EXTRA EDITION. THE AUCKLAND HOSPITAL ENQUIRY.

Evening Post, Volume LXVIII, Issue 136, 6 December 1904, Page 6

EXTRA EDITION. THE AUCKLAND HOSPITAL ENQUIRY.

REPORT OF THE ROYAL COMMISSION. SERIOUS FINDINGS AGAINST THE MEDICAL SUPERINTENDENT. REFORMS URGENTLY NEEDED. The Royal Commission of Enquiry into a number of complaints as to the administration of the Auckland Hospital (Judge Ward and Messrs. R. Beetham, S.M., and S. E. M'Carthy, S.M.), have presented their report to His Excellency the Governor. The report states that consequent on an agitation in 1901 an entirely new departure was taken by the appointment of Dr. Collins as Senior Medical Officer, lac intention pf the Hospital and Charitable Aid Board being apparently to curtail as much as possible tne work and responsibility of the Honorary Medical Staff, and to place the senior _ medical officer in a position unique in the history of any city hospital in the colony. The effect of this had been to create friction between the Honorary Medical Staff on the one hand and the Board and Senior Medical Officer on the other; had caused the resignation of many of the ablest men on the honorary staff; and had prevented others from applying for a position "which is usually largely sought after by the first men in the profession." Since the appointment of Dr. Collins as Senior Medical Officer in January, 1902, there appeared to have been a steady deterioration in the surgical and medical work of the hospital, to the manifest detriment of the patients. Instances were not infrequent where fractures had been set and attended to by fche Junior Resident, with disastrous results. "A MOST SERIOUS CHARGE." The Commissioners give several instances of such cases, and then report on "a most serious charge" against the Senior Medical Officer, Dr. Collins, made respecting the treatment and subsequent death of a patient named Wallis A. White. In this case the Commissioners report that on 17th May last White was brought to the hospital dangerously iH. He was examined by Drs. Collins and Neil. On being questioned he indicated the right side as the seat of pain ; but Dr. Collins, in spite of a romonstrance from Dr. Neil, determined to perform an operation for appendicitis, in which the incision is made on the left side. That incision was made accordingly, and the appendix was found to be normal. After giving details of further operations made on the patient, the report goes on to state that the patient, who was two hours on the operating table, died two days afterwards. "We are unanimously of opinion," report the Commissioners, "that the reliable- evidence before us shows" (1) that the incision for appendicitis ought not to have i/ctii uuictc , vi, , .u.i i .- .su >.- d to have been a mistake which even a skilful surgeon might make ; (2) that the two incisions in the intestines near the appendix were both of them most dangerous and muiecessary ; (3) that the sucures put bj' Dr. Collins in a stomach which was proved to be an ulcerated one can only be characterised as wanton and urcilled for surgery, without any justification whatever, and that the time taken up by that portion of the operation apparently lessened the patient'a chance of life; (4) that though the patient on his admission to the hospital was in a very serious condition owing to the perforated ulcer in the duodenum, he had a chance of life which was seriously diminished by the malpractice of Dr. Collins; (5) that in order to conceal his malpractice he falsely stated to Dr. MacGregor at the Departmental enquiry that he found the anterior wall of the stomach very friable, and having three perforations in it, and that he had great difficulty in uniting them." In regard to a charge of unnecessary, and unjustifiable operation on another patient, the Commission reports that the operation was justifiable. "• Ab to the constitution of the Board, the Commission suggests an alteration of the statute »yhereby it would be elected for three years, a«d thereafter a certain proportion of the members (say one-third) should retire annually in rotation. It should consist of representatives elected by the local bodies and nominated by the Government, and there should always be at least one medical man on the Board. UNSATISFACTORY CONDITION OF BUILDINGS. The present condition of the hospital buildings (with the exception of the children's hospital and the nurses' home) is reported on as being far from satisfactory. "The operating room can only be regarded as a make-shift." The Commissioners urgently recommend certain alterations to the old main hospital building, including the provision of lifts, an up-to-daw operating theatre, and that some attempt should be made to render more sanitary the main wards. The Commissioners think that the spending of large sums of money by an annually elected Board, which can hi the nature of things have no continuous policy, is vicious in the extreme, and is likely to result in the waste of public funds. SENIOR MEDICAL OFFICER AND HONORARY STAFF. Dealing with the relations of the Senior Medical Officer to the Honorary Staff the report says that it is recognised as sound hospital practice that the authority of the Honorary Staff should be supreme in medical and surgical, as distinguished from administrative matters. About two years ago a departure from this practice was made, the Board making the Senior Medical Officer the medium of communication between the staff and the Board, whilst that officer "by insidious methods, such as calling the staff to useless consultations and minor operations and appropriating to himself the ma>jor operations, sought to make himself and not the Honorary Staff supreme in matters medical and surgical." The advantages of placing the Honorary Staff in the position of responsibility are : (1) The sick poor receive the best professional skill, and (2) the doctors in attendance have the advantage of the collective wisdom of the staff. The disadvantage of placing the Senior Medical Officer in supreme control is that all difficult cases have a tendency to fall under the exclusive care of the resident and such members only of the Honorary Staff as he chooses. The Board's reason for this departure — namely, that young and unmarried men, such as residents usually are, should not have the duty of attending married women, and that complaints against the Honorary Staff had appeared in the press — are characterised as being "of the flimsiest character." The first of the two is decjared to be obviously ludicrous, and with regard to the second, it did not appear that proper investigations were made to see if justification existed. "It should be insisted upon," the report continues, "that the authority of that (the Honorary) staff should be supreme in 'the before-mentioned matters." Accordingly, it recommends the adoption of what is the practice in most central hospitals; "namely, the appointment of two.

junior surgeons and one physician, who should be unmarried, and should reside on the premises ; and should be subject in all medical and surgical matters to the Honorary Staff. . . The cost of this, we are informed, would be less than that of the disastrous arrangement now in force ; and the ablest surgeons and physicians in Auckland, relieved from the incubus imposed on them by the present rules, would not only be willing but anxious to serve on the Honorary Staft. MAJOR OPERATIONS. The Commission finds that there can be no doubt that the rules which provide that major operations shall be performed by and be under the control of the Honorary Surgeons "have been persistently misconstrued and ignored by the Senior