HOSPITAL MANAGEMENT.

New Zealand Herald, Volume XL, Issue 12266, 9 May 1903, Page 6

HOSPITAL MANAGEMENT.

CONFERENCE OF LOCAL BODIES.

COMMITTEE OF INVESTIGATION Sip UP.

SUGGESTED INCREASE OF FEES.

A CONFERENCE of representatives of local bodies was hold in the City Council Chambers yesterday afternoon to discuss the questions o; the increased levy made by the Hospital and Charitable Aid Board and the work of th» Public Health Department. Mi. A. Kidd, Mayor of Auckland, presided, and there were about 60 representatives of local ! >odies present, as well as several members of the Hospital and Charitable Aid Board, and Dr. Makgill, district health officer.

The Chairman introduced the business, stating that ho desired the Mayor-elect, the Hon. E. Mitchelson, to take the chair but Mr. Mitchelson had been unable to be present. He thought the best course would be for the representatives of those bodies who asked for tho conference to opon the discussion.

Mr. E. W. Alison (Mayor of Devonport) suggested that the chairman of the Hospital and. Charitable Aid Board should state the reasons for the mam of about. 50 per cent. in the hospital and charitable aid levy. Mr. G. J. Garland (chairman of the Hospital and Charitable Aid Board) said ho would be pleased to answer any questions. He had not come prepared to make a speccn; in fact, it was only that morning that he was informed that his presence was required at the meeting. . , Mr. Alison said the question ho wanted answered was, how it happened that the Board found it necessary this year to increase- the levy on local bodies by about 50 Mr. Garland said the new Public Health Act was, to a large degree, answerable for the increased levy. Within the last 18 months, the treatment of infectious diseases, for which the Board thought they were not responsible when making the last levy, had coat £3015. At the end of the year the Beard was more than £3000 behind, and they had to cast their estimates so as to put them in a Bound financial condition. To show that the cost of running the hospital was not increasing, he stated that 10 years ago the average number of patients was 100, and the total income of the Board was £8000; now there were 200 patients, and the income was £13,000. There was not much to quarrel about in that. Included m the sum 3 on the estimates was £1300 for a sterilising plant. That, of course, could bo taken from bequest money, but he did not think it wise to do so. Mr. C. Bagley (chairman of the Mount Roskill Road Board} asked what had been the increase in the number of out-patients and in-patients since 1901. Was the increase sufficient to justify the levy on local bodies being doubled? Mr. Garland isaid the levy had not been doubled. The increase in some cases seemed greater than it was, because of the rise in the valuations in some localities. Mr. W. R. Bloomfield (chairman of the Epsom Road Board) said it was evident that the meeting would, more or less, have to treat the Hospital and Charitable Aid Board as on their trial.. Many things struck him as requiring investigation, such as the tremendous amount being spent on outdoor patients, and the question of the friendly society patients getting treatment at; halfcost, "and also whether the full charge of 28s per week was sufficient. There was the question of the heavy cost of drugs, and the question whether it was necessary to havo a medical superintendent in the hospital at all, or whether the hospital would not be better conducted by a resident staff and honorary staff- ~.'„, J -a Mr. Alison, replying to Mr. Garland, said tho question of valuations did not come into it at all: There had been no increase of values in Devonnort in the last three years, on account of the rating on unimproved values, yet last year's contribution to hospital and charitable aid was £281; this year the demand was for £4-22.

