BRYCE CASE.

Manawatu Times, Volume LXIX, Issue 2560, 18 December 1924, Page 7

BRYCE CASE.

HOSPITALS ARE FOR EVERYONE

Eui Adequate Fees should be Charged

SEMI-PRIVATE WORDS RECOMMENDED COMMISSIONER’S FINDINGS, ; Th e question of the practice and powers of hospital boards or medical staffs of hospitals in regard to discrimination in the admission to public hospitals is dealt with in the report of Mr E. Page, S.M., who was appointed a Commission to inquire into what is generally known as the Bryce ease at Palmerston North. The inquiry was asked for by Air John Joseph Bryce, farmer, of Kiwitea, who wished it treated as a test case, and was so regarded by the Palmerston North Hos. pital Board, and by at least a member of members of the medical profession.

The facts were that in the month of Alay, 1923, a daughter of Mr Bryce had a severe recurrent attack of appendicitis, and was confined to bed for a fortnight. She was attended at her homo by Dr. F. Cameron, of Feilding, who advised that an operation for the removal of the appendix be performed. but recommended a little delay until the attack should become less acute.

‘Mr Bryce informed Dr. Cameron that he desired the operation to t>o performed at the public hospital at Palmerston North. Mr Bryce was well able to afford the cost of the operation, and of the necessary treatment in a private hospital, but he desired the operation to be done in the public hospital for two reasons. Right of the Public. The first and dominant reason had reference to Mr Bryce’s personal views regarding the rights of members of the public to the use of the public hospitals, Mr Bryce had himself been a member of the Palmerston North Hospital Board. For many years he had held the view that no member of tii e public whoso case ( was from a medical point of view* suitable for treatment in a public hospital should, if accommodation was available, be refused treatment there solely on the ground that ho was financially able to pay for treatment in a private hospital. Mr Bryce objected to the practice, which he considered existed in and around Palmerston, of what he called the drafting by the medical profession of patients into the public or the private hospitals, according to the actual or supposed, financial position of such patients. Mr Bryce had frequently voiced those views, both publicly and in private. When he found hts daughter required an operation, he considered that a suitable opportunity was presented for the testing of his claims. Ho desired either that his daughter should be treated at the public hospital or that he should get a definite refusal (on the ground of his financial standing) to treat her. The Second Reason. The second reason for desiring her to be treated in the public hospital was that Mrs Bryce, mother of the girl, considered that, with the equip, ment and nursing available, her daughter would get bettor treatment there than in a private hospital. Mr Bryce desired Dr E. C. Barnett, one of the honorary surgeons to the Palmerston North Hospital, to perform the operation, and asked Dr. Barnett for a certificate for the girl's admission to the public hospital. Dr. Barnett raised the objection that Mr Bryce, being a well-to-do man, should not make use of the public hospital, and declined to give a certificate. Mr Bryce reported the position to Dr. Cameron who decided to himself give a certificate of admission. Miss Bryce was brought to the hospital in a motor-car, and was admitted Dr. Barnett declined to perform the operation. His reason for so declining was given in the following letter to the board: — Dr. Barnett’s Letter. Miss Bryce, daughter of ,T. J. Bryce, Pemberton, was admitted to the hospital on Saturday, 9th June, suffering from a recent appendicular attack. Mr Bryce had previously telephoned me regarding the case, and I had expressed my surprise at his wishing to get his daughter into th e public hospital, pointing out to him that the public hospital was primarily intended for patients who were not in a position to pay for private treatment, and that there, fore, I did not consider his daughter a suitable case for admission. Miss Bryce was, however, admitted on an order signed by a Feilding doctor. I examined Miss Bryce on Sunday and Monday, and as the case was not urgent, and fit to be moved, I informed her parents that under the circumstances J could not see my way to operate. Miss Bryce left the hospital on Tuesday, and I referred the case back to her doctor in Feilding. “Throughout her slay in the Palmerston Hospital,” continues the Commissioner, “Miss Bryce received pro. per and efficient and complete care and attention. Except for the fact that there was a refusal to operate, no complaint whatever is made regarding the treatment accorded to her by Dr. Barnett, or by the resident or nursing staff.while she was in them care. “Miss Bryce was discharged front the hospital at about 11 a.m. on the 12th June, having been there approxlj mabely three days. She was In a weak condition at the time of discharge, ant had to be wheeled from her bed to thfe waiting motor-car. She was taken Ip train to Feilding (same twelve miles from Palmerston North), was placid in a private hospital that evening, ana at 9 o’clock on the following morning she was operated on. “The medical witnesses were all agreed that at the time she was in th«

