Marie Osborn pioneered nurse practitioner care
By Mary Stamp
Idaho's first licensed nurse practitioner, Marie Osborn, practiced emergency care and family medicine from 1972 until 1999 at the Salmon River Clinic in Stanley, Idaho, the sole medical provider for 6,000 square miles.
She also did occasional veterinary services and was the county coroner.
Practicing rural medicine 60 miles from the nearest doctor or clinic was a 24/7 commitment, requiring a strong sense of ethics and the ability to keep her cool in tragedies.
In May 2022, the College of Idaho in Caldwell recognized her contributions to rural medicine by awarding her an honorary doctorate.
In October 2022, Marie, 91, joined volunteer EMTs and clinic staff to launch a $500,000 campaign to support the rural ambulance service on the 50th anniversary of Stanley buying its first ambulance.
After a 1971 car accident, the two-and-a-half hour wait for the ambulance to come from Hailey for four badly injured teenage boys sparked her career.
With community backing, Marie pioneered improvements in rural medicine by raising funds to buy an ambulance and build the clinic. She advocated in the state legislature for funds to support rural clinics and ambulances, and for appropriate standards for nurse practitioners.
Marie grew up in Muncie, Ind., in a low-middle class family whose parents were gung-ho about education. They attended a Southern Baptist Church. Living across the street from Ball State University, Marie decided to study nursing. After earning a bachelor's in nursing in 1953, she married Cal, a graduate of Indiana University in business.
They headed west with a small trailer, expecting to live in it near the University of Washington in Seattle, where Cal began graduate studies. Soon after starting, he met an IBM recruiter. IBM hired him to sell office equipment out of Bellingham.
Cal was later promoted to Boise, where he worked the rest of his career. Marie reared their five children and was involved in the community.
At an IBM employee campout and barbecue at Redfish Lake, Marie and Cal fell in love with the area. They bought property 15 miles from Stanley—then with 37 residents—and built a log cabin for summer use.
When some of their children worked at a local restaurant and gas station, they sent people needing medical care to their mother because she had nursing skills.
Stanley grew to 50 people. Thousands more came in the summer to campgrounds in the Sawtooth National Recreation Area. By 1999, 99 lived in town and 400 lived in the surrounding area as people with cabins retired and families moved there, plus more than a million rafters, anglers, hikers and campers came.
"Originally, the Forest Service put anyone who was injured in the back of their station wagon and drove 60 miles over Galena Summit to the Sun Valley Hospital," Marie said. "Military Air Safety Transport flew people from the backcountry to hospitals before Life Flight began."
After the 1971 accident, Marie realized her three sons, Cal Jr., Jerry and John, would soon be driving. She insisted someone had to help the remote rural community with health care.
A local garage mechanic had been a medic in the military, but turned down a training program for former medics. She was the only other person in the community with a medical background.
"So that someone turned out to be me," said Marie, who was then 41.
She contacted the Idaho Hospital Association and the Idaho Boards of Medicine, Pharmacy and Nursing. They suggested she do more training to staff a clinic, to be able to suture wounds and splint broken bones.
To be certified as an emergency nurse practitioner, Marie completed a one-month program in Harborview Hospital at the University of Washington and a three-month internship at St. Alphonsus Hospital in Boise in 1971. With her, Idaho became the first state to license nurse practitioners. Now there are 355,000 in the U.S.
She continued to improve her skills. In 1976, she was certified for family practice, working with Bryan Stone, M.D., of Ketchum as her preceptor.
As Marie's patient care responsibilities increased, the Boards of Medicine and Pharmacy wanted to limit what she did. The Board of Nursing and Stanley community defended her work. When a Sun Valley doctor objected to her caring for patients, another suggested he take her place. No one did.
In 1976, she completed the first class in the University of Utah's three-month Family Nurse Practitioners Program and 800 hours of internship in Salt Lake City and Sun Valley Hospitals, plus a month of independent study in lab work and radiology.
"Nurse practitioners were ideal for Idaho because there were so many isolated rural areas with few physicians," Marie said.
What started as a solution for underserved rural communities spread to urban areas as doctors hired nurse practitioners to expand their practices.
Action to provide an ambulance, nurse and clinic in Stanley began with election of a board of directors in 1971.
The board's president offered a three-room house he owned beside the post office. In May 1972, Marie started seeing patients and responding to emergency calls. On June 19, the clinic formally opened as the Salmon River Emergency Clinic.
Marie expected to return to Boise at the end of the summer, but after three months of nonstop ambulance runs and clinic patients, community leaders asked her to keep the clinic open year-round.
The clinic space was also the house for Stanley's teacher. So the kitchen was the treatment room, and the living room, the reception room and morgue. The teacher had the bedroom.
Whenever someone died, the teacher had to wait to return until the mortician came from Hailey to pick up the body.
"We knew we needed a building just for the clinic," Marie said. "People also came for non-urgent medical care."
In October, a resident offered half price for a lot to build the clinic and an ambulance garage.
In 1971, Stanley bought its first ambulance, a 1958 Pontiac hearse-style ambulance for $300 from Mountain Home Air Force Base military surplus. It had holes in the floor, filled with exhaust fumes and had electrical failures causing the lights to go out. They replaced the military colors with white and orange, and painted "Stanley Ambulance" in blue.
