Napier Hospital Inquiry

Hawke's Bay Herald-Tribune, Issue 127, 15 June 1937, Page 6

Napier Hospital Inquiry

DISEASE OUTBREAK Sister Alleges Lack of Consultation HOT-BATH TEMPERATURE Statements that for several weeks «ii« had liad to carry on without extra nursing assistance and without any consultation from the matron or tbe medical superinten- " dent following an outbreak of infectious dfssaso in the ward wero jnade yesterday by tlie sister of Bhrimpton Ward before the Royal Commission investigating the management and administration of the Napier Public Hospital. Very little instruction or guidance dealing with tnfection was available. she said. A good deal of questioning centred npon the hot-bath treatment, and witness .said that baths of up to 120 degrees were given. Tempera-ture-sheets were stated to have "been destroyed hy the children who were patients. ■ The eommission, after inspecting the hospital yesterday morning, began the leariiig of evidence. The evidence heard yesterday afternoon concerned the outbreak of v.ulvo-vaginitis in the Bhrimpton "Ward. The public were exelnded from the sitting. Mr iif. A. Foden, Crown Solicitor, xepresented the Director-General of Health and conducted the proceedings. • The eommission consists of Mr E. D. Mosley, S.M., of Wellington, who is preiiding; Sir James Elliott, K.B., M.D., of Wellington; and Miss Cecilia McKenny, formerly matron of the Wanganui Hospital. The first witness called wa* Edward Thomas Rees, managin^ secretary oi jfche Hawke's Bay Hospital Board, who ■ubmitted formal returns * of children in the Shrimpton Ward. The examination of swabs submibled to hin> last year was described by Norjnan Joseph Ellison, -bacteriologist at the Napier Hospital. To Mr A. E. Lawry, who appeared on behalf of the sister oi Shrimp.on Ward and Dr. Berry, witness said that he did not know that the children in question were receiving bathing treatment. He had no knowledge officially of aay medical treatment being given. In reply to a question by Mr Lawry as to whether he had discussed the matter with the sister of the ward, witness gave a negative answer. Method of Taking Swabs. Mr M. R. Grant (for the Hawke's Bay Hospital Board) : Are you 6atished that the method of taking and aending ihe swabs to you was as near fool-proof as possible. Witness: It is the usual method wdopted in hospitals. In reply to a question regarding the technique shown by the nurses in the taking of the 6wabs, witness said that when he xeceived them they appeared to have been taken well enough, alfchoagh he had not actually seen them taken. On examination' of* the Bwab witness maac a report, and he •uggested that it should be 6igned by a house surgeon instead of being left blank. Mr Foden: Was the bacteriolognal finding substantially the same in. all cases? Witness: Yes. •Replying to a further question, witness explained that it was encumhent upqn.a medical man to determine the nature of the disease. At tliis stage foi'mai evidence was given by parents stating that their children, before admission to hospital, were in no way sulfering from vulvovoginitis. Evidence was given by & sister of Shrimpton Ward, who explained that the pursing staff was always on the Jook-out for disease but that swabs were not taken. All patients were admitted by medical men through the outpatients' depavtment. Reliance was placed entirely on the admission note. Witness had no idea of the practice carried out by the medical men in making their examinations before the admission of patients. Atter admission the only two chances of detection of disease were by the doctors' examination, and the sponging of the patieut by a nurse. Witness had not heard oi any suggestion that vulvo-voginitis was hovering about the hospital. She was the actual discoverer of the disease by finding a very noticeable discharge on one of the patients. From tfie stage it had reaehed when she first «aw it *he thought that reasonable observation wouid have detected it sooner if it had existed. Owing to the nature of another trouble which the child had had, detection wras made easier. " "Sudden Onset" of Di aouSCi In reply to the chairman, witness •aid she regarded the disease as beiug a sudden onset. Witness was not certain whether she inrormed the matron -- that morning or not, but she knew eoout it within 24 hours. The houorary doctor knew of it within 12 hours, and the medical superintendent within 24 hours. The house surgeon was lTotifiec] within a i'ew hours. To cuui.bat Ihe disease a swab was taken and sent to the laboratory, tht resuit being shown to ber at 6 p.m. nine hours after her visual diseovery The child was removed to a side-rooir on its own, and all precautions wert taken according to practice with inl'oc tious oiteases. No instructions weri reccived from either the matron or tb medical superintendent in amplifioa tion of the precautions that should b( taken. N» detail was asked of the pre eautions that were being taken. Wit seia cqnsidered that mucli o£ ihe re*

