Fatal Collapse of Child

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

Fatal Collapse of Child

TREATMENT WITH HOT BATHS Ward Sister "Knew it Was Dahgerous" HOSPITAL INQUIRY When the inquiry by Royal Commission into the management of the Napier Public Hospital was resumed this morning the sister of the Shrimpton Ward continued to give her evidence, which was not completed yesterday afternoon. In reply to Mr N. A. Foden, Crown Solicitor, witness explained that the only record kept in the record book concerning the hot-bathing of the children was merely that she had been bathed. She received in all 21 hot baths which were entered in the record as "bathed." Witness explained that very little treatment was ordered for the other doctors' patients. At this stage the commission spent some minutes perusing the ward roports relating to the treatment carried out. Mr Foden pointed out to the commission that the trend of the evidence by witness was that the doc.tors evidently had preseribed insufficicnt treatment. Continuing, witness said that one of the doctors concerned did not prescribe any treatment. Mr Foden: Your evidence casts a reflection on that doctor? Witness: I suppope it does. Continuing, wituess said that she could not say whether the doctor iu question did or did not discnss tho question privately with the house surgeon who preseribed the treatment. Jt was quite possible that any t.reatmeut that the latter gave was the resuit of consultation. with the honorary. Mr Foden: Did you discuss the hotbath treatment with the house surgeon? Witness: I mentioned it to him. You were really keeping him in the dark about the hot baths then? — "J. ' did not think that there was "anything to keep in the dark. " Continuing, witness said . she thought that the matTon and the medical superintendent were sati'sfied that she had don| all that was necessary in regard to the isolation. In regard to the gown technique, witness said that at times when it was not observ"ed the nurses were told about. it, Knew it Was Dangerous. Mr Foden: In regard to tne' hotwater treatment, did you know that it was dangerous? Witness: Yes, I knew that. Who told you? — "Dr. Berry." I think you realise that you have made some incousistent statemeTits. You said yesterday that you regarded the hot baths as ordinary baths. Now 'you say that there -was risk with ' them?-— "At the latter part I considered that there was a risk." Can you say at what date the bath temperature reaehed 120 degrees? — "1 could not say. I think it was a Bunday. " • • It was not rscorded? — "No. " That experiment was conducted by Dr. Berry and yourself? — "Yes." Were you instrueted not to record ct?— "No." Why was it not recorded?— "I regarded it as being merely an experiment..' ' I suggest that Dr. Berry conducted an experiment in taking the temperature up to 120 degrees? — "Yes." It was done to see what tho child would stand? — "Yes." Did you notify any of the parents that the children had contracted the disease? — "No " ' When the parents visited the children, did they not ask why they were in a separate room? — "I thinlc they 'saw the house surgeon." Did they ask some of your subord inates ? — ' 1 1 think • they did. " What did they say?— "They referred them to the- house surgeon.'" Report On Tatai Collapse. Mr Foden then proceedod to read a report by tlie sister regarding .tfie fatal collapse of a child. At tfie end of.an fiour in tfie batfi, the report road, the cfiild was placed in a warrn bed, her pulse being regular. Later witness- wastold that the cfiild fiad collapsed, and in spite of all restorative mcasures it expired an fiour after being removed from tfie bath. Mr Foden: How-loug after the- child was afetually taken^out of the batfi did sfie expire? — "Oue fiour." You eonlirm that account of tfie collapse of tfie cfiild? — "Yes." Bait you say wfiat tfie fiigficst teuv perature was of the bath-water during tfiat fiour? — "It was not above 112 degrees. ' ' Tbe water reactied witfiiu ono incli of her armpils? — "Yes." You gave fier a saline drink. On wliosc instructions did you do that? — • ' ' Dr. Berry 's. " . The batfi temperature was brought up from 101 to 112 degrees iu a quarter of an fiour? — "Yes. " 1 At the end of tfiat quarter of an fiour the cfiild was perspiring freely. Waxs that tlie normal conditiou from tfie hot baths? — "Yes." Tfie cfiild was then given another saline drink \ aud her faee sponged with cold water ? — ' ' Y es. ' ' Continuing, witness said that after the bath the child was wrapped in a warm blanket and taken to ber bed. Her pulse was then 150; it hnd beeu US before tlie bath. The 'cfiild 's i'aco was ilusfied and sfie was given a drink when she wanted it. Witness at tbifi slage stated that she left the ward. for a while to attend a presentation to Dr. Berry, leaving the child in the charge of a nurse to wateh her. When witness returned, the nnrvsc remarked that the child was all right After a few minutes tlie nurse came out to witness looking scared. Witness immediately went to the child and took certain stepe to rally the cliild. A • doctor was immediately sent for, and

