THE HOSPITAL CHARGES.

Auckland Star, Volume XXII, Issue 72, 26 March 1891, Page 8

THE HOSPITAL CHARGES.

REPORT OF THE COMMISSION. The report of Sir Maurice O'Rorke and Dr. Yon. Mirbach on tho charges against Dr. Collins, of Auckland Hospital, has been forwarded to the Governor.

Early in tho report; the Commissioners state that they are unable to discover any motive for Miss Arnaboldi making these serious cliar.es against Br. Collins unless it be a souse of duty. They also obsorve that tho charges ol neglect and unskilful treatment) against Dr. Collins appear considerably modified as the inquiry proceeded, and the counsel for Miss Arnaboldi limited tho charges to those of delay in treating bho and disclaimed any intention of imputing want of skill to him.

The Commissioners then proceeded to give their opinions on each case. In tho case of Joseph Berry, after detailing the accident, the Commissioners rejjort that immediately on tho patient arriving at the Hospital, ho was at once treated by Dr. Collins. The treatment of tho wrist consisted of an application of two pieces of cork to the main arteries, which were intended to bo secured in proper position by a tight bandage round the wrist. The pressure of the corks and bandages does not appear to have boon sufficient to havo stopped the bleeding, which continued either constantly or intermittently throughout the day. At 11 at night Dr. Bond, one of the consulting surgeon.*, was called in, and ho, in conjunction with Dr. Coilins, examined the wound, and amputation at the wrist was decided upon as immediately necessary. The operation was performed properly, but tho patient died three hours afterwards. We avo of opinion that it is clearly established by evidence that Berry died of hemorrhage, and we havo further to state that when the means adopted of stopping the bleeding by the pressure of two corks on the main arteries, and a li. lit bandage proved ineffective, that recourse ought to have bean at once had to tho more efi'ective measures of controlling the hemorrhage ; thab the extent of the surgicnl shock under which the patient, Berry, was labouring when brought in to tho Hospital was over-estimated, and not, so severe as to render it necessary to posbpono amputation for some 12 hours when tho operation was undertaken as stated in Dr. Collin's report as a lasb resource.

In tho case of Duncan McKenzie they say, after relating tho details of tho accident that McKenzie reached the Hospital ab 8.30 p.m. on bhe 50th October. A thorough examination did not fake place till 3 p.m. on the 31st, when nine fragments of comminuted bone, constituting about two and a-half inches of continuity of tho tibia, wero removed. From this ib may bo inferred that tho nourishing membrano or periosteum was destroyed to some extent, and to such a degree as to render the natural procoss of bhe union hopeless. From that time tho patient continued to suffer great pain, and appears to have been treabed in bhe ordinary way till the Bth of November, when the wound showed signs of sloughing and gangrene. Dr. Collins then called in the consulting surgeons, Drs. Philson and Hooper, who examined tho leg, and decided on an immediate amputation. i: The operation took place ac once and the usual restoratives were administered. Tho man was put to bod bub appears never to havo rallied. In a few days—the third — there was for tho first time discovered that blood was oozing from the stump and a very offensive smell from the wound. Dr. Philson and Hooper were again called in, examined the leg, and pronounced tho man moribund, and further amputation above the knee useless.

'Dr. Collins' contention is that, in this case also, tho existence of surgical shock pro hibited the immediate removal of the limb.

We consider this' untenable, assuming his viow of tho case to be the correct one. This, in our opinion, rendered it more imperabive on him to proceed moro speedily to the amputation of tho limb. Dr. Collins' allegation that, he deemed it advisable to refrain from earlier amputation because lie expected by conservative surgery bo save the limb we consider to be ill-judged. On carefully considering the evidence in this case, which is to some extent contradictory, we have come to the opinion

