HOSPITAL AND CHARITABLE AID BOARD.

Globe, Volume XXII, Issue 2132, 23 December 1880, Page 3

HOSPITAL AND CHARITABLE AID BOARD.

I A speoial meeting of this Board was held '■ Wednesday afternoon, at 4 o'clocl. Preset t —Mr Thomoon (chairman), the Mayors of Ohristohuroh, Lyfctelton and Sydenham, Dr. Turnbull, Mr Hawkes and Mr Montgomery. The meeting was called for the purpose of considering the report of the Royal Commissioner on the late Hospital Enquiry. In reference to the presence of Mr Gapes at the Board, a communication was read from Mr G. S. Cooper, intimating that, as the Mayor of Ohristohuroh was a member of the Board by virtue of his office, his appointment did not reauire to be gazetted, the chairman explaining that the information was furnished in reply to a telegram sent to the Government by order of the Board. AN EXPLANATION.

The Chairman said an explanation was due from him in relation to a special meeting held on the 14 th instant, when the medioal staff were appointed. Ho found it to be tho more necessary, because no allusion appeared on the minutes a» to why that meeting was held, and a statement had been made to the effect that ex-Mayor Ick, who was a member of the Board, had somothing to do with calling the meeting in question, in order that he might record his vote on a certain matter in which he was interested. As a matter of fact, the meeting wM called on that day by general consent, sad for the convenience of all parties, but esppoially to meet the case of Mr Montgomery, who was going to Akaroa on the following day, Wednesday, and could not then attend ; and the meeting of Tuesday wag held s half-hour earlier than the usual time, also to convenience Mr Montgomery. The faot of the Board having decided to hold a special meeting should have been recorded on the minutes, but it had been overlooked. Mr March, tho secretary, distinctly remembered that a note of the decision appeared in his rough minutes, and he must have overlooked it in entering them up. Mr Montgomery could testify that the day and hour for the meeting was arranged in open Board. Mr Allwrigbt's recollection of the circumstances was similar in effect, the matter having been decided on by general consent at a previous Board meeting. The Chairman said he had mentioned the matter in justice to an absent colleague, who had as much to do with the matter as the man in the moon. The question of holding tho special meeting arose with him (the chairman), whose object was to relieve a pressure of business.

The matter was then allowed to drop, THE liATB HOSPITAL ENQUIRY.

The Chairman informed the Board that the object of the present meeting was to take into consideration Dr. Skae'a report on the Hospital Enquiry. He might say that a reply to the report had been received from the medical staff, and he thought it was only fair to those gentlemen that their letter should be read. The letter was then read, as follows : Christchurch, 22nd Dec., 1830. The Chairman of the Hospital and Charitable Aid Board. Sir,—We have the honor to acknowledge Dr. Skae'a report on the alleged _ cases of typhoid fever at the Christchurch Hospital. In questioning the decision of a Court of Enquiry, we are aware that we place ourselves in an invidious position, inasmuch as this present subject of enquiry is to a very great degree one of opinion, guided by technical experience. And if we differ from Dr. Skae in his conclusions, we wish to express our views with all respect towards Dr. Skae in the irksome duty he has been called on to perform. We submit that we are justified in stating our opinion that the decision is contrary to the weight of evidence; when we point out that the physicians and house surgeon who had charge of the cases in question, in their diagnosis and the conclusion they came to, as to the character and nomenclature of the diseases were supported by such eminent authorities as Mnrchiaon, Bristowe, Tanner, Hooper, Guy and Harley, as also by the best writers in the Sydenham Society's publications, the most recent and valuable works extant and authoritative, not only in England, but also on the Continent and America; while as opposing evidence the health officer could only quote an authority on medical jurisprudence or criminal law (Taylor), and a work on_ hygiene, with hearsay and lay evidence and discharged nightnurses, who admitted that they were liable _" to confuse one case with another," and professional evidence in one case only, after a very cursory and hurried examination at the early stage of the disease.

We also feel compelled to draw your particular attention to the entire absence of professional or scientific evidence in favor of the existence of typhoid fever in all the other cases mentioned in the report. We might also urge another point, that on a question less important to our professional reputations, we might ignore, and which, under present circumstance?, we feel considerable diffidence and delicacy in touching. In selfdefence, however, we think it only fair to represent that the physicians whose opinions have been questioned are men of large and varied experience, and whose lengthened practice has been calculated to foßter that intimate recognition of symptoms, the nicety of judgment, and what we may term intuitive in diagnosis which constant and unremitting practice, study, and observation oan alone give. On the other hand, while doing justice to the ability and theoretical knowledge Dr. Skae may possess, the fact remains that they have been conned to the practice and study of one description of disease —lunacy. We refrain from further comment, but without disrespect must beg to retain what we consider a more mature and experienced opinion than that expressed in Dr. Skae's report, which, in our opinion, is based on inference and not facts, as adduced at the inquiry. Upon these grounds we feel bound to enter our respectful protest _ against Dr. Skae's conclusions as not being in accordance with the weight of evidence.

