HOSPITAL SYSTEM.

Taranaki Daily News, 17 December 1924, Page 8

HOSPITAL SYSTEM.

THE QUESTION OF CONTROL. HiyCCSSION IX TARANAKI. ATTITUDE OF THE BAI.A Regarding the recent discussion on the question of the control of public hospivais, the following statement, signed by Dr. George Home aud Dr. G. H. Thomson, president and acting hon. secretary respectively of the Taranaki division of the British Medical Association, has been forwarded to the editor of the Daily News: — At the last quarterly meeting of the Taranaki division of the 8.M.A., there came up for discussion certain statements made by the chairman of the Taranaki Hospital Board, as published in the columns of the Taranaki Daily News on November 19, 1924, and also remarks contained in the leading article next day commenting upon these statements. The meeting was of the opinion that the statements were misleading to a certain extent and should not be allowed to pass without comment. The following statements in the ciuurman’s speech were particularly objected to: (a) “Our hospital is for the people of Taranaki, whether rich or poor, and 1 hope the day will never come when we shall have an honorary staff that ■aun stand at the door and refuse admission to any one who comes along for treatment. ’ Such a condition of affairs has never occurred nor is ever likely to occur in Taranaki; but a medical man is not bound by law to att.ind any individual patient and has rhe right to refuse. The medical superintendent of a hospital, being an officer pail by the 'board, is so far bound to carry out the wishes of the controlling body and cannot refuse to treat anyone, wber.her rich or poor, who is admitted into hospital. HONORARY STAFFS.

Some idea of the attitude of the B.M.A, regarding honorary staffs can be gleaned from perusal of Dr. R. Campbell Begg’s evidence at the Palmerston North hospital inquiry, which reads, inter alia: —“The attitude of the British Medical Association in the matter of the position of honorary staffs in public hospitals was placed betore the commissioner by Dr. R. Campbell Begg, who watched the proceedings on behalf of the association. The speaker strongly emphasised the attitude of the B.M.A. towards members of the honorary staff in their refusal to treat wealthy patients in -public Hospitals, <out pointed out •that in no circumstances was the health of patients to be jeopardised by any such action. He pointed out that when the Medical Practitioners Bill was being placed betore Parliament and he had been called upon tu give evidence, the argument had been used that a doctor might be called to an accident or an urgent case and might refuse to attend until he had received or was guaranteed a fee. The association had then decreed that any action of this character would constitute infamous conduct in a professional respect.

“Dr. Begg added that apart from the treatment of the sick and the indigent, one of the very important aspects of a hospital was that scientific knowledge which was to be gained by medical men concerned, which would in turn lead to wider experience in the profession and better medical services generally. The association favoured the system of honorary staffs with proper conditions. They advocated the establishment of a community hospital system, and divided the people into three classes —poor, middle-class and wealthy, ne thought provision should be made lor the treatment of poor people, to whom three guineas was a vast sum, and he said that some indication should 'be given prior to entry as to how much could be paid. AIIDDLE-'CLASS ATTITI'DE. “In regard to the large middle-class, the doctor said many people regarded a public hospital in a similar light to gaol, and would go to any length to be allowed private treatment. The B.M.A. did not think the profession was justified in allowing these people to go to such lengths, foi* some of them were financially crippled for years as a result. For this it was difficult to find a remedy. Wealthy people who could afford to pay for the best should receive tiie best were available iu a hospital. *By having such a system,’ concluded Dr. Begg, ‘which caters for the whole community, hospitals, instead. of being looked upon with dread, will be regarded in their proper light, where sickness is relieved and proper medical attention is secured.’ ”

