Many Witnesses Recalled

Hawke's Bay Herald-Tribune, Issue 132, 21 June 1937, Page 8

Many Witnesses Recalled

HOSPITAL INQUIRY Circumstances Surrounding Post-Mortem EXPERT EVIDENCE The recalling of several witnesses as a check upon certain aspects of subsequent evidence occupied the major portion of the Royal Commission investigating the affairs of the Napier Pnbtic Hospital this xnorning. The m&xn point raised in the evidence was tlie circumstances surrounding the post-mortem and the death certificate of the child who died In tho Shrimpton Ward. After hearing these witnesses, the Crown Solicitor, Mr N. A. Foden, called the first of his expert witnesses. Called by Mr. Foden, Pr. E. J. Harold Berry, medical practifioner in partnership with his brother Dr. J. Allan Berry, said that he had: been interested in the fever treatment for some years. He was told by his brother that a hot-bath treatment wae to be embarked upon at the hospital. Witness approved of the hotbath treatment. Mr Foden: You visited the hospital on a number of cases to see how the treatment was getting on? Witness: That is quite .wxong. You discussed the treatment with the sister on several occasions! — "No. 1 discussed it once with her." What led to yomr diecussing it with her!— "My brother came to me when I was a patient and' said that if he had not given the sister coraplete instructions and if I • saw her, would I help her. ' ' Did he tell you to inspect the children during the treatment? — "Oh, no; he wouldn't have dreamt of thai course." Would his request imply that tho sister could rely on you?: — "No." Diji your brother consider that the sister was to 6ee you, or were you to go and see her! — "If I ran acro&s the sister, then we would have a talk about it.'? Mr MoBley: If you "ran across. " Do you mean that you ran all over tho hospital? Witness: Well, hardly that, 1 . . Mr Mosley: Well, don't use such extravagant terms. "Don't Be Imperttnent." Mr Foden; Now let us get this thing right. Witness: As I was crawling about the ward, for you will appreciate that I was very weak, I . . . . Mr Mosley: Don't be ampertinent. Witness: 1 am not being so. Mr Mosley: Don't argue with me. Witness: I'm not. Mr Mosley:- Just answer the questions. Witness: Yes, yes, yes. Mr Foden: You were a patient in bed! Witness: I was to be up in a day or two. When you gofc up and were convalescent, did you see the sister? — "I did see her accidentally, and discussed it with her." When did you see her?-—"I think she was going off duty." You discussed it only once with her? —"Yes, as far as I know." You had a discussion with her in her oflice, or duty-room!— "That is quite wrong. ' ' You are very definite? — "Yes, I know the occasion you are referring to." What was that?— "I went to the hospital to make a small presentation of appreciation to the nursing staff for the attention given my wife and myself . ' ' If the sister said that the only discussion that she had with you on the heat treatment was in> the presence of your wife? — "Yes." You were concerned at the death of the child?— "Yes." You were anxious to attend the postmortem ?— ' ' 'Yes." Did you go up to the post-mortem room with your brother? — "Yes." Who put the child on the table? — "I don't know." Had your brother started the postmortem before Dr. Foley arrived?— • "Yes." Before the post-mortem commenced your brother had rung Dr. Foley and epoken to him about the post-niortem ? —"Yes." Attendance at Post-Mortem. When you went out to get Dr. Foley to come down to the post-mortem di'd you acquaint him with what you wanted? — "Yes; I can't say what words I used." You considered that you were entitled to be present? — "Yes. I .was interested, and if I could learn something no medical man would say otherwise." The chairman reminded witness tlial the coroner authorised an inquest and medical men would be present by his leave. In reply to Mr Foden, witness said that the sister appeared to be fully conversant with the points of dangerj regarding the hot-bath treatment which witness discussed with her. Sir James Elliott: I asked your brother if he had not misled a uumboi oF people. Do you think he misled the parents? Witness: No. It seems tliore was :i misunderstanding over tho torm 'examination' for 'post-mortem examination.' " Did you and your brother discuss Ihe details of the post-mortem? — "Yes. " Were any notes taken of the inquest? — "I don't know. I toolc a few notes." Have you got those notes? — "No. " Where are they? — "They were in my pocket for mouths and became dirty, and I threw thenx away. Mr. Mosley: Then the details were jnterestiagP

