WESTPORT HOSPITAL COMMITTEE.

Westport Times, Volume III, Issue 407, 19 November 1868, Page 2

WESTPORT HOSPITAL COMMITTEE.

At the meeting of this committee, on Tuesday evening, the members present were Dr. Giles, (chairman), Messrs.Tyler, Powell,Field, M'Farlane, Munro, Daly, and Harris.

BYE LAWS. * Mr Tyler, as one of a sub-com-mittee, presented and read a series of bye-laws, includingrules for in-patients, instructions for the hospital attendants, and rules for the admission of patients. The rules for admission of patients, were as follows—Except in cases of emergency, no application for admission will be entertained, unless accompanied by a written recommendation from a qualified subscriber ; such recommendation to set forth clearly the means and circumstances of the applicant. Jlf the case, on examination by the medical officer, is considered by him a fit case for admission, he may admit the applicant provisionally. The Visiting Committee will, on examination into the means and circumstances of all patients and applicants determine on the propriety of their admission otherwise than medically, and whether the case shall be treated gratuitously or not. In the latter case they will arrange the terms of payment with the patient or his friends. Mr Murro moved, and Mr Tyler seconded, the adoption of the several series of regulations, and they were adopted, with the exception of the following, which was reserved for discussion :—''The medical officer shall not be required to treat gratuitously at the hospital any casualty which does not need admission, unless the Visiting Committee shall be satisfied that the person to be treated is unable to pay for medical attendance."

The Chairman- explained that the meaning of this regulation was, that if the medical officer found at the hospital a case requiring immediate attendance, but not deserving admission, he should attend to it at once. It might happen that the person would be quite capable of paying a fee, and therefore the rule provided that the medical officer should see that persons should be _ fit subjects for hospital treatment, while the Visiting Committee should satisfiy themselves as to his ability to pay.

Me Tyler moved the adoption of the rule.

Mr Powell seconded the motion. Mr Field could hardly see where the line could be drawn.

Me Tyler : This is the way to look at it. We do not pretend to treat persons who are not destitute. The primary object of the institution is to aid those who are destitute. Circumstances like these might arise—A man might break his arm, or put his shoulder out, and, not being able to find a medical man, might at once go to the hospital. The doctor goes immediately to the hospital; he sees the man requires immediate attendance, and, without making inquiry, he attends to him. Then comes the question, whether the hospital is to pay for this, or the man. If the man has means, the hospital has no right to pay.

Me Field : But if he is once admitted into the hospital does not that fact imply that he is to be attended to ?

Me Tylee : But he is not regularly admitted. He only goes there of his own accord.

The Chatemats t : If he is a person entitled to expect relief, he has only to go to the Visiting Committee, and satisfy them. Me Daly : And the patient would require to remain in the hospital till the Visiting Committee may call. The Chaieman : I think that is contemplated. It is presumed that all the functions of the Visiting Committee are discharged in the hospital. Mb Field : "Would it not be an admisson if he waits there until the Visiting Committee should come ?

The Chaieman : Clearly not. He is not admitted until the Visiting Committee has decided.

Me Tyler. : It must be remembered that it is a consideration witb a medical man, in taking charge of an hospital, what private practice he may have. I .think we must regard a little the practice of a doctor. If a man is able to pay, why should he not ? If he is not able, he will be admitted as a patient. Me Field : But supposing a man goes to the hospital, and it is found he can pay, then the medical man might summon him, and the institution would be brought into bad grace. Me Daly: Taking that view of the question, I would not consider it right he should be attended to at all at the hospital, so long as the doctor has a private place. The Chaikhan : Quite so, But whenever a doctor meets a man, suifering from injury, the first thing is to attend to him. It would he hard to Ivantage of him in any way.

Mr Daly : It will not look well on the face of it, aud it will compromise the patient to put him in such a position.