The definite extent of the power of an honorary staff regarding its right to control entry of patients will be defined by the commission investigating the case before the Palmerston North hospital inquiry, ami will become the rule for all hospitals having honorary staffs. Until, therefore, the commission’s decision is announced, the chairman's hope is rather premature. A patient admitted into hospital is treated largely at the expense of the ratepayers in general (hospital rates being struck on the unimproved value I; and as such lie must be regarded as being in receipt of charitable aid. for the value of the services rendered to the individual patient by the community of ratepayers is incomparably greater than the value of the rates paid by that individual. If the matter is viewed in this light, it is quite easy to understand that an honorary medical officer may . object to giving his services and trained I skill free to wealthy peciplc, as he himself is a ratepayer-—giving his services and time which he could use in increasing his own income. He is practically required by the public to maintain a position of expensive standing in the community and is called upon more than any other tradesman or professional man for public donations, in addition to going through a very long ami expensive term of apprenticeship without remuneration —an apprenticeship, nowadays, amounting at the minimum to ten years of adult life. THE CONTROL ISSUE. (b) Replying to a question in re the appointment of an honorary staff to the local hospital, the chairman said:—“lt appears to me that there is a wish or a determination on the part of the •8.A1.A. to get a grip of hospital management in this Dominion.” Comment: The function of the B.M.A. is to govern the behaviour of its members and to set up lines of conduct to guide the members in their relation to each other ami to the public. Stick matters as the

control of hospitals are quite outside the limits of the activities of the B.M.A. The wishes of the Taranaki division of the B.M.A. regarding t’he control of hospitals van be readily gathered from a resolution submitted to the central council and carried unanimously by thia division, which was:—“That legislation should be introduced providing for Lhy administration of the hospitals of the Dominion by a Board of Commissioners representing the Government, the publio and the medical profession. This would eliminate th® present unsatisfactory relationship between the department aud the hospital boards on the one hand, and between the department and the medical profession on the other hand. It is our conviction that the admini«tration of hospitals would be best server! by creating a Board of Commissioners, and leaving the Health Department to devote its energies to its proper sphere, viz., the prevention of disease, and leave the curative part alone.” (c) “What Patients Save.’’ The chairman said:— year 680 operations had been performed at the hospital, and if these had been performed privately they would have been worth aliout £20,000 to the doctors, so they could not blame the doctors if they wanted a picking of this sum. AU that work wa» done at the hospital for practically nothing, and on two days each week their surgeons were doing nothing else. Either the board must appoint an honorary staff to relieve these men. or it should see that the men wild "did the work were adequately paid.” 'Comment; he chairman’s estimate of £20,000 for 680 operations works out at about x £3O for each operation alone. He overlooks the fact that the majority of the 680 operations were minor ones; in fact, every anaesthetic given within the hospital is included in tha-t total. We have computed that this list of operations, if performed in private hospitals or in private practice, would at a generous estimate work out at much, less than half the sum mentioned fey the chairman, whose statement gives to the public an erroneously exaggerated idea of the charges made by medical men. (We would here remark that medical men have not pushed up their scale of fees to anything like the extent that all other trades and professions have done since the financial effects of the war have become apparent.) What proportion of this would be collected is another matter altogether. CDMMUNITY HOSPITALS.

The leading article on “The Hospital Controversy,’' appearing in the issue of the Daily News for Thursday, November 20, 1924, contains, among others, these statements:—

(a) “It is much to be feared that the money-making clement is to be found at the root of the attack that is being made by the B.M.A. on the present hospital system, and the appointment of honorary medical staff’s, a movement that should be strenuously opposed.” Our comment i«: The desire to make money is, in our present social life, the main incentive to exertion, and even a. medical practitioner has to make money to live, to improve his position, to extend his knowledge and skill, to obtain better material, and to maintain the social standing demanded by the public. (b) “There is no getting away from the basic fact that public hospitals were instituted for the piirjxjse of enabling the public to receive the best treatment that skill, equipment and good management could secure.” Comment: We would interpolate at this point "and at 'the cheapest possible rate of remuneration to the medics] men.” (c) “There then may be continual friction over the matter of who shall be admitted as patients and who shall be denied the benefit of treatment, and be forced to enter the private institutiona at which doctors can charge what fees they please.” Comment: Members of the B.M.A. cannot charge whit fees they please, but are limited by a scale; and. we would add, charging and collecting are two things totally different. In conclusion, the B.M.A. is absolutely and entirely in favour of the institution of the community hospital (the Toronto hospital system), and does not wish to seriously interfere with or ha'inpcr the administration of any hospital, pending the arrival and establishment of community hospitals throughout New land.