Witness: No. But you made notes. of them? — "Yes, a few, but there was really notbing of importance." papers Misslng. Mr. Foden : You will understand that quite a number of bits of papers are missing. It is unfortunate, is it not? Witness : Quite. Quite. What conclusion did you and your brother come to after your discussion? — "We really came to no conclusion. We were waiting for the patlxologists' report to see if it could throw any light on the cause of death.'' • I understand in medical science it is the practice to eliminate possible hypotheses? — "How do you mean?" I will give you a few. Was tlxe hipdiseaso the cause of death?— "No.' Was vulvo-vaginitis, then? — "No." Was it constitutional heart movenient? — "No." Do you think that the hot baths wero a possible cause of death? — "Yes, they would be a factor." Mr. C. G. E. Harker, for somd ot -iie parents: You say the hot baths were a factor? Witness: Yes. Do you think all the saleguards necessary were taken? — "1 understand they were." . Had you had the responsibility of undertaldng the treatment, you would have done as was done? — "I certainly would not have had an irresponsible nurse and an inexperienced one take the pxxlse-beats." Do you consider it right that a 3ister should take it upon her own responsibility to order a treatment without the doctor's consent? — "Most certainly not." Consent to Treatment Needed. In reply to a further question by Mr, Harker, witness said that the medical superintendent should have known about the collapse of the cliild. . Mr. Harker : The proper way foi- him to know about it was to record it on the chart? Witness: -Yes. With the hot batlxs you will agree that there was an element of risk? — "Yes, there is an element of risk." It cannot be suggested that the consent obtained for the treatment of hip disease also applied to the treatment of vulvo-vaginitis, which was not 'then contemplated ? — ' 'No." Then consent for the special treatment of vulvo-vaginitis ekould have been obtained? — "Yes." To Mr. W. E. Bate, representing the Hawke's Bay Hospital Board, witness said he took no authority for otderiiig any treatment. He admitted that he might have acted in an advisory capaeity in a general way. He, however, did not see the child. Mr. Bate: When did you know that Dr. Whyte 's patients were receiving the treatment? Witness: I know nothing about that at all. Did you know that the sister had bad no pxacticnl experience in the treatment? — "That is so." Well, all she knew about it was from a pamphlet given her by your brother. Do you think, then, that she' was thoroughly competent to be ixx charge of sucli a treatment? — "Well, no. ' ' You consider the risk was one in 2000?— "Yes." How do you arrive at that? — "I have a lot of figures." Sir James Elliott: Do they refer to the machxne or hot-baths treatment? Wtiness: To both. Discussed Post-Mortem. Mr. Bat.e: I gather you discussed the question of the post-mortem with your brother before the post-mortem was held? Witness: Yes. And you made 'available some literature concerning deaths from heat treatments? — "Yes." s • When did you declde to hold tho post-mortem? — "I didn't decide it. , It Had . nothing to do with me." You disclaim any responsibility for it?— "Yes." Was there qny discussion between Dr. Foley and yourself concerning hyperpyroxia? — ' ' Yes. " W hen ? — ' ' During the post-mortem. ' ' Dx\ A. D. S. Whyte was also recalled and he said that he was concerned about the rumours or suggestions that he xvas not diligent in his care of the children and in consequence he wroto to the late Mr. C. Duif a member of Ihe board and pointed out to him that he had ordered a certain treatment. Mr. Foden: Can you give tlxe commission axi assurance that you give all the attention and skill that a medical man should give in the treatment o£ these cases? Witness: "I can." To Mr. A. E. Lawry, who appeared i'or Dr. J. A. Berry and the ward sister, witness said it was difficulc to say at what time he would have arrived iu the Shrimpton Ward in the course of his inspections. An cmpty bed wouid not convey anything. Would Have Noted It. Mr. Mosley : You did not find the bed empty with regularity? Witness: No; had it been so l would inive noted that. Mr. Harker: Did you discuss with the sister tbe treatment oi jour •patients ?. Witness: Most certainly, yes. My ietter to Mr. Dulf indieates tbe Jines of that discussion. Do juu appruve of the suspjnsio'] ,ul' your treatment? — "Certainly not." (And tbe substitution would rutaid tbe eificiency of your treatment''-— "Yes." The chairman: 1 take it that aa as expericueed surgeon you would be horriliod to lind tlial a nurse had done tbat.y Witness: l wouJd buve been vuy unnoyed. The chairman : l should thiuk you Would. Mr. M. 11. Grant, who appeared rdr tho Hospital Board: Dr. llutter, wlio was the liouse surgeon, has been uientioned a good deai. Did yo'u have -'very ecnhdence in him ? Witness: i did. The sistei cousistently said that she was justified ip doing what she did because you did not take sufficient interest in the children ?— "She was not justified. at all, I always made a point

