HOSPITAL BOARD.

Lyttelton Times, Volume CI, Issue 11888, 11 May 1899, Page 6

HOSPITAL BOARD.

THE CHAIRMAN AND THE MEDICAL OFFICER. A LIVELY DISCUSSION. THE CHAIRMAN ASKED TO RESIGN. A special meeting of the North Canterbury Hospital Board was held yesterday; present— Messrs C. M. Gray (chairman), G. Payling, J. G. Murray, J. M. Douglass, E. Feldwick, W. Jacques, J. Wolfe, J. Dobson, G. Wallace, H. White and G. H. M'Haffie. The Chairman stated that the meeting had been called for two purposes—to consider the tenders for the re-plastering of tho Hynian Marks Ward, and also a letter from the House Surgeon. The following letter from; Dr Fox was read:

"Christchurch, April 19, 1899.—T0 the members .of the North Canterbury Hospital Board, Christchurch,—Gentlemen^— I am in receipt of a letter from Mr Miller, conveying to me the resolution passed by the Board at its meeting of the, 23rd ult., that after the end' of March : it would no longer authorise the payment to the house surgeon of-the salary accruing to the position of assistant house surgeon during the vacancy in that office, but resolving that such allowance shall be received by the house surgeon at all times when the assistant house surgeon shall be absent with leave on his annual holiday. In answer thereto, so far as this resolution is intended to 'deprive me of tho extra £l2 10s per month I am_ at present receiving for performing the assistant house surgeon's duties in addition to my own, I beg to inform you.that"l protest against the same, and decline to recognise the legal right of the Board to curtail at their will any remuneration for the services lam rendering. I cannot think that, in passing this resolution, the Board have considered the duties I am just now called upon to perform.. Three hundred pounds per annum is not a very liberal salary for a house surgeon in an institution like the Christchurch Hospital, and were it not for the love I have for hospital work, I should go into private practice, as, from a mere moneymaking point, of view, I am, by remaining here, sacrificing some of the best years of my life. Since I have been in the hospital I can say without egotism that the institu : tion never bore a. better name thanit does at present, and that the patients in the hospital, or those connected with it, know that nothing is omitted to relieve their infirmities, and to make their convalescence as rapid and as complete as possible. This is some tribute to the faithfulness with which I have performed my duties. But one - ' cannot please everyone, no matter how much they may ' try. I, unfortunately, am no exception to the rule, as I have failed to make myself agreeable to Mr C. M. Gray, one of your Board, the indirect result of which, I think, is the passing of this resolution now sent to me. My difference with Mr Gray arose on the question as to whether he or I, as house surgeon, was to have control of the nurses. A nurse was due to leave; Mr Gray instructed her to stay. I requested the nurse to leave the hospital; she informed me that Mr Gray said she was to remain. Mr Gray's instructions were incompatible with the maintenance of discipline, - and I felt that either the nurse must leave or I should be unable to stay, and I forced this view of the'matter upon Mr Gray, who then ceased supporting the nurse, but ever since I have been the victim of a petty and rancorous system of espionage and tyranny on his part. Not long since I had some exercise at polo for two hours, after providing that I could be at the hospital in a few minutes if the necessity arose, and the day after Mr Gray sent me. a letter, through the Secretary (a, copy of which is enclosed)', asking • what arrangements had been made for carrying out my duties during the brief interval I had been away. Now I had been working at the hospital fifteen hours per day continuously for weeks before, and I suppose it will be conceded that even a house surgeon must breathe fresh air occasionally if he is to do his work, and yet because I rode a pony