Mk Harris : It would look much worse if the doctor were to say, "I will not attend to you here ; you must come to my place." Mr Munro : I am afraid the rule contemplates an extreme contingency not likely often to occur. I would agree with the principle, but, as it is likely to be so rarely applied, rather than bring disgrace on the institution, we should dispense with it. Mk Harris also thought that cases might be met without any rule on the subject. The whole case lay with the Visiting Committee. The Chairman thought also that a rule was scarcely necessary, as the doctor could inform the patient that he must satisfy the Visiting Committee.

Mb Daly had no objection to the doctor attending such cases, and being paid for, but he objected to it being done under the cover of the hospital. Mr Ttleb : In such a case, a man who is able to pay may remain in the Hospital.

The proposed rule was then put to the meeting, and was negatived. _ Mr Mtjjstro proposed another addi tion to the rules, to this effect:— " Subscribers recommending cases for medical advice as out-door patients will be required to certify that the applicant is unable to pay for medical attendance. Such recommendations to be presented at the Hospital, on Tuesdays and Fridays, at 10 a.m., for medical advice only, and the medical officer shall not be required to give medicines gratuitously." He had lately laid before the Committee a motion that medicines should be given gratuitously, but, however liberally the Committee might desire to act, the full execution of their liberal intentions was, for a time at least, impracticable. He thoroughly sympathised with the desire to provide medicines, as well as advice, especially in the case of women and children, but it was impossible to provide for everything The Chairman : And it ought to be remembered that out-door patients are not yet recognised as part of the Hospital arrangements. Mr Harris reminded the Committee that, lately, they had been at very great expense in buildings and furniture.

Mr Daly was of opinion that the Hospital could not be hurt. The giving of medicine might prevent some patients from coming into the Hospital at all. What might be lost in one waymight be gained in another. The Chairman suggested that Mr Daly should propose an amendment, expressing his wish on the subject. Mr Daly proposed to add'to the motion the words—" But in cases of destitution, the Visiting Committee may provide medicine as well as medical attendance."

Mr M'Farlane seconded the amendment ; and the motion, so amended, was agreed to. Forms of requisition for the admission of patients, to be signed by subscribers, were also approved of.

ADAMS'S CASE. Mr Tyler, as one of the Visiting Committee, said that, after the appearance in the Westport Times of a letter signed by Alfred Adams on a subject as to which there had been many exaggerated reports, they thought they were justified in taking some action in. the-matter. Having seen the letter, although they found it contained nothing like the statements which had otherwise been made, they thought it desirable to take notice of it, and wrote to Dr Thorpe, calling his attention to the letter as an embodiment of certain remarks calculated to seriously injure the Hospital, and asking for a full report of the case. At the same time they addressed a letter to Mr Poole, the Hospital Steward. From Dr Thorpe they had received the following reply : Sir, —In reply to your letter, requesting me to furnish the Visiting Committee with a full report of Adams's case, I proceed to state the facts, so far as they are known to me.

On the afternoon of the 9th ultimo a man came to my rooms, stating that his mate had injured his shoulder, and had gone down to the Hospital. He said that the accident had occurred on the previous evening, and that I should have been sent for at once, had not the creek been flooded. They had just walked down from the Caledonian Terrace, passing my door. I told the man that I would follow him directly, and did so. On my way I happened to meet Mr O'Conor, who asked me if I had heard of the case. I replied that I had, and was then on my way to the Hospital, where I learned the man was. On arriving there I found the man Alfred Adams. I believe he or his mate had a card, but I did not look at it. I regarded the case as an " emergency case," and at once proceeded to examine the