fie arrived in a sfiort time. Artificiai respiration was resorted to, and in response to a call the medical superintendent arrived. Not a Heat Treatment. He immediately applied a treatment without avaiiL Dr. Berry was sent for and arrived in a few minutes. Witness was told by Dr. Berry to write a full report of what had happened. Witness did not know the temperature-reading after death. This was taken by Dr. Berry, who did not tell her what it was. To Mr A. E. Lawry, who appeared for Dr. Berry and also for the witness herself, witness explained that she did aot regard the low-temperature baths to 106 degrees as a heat treatment at all. One of the babies was bathed for a week at a temperature of from 110 to 112 degrees, with good results. Afterwards she gave several negative swabs. 1 • * The chairman: Did the child show any signs of blisters or ecaldsl Witness: No. To Mr Lawry witness explained in eonnection with another of the children affected that she did not receive any. special instructions and carried-on on her own account with the treatment that she had given to th® other* Continuing, witnes* explained that a further affected child suffering from a ekin trouble was bathed under, instructions from Dr. Berry. Dr. Berry's - Position. Sir James Elliott: I don't see how Dr. Berry comes into this case at all. He was not the medical man for the ward, anct the complaint on which the case was admitted was purely a medical one and not a surgical one. How did Dr. Berry come into it? Witness, in reply, explained that she was not quite sure whether the child was under Dr. Berry or under another doctor who was an honorary. Counsel then proceeded to refer to the nursmg staff of the ward, pointing out that one was inefficient. Ho was in no way, however, attacking her The chairman: But the witness did Witness explained that it was due to the nurse's. incompetence that fiho had asked the matron for additional nursing assista,nce. This nurse, however, was not relieved, and she remained in the ward until she left the hospital. . Regarding the practice of admissions witness stated . that some time after the outbreak she made a suggestion to the medical superintendent that as an •extra precaution all- patients should be swabbed before being admitted. He agreed that "it could be done, but as far as she knew no effect was given to it. . . Witness explained that she was for a mouMi without a charge nurse or extra assistance. The chairman : Did you ask for any ? Witness :No. Regarding "instruction in nursing technique, witness explained that she attended most of the meetings called by the • matron and that nothing of this nature v^as ever discussed. when she" was present Witness Bursts into Tears: In regard to .Dr. Berry's relations with • the children" in the Shrimpton Ward, witness said that Dr. Berry. was interested in them all in a friendly way. Whether they were his patients or not they used to wave to him in his car whenev.e? he passed. They all seemed to know him. "I thought that Dr. Berry always observed the etiquette of the profess.ion in regard *to other doctors' patients," she added. - Witness added that all doctors generally took notice of , the children whenever they passed through the ward. Referring again to the giving of the hot baths, witness said that when the temperature was brought up to 120 degrees the child was taken out. The only effect on the child at tbat temperature was that it hegan to whiiiLper. When referring yesterday to the period of bathing of one minute at 12C degrees she ha'd used the word in a general sense only, not thinking of 6C seconds. . . . The chairman: The term was used carelessiy. I hope that ihe nursing was not in the same category The strain of the lengthy period of t | --examination had visibly told 4.ua the witness, who finally buiv into tears. At this stage the luncheon adjournment was taken. • Reason for Baths. Regarding the temperature of the children while in the hot batbs, witness explained that she had' kept a record in a note book for her own iniormation. "1 want you to teli the commission why you took it upon yourself to give tlie children the hot-bath treatment," said Mr Lawry. " : "The children were under the honorary medical practitioner, who visited the ward upon occasions but never really preseribed treatment for them," was the auswer. "He never examined them to see if they were suffering irom tfie disease. Usually he would just walk into the ward and ask which were those patients and walk on. .1 thought wljen 1 . started the treatment tfiat it was ouly personal hygiene, and as the children seemed better and ' cleaner tor having been bathed I took it upou inyself to order the treatment." Mr Lawry' s examination of the witness was then decJared completed, and Mr C. G. E. Harker began his crosscxanunation. The witness was still in the box when tht Herald-Tribune went press this afternoon. (J'roceeding.)