TIMARU HOSPITAL.

Timaru Herald, Volume CXXIII, 25 March 1926, Page 6

TIMARU HOSPITAL.

RE ARRANGEMENT OF STAFF. MEDICAL SUPERINTENDENT’S REPORT. The policy of the South Canterbury Hospital Board in regard to medical treatment at file Timaru Hospital, presented by tbe medical superintendent. (Dr. T. L. Parr), occasioned considerable discussion at yesterday’s meeting of the Board. Under the heading of “Medical Staff,” Dr. Parr reported as follows: — ‘A review of tlio present state of this question shows that the possible plans have been reduced to two : To remain as we are, or to appoint an honorary staff. I am satisfied that the latter could be done without sacrificing any of the advantages we have in the former, provided that the appointments are on the lines of my previous report, in which it was one of'the alternatives suggested. It will he remembered that the control of the iiospital was to lie. retained by the Board, that all classes were to have free access to the services of the hospital. Thii£ those well able to pay could choose between employing the full-time medical service of providing their own doctor, while those in less fortunate circumstances would have the services of both full-time and outside staffs. It would mean to> the public more variety of skilled service and more satisfaction •of personal fancies, and would enable the work of the hospital to. go on increasing without calling on the ratepayer for more funds for medical services. The provision of my fuM-time services is ample protection for those on the ‘borderline’ financial position and the Board can afford to give the outside staff the right to decline to troat, without fee, those in a position to pay. Protected in this way, a staff would not be working against its own interest, and could reasonably be expected to protect and advance the good reputation of the hospital.” The chairman (Rev. JT- AV. Potts) said that he had thought the matter over very carefully, and after conversing with Dr. Parr on the subject, he thought that the scheme to bo submitted was on a line with that adopted by the Board some: time ago, and which had been turned down by the Health Department. He would say straight out that he would not stand for a moment, for any scheme which meant going back to the old honorary system, or permitting any outside interference with the authority of their medical superintendent, as the man in charge. If he was convinced that it was for the good of the patients he would accept the report, but he always felt that the Board must have full control of the hospital. If a way out could bo found that did not involve any such interference he would not object, but lie would far sooner resign than see anything adopted that meant returning to the old system. He was quite-pre-pared to hear Dr. Parr’s proposals, but that was his personal feeling in the matter, and he also believed that it was the feeling of the Board that there should bo no interference with the authority of the Board or their medical superintendent. Mrs AW H. Unwin: “AVhat do you mean by losing authority?”

The chairman: “Under the 1 old .system the medical control was in the hands of the honorary staff and the medical superintendent was regarded practically as a junior. In the selection of four medical men to act as an honorary staff the Board desired to select its own four men; the British Medical Association, on the other hand, wanted foiir different men appointed every, year, so dividing the work out among all its .members. ‘That is what I mean by losing authority. Dr. Parr, as our medical superintendent, is our recognised head, ‘and aS our medical superintendent, must be the man in charge.” Mr G. Dash: “Is there any report before us to show that our work has been a failure?” He considered that if more assistance was required at the hospital it should have been asked for. The whole country, he said, was being worked up to crush the system of paid staffs, and lie considered that the reestablishment of an honorary staff at that stage would bo deplorable. Even at the present meeting the Board had provided the staff with more assistance. and were prepaid to provide still further assistance if it was required. He did not know why they should have ail honorary staff, or what they (the honorary staff) had (ione in the meantime to make the Board feci more kindly disposed towards them. If the Board were going to give in regarding that question he would sooner leave the Board that day. He deplored the fact that Dr. Parr had been made use of by the British Medical Association in order to turn down tlio system of paid staffs. There was no doubt that Dr. MclCaehern would report on that in the interest of the British Medical Association, and that the question would come up later. He would move that the Board proceed with other business. The chairman said that Dr. Parr had no doubt given a good deal of time and thought to the question, and the Board should hear his views on the matter.

Dr. Parr said lie very much resented the remarks passed liy Air Dash, insinuating that lie was being used bv the British Alcdieal Association. That statement was far from correct. However, he would assume that Air Dash did not mean exactly what lie said. As a doctor, he was trying to do his best for the hospital. The experience in the past showed that the old system had worked we 1, especially in regard to the treatment of the poor, and was. also easier on charitable rates. That work was also being well carried out in England and Australia, whore hospitals were still being conducted on these lines. There had been a marked tendency to have a hospital for all e’nsses of the community and with a staff expected to treat all classes free of charge. It was in introducing this that difficulty had occurred. In the cities where doctors largely obtained their reputations for work done in the hospitals they did not mind continuing tliat _ work, but in smaller towns the hospitals seriously affected their interests and a certain amount of opposition was unavoidably created, the doctors feeling that in working for the hospitals they were working against their own interests. He thought that the time had come when the Board could bury the hatchet without any disadvantage and yet obtain all the advantages of the old system. To make the hospital adequate, at least three efficient medical men would be required, and to hold three such men good salaries would he necessary. I'o continue the proser l vS; of affairs would mean the development of two distinct services—private and State—a vorv foolish thing from an economic point of view. The more co-operation that con’d be effected between the doctors and the hospitals the better it would be for all concerned. Under the present system two entirely separate services must eventuate. ' It was most important to the community that the standard of medical work must be kept up to the highest possible level, and the place to keep that up was in the hospitals, where, with the. co-operation of the doctors, the highest standard possible would be obtained. To work independently and yet obtain this standard would mean enormous expense, and an expense that the ratepayers would not be prepared to stand. He was looking at tile matter solely from the .point of view of the patients, and considered that the honorary service was a good system, and that it could also be used in conjunction with the Board’s new system. The paid medical officer prevented exploitation, and he could still he used, while also using the best services that could possibly be, obtained, Under his .scheme he would recommend the appointment

of a senior surgeon, an ear, nose, throat and eye surgeon, and a general surgeon. The positions would be advertised and appointments made by the Board on the qualifications and reputations of tlic applicants. .All cases could be 'allotted bv the medical superintendent on admission. At the present time, said Dr. Parr, lie knew of one case where a local specialist had performed an operation, for which in ordinary circumstances lie would have been paid twenty guineas, and ho received two guineas. That specialist had said that he would sooner do the work for nothing. 'To the chairman: “Under the scheme lie proposed, if an operation in liis opinion required a specialist, tile hospital would merely do the'nursing.” ’Mr' AV. Gcddes: “I think Dr. Parr lias taken a very fair view of the mutter.” Mr Dash said that lie did not mean to suggest that Dr. Parr was being made use of by the British Medical Association. AVhen the present system was started it was regarded as an interesting experiment in seeing how long Dr. Parr would he able to resist the influence of the British Medical Association. The work was now getting rather heavy, and he supposed Dr. Parr thought it would bo nicer to work in conjunction with tire other doctors. He though Dr. Parr was trespassing when lic'svd that the ratepayers would not stand tile expense entailed in raising the standard of the hospital. He was quite satisfied that the ratepayers would stand the expeuso entailed in making tlic-ir hospital more efficient still. If Dr. Parr wanted an assistant, oven one nearly as good as himself, he .could have him. The Board would liol stand in the way, and would be prepared to pay for part-time specialists if required. Dr. Parr: “The same tiling as I am proposing, only my specialist would be unpaid.”

At this stage the chairman suggested that as tlie Board would be inspecting the AYaimate Hospital in the afternoon, it would be better to postpone, tlio questions until some date when they could have a full discussion on tlio matter. He would suggest that Dr. Parr meet the House and Finance Committees at some future date, when they could have a round-table conference on matter and discuss it fully. _The chairman’s suggestion was adopted and the matter was then allowed to drop.