injury, which I found to he a dislocation of the shoulder-joint. I reduced this without any delay, and told the man lie vyas all right. I gave him some directions as to keeping the joint and himself quiet, not intending to keep him in Hospital, as I did not consider the case required it. He complained of no other injuries but the one I had set" to rights, and was fit and free to go. Adams, however, seemed to expoct, or wish, to remain, and some remark was made, I believe by him, as to the noise of hotels. As I did not feel justified in taking the man in, simply as a matter of accommodation, unless on payment of the maintenance money, I took his mate out of the room, and enquired what his(Adams's) circumstances were. I was told that he was in a claim, from which he was receiving £6 to £7 a week. Whilst outside I saw that the weather was threatening, and that the men could not reach home before dark. I returned to the ward and told Adams that under these circumstances he could remain in the Hospital if he liked, on condition that he paid the sum fixed upon by the Committee as maintenance money, as I understood he was in a position to do so. He agreed to do so. To the best of my recollection, the amount was neither enquired nor named, but, if it were, £3 a-week was mentioned. The man needed and received no further treatment; but, the weather continuing bad, remained until the fourth or fifth day, when it cleared up. On my morning visit of that day, I advised Adams to take advantage of the fine weather to return home. He said that he had intended doing so. On my leaving the building, he asked me if he could go without paying the money before leaving, as he had not it with him. I said I would take his word to send it down. This he promised, (I think on the following Monday). He asked what the amount was. I told him that it was for the present fixed at £3 a-week, and I supposed that, for part of a week it would be at the rate of 10s a day or £2 ; but that he could speak to any of the Visiting Committee on that point. I then, believing that I had been often unfairly called upon to act as Hospital surgeon, in cases where men were able to pay as private patients, (their cases not being such as to necessitate their treatment within the Hospital,) and that this was a case in point, spoke to Adams on the subject generally—he appearing to be a sensible and intelligent man. I mentioned the rules and objects of such an institution, as I understood them, and the classes and cases for which they were designed. I told him that I did so only with a view to these things being more generally known than they appeared to be. He replied to the effect that he had not known these, but had been under the impression that any bearer of a " ticket " could claim admission or treatment. Pie asked what my fee was in such cases as his own. I replied that had he come to my rooms as a private patient, with such aninjury, my fee would have been five guineas or £5 (I forget which), but that as I had already attended him as an Hospital patient I did not require any fee from him, nor did I speak to him with that object, and all it was necessary for him to do was to send down the maintenance money, for which I held myself responsible. I remember that Adams then expressed his intention of sending down £5, professing his wish to make me some acknowledgment, and that I replied that if he did,"l should pay in £2 as maintenance money, but, I said, I wish you distinctly to understand that I do not ask you for any fee.

This conversation took place outside the building, and after I had discharged the man.

I have not received any money, nor have I heard from Adams since. I need scarcely say that had the promised money been sent it would have gone into the Hospital box, or that, as it was not, I hold myself liable for the maintenancemoney. These, Sir, are the facts of the case as known to me, and I have, I believe given the very words. To sum up, Alfred Adams, being in a position topayfor medical attendance,came to the Westport Hospital instead. He brought no recommendation, nor was his name on the subscribers'.list. He had a card, which I believe to have been a receipt for a subscription from Mr J. Braithwaite, but I did not examine it, not recognising such a document as of itself entitling the bearer to Hospital relief. I attended the man as an "emergency case," and at once remedied the injury regarding that as a sufficient recommendation. He could have left directly, had he so chosen, without being called upon to pay one farthing. The question of his means was not mooted until that of his remaining in the Hospital was. It was simply an accommodation matter. He agreed to pay the maintenance money for the accommodation. I made myself liable for his maintenance money by trusting to his word instead of having his promise to send it in writing. I asked him for no fee—what was said in reference to a fee, I have exactly stated previously. I named £2 off-hand, as his maintenance money for four days, leaving it open to abatement if he chose to apply to the Visiting Committee. My chief regret in connection with this case is that I did not dismiss the man at once, after reducing the dislocation. That I gave him the option of remaining, was owing simply to motives of kindness, and to my belief that the charity would not thereby suffer loss. In concluding this statement, I would respectfully suggest to the Visiting Committee, as bearing upon, and perhaps originating, this case :—lst, the misconception which is so general, as to the nature and objects of this institution—the classes it is intended to benefit, and the mode of

