HOSPITAL LAXITY.

Dominion, Volume 6, Issue 1746, 10 May 1913, Page 6

HOSPITAL LAXITY.

ST. 'MEN'S INQUIRY. AUCKLAND ALLEGATIONS OF NEGLECT. COMMISSIONER'S FINDING. Mr. C. C. Kettle, S.M., who was recently appointed by tho Government to conduct an inquiry into the administration of the St. Helen's Hospital at Auckland, 'has now delivered his report. A copy of the document was handed a Dominion reporter Inst evening by tho Hon. E. IT. Rhodes (Minister for Public Health). Mr. Kettlo was instructed to report .■upon (1) Tho circumstances surrounding the death at St. Helen's State Maternity Hospital nt Auckland of Mrs. Laura Elizabeth Chamberlain, and (2) Generally as to'tho administration of tho. said St. Helen's State Maternity Hospital. • . \ In opening his report, tho Commissioner sets out in detail the complaints lodged by Mr. A. ,E. Skelton (counsel for the Auckland Timber Workers' Union), with regard to the treatment of Mrs. Chamberlain while sho was in the hospital from August 10, 1912, to the date of her death on September 9, 1912. One complaint was that the matron failed to send for a medical practitioner when it was her duty to do so, and another, that Dr. Tracey Inglis,,in his capacity of medical officer of the institution, declined to allow Mrs. Chamberlain to be examined by another registered medical practitioner when her' husband requested that such an examination should be made at a time when her life was in grave danger. - The Case of Mrs. Chamberlain. "The circumstances surrounding Mijs. Chamberlain's death wore gone into very fully during the inquiry," tho commissioner states, "but owing to tlio destruction, of nurse?' daily report books, and neglect to keep and preserve proper records at tho hospital, I have not been able to obtain an entirely satisfactory and reliable history of this ease. . . . The matron, during her evidence, said: 'It is not possible for me, or the doctor, or sub-matron, to givo a detailed account of Mrs. Chamberlain's case from her admission till her death, except from memory-''"

The Commissioner goes on to quote the history of Mrs. Chamberlain's caso: "According to the Caso Book (Case No. 1325— written up some considerable time after ' Mrs. Chamberlain's death)."', ~ ' "With regard to complaint No. 4,". tho Commissioner continues, "Dr. Inglis admitted that he refused to hold a,formal professional consultation with Dr.'Brockwav, Mr. Chamberlain's family medical advisor, as to Mrs. Chamberlain's condition andi treatment. lam inclined to tho opinion that, as Mrs. Chamberlain's condition was very unsatisfactory -immediately after the birth of her child, and as her. condition apparently grew worse as time went on, Dr. Inglis should have had a consultation with Dr. Brockway or another experienced and reliable medical practitioner, on or about August 16 of 17, if not earlier. ... The evidence does-not satisfy mo that every stop was taken and every effort made during the earlier stages of the patient's illnesstay, up to August 28—to ascertain, as far as possible', tho truo cause 'or causes of her very high and increasing temperature. The Commissioner states that tho evidence does mot establish to his satisfaction that tho matron failed to provide Mlvs. Chamberlain, during her confinement with tho necessary comforts and requirements. As to:complaints .that tho; matron, performed 'herself certain duties, in attending the patient, which should have been relegated to a medical practitioner, the Commissioner expresses the opinion that matrons or midwives should not be permitted to perform such duties except in cases of absolute necessity, or when tlio services of a medical practitioner cannot readily bo obtained.