Mr. Garland proceeded further to explain the increase by showing that salaries last year were increased by £935 8s 9d, as' compared with the previous year. The senior medical officer got £550. Last year they had to employ extra nurses to take charge of infeotious cases. Then there was an increase of £774- on the cost of drugs, largely duo to the large number of out-patients treated, the total attendances on out-patients being 7700. As soon as he became chairman he wrote to the medical superintendent, pointing out that only discharged patients, and people receiving first dressings as the result of accidents, should be treated as outpatients, and the number of those had been greatly reduced. Mr. C. J. Parr (Auckland City Council): Can you give us any idea of the total cost of this outdoor treatment'.' Mr. Garland said he could not give that, but no doubt a large portion of the £770 increase in the cost, of drugs wa3 due to the treatment of out-patients. Mr. Parr then asked if this outdoor treatment was recognised as a proper function of the hospital. Mr. Garland read the rule on the subject, which showed that patients who have been discharged from, the hospital, ophthalmic patients, and first dressings, in case of accident, may be treated at the discretion of the medical officer. Mr. Bloomfield: Do you accept them without regard to the patient's position? Mr. Garland: No; except in the case of an accident. Mr. Bloomfield said there was an impression that people were making use of the hospital who could afford' to go elsewhere. Mr. Garland (warmly): I have been in the hospital, and I am not ashamed to say so. _ I have a perfect right to go, and if I were ill to-day I would go again. Had I not gone it might have been said that tho treatment other people get in the hospital was not good enough for the chairman. Mr. Alison: Do you think 7700 attendances on out-door patients a fair number? Mr. Garland admitted that too many outpatients had been treated. Mr. Alison: Who ie responsible? _ You | have told us it was not you. Was it tho Hospital Board or the late chairman? j Mr. Garland: I.don't think that is a fair j question. Mr. Alison: Surely wo are entitled to know? Mr. Garland: I must ask you to put the question to the representative of your own distinct. lam not going to answer that question. Mr. Alison repeated the question, and Mr. Garland said he" would take the ruling of the chairman whether the question was a fair one. The Chairman said ho agreed with Mr. Garland that every local body had its representative, and questions of policy could easily be explained to each local body by its representative. Mr. Alison Then I will ask the question of Mr. Bruce, who is the represostativo of the borough to which I belong. Mr. A. Bruce: I think it is hardly fair to ask me to answer for the Board. Mr. Alison: Why not. Are you ashamed of it? (Laughter.) Mr. Bruce: I don't think you could blame tho late chairman. I think tho Board is responsible. Mr. Alison: Then you, as a member cf the Board, accept your share of the responsibility? Mr. Bruce said iie did, and would explain lator on.

Mi. Jno. McLeod, member of the Hospital Board, said nearly every representative of the local bodies had come to these conferences prepared to grumble, bu' no one had come forward with any suggestion for improving the management of the hospital. Up to last year the Auckland Hospital was run at a cheaper rate than any hospital in the colony. It was only last year that the expenditure was abnormal. The chairman had pointed out the reason fo.- that abnormal expenditure. No expsnspi was snared in connection with the returned troopers, and there were more cases of infectious diseases in the town than usual, yet the cost per head only averaged 2d per day more than it did in WellingI ton the previous year, and he had no doubt J that when they got the returns from Wellingi ton this year they would find the cost had I gone un there also, owing to the epidemic of J infectious discaiios. He thought the local ' bodies should endeavour to devise means to curtail expenditure, and to raise money to meet the "necessary expenditure. He noted that in Wellington some £3131 was subscribed to the hosnital. That carried a Government subsidy. He thought that example might bo followed in Auckland. iliey might have a Hospital Sunday or Hospital Saturday. That he thought, would be a more sensible course than to hold a conference for cheeseparing purposes. With regard to the question of friendly societies, he thought members of friendly societies should be treated in the hospital free. The friendly societies were the only people in the colony taking means to ensure themselves against hoepital and charitable aid. According to the last re-turns these societies paid £37.000 for medical attendance and £4-0.000 in sick pay, thereby relieving the Hospital and Charitable Aid Board, because they were of the same class of people who, when sickness came, fell upon charitable aid,

