HOSPITAL INQUIRY.

Auckland Star, Volume XXXV, Issue 249, 18 October 1904, Page 4

HOSPITAL INQUIRY.

DR. NEIL'S ALLEGATIONS. EVIDENCE TAKEN BY BOYAL COMMISSION. The hearing of evidence in support of the charges preferred against the management of the Auckland Hospital was begun in the Chambers' room of the Auckland Supreme Court at 10 o'clock this morning. The Commissioners were District Judge Ward (president), Mr R. Beetham (ex-magistrate), and Mr S. E. McCarthy, SAL, Messrs. Bruee and McLeod. The medical gefftlemen and other officials present were Dr.. Collins (senior medical officer at the Hospital), Mr G. J. Garland and Mr Stevenson (chairman and secretary of the Hospital Board), Mr J. R. Walters (a member of the Board), Dr. J. Hardie Neil, Dr. Roberton and Dr. Ingiis (president and secretary of the Auckland Medical Association), Drs. Parkes, McDowell, Craig, Bull, King and Savage, Dr. Mac-Gregor (Government inspector of hospitals), Mr MeVeagh (counsel for the accuser, Dr. Neil), and Mr J. R. Reed (counsel for the Hospital Board, instructed by Messrs Hesketh and Richmond). The following are copies of the charges put in: DR. HARDIE NELL'S CHARGES. Dr. Hardie Neil made the following charges against James Clive Collins, the senior medical officer in charge of the Auckland Hospital: (1) That the said James Clive Collins infringed rule 21 of the rules and regulations for the management of the Auckland Hospital, as adopted by the District of Auckland Hospital and Charitable Aid Board in January, 1902, inasmuch as he performed a certain major surgical operation on one Wallis White on May 18th, 1904, the said rule requiring that the honorary surgeons shall perform all the major surgical operations. (2) That the said James Clive Collins performed such last-mentioned operation without a previous consultation of at least three members of the honorary staff, and that the performing of such operation under those circumstances was a violation of the said rule 21. • (3) That the said James Clive Collins did not take sufficient care before performing the said operation to obtain correct clinical histohy of the ease, and that in violation of rule 51 of the said regulations he did not see that the bed chart of the said Wallis White was filled up with full particulars and history of the ease. (4) that the said James Clive Collins recognised that the case of the said Wallis White was a desperate one, and, notwithstanding that, took as his assistant in the performance of the said operation the junior medical officer of the said Hospital, as to whose previous experience in assisting in abdominal operations the said James Clive Collins had no knowledge whatever, and who he was aware had charge of septic and infectious eases. (5) That the said James Clive Collins made two incisions in the large intestine of the said Wallis White, and that there was no reason or justification for so doing. (6) That the said James Clive Collins made a statement to Dr. McGregor (the Inspector-General of Hospitals) at a formal inquiry mads hy him that he the said James Clive Collins did not make two incisions in the intestine of the said Wallis White, whereas, in fact, he did make two such incisions. (7) That the said James Clive Collins stated to the said Inspector-General at such last-mentioned inquiry that there were three ulcers in the stomach of the said Wallis White, whereas, in fact there was only one. (S) That the act of the said James Chve Collins in making the incisions into the large intestine of the said Wallis White resulted in great loss of time during the performance of the said operation, and very seriously prejudiced the chances of the patient's recovery. (9) That the said James Clive Collins violated rule 21 of the sad rules and regulations on the 3rd August, 1904, by performing a major surgical operation upon Arthur Duke at the said Hospital, that the said operation was performed without a previous consultation of at least three members of the honorary staff. * (10) That the said operation that was performed upon the said Arthur Duke was entirely unnecessary and unjustifiable. (11) That the said James Clive Collins on the 24th May, 1904, at the Auckland Hospital, performed a major surgical operation upon one Martha Gordon. (12) That in the performance of the operation upon the said Martha Gordon the said James Clive Collins negligently failed to discover that the ca c was one of perforation of one of the fallopian tubes, the discovery and proper treatment of which would probably have