MATERNITY HOME

Evening Post, Volume CXXVIII, Issue 71, 21 September 1939, Page 7

MATERNITY HOME

TOO MANY PATIENTS

MIDWIFE CHARGED

A HUTT VALLEY CASE

In the Petone Court yesterday, Olive Gertrude Maud Linklater, licensee of Leith House Maternity Hospital, Hutt Road, was fined £7 10s on each of two charges of admitting more than the registered number of patients, and £3 for failing to take the temperatures of patients as prescribed by the regulations. Mr. W. H. Cunningham, the Crown Prosecutor, prosecuted on behalf of the Health Department, and Mr. A. B. Sievwright conducted the defence. I "In this case, the record book shows . that over a substantial period of time the defendant has taken a .greater number of patients than her hospital is licensed for," said Mr. Cunningham. "The Department regards this as serious, particularly in the case of maternity hospitals where the care of babies is also to be considered. Temperature charts are also important, as a rise in temperature is the first indication of sepsis. There were six patients in a hospital licensed for four, and for three days no temperature was taken." Mr. Sievwright recorded an objection to this statement. Dr. T. L. Paget, an officer in the head office of the Health Department, said that his duties were principally concerned with maternity hospitals. The defendant was the licensee of Leith House, a private hospital on the Hutt Road. It was licensed as a . maternity hospital for four beds. Unless there was more than one registered maternity nurse on the staff, the Department would not "register a hospital for more than four beds. One nurse certainly could not handle seven cases. DEPARTMENT'S WORK. The Health Department issued charts of temperature which had to be kept, with other particulars, by the licensee. It was most important that the temperature of each patient should be taken regularly and accurately, as a rise in temperature was the first indication of sepsis. Sepsis was most likely to occur when women were together in a hospital. The Department had to be informed as soon as a patient's temperature reached 100.4 degrees. If precautions were not taken, sepsis was liable to spread through the hospital and infect all patients. Before the passing of regulations in 1927 sepsis was a major danger in maternity work. Since they were in . force, the fall in the incidence of sepsis was remarkable. Prior to 1927 deaths were between 50 and 60 per annum, and that year the number was 56. As soon as the regulations came ■; into force, the number of sepsis cases -■■ dropped. In 1928 there were 42, in 1929 30, while in 1935 the number reached the record low mark of eight. The rate came down from 2.01 to .33. Lately there had been rises which were disturbing, though not nearly as bad as prior to 1927. On the symptoms being discovered, the licensee of a hospital must at once notify the doctors attending ' the patients, as well as the Department. The doctors were entirely dependent on the accurate taking of tempera- ■ tures. '■ - t*-;- Cr6ss-examiried i!...by" Mr. Sievwright" witness said that the average number of births per year was 17.98 per thousand.. In a district of 40,000 inhabitants 720 babies were being born per year. In .the Lower Hutt and Petone district there were four licensed maternity hospitals providing a total of 20 beds. The average confinement lasted a fortnight. Therefore 40 patients per month or 480 per year could be ac- , commodated. Others were taken care of in Wellington hospitals, St. Helens, ... and in one-bed homes. These latter .were not registered, and he could not say how many there were. NOT INADEQUATE. He did not agree that the Health Department was taking inadequate measures. It had' recently urged for an extension of the number of beds available. Mrs. Linklater's hospital had twelve rooms, and could take more beds if sufficient nurses and equipment were provided. Some years ago he had been in favour of increasing the licence to eight beds, if this was done. In response to an appeal by the Department, he understood that another hospital with ten to twelve beds would be opening in the district within three to five weeks. Social Security provided monetary help, but not hospital accommodation for everyone. If a woman remained in a hospital for 15 days, she received £11 towards the fees, with less in the proportion of 12s«6d per day short of the 15 days. If a hospital was temporarily in excess of its licensed number and advised the Department, the Department was in the habit of allowing the matter to go on, if the additional nursing help was provided. An application had been made by the defendant for permission to use three more beds, but it had not yet reached witness. This did not indicate laxity on the part of the Department. Mr. Sievwright: You and your Department appear to be supremely uninterested in the welfare of women and babies in this, district. You have not provided any extra beds since the 'enactment of the Social Security legislation. Dr. Paget: It is not our task to provide beds, sir. Dr. F. S. McLean, district medical officer" of health in Wellington,. said that it was necessary for private hospitals to send in monthly returns. The defendant's return. for July showed eleven or twelve, patients, as against a maximum of eight for a four-bed hospital. He called on Augus| 10, and the register showed that on 24 days out of 30-odd the hospital had more than the licensed number. Witness suggested that the temperatures had not been taken because the thermometer had been broken. The defendant said' that this was so. During the period of overcrowding Mrs. Linklater had communicated once with the Department. She engaged another nurse from July 28 to 31, and during that time there were seven patients at the home. SOMETIMES OVERTAXED. Cross-examined, witness said that there were from 14 to 16 beds in the other three hospitals. After the social security legislation came in, the hospitals were sometimes over-» taxed. A quota of 84 cases in a year, or of 54 in eight months, would be reasonable in a four-bed hospital, being seven or less per month. After his visit, Mrs. Linklater had applied for a licence for more beds, but as a prosecution was pending it was hardly a time to consider it. A larger maternity hospital in the district would be a definite advantage. Bookings were often as much as six weeks out. The Department had ■ referred the matter of the shortage in the district to the Hospital Board, and asa result there would be another hospital within. Iwo or three weeks. Regarding the absence of a thermometer, he was sure that one could be obtained from a chemist in an hour or so. In any case, the licensee of such a hospital

should not depend on only one thermometer.

Mr. Sievwright contended that the Health Department had been inefficient in not making arrangements in view of the social security legislation. If it was not the Department's job to provide beds, whose was it?

In evidence, the defendant said that she had been a registered midwife for 19 years, during which time she had had one case of septicaemia and no deaths. Her house had accommodation for eight altogether. Three years ago she had asked for a licence for seven, and Dr. Paget approved of this, subject to certain conditions. The excess" of patients in July could have been avoided if the patients had been kept less than a fortnight. When Dr. McLean arrived there were six patients in the hospital. One was to be discharged that day, and one the day following. She produced evidence showing the difference between expected and actual times of bookings. No objections to the overcrowding were made by doctors or patients. She considered that she could, easily look after seven patients, three of whom would be in the convalescent stages.

"It is not right to blame the Health Department for the inadequacy of maternity hospital accommodation in certain districts," said the Magistrate. Mr. A. M. Goulding. "The defendant could have foreseen the demand which would arise as a result of the social security legislation, and could have made provision for it. It is inexcusable that a broken thermometer was not replaced for three days. There is something to be said for the defendant, however, taking all the circumstances into consideration."