HOSPITAL MATTERS

Taranaki Daily News, Volume LI, Issue 205, 19 August 1908, Page 4

HOSPITAL MATTERS

CONFERENCE AT HAWERA. j MEDICAL MEN VENTILATE THEIR! GRIEVANCES. | A conference of representatives of the New Plymoutli, Stratford, and llawera Hospital Boards was he'd iu the liorougli Chambers at llawera yesterday. There were present: Messrs.-I*l. \V. Sutton, J. .Marx, T. A. Bridge, .1. Conaglen, \\. Duirs, and C. E. 'Farringlon (llawera), G. A. Marehaut, 11. N. Liardet, and P. F. Italic (Stratford), and Fred. Bellringer, J. lirown, G. \V. Browne, D. H. McDonald, and (J. M. Lepper (New Plymouth). Mr. Sutton was voted to the chair.

Mr. Bellringer said that the medical men were desirous of addressing the conference. It must bo understood that the doctors were here at their own request, and not upon the expressed wish ( of the delegates.

It was decided to admit them at the commencement of the proceedings. Dr. Paget- tabled the following letter, which he said contained the decisions of the three medical superintendents arrived at in conference:—"The medic.il superintendents of*.tile New Plymouth, Hawera, and Stratford hospitals submit to the conference of the above Hospital Boards that the following principles governing the admission of patients to. ■ the public hospitals be recognised:—(l) | That patients who are able to pay the. ordinary cost of medical and surgical attendance shall not be admitted to tiie

hospitals on the same terms as those whgse financial circumstances warrant their admission to the hospitals at a rate which does not cover the full cost of maintenance in the hospital; (2)' that any patient able to afford ordinary fees for private attendance, but whose condition of health or conditions other than financial make it desirable that he or she be admitted to a public hospital, be charged the full cost of maintenance in the hospital, and that the medical man attending such a patient be empowered to charge his fees, such fees to be arranged between the two contracting parties; (3) that no patients residing within any hospital district be admitted

to other than the hospital of the district in which they live except in eases of

emergency or by agreement between the medical superintendents of such' hospitals.—Signed by H: B. Leatham (New Plymouth), V. A. Mac Gibbon (Hawera), and T. L. Paget (Stratford)." Some discussion upon the method o> procedure followed, Dr. Paget taking exception to the term "ultimatum" used in connection with the medical men's report. He asserted that the conference had been called in order to discuss this report. Mr. Bellringer differed.* Dr. Paget said they were here fu'l of the spirit of compromise, and they wished to avoid putting in an ultimatum. He had read Dr. Leathani's report, but he contended that that was not the matter before the conference.

The conference adjourned for about half an hour to allow- of Dr. Valintine conferring with the medical superintendents. Mr. Marx asked, What is the .conference called *f or? The chairman: I don't know. Mr. Marx: Who called it? The chairman: Well, the- doctors seem to have ingratiated themselves here. They invited themselves here. Mr. Bellringer explained that the conference was the outcome of a meeting of the House Committee of tlie New Plymouth Hospital to consider clause 1 of the proposed agreement between these three districts upon general management. Had not Dr. Leatham taken exception to the clause this meeting would not have been held.

Upon the conference resuming, Dr. Valintine said the medical men had conferred, and he would give their decisions on the clauses seriatim. He would recommend- the conference <'» adopt the first clause, because it practically embodied What was taking place in many parts of the Dominion. Men who could pay for medical treatment should certainly be made to pay, and he thought the Board should take advantage of that section of the Act which empowered the Board to collect from patients according to their means. He could not see his way to recf>minen3 the adoption of clause 2 in toto, and the words after "hospital" would be deleted and the matter held in abeyance pending his interviewing the Minister on the subject of coping with the increase of hospital abuse. He favored clause 3, but with words jjiving power to Boards as well as the medical superintendents in the matter. The Chairman said that the liawera Board had clause 1 in actual operation now, patients' fees being charged according to ability to pay. He was pleased to see that Dr. Valintine disapproved of the latter portion of clause 2, which would tend to introduce a dual control. Clause 3 concerned a matter that was frequently discussed between the Hawera and New Plymouth Boards, and ho ought to say that New Plymouth had always behaved very "courteously to Hawera. Of course, patients would always feel inclined to go to the hospital where the better ap-' pliances and larger medical staff to be found. It was hardly fair, though, that paupers—and people who could not pay their fees were practically pauper patients—should be allowed i(\ leave their own district for another, making his maintenance a charge upon his own district.