application for its benefits ; and secondly, the desirability of publicly correcting tbis misconception, (if indeed I am right in supposing that to be one which regards the Westport Hospital as a club, rather than a charity, and a club, the tickets of which are transferable to non-members). I have myself tried to explain the matter, on several occasions, but as I find my motives misconstrued, I have ceased to do •so, in the hope, Sir, that your committee would take action in the matter and by openly deciding the " ticket question," protect both the institution and myself from imposition, and your committee from a recurrence of similar annoyance to the present. And from Mr Poole they had received the following letter : Gentlemen, —In obedience to your circular requiring me to furnish you with the facts within my knowledge bearing upon Alfred Adams's case, in reply, I beg to state that on the 9th of October Adams came to the Hospital and demanded admittance, handing me a card " belonging to a subscriber." I told him, in accordance with the Hospital regulations, he should have brought a letter from a subscriber, which would have to be counter-signed by a member of the Visiting Committee, and handed to the medical officer, who would send me an order to admit him. I immediately took him into the Hospital, and his friend went and got the order as directed by me. Dr. Thorpe promptly attended, and reset the dislocated shoulder, bandaged him up, and told him to remain perfectly quiet, or he might put out the shoulder a second time. Adams was discharged on the 13th of October, and, on leaving, he thanked me, and to my surprise apologised for not being in a position to remunerate me for my attention. I told him distinctly that as a rule I never accepted money from patients, and that he had given me no trouble. He then said be had a small wages claim, and that when he would be in funds he would contribute to the Hospital ; such are the plain truthful facts. In addition, I have no hesitation or mental reservation in distinctly stating that Adams never directly, or otherwise, mentioned that he was to give Dr Thorpe any remuneration either within the Hospital or when leaving.

It was necessary that they should come to some resolution upon the knowledge obtained by these letters and other inquiries. There was a good deal of misunderstanding on the matter, and a resolution might prevent the recurrence of similar cases, to the injury of the institution. Mr Minsrito thought it was evidently a case in which some statement had beenmadeby Adams toavery indignant "correspondent of the Times. The parly signing himself " Subscriber " was to be blamed for any noise in the matter. He thought it unnecessary to take any notice of an anonymous letter, but he might say that he considered that it was not supported on any side. He thought it would be as well to express some opinion as to the conduct of Dr. Thorpe in the case. He thought the two parties were at cross purposes. It would appear that Adams considered he was free to the accommodation of the Hospital on a ticket which was not his own; and the Doctor found that, except for the flooded state of the creek, he would have had a private patient. A hasty explanation had taken place, and a general misundering was the result. Mr Tyler, after a desultory conversation on the subject, read, as the report of the sub-committee, +he following :—" That this committee is of opinion that the case of Adams does not warrant the commotion which has been made about it, and that the Doctor was right in not recognising the production of a ticket as a title to admission; and that he reduced the dislocation at once without making inquiries as to Adams's means ; and that after discovering he had means, and there being no necessity for Adams remaining in the Hospital, asked him for maintenance mo :ey at the rate of £3 per week, and did not ask for any professional fee." Mr opinion. Mr Mtrinto : And mine. I perfectly agree with the report. Mr Powell proposed the adoption of the report. Mr Field seconded the motion, and it was agreed to.

THE NEW HOSPITAL. Mr Harris reported that the amount of the contract for the erection of the new hospital had been paid, and he submitted accounts for "extras," which he recommended should he paid, subject to the report of the Inspector. Mr Munro reported that the bedsteads for the new hospital had been received, and, through the kindness of Mr Field, had been obtained at a very moderate price. Including all charges, they cost only £1 8s 9d each. Mr Harris reported the necessity of an assistant to Mr Poole, as Hospital Steward, and the Visiting Committee were empowered to engage a person in that capacity. It was agreed that Mr R. C. Eeid should be appointed a member of the

Committee, and that Dr Giles should be empowered to act in concert with the Visiting Committee in all matters —the Visiting Committee for the month being Messrs Powell, Field, and Harris. The meeting was then adjourned.