of seeing the sister and discussing any matters of importance, if I could not always visit all the wards." Do you consider the treatment for vulvo-vaginitis a dangerous one ? — "The local treatment most certainly was not." Sir James Elliott: There xs one thing we would like cleared up. We have been told that four or five children were hot-bathed for an hour or so and' that afterwards they each had a special nurse at their bedside. Would you have seen these nurses if they had been there? Witness: I have no recollection at all of seeixxg them. saw No Special Nurses. Did you see any special nurses giving vigilant attention? — "No." . Would you have realised that there was something unusual if you had seen four or five special nurses there? — "I certainly would have." Mr. Ellison, patliologist, was next recalled. Mr. Foden: You were in the1 postmortem room and I want you to tell the commission what the discussion was fchere. "I can't give the jxctual discussion," witness replied, "but the impression 1 got wa? that the two Doctors Berry were trying to put something over Dr. Foley. I was embarrassed and I spoko to Dr. Foley and asked him if I might not leave. He told me to remain." Mr. Foden: Was there any mention of hyperpyrexia ? ..Witness: No. Was the examination they made a thorough one? — "As far as I am concerned: it was, but 1 don't know." Mr. A. E. Lawry: You thought they were making a thorough examination by the inquixies they made? Witness; Yes. "Thought Something Was Being Put Over." Now, you say that you gained the impression that the Bex'rys were puttxng something across Dr. Foley? — - "Y%s, so much so.that I went out of my way to find Dr. Foley and took the iibexfy of telling him tlxat- I thought sonxetiiing was being put over him." Mr. L'awx-y; That is a very serious 'thing indeed. ... Witness : Yes, and it is the truth. Something was said then?— "No. The general trend of conversation gave me tixat impression." Was Dr. Harold Berry', while you were in the post-mortem room, quoting from text-books? — "Not while I was there." Hove you seen any hostility between the Doctors Berry and Dr. Foley? — "No." What were you acting upon? — "From the impression that i gained. I liad no axe to grind. I was feeling embarrassed, and tliat was why 1 asked to leaye." t Mr. Foden: On tlxe occasion that Dr. Ailen Berry made some uncompiimentary rexnark concerning Dr. Foley, was it arising out of the postmortem ? — ' 'No. " To Mr. Gran't, witness said he reinembercd Dr. Harold Berry teleplxoning iii his offiee i'or Dr. Foley, leavinga nxessa^e i'or him to "come down to the mcxgue." Dr. Foley Recalled. A "further ' recall was tliat of tlxe medical superintendent, Dr. J. J. Foley. He eaid that he was not aware until lio entered the post-mortem room that Dr. Berry was actually going to conduct the examination. Mr Foden; To your knowledge has Dr. Berry ever conducted a post-mortem without consent? Witness: Yes, and so .have I. That, then, would explain why there was no question raised" about consent? —-"Yes." \ Sometimes you have had your postmortems ratilied later? — "Yes." You agree now that such should not be done? — "Yes." The chaitinan: I suppose that iu xuture you will see that no pqstxnortems will be ' carried out without lirst obtaining consent? Witness: Yes. It was only in exceptional cases that it was not done in the past. To Mr Foden witness said that he vonsidered the hot baths * that the children were having were merely hot cieanaibg baths. Mr Foden: You wero emphatic that Dr. Berry knew what was going into the death certificate? Witness: I was convinced that it was neart failuro. We all thought that. Di\ Berry was emphatie that he did not know? — "I am confident ;that ho did know. He might n'ot have knowns wnether there would be any mention oi' vulvo-vaginitis in the certificate." Mr Ellison said that Dr. Harold Jborry said: "You're in on this, Jim. " What do you say. to that? — "We were in the post-mortem room, and Dr. Harold did say something qiiite jooularly like that. Did Mr Ellison see you afterwards? — ''Yes, and sqid something about tho two doctors Berry putting something over me." 3 "' Mr Grant: At what stage did hyperpyVexia sxiggest