Dr. leathain said that thig question had been for a very long time becoming more and more serious. Good hospitals, well managed, naturally attracted sick people from all over the country. Of course, people had a right to go there, hut there was the business aspect to consider. The hospitals of this country had been erected for needly people, but the well-to-do people, seeing the up-to-dateness of the appliances and the nursing there, commenced to use the public institutions. Why should these people be allowed to take advantage of a system that had been provided free or practically free for the needy. Of course, under present conditions the poor man was just- about confined to his own district, whilst the man with the cash was allowed his choice. Wliy give the rich a privilege that the poor could not get ? It was quite vrong that wealthy people should be allowed to obtain in a public hospital ior 28s what it cost the ratepayers two or three guineas to provide, whilst the doctors gave their services for nothing. And why should not people he allowed to pay the surgeons for hospital operations if they so desired? Dr. Paget followed. He regretted that the legislation of this country was fuch as to compel the retention of what Dr. \alintine termed the abuse of lios-

pitals, which abuse was increasing every day, and he hoped that this coiifercme would give a fillip to some just legislation that would tend to limit the abuse. The medical men complained that to do their duty by their patients thpy were compelled to* rob themselves of fees and send the patients to the general hospitals, and there attend to them without charge. That was expecting too much of human nature, and ratepayers had no right to expect it. If they insisted on it they would find that the l»st doctors would leave, the hospitals, and the.se would fall into the hands of the ''black sheep" of the profession, who would make the hospitals pay them by underhand means. lie could tcH them of a ease in which the wife of a wealthy man was admitted to a hospital and given a private room nt the rate of Co .>« a week, {.lie medical superintendent being instructed to perforin a surgical operation which 'u

private practice would have cost about £SO. lie refused, resigned, and l!i' hospital fell into disrepute. The people

of X«w Zealand liad never had this abuse brought clearly before theiu, so they mistook the use of (lie public hospitals, to the detriment of the medical profession. lie wanted the principle admitted that the charity of (lie medical men must not he openly, llagrantlv, and abominably abused. He saw no difficulty at all in adopting the whole of clause 2. At present a millionaire from London, if taken ill in Stratford, would have to lie admitted to the public hospital, and that, after undergoing a skilful operation, he could walk out after paying the ordinary fees of a fewshillings' a day, when he would have bad to pay £IOO for the same treatment in London. Of course, that was an extreme case. Tie wanted the delegates to ioolc at this matter, if possible, from the viewpoint of the medical men. w hose services, given free to (lie r. were wilfully abused by the meaner well-to-do people.

Air. Sutton said that they had no 1 such cases of abuse in ilawera. I Dr. Paget cited a Stratford instance,; in which a wealthy visitor to Stratford had declined to pay tlie full cost of his maintenance in the hospital (£2 2s weekly), though he had been extremely well satisfied with his treatment there. Answering Mr. Bellringer, J)r. Vagei said there wan no private hospital at Stratford, and do chance of one competing successfully with the public institution miles* the doctors robbed llio latter to keep the private concern going, j Of course, where there was a good pri- | vale hospital the position was not bu acute, lie had not recently recommended any patient to go into a Stratford private hospital for operation.

