REPORT OF THE INSPECTORGENERAL OF HOSPITALS.

Auckland Star, Volume XXXVII, Issue 230, 26 September 1906, Page 3

REPORT OF THE INSPECTORGENERAL OF HOSPITALS.

|| ! RQBT . S. BAEEWELt, M.D. i,% - . the omissions in Dr. Mac- -« is that of the Cambridge < nfs sanatorium. It fms 5& * n " that -bile tho Waikato hospi<S on in the usual way. I V *"ifno mention of the consumptive *: Tt is very important that we >*W* what is the success of this *-S JooW kD ?; exper iment; what it costs, of the cost is repaid by ll KiSTomission which I find in all *«nenN I have examined is that 1 M;X count. I can find no state- ' "*SShcrcof the value of the site, , and stock of the • uildWg-' jptorest on the money ' "f providing these must amount to considerable sum. What are they *'"$, Some of the sites have very ■ °Tincreased in value and might P toWtoadvnntn.e.nndthcproL '- I dented to the building of a new ' •(!] For example, the Inrge piece ' ifCd , . the greater part of which is .J by the patients or staff, which fek "Jidby the Auckland hospital, and 5 J,* few cows, might be sold on ■ "' Rin'ff leasos for a sum that would ■ ; nUhe Board to build a new hospiPm« ff on in accordance with modern >l 'j than' the clumsy structure now in 4 which is in < a raost inaccessible situ- ' •* U l-' n and in many respects behind the ■ • ' luir«" ents of th ° prC3ent « ay - ■ it* Another point that urgently requires be. t j fe is the appointment of a man "fr "'ftr in the Government service, or cn U rapvin" tic portion of a Government Go& chairman of every Hospital I ti Considering that the GovernS 'subsidises all these hospitals, it certainly ought in have, a nominee of its i mc, en on " le Boards in order to super- . ;o£ - se tte expenditure and exercise a sus--505 nave veto on any item of expenditure, i There is nothing so fascinating as spend- j a 2 jjjother people's money, mid there can ijjo doubt that the. expenditure on our , *r? jjspjtttls could be greatly reduced with- ! ijj oat i n any way impairing their efficiency, ; * jf anyone in the position suggested were ! itq| jjctructed that it was his duty to ccono- ; el "' isc I ° 5 for instance, the cost of drugs and j ," dispensing seems to mc enormous. I i J anil on inquiry that in this part of the I (I colony, qualified lnedirvil men will under- | J iake"lodges or benefit societies at the \ A wte of 20/ per member, for which they j I undertake to give medical attendance j ■• and medicine to the member, his wife, j . ■ al ](i all children up to the age of eighteen. I think this is less than Ire rate 1 paid in the South, where i< used to be. (if 1 remember aright) a pound for medical j X attendance and eight shillings for mcdi- j , cine, which was contracted for by ehem- 1 Ms. In Auckland, as is well known, some of the friendly societies have com- *• lined, and keep a dispensary with qualified dispensers. Jt. would be interestingfo know how much it costs in that establishment for drugs per case. Another matter which requires fur- ' 1 Jler investigation i> the extraordinary "difffronce in the number of days the patients stay in the various hospitals. This ranges from 18.36 days in tho Northern Wairoa and 10.00 in Akaroa to lti.G in Eos=. The average is 30.41. 'Soy, docs this extraordinary range .arise from a different class of cases being treated, or from greater strictness aerdsei by ihe me.dienl officers, or ■' itm'tha anxiety of the patients to es- , ajie from the hospital at the earliest Doment ■possftilc'! A good many years ago, I was suffering from double bronchitis, and thought I would jo into the Auckland hospital so as to save my people the trouble of raising mc and laying mc out—for I did not expect to recover. I .stipulated for a private room, and pnid two pounds or two guineas, I forget which, for a private room. It had no fireplace, and although the nurses gave mo hot water bottles and kept a lamp burning on the floor. I was so desperately uncomfortable that I took my departure the next day, after just 24 hours' stay. Now. the nurses