HOSPITAL WARDS

Evening Star, Issue 14531, 6 December 1910, Page 7

HOSPITAL WARDS

ANOTHER CHANGE OF SYSTEM. SAUNDERS'S CASE DISCUSSED. At last night's special meeting of the Hospital and Charitable Aid Board an official report was read on the ease of tho boy Saunders, concerning whose treatment in tho Dunedin Hospital complaints had been made, particularly in respect of tho working out in his case of the system by the honorary staff aro now periodiaiflv changed from ward to ward. T"he report was from the honorary racdi»tU staff of the hospital, and it enclosed Dr Stanley Batchelor's report on tho case, which report tho honorarv staff had unanimously adopted. ; Dr Batchelor's report ran as follows:

"The boy Saunders came under my care when I took over the children's ward from Dr Closs on the Ist October, 1910. The boy's temperature was then normal; on the 7th October the temperature rose to 102, and remained high for threo days. I thought it probablo that the wound was not draining properly, and informed the sister of the ward "that if he did not improve I would examine the wound on my next operating day (October 18). 1 in no way specified what tho proposed operation was to be, and as a. matter of fact I only intended to reopen tho wound already present, so as to let out any matter that might be retained there. The sister of the ward very properly informed tho parents that there might be a further opera, tion, but, as things happened, in a few days the boy's temperature came down, and the necessity for the proposed interference no longer existed. The telegram reporting the proposed operation was sent without my knowledge, and if the boy's father had consulted mo instead of Mr Fraser on the 14th October he would have found that it was no longer intended to reopen tho wound. These are tho entire facts as to the surgical treatment of the case. It is also stated that I refused to transfer_ tho case to a colleague. The reply to this is that I was never asked by Dr Closs to transfer the case to him. 1 would have been onlv too glad to- have left him in chaTge of" the case. On transferring from one ward to another it is customary for tho outgoing surgeon to keep' chargo of such cases as lie thinks tit, and I am sunin no instance would the incoming surgeon object to this. As an example 1 may say that when I left Phmket ward I kept <m six cases which I thought I ought to see through. Tho first intimation 1 had ot a desire for the ease to lie left under the control of Dr Closs was when Dr Falconer rang me up and read me extracts lrom Mr Fraser's letter ordering that the case should lw transferred at once. I replied that I would do nothing in the matter until I had seen Dr Closs, and also until the letter was withdrawn. The letter was withdrawn. 1 saw Dr Closs, and the transfer was effected. I was perfectly willing to transfer the case at the request of Dr Closs, but I strongly objected to an ultimatum from someone having no connection with tho hospital." The honorary staff reported that they had passed the following minute concerning the hospital staff arrangements: The arrangement whereby the three surgeons exchanged duty every four months was an attempt to overcome the inconvenience of having three surgeons visiting one ward at tho same time, and thereby embarrassing the work of the ward. It was adopted as the best of several proposals, and it was clearly understood that tho arrangement was only tentative, and was to be tried for one year. It was part of the original scheme that each surgeon hail the right to continue in attendance on any case in which he considered 6U.ch attendance desirable. No member of the staff has been very strongly in favor of tho arrangement, and none will regret its abolition if other means can be found to attain the same end, but at the same time it has been the cause of no hardship to any patient. The case which has given riso to a lengthy correspondence Mould have been settled in five minutes if the father- of the child had adopted the reasonable course of communicating his cause of complaint to the medical superintendent. Instead of doing this, he consulted a member of another profession, which is notoriously emotional and impulsive, and ajl the subsequent trouble has been due to that gentleman's explosive methods. The case of tho boy Smith has already been mado the subject of a Teport to the Board. Mr Keast suggested that this report from ■Dr Batchelor should be withheld from publication until it had been submitted to Dr Closs for a reply. Dr Jlarshall Macdonald informed tho meeting that Dr Closs had assisted in drawing up the report. Mr Loudon, chairman of the Hospital Committee, moved—"That the changes of the honorary staff from one ward to another shall not be made more frequently than once a year." Mr Hamel seconded thiijj Mr Keast, after explaining that he had acted in this matter as the member representing the district in which Mr Saunders, sen., lived, reviewed the circumstances. Mr Saunders, on learning that the boy was to be placed under another doctor, who proposed to operate again, approached him, and thev went, together with Mr Walker, to Dr Falconer. They asked if the hoy could remain under Dr Closs, and Dr Falconer said it could not lie done until Mr Fraser withdrew a letter he had written to the medical staff concerning the case. In the correspondence just read the minuto (which Dr Batchelor had. with others, signed) contradicted that. ' He contended that Dr Batchelor should have consulted Dr Closs as to whether there should be another operation. Mr Fraser's letter should not have stood in tho way of the child being left under Dr Closs, which was the father's express wish. He (Mr Keast) expressed the opinion that Dr Batchelor and Mr Fraser wero not the best of friends —(interruption)—otherwise Dr Batchelor would not have,written as he had done in the correspondence just read. The Chairman (Mr J. H. Walker) pointed out that tho letter was from the medical staff as a whole. Mr Keast said he would move that an inquiry into the case be set up, and the result reported to the Board's next meeting. The Chairman ruled tho motion out of order. Mr Keast could give notice, of motion for next meeting. Mr Myers supported Mr Loudon's resolution. He did not think the yearly changes would be an unmixed blessing, but they would be preferable to tour-monthly changes in some respects. Possibly the four-monthly changes would ultimately be reverted to.

Mr Knight asked whether consultations were not held over serious cases.

I>r Falconer: The practice has been that in an important case the doctor has the option of retaining it himself. A fair proportion of these cases are retained, and are not passed over to the incoming surgeon. If it were a case requiring consultation, the incoming surgeon would ask for it, if ho were not satisfied with the go-between, who is the house surgeon. In such a case it •would be his duty to consult with his colleague under whom the case had been before. Although 1 am against the fourmonthly changes for other reasons, I cannot recall a case that has been detrimental to the interests of the patient owing to that system. The Chairman 6aid that the four-monthly changes had not been responsible for any of the trouble. It arose from one doctor not consulting with another before taking • case over. If Mr Fraaer had referred this particular matter to Dr Falconer it <ould have been easily hxed up. He sugjspsted that Mr Loudon should add to his {notion " and that in all cases so transferred the medical practitioner in charge of the case should consult with the incoming doctor."

Mr Loudon: That is already provided for in the by-laws passed last meeting, which read: " That when the honorary staff is changing over from one ward to another, if a member of the staff in charge of any particular case or cases is of the opinion that, in the interest of the patient or patients, it is desirable that no change should be made, he shall communicate the same to the medical superintendent,

will immediately confer with ihe outgoing ami incoming medical officers, and make such arrangements as will give effect to the principle indicated." Mr Loudon added that ho supported the yearly change, becauso Dr Valintino strongly favored it and Dr Falconer advocated it. Ho informed Mr Keast that tho Hospital Committeo proposed to have another inquiry into the case of the boy Saunders, and a report .would probably be presented to next Board meeting. Mr Loudon's motion was then agreed to.