itself to you? Witness: Not until some weeks after, when 1 learnt that the children wero receiving heat treatment. At this stage a brief adjournment was taken and upon resumption tho acting-coroner, Mr. A. E. Bedford, was recalled at the special request of the commissiou. The chairman rcmarked to witness that as Ihe result of his qucstious hc liad been satisfied with the answcrs given regarding inquests on hospital patients. "I desire to aiake absolulely certain that you do not hold inquests on hospital patients," he said, "and in reply to the questions I put to you, and also those of Mr. Foden, you gave me your assurance that you do not. Now, I-have had a return made up for ino of all Ihe inquests you have conducted sinco HfiM on patients who have died at the hospital. When did you becomc a inenx-: ber of Ihe board?" vWitness: About 9A ycars ugo. This list of inquests shows tliat you have licld 1-t since March, 1934, on people who have died at the Napier Hospital. Would that hc right?— ' ' Yes. ' ' Yet you gave a definite assurance tliat you don't hold inquests on patients of the hospital"? — "I understood1 that you meant patients other than aecident cases; or where the polico were likely to step in to the proceedings bccause of th« cireuruaLance* sur-

rounding the cause of death." You did not convey it in that form? —"I'm sorry if I did not. That is what I meant." The chairma'n commented that when a person entered the hospitai alive, and was treated in any way at the hospital he became a hospital patient. '"Surely that is so?" he asked. Witness: I have not looked at it in that light. What line do you draw between a hospital patient and one that is not? — "Well, say the case of a patient dying under an anaesthetic. That woud be a hospital case, but where there has been an accident outside the hospital,. and the patiern; is brought in to be cured if possible, then I did not look upon it as a hospital patient." To further questioning, witness replied that he did not think there was any confliet between his duty as a member of the board and his duty as coroner when the cases were such as were brought to the hospital' from aecidents. Mr. Mosley: But there might have been some question raised as lo the treatment given that patient after his admission? Witness: Well, there might have been. After further questioning, the chairman remarkcd: "I beliove you are perfectly honest, but you can't serve two cnastors. " • . The first of the expert witnesses was Dr. John F. Brown who has been engaged in the study of venereal diseases for 21 years and is now stationed. -at Auckland. On having outlined to him the treatment ordered by Dr. Whyte, witness said that the treatments were in accordance with established practice. ' . . , . Regarding the disease, witness said that ho had found it a particularly disappoinling one to treat. He would not treat any such case where there was any mortality risk from the treatment. He ttas aware that tne hot_ treatment had been heard of for a number lof years, but it was still on trial and had not beeome a standard treatment. He nad tried the application of local heat on one occasion some years ago when he thought that heat would kill the germ, and had tried a diatherinic treav nient, but he had found the more com7 mon form of treatment more satisfactory. . .. Mr. Foden: Do you agree that the>re is less reason to apply the heat treatnicat to children than. to adults? Witness: Yes. What do you favour? — "I- take a very conservative treatment with . children. " * . . You are. not prepared to take any treatment either with children or adults?—' "If a cure became adopted and liad spectacular results; thougn it xnight have 'some mortality risk, . I wouid discuss. it with the parents. Pcrsonaliy, I would not become a pioneer of that treatment." _ - Oontinuing, witness said that in the particular case in question, if a treatment involved admitted risk, then he would undertake tiie treatment if it were' agreed by all parties concerned that it should be carried out, only oi£ the condition that' it was carried out wilh fully- qualified and very close supervision. Mr. Foden: What is your criticism of Dr. Berry 's treatment? Witness: I am prepared toadmitthat Di. Bex'ry may well liavo been justified in contemplating the treatment, but my criticism is that was done without con- . sent, and secondly in a hapkazard manner as regards supervision. To embark without tho parents' consent and without duo regard for the risk involved I do not consider Tight. Do you consider, as Dr. Berry says, tliat tbe risk is negligible? , * Witness: Well, the risk was one in five in this case.