ponsibility was on her shouiders to* prevent the spread of the disease. It was her responsibility to adopt the "infectious'' technique of necessary precautions. Since 1934 witness had nursed two individual cases in the Shrimpton Ward of vulvo-voginitis, there being an interval of some months betweeii them. It was a likely suggestion that the disease was admitted to the hospital while she was away on her holiday. The standard of diligence of the nurses at the timo was of a good average order. Witness thought the nurses 6hould have noticed the disease if it was there. She could advance two theorie3 for its sudden outbreak, one being that a child was admitted in whom the disease had not been discovered. Mr Foden was attempting to isubmit a further question when the chairman pointed out that a nurse might be well up dn nursing technique and able to carry out nursing duties splendidly but would not be able to answer questions which were purely for the medical men. Purpose of Question. Mr Foden: Nurses handliug cases day after day would be able to notice externai signs. I want to see if tho witness was alive to the iact that these things origmated somewhere and if shc was on her guard against them. The chairman: The evidence we have shows that she was not on her guard co the extent that she might have Deen. What I wanted to find' out was who gave the instructions regarding isolation and what form it took. 1 do not look upon the side-room as isolation at all, To Mr Foden wutness explained that the patient was removed to a room and not to the ward, servery. Tliis was done on her own initiative. The secoud case was put in the same room. All the rest of the patients in the ward were females, and it transpired that others were affected. The four patients were in two separate rooms. There was no extra nursing stalf put on. The nurse attending these patients did nursing also in the main ward. This nurse was instrueted in the precautions she was to take. To the chairman, witness explained that this nurse was a trainee with a year or more of experience. To Mr Foden witness said she recognised that there was a risk, and a few weeks afterwards a special nurse was asked for. She was worried about it from the start. Regarding the delay in obtaining the extra nurse, she thought it was not her duty to ask but that one should have been given. Sir Jaines Elliott said it appeared to him that the nurse had been allowed to go on for some weeks without any consultation from the matrcm, the medical superintendent or the honorary doctor. She had been left hhaided. To Mr Foden, witness explained that the had reason to believe that one nurse was not as reliable as she might have been. She was incompetent, and .this was pointed out to the matron when a special nurse was asked for. The Matron' s Attitude. The matron appeared to regard it as an unreasonable request, stating that one nurse would not have enough to do in looking after four patients only. The request did not meet with suceess, o,nd the position continued unchanged for a further fortnight. The matron knew what was being done. To the .chairman, wiitness said she considered that, the responsibility of the precautions carried out was hers as l'ar as the application of the nursing technique was concerned. Witness did not consider that the matron was absolved from the responsibility -tof consultation and supervision of the nursing. To Mr Foden, witness explained' that the matron called some of the 6isters up about three months afterwards to discuss the sterilisation of the linen. The matron' did nothing more than to make her usual rounds of the wards. Witness said that the nursing technique carried out was her own, not having been set by the matron. The spread of the disease could have been caused by the laundry. Until the disease was discovered the laundry of the affected patients was not treated separately. Up co the time of the infection the children were all sponged in bed. The taking ot temperatures before the diseovery of tho disease had been by means of a common thermometer. The method adopted of taking the temperatures was a possible sourco of the spread of the discaso, To Sir James Elliott, witness explained that no warning was given as to the method of taking the temperatures until after the second infection. To Mr Foden, witness explained that the method had been customary iin the ward ever since she had entered tlie hospital. She thought that the matron, the medical superint.endent and the honorary doctor were aware of the use of this method. There was nothing in the ward instruction book dealing with infection. Little Guidance in Wards, Mr Foden: There secms to be very ilttle for guidance aud instructions in tho ward? Witness: Tliut is so. Witness added tbat she kcpt lic uursiug technique up-to-dato. The chairmau asked if auy steps were taken iu the Napier Hospital to ascer tain if the siste'rs were conversaiit with ; uursiug technique aud kept up-to-date ! Wituess explaiued that the matron ' did not question the sistors except 1 when on her daily rounds. The chairman: JJid shc take you 'iuto ' her room and put nursing technique | adopted in modern hospitals befom : you? ' Witness: She discussed intarnal problems of the hospital but not matters i on the professional side. The chairman: How luug did thesn . monthly meetings that the matron . called last? i Wituess: About half au hour. i. What was discussed a't lliose meet- ■ ings? — "Anytliing that happencd duv- * ing the month." ; Were expressions of opinion invited? - -r-"If any of the sisters had anything s to say thoy said at." - , The next phase touched upon was tlie - question of the hot-bath treatment. -I To. Mr Foden, witness said .that aho