were very kind and attentive, and I had nothing to complain of. only that I felt uncomfortable and cold \ great many patients complain of the Dietary, either as to its composition or its cooking, and leave on this account. J cannot find that any complaints were made to Dr. Maegregor on this point, tat one hears plenty of complaints from patients. Jw, the " dail ? avera ?e cost of each F«, as given in the table at the WnlT'u i normousI y- I may tell Mr. Jtojfldd that I have n ., it hnr the time >»r the inclination to go over this table Zj,? l * l6 its fi & uxea w «h those in thp H of the report. Dr. McGregor * responsible for both -^uie^orj X l iv Havelock ™d (next) 3/31 wL,- n/o nest hi " host is Wairoa, 2 w f 7 n X observe that Wcsi " P rt (West Coast. Middle Island) is !«7 low, only 3/7, and Ktunara 3/51. i J xt , that the cost of a g nt should be so much less in these i 5 f n r P R ° n tllC Wo?t Coast I and \ 6 ? r ° vi "«al district of Auek- ! Sμ . mi ? ht be cx P«ted, all the i I averal e rg Spitals ;,ro bdow lhc I la ft Northern Wairoa, which' »hJh £ M CondUote,l in " i""ncr . 5 Jin s^ ?rec;or ye - Ptrongiv <Us- : : Proves 0{ and witl 1 .iukicc. the'high-^, «on !»?^ c Of cost °t administra- \ W,? , , 68 - 84 ' and the lowest at ! SO 75 n Th ° next is the Waikato i' Pitalk-, W%r ri ,° US that a small llos - '■''■ ot4vl*- C l Vaikato mth onl y a total , a 4L P ru ts ;1 oul,l ' cost than «4ni3r ;■ rp arc some cosis of Cintl' 011 Whicb havo t0 to in- , n n l,- the Bni allest: hospital j " certainly 1 \ tabic SV 11 c hoepitaK I n the i, votd te *w divefindone column de-r thi ß \ZI Z Dg aUd laund n-." Under ! %Z", turn ;i1 »"! i fin 'l the foap Wa " g fOt uolhin S- ™* fiothiZ! w tch f Urch ""thing; Dunedin ( Church - Th « tallest " i £1 10/f tl CXpended is Crom-: r 3ee tiV c stay ,-n k 68 .F atients whose col- \ Th at is to'sav \ ? kl Was 1427 d *Js- - L ar fe^ r that l **™ ' _ .«,areaned my readers -Wit h so '

■ many. But when they consider tnat the expenditure on the hospitals so imi perfectly reported >on amounts to a sum of £ 167,000 last [tear, and that we have !no guarantee whatever that that sum is properly spent, I think it will be admitted that I have done well in calling attention to the omissions in Dr. Macj gregor's report. I think the office of Inspector of Hospitals should be filled by a man of not less than 27 nor more than 35 at the time oi his appointment. For the salary we i give we can get a good man of this age —not a first-class man, hut a good secI ond-class man, who has had actual hospital experience either as a resident ,or as a visiting physician or surgeon. He ought to have a hrst class diploma, cither member of the Royal College of ' Physicians of London, or Fellow of the : Royal College of Surgeons of England. 'He ought to have done some work in the medical journals, or by reading pa- : pers before sonic of the principal mcdi- ! cal societies. Ho ought to be in good health, not one of those sickly incipient consumptives who come here solely for j the benefit of their health. Nor, if the J Agent-General can help it, ought he to I come out for his wife's health. A man I tied to a sickly wife can hardly do the i work of an Inspector of Hospitals in such ifi colony as ours. He ought to be a man of a vigorous mind with plenty of energy, determination and moral courage, and he ought to be appointed only for five years, with a distinct understanding that he would not be reappointed. At the end of tho term we ought to get a new man. His duties should be strictly defined, and should include a visit to every hospital twice in the year. He should be required to make a report for publication, in which any glaring defects either on the part of the Boards or the officials should be pointed out, and another report (con- : fidential) for the Minister, in which mat- ; ters that it would be improper or highly j inconvenient to mention in a report mii tended for publication would be brought under tho Minister's notice. I For example, the Inspector hears that j the medical officer drinks, or has the i cocaine or morphia, habit. He reports it, I confidentially, to the Minister, who sends ! a private letter to the medical officer in- | timating that he had better resign. Or possibly he has reason to suspect ■ embezzlement or misapplication of I store?; he recommends that some officer J connected with the supply department of j the Government should be sent down i thoroughly to investigate. In Trinidad I I was the chairman of a sub-committee ■of the Ho.