THE HOSPITAL BOARD AND THE MEDICAL STAFF.

New Zealand Herald, Volume XXVI, Issue 9531, 25 November 1889, Page 6

THE HOSPITAL BOARD AND THE MEDICAL STAFF.

'■•//■ ;' v '\. ■ —-•- — "—— i.-pr .. 'V;-\ STATEMENT BY DR. MACKELLAR On Friday evening Dr. Mackellar, in replj to-a Hbeald reporter, made a statement as to the proposed change in the management of the Hospital, and che remarks of the . membersof too Board, published in Friday , issue of the Hksald. Dr. Mackellar said that-ho spoke as an individual, and not as 8 representative of the lafce medical staff. He went on to say:— ; £" In his statement) in the ■ Herald, Mr.

Atkin says that the Board had no control over the visiting staff or over the expenditure. But rule Nα 5 says that the House Coinmittoe of five members, three of whom shall, form a quorum, shall be elected annually for the purpose of investigating sad regulating any matters relating to the internal mananagement of the Hospital, subject to the control of the Board. Is this rule, then, a mere empty form ? If it is not, why did the House Committee not report irregularities to the Board, or report long before six months ago that, owing to the constitution of the Hospital, they were unable to carry out their duties? Mr. Atkin reports a case in which the wife of a patient attended by Dr. Girdler, could get no information from, Dr. Knight. It would appear to any reasonable person that the information should have been obtained from the medical man under whose care the patient was ; and Mr. Atkin knows, or ought to know, that by telephoning to the Hospital he can always learn from the house steward, or one of the resident surgeons, or one of the nurses of the ward, under whose care any particular patient may be. If the chairman could not get information in such a case which could easily have been obtained by merely telephoning to the Hospital, it is a fair inference that much importance caunot be attached to the reiterated statements of the Board that they could not geb information on other points. To go into more details in this case, it should be added that the patient named above is suffering from chronic incurable-spinal disease, and is under the care of a physician. The chairman, of the Board makes it a charge against the constitution of the Hospital that' a patient's wife cannob learn particulars about her husband when she goes to one of the surgeons ! In private practice the patient is generally under the care of one medical man ; but the patient, or patient's friends, can have as many more medical men in consultation as they like to pay for. In the Hospital the patienu is under the charge of one medical man, and as long as no complication or difficult} , arises remains under his care singly, but when any complication or difficulty does arise a consultation is called, and the patient gets the benefit of the combined opinion of the Hospital staff. Ik astonishes me—in fact I can hardly believe—that th Chairman of the Board can stigmatise sue a system as ' moonshine.' , "The chairman goes on to say:—'One member of the medical staff M-as in attendance each week.' Surely the chairman ought to know that this is a mistake, for, not to speak of the ophthalmic surgeon, two members of the medical staff are on duty each week. Mr. Atkin continues : —' Supposing one of the honorary medical staff has an urgent private case, is it to be expected that he will neglect that in order to attend a case at the Hospital ?' I should like to ask Mr. Atkin if of late at least there is any instance of a Hospital patient having suffered owing to the member of the staff under whose care he was being too busy with some private case ? But I shall instance a case which might have told in favour of Mr. Atkin's suggestion, and yet there was no miscarriage : I was engaged in a suburb with a private case which I could not leave during one evening of my week of duty (or, rather, not my week of duty, but while I was doing extra duty, consequent upon the Board's being too inert or careless to fill up a vacancy that had occurred in the surgical staff of the Hospital), when Dr. Bell communicated to me by telephone the fact that a patient had been brought in with an injured arm, and that an operation was necessary. This was at about 7 o'clock in the evening. Dr. Bell also added that the patient was weak, and would be the better "for a few hours' rest to recover from the shock of the journey. I arranged with him that a consultation should be called for 9 o'clock, and that if-1 was unable to leave my patient, and was not present at that time, he would request Dr. Knight to act for me. As a matter of fact, I was unable to leave my patient; a consultation was held at 9 o'clock; Dr. Knight operated, and the patient is now convalescent. Could the system have been put to a much severer strain than this ? and yet it worked exceedingly well. Mr. Atkin's weapon seems rather to turn in his hand. " Mr. Atkin says that the Board should ' have some control over the casee admitted and the cases that should be discharged.' That i 3 to say, Mr. Atkin thinks that the Board should have an opinion in a medical question as to whether patients required to be treated as internal patients in the Hospital, and should have a voice in deciding whether they are well enough to be discharged or should be discharged because incurable, or are nob fit to be disharged. This seems control with a vengeance ! Laymen are to decide on purely professional matters. The late Dr. Stockwell resigned his position as a member of the honorary visiting staff of the Hospital because one of the members of the Board of that time (18S3) on his own responsibility transferred a gangrenous patient whose condition was a source of danger to those near him, from the Refuge to one of the chief wards of the Hospital, and the Board gave no satisfactory explanation to Dr. Stockwell for such a proceeding on the part of one of the members. " Mr. Atkin instances a case in which a boy 'was in the Hospital for six or nine months, and who was not under treatment,' also, ' that Dr. Knight, when spoken to on the subject, said he knew nothing of him, as the boy was nob|a patient of his.' As a matter of fucfc, the boy was in the Hospital between five and six months, and was under treatment; also, Dr. Knight informs me that he said to the Board, or their chairman, that he did nob know anything about the case, as the patient was not under hie care, but that he would find out about the case if they wished it. He further informs me that he was never asked to make enquiries. The patient was under my charge; he was admitted suffering from a congenital affection which would greatly cripple him in his after life. An operation, if successful, would cure this affection. The boy was kepb under observation in the Hospital, partly to make attempts to cure the lisease without operabion, partly to let him become accustomed to bhe place, so that after the operation he would lie quietly and would not fret (a most important point for success), and more especially to get his health into a condition likely to make the operation successful. He was under close observation, his father'was in frequent communication with me ; his health did nob improve, and he was at lasb discharged. Had he been operated on without this care the operation might have failed, or the child . might have died, a thing hardly creditable to the Hospital. I think that if a successful operation, performed at bhe right time, can restore a child of three years old from a comparatively crippled state to one of fair strength, it is worth waiting and keeping him under observation in the Hospital not only for five or six months, but for five or six years, if need be. It may be added that in this case bhe necessary observation could not have been continued ba3 the child been sent bome. "I shall instance another case. A servant girl received an accident that presented her from performing her duties. She was operated on by two of the best nedical men in town, but the operation 'ailed, owing to the girl's bad state of lealth. These medical men sent her into ;he Hospital to be under my carei I kept ier from two to three months, doing lothing bub watching her and having her iealth built up till I thought she was in a proper state to bear a repetition of bhe >peration. I operated at lasb; she is now .veil and strong, and back at her work. The success was due to no skill of mine, bub to ny {superior opportunity of watching the patient in the; Hospital improving her l'ealth, and of seizing the right time for the >peration. , . ; ."It must have been perfectly well known iO the chairman that he could have found >ub by the telephone or through the House Committee under whose care the boy aboveueationed waj, A. reference to. his case by