only that by a little prudence and a little absence from the racecourse they provided for themselves. If the general public paid as much in fees to the hospital as the friendly society members paid there would have been no trouble. The friendly society patients paid 2s a day, while the other patients only averaged Is o|d. Probably not one man in a hundred paid the _ full 28s a week, which was merolv a nominal charge. Members of friendly societies could not be sent to the hospital without a certificate from their medical attendant that they could not be properly treated in their homes, but it had been found that many of the medical men endeavoured to shirk their responsibility by shunting the patients into the hospital. It would be a different thing now that the friendly societies had their own medical men. He did not think a single case had been sent to the hospital since that system was started. Mr. H. B. Morton, chairman of the Onetree Hill Road Board, pointed out that in 1901 the total levy was £6689, 1n 1903 it was £13,146. He wanted to know when this was going to stop. Why should the cost be doubled, especially in a time of general prosperity? Mr. Garland said it would almost appear from the attitude of representatives present that he (Mr. Garland) had been getting £1000 a year salary for running the hospital. If the Board was not saddled with much infectious disease next year there was no reason why they should not go back to their former levy. But they had gone to the bad in the past, and they wanted something to com© and go upon. The Chairman thought if the conference wished to come to any satisfactory conclusion On tup, Subject they would rebate the whole matter to a small' commission of, say, five or seven members, to go into the whole question and" report to a subsequent injfMr. John Bollard, member of the hospital Board, said the expenditure had increased because the number of patients had increased, the cost of food had increased, tho number of outdoor patients had largely increased, and consequently tho drug bill had increased, and there had been an increase in salaries and wages. This might not appear to be a sufficient answer for the jump made in the levy, but the fact was that the Board had in the past been cutting their estimates too fine. Had he had his way, the levy would have been increased some time ago, so that the jump would not have appeared so big. But for the fact that they had trust moneys amounting to some £5000, which could not be used except for buildings, etc., but which stood as security for overdraft, the Board could not have carried on with Inst year's levy. It was a fact that the cost of running the" Auckland Hospital was less than any other hospital in New Zealand. Reference had been made to the large salary of the | medical officer. The medical officer in Wellington got £700 a year and free house, while the Auckland man got £550 altogether. With regard to the collection of fees, the Auckland Hospital collected a far bigger proportion than any other hospital in New Zealand. The returns would show that if any delegate caved to go and look at them. He admitted that a large number of the outpatients treated at the hospital ought not to be treated, and had it not been for a mistake on the part of the medical superintendent they would not have been treated. But that was all past now. There were not 10 per cent, of the people who went to the hospital who paid full fees. It was impossible to get full fees from them: they were really not able to pay them. A great many paid half-fees and a great many paid nothing. Under the present, system any ratepayer was entitled to demand to get into the hospital as long as he paid the "fees charged. Mr. McLeod was quite correct in the statement that the friendly society members paid more on the average than the other patients who went through the hospital, but at the same time he thought it a bad precedent, and he, meant to test the question at the next meeting of the Hospital Board. Mr. J. A. Walker (Devonport) moved, " That a committee, consisting of the Mayors of Auckland and of all the suburban boroughs and the chairmen of the Mount Eden, Remuera, One-tree Hill. Mount Albert, and Mount Roskill Road Boards, be appointed a committee to inquire into and report upon the extraordinary increase in the expense of running the Auckland Hospital." He criticised the proposed expenditure on sterilising apparatus, and held that the Hospital Board, instead of running the hospital, had allowed the hospital to run them. The members had failed to take a grasp of the position. It the increased expense was due, as Mr. Garland said, to the Public Health Act, the Hospital Board should have seen long ago that tho Act was remedied. With regard to the arrangement with the friendly societies, every friendly society member who went to the hospital went there with the knowledge that half of his fees was to bo paid out of charity. That was not a fair position to put anv respectable man in. Mr. G. Knight (chairman of the Point Chevalier Road Board) seconded the motion.

Mr. C. Bagley said he was instructed by a meeting of the ratepayers of his district to move, " That the Government appoint a committee to investigate the matter," but he thought the suggestion now before the meeting was better.

Mr. J. W. Shackelford (Mayor-elect of Grey Lynn) agreed with the petting up of the committee, but he did' not think they should stop at that. Personally he was not inclined to blame the Board. Possibly representatives of Government Departments had forced expenditure on the Board in a way they could not resist. He thought they should put as a preamble to the resolution, "That in the opinion of this meeting the expenditure on hospital and charitable s*d must be curtailed."

Mr. McLeod, Mr. A. P. Friend, and Mr. Garland all stated that the Board would welcome the investigation. The latter added' that he thought Mr. Walker, who seemed to know so much more than the members of the Board, should be added to the committee.

Mr. Parr promptly seconded, and Mr. Walker's name was added.

The chairman of the Epsom Road Board was also made a member of the committee, and Mr. H. B. Morton, as chairman of the One-tree Hill Road Board, asked to be relieved, which was agreed to. Mr. Bloomfield asked what assistance the Hospital Board would give the committee, and Mr. Garland paid they would get whatever papers they desired, and ho would ask the honorary medical staff to attend if required. The motion appointing the committee to investigate was then passed, and it was decided that the committee meet next Friday at the Hospital Board office.