resulted in the saving of" the patient's life. (13) That the said James Clive Collins on 9th July, 1904, at the Auckland Hospital, performed a major surgical operation on one Clarence Walters in violation of the said rule 21, and that in the performance of such operation, the said James Clive Collins negligently failed to ensure the removal of pus* in the abdominal cavity of the patient. (14) That the said James Chve Collins, on the 11th May, 1904, at the Auckland Hospital, in violation of the said rule 21, performed a major surgical operation upon one Walter Freestone. (15) That the said James Chve Collins on the 31st January, 1903, at the Auckland Hospital, in violation of rule 73 of the said regulations, operated upon one William Peake for a fracture, the ease being one requiring operative interference. (16) That the said James Clive Collins or. the 3rd July negligently failed to acquaint hirossli with the condition of Florence While, a patient who had been operated upen in the said hospital, and c-n that day informed Mary Anne White. L>er mother, that the said Florence Wh'te wa<s o-std. 7?hores3, in fact, she was then alive :n the s'id hospital. (17) That en the I3th January. 1902 an anaesthetic- was administered in the said Auckland Hospital to one John Burke by Dr. Teague, the junior medical officer of the said hospital; that the said Dr. Teague requested the said James Clive epMins to he present at such ad-

ministration, and the Collins neglected to £' so patient collapsed while under* thT- tlft ence of the anaesthetic. Th e saidi" 83 " Clive Colhns having perrmttprf tv am ' a Dr. Teague to administer <uel an thetie alone, the circumstances V**" violation of rule 48 -of the said g , a tions. r6 «- u §- ---(18) Thaj; the said James Clive (*m> on the 14th July. 1904, at the AuoM Hospital, performed the tereetomy upon Ethel Maud XdnT' aged 18 years, and the Sai J Jgjg was unnecessary and unjustifiable. (19) That the said James Chve Collin violation of rule 51 of the =a-'d - lations did not see that one Vjii— Allen, a patient in the said hospitarW. a attended to on admission, the foot Z* ing that the said William AllentT kept waiting at the said hospital for* 3 period of three hours or thereabouts k! ; fore he was seen by any doctor. (20) That the said James Olive in violation of rule 51 of the saidreff2' lations, did not solely treat the aid William Allen for a broken arm and th said William Allen was, in fact, treat! therefor by a junior resident surgeon (21) That the said James Cliv e (,'olljn, in violation of rue 73 of the said resir lations, did not solely treat one Josmh Coihun, who was admitted to the said aospital about the beginning of'Febru aiy, 1903, suffering from a eompo UDi fracture to his arm, and that the said case was, in fact, treated and the ana set by a junior resident medical offleer of the said hospital. (22) That the said James Clive ColhV did not see that a patient named Hit Mooney, suffering from a fractured Ip-" admitted to the said hospital for treat" ment was attended to on admission, and the fracture was not set until 24 h'ourt' after her admission to the said hospital' (23) That the said James Clive Col- 1 lins, in violation of Rule 51 of the said regulations, did not see that a patient in the said hospital named Victor George Swinbourne who wa3 admitted thereto on 10th August, 1904, was at. tended to on admission, the fact being that the said Victor George Swinbourne was not attended to until five hours after his admission, or thereabouts.. (24) That the said James Chve Coffins performed a major operation upon one Roy Carrington Barnes for the purpose of exploring the Mastoid Anthrum, that the said operation was unnecessary and unjustifiable, and caused facial paraiysis and meningitis. (25) That the 3aid James Chve Coffins; omitted to correctly keep a case book for each visiting officer of the said bos-; pital, the same being a violation, of Rule 44 of the s A id regulations. (26) That the said James Chve Ceuins has during the time that he has been the Senior Medical Officer of the said hospital neglected to ensure that a detailed account of morbid appearance! should be correctly entered by the officer conducting the examination in the post-mortem bock. (27) That the uaid James Clive Collins in violation of Rule 60 of the said regulations has failed to ensure that the proper records of consultations be kept. (28) That during the time the said James Chve Collins was Senior Medksl Officer of the suid hospital, patients were