In conclusion we wonld express onr concurrence with the Commissioner a 3 to the desirableness of keeping case books, pathological records, and of making post-mortem examinations in obscure cases, when leave can be obtained from the friends or relatives of the deceased.

I have, &c, H. H. Pkins, Chairman Hospital Staff. The Chairman intimated that the report by Dr. Bkae was now before them, oopies thereof being handed ronnd to members. Mr Brown naked what position the Board occupied in reference to the report. Seeing that they were a lay body, they could soarcely presume to criticise the opinions expressed in it. They had expressed their thorough willingness to have the Hospital difficulty investigated, and the Government being requested to do so, did appoint a Commission to inquire into the charges brought against the medical staff. The decision of the Commission had now been handed in, was before them, in fact, and he did not consider it became them as a Board, under all the circumstances, to question that decision. The proper course for them, he supposed, was to receive it. Mr Allwright—We received this report from the Government, and I think the best course would ba to send the letter of the medical staff in answer to it. Mr Brown did not aoa how they could recognise that letter in such a way. If there was any battle to be fought between the medical gentlemen they ought to fight it out themselves. Mr Hawkes —Hear, hear. Mr Brown—l do not think we can go behind this report. We encouraged the enquiry in every possible way, and now that the Commissioner's decision is given, our staff do not appear to go with him. I want to know what we can possibly have to do with a document like this (meaning the staff's reply). Dr Turnbull —One of Mr Brown's remarks appears to be vague. I wish to say Ido not know anything about a doctors' fight. [Laughter.] The medical staff cannot whip the air. He knew that the Board of Health and the Hospital Board were concerned in a difference as to a professional question ; but he knew of no medical men who were opposed to the medical staff of the Hospital, nor could he see anything before them indicative thereof. [Renewed laughter.] He would repeat what ho had said—that no medical men were engaged in this dispute except the staff. He would point out that they could only take what they had before them. They had the Hospital Board and then the staff on one hand, and the Board of Health on the other. What other medical men, he asked, were concerned or implicated in the matter. No reoord of any kind appeared as to a dispute between two sets of medical men. [Laughter, and "Oh!"] Mr Allwright—Do I understand from Dr. Turnbull that this Board is supposed to fight the Board of Health ? Dr. Turnbull—Yes. Mr Allwright—Then all I cau say is, I should certainly object to fight a Board the members of which hod been asked to resign as no longer possessing the confidence of their constituents. I Mr Brown —It seems to me, Mr Chairman, that all we have to do is to accept the Commil sioner'a report.

Mr Hawkes suggested that the report should be simply acknowledged. Mr Allwright maintained that the Board should support their staff, and aoeept their letter as an answer to the report of Dr. Skae.

The Chairman—l have no hesitation in saying that in my opinion the whole of the present difficulty arose out of a dispute between the doctors, and that but for them the late enquiry would never have taken plaee._ Mr Allwright endorsed the ohairman's opinion. After some further remarks, in which allusion was made to remarks passed outside upon the Hospital, Mr Montgomery said he did not think it advisable to take the opinion of the man in the street. They now had before them the report of -Dr. Skae, who was appointed by the Government to enquire into .certain allegations that false certificates had been issued from the Hospital, and the report sustained the allegations so made, besides making certain recommendations as to the manner in which the Hospital books should be kept for the future, with a view to ensure better management of the institution. He thought they should acknowledge receipt of the report and state that the recommendations of Dr. Skae with regard to the keeping of books and the making of entries would be duly attended to. Mr Hawkes pointed out that the committee met on Monday morning last, and gave Mr Marsh instructions for carrying into effect the recommendations contained in the Commissioner's report. Mr Montgomery would simply acknowledge the report, with the assurance that the instructions embodied in it would be carried into effect. He did not see any necessity for going further than that. Mr Hawkes suggested that in any acknowledgment sent by this Board to the Government, special attention should be drawn to tho fact that immediately it was discovered an omission in reporting had taken place previous to the inquiry being held, this Board laid down certain hard and fast regulations for the guidance of the house surgeon. He thought it desirable the Government should know that on a complaint being made by the Looal Board of Health, the Hospital Board at once took the strongest possible means to effect an amendment in the regulations. Mr Allwright submitted that the letter of the staff should accompany any acknowledgment of the report as an answer to it. The Chairman—l do not think it advisable to mix the two documents together. Mr Allwright—l certainly think we must accept the letter of the staff as an answer to the report. Mr Brown contended they had no right to question the report in the slightest. Mr Montgomery deprecated any attempt to go behind the decision of the Oommis sioner.

