THE B.M.A.

Evening Post, Volume CXI, Issue 108, 7 May 1926, Page 8

THE B.M.A.

ITS HOSPITAL POLICY

COMMENTS ON MINISTER'S LETTER.

The executive of the New Zealand branch of the B.M.A. supplies the following comments on the correspondence between the B.M.A. and the Minister of Health: — The hospital policy of the New Zealand branch of the B.M.A. is as follows :■ — 1. Public hospitals should be so constituted as to be available for treatment for every member of the community. 2. Patients should be divided into three classes: (a) Those unable to pay anything; (b) those able to pay for maintenance; (c) those able to pay for medical attention as well as maintenance. 3. As regards paying patients, the fee to be a matter hetw'een the patient and his medical adviser. 4. The treatment of those patients who voluntarily enter the private wards of a hospital, and those who are deemed by the secretary to be in a position to pay private fees over and above maintenance, should not be under the medical and surgical control of the resident medical officers, but such patients should make their own. arrangements for attendance with the doctor of their choice. 5. Patients entering paying wards should not be attended by the stipendiary staff of the hospital, but by the medical adviser of their own choice. Nothing in this clause is to prevent a part-time stipendiary surgeon or physician from being responsible for the treatment in the hospital of anyone who is his genuine private patient. 6. In tho larger hospitals, as far as practicable, whole-time medical superintendents should confine their duties to administration. 7. In tho case of smaller hospitals, even if the administration work remains permanently in the hands of one man, the medical and surgical work of the public wards of tho hospital shall go to the registered medical practitioners in the district who, if they desire, shall attend their own patients in the hospital, except such doctors as are found' by the central controlling board to be unsuitable. 8. Hospital policy generally, with special reference to the limitation of the number of districts, should be under the control of the Board of Health, or some similarly constituted centra! board. 9. In addition to the elected members, the law should be amended to permit of nomination by the Government of an appropriate number of members of all hospital boards in virtue of-the Government subsidising hospital funds. 10. The Government should subsidise the capital cost of accommodation for paying patients on the same basis as for non-paying patients, or, failing that, advance the money at a low rate of interest. 11. The work of hospital boards should be divorced from charitable aid administration to enable hospital boards to concentrate on hospital administration. 12. Some modifications may be required particularly in connection with tho Dunedin Hospital, as being an integral part of the Medical School of tho Otago University. The above policy was reaffirmed on 12th June, 1925. (b) At Huntly the Minister of Health went out of his way to adopt a heroic pose as the protector of popular liberty against the threatened tyranny of the medical profession, which, in his opinion, was striving to take control of hospitals. He aggravated this offence when, a few days after the Huntly outburst, in Blenheim he threatened that he "would be up in arms and would take a stand against the whole medical profession." His courage, however, was of the calculating kind, because after leaving Blenheim he went to Auckland and declared at the opening of a Nurses' Home that he "did not accuse all doctors of being actuated by personal motives in regard to the control of hospitals, but he could see the cloven hoof showing itself in some places." When asked by the B.M.A. to substantiate or withdraw his accusation against the medical profession of attempting to take control of hospitals, his answer is an evasion of the point at issue and merely a reference to the principles of democracy which are not in question. He has the audacity to take credit for having made the B.M.A. abandon its claim to take financial and administrative control of hospitals when it is clear to the most casual observer that the B.M.A. never made such a claim, and even more surprisingly the Hon. W. Young proceeds: "There is now just one other disclaimer that I would much like to hear: That no section of the B.M.A. has any desire through the honorary staffs of hospitals to restrict the right of every citizen, who so requires, to obtain entrance to the public hospitals of the Dominion for treatment." He evidently has not paid much attention to the hospital policy of the 8.M.A., because Clause I. (videante) reads: Public hospitals should be so constituted as to be available for treatment for every member of the community. Surely a "disclaimer" in this mstanco is required only in the interests of political sophistry. (c) On the attitude the Minister of Health adopts towards "the gentleman from America," Dr. MaeEachern, the executive of the B.M.A. is in complete accord with a Press criticism that not one of the requirements of courtesy, justice or policy has been obeserved by the Minister of Health." In his reply to the'B.M.A., the Hon. Mr. Young is pleased to recognise Dr. MacEachern s standing "as an authority on hospital problems and organisation in Canada and America." Mr. Young is badly advised by his departmental officers that he docs not know that Dr. MacEachern is an eminent authority on hospital matters throughout the civilised world, including New Zealand and such States as near home as Victoria and New South Wales. Our Minister of Health

will obtain an adequate conception of Dr. MacEachern's status if he applies to the •Minister of Health of Victoria. It is difficult to characterise it measured terms the spirit of international, or inter-Dominion, suspicion and enmity which the New Zealand Health" Department engenders through the public utterances of a responsible Minister of the Crown, the Hon. J. A. Young, and which has given the impression in many quarters that the New Zealand Department of Health is bigoted, reactionary, parochial, and averse from kindly-psoffered "iclp frow without. If it it at all relevant, as a matter of fact Mr. MacEachern is a Canadian and as British as the Hon. Mr. Young himself. (d) The executive of the B.M.A, confirms the hon. Minister's statement in his letter that the relations between the Health Department and the medical profession were cordial. It is characteristic of the Minister that he makes an appeal for co-operation and cordiality when he, himself, precipitately and wantonly disturbed the peace. A month ago at a preliminary round-table conference representing hospital boards, the Health Department, and the medical profession there wa-o a very friendly and fruitful discussion on various hospital problems. Before this conference again resumes, the Minister thinks fit to alienate one o the parties. While it is true that the medical profession has no desire to control hospitals, it is even more obviously true that hospitals are not much use without doctors. Whether they are better or not without , politicians is a matter which at present is not under discussion. -The Minister wishes to restrict the function of doctors to helping the community in sickness and maintaining its health. In the opinion of the B.M.A. this function should include an intelligent interest in the equipment, staffing, an<2 medical administration of hospitals. (c) In the absence of any withdrawal of the Minister's reckless and harmful statements, which are taken at their face value by, for instance, some of the smaller hospital boards, the executive of the B.M.A. considers it futile to attempt further negotiations with him. He has already been well castigated by the leading newspapers of the Dominion, some of them the strongest supporters of the Government of which the Hon. Mr. Young is a member. After all, fortunately, hospital reform is a question which concerns, first of all, the people generally, also hospital boards, th Press, the medical profession, and, indeed, every individual in the community. The executive of the B.M.A. cannot look for support to the Hon. Mr. Young, but will continue, with the aid of all fair-minded people, to help the profession to give good service to the hosp.itals and expect help and advice so that our hospitals may be, even more than in tho past, useful public institutions, and in the van of progress. No Minister of Health, however reactionary and unreasonable, has the power to establish a dictatorship in the scope, the administration, or clinical service of our hospitals.