An Unsuitable Building,

The.building used as a. St. Helen's Hospital at Auckland, tho Commissioner states, was at ono time used as an institute far tho treatment of habitual drunkards. Later it was used as a bcardinghouse, and in 190G purchased by tho Crown for tho purpfea which it mow 6erves. The brick portion of the- building was Built in 185-i aud the wooden portion 1885. "The evidence given.during th 6 inquiry by many medical men of standing, the Commissioner continues, "clearly establishes that tho building is quite unsuitable for a maternity hospital, and that the site on which *the. building is erected is not an ontirely satisfactory one." The Act and Regulations. The Commissions* goes on to quote the Bections of.the Midwives Act dealing with the establishment of Stalo maternity hospitals. ; The only regulations under tho Act; he continues, are those gazetted on April 27, 1905. No examiners of pupil ' nurses have been appointed by the Governor nnder Section 18 of the Act. Tho' examinations have-apparently been held by examiners appointed by' tha InspectorGeneral of Hospitals, and not in the manner prescribed by the Act. "Under these ciroumstances, it may be a question whether certificates heretofore issued to pupil nurses under the Act are valid." Section 18 of the Act provides that the Governor may appoint fit persons to be matrons of maternity hospitals, and the regulations mentioned provide. thM every maternity hospital shall be in charge of a matron appointed under the Act, who shall 'liavo full control of the institution, subject to the directions of tho Minister. With regard to the appointment of the present matron (Miss Ludwig), tho Commissioner states that Dr. Valintine said: "She was appointed by Mr. Fowlds." There was no appointment by the Governor. There was no Cabinet minute. This appointment was made by the Minister.' without tho Governor's warrant, and without a Cabinet minute. Tho sub-matron was appointed in the same?', way. There is nothing' in tho Act with, regard to sub-matrous."

The Act (Joes not provide for tho appointment of a medical officer, tho Commissioner goes on to remark, but No. 9 of tho Gazetted regulations provides that for every maternity hospital medical practitioners sluill bo appointed by the Governor annually (o deliver lectures (not less than one in every two weeks), and by No. 10 of- Ihe same regulations the practitioners are rcquired'to lake 'pupil nurse# out to cases of labour where practicable, and to attend cases of labour in 'tho Hospital which are abnormal or which rc-quiro the administration of an anaesthclie.

Regulations Not Complied With, "It appears," states the fjommisiioner, "tliat Regulation No. !) lias not been complied with. Dr. Tracey IngHs has apparently i;een acting as medical officer of tlie St. Helen's State Maternity Hospital in Auckland from tlio time tlio hospital was opened in the year MOC up to the present time, but it is at lea>!' doubtful whether his appointment was mado in accordance with law." , An Overworked .Matron, ' With regard to the general management of the hospital by Miss Ludwig, tho present matron, the Commissioner remarks that tho evidenco justifies him in reporting that, having regard to tho very unfavourable conditions under which tlio work has been carried on, there is 110 real ground for complaint. "I am inclined to tho opinion," he adds,-"that tho matron has at times been overworked, Olid that, having regard to tho yory responsible position which she holds, her remuneration of £120 per yrar i.s not mlerjUtitc. Tlio sub-matron (JFifS .'avo evidence during tho inquiry. S ho appears to 1110 to bo a thoroughly loliaMe, capable, and zealous officer. Her salaiy is only t £Bo per annum.". Satisfactory Results. In reference to tho statistics of tho hospital from tlio date of its opening to tho present time, tho Commissioner states that it must he admitted that tho results, as shown Ly these returns, arc most satisfactory. Ho (|notes the Auckland District Health Officer as saying Hint lie had compared the statistics of tho homo with

those of otlier countries, and that those of St. Helen's were extraordinarily favourable to Now Zealand, nml to Auckland. It was a feather in the cap of tho staff, Dr. Makgill added, that they had kept the mortality and sickness returns so low, considering that their work had to l>e dono in a building old and nana it a bio. Destruction of Records. Regarding the destruction of certain records, viz., nurses' report books, medical officer's diary, and charts, the Commissioner expresses t'lie opinion that diich records should not bo destroyed, except under tho sanction of regulations made under tho Act. The Commissioner recommends that a number of questions- raised during tho inquiry should receive early and oareful consideration, and should be clearly and exhtmstivelv dealt .uith by regulations under the "Act. Thttse questions include tho administering of drags in the absence of a medical man, and the holding of consultations between medical practitioners ill tho event of serious illness of patients or at the request, of their husbands or. relatives. Mrs. Nicol's Suggestions. With regard to suggestions made during the inquiry by Mrs. Nicol, the Commissioner states that he does not consider it necessary at present to appoint a resident medical otEcer, and can see no reason why the medical officer of the institution should bo prohibited from practising as a surgeon outsido tho hospital, provided ho takes the usual well-reeognised and necessary precautions 'to prevent the spread of sepsis, etc. Ho sees no objection to a suggestion that persons seeking admission- to tho hospitals sliould be entitled to appeal to a magistrate or inspector it rciused admission by the officer lii charge. Iho gazetted regulations should, ho, tmnks, provide for the admission of a patient, ii\ case, of necessity, before labour conics oil, on the certificate of an inspector, medical practitioner, or matron. . Regarding a number of complaints locked by Mrs. Nicol, the Commissioner states that it was proved that the solution ward was fumigatod and disinfected after Mrs. Chamberlain's body was 10moved and before Mrs. Porch was put into the ward. He expresses the opinion that Mrs. Porch should have been visited and examined 'by tho medical officer cr another practitioner after she had been in labour for twenty-four hours. _ Aho Commissioner holds that a complaint regarding Mrs. Marsh was not conclusively established. ■ As to another complaint—regarding Mrs. Allen and her chilfl —lie states that the evidenco was very conflictingThe Case of Mrs. Stevenson.

