HOSPITAL BOARD POLICY

Taranaki Daily News, 23 October 1930, Page 10

HOSPITAL BOARD POLICY

SPECIALISTS’ TREATMENT

STRATFORD-NEW PLYMOUTH CASE

DR. DORIS GORDON’S STATEMENT.

In the course of an interview with a representative of the Daily News ye o " terday Dr. Dorie Gordon stated that she was at a loss to know how a private letter of hers addressed to Dr. Home had found its way to the New Uymouth Hospital Board’s office, and was more at a loss to account for the fact that a board of the standing of the New Plymouth Board had seen proper to forward her private letter to Dr. Home on to the Stratford Hospital Board for the latter’s consideration. The Stratford Board had published the letter in the public Press, which was a surprising breach of etiquette but, Dr. Gordon said, she was quite willing to overlook these errors in committee management in view of the larger issues ventilated in the letter and subsequent discussion, namely, the welfare of the patient. . “The present incident, which has been made public by the joint action of the boards, serves,” said Dr. Gordon, “to direct attention to a crucial question of hospital policy. The question is ‘what is the object of our public hospitals?’ Do they exist simply to publish blowing monthly reports of institutional efficiency and cconohiy? Do they exist to be ornaments to our towns? Or do th®y exist primarily and solely for the welfare of patients needing their healing services? *Our New Zealand public hospitals, taken on the whole, are excellent institutions, but our system of having them controlled by multiple small boards, each operating its own area as a ‘water-tight compartment,’ is a great disadvantage to patients, particularly rural patients whose local hospital may chance to be a relatively small one. Every now and again we encounter instances of chronic cases being tossed like a shuttlecock between one board and another, each declaring the case is a public charge upon the other. In the present instance a stir is being made because I sent a patient from the Strattord district to the nearest’base hospital where a team of workers, including an expert radiologist, will have a much better chance of curing her than would be the case if she re-entered a one.doctor hospital.

UNIFICATION •OF INTERESTS.

*‘lf we in Taranaki had one overhead board governing all local hospital boards, cases requiring intricate X-ray diagnosis, eye or ear service, brain or geneto-urinary surgery would be admitted to the hospitals able to supply all suph service. The only hospital at present able to supply all these requireincrits ill Taranaki is the New 1 y* Hiouth hospital. Under our present system patients residing outside tb», Taranaki Hospital Board’s area vdio'require specialist’ service* havp au. exciting gamble as to whether tneir disorders will be treated by a busy general practitioner, with no claim to specialist s skill in their particular ailment; whether they will be passed up to a genuine specialist; or whether, in fact, they will receive any attention at all. Their chances in the gamble are apparently determined by th® broad-mindedness and enlightened viewpoint of the particular board administering their area. “I am sorry,” Dr. Gordon continued, “both for the sake of the patient and for the sake of the boards that this discussion has arisen. The patient concerned has already had more than her share of suffering and distress, and the last thino- I wanted was any controversy with °th® boards. The whole object -of my private letter to Dr. Home was an effort to secure for Mias “J.’ the benefit of a specialist’s services without stirring up trouble with ray local board. But as the matter has been taken out of my. hands and made a public affair an abbreviated statement of the case is necessary.

THE PATIENT’S SAD STORY.

“I first saw the patient early in September being called out of chinch to attend her, the landlady excusing her action by saying she could not bear to see her boarder suffer the pain of the last few days for one hour more. The. hiatory as supplied to me by the patient is,as follows: Ex-nurse from Waikato hospital; left there after two year#’ training because of tuberculosis, of the spin'e. Recommended for sanatorium treatment, but before she could gain admission thereto became acutely ill in Taihape and was taken to that hospital, where she remained for eighteen months, her back being in plaster most of the time and her spine X-rayed at intervals. Approximately two years later she came into the Stratford district and, becoming ill after a while, was sent by doctor at Tangarakau into Stratford hospital last autumn, with the idea that she would be passed on to a sanatorium by. this board. Discharged after four wdekfl, no mention of /sanatorium. Readmitted in June and remained in this institution until Aug ust. Still no mention of sanatorium. Patient stated though she had pain in her back during the three months in local hospital she had no special spinal treatment, neither was an X-ray picture of her spine taken. «I found the patient extremely emaciated, running a quick pulse, and inspection of her spine and chest assured me her story was certainly.correct as regards her long and crippling spinal disease. Questioning her re her finance, she said her mother occasionally helped her but was now ill herself and unable to assist, and patient having been unable to work for over six months was down to her last 30s in the.world. In addition to this the woman was in severe pain. I advised re-admission to the Stratford hospital, but patient refused, giving certain reasons for not wishing to re-enter this institution. I was particularly careful not to quote f,beso reasons in niy letter to Dr. Home, being satisfied he was well able to assess the pros and cons of the case himself. Realising that expert radiology was essential for her, I told the patient it would be to her advantage to go to New Plymouth, and that I would refer her to Dr. Home. Patient being in severe pain, I supplied her with morphia for the journey, gave her £1 to supplement her meagre 30s, and a kindly resident of Stratford drove her to Dr. Homes surgery. This was the last I heard of until Dr. Home rang early this morning to advise me of the contents of the morning paper. ‘•Therein I find some member of the local board has misconstrued my priv-

ate letter to imply that Miss “J” was p'ematurely discharged because she wrws practically a charitable aid case. This idea was far frota my mind, the patient, having told me her mother wanted heito go to .Hawera to help nurse the mother, who was ill.- Moreover, she gave me reasons why she desired to leave the Stratford hospital. ‘I have -written the local hospital board asking them to allow me to discuss this case in open meeting shortly, and will be prepared to answer all questions upon this point that members care io submit.

“Whether the patient was fit to leave the hospital when she did, whether the authorities should have sanctioned her discharge, whether she was really down to her last 30s I know not, for I saw her only once, and that was fourteen days after she left the institution. But when I saw her the woman was very ill and needing X-ray, and I sent her to Dr. Home to secure X-ray for- her. “Another board member asks why I did not refer the case back to them before taking action? The member forgets that only two months ago, in reply to a written request that the board would frank X-ray expenses for our necessitous patients, the board replied that such expenses could not be met. What, then, am I to do When a patient, requires such services ? Another member asked if the case of Miss “J” was a repetition of ' the case of Miss “R”? ' The latter was an instance, six years ago, when specialist’s services were required and refused by the Ideal board, and finally I paid the'specialist’s fee myself in order to have the patient examined privately in Wellington. “I contend that no such prevention of special services would hold if local boards were under the jurisdiction of one super -board, whose higher judgment would always place patients’ health before the matter of economy, and would assess all boards to contribute towards the specialists’ retaining fees. ■ “I believe the members of the local hospital board arc as anxious to do their duty (according to the light that is in them) as I am anxious to do my duty by my patients. The crux of the matter is, however, specialists for special services or no specialists. Economy or efficiency? I have asked the local board to allow me to discuss this case with them in open meeting at an early, date and their willingness to debate this case before the Press will be the measure of their genuine desire to secure the maximum health of '’the residents ot their district.