NEW ZEALAND MEDICAL ASSOCIATION.

New Zealand Herald, Volume XXVIII, Issue 8538, 11 April 1891, Page 6

NEW ZEALAND MEDICAL ASSOCIATION.

ANNUAL MEETING. HOSPITAL MANAGEMENT. The annual meeting of the New Zealand Medical Association was this year held at Nelson. The sittings, commenced on Tuesday, March 31, and lasted until Friday evening. Among the questions discussed was that of hospital management. \ On Wednesday afternoon, Dr. Roberton, on behalf of the Auckland branch of the Association, brought forward the resolution already passed by that branch, regarding the necessity of an amendment of the Hospital and Charitable Aid Act, and asked the Association to affirm the recommendations contained in it. Dr. Roberton spoke of the recent trouble in connection with the Auckland Hospital, which had already beon brought under the notice of members, not only in the New Zealand Medical Journal, but also in the daily press, and by means of the report of the Commission appointed by Government to investigate certain charges against the medical management. He narrated what had occurred since the report of the Commissioners was issued, and said that at the present time there was fair hope of such temporary arrangements being made as would prevent the Hospital suffering further from the effects of the recent experiments made by ft he Hospital and Charitable Aid Board. The latter, however ? did not yet seem convinced that there had been even an error of judgment on its part, and the expression of individual members at its recent meetings showed that some were still inclined to experimental hospital management. The Auckland branch of the Association had been asked by the Board to give advice as to tho best system of Hospital management, and had made suggestions" regarding the best way to conduct the Hospital until the present Hospital and Charitable Aid Act had been amended. Two years ago there had been a visiting staff in connection with the Auckland Hospital, and the differences between the Board and the visiting staff had been the outcome of ,a want of ready communication between them. Misunderstandings had arisen which might readily have been prevented had a medical man been on the Board. To obviate this difficulty the visiting staff and the Medical Association had; eighteen months ago, offered certain suggestions to the Board, among which was one, that the chairman and one member of the visiting staff should be members of the Hospital House Committee. The advice was not taken. The law, as it stood at present, provided for no medical representative : the members of the Board being elected by local bodies, which nominated some of their own members— originally chosen by the ratepayers for no qualities which specially recommended them as Hospital governors. It must be acknowledged that members chosen originally as members of Highway District Boards or Borough Councils, and others selected again for the combined, yet very different duties of distributors of charitable aid and managers of a hospital, were not so likely to form a capable Hospital Board as would men chosen directly for their capabilities as hospital managers. This was the reason that the Auckland branch offered for suggestion that the Hospital Boards should be distinct from the Charitable Aid Boards. It would seem that when the present Hospital and Charitable Aid Act was framed it was thought advisable to entrust full control of the hospitals to the Charitable Aid Board —to the representatives of the pockets of the local ratepayers. This was hard to understand, considering that the general Government contributed to the funds of the hospitals an amount equal to that raised by local rates, and that the services of an Honorary Medical Staff, in themselves the equivalent of a large contribution to the funds, were taken advantage of. If contribution to the funds is to be the qualification for representation on the Hospital Board, then local ratepayers, Government, and the hon. Medical Staff, where there is one, should be represented. There is, however, another aspect from which the same subject may be regarded. It is now-a-days usual to allow that the patients of a public institution have certain rights and interests which require guarding, and it is the duty of the Government to see that this is done. Where the pockets of the ratepayers, compulsory contributors, alone have a voice in the management, the interests of the patients can never be fairly considered. The Government representatives of the Board, while watching the expenditure on behalf of the colony, would at the same time see that the efficiency of the hospital is not sacrificed to a false economy. In this they would be aided by the medical member, who would act as a skilled expert adviser in matters of hygiene, or those affecting medical management. With regard to that portion of the Auckland suggestions which referred to the necessity of having a visiting medical staff in connection with the Auckland Hospital, the Auckland branch of the association had been much misunderstood. From occasional expressions of opinion in the daily press, it would appear that some "of the public imagined that the members of the profession had opposed the late socalled " system" of Hospital management on selfish grounds,; hoping to force on the Hospital Board a visiting staff, the members of wmch would gain an actual persoaal advantage from their position, which would be shared by the whole profession to the disadvantage of the public in general and the Charitable Aid Board in particular. That a gain in professional capability. would ensue is without doubt, but the general public would be the ultimate gainers, and at the expense of those members of the profession who sacrificed time and energy of brain and body in gratuitous service on behalf of the sick poor. The action of the Auckland branch during the past two years had been based on a conviction that the Hospital was being* mismanaged, that reform was necessary, and must be brought about by a consideration of the "experience gained in the management of similar institutions ,by practical men who had devoted themselves to the work. The Auckland Charitable Aid Board trusted in their own wisdom and refused the advice of the only body of men in the town who could claim to have experience of the practical working of hospitals, and the result has been made public in the report of the recent commission. The public remain apathetic in the matter, and it rests with the medical profession to effect the reform it advocates. The Auckland branch had resolved to do its utmost, and asked the cooperation of the rest of 'the Association as well as the individual members of the profession. Dr. Roberton then read the recommendations of the Auckland branch, and moved that they should be affirmed by the General Association. The motion was seconded by Dr. Hudson (Nelson.)