allowed to have access to morphia and to administer hypodermic injections thereof, •particularly between tie months of June and October, 1904. (29) That during the period that M said James Clive Collins wa3 Medical Superintendent of the said hospital certain male attendants have been habitually allowed to administer hypodermic: injections of a poisonous nature in; the' said hospital, and that the said practice is a very dangerous one. . . (30) That th» said James Clive Collins, in the year 1902, while he was Medical Superintendent of the said hospital permitted an excessive quantity of stimulants to he used in the said hospital, and out of all reasonable proportion to the requirements of the patients. (31) That the said James Chve Coffins' is required by Rule 33 of the said regulations to make an official visit to the wards of the said hospital at 3 a.m. and 6 p.m., and that he has throughout constantly failed to comply with this rule, whereby the efficient administration and government of the said hospital has been himpered. (32) That in point of fact, the"sutf James Clive Collins has n- many instances never visited some of the wards in the said hospital for .several days at a time. (33) That the said James Clive Collins during the time that he has been Medical Superintendent of the said hospital has failed to be present at the hospital for the discharge of his duties until 10 o'clock in the morning or thereabouts, and that during such time he ha 3 also left the hospital for the day at 4 o'clock in the afternoon or thereabouts. (34) That tbe said Jame3 Chve Coffins was required by Rule 68 of the said regulations to make a daily inspection accompanied by the head of each department of food, kitchens, offices, and ward 9to see that all food wa3 properly cooked and served, that he constenti) failed to comply with this rule; in consequence thereof the food supplied ta the patients was of an unsuitable nature and badly cooked. . • (35) Tluvt the said James Clive Collutf was required by Rule 71 of the said regulations to superintend the trdaing of all nurses, and r.hat he has constantly failed to do so. .yV (36) That during the time that i| said Taints Clive Collins has been Senior Medical Officer of the sala Hospital Mj has performed post-mortem operation-, and within a short time thereafter irto also oerformed major abdominal tions* in violation of the accepted P ra -. face of surgery. . r r ' (37) That the said James Chve w» lins dur : ng the time that he was £J d - senior medical officer of the hospital permitted and allowed a mental case, namely, that of Mrs Grey, i be treated in the typhoid fever wart the said hospital: that the said meni ease was a very noisy one. and that action of the medical officer in * n V ffi _ spect was calculated to retard M.d|g fort and the recovery of the typ patients. nive ; (38) That the said Janies_ >< Collins permitted a delirium case, namely. one Russell, to he. -* g ed in the male tvpho'd ward at ?*so time that patients suffering .i. typhoid fever were being treated w- - in. and that he said the delirium. mens case was a very noisy the disturbance he created *& r¥ lated to retard the comfor. ana coverv of the typhoid fever ■ (39) That the said James Collins during the time that ne ; senior medical officer of the sa . , o f. ■ pital. was enraged tor time "in the bacteriological laD °" tir ,!v and that the said work was * " d unnecessary, and ! t interfered encroached upon his d'tHes V. . a {j o n to the government and admnns" ■ • of the said hospital. . -i on by (40) That the work so carrttu lhe the said James Clive Collins .» ■

rZrktory, seriously bacteriologist, Dr. s"* S& bacteriological exÜby"vff?lTeU by "vff?lTe ciißica! specimen of J'ioß tobe the■ Sanator-um- at **»>•■■££- tre.tn.ent of eonblidge, S honorary bacteno:og.st saniptivea; tte J O n several fflnical specimens and having obS|f« « Clive *■ %« eercising medical and *:*!£ over\the said hosr" 4 waS fl S a to°euhtin s guinea pigs cnlt^ a i conduct being a menace patients in the tfiil°fff' +he S aid James Clive d .position J cases the Awards inthe said hospital "Jifi the said James Olive &■ ™Ll* the medical side of the ft 2 Ibv Noting more time fiSU necessary to lf£ rk 'the Ud James Clive r,L frequently called for a number SSons in trifling cases, where Imitations were really unnecessary. ff£ remit that the honorary staff £T£fiM* aDd th , ei r attenUon T™ diverted irom those senous J"! , j_ which prolonged consultations T ere necessary. .

ASSOCIATION'S " , '.'CHARGES.