-pital which in two ; hour.- , .' inquiry found out embezzlement ■of store- that entailed the summary dismissal of the medical officer and the* clerk in charge. j He should be gazetted as InspectorI General and Consulting Physician and Surgeon of all hospitals subsidised by j Government . This would give him the ■ right to be present at all consultations, whether in the wards or elsewhere, without any breach of medical etiquette. At present I should doubt whether he has any right to be present at a consultation, or even to examine any of tho palients. Hp would, when at home, be able to attend the operations, P.M.'s, etc.. at the Wellington Hospital, and visits tho wards when he chose. If he had any tact he could do this without giving any offence to tho visiting staff. If he were the right sort of man fhe visiting staff would be glad of his opinion and help. He should. I think, be allowed private practice, to the extent of seeing cases in consultation with the regular medical attendant. It should be stipulated in writing, on his appointment, that this I privilege was granted as a favour, and that it would be entirely withdrawn if iv nay ease (except urgent accident) ho were found to have seen or visited a patient without another medical man being present. lie should not be allowed on any pretence to practice midwifery. The object of these regulations would be to establish at least one regular consultant, who should set an example of correct medical demeanour to all tho profession. He would, for instance, both officially and privately, abstain from addressing any of the hundreds of medical practitioners who now absurdly call themselves '"Doctor" by that title, which by right belongs only to men who have received the diploma and degree of Doctor from a recognised University. There are many other points I should like to have noticed, but my limits are rerrched. I am only afraid that, as in my first article, in labouring to be brief, I become obscure. '"Brevis esse laboro, obscurus fio. - ' Onchunga, Sept. 17th, 1906. THE ACCOUNTS OF AUCKLAND HOSPITAL. _____ (To tho Editor.l Sir, —Since my third paper on Dr. Ma-cgregor's report was forwarded to your office, I have, by the courtesy of the Chairman of the Hospital and Charitable Aid Board, been favoured with the full "opy of tho accounts of tho Board for the years 1004-5 and 1905-6. I regret very much that I did not sec. thepp accounts before writing any of my articles, for they afford such a convincing proof (if the. inadequacy of Dr. Macgregor's statistical tables, that I should have been saved many hours of intricate nnd trouble-some calculations. Ex pcclc Hcrculem. Take the following as a ] sample: j The HoFpital accounts begin, as every j balance-sheet I ever saw in my life be- ! gins, with a statement of the balance, in j hand, followed by a lift of tho receipts ! during the year from every source. I The Inspector-General's account docs i not recognise any balance in hand, but , begins: "Receipts from Government,, £7227 (I omit shillings and pence to save ; space) ; local bodies. £7227.'' The total expenditure of tho Hospital is given in , the report as £18.510; in the Hospital account it is £15.960! In Dr. Macgregor's report the "Sala- ; ries and wages'' are given as £4463; in the Hospital account they are £4272. But it is useless to proceed further; the facts and figures quoted wall suffi- ! cicntly illustrate tho objections I have taken'to the report.—l am, etc., K. H. BAKEWELL, M.D. Arthur-fit.; Onehunga, Sept. 22, 190 G.