In 1973, Stanley started raising money to buy a new ambulance. The community placed jars in the stores and bars, and sent letters to people in the permanent and summer communities.
"People were generous, raising $70,000, knowing they might someday need to use the ambulance themselves," Marie said.
She drove one volunteer ambulance driver to Spokane to pick up the new, fully equipped ambulance. He drove into Stanley with the sirens blaring.
Later, former Idaho Sen. Frank Church told Stanley's ambulance story to the U.S. Senate to pass increased federal support for rural ambulances.
Marie likened building the clinic to "an old-fashioned barn raising." In October 1973, a company poured the foundation just before a snowstorm buried it for the winter. On St. Patrick's Day, everyone showed up with hammers. They removed the snow and started building. Electricians from Boise volunteered to wire it. People from across Idaho donated labor and materials to build Stanley's clinic.
The clinic, which had two treatment rooms, a lab, pharmacy and X-ray room, was dedicated June 15, 1975.
In the early years, Marie said, "My generous husband and patients' fees supported the clinic."
Marie lobbied the legislature to pass a bill to allow Stanley and other rural communities to form clinic hospital districts to raise taxes to fund clinics.
"Then we became self-supporting," she said.
At first, insurance companies did not recognize nurse practitioners and would not pay for their services. Then one day the mother of the director of Blue Cross was fishing and slipped on a rock in the Salmon River and broke her ankle. After that, Blue Cross covered treatment, and soon Medicare and other insurance companies also covered treatment, she added.
Marie's testimony before the legislature in Boise also helped define nurse practitioners' roles.
When the clinic was open just three days a week, she commuted 130 miles from Boise. In the winter, with Highway 21 closed by snow and avalanches, it was nearly 250 miles, until Gov. Cecil Andrus committed to keep the highway open all winter.
Eventually, Marie lived in the family cabin, on call 24/7. In the winter, she "commuted" 14 miles to Stanley by snowmobile, or 12 miles by car.
"I was surprised how many came out of the woods for care. The first time we camped at Redfish Lake, a woman who fell and broke her arm walked out of the woods with her husband. I splinted it and sent her to Sun Valley," she said.
"A young man hiked out of the mountains and stopped me at an intersection. He had cut his hand with an ax and tried to sew it up. It was infected. He said he had no money. I said if he didn't let me treat the infection, then the funeral director would not get paid. I treated it and wrote off the charge. Ten years later, he came, no longer a scraggly, long-haired hippie, but wearing a white shirt and tie. He paid me in full and made a donation to the clinic. He showed me the scar."
"People are better than you think. A few skipped out on their bills, but not many," said Marie, who also did the billing and cleaning.
"I did all I could to preserve lives and never had a lawsuit. I knew what I could do and what I could not do," said Marie, who was attentive to details.
In 1975, she and her son, John, set up the Salmon River Medical Internship, a three-month summer program for pre-med students from the College of Idaho to give them immersion into rural health care.
To mark the 50th year of the program the college established the Marie Osborn Salmon River Medical Internship Fund.
John, who is now a physician, completed residency training at Sacred Heart and Deaconess Medical Centers in Spokane and joined the staff of Spokane Veteran's (VA) Medical Center in 1986. He now provides care at the Seattle VA emergency department.
Marie's daughter, Debbie, is an ER nurse who provided care for COVID patients in New York City, Los Angeles and Southwestern Idaho.
Her other children, Calvin, Jr., retired from sales, Jerry is an architect, and Melinda runs a cleaning business in Stanley.
Marie cared for people from cradle to grave, starting with well-baby checks and following children as they grew up, giving shots, doing physicals, suturing, and treating colds, earaches, pneumonia, chicken pox, measles, poison ivy rashes and everything else.
The emergency-room care included fish hook injuries, heart attacks, strokes, emergency deliveries, and broken bones and head injuries from skiing, snowmobiling, falls while hiking and climbing, and auto and bike accidents.
She told pregnant women not to plan to deliver babies in Stanley. It was too far to go if anything went wrong.
Marie also treated some animals, because the closest vet was 75 miles away. She stitched up dogs and horses, pulled porcupine quills from dogs' noses, but sent fractures to the vet in Ketchum.
Marie, who recruited and trained about 50 volunteer EMTs, taught them never to lose their cool.
Once, early on, she realized it didn't help when she threw her bag in anger after a teenage boy working at a ranch borrowed a motorcycle with defective brakes. He drove fast, crashed and was killed.
"The owner should have fixed the motorcycle. It still upsets me," she said.
Marie also became coroner of Custer County. As the only medical person around, she started as deputy coroner. After training at Cook County Hospital and Morgue in Chicago, she signed death certificates and investigated unattended deaths, accidents and deaths by gunshots, suicide and hanging.
Marie retired in 1999 from the Stanley clinic. She then saw patients in other rural communities before caring for low-income patients in Boise.
Losing her eyesight from macular degeneration, Marie took off her stethoscope and white coat for the last time shortly after she turned 80. Now she lives in an independent living center in Boise.
"If you wait long enough, things happen for the best, but you need to work for it," she said.
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