Mr Brown—■We must not forget that we asked for the enquiry, and should abide by the result.

Mr Allwright denied that this Board had solicited an investigation. Mr Hawkes—The question never arose with us until the Board of Health took action in the matter.

Mr Brown—But we facilitated it as much as possible, you will allow. Mr Hawkes—That is entirely another matter, and does not render us responsible for it.

Mr Allwright asked Mr Thomson how the question of an enquiry arose. The Chairman replied that this Board had no hand in the matter originally. He wonld state how the enquiry oame about. Letters passed between the Board of Health and themselves in relation to an enquiry, and to the first of these this Board replied that they could not see their way to acquiesce in the proposal. Then another letter came from the Looal Board of Health on the subject, and a resolution was "passed, to the effect thai if the Government granted an enquiry this Board would offer no obstruction, but would give every faoility to forward the same. Mr Gapes—Then the Board did consent and agree to the enquiry. The Chairman—l have already said that we at first dissented and then said we would offer every facility in the event of one being held.

Mr Montgomery moved—" That the chairman acknowledge receipt of the letter from the Colonial Seoretary, dated the 11th September, enolosing copy of the report of Dr. Skae, the commissioner ' appointed to inquire into the allegations made that the deaths of certain patients in the Christohurch Hospital, certified to have occurred from other diseases, really eoourred from typhoid fever,' and to state that the Board will give strict instructions to the house surgeon to carry out the recommendations contained in Dr. Skae's report." In moving this resolution he again urged that they ought not to discuss the merits of the report. The idea was absurd. They might just as well argue a question of law, and a great deal better.

Mr Brown seconded the motion. The Board had no title to enter into the question whether or not Dr. Skae's was a correct decision.

Mr Hawkes complained that the resolution appeared to tread on the toes of the committee. The Hospital committee had always been empowered to give instructions in suoh cases, and they had done so here. This, he thought, ought to be stated. Dr. Turnbull said they could not inform the Government of a fact of which they had no knowledge. As a Board they not even considered the matter, and they could not therefore go to the Government and report officially on a matter that had not come before them.

Mr Montgomery pointed out that the effeot of his resolution would be to bind the Board to carry out the instructions contained in the report. The Chairman laid he could meet Mr Hawkes' wishes by stating in his letter to the Government that Dr. Sine's directions had in part been given effect to already. Mr Hawkes' object was to show that there never had been the slightest attempt or inclination on the part of this Board to obstruct any effort in the direction of amendment. Mr Montgomery—l do not know that any allegations had been made against the Board to that effect. Mr Hawkes hinted at the man in the street. Mr Montgomery —You should take no notice of anything in that way. Mr Hawkes —But the man in tho street, as the saying is, has a good deal to say about it, nevertheless. After some further discussion it was agreed that the chairman should give effeot to the suggestion made by Mr Hawkes when writing to the Government. Dr. Turnbull then addressed himself to the resolution. They had received a letter from the Hospital staff in reply to tho report of Dr. Skae, the Commissioner appointed by Government to conduct the reoent inquiry, and one very important section of that letter impugned in a very marked manner, Dr. Skae'sability to givo a decision upon tho question of typhoid fever. Now, what he wished to say on that point ought to bßar considerable weight in considering the matter. The question of asking for a commission of enquiry was agitated for a considerable period previousto|its actual appointment. The knowledge that Dr Skae was to be appointed commissioner arrived in Ohriatohuroh a considerable time before he himself appeared; and the staff knew as well at that time as they knew now the particular tbranoh of his profession, which Dr. Skae made his specialty, and how far his experience as a medioal man extended. They not only accepted Dr. Skae as arbiter, or commissioner, to decide upon tho question at issue, but at the termination of a long enquiry, over which that gentleman presided in his judioial position, they thanked Dr. Skae for the impartial and able manner manner in which he had conducted that enquiry. They would find by reference to tho papers of that date, that Drs. Ned will and Prins both complimented the Commissioner on his impartiality and ability in the oonduot of the enquiry. So that if they had any donbt about Dr. Bka3 at all, their knowledge of him then was equal to their knowledge of him now. It was not, therefore, well for them now to dispute the Commissioner's decision, which they would no doubt have aooepted with pleasure had it been in favor of the staff and the house surgeon, instead of being favorable to the medical officer of the Board of Health. He muet at once take exception to this report in volving considerations of a professional or medical oharacter at all— so far as this Board was ooncerned. The question involved in the report was purely one of honesty of opinion, whioh any layman, equally with a i doctor, could decide. He appealed to them to . say whether it required a medioal man to de- ' cide whether a man had done right or wrong lin reporting to the Registrar that three patients had died of a disease whioh, according to tho Commissioner's report, never existod in those cases; when their death really

