Contents of Death Certificate

Hawke's Bay Herald-Tribune, Issue 129, 17 June 1937, Page 6

Contents of Death Certificate

NOT ALL THE CAUSES STATED Coroner Inadvertently Misled, Admits Dr. Foley CHILD'S FATAL COLLAPSE The sole witness to give evidence at this moming's session of the Royal Commission investigating the affairs of the Napier Public Hospital was the medical superintendent, Dr. J. J. Foley. He admitted that the coroner and the Magistrate had been inadvertently misled regarding the true facts of the death of the child patient in Shrimpton Ward in that they were given the impression that the child died from heart failure. It was also admitted that the death certificate issued did not set out all the contributory causes of death, which might have been aggravated by hyperpyrexia (high fever) and not heart failure, as indicated in the certificate. Dr. Foley said that at the time he was not aware of the true state of affairs in connection with the hot-bath treatment of the children. Eesuming his evidence. Dr. J. J. ■Foley, mCdical superintendent at the Napier Public Hospital, in replying to Mr. N. A. Foden, Crown Solicitor, said that the Tesponsibility for seeing that the nursing technique was properly carried out fell first on the sister in eharge, then on the matron dn the course of her routine supervision, and finally upon himself as the senior officer. There was no particular "timo set apart to discuss matters by the matron and himself, though they saw each other several times a day. Mr, Foden: Now, regarding the pre.eautionary measures. Do you regard the swabbing precautions a satisfactory safeguard? Witness: Yes, I think eo. Did1 you tell one parent that the child was suffering from effects of the medicine? — "Well, not exaetly that. 1 felt that there was undue alarm on the part of the parent and I tried to ' cushion ' the whole thing. ' ' Did you mention anything of the clis ease • to the children?^ — "I admit I wasn't fair to the parents by trying to '-cushion' the affair." Did you deliberately keep them Jn the dark? — "No; they knew from another doctor at the hospital that #tho child had vaginitis." Policy of Non-Disclosure-Your policy was one of non-disclosure then? — "That ie so. I did it more iD

the interest of the hospital and the little children themselves." Witness added that he had told the sister and charge nurse to refer parents to him. He could not recall telling one parent that it was "all rot," but he might have done so. He agreed that the evidence of the parents indicated that they had not been informed until same time later of the disease and that the parents might be rather aggrieved. To a further question he said he did not know that the child was having hot-bath treatment just before it collapsed. He thought it had had a warm bath. Were you upset by the death o£ the child?— "I was." Why? — "It seemed to .be another blow to me." In what way? — "The sister had said that this was the first bath after the child had had a cold, and I thought it might have been put in too quickly after the cold." Questioned regarding the post-mortem examination, witness said that he did not ask the coroner. Mr. A. E. Bedford, for authority to conduct the postmortem. He must have been aware that there was to be a post-mortem, because on the morning at was carried out he went to the post-mortem room and there found Dr. Berry about a third-way through the examination. Mr. Foden: Did you ask for the coroner 's consent to the post-mortem? Witness: No. * Did yop ask Dr. Berry if he had?— "No, I suppose I assumed he had." Conversations With Coroner. Questioned regarding the postmortem and his conversation with tho coroner, witness said he did not say to Mr. Bedford that the child had died from the effects of a hot bath taken during a special treatment.' The chairman: Did you leave the impression in the coroner 's mind that the child had died of heart failure? Witness: That is probably so, Did you tell the coroner that the child was having its first bath after a few days? — "I probably did." Mr. Foden: Do you suggest that the coroner let it go at that? Witness: No; Mr. Bedford did mention that he would see the Magistrate. What was tie result? — "Later Mr. Bedford said that if I was sure the child had not died from the disease, then he did not want an dpquest." The chairman 'said that the position appeared to be that the doctor conveyed the impression that it was a simple case of heart failure to the coroner, so it was only natural that the coroner would convey that idea to the learned Magistrate. Under those circumstances the Magistrate would merely say he did not thdnk an inquest was necessary. Mr. Foley: That is probably the position. Mr. Foden: Seems that we will be required* to call Mr. Bedford. The chairman' I'm afraid we will have to call him. The Death Certificate. * Questioned regarding the death certificate, he agreed that on the original there was a note to ihe effect that a post-mortem had been held, but dn the copy submitted to him by counsel this was not signified. Mr. Foden: Do you now regard that chjld 's certificate as a. good death certificate? Witness: No, not if there was hyperpyrexia.