in the open for an hour or two close to the hospital, .Mr Gray must think it necessary to'show that his espionage was not released, for one moment, and took it upon himself to address. a subordinate officer upon matters concerning myself. Another matter I desire, to bring before your Board are the allegations made by Mr Gray that I have been the means of' driving out the assistant house surgeons, and his insinuations that I,have done so for the purpose of adding their stipend to my own. These allegations are baseless, and there is no shadow of truth in them, as the assistant surgeons and myself have been and are the warmest of friends, in proof of which I enclose copies of letters they have sent me, from which it will be seen 'that Mr Gray, when he charged me with driving these men out, knew perfectly well the reasons why they left, and that those reasons were totally unconnected with myself; yet he hesitates not to . assail my reputation and to impute to me mercenary motives with full knowledge that his charges were absolutely devoid of truth. If it were only money that I wanted I need not stay in the hospital working fifteen hours per day for £3OO per year, or'even more, when I could obtain the same remuneration in private practice and have most, of my time to spend as I please. If lam not responsible for tho assistant-surgeons leaving "the hospital, why should the Board desire to penalise me by iusisting that I shall perform the assistant-surgeon's, duty during .the. vacancy without extra, pay? Compelling me to work as the Board is, doing night and day, never giving me a moment for reci-cation or exercise, is bad enough.,' but to insist that I shall do two men's work for one man's pay is simply applying .to the hospital those practices which, in other spheres of "life, have rendered anti-sweating legislation" necessary. lam quite unable ,to understand whv the House Surgeon is to be paid if he performs the assistant's duties during the hitter's holiday or leave, and yet if his absence is of a permanent nature the remuneration is to cease. I can .only understand the logic of this by supposing that the Board must have considered that Mr Gray's allegations were founded upon fact, and that I should probably cultivate more amicable relations with my assistants if I had no money to gain by'their departure. I should like, for the information of the Board, to give a slight sketch of my ordinary daily routine since Dr Liddle left, now about eight weeks since. I am in the wards at 7.30 a.m., where I remain until 1 p.m., with an interval for breakfast. During the greater portion of each afternoon I am occupied with casualty cases or out-patients, visiting and attending people inside, having besides to perform a considerable amount of clerical work. In the evening casualties have to be attended to, out-patients often apply for treatment, and the patients in the wards very often need attention, besides many details which occupy one's energies and time. At 10 p.m. a round of the whole establishment is made, the more serious cases are examined, nurses interviewed, and instructions given for the night, and at 11 p.m., after fifteen hours of incessant mental and physical strain, one would suppose that the daily work was over, but I am frequently called once, and occasionally twice, during the night to attend to cases. Believe'me, the office is no sinecure; no medical man, unless he is devoted to the work, could conscientiously perform all that is required to do justice to the patients, and no person, except from practical experience, can understand the depressing influence resulting from the continuous contact with so large a number of sick and dying people. For the last eight weeks I have been compelled to attend to everything ; the sick cannot be left, whether there is one man or two to attend to them. If one doctor has to do the work of two, he must keep on untikeveryone has been seen, no matter if the extra work encroaches unon hip. hours of relaxation or ov.-n of: l?ep.

