ADMISSION TO HOSPITAL

Taranaki Daily News, 19 November 1930, Page 9

ADMISSION TO HOSPITAL

CASE Op WOMAN PATIENT

DR. DORIS GORDON’S STATEMENTS. STRATFORD BOARD SATISFIED, Finality 'was reached at yesterday’s meeting of the Stratford Hospital Board in a matter about which niucji public interest has been aroused in Taranaki. Equipped with a letter addressed to ' D r . G. Home,.New Plymouth, by Dr. Doris" Gordon, Stratford, a patient, Miss J., was admitted recently to the New Plymouth hospital without the knowledge or .authority of the Stratford Hospital Board.' Dr. Gordon’s letter was sent by the New Plymouth board to the Stratford board and dealt with in open meeting at Stratford. Dr. Gordon waited upon the Stratford board yesterday and made a statement on the subject. A statement' was also submitted by Dr. Steven (Medical Superintendent of the hospital), and the board recorded its continued confidence in Dr. Steven, the matron and staff. ■ Dr. Gordon prefaced her remarks by expressing regret at the step taken by the board in publishing hei’ private letter, claiming that, this action now com- • pelted'her to state facts she would have preferred to have left unsaid. “If you doubted my motives’ and the integrity -of my remarks made in the free style of a .private letter do a trusted, colleague, a more honourable and diplo- ' matic course was open to you,” she said. “You could easily have apprised me that ' the letter Was in your hands, and have said that though you realised it was not your.property you felt you were justified in asking some private explanation thereof. As it is, you chose to criticise - openly and in so doing you compel me to answer you openly. As you, Mr. Chairman, had time to prepare a public statement refuting my remarks I can only '-- think'that your decision to publish this private letter was not a decision reached on. the spur of a moment’s indignation, but was a deliberative procedure calculated to drive me to a public apology or explanation." In this case the responsibility for my public statement, whieh ’may be fraught with unpleasant details, rests with you, not with me. If I am mistaken in my last deduction and . you care to assure me publicly that you regret the irregular action you took, and - that you do not doubt that in the recentcase of MiSs J. I acted solely in the patient’s interests, then I will be more than pleased to call the unhappy irici- ’ dent clqsed.” ■ Dr. Gordon offered to retire while the board considered her offer, but the chairman (Mr. W. L. Kennedy) interposed. “In the first place, Dr. Gordon, as far as this board is concerned, that ■ letter was not a private one,” said Mr. Kennedy. “It" came into this board’s ' hands without .any indication or mark of ‘private’ or ‘confidential.’ If, originally, it was intended to be of a private nature, it was not so when it reached this board. You say we had time to compose a reply. On the contrary, your letter came as a thunderbolt to us.” J " TWO ISSUES ANSWERED. ‘ f , - ' . ' " -A ’ • ■ ■ . ■ - “In that case, I shall continue,” said 7. Dr. Gordon. She then read her statement, which opened with a brief recapitulation of the case and the statement that •; the chairman of the Taranaki board agreed that Miss J.’s case was urgent upon, arrival at New Plymouth hospital , and that the senior physician, who admitted her, said his provisional diagnosis confirmed that of Dr. Gordon. ‘ ■ S “Two important questions remain,” (she continued. “(1) (Jan-I substantiate • my remark, ‘I have known one or two other instances where charitable aid - cases of hopeless invalids have been .’( turned out on the 'world when they ! should have been sheltered by the local hospital? and (2) why did I not refer the : case back to your board instead of send- , ing her to Dr. Home? “No. I.—<l can definitely say that the •penny wise and pound foolish’ policy- of your board tends sometimes to permit-' ' the discharge of seriously ill patients, to the detriment of their health, and also of chronic-cases in poor circumstances. With, "your 'medical superintendent’s permission, I am willing to substantiate this statement even to the extent of giving you now the names, dates of discharge of one or two such cases, and a copy of the death certificate <of a third case, . which died within 24 hours of leaving your institution, if you doubt that these •premature discharges’ have occurred. The discharge from hospitals of non-fin-ahcial, chronic cases is always a-respon-sibility. If not fit to work they either 'work and knock up in consequence, or do liot.-yWork and do not get necessary food and comfort. Either alternative tends to land them back again at the hospital doors. a few weeks later, their latter state being as bad as their former, -and the financial burden to the taxpayer being greater than if they had been detained in the first instance until a full restoration to working health was ' assured. • . “Miss J. was non-financial, unable to work, and assistance from relatives was ’very doubtful; If hospital boards could coalesce aiid run district convalescent homes the problem of the charitable aid chronic be. less anxiety to superintendents, and the' burden to the ratepayers'-. jvoiild .be lessened, ’■ as the cost of maintaining cases in such a home would be less than the expense of keep- \ ing them in general hospitals. ‘ “No. 2. —My answer is that I was driven to take the step I did by the unique policy of hospital administration you pursue. . No other board in New Zealand expects one part-time superintendent to do all the work of a 50-bed hospital. They realise it would be an impossibility for one nian, in anything less than a full day, to do justice to this number of patients as well as outpatient work, lecturing to nurses, and generally supervising the whole institution. Your neighbouring boards have shaped their policies to suit the times and have appointed full-time superintendents with several assistants,'but you follow the same routine that suited your needs 20 years ago, when you were a 20-bed hospital. “If you - ask impossibilities in supervision sooner, or later some cases will