A'complaint by Mr. W. 0. Stevenson is dealt with in extenso. Ho stated that his wife was lodged at the Hospital under conditions which led to her catchin" a cold, which developed into pneumonia in double form. Mr. Stevenson further states in his complaint that Ins wilo was discharged in such a condition that she was admitted to tho public hospital on the same night, • practically, dying. Finally she developed ft loss of reason and died after being in a.mental hospital for' seven weeks. Tho baby lived only live weeks. . . To this- complaint the Commissioner makes tho following reference:- Mr. Stevenson appeared before me, and his complaint was fully investigated- After the evidence was given he stated that he. was satisfied that his complaint had been, thoroughly investigated. He said he would send me a statement from a Mrs. Poole and that, subject to that, he had no further evidence to offer. Mr. Stevenson has not sent in Mrs. Poole's statement, although he was requested to do so, in writing, by me. The facts are fully and sufficiently disclosed in the evidence. Mrs. Stevenson was allowed to leave tho hospital within fourteen days without the medical officer's consent being obtained. Tho matron stated that in her opinion. Mrs. Stevenson was in a fit condition to be discharged, that she was anxious to return to her home, and that her husband did not object to her leaving tho hospital." > Recommendations. Finally tho Commissioner recommends:. (1) That if it is considered desirable to continue the State Maternity Hospital in Auckland in lieu or or in addition to maternity wards at tho general hospital, a new up-to-date and properly equipped building, with a nurses' home and lecture room, should bo erccted as as practicable on the present site in Pitt Street, or preferably on & more suitablo site if ono can be obtained. (2) That the nurses' quarters be provided with a library containing all the best and latest text books, etc. (3) That the matron and sub-matron bo provided with modern midwifery bags, with steriliser, etc. (4) That the Inspector-General, under the Hospitals and Charitablo Institutions Act, 19011, should be ex-officio Chief Insp;ctor of - State Maternity Hospitals. That district health officers should bo ex-officio deputy inspectors of such hospitals. s . (5) That the Act and regulations thereunder be carefully and thoroughly revised. ■ (6) That tho regulations to be made under the Act deal with tho following •matters—(a) Regulating the admissiou and discharge of patients (married women only i, entitled to the benefits of t'lie institutions and tho attendance on outpatients: (b) the maintenance of discipline, order, decency, and cleanliness among the officers, pupil nurses, and inmates of the institution; (c) prescribing the duties, powers, and authority of iivspeciors, matrons, sub-matrons, nurses, pupil nursEis, attendants, and servants of tho institution; (d) prohibiting the suturing by m-atiora-of ruptures of the perinaeurn and other soft parts when the services of the medical officer or medical practitioner can be readily obtained; (e) preventing trespass upon tho premises of the institution or the grounds attached or belonging thereto; (f) prohibiting tho introduction of any specified article or thing into the institution; (g) specifying the books, including oase book, nurses' wport bool;?, etc., which are to be kept in the institution and tho manner in which such books are to bo kept and preserved, etc. ; (li) defining the duties of all medical practitioners appointed by the Governor under Regulation No. 9 of tho gazetted regulations; (i) prescribing tho: times and manner •in wliich . tho ■ institution and tho wards thereof shall be disinfected and fumigated and also providing for the thorough sterlising of all instruments, utensils, etc.; (j) providing for tho appointment of inspectors and the frequent and thorough inspection of the institution and tho books, etc., required by the regulations; (k) providing for the holding of consultations between medical officers and other medical practitioners as to the condition and treatment of patients in tho caso of serious illness or operations; (I) generallv making provision for all matters referred to in Section 19 of tho Act and olher matters affecting the care and treatment of patients, and tho management, etc., of tho institution; (m) providing for a breach of any such regulation a fine not exceeding, say, .CIO. (7) That tho Act and all regulations made thereunder be printed and posted in convenient and conspicuous places in the institition and a copy thereof delivered to every officer, pupil, nurse, and servant. ■ (8) That , if necessary, the certificates heretofore issued to pupil nurses under the Act bo validated. Cost of the Inquiry. "With regard to the costs of the inquiry. I am of opinion." states the Commi«ioner, "that the whole of such costs, including the cost of the parties thereto. I should be borno and paid by the Hospitals Department. The inquiry into the matters referred to me' lasted much longer than was anticipated. This was due almost entirely to the fact that on two occasions Mr. Mavs, who appeared for tho Crown 'Solicitor, applied for and obtained adjournment s ? to enable him to attend to other public business and on one occasion. owing to Mrs. Nichoirs illness, a further adjournment was necessary.

