a trick, because you had to have so many on during the day shift, so many on the evening shift and so many on the night shift. And again with the turnover problem and it had to do with the pipeline activity it was really tough. So some of them stuck through the whole process and were with us for 30 years. Some of them, you know, we just had a group that just came and went and came up for oil jobs and worked for six months and be gone, but that was the trick. But the units -- the unit system and I should tell you the other part of it that we -- that was very critical was we -- the building was built in an open expanse, which was not very good for what we were trying to do. So we took each unit and broke it into individualized bedrooms, semi-private bedrooms were built on each unit, which made it more homey. So our whole philosophy was to create a home-like environment, you know, trying to, you know, and the more you could break it up and partialize it and give people space and privacy and all the little amenities that you try to do. The only thing we didn't do was having semi-private bathrooms and we had to get a waiver for that. There wasn't enough room physically, but again the regs require that they have 80 square feet or something per client and we called them residents, but anyways -- we spent a lot of money remodeling the building. In the meantime that compromised the duct work because the duct work is based on an open system, so it got more complicated and the other part of the puzzle that was eventually probably part of our demise was all the heat came from the Department of Transportation. They had a huge high pressure boiler system. So that in itself kept six people working because that was -- had to be monitored 24 hours a day and that was piped underground over to Harborview. Huge underground pipes that went over to the Harborview facility, which was fine when it was built when fuel was, you know, 70 cents a gallon or whatever it was back then, but it became so extraordinarily expensive. So the overhead ate us up, you know, the heating costs became extraordinary. It was not many years before we had to close the place. We actually separated ourself out and built a, you know, we put like four million dollars in that building and the sad part of it and then they go and tear it down. But we put in our own private boilers and we redid the whole boiler system so to make it more economical, but it was still, you know, very expensive and so -- KAREN BREWSTER: That open expanse land did that mean that the residents were sort of in dorm I mean -- PAT LANDO: Open -- open bays. Each unit was open and there was some semi partitions, but it wasn't very private. KAREN BREWSTER: So they were allotted blocks --
PAT LANDO: Yeah
KAREN BREWSTER: Per space? PAT LANDO: Right. And there was more clients, so we reduced the total population down to 96 I think was what we got down in terms of what the square footage would accommodate, but I say it was up at one point up to 120 some as I remember, which is -- but it was way too many, you know. But when we actually made it into bedrooms then we, of course, the numbers had to come down. And again so much -- everything you did was done because of regulatory requirements. I mean everything that you could think of was -- is down in regulations and so that's what we were constantly trying to keep -- keep ahead of the curve. For that, you know, that dictated most of our activities, you know, and it was -- it got expensive, you know. And this is what happens in all your -- all your medical facilities and that's why it's so damn expensive now. I mean I can -- I watched the nurses. I was in the hospital not many months ago and they spent their whole time, you know, filling out papers, constantly filling out papers and it does take away from patient care and I kind of shook my head and said this looks real familiar. KAREN BREWSTER: As the philosophy of care changed with this behavioral model, how did that go over with the employees? Were they willing to do that? PAT LANDO: I think it went over great, you know. I'm telling the initial response was I can think of at least three nurses that were absolutely, you know, they got their nose out of joint and they just -- they literally walked. Said I can't do this any and then overall everyone bought into it. I remember our chief nurse -- well there's a -- there's a road right up there called Dylen Drive. It's right across the street from here -- she was our chief nurse and she was in tears because it was overwhelming to think, you know, being trained as a nurse, she was actually a chief nurse up at API and she came down here and, Joyce Dylen, and but she was overwhelming when she had this thing come changing her whole way of doing business, you know. And so, you know, some of them didn't fare too well and -- but overall, you know, they did buy into it. We had some really great nurses. The nurses made the worse employees and they also made the best employees. They were very strong willed, very conscientious, but if they got on a rant or they got off on, their own little tangent, then they became a problem. KAREN BREWSTER: But you had other employees who weren't nurses? PAT LANDO: Of course, and then that's why the job descriptions were written to incorporate again under the QRMP definition thing. It included all number of disciplines. You could be a -- have a BA in psychology, social work or a Masters or whatever, in any number of disciplines and you had to have some related experience in developmental disabilities. And so we were able to hire -- I know we hired God knows how many different people with other backgrounds, you know, teachers, people in other educational backgrounds. So we had a pretty good spectrum of other disciplines that came along. And they came some would stay for two or three years or four years or whatever then they would kind of move on. We had a person -- we had -- we had a staff that all it did was in-service training, a couple of great ones. You know, we had in-service training programs that were constantly going. We brought things up to this state that were -- a guy named David Mandt. I don't know if that name rings a bell. M-A-N-D-T. He was a -- he was a the one that could teach control measures without being aversive, you know. He had all kinds of ways of approaching very difficult clients and so he came up and was our mentor for that and then he was snatched to do work up at API and then corrections got a hold of him and so he made himself quite a living just coming up to Alaska and teaching his philosophy of dealing with difficult clients without getting into, you know, restraints. So, you know, we were able -- the other part of the puzzle that evolved later on was we got into a Dementia Unit. We had one of the very first dementia units in the state. And we had a gal and her name slips my mind. She was from Oregon -- Portland, Oregon, who was the guru of dementia. She wrote several books on Alzheimer's and she came up and we had the Sourdough Unit. This was towards the end of our career as the clients