"An&la!i£.October 14, 1904. To the Commissioners appointed to inquire into tie management of the Auckland Hospital- : -Sirs.—On behalf of -the m&mfcrsi of the Auckland division of the British Medical Association I have the lononr to suimit that the management of the Auckland Hospital has ten, and is, unsatisfactory, and has resulted in impaired efficiency and unnecessary expense. "1. This is due in the first place to tie constitution of the Board of Manjgament being unsuitable. "2. The management has shown itself defective in the following respects: — (i) Theresas been no consistent and continuous policy in regard to medical nmnajemrat. (b) There has been a ■rant of.proper method in arranging for increased accommodation, leading to nmecessary exoense in maintenance. f (c) Proper provision has not been mn '-> for the isolation of infections di~r including tuhercu'osis. (d) The penses of the hospital have been'unduly increased hy the right of admission not being-restricted to the sick poor, except jn .cases of emergency, (c) The stringent. system of fee-eol!ec f ing has tome hardly on the sick poor, and has led to arwidespread feeHng that the really poor, cannot afford to go to the hospital .(f) There has been a recurring tendency;; to the creat : on of an ont-pt;eDt-departmrnt in spite of rules against'jfc- (g) The Board had adopted th-jiolfijr-.of appointing the honorary ria'fegJrfaff' fr,om year to year only. (Mllerpb'sijtion assigned to the senior medical officer in relat'on to the honorary risiting staff, and the divided responsibility ~,for the- treatment of patients has been detrimental. Ji) The work of the honorary vis-ting physiri-m las been, hampered, and its efficiency impaired, hythe time of the resident pnysiaan feeing too much occupied by Tork other than that in connection with med : eal cases.—l hare etc Ernest mtxGm M.D., president Auek-taddmsion'-New Zealand branch fetish Medic?l Association." I ?*$*??!&. sta * ed that he would not address the Commission, but would BU his witnesses immediately. THE FIRST WITNESS. ffTii * I ' lttnders Hill, a steward on tta ] McGregor Steamship Co.'s Gael, S* n i the fet.witness. He stated that Wafl« White, mentioned in the ch-u-e, 7L\ - ?° SFital mite explained side, and witness S?!.^ 8 ? 0 " ~lll* most of th e time. Jtl, t, Mm Sent t0 the Hospital J he ambalance, accompanied by Wm. «m, a hand en.the steamer. &?s**'***. the witness said JSf S bdn ? sent fr °m the soma » i 7 e nad complained for WS" S Patsent lir3t ffiSteM 1,,,8 the preViOUS ni * ht •« srt ,S u^' and when he as vL *, ■ matter ' re P !ied ' * Ss th ™ g! He Was ask " «% pam ' and ? laceJ his «omahf wharf t* The .y then steamerreanh!?'a t, as S£>on as the io tteHosS AUCklandheWaSsent e srv th v en( i uestioiietias h -f, the dece * sed "«* and S P f" / Said he ate h ' :art y ed rt4k an^/i? od W ° uld incluae si ™- nn t« d other me at. Af+er hf be •ffltta?L Z 1 ? 4 Et Wm Coining S° iu S to die. «« from the witness "Omaha! £% he attended a *«»«* stage, 0 '"; san S a song on Fesent^elS 011 /' • a ' gmndiggei, at b4 heen an illf Taid he J««,andoeeStv f the Hos P ital thi3 Ss White r?KJi c next bed t0 Waifeet apart. four « five mL DeSS , heard Neil en ? ere , he felt th e pain, left S S r r, epl y that it was - lde - Dr - was with W^^then ? JtNea^ai?-! 7 Se ! med t0 be" differing. fef^THBHOSP^. d SfeSae± te >s at the "H»— gainst £ r to tfa e joint to'tww - c admi s 3 ion of pa - n ßtSfe- P w glveMa evdenee re«lle ? two o r r ge t , to Bay * witnesses J he :Fre« l( S. Or l times. Waiiufc^ , to consider-

venient to the witnesses, but as a rule we must dispose of-one set of charges, and then proceed with , the: others, but we will hear him. Mr McVeagh: You were operated on for appendicitis? Witness: Yes. Who operated?— Dr. Collins. When you took |11 you were at Ku- : meu ?—Yes. : ; i Was there any medical man there?[No. Not nearer than Helensvilie. I You decided to go to the Auckland Hospital for treatment?— Yes. Whom did you see at the Hospital-? I saw a porter, and asked to see a doctor. What did he reply?—He said, "No; you can't be admitted here without an order from a doctor." Did you say you were — Yes, I told him 1 was very ill and in great pain. I asked where 1 couid go to see a doctor, and he said "the near- , est place I know is~Sympnds-street." Where did you. go?—I 'went across the Cemetery Bridge to Dr. Neil—a distance of three-quarters of a mile away. Ho gave mc an order, and I was admiv ted. When were you operated on?— Two hours later. Do you remember saying anything to the porter about dying? —Yes, 1 said while 1 was going to look for a doctor I might die. Jixuuiined by Dr. Collins: How long after 1 operated on you .did White come in? —A week later. What condition were you in then?— Better than when 1 came in. >peaking of White, l>r. Collins asked: Did you hear what 1 said to Dr. Neil?— VVimeas: No. Did you hear what he said to me?