Thab such a serious wound as Moivonzio's was nob so fully and surgically examined and dressed immediately on admission bo the Hospital as it ought to have beon ; thab That 19 hours ou. ht nob to havo been allowed to elapse before tho wound was thoroughly examined and freshly dressed ; that every day subsequent to a thorough examination the wound should have been regularly examined and dressed onco a day up to amputabion. Thab the bad smell which ia alleged to have arisen from the leg shortly after the patient's rccoption in bhe Hospital may not necessarily been indicative of tho sobbing in of gangrene, bub may have beon attributable to the accumulation of decomposing pus in the wound which ou. lib to have been attended to oftener than onco in 24 Lours. That in the case of such a serious wound Dr. Collins ought nob to havo waited pr nine days before calling in regular conBulbing surgeons. That when the leg was amputated ihe evidence of the four medical gentlemen present, Drs. Collins, Philson, Hooper and Daldy, in our opinion, clearly established the fact that tho operation was performed skilfully, and thab there are no grounds for believing as is alleged by probationary Nursa Arnaboldi that one of the flaps exhibited symptoms of gan. rene when being folded over the stump. It is, no doubt, true that when the stump was first examined three days after amputabion bhab gangrene had supervened to a fatal extent, but this does not alter our opinion that the flap showed no appearance of gangrene when it was bandaged, nor can we give credence to Nurse' Arnaboldl's charge on this point, who certainly after nine months' tuition as hospital nurse, cannob be regarded as a compobenb judge of bhe symptoms of .angrene such as three medical gentlemen who wore present at tho operation undoubtedly were. At the same time we do nob seb down this mistake of Miss Arnaboldi's to maliciousness, of which we discovered no trace, but simply to her ignorance of medical matters. Be the costs of the complainant and counsel for Berry's son, the Commissioners say it seems to us ohab as the Hospital and Charitable Aid Board has nobappeared before us it would nob be righb to award costs against them without hearing them on the matter. It is true tho Commission states that the Auckland Hospital and Charitable Aid Board requested the inquiry, but wo doubt whether the law contemplates, or the Government contemplated that payment should be made to tho complainant, a position Miss Arnaboldi occupied when ehe laid the charges. They concluded : We did not feel in any way warranted by the terms of the Commission to make inquiry into tho causes that Lave led to the retirement of nearly all the medical practitioners of Auckland from attendance upon the patients in the Auckland Hospital, bub wo cannot refrain from deploring the fact that these patients reap no benefit from the skill and experience of the large body of Auckland medical practitioners, and thab the interest that ia invari. ably shown elsewhere by physicians and surgeons of eminence in the cause of suffering humanity, a benevolence they generously bestow upon poor inmates of the Hospital, has either ceased to exist in Auckland or is not allowed to be now exercised in the Auckland Hospital.

Dr. Mii-bach. in an addendum, sajsho feels ib hi.s duty to say that he considers

Dr. Collins the victim of unskilful and inadequate administration, for ib is impossible for a surgeon bo work a hospital successfully averaging 100 beds practically single-handed. Respecting a suggestion by counsel that Miss Arnaboldi deserves the thanks, and praise of the community. Dr. Mirbuch s«.ys thab although under the system of management it would have been (tifiicuib, if nor, impossible, to expose tho unfortunate state of nliairs at the Auckland Hospital without the acr.ion taken by Miss Arnaboldi, nevertheless bhe precedent is a had one, and her act, bends lo bo subversive of necessary discipline : and espionage by subordinates is quite destructive of eonlidence on the part of responsible officials and ot the respect duo to them by their assistants.

In conclusion, ho submits that the system of management; of the hospitals now prevailing in the colony might well bo reconsidered in the direction of removing them from the exclusive and unrestricted control of elected boards.

The report of the Commission was considered at a meeting of the Hospital and Charitable Aid Board on the 16th March, when Br. Collins made a statement to justify himself against tho strictures parsed on his treatment of tho patients. Alter some discussion a deputation from the Board was appointed bo meot a deputation from tho Medical Association, to consider tho future management of the Hospital. Tho conference of tho two deputations, with Dr. MacGrogor, Inspector-General of Hospitals, prosiditig, was held on March 19. Dr. MacGrojror spoke strongly against the system of management of bho Hospital as at present carried oub by the Board. Ho thought the Board should terminate their present arrangements as soon as possible. Jh\ Collins strongly defended the system, and in spite of the report-of the Commission, contended that ib had been a success. After some desultory discussion it was decided to adjourn consideration of tho matter for a week. An amicable conference has since been hold by bho representatives of tho Medical Association and Hospital Board.