Dr. Thomas (Christchurch) had pleasure in supporting the Auckland proposals. In Christchurch also they had had difficulty with the Hospital and Charitable Aid Board, and felt the necessity of an amendment of the Act in such a way as to guarantee that the Hospitals should be managed by competent Hoards. The difficulty was _ that there was no means of communication between the Board and the visiting staff, and the inconvenience thus occasioned had shown the necessity for some member of the visiting staff being connected with the Board of Management. The subject had been discussed at previous meetings of the New Zealand Medical Association, and in 1889, when the annual meeting was held at Christchurch, it had been decided that it would greatly conduce to the welfare of patients in Hospitals if the chairman of the medical staff were ex officio a member of the Hospital Board, and the meeting instructed the honorary secretary to forward a copy of this resolution to the Colonial Secretary, the Inspector - General of Hospitals, and all Hospital Boards. The Parliamentary Committee bad also been requested to get this clause inserted into the Charitable Aid Act at the first opportunity. As to the question of a visiting medical staff being connected with the larger Hospitals of the colony, the ad visibility of this was not to be doubted. If the Auckland proposals became embodied in an amended Act, the condition of the New Zealand Hospitals ought to be materially improved. Dr. de Zouciie (Dunedin) said that the Otago branch desired its representatives to affirm generally the principles suggested by the Auckland branch. There was, however, one important omission. No provision had been made for representing > on the Hospital Boards these who voluntarily contributed to the funds of any Hospital. In Dunedin they had, perhaps, experienced less difficulty in relation to the Hospital Board from the fact that the number of voluntary subscribers had enabled them to take advantage of certain provisions in* the present Act by which the Hospital became managed by trustees, apart from the Charitable Aid Board. In forming Boards of Hospital management it ought to be remembered that the members of the honorary staff of each Hospital, in giving their services gratuitously, became, in fact, the largest individual contributors to its funds. • ■':,: Dr. Symes (Christchurch) agreed with the proposals, and had for many years wished'for some such change as they suggested. Though not now connected with any hospital he still desired a change in the interests of the patients. He had brought the matter forward at the annual meeting of 1889, and had then given many instances of great inconvenience resulting from the want of any official intercourse between the medical visiting staff and the House Committee. As,. chairman of the visiting staff the only