—l heard him say something to the effewt that it could not be appendicitis. Do you remember xjt. Craig coming in on "that night?— No. I did hot see him. DR. NEIL'S EVIDENCE. Dr. Neil was the next witness. He described bis qualincati'oas and experiences, which covered periods in English, hospitals,: the Auckland Hospital, peiiods as senior surgeon to the Ist is 2*. contingent in Soutn Africa, and recently hon. anaesthetist and hon. ear, nose, and throat surgeon at the Auckland Hospital, «tc. Concerning Wallis White, Dr. Neil said he was summoned to the hospual on Wednesday, May IS, to see an urgent ease with." Dr. Collins. After finishing the case he was engaged on he weni to ward No. 3, where White was lying. Dr. Collins said it was a case of acute appendicitis, and as the hon. surgeon in charge was away he was going to do the case himself. Mr. McVeagh: Did you examine the patient?— Yes. I examined him generally, and asked him some questions. I asked White to point with one finger to the locality of the pain. He pointed to the left side level with the navel. Where was Dr. Collins? —At my right toward the foot of the bed. Was the patient sensible? —He could answer my questions. I. asked'the man a second "time to point, and he pointel again to the left side level with the navel, but somewhat nearer to it. Dr. Collins remarked that the man was not consistent with his former statements. They then walked away near to Freestone's bed, and witness remarked to Dr. Collins: "You can't say dogmaticlly it's appendicitis. Why not open on the middle line?" Did Dr. Collins make any reply?— Yes. He said, "No, it's my case. I'm responsible for it, and I'm going to do it." I said, ".Why..have a consultation? You seem to have settled the matter." Dr. Collins replied, "On, 1 want a consultation. The hon. medical staff can come and look on." Dr. Neil said he then chatted to Freastone, land they moved towards the door. Dr. Collins asked if he thought the case was urgent. "Certainly I do," witness replied, and it was agreed to take the operation at once. He said he would give the anaesthetic. He left the hospital between 5.30 and 6 o'clock, and shortly before eight pjn. he returned. The case was brought down into the theatre, and witness commenced giving chloroform. Members of the honorary and resident staff were present, and Dr. Parkes made a cursory examination of White's abdomen. " The operation then commenced, Dr. Collins making the usual incision for appendicitis. Dr. Collins quickly found the appendix, and said, "It is normal. He said he felt foecal concretions in .the large gut near the appendix, and would take them out. He made a cut and took out some foeces. Then he found some more, and made a secor.d incision. Then he found a tTTird concretion, which witness said must be scybolla. Dr. Collide removed it, and asked how the patient was getting on. This witness took to Dβ a hint to mind his own business. About that time Dr. Collins asked him what time it was. Witness said it was about five minutes to nine. Time in such an operation as that was of paramount,importanee, and as a medical man he gave his opinion that in such an operation it w..s not necessary to remove the foecal concretions. The second concretion could easily have been manipulated so as to be taken out through the first incision. Before the first incision was made he told Dr. Collins that the man was very bad, and could not stand more than half to three-quarters of an hour and recover. Then, after the incisions, he told tne operating surgeon that the man could not stand more than 20 minutes at tne outside. Dr Neil proceeded to state that Dr. Collins then made the central incision, and punctured the small intestine to remove gas which distended it. He made several sutures in the belly wall higher up than an ulcer he discovered. Mr McVeagh: In what state was the patient then? . , Witness: I knew what was going to happen to him. He was, going to die. What led you to that conclusion?—ills general condition. From your observation as an anaesthetist?— Yes. and from my experience of the work generally.. What effect would the making of the incisions have on the patient's chance of recovery?—lncisions in the intestine are always a serious matter, and the long time occupied also reduced his chance of recovery. Did you examine Whites bed chart?— Yes; I asked Dr. Collins, "Where were the notes?" He said, "Oh, the man is only just come in." . You left the Hospital after the operation ?—Yes. Witness, continuing, said that, tne case was one which, taken swithin 20 hours of the first symptoms, and skilfully operated on, would have had. a'so per cent, chance of life. ; DR. MAOGREGOR'S POSITION. Dr. MacGregor, whd had asked the witness one or two 4i le st' ons >' as a * this stage asked by Judge Ward what position he occupied at the - inquiry. Dr. MacGregor replied that he appeared on behalf of the Department. Coatlmned om v«s* tw*.