miss their full diagnostic treatment, or be prematurely discharged simply y through the sheer inability of one parttime doctor to cope with the work. You have got a wonderfully capable and conscientious superintendent, but you have given him a load of work at present ■ without parallel in New Zealand.

CRITICISM OF HOSPITAL POLICY.

. “Some personified ‘impossibilities’ come to us shortly after discharge from vour institution, and, in respect for. your hard-worked superintendent, and in the interests of the district, we have always advised them as tactfully as we could, and with the maximum loyalty to your institution. As & rule such eases can be easily managed. Now and again one presents singular difficulties. The present ease was one such, and rather than risk complaints being lodged,-and controversy between your board and ourselves reopened, I sent the case away to Dr. Home, glad of the genuine plea that she required full- X-ray treatment. “From vour remarks, I think you have

taken exactly the. opposite view of 'my action, believing I am still nursing the time-honoured feud that existed between your board and a previous owner of this practice. This is not true; We harbour no feud and are well content to go our our way while your institution goes its own way. Your superintendent, however, knows we are always willing to stand -by him and assist in emergencies’. For the sake of local peace I would have ignored all your criticisms at last board meeting, had it not been that you are again enlarging your hospital, further, increasing the burden of administration, and further increasing the risk of other patients (for the reasons above mentioned) coming to us to perplex us with their medici- problems. As you have made the matter public it seemed better to discuss it to a finality now co we may have a better working basis for the future. Allow me also to say that my criticism of your policy arises from no personal regrets that you have never allowed us to be members of your honorary staff.

“Now, reverting to the question why I did not refer the case back to you, my. reply is that had I done so you would have told me, as you have told me before, to send the patient back to your hospital, where everything necessary would be done for her. Miss J., however, informed me that- during her sojourn of three months with you - she never had full X-ray treatment, and I believed her, knowing your institution could not supply this type of work. Had I gone to vour next board meeting and suggested that Miss J. be rent to New Plymouth for full • X-ray investigation; after she had been three months with you, you would have interpreted ray remarks to be a reflection upon your hospital and would have told me politely that you knew your own business and had your own X-ray plant. “The 'matter of the X-ray plant further illustrates the fallacy of your policy, for you not only ask one parttime doctor to do a full-time doctor’s work, but you expect him to be an X-ray expert as well. All other hospital boards r.-cognise "that to have a radiological department efficient to cope with all branches of treatment it is necessary to have a thoroughly up-to-date plant and accessories, as well as the services of a specially-trained radiologist. The turnover of cases here will not justify your employing such a specialist for probably 50 years to come. Meanwhile, all your intricate X-ray cases should be sent to New Plymouth with the mihimum delay, but this you are unwilling to do because you are still influenced by your late chairman’s opinion that your relatively little hospital was equipped and staffed to provide adequate treatment for every known illness to which the flesh of man is heir.”