the * chairman rather implies that we keep our patientd too long In the vHospitaL I shall give statistics to show;-the average length of stay in the respective hospitals an the colony:—ln Dunedin, 42*2 days; Christchurch, 37 43 ; Auckland, 34*72; Wellington, 3412. Mr. Atkin instances the case pi a Mrs. Judd, sent from Port Albert, in which he backs his own opinion about the medical condition of the patient against that of the resident surgeon. It is for the public to judge who is likely to know best. " Mr. Mays speaks of the expenditure. I shall again quote statistics to show that we compare well with other hospitale :— The average daily cost per head for patients in Christchurch is 5s 11 Jd ; in Wellington, 4s 3jd ;in Auckland, 3s 4Jd ; and in Dunedin, 3s 3fd. And in Auckland, if the patients' payments be deducted from this sum, the average daily cost amounts to 2s Bfd, whilst in Dunedin it is brought down only to 2s IOJd. To this ib may be answered that our contracts are low, because provisions are cheaper in Auckland. If this be a fact, the answer is plain. A poor person can buy in Auckland things that he cannot obtain in Dunedin, and therefore when he or she is admitted to the Hospital, these things should not be denied that person. Very many colonial working men have butcher's meat twice a day ; a Scotch shepherd, perhaps, hardly ever eats butcher's meat. , The diet scale in a hospital that would be good for the one would be absolutely injurious for'the other. '' Mr. Mays says that the Hospital caste £6000 a-year. T shall analyse this statement : Tno returns from the various principal hospitals in the colony show :—Auckland : Total under treatment,' 1012 patients ; expenditure, £6049. Christchurch : Total under treatment, 64S ; expenditure, £7402. Dunedin : Total under treatment, 961; expenditure, £6131. Wellington : Total under treatment,-909; expenditure, £7282. " The figures which I have cruoted show, therefore, that patients are kept in' the Auckland Hospital for a shorter time than in any other hospital except" that at Wellington, which beats Uβ' only by a fraction ; that our average daily expenditure is the least, and that the cost of the Auckland Hospital is much the lowest, though it contains the greatest number of patients. Besides, to strengthen this argument, I may be permitted to suggest that Auckland is a large seaport; that we have many seamen who have often to be kept a long time in the Hospital because they have no homes to go to ; that our climate is a salubrious one, and much sought after by consump- ! tives, both from other parts of the colonies, and from the mother country, and that these patients are nearly always chronic cases; and, lastly, that not very long ago we had a severe epidemic of typhoid—a disease that often cripples patients for a long time, so that they cannot be transerred from the Hospital to their own homes uutil a considerable porkxl of convalescence ias elapsed. * " Mr. Mays says, ' Every raedScal man in ■ the city and suburbs has the privilege of sending a patient to the Hospital, and properly so; but this patronage is often abused. . Can Mr. Mays make his statement good ? Mr. Mays refers to the same patient as is spoken of by Mr. Atkin— the patient kept for six months in the Hospital, but calls him a ymUh. Mr. Mays' youth was three years old. This shows that Mr. Mays had but little knowledge of the-case—in fact, misunderstood its bearings altogether—for the fact of the being a young child was one of the main* reasons why he bad to be kepb long under observation. This M'ould not have been so necessary in the case of a youth. I am willing to admit that Mr. Mays always makes the best of any question he takes up; and this three-year-old youth is a capital argument against the staff, as long as the actual facts of the case are nob fully explained —so long, and no longer. In speaking of bhe proposed new way of managing the Hospital, Mr. Mays says, * Both gentlemen'—that) is, the superintendent and hie assistant—'are cut off from private practice, and will be expected to devote all their ability and experience to the benefit of the institution.' He politely ignores the fact that there are at present two resident medical men in the Hospital who 'devote all their ability and experience to the benefit of the institution,' except when, by order of the Board, one of them is taken from his proper duties and made to visit the outdoor poor in their own homes. Mr. Mays, also, is silent about the fact that at present £350 a year are paid in salaries to the resident medical staff, whilst about £700 a year will probably be paid in medical salaries in bhe ' new model' —that is : Superintendent, £500; his assistant, £100; two