public hospital the case was a proper one for an operation, and that an operation was advisably, but that the need for it was not immediate or urgent. It was not shown that Miss Bryce’s health was prejudicially affect ed by her removal from the Palmerston Hospital to Feilding. Practice of Medical Staff Regarding Admission. "With regard to the practice of the honorary medical staff and the medical superintendent of the Palmerston North Hospital relating to the admission of patients and the discrimination relating thereto, the practice is to admit patients irrespective of their financial standing. The board has no machinery and it takes no steps to inquire into the financial position of patients seeking entrance into the hospital. Ostensibly it admits rich and poor alike. “The medical practitioners in the district, however, do not ignore the question of the financial position of patients seeking admission to the hospital. When a certificate of admission is asked for, it is the custom of the medical practitioner to make inquiries from the patient as to his ability to pay for treatment in a private institution, and, if of opinion that the patient can afford to pay, to dissuade him from going into the public hospital, and in some cases to refuse the certificate. This custom may not be adopted by every practitioner, but appears to exist amongst practitioners generally in this district. "The result is that patients who appear to be able to afford private treatment have difficulty in obtaining admission into the public hospital, but such difficulty is caused not by the policy or the practice of the board, but by the action of the private practitioners. In Justification. “The argument that is urged on behalf of the medical profession in justitication of their action is as follows: The honorary medical staff of a public < hospital devote a large amount of fihcir time and thffir skill to the treatment in the public hospitals of poor people who are unable to pay for their treatment elsewhere. Such services are given by the members of the honorary staffs entirely free. Moreover, the maximum fee that is charg- j ed at a public hospital, usually Ds a day r is little more than one-half the amount that rt costs to keep and maintain the patients. The balance of the amount is paid by means of rates and Government subsidy. It is contended that the honorary staff .should not be asked to extend to patients who arc well able to pay for treatment in private institutions the benefits of the free services which arc intended for those patients unable to afford private treatment, ’nor should such well-off patients be maintained at the public hospitals for a foe which does not cover the cost of their maintenance. "It is said that as the honorary medical staff give their services free, the hospital board should in return flake steps to see that such services should not be exploited by well-off people. As the Palmerston Hospital Board takes no steps to effect this object, the medical practitioners consider that the duty devolves upon them of seeing that such patients are not admitted. “In this connection it is proper to say that the people of this, country are indebted to the members of the medical profession for the great and valued services thus freely rendered by them to the sick and the suffering in the public hospitals. The Commissioner mentions some compensations of the honorary surgeon or physician. Findings of Commission “Looking at all the circumstances, 1 think that Dr. Barnett, having accepted the appointment of honorary sur. geon, should not have declined to operate on a patient who was duly admitted in accordance with the practice and policy of the board, and whom, in the ordinary course of the hospital system, it fell to his lot to attend. “This must, however, be said: Miss Bryce was sent there primarily to assert or to test the principle which Mr Bryce maintained. Dr. Barnett was aware of this, and his refusal to operate wag dictated by his desire to vindicate the view held by himself and by other members off he-honorary staff on the important question of principle which Mr Bryce’s action had raised. “Not a Desirable Practice.” “I am of opinion that the practice of the medical practitioners in the Palmerston North district (including the members of the honorary medical staff), in discriminating, according to the patients’ financial position, between the various patients seeking ad. mission, is not a desirable one, and should b e discontinued. If it should be the policy of the board to seek to discourage the better-off members of the community from obtaining treatment at the Public Hospital, the duty of taking steps to carry out this policy should lie undertaken by the board. It is unfair to allow it to fall on to the medical practitioners. Not For Poorer Classes Only. "While there does not appear to be any precise statutory provision compelling a hospital board, if it has accommodation to admit a patient who may be able to afford treatment In a private institution, .the origin and trend of our legislation does not. In my opinion, contemplate that the benefits of our public hospitals should be confined to the poorer classes. It is not the practice of hospital boards generally throughout New Zealand to admit only the poorer classes of the community, though a few boards make some effort to do so. “Hospitals arc maintained out of local rates, and general taxes, zo which all classes of the community contribute. I think that the hospitals should be open to everyone, though, if the accommodation is limited, the 1 poorer patient should have the preference. Adequate fees (including rea- | sonable fees for operations and other special treatment) sufficient io cover the whol e cost of treatment should be charged to those able to pay. Recommendations.

mont of patients while in hospital be increasel to such sum as will cover the full cost thereof (including a reasonable charge for operations and other special treatment.) Boards should retain the power cf remitting the, whole or part of the fees in th e ease of any patient who is unable to pay. Hospital to Serve All Classes. “Evidence on behalf of the New Zealand branch of th e British Medical Association was tendered at the hearing-. From this it appears that therfl is unrest amongst, members of thd medical profession throughout New Zealand at Iho . growing tendency amongst the better-off people to make use of the public hospitals, and thus to obtain, without cost to them, the services of the honorary medical staff. “It is doubtless due to this feeling that the case in Palmerston North now under review has arisen. “I suggest that hospital boards and the Department of Health might take into consideration the important question of so extending the operations of the public hospitals, as to adequately serve all classes of the community. “The trend of hospital administration of the present day is towards centralisation, tlm establishment in the main centres of large well-equipped hospitals which can specialise -in every branch of modern medicine and surgery, which will be equipped with Ihe most modern scientific appliances, and in which all classes of the. community can bo treated. Private Rooms; Paying Patients. "There is. I think, a present demand for the establishment of private rooms and semi-private wards in the main hospitals. “These could be made use of by patients willing to pay for them. A workable scheme can, I apprehend, gradually bo evolved whereby patients may, if they so desire, and are willing to pay therefor, obtain the services of and be treated in the Public Hospitals by their own private practitioner in lieu of treatment by the regular start of the hospital. Fees Dor Honorary Staff. “If honorary medical staffs are to be continued, further provision might be made that for treatment or operation, accorded by them to patients able to pay, there would be charged to the patient, and paid to the physician or surgeon a moderate fee In accordance with an agreed scale. “These matters, no doubt, raise many difficulties financial and otherwise that will require to be overcome, but if a steady and earnest effort is made io cope with them, conditions. Such as those which brought about the present inquiry should gradually dis. appear.