•■•;.:., ',..-. |.«..„ ',-,..- ■ i.r-.sil'-.'i. ;'nd r.nw I fi •{} (he P.oitrd "" f;l !- from riviiijj ir...i rv-r 1 for v.-hat T nrn dnitio-. or taking the necessary steps to lighten my labour, pass a resolution that the very small extra remuneration I have received shall no longer be payable. So long as I am com-

pelled to perform the extra duties, T shall consider I am entitled to be paid, and am so advised. In the meantime, may I hope that if Mr Gray has any allegations to make against me, he will do so openly and in a manner which will permit me to reply. May I be permitted to- say, in conclusion, that unless the Board recognise tiie self-sacrificing nature of good medical services and pay fairly for such services, and protect their house surgeon from petty and spiteful attacks on the part of individual members, they will be unable to retain for long the services of any selfrespecting man, no maiter how much he loved his work, how hard he strove to attend to the nursing and. suffering of those under his care. Apologising for the length .of this letter.—l am, gentlemen, yours truly, Walter Fox."

Letters were read from the four former assistant surgeons denying that tnere had been any ill-feeling "between them and the doctor.

The Chairman.said be supposed the Board would allow him to reply.

Mr Jacques suggested that it would be better for the Chairman to leave the chair. This was agreed to, and] Mr Douglass was voted to the chair.

Mr Gray said one story was all very well until another had been' toßd, and he was glad that the matter had been brought to an issue. Some of the subjects mentioned in the doctor's letter had been previously dealt with, when Dr Fox had written to the last Board a letter, making complaints with reference to his action. The Board had then simply passed' a resolution on the subject. With regard to the question of salaries, he said this matter had also been before the Board. Ho had then drawn attention to the fact that Dr Fox was drawing the salary of the assistant as welll as his own during the absence of an. assistant, and did not seem to get on very well with his assistants. One of the members of the Board remarked that it seemed to be to Dr Fox's interest to be wit-bout an assistant. Up to that time there had been three assistants —Drs Gane, Crosby and Irving, and what he had said had been on account of what he had been told. He had been informed that Dr Gane had, before taking a holiday, been giveni a certain proportion of the work, but after returning had been given only work which a wardsman might do. When Dr Irving left, Dr Fox informed him that he had left without saying good-bye. He had, a day or two after, seen Dt Irving, and told him what Dr Fox had said, and the former had expressed surprise and indignation. The aspect that Dr Fox had put on the case of the . nurse who had left was altogether untrue. At that time there had been three nurses due to Ueave at the end of their training. He had previously spoken to Dr Fox, pointing out to him the disadvantage of the nurses having to leave immediately at the end of their training, thus depriving the' hospital of mature experience. It was agreed that it would be a good thing to have one or two nurses in reserve. He (the speaker) had mentioned the case of this particular nurse to the House Committee, who bad agreed that, as the nurse's parents lived in Dunedin, she might remain for a day or two. He had come up to-telJ the doctor about this case, but the doctor had commenced talking about his pet grievance, and the speaker had forgotten what he came up for. He had, the day after, spoken to the doctor, who charged him with -having told this nurse three months before that she was not to go. The speaker denied this, but the doctor had said he did not believe him. There had been a good deal bi trouble with the nurses since Dr Fox came.. He had at the beginning tried to raise a nurse to the position of sister, over the heads of three senior nurses. The Board had declined to allow this to be done, and had promoted the one entitled to the place. As a result two good nurses had left. The doctor frequently brought this matter up. The' House Committee very seldom had the doctor in at the meetings, as he nearly aDways quarrelled with some member. He would like to say that during the whole time he had been "in. tho hospitaT there had been very few complaints against the nurses, but there bad been complaints against a nurse : in charge of one of the wards. He had mentioned the case to the doctor, who-had made a rude answer. The doctor had not stated correctly the case with regard to his absence at a : polo match. He had not written to tbe doctor, but to the secretary, as he had a perfect right to do so. The doctor had been absent during the afternoon, and, had there been any serious accident, there would have been complaints in the; papers. Mr Millar had, however; shown the letter to the doctor. Consequently, " the fat was in the fire." Had he had the explanation he learned afterwards he would have been perfectly satisfied. • The accusation that he (the sneaker) was stating what he knew to be untrue with regard to the reason of the assistant surgeon's leaving, he hurled back with indignation. Coming to the paragraph dealing with the doctor's work, the speaker made a counter-charge: that there was in the hospital a ward which was regarded by the doctor as a private preserve, and in which he would nob allow the honorary- staff. One patient in that ward had told him that he had been there two years without seeing any other doctor than the house surgeon. Some of the doctor's statements were rather reckless. The number of admissions during the last two years of Dr Murray-Aynsley's term of office had been almost the same as during Dr Fox's two vears, but there had been thirty more deaths during Dr Foxs regime. Dr Fox had stated that m this ward he had mentioned there were only chronic and convalescent cases, but he found that there had been cases of diphtheria, erysipelas, and other cases, which should have been treated in other wards. The doctor had accused him of espionage, but all he did was to visit the hospital on Thursdays and Sundays, and. to obtain what information he thought it was his duty to do He never on any consideration questioned the nurses, except to ask how the wards were. The doctor had been very rude to him, and in the letters recently sent had ignored him, addressing his letters to the secretary and the members. Tho doctor might wish to rule the'Board and'the staff, but he was not going to rule the speaker. Mr Douglass said they had heard Mr Gray's reply to Dr Fox's _ letter, and the matter was now open for discussion.

