OUTPATIENTS’ AID

Gisborne Herald, Volume LXVI, Issue 20052, 26 September 1939, Page 4

OUTPATIENTS’ AID

CASES OF INDIGENTS AGREEMENT WITH B.M.A. NO ROOM AT HOSPITAL BOARD MAKES CONCESSION Details of the proposal for providing out-patient treatment to indigent people, by co-operation with the British Medical Association on the basis- of a flat rate of 5s per visit, were adopted by the Cook Hospital Board at its monthly meeting yesterday afternoon. The board will meet the cost of this treatment, which will be confined to indigent out-patients, with the exception that members of the Wharerata Medical Association will be subsidised to the extent of 2s 6d per visit. At the August meeting of the board, it was decided that as the board had neither the staff nor the accommodation to deal with outpatients other than those classed as indigents, it could not undertake to give out-patient treatment to members of the Wharerata Medical Association, nor would it be possible for the board to take over the services of the nurse at Bartletts Camp, who was in the pay of the medical association.

The matter was dealt with further at yesterday’s meeting of the board, when three letters touching on outpatient treatment were read. Friendly Societies’ Requests .The Auckland District Independent Order of Oddfellows, writing in sup- ■ port of a request that out-patient treatment be given to lodge at half rates," stated that the Auckland and Waikato boards had given this privilege for some time. The secretary of the Gisborne council of Friendly Societies also wrote, asking the board for an agreement for the treatment of out-patients who were the responsibility of the lodges, and who required treatment after discharge from hospital. A further letter on the same subject was received from the Poverty Bay branch of the British Medical Association offering to undertake treatment of out-patients by agreement with the board. A report upon a conference with Dr. F. Kahlenberg, representing the' British MedicalAssociation, was submitted to the board as under: — “The British Medical Association, having- anticipated the board’s requirements, conveyed its recommen--dations through Dr. Kahlenberg in the form of a memorandum.

“The following classes of patients are at present being seen by the board's medical officers as outpatients:—(l) Indigent cases who receive dressings, massage treatment and medicines; (2) other cases recommended by the medical superintendent as requiring further treatment at hospital following their treatment as in-patients; (3) X-ray examinations; (4) examinations of persons requiring specialist treatment; (5) examination for social security purposes, i.e., classification of fitness for work, and certificates lor sickness benefits; (6) consultations with relatives of patients in hospital. Attendance on Indigents

“On the present basis approximately 1500 indigent persons per annum are seen by the board’s medical officers, and can be regarded as necessary consultations. In addition, approximately 500 per annum are other cases who cannot be regarded as wholly indigent. These patients, together with the patients who receive dressings, massage, X-ray and medicine, based on last year’s actual record, involve a total number of attendances at hospital of approximately 5000, made up as under: —To wards for dressings, including medical attendance, 1896; massage treatments, 2130; X-ray examinations of out-patients, 350; medicines supplied, 750; total attendances, 5126. “These figures indicate that the demands for consultations by our medical staff call for some special arrangements to deal with the problem. The board is already in agreement that it has neither the staff nor adequate facilities for providing an extensive out-patients’ service. To provide suitable facilities at the hospital, the board would be faced with considerable capital expenditure, and further medical staffing, which at present cannot be advocated.

Practitioners’ Offer Approved "We arc of opinion that the needs of the district can and should be met by entering into agreement with local practitioners to attend those out-patients who are deemed to be the responsibility of the board. We therefore recomment that: — *• ti) The 1500 patients referred to be in future attended by local practitioners.

"(2) Such patients shall require first to make application to Die board for treatment and furnish satisfactory evidence to the board’s authorising officers, following which authority for treatment will be authorised if the applicant shows that he or she is a responsibility of the board, “(3) The patient shall have the right to nominate the medical practitioner of .:is or her choice.

"(4) The present arrangement with local chemists to supply medicines to be extended to cover out-patients seen by practitioners under the above authority.

"(5) The scheme should operate as from October 1. and subject to the provisions and benefits under the Social Security Act: shall continue in force for a period of 12 months. “We are of opinion that the fee of 5s indicated bv the British Medical Association is a reasonable charge and we would recommend that the board accept this as a flat rate for h 1 i cases referred. Board Reserves Rights “For 1503 consultations, therefore, lie probable cost would be in the vicinity of £575. plus the cost of c edicir.cs. which woiud be greater .ban the present cost to the board by supplying from our own dispensary. The actuil cost of medicines is a ligure difficult to determine at present. “This service should be available to the indigent only, and the decision of the board through its appointed officers should be final ns regards the ’•ight to supply or receive any attention or treatment. A definite procedure with approved notification and -eport forms should be instituted and ill members of the medical profession fully acquainted with the conditions upon which the board agrees to provide and pay for such a service. Notices indicating the conditions of •his service should be displayed in “uitable places for the information of ‘he public, and in the rooms of each medical practitioner a copy of this notice should be displayed. “We discussed with Dr. Kohlenberg the question of including in this service treatment of members of the •’Mrrerata Medical Association, and have asked that the association agree ‘n include any case? referred to them through the district nurse at Bartletts. or in the case of their members or dependents resident in town who produce satisfactory evidence, to treat them on the same basis as our indigent cases. Patients' Choice of Doctors “We have the authority of Dr. Kahlenberg to state that .the British Medical Association is agreeable to this, subject to the rights of patients so referred, to have free choice of their doctor. “We lecommcnd further that dressings required by ex-patients should continue to be done in' the wards at the hospital in the meantime. At this stage we consider that the service required of practitioners should coyer consultations only and such attention as can be carried out in their surgery. The question of arranging for dressings, etc., to be carried out in town could be further considered at a later dale if necessary. Massage treatments and X-ray of out-patients o; course, will -equire io be continued in hospital. Wharerata Association Members With regard to the members.Of the Wharerata Medical Association, the committee recommended: — “That the board should include in its arrangements for an out-pati-ents service with the British Medical Association, provision lor the attendance upon Wharerata cases at the same fee as for indigent cases. Tne board would collect from the Wharerata Medical Association 2s 0d for each case, attended, and therefore would subsidise to the extort of 2: 0d in each case. The operation of these benefits will require very definite authority from the association for rights to treatment, and this in all those cases from the Wharerata area should come through the district nurse. In the case of the residents in town, the association is to provide some satisfactory authority where these dependents require attention.

“The medical superintendent is agreeable to advise the district nurse in such cases as it may be necessary. Where, however, the case is being sent to a private practitioner, she will, of course communicate direct with the practitioner concerned,’’ the report concluded. “Any case referred by the district nurse at Bartletts as an urgent case, whether accident or sickness, should be admitted to hospital without the necessity of having jo be .further referred to a doctor in town.

In respect of the letters affecting the out-patient treatment of lodge members, it was decided to give a reduction of 50 per cent in the fees for people continuing as out-patient' after having undergone treatment as in-patients. The chairman, Mr. M. T. TrafTord. and executive officers were recommended to examine the possibility of providing for the attendance oi the welfare officer in town at stated times to meet applicants for indigent out-patient authorities.