Mr. Alison then moved. " That each patient treated at the hospital should be charged a fee equal to the full cost of treatment, it being in the discretion of the Board to remit the whole or any portion, of the fees when the patient is unable to pay." He stated as \\is reason for this that Dr. Collins had stated that no patient paid sufficient to cover his treatment. That should certainly be altered.

Mr. John McLeod: I second that. Mr. Alison apparently thinks a little more can be squeezed out of the friendly societies. I will not be one to stop the squeezing. The motion was carried unanimously. THE INFECTIOUS DISEASES HOSPITAL.

The discussion with reference to the management of the Auckland Hospital having been closed', Mr. Alison referred to the question of' the infectious diseases hospital. He said the Devonport Borough Council put certain questions to the Health Department with reference to this, and in reply they got the following information: —That the cost of the 44 acres of land to be acquired was not included in the £6700 estimated in the cost of the hospital; that the furnishing of the hospital was not included beyond that the furniture in the present infectious diseases hospital would be transferred. Then there was the cost of making a road. Dr. Makgill said he would get the cost of the building out down to cover that, but why should the local bodies as a whole contribute to the cost of a road at Point Chevalier? Then Dr. Makgill estimated the cost of upkeep at £1700 a year en the assumption that the hospital was occupied to the extent of six beds all the year round, which, he said, would be an unusually high proportion, so all this fuss was to provide six bods all the year round, and before they were done it would cost ,£IO,OOO to provide six beds. If the local bodies did not put their feet clown now they ought to be prepared to put up with anything they might get. They should resist "the Health ! Department right along the line. (Applause.) The Minister might support the Department, but the local bodies, as representatives of the people, should unite and show the Health Department, the Minister, and the (Jovernment that they would not be footer! a loir/ by any Health Department. He moved, "That this conference again emphatically pso tests against tho erection of an infectious dif.eusjes hospital at Point Ohevaliei, ami will use every legitimate moans to [mivttiu the erection of the same on that site, and if the Health Department pcr<ii»t« in tree-ting Die hospital at Point Chcvulie/- this conference will use- every effort to influence th.« com tributing local bodies to refuse to contribute towards its' maintenance, upkeep, or other expenditure.-" He trusted the wnfertiHtM would be unanimous and thai, they would fight the Health Department, Dr. Makgill, Dr. Mason, ttir Joseph Ward, ami the whjje Government if required, to resist tyranny and oppression. , , . , . Mr. V. F. Kerr-Taylor seconded, and the motion was carried unanimously. Mr. Walker then submitted a resolution reaffirming the resolution passed ftt recent, coherences, that the infectious diseases hoes-

pital should be within the grounds of the general hospital and under the supervision of the Hospital Board. I This was also carried unanimously. Dr. Makgill at this stage explained that he never meant to say that he was calculating on six patients in the hospital all the year round. There might be sometimes 20 and sometimes none. He was calculating on an average of six. That did not moan that there would never be more than six beds in use. Mr. Bagley moved, "That as the Hospital Board has iJoOQQ available for the erection of hospital buildings the cost of erecting the infectious diseases hospital should be taken from that fund." Mr. Garland said the Board had £5000 in trust, but not for the purpose Mr. Bagley stated. Mr. Bollard said there might not be £5000, but there was plenty of money to build an infectious diseases hospital. Mr. W. Cooper (Avondale Road Board) moved, " That the Mayors of Auckland, Devonport, Parnell, Newmarket, and Grey Lynn be appointed a committee to obtain legal advice as to the legality or otherwise of the Treasury Department deducting from subsidies due to-local bodies the contributions demanded from them towards the erection of the proposed infectious diseases hospital, and to take such steps for the maintenance and enforcement of tho legal rights of local bodies concerned as may in the opinion of counsel be advisable or necessary, and this meeting agrees that the cost be paid by the local bodies in proportion to their contributions to the hospital." Mr. Cochran (Waitcniata County Council) seconded, and this also was carried unanimously. Tho proceedings then closed.