Mr Payling said he regretted that tbhv.-s should have come to this pass, but he blamed the Chairman, to a certain extent, for not having brought the matter up before. A great deal of the trouble -i-rose ir-.-m the Chairman listening to tittle-:,aille (Mr Gmy, »No")—well, listening to heir.ay H'-.cVrce, and obtaining information from outsiders. (Mr Gray denied having don i this). Mr Pay■ ling said Mr Gray had led the Board to believe that no assistant surgean would work with the doctor, but »,he looter.; produced showed that, that *>is u't u.o rav. .h;e reason the Board has decided to reduce the doctor's salary was 'ha' li"-'' ''tea under the impression iti p d-Wor drove the assistants awav. Mr Payling said he had recently made inquiries from people who had been in the hospital, and had learned that they were perfectly satisfied with their treatment. Dr Fox was a high-spirited man, and it was not to be supposed that he would nllow a layman to interfere with his work. Had the Chairman made his inquiries about the doctor's absence at polo from the doctor himself the difficulty might have been avoided. The matter of the private preserve ward had been brought before, the House Committee, but he, for one, would not allow any charge to be brought against a man unless* it could be substantiated. He had made inquiries, but had been informed that there was nothing in the charge. The argument that there had been more deaths in Dr Fox's term'than during Dr MurrayAynsley's was useless, because the cases might have been of a very different nature. He quite disagreed with any member, of the Board or committee interfering with the doctor's authority over the nurses. He blamed the Chairman for not bringing the matter up before. He had not been on speaking with the doctor, and had iu;pre;-f-?:l his opinions on the committee. Mr Feldwick tuoigested that it would be only fair to have Dr Fox in at the meeting, to answer the charges brought against him. He said that the proposal to withdraw the assistant's salary from Dr

Fox had been decided upon very hurriedly. Mr Wallace moved that Dr Fox should be brought into the meeting. With reference to the number of -deaths that had occurred, he would like to mention that the number would probably have been decreased had it not been for the fact that, on the doctor's advice, a resolution to exclude moribund cases had been lost.

Mr M'Haffie, who seconded the motion, said there had never been a more, highly qualified man in the hospital than Dr Fox. He did not care what the man's social qualities were. He had spoken to many medical men, who had expressed the highest opinion of Dr Fox. If it came to a choice he would support the doctor, much as he respected the chairman. Mr Murray said he did nob see what was to- be, gained by bringing the doctor in. They had his statement in writing, had heard Mr Gray's reply, and woidd probably only have a wordy warfare. The matter could be put in a nutshell—either Dr Fox would have to leave the hospital, or Mr Gray would ha.ve to leave the chair. Mr Dobson said he thought the troublewould have been avoided if Mr Gray had accepted the advice he had given him at the annual meeting—not to accept the chair while there was bad blood between him and the doctor. The motion was carried. Dr Fox was then called in to answer the charges made. He said he was-entirely irresponsible for the lassistant's duties, which were Hid down by the Board. If there was any drudgery to be done, who else should do it but the junior? Dr Gane had taken the position of assistant merely to fill a gap. H& was a man nearly as old as the speaker, and with almostas much hospital experience. He had given Dr Gane a certain proportion of the work, but had found that an impression had got abroad that he (the speaker) was shirking his duties. Consequently he had had to confine him to the duties scheduled by the Board, and Dr Gane had seen the matter in the same light as he had done. They had remained friends, and were still. He utterly denied that he had told Mr Gray that Dr Irving had left without having said good-bye. Mr Gray: "You told me that in your own room."