had received instructions on a scrap of paper giving the temperatures of the bath and that the period was for one hour. The note was unsigned. - The temperature was shown at which the bath was to begin and the maximum to which dt was to be brought. No instruction was given as to what was to be done with the child after it was taken out of the bath. The plaster treatment on the child affected with hip trouble was suspended for a few days, but not for the purpose of the hot-bathing. Nurse in Attendanco. During the hour for wluch tho child was in tne hot bath, a nurse remaaned with it. The temperature of the bathwater began at xOO degrees and was Drought up to 106.8. Tne instructions were that the bathing was to De done uaily. Witness was told -verbally by che doctor- in ■ charge of the child that after eight days of the bathing there would be no further discharge. ^vt that time no aim was made to raise 'the chald's temperature. Witness was not present when the child' practically collapsed in the bath. i'rom the appearance of the child and its colour witness thought that the nurse had become unduly alarmed. The matter was reported to i)r. Berry a few minutes afterwards. He said that the child was all right. This treatment' was preseribed for one child only, witness added. Tlie treatment, however, was given to other children for whom it .was not preseribed. It was not done under Dr. Berry 's instructions. Dr. Berry, who gave the treatment for the first child, had not mentioned giving it to the other children. He did not know for a week afterwards that they were receiving it, and when he knew he was very surprused. * To Mr Foden, witness explained that the doctor in charge of ' the other children had not preseribed any treatment, although he was aware of their condition. He was not informed of the hot-water batlis beihg given to his patients. There did not appear to be anything very special about it. The chairman reminded witness that the children in the ward were only receiving a sponging. Not Abnormally Hot. - * . To Mr Foden, witness could not say whether Dr. Berry regarded the hot bath as a special treatment but one simply for his patient. The bath was not an abnormally hot water bath, being an ordiinary daily hot-water bath. Witness said she had seen Dr. Berry, and she admitted having discussed tho evidence With him. She could not remember having discussed specially the hot-bath treatment with hlm. The doctor attending the other affected patients did not visit the hospital .daily, 6he added. He was informed of what happened soon after the results of the swabs "were known. He gave no remedial instructions to check the v.ulvo-vaginitis. The temperature of the bath was later increased beyond 106.8 degrees. For ono minute only the maximum temperature was 120 degrees. The chairman: Who had the watch on ? Witness: Nobody. Mr Foden: You estimated the time, then? Witness: , Yes. Questioned regarding the bath temperatures, witness said that verbal instructions wero given ior them to be to 110 degrees. On occasions baths were given to 112 degrees. On one oceasion it reaehed to 116 degrees, which was due to lack of attention by the nurse, who expressed regret when reproved. Tho nurse remaaned in constant attention while the child wais in the bath. Fatal Collapse. The child having a cold, bathing was suspended for 14 days. On the second bath after resumption, the child had a fatal collapse. The temperature on these two days Was from 110 to 112 degrees. Continuing, witness explained that some of the clinical charts for one child were missmg. This was due to the child pulling them off her locker and tearing them up. Among them was her history sheet which was subsequently rewritten from inemory. Other children in the ward at times pulled down their charts and tore them. Witness did not know that the missing temperaturo-sheets were of special importanee, Mr Foden: Was the day when the temperature of the- bath was 120 degrees recordod? Witness: No. That informatlon would never have come to light if inquiries had not been since made^ — "It would have been if asked for." Don't you thijak that you were remiss in not making a record of that temperature? — "Yes. I was." Mr Foden: And the doctor? " The chairman: The doctor can answer for his own sins. At this stage tho proceedings wero adjourned.