Dr. JlacGibbon followed on somewhat similar lines, pointing out that few private hospitals in the colony were equal to even the smallest of the public institutions. Dr. Paget explained that in the event of doctors being allowed to attend patients privately iu hospitals, the private fees would be reduced, ill recognition of the fact that the ratepayers had already contributed to the cost of the buildings, and so forth. In answer to Mr. McDonald, he said there would be no dilliculty in ascertaining whether or not a patient was able to pay. The system ill vogue at tin Cambridge sanatorium could be applici

ill this case, and he didn't think that any member of the conference, would accuse medical men of being ulldu'V hard upon their poorer patients iu this regard. , Air. Conaglen said that for years past he had been paying a hospital rate, ind he reckoned it a pretty sound investment. lie had never used the hospital, and lie wasn't particularly anxious to, but he would consider it an undoubted

hardship if he were asked to pay more than the ordinary fee. livery ratepayer, in his opinion, was entitled to the use of the hospital on payment of the usual maintenance charges. Dr. Valintine said that abuse of hospitals was becoming an acute probbm all over the world. In the United Kingdom hospitals for the needy were maintained by benevolent subscriptions, and many of the subscribers found themselves in this anomalous position, thai -'the needy patients were receiving better medical and nursing treatment than the subscribers themselves, for the public hospitals were in every way right up to date. The poor and the very ri:ii got the best attention, the middle classes being hardly wealthy enough to afford private hospitals, yet too affluent to secure admission to a benevolent in stitution. It would be very hard, lie said, to define the beginning and ending I of hospital abuse, or to fix any limit after which the patient should bt ' charged full fees. A man receiving , £4OO or £SOO a year might, by a series of illnesses or misfortunes, be less able to pay than a mail on ordinary wages. But it was the mean man that the doctors wanted to get at, for it undoubtedly seemed hard that a doctor should he called to attend for nothing aspatieni, wealthier than the doctor himself. He cinpha. ically disapproved of the doe tors' private practice scheme, which

would lead to nil .sorts of abuses and bring about that state of dual cont-ol which wot Id spell disaster. The only way to effect this change would be o have a separate staff for the private ward, and this would be expensive and unfair to those private hospitals which the Government had compelled to lie brought fully into line with modern requirements. Hospital fees should be raised, if only 011 the grounds of the greater expense incurred in surgeiy. which everyone knew had so greatly advanced in recent years. These fees would be levied, of course, So that they should not press hardly upon people who could not pay. Mr. ■ Bellringer again asked if there was no private hospital in Stratford. .Mi'. Bellringer was proceeding with another question, when Dr. Paget jerked in an interruption: It's no use asking Mr. Liardet. Whatever I say, he'll say I'm wrong. Jlr. Liardet: 1 didn't speak, ill'. Bellringer thought he had a right to ask the questions. Dr. Paget (hotly): Oh, "I'm not going to squabble over anything Jiardet likes to bring up here. There is 110 private hospital there. X told you befoie: and | I'm not going to discuss it or enlarge lon it. It's not what we .came to Jis- | cuss at all. Mr. Bellringer strenuously opposed | clause. 3, which he said would tend to divest the Board of authority. People in tile whole of the Taranaki province had in the past, contributed to the upkeep and assisted in the management of the New Plymouth Hospital, and he was not going to bar them from treatment thc«le. Dr. Valintine thought 110 one would raise any objections to patiejits being sent from llnwera to "Stratford to the New Plymouth Hospital for special treatment unobtainable in their local institutions. In another brief altercation, Mr. Bellringer informed the Board that Dr. Paget was adopting a "stand and deliver" style that he (Mr. Bellringer) wasn't prepared to take. Dr. Mac Gibbon again pointed out that •the medical men had no objection to placing their services at the disposal cf the needy. He was sorry to sec the conference was developing into, an antagonism between the profession and the laymen. (Cries of dissent.) Mr. Brown asked if the difficulty would be lessened by engaging a resident surgeon for hospital work alone. Dr. Valiatino said that it depended on the district. The New Plymouth hospital could 'hardly be better 'managed than at present, and as for as New Plymouth was concerned it .would be better to "leavo well alone." . Mr. Brown said it appeared the doctors were dissatisfied.