Dr Fox, continuing, said that Dr Irving and himself had been very good friends, and it would have been.quite impossible for him to leave without saying good-bye. Had they not parted friends he could not have written the letter he had done. Nothing occurred during his conversation with Mr Gray which could lead a man of the most fertile imagination to attribute what had been said to him. From what he learned, Mr Gray had made charges about the working of the hospital; but he (the speaker) would ask whether he bad brought any proof? With regard to the case of the first nurse mentioned by Mr Gray, he said that the rules of the hospital laid it down that a nurse was to leave without question after her three years' training. This nurse had, a few weeks before her time was up, committed a grave error of judgment, and had been suspended. j; Conversations .which the matron and he had had with her gave them to understand that Mr Gray had told her a few weeks previously L that she need not leave. Mr Gray denied this. Dr Fox said that the matron could prove his statement, and it was decidedl to call in the matron. Continuing with regard to the charge dealing with the other nurses, who it was said left V~"im - promoted, he would say that it was imposiiUie to pieate nt a«<..,..u was a better judge of the qualifications of the nurses than himself. He made it a practice nob to know any of the nurses outside their work, and denied that he had any favourites. With regard to the two nurses who had left, he said that the honorary staff had, been concerned in that; the nurses had been asked to resign, as it had been considered that they had not been suffi-g, ciently competent. Sister Ewart was then questioned as to the conversations which had taken place between her and the nurse mentioned by Mr Gray. With regard to the case of the sister who Mr Gray said had been complained of, Dr Epx _said.the" answer he ..had made at the time had been made in jest. He understood that Mr Gray had been speaking in a chatty manner, but he had spoken privately to the sister concerned. As to his absence at polo, he said that for eight weeks | before that time he had been, doing double duty, and had".only "been absent for about two hours. As to the ward which Mr Gray spoke of as being his private property, if the honorary staff did.not visit.it it was not his business. The honorary staff was at perfect liberty to visit the ward at any time. As to the death-rate quoted, he said that figures could be made to prove anything. He believed the hospital bore as good a name now as it ever had done. If he had wished to manipulate his death-rate, he could have refused to receive patients who would certainly die in the institution, but he looked on the hospital as a placs for the alleviation of suffering. Only tho previous day he had received into the hospital a man who was suffering from cancer, and could not recover. If he had had an eye to his figures he could have declined to receive tbe man ; but the patient was homeless, and would at least receive attention and jcara in the hospital and die in comfort, ne had had to asssrt himself, and to decline to continue' to be in the anomalous position of being in charge and yet not being in charge of the hospital. Mr Gray and Dr Fox then retired. .

Mr'M'Haffie said that Mr Gray's charges were frivolous*in tho extreme, though hs regretted having to say. so. , The statement made bv Dr Fox was exceedingly clear.

Mr Feldwick • moved—" That, in the opinion of this Board,'for.the good of the hospital, that the Chairman bo asked to resign that position, the Board being thoroughly*' satisfied with the .House Surgeon's explanation." '. '- •' ' : Mr M'Haffie seconded the motion. He regretted having to do so, as Mr. Gray was a very capable chairman. After a brief discussion the motion was carried unanimously. Mr Gray, on • being ' informed. of the Board's decision, said he Would, accede to their request with much pleasure, because his position bad been very unpleasant for some time. The judgment was a severe one. They had taken somebody else's word in preference to his, and time would show whether they were justified. He believed there would come a time when they would be sorry. He could conscientiously say that he had done nothing to be ashamed of. He would resign his position as chairman, but hoped to retain his seat as a member of the Board. Mr M'Haffie gave notice to move that the House Surgeon should receive the assistant's salary up to the time that Dr Crooke took up his duties. It was decided to adjourn consideration of the tenders for the re-plastering of the Hyman Mark's wa.rd until the next ordinary meeting. The Board then rose.