Dr. Gordon, then proceded to deal exhaustively with a previous case which was sent to "Wellington in 1924 under somewhat similar circumstances, justifying the introduction of this subject on the ground that a member of the board, at its last meeting, had made mention of the similarity of the two issues. “I think I have said enough,” she added, “to show you that our course of duty with your poorer patients requiring specialists’ services is anything but simple. I can only hope the present discussion, distressing though it has been to me to give destructive criticism, will result in some clearer understanding for; future working. “I will conclude by summarising my remarks thus:—

“(1) My criticism has been of your system, not of your officers, for whom I -have the greatest respect. “(2) Your hospital .cannot hope to cater for the unusual forfiis of treatment, and prompt automatic transference of patients requiring specialists’ services should be guaranteed. “(3) That you can run your hospital on any principle you like, so long as you will not misjudgo our motives when we are compelled to quietly try and help yotf. , “(4) That.l. neyer alleged.there.had been discrimination for financial reasons in Miss J.’s case. But as you introduced the term into the discussion I will suggest that your present policy savours strongly of financial discrimination. If anyone in Stratford with a bank account needs specialists’ services he can jump into his car and secure the same for himself in New Plymouth or other large centres at' an hour’s notice,, but the poorer man in our midst can only -secure the same by a cumbersome, time-en-grossing and precarious process.” QUESTIONS BY MEMBERS. In replay to Mr. Rutherfurd, Dr. Gordon said she had had no report of -the patient from the New Plymouth hospital. She had carefully ‘refrained from making inquiries and'liad declined to receive a copy of the report, though it had been offered to her. The chairman: Can you say the number of cases which this board has sent for specialist treatment, say, only for the past three years? Dr. Gordon could only remember one case recommended, personally by herself for specialist treatment in that period, and she acknowledged that the board haq given prompt measures to accord the necessary treatment. t The chairman: Then you may be surprised to kn,ow that this board has sent no less than 31 cases away for specialist treatment within the past three years, and of these 16 were sent away on the recommendation of the Drs. Gordon. Mr. O’Neill: Does Dr. Gordon think it was playing the. game to take the steps she did without first consulting the medical superintendent ? Dr. Gordon: I made no arrangements about the New' Plymouth hospital. I merely sent the patient to Dr. Home at his address in Powderham Street with the request that Dr. Home take steps to admit her if he deemed such a course advisable.

Mr. Harkness: But didn’t you send her there, knowing that she could not come back ? Dr. Gordon: That was a matter for Dr. Home.

The chairman: Don’t you think, Dr. Gordon, that there is a better way of going about these matters than by ‘wangling.’ Tha,t is a word I scarcely understand, Dr. Gordon: “Wangling* is - a word

quite well understood in medical language. With all due respect to Dr. Steven it will be obvious that I couldn’t go to him when, he knew and I knew that certain X-ray diagnosis could not be given at the Stratford hospital.” . Prior to calling upon Dr. Steven (the medical superintendent) to reply, the chairman said - the superintendent had been more deeply affected by Dr. Gordon’s insinuations than anyone else, and the hoard had taken up the cudgels more onNhis behalf than for any other reason. DR. STEVEN’S REPLY. Dr. Steven stated that of the 31 eases sent away for specialist, treatment and paid for 'by the Stratford board, many of the patients never entered the Stratford hospital at all, but were sent forward on the recommendation of outside doctors. The cost of these cases'had been £1749, paid by the board, and, in the past there had never been one hitch or friction. He did not pretend to be an X-ray specialist, and had never maintained to the board that the Stratford plant was fully equipped to deal with all X-ray cases, lie, had rather adopted the policy of having the board send patients on to neighbouring institutions for this treatment.”

Dr. Steven then read a report of the case. “Certain statements,” he said,

“have been published concerning the ease of Miss J.. As I am prevented (by-law--130) from publicly replying to them, and, as they contain insinuations reflecting on my professional ability and administration, I desire to make to board members the following comments: — “Dr. Gordon stated “in a nut-shell, I think it is summarised by diagnosing that she is suffering from girdle pains from a T.B. spine.” This statement indicates that Dr. Gordon’s diagnosis was completely wrong. Miss J. did not have a T.B. spine, and an ordinary clinical examination (without an X-ray examination) should have convinced Dr. Gordon of this, as the movements of Miss J.’s vertebrae were free and normal. “‘Homeless.’ Arrangements were made concerning a temj>orary home for her with a Stratford resident before I sanctioned her discharge. This was confirmed at a personal interview with that resident.