consultants, £50 each, making £700. "Mr. Mays tries to make much of the fact that the Medical Association is a sort of trades union, and that its members have gone out on' strike against bhe Hospital, and will nob allow any of their members to bo elected as consultants. Mr. Mays knows, or ought. to know, before ho makes such statements, that the medical men have refused to be appointed consultants for bhe new system because they think ib is a bad system, and that they would be wrong in helping to make workable at all what they consider to be a bad system. Were there no other system, the medical men would be right in helping it, indifferent though they might think it, bub they could never be called upon—in fact they could never be justified in aiding a system which they think is a bad one, and which has taken the place of a system that they consider good. Mr. Mays also should nob be so fond of reiterating the words 'Medical Association" ad nauseam, and trying to make the public believe that if the Medical Association will not furnish consultants, he can go into the highways and byways and easily get other men as good. I have had bo do with the Hospital almost continuously ever since there was a consulting staff. It so happens that I do not belong to the Medical Association, but I thoroughly agree with their action ; and I dare say many others who do nob belong to the Association fully agree that in this, as in many other points, the Association is acting in bhe way that is best for the sick, for the Hospital, and for the public. "Mr. Dignan makes no particular statement not already more fully made by Mr. Atkin or Mr. Mays ; and therefore his remarks do nob call for reply. Veb I cannob help remembering bhab when I represented bhe staff ab a meeting of the Board, Mr. Dignan said bo me bhab there was no use in my pointing out that certain of their own rules had nob been kepb by the Board, because the Board had the power of changing their rules. I answered—and surely a very selfevident answer—bhab though the Board had bhe power of changing their rules, they uould nob do so without informing those to whom they applied, and that we had had no intimation of such change. Mr. Dignan also stigmatised the letter af Dr. Davy as 'childish.' , That letter tias never been answered —in .fact, ib has been quite ignored; bherefore I feel that I must, on this point at least, agree with Mr. Dignan—namely, that the letter was ' childish,' but I differ from him in tho explanation of bhe term. To my mind, it was only childish in the sense in which badly-educated parents sometimes tell their children nob to ask childish questions, using the word 'childish 'nob because the questions are so really, but because they cannob answer them. "It seems to me that thelarguments of the Board resolve thenoselves into these statements : Let us have a paid staff, as we want more control, and that greatest and worst argument of all: We have made up Dur minde. and therefore we won't turn back." •