' means he ever found of bringing any matter under the notice of the House Committee was by button-holing its members in the street, as no opportunity of being present at its meetings was given to him. The Hospital Committee, although repeatedly requested to allow the chairman of the visiting staff to be present at its meetings, had absolutely refused to do so. He thought it would be best if the ratepayers elected members of the Hospital Boards directly instead of through the local bodies. In such case there would in many instances be a contest; and the public would, in consequence, take more interest in Hospital matters, and an opportunity would be given to discuss and ventilate questions of Hospital management. Elections by local bodies were too likely to be influenced by political motives. He would suggest that the Association should distinctly state its preference for direct representation of the ratepayers. Dr. Truby King (Seacliffe Asylum) stated that as resident medical officer in Wellington Hospital he had found things work remarkably smoothly, probably because tho members of the Managing Board were amenable to reason and devoid of the obstinacy of purpose which characterised some other Hospital Boards. They were an exceptionally good Board, but even there difficulties arose from no means being afforded tho visiting staff of advising the trustees. Matters were advocated which could not be passed in the interests of the patients. The absence of friction was probably in part due to the fact that there was a medical man on the Board, although he represented along with the other members tho ratepayers. Dr. CRESSY (Nelson) had been connected with several English hospitals of the same size as the larger New Zealand hospitals, and in each of these the medical staff were fully represented on the Board of, Management. There the public were grateful to men who devoted their time and ability gratuitously to the service of the poor, and the only part of the medical staff not represented on the Board was the paid resident medical officer. Even the latter, however, was present at the Board meetings, usually in the position of secretary, and was constantly called upon to make explanations or suggestions. If the public of New Zealand considered the medical men of the colony unfit to have a vote in the management of institutions that they aided gratuitously, the sooner the profession asserted itself the better.

On the motion of Dr. Hudson, seconded by Dr. Dk Zoucue, it was resolved to consider the suggestion contained in the original motion seriatim. On the motion of the Duncdin delegates, it was resolved unanimously that provision ought to be made for the representation on Hospital Boards of voluntary subscribers. With regard to section -1 of the Auckland suggestions, the original proposal referred only to the Auckland Hospital, but it was unanimously decided that it should refer to all hospitals in the colony having at least fifty beds on an average occupied. It was also decided to omit " consulting staff" from this section, on tho grounds that the visiting medical staff was the real consulting staff, and that the so-called " consulting staff" in British and colonial hospitals was only nominal, and a complimentary appointment. The only part of the proposals to which opposition was shown was that dealing with the election of the resident medical staff. The original suggestion was that the election should be annual. Amendments to the effect that the election should be biennial or permanent fell through from want of seconders. Finally, the original motion was passed, amended as follows: That, with regard to the necessity of amending the Hospital and Charitable Aid Act, this Association recommends :— 1. That the Hospital Boards of Management should be distinct from the Charitable Aid Boards. 2. That the election of members of the Hospital Boards should be on a different system to that by which the members of the Charitable Aid Boards are at present elected. That a certain number of members should be elected either by the ratepayers directly or by the Charitable Aid Board certain number by the Government, and a certain number by the visiting medical staff, in those cases where there is a visiting medical staff; also, that provision should be made for tho representation of voluntary subscribers. 3. That the members of the Hospital Board should be elected for a period of three years. 4. That in connection with any hospital having at least 50 beds on an average occupied, there should be a visiting medical staff and a resident medical staff. 5. That the members of the medical staff should be appointed by the Hospital Board. 6. That the visiting medical staff should be elected for a period of from three to five years to be eligible for re-election. ',; 7. That the resident medical staff should be elected ' annually ; to be eligible for reelection. [by TELEGRAPH. — press ASSOCIATION.]

Wellington, Friday. The Medical Congress which recently met at Nelson decided upon several questions which they intend to bring before the Municipal Conference which meets in Wellington during next session of Parliament with tho view of amending the Municipal Corporations Act. These are the necessity of establishing public abattoirs with qualified inspectors, the creation of a department of public health under the supervision of a Minister of the Crown, and the advisability of strict supervision of dairies.