THE MINISTER INTERVIEWED. NEW BUILDINGS IN PROSPECT. Interviewed last evening, tho Hon. T!. 11. Rhodes (Minister for Public Health) said that he did not wish to comment in any way 011 the findings of the Commissioner, but he suppliod some information in regard to points raised in tho report. Tho uso of old buildings <as St. Helen s Hospitals, thn Minister remarked, was 110 doubt due to the fact that the late Mr. Seddon, at tlio origination of tho scheme, was anxious to see it in working order with as liftlo delay as possible. I" C'hristchurch a closed hotel was acquired, and in Wellington and Auckland

also old buildings were purchased. Tlio Department reported adversely upon Iho building in AVellington, and ultimately a new hospital was erected. The Inspcc-tor-Geaerul of Hospitals (Dr. Yalintine) had on several occasions reported thai; neither tho Auckland nor Christchurch buildings were suit able, anil as a result an activo search for new sites was in progress in both cilies before the late inquiry nt. Auckland was ordered. Mr. G. W. Russell, whilo Minister for Public Health, was anxious to rebuild in Christchurch, and a sito was acquired in that town upon which if was proposed to erect a newi building. _ Mr. Rhodes mentioned that ho had himself spent' somo timo when lie was in Auckland in January' last or earlier, in going over proposed sites for a new St. Helen's Home. Tho site had not yet been obtained, but in both Auckland and Christchurch tho Government proposed to erect new buildings as soon as possible. The Dunedin hospital was in better condition than the other old buildings which had been used, and was' better fitted to servo tho purposes of a maternity hospital, and it was not proposed to rebuild there in the meantime. The present Government, Mr. Rhocte pointed out, was not responsible for tho purchase of tho old buildings which had been used, and it necessarily took somo time to ropiaco them with new and up-to-date structures. As to tho appointment of Dr. Tracey Inglis as medical superintendent ajid that of Miss Ludwig as matron, nt Auckland, the Minister stated that the Government was advised that both appointments were legal, Tho matron, he stated, was appointed by way of promotion. Prp-' viously she was sub-matron. As to tho absence of regulations, tho Minister remarked that the St. Helen's Hospitals, like other hospitals, had their printed rules which, by custom, had tho force and effect of regulations. This was not in any way a new departure, but had been tho state of affairs from the beginning. If necessary, these printed rules could bo gazetted as regulations, but hitherto they had taken tho place of regulations. One recommendation of the Commissioner is that women should be admitted to tho St. Helen's hospitals, in cases of necessity some timo before labour. This, the Minister stated, had been, in the past and still was. the practice at all the State maternity hospitals in Auckland oiid elsewhere. The Commissioner's recommendation that nurses should be provided with midwifery bags also was already provided for. These appliances were furnished at all the St. Helen's hospitals. -Asked what tho position was under tho existing regulations, regarding the admission of outside practitioners to tho St. Helen's hospitals, the Minister replied that it was not customary for a patient to call in any (Joctor she liked, but tliatf a medical superintendent would call in any brother practitioner in consultation, whose opinion lie desired to obtain.