Pima County has provided health care since its founding

Providing for health care has been a priority for Pima County's government since its foundation. The law passed by the Second Territorial Legislature of 1865 that created county boards of supervisors enumerated 13 duties for the new officers, one of which was to "take care of and provide for the indigent sick of the county.

For years, the challenge was a lack of doctors in what was then a remote and undeveloped region, a problem which has echoes today in some rural counties around the country who struggle to merely attract health care providers. Then, as now, one solution was to provide a subsidy.

With some notable exceptions, in the early days of Arizona Territory, most medical doctors were associated with the Army. These doctors frequently serviced the local civilian population as well as the soldiers, so it could be argued that this comprised a rudimentary public health system. However, the rigid command structure of the "Old Army" provided for too-few commissioned surgeons for the frontier service, a shortcoming that was addressed by hiring civilian doctors on contract.

One such doctor was John C. Handy, a competent but ill-tempered civilian contract surgeon who was posted to Camp Thomas on the Gila River. In 1870, Dr. Handy came to Tucson on an errand and was called to help prominent local resident Sam Hughes, who had fallen ill. The Old Pueblo in those days had a population of 3,215, but no working doctors. Impressed with Dr. Handy, Hughes saw an opportunity, so once he was better, he took up a collection of $2,500 as an incentive to get the doctor to stay.

By the time Handy established his practice in Tucson, another doctor had been employed by the County. Dr. R.A. Wilbur, who had worked as a physician for the Indian Service, established a practice in Tucson and briefly secured a contract to serve the county's indigent for $50 a month. However, for reasons that remain unclear, the Board canceled the contract in August 1871, and asked Dr. Handy and another doctor for bids. Handy became the new Pima County Physician for $50 a month and received an additional $130 a month to maintain a "hospital," really a re-purposed rented house, for two patients. These accommodations, and the appropriation, would expand as the county grew.

In 1880, the Sisters of Saint Joseph established Saint Mary's Hospital primarily to serve employees of the Southern Pacific Railroad, for whom care was paid for from a fund established by a 50 cents per month deduction from each worker's monthly wages. By 1883, the Sisters were contracting with the county as well at a rate of $1 per patient per day.

This led to a public debate that may sound familiar today, with some arguing that the sort of fixed-sum arrangement the county had with Handy gave him an incentive to limit care, while others argued that the per-patient contract with the Sisters was simply too expensive. This dispute led to calls for the county to establish its own permanent hospital. For his own part, Handy was also employed by Saint Mary's Hospital as house physician along with his county duties, so either policy suited him.

Handy's generosity and competence earned him near-universal respect in the community, and doctors throughout the territory deferred to his medical opinion. He called out the itinerant quack practitioners who came through town from time to time. His heroic response to Tucson's 1877 smallpox epidemic, which included the first program of mass inoculation in county history, solidified his reputation. However, he seems to have had an arrogant streak, and was occasionally high-handed with his colleagues and those around him. For example, he was forced off the Territorial Board of Regents after he petulantly stopped attending meetings when he disagreed with other members about building design for the new University.

Handy was well-known to be abusive to his wife, who had filed for divorce in 1888, but dropped the issue after the doctor threatened a number of people involved in the case. In 1891, she filed once again. When Handy threatened her attorney, the lawyer shot him. The doctor died early the next morning. A grand jury, likely familiar with Handy's violent temper, ruled the killing was justified.

The issue of how to best provide medical care to Pima County's residents remained unresolved. While the colorful George Goodfellow of Tombstone fame would take over much of Handy's practice, it would fall to Hiram Fenner, another well-established Tucson physician, to take care of the "indigent sick" of the county. He soon became the county's new "Superintendent of Public Health." The issues of compensation and establishing a permanent hospital, as well as an overall modernization of medical care in the county in the face of advances in medicine and public health, would now be his responsibility.