occurred through another disease, having an important and vital influence upon the health of this community. Did it require a medical man to say whether that was right or wrong ? Certainly not, he should say. Therefore, to put it down to a dispute among the professional men was not by any means fair. He contended that this Board was perfectly competent to determine whether the staff who Kavo those certificates acted honestly or not. He did nut consider it competent for them to say whether Dr. Skae's deoision was truthful or otherwise ; what he said was that whoever gave those certificates aoted wrongly, and vitiated the vital statistics. The effect was not confined to three certificates thus erroneously given, but was calculated to induce a complete want of faith in the vital statistics of the colony, and thereby frustrate, to some extent, the efforts being made towards the improvement of health and the annihilation of sickness. That was what they had done.

The Chairman called the speaker to order, and pointed out that the 'Board had decided not to diaoues the merits of the report from the point of view to which he was addressing himself.

Dr. Turnbull submitted that he was in ordor, only referring to so much of the staff's letter as was necessary to illustrate his remarks on the resolution.

Tho Chairman thought to the oontrary. He was not sorry, however, that Dr. Turnbull had opened the question, as he should take an opportunity of saying something therein himself.

Dr. Turnbull proceeded in the same strain, and asked how that Board could reconcile it with their duty to elect tho staff who had been the cause of this inquiry ; who had put the people to all the attendant expense; who had vitiated these statistics; who had, in fact, done everything to bring about this inquiry.

The Chairman again called Dr. Turnbull to order. He should like to know what amendment, if any, he intended to propose. Dr. Turnbull said he was speaking to the resolution.

The Chairman remarked that he was going very wide of the mark, besides touching on ground which the Board had generally consented to avoid. Dr. Turnbull said be would bow to the ruling of the Chairman, and could only refram from saying any more, whilst protesting against being prevented from exercising his privileges as a member of the Board. The Chairman said that was taking an extreme view of the matter. He had already allowed Dr. Turnbull considerable latitude, and should not have interrupted when he did had he not perceived unmistakeable signs that other members of the Soard considered him out of order. Dr. Turnbull then resumed his seat. Mr Brown supported tho resolution, simply because he considered they had no right to question the correctness of the report. He did not know what the different points were referred to by Dr. Turnbull; and thought it would be well for that gentleman to put them clearly before the Board. One thing was clear, that the Board had got into a mess. Mr Allwrighb denied the last statement. Mr Brown said ho foresaw the faot at the special meeting, but was in a minority. He did not, however, wish to make undue reference to that. Mr Hawkes—Such remarks as had fallen from Dr. Turnbull would compel the Board to consider whether Dr. Skae's report was right or wrong, seeing that it affected their staff. If Dr. Turnbull wished to move a vote of want of confidence in the staff or the house surgeon, let him do it afterwards boldly, and not attempt to effect his purpose by a side wind.

Dr. Turnbull said he had no such intention. His idea was to move a want of confidence in the Hospital Board. The Chairman said that could scarcely be taken in connection with a resolution of the kind before the meeting. The resolntion moved by Mr Montgomery was then put and carried.

A discussion then arose on the motion of Mr Allwright, that a copy of the staff's letter be forwarded to the Government; an objootion being taken on the ground that the report was final and required no answer, and that the Board would be departing f'.'om its province in sending a letter commenting on it to the Government without being requested to do so by the writers. A good deal of talk ensued.

It was was ultimately resolved on the motion of Mr Hawkes—" That the chairman be authorised to forward to the Government tho letter from the medical staff, should it be their desire that such should be done."

With regard to the appointment of a medical man to fill the vacancy on the staff caused by the resignation of Dr. Anderson, the Board resolved to invite fresh applications from those willing to accept the office. The Board then adjourned.