I)r. Valintine said that if the people who could pay were made to pay many of the doctors' objections would b-e overcome. He thought the doctors' objections to hospital abuse were justified.

Mr. Bollringer objected to the doctors' frequent use of the term " gratuitous services," for were they not paid? Mr. Kalft; said that in Stratford a ease had come under his notice in which tile medical superintendent had refused to admit a ease, oil the ground that the mother of the sick child eould afford to pay for treatment in a private hospital. .Sho assured the speaker that silic could not, and he had given an order ior admission. She was a"ain refused by tile medical ollieSr. Now, who was to decide these maters? Dr. Valintine said the right person to settle that matter was tin; secretary. -Mr. Sutton: 3s tile medical ollicer to overrule the action of the chairman or a member of the Board? Dr. Valintine: That wholly depends upon the medical officer and the Board. The medical officer could object to a patient only on the grounds of imlit-

Iness medically, as proscribed by the regulations. Finance was 110 concern of - his. Clause 1 was adopted, with the provision added that the Board should fix a maximum charge. Clause 2 was struck out as being merely a repetition of the first, (llellringer—McDonald). Discussing clause. 3, wliicii governed the admission of patients In hospitals outside their own districts, Mr. Liardel quoted a Stratford case in which a woman was lvt'used admission to her local ihospitnl and went; to New I'lymnutli, where she paid in advance. The .Stratford medical siipcrinl'.'ndcjit protested lo his New Plymouth confrere, with the result lhat after being four days in Ij.'il preparing for an operation the woman was turned out and sent to Stratford. It was it most unfortunate case, and quite a scandal ill Stratford, for the patient subsequently died. Tjhe question arose, said Mr. Liardct, who is lo decide on wlliat major operation mi;;lit be sent to the New Plymouth hospital? The local medical ollicer would urge, "1 can do tile job here," and veto admission to ally other institution, which was unfair, as every person able to pay maintenance charges hail every right to enter any hospital. Mr. Conaglcn mentioned the case of an Opunake mail who was anxious to enter the New Plymouth Hospital but hail been refused admission. The Conference allii'ined the principle that it. was desirable that patients shall, as far as possible, be treated in j the hospital in their own district; and after long discussion, that, the patient resident desirous of being treated in the hospital of another district shall be admitted to sncJi hospital on the recommendation of the Hoard in their

(hospital district, it being understood that such admission would be of urgency or emergency, incurable, consumptive, and special treatment eases. A PRINCIPLE AFFIRMED.

Mr. Ma reliant said that tire Expressions "eliurity M alia -charitable aid" had been used far too frequently iu tihe doctor.-;' representations Even their letter was addressed to the I "Chairman. of the Taranaki Charitable Aid Cont'eiviice,' 1 and there lma noen imported into the. discussion an element that would have been belter left oiil. llu moved, •That, iliaving in view the fact that every member of thv community contributes, directly or indirectly, or both, to -the erection and maintenance of public hospitals, UiU Conference nllirms that any person is entitled to claim admission to such Hospitals for treatment as a matlv.r of right and not of privilege or charity." The motion avus greeted with applause. Mr. Marchant added that it was the duty of the Conference to make its views on this subject clear to the ratepayers and to the medical profession. 'l'die resolution might have a good Hl'eet upon people who. from their very training, did not take a broad view of the matter. Mr. Kalfe seconded, Dr. Valintine said that no-no "of om legislation contemplated the idea that a man in a public hospital was receiving ciharity, and 110 man who fell upor evil times and had to get help to tide him over lug difficulties should be stig matisod as a pauper. (Hear, hear). The motion was unanimously carried

It was decided to recommend to the three Boards to raise the fees to (is per day for district patients and 7s per day for patients from other districts. The agreement arrived at between

tllio Boards in regard to the establishment of a home for incurables was amended to provide that the home should uot be erected except upon the decision of the three contributing Boards. Hearty votes of thanks to Dr. Valintine and to the chairman terminated the proceedings.