“ ‘Two years’ training.’ This statement is not true. As shown later, she had no nursing training. “ ‘Charitable aid cases and hopeless invalids have been turned out on the world.’ I have no knowledge of such, nor has any complaint of same been made to me. I certainly do not regard Miss J. as a ‘hopeless invalid.’ “ ‘No X-ray diagnosis.’ This statement is untrue. The diagnosis was certainly made without X-rays, but very careful X-ray examinations of chest and of spine were made to .corroborate and amplify same. . “‘Little in. the way of spinal jacket.’ This is true. As already stated, the case was not one of spinal tuberculosis, and there was no indication for a spinal jacket. . “‘Get her properly diagnosed and her prospects summarised.’ I maintain that this has ■ been completely and efficiently done in the Stratford hospital. Our findings and diagnosis have since been fully and completely confirmed by New Plymouth hospital, who report that ‘her spinal movements are fairly normal. X-ray of. the spine shows no sign of tuberculosis, healed or active.’

“The rest of the letter calls for no comment from me, save that it was written on September 2L Miss J. went to New Plymouth next day. Had Dr. Gordon so desired, she could, by a telephone ring, have obtained from me any of the details in the attached history of the case. It has been inferred or stated that Miss J. required specialist diagnosis or treatment. I maintain that this is not so.” . HISTORY OF THE CASE. Dr. Steven proceeded to give the history of the- ease, saying that Miss J. was/not a nurse in the Waikato hospital. She was a telephone attendant. She was not sent away, a wreck, to a sanatorium. She left of her own accord, and no one on the staff knew that she was ill, if she was; On January 1 last she was admitted to the Stratford hospital. On examination, no sign of tuberculosis could be found, and repeated examinations of sputum for T.B. were negative. Actually she had hysterical aphonia. She left hospital on January 28 and was readmitted on June 17 on a note which gave no diagnosis, and made no recommendation for admission. Her physical condition then was much the same as it had been during the period,' nearly three years, that he had known her. There was a suggestion of mild hyperthyroidism, and some degree of scoliosis. This was a “deformity of growth” rather than a result of disease,' and was not to be confused with spinal tuberculosis, having a different pathology and requiring different treatment. The movements of her spine were free, and there was no spinal or pulmonary tuberculosis. There was no sign of serious .organic disease. The most important feature of her case wqs her condition of nervous instability. She was treated along lines recognised for such cases Arrangements were made by Miss J.’s mother for. the girl to board with a Stratford resident, and at a personal interview with, him on August 29 Dr. Steven arranged with him to call with a taxi. That was the last he saw of Miss J.

“I desire to assure the board,” added Dr.'Steven, “that during the whole time that Miss J. was in hospital I had the whole-hearted and loyal co-operation of the’nursing staff. They showed the utmost patience and tact, encouraged the patient’s interest in fancy work and things other tha'n her own more or less imaginary ills, and generally upheld the best traditions of their profession in the handling of a difficult and trying case.”

After hearing the report Dr. Gordon said she was prepared to agree that the case might have been one of the pitfalls that sometimes beset the medical profession. ,-Members of the board would recall that she had written in her original letter to Dr. Home that the patient’s tale was so extraordinary that she hardly believed it until she had examined her. Even Dr. Taylor, senior physician at the New Plymouth hospital, when he first saw the patient was inclined’to agree , with her diagnosis. Mr. O’Neill: If Dr. Gordon had taken the ordinary procedure all this trouble would never have happened. The chairman: That is the point. Dr. Steven: Dr. Rich’s report upon the girl’s condition is quite definite, while Dr.' Taylor had said “glancing at the patient I was at first impressed by the fact that she might be suffering fromT.8./but an examination showed clearly that the movements of her spine were quite free.” The chairman: I am satisfied with the conduct of the medical superintendent and with the management of the hospital. Efficiency is first of all necessary and no matter wljat assertions are made, we have an efficient staff here in Stratford. Not in the 10 years during which I have been associated with, this board has any member ever expressed one word of dissatisfaction or complaint. Dr. Steven: I would like to thank Dr. Gordon for the kindly remarks she has made about me personally. In reply, for. Gordon said the case in question was largely a matter of opinion. “I simply venture to suggest,” she added, “that this board will have to consider carefully the future of its institution, to see that it is' developed on progressive lines, and that its administrative department is brought up-to-date.” She expressed the hope that a' better working basis would be established for the future and reiterated that cordial relations existed between the doctors practicing in Stratford.

After Dr. Gordon had retired Dr. Steven’s report was accepted as a clear and accurate history of the case, and an expression of continued confidence in the medical superintendent, the matron and staff was placed on record.