were moving out. We took the most difficult dementia clients in the state and did very well with them, because we had the behavioral backgrounds to deal with them. You know, nursing homes don't know what to do with them, you know. And we had all the tools to deal with these very difficult -- we had guys that were -- my favorite was Wild Bill and he's from Kodiak. I won't give his name, but he's gone now. But he lived in a cabin for 50 years in Kodiak and I just happened to know where he lived because I had a cabin not very far from him, but he was so wild that they couldn't deal with him, so they shipped him over to us and he hadn't taken a bath in 50 years and, but anyways he -- we dealt with some of them -- some very, very difficult dementia clients. But that again was towards the end of our -- of our Harborview career and that unit went on for about -- what was happening was we were looking at a number of things. We were looking at populations that we thought we could deal with as the DD [developmentally disabled] clients were leaving and there was a whole process of that as the private providers grew and they grew as the Medicaid money came in. So, you know, we were basically seeding our own demise, which is we kind of knew what was going on. Hope Cottages, as you know, was a big one. I mean Hope Cottage thought they were the best thing that ever happened and I'm sure they -- they probably were in some ways, but we -- they led the charge and they became an institution under themselves, but they had a huge, huge impact because they -- and they are still active up in Anchorage I know. But all the providers, you know, were very strong and every year when it came budget time they all got on airplanes and went down and lobbied the legislature. I mean a tremendous force they put on the legislature. And it always was we need to get the money out of Harborview and pull it up into the nonprofits and that -- we went through that for so many years I became numb to it. A lot of things happened during that time. We had a very strong legislative group here that -- that, you know, and unfortunately it got into some politics. We didn't fight the philosophy of home care and getting folks out of the institution. We supported it. We were the ones that started it, but, you know, the issue became as the population depleted the per diem costs escalated. You know it's all a matter of numbers, you know. You have to have a fixed group, you know, whether you have one or twenty or fifty. So the per diem costs became more glaringly obvious. So the population went, you know, from those kinds of numbers we're down to the 80's and then we were down into the 60's and then the numbers were just, you know, would skyrocket. So they would rush down to Juneau and say look at what it costs to keep a person down at Harborview and it was very, very expensive. It would get into the couple hundred thousand dollar range, you know, I mean if you looked at the numbers because to keep the building open with no clients at all was like a million dollars. I mean the heat bill, electric bill was huge. I mean I'm talking about half a million dollars for heat and electric. That building was a very big, plus the hospital was there. The other thing that I didn't mention, which is kind of -- was interesting change was that, you know, the community hospital was taken over by the City of Valdez. We could not run that, although we did for a number of years, but it was, you know, when things started happening with the pipeline and all the accidents and things, we were running scared how can we possibly run a medical thing and then do our own thing over at Harborview. So we -- the city took it over on a lease basis and they then contracted it out to what they call Lutheran Home Society. Now it's Providence, as you know or don't know, came in and then -- and then after whatever I -- I'm getting ahead of myself, but, you know, the, you know the thing was waying down and the -- kind of the final piece of the puzzle is that the -- they got the right people in the right place, you know. Tony Knowles got down there. He's from Anchorage. They got the right commissioner in there, who was from Anchorage and they got the right medical director and they had all the pieces that it would take to bring the final demise of Harborview. And, you know, we were able to finally -- and the obvious thing they did first was to freeze -- freeze hiring. Freeze hiring and freeze client, you know, we could not accept any clients. KAREN BREWSTER: No intake, yeah.
PAT LANDO: Yeah and no intake. I mean that's -- so that's the first thing they did and my good friend Mike Renfro, you know, he knew how to, you know, get to the jugular and you -- basically if you freeze that then all the numbers just go up and looks so conspicuous. So there was a strategy and it was, you know, but it was, you know, a long time in coming and we knew -- my, I guess my concern was I -- we had such a great staff. I'm not just making this up. This -- these folks had lots of talent and it was -- and they wanted to get here and I tried to get corrections to take it over and open up, as you know or don't know, the city -- the state was spending twenty million dollars sending folks to Arizona and they still are sending -- spending that kind of money, probably a lot more. And they opened the one up there in Anchorage now. I don't think it's open yet. But anyway they were spending twenty million dollars to Arizona as I remember the numbers and we said well why don't we take Harborview and develop it into a minimum security corrections program. So we spent several years trying to do that, but again this was towards the end when I knew that -- that our population was going to be leaving and we almost had it happen, but I think the City of Valdez didn't want to be dirtied with -- I least that's how I perceived it, because everyone was -- thought it was a great idea. We had architects already in there and it would have made a nice fit, you know, and it would have saved, you know, a lot of money. It would have been a fix for the community in terms of an economic base, because right now the whole city is hanging its hat on the -- across the bay here in '96 or '94. KAREN BREWSTER: Alyeska.
PAT LANDO: Ninety-four percent of the total budget comes out of Alyeska. I mean it is a one-horse town and that's -- and if that pipeline, which is behind the house here, you know, and is down to like half I think whatever the levels are. If that ever goes down, you know, this whole town is going to blow away. KAREN BREWSTER: But as you said Harborview was a really big employee here in the earlier days -- PAT LANDO: In the early days it was a big hunk of the employment. Everybody -- everybody worked at Harborview. It was -- I still run into people too. In fact, I had a guy at the swimming pool yesterday say were you writing your reference letter? I says Tom I haven't -- I haven't -- that's 15 -- or so years ago. So yeah, every day I run into people that, you know, have worked there so.
KAREN BREWSTER: We're going to take a -- tape change.