Then this method of the medical superintendent % giving the certificate automatically is wrong? — "It has beeU proved so." Diff not Dr. Berry show some interest in the death certificate to be issued? — "He knew what was going in it." It has been suggested that you are trying to shield Dri Berry. Is that so? — "Oh, no." There seems to be something that you are not telling the commission. — "In what way?" In the circumstances in regard to the issuing of the death certificate.r— "If it happened again T should go to the coroner and say that the child had been given baths that were at a certain temperature, which was maintained as long as possible. For my own procection. ' ' Did Dr. Berry know what was dn that certificate? — "Yes, he knew I was going to say it was heart failure." Dr. Berry Did Not Suggest It. The chairman: Did he suggest it? Witness: No. Would you say he concurred? — "Yes." Questioned regarding the post-mor-tem conducted on the child, witness admitted that he had been partly at fault in conductdng an unauthorised postmortem. He had continued it with Dr. Berry without asking if it had beeu authorised. To Mr. Lawry, witness said that the honoraries could not be fully relied upon to enter treatment. They had agreed to do so several times, but always broke the rule. The chairman: Did you ever report tMs to the board. Witness: No; I think the board is aware of thd position. Some of them are members of the board. .Mr. Lawry: If you order a treatment, do you enter it on the chart? Witness: Sometimes I do. Sometimes I ein snyself. Inspections of Hospital. To Mr. A. E. Lawry, counsel for Dr. Berry and the sister of the ward, witness admitted that, according to the bylaws, he should make an official visit to all the wards daily but that he did not always do this at nine o'clock in the morning. It was not possible for him to do so. At one stage there were only two doctors in charge. He considered that the hospital was under, staffed in that respect. Mr. Lawry: It has been suggested that there was a conspiracy of isilence between Dr. Berry and yoiurself ? Witness: No, but I don't think Dr. Berry has told me all he could as regards the case. For e^ample, he has never told me yet the temperature of the child after the bath. You know that the suggestion is that death was 'due to hyperpyrexia? — "YesJ I know that." Are you satisfiecf wdth that? — "Well, death might have been from that or merely exhaustion after the treatment. ' ' Mr. C. G. E. Harker (on behalf of some parents): If you had been possessed of the information that you have ■now, would you have put in the certificate you did? Witness: No. It is clear that I unconsciously deceived the coroner. Should the sister have recorded the temperatures during the hot baths? — "Oh, yes." There have been serious eonsequences from that remis'saon? — "Oh, the child would have died just the same." Would Have Stopped Treatment. Continuing, witness said that had he been awaTe tha't the temperature of the baths was 110 degrees he certainly would have consulted the honorary doctors and diseussed the matter. He certainly was not aware that Dr. A. D. S. Whyte's child patients were having the treatment* Had he known it he would immediately have stopped it. To Mr M. R. GTant, appearing on behalf of the Hospital Board, witness said that, under the circumstances as he knew them at the time, he did not think it necessary to attach a special nurse to the ward. He said that after the 1928 outbreak of the same disease a swab was taken of all admissions as a precautionary measure, but this was discontinued after the earthquake. It was immediately revived after the first outbreak last year. He said that the board had obtained a specialist to conduct an examination of the children, and he had Teported that in his opinion all would be free of the disease at the end of three months after his exr. inination. Did the sister tell you about the hot baths?— "No." Has the sister the right to keep a private record? — If it has a bearing on the patient it should be part of the clinical record." "That Is the Point" Don't you think the sister desired to keep the information away from you and the other authorities? — "Well, I think she might have wanted- to keep the information for Dr. Berry." The chairiqan: That is the point. Mr Foden: That it was a secret record? Witness: Well, we want to be charltable. To Mr Grant witness said that if he considered there was something amiss about treatments he had the power to call a meeting of tho honorary doctors. Iifc could not, however, veto Dr. Berry 's treatment on the doctor -s own patients. The chairman: You could report to the board? Witness: He is one-tenth of tho board. The chairman: Yes, I know that's uut'ortunate. Sir James Elliott: Doos it not strike you as peculiar to see On several oeeasions young children and babies being put into very hot baths? Witness: It certainly was unusuul. lue nor mai eleansing bath temperature is between 95 and 100 degrees. Could not the children have been put into separate aecommodation? Wo have been very short of aecommodation The isolation ward was always iull." lo Sir James Elliott witness said that tlie weekly meetings of the lionoraries were not always successful or in stnct keeping with the general »*lea of holding tlie meetings. Witness was responsible for the keeping oi the records, and he was satisfi^* that the system at the hospital was a gooj one despite the present apparent breakdown. He had deliberately refrained from investigating this breakdown in view of the board's inquiry He added that it was unusual to t immerse young children and babieB in,

very ho.t baths. The norma! eleansing bath would be of a. temperature from 95 to 100 degrees. He admitted that he relied upon the nursing technique to be observed efficiently "Confrere and Boss" Sir James Elliott: How often is the hospital inspected? Witness: About once a year. Mr. Mosley; Should you not have advised the Department of Health of the outbreak? Witness: It is not a notifiabl© disease. Certainly it would have /been better if I had. Sir James: The death certificate is open to question on the face of it? Witness : "Yes." It was accepted by the authorities? —"Yes." Did the fact that Dr. Berry was a member of tbe board have a bearing on you when making out the certificate? — "No, Y do not think so.", Was there any suggestion of master and man?— "No, but certainly it is an invidious position to have a man who is your confrere also as your boss " Was the board a happy family, or divided ..into hostil© sections? — "Hostile secfions." Did you consider your position unusually difficult? — "Well, it is not a very happy one."5 Was Sister Wood specially friendly with Dr. Berry? — "They were friends only." But very friendly ? — "Well, Dr. Berry did appear to-be so." This eoncluded the examination of the witness ,and after an intimation was given that the coroner, Mr. A. E. Bedford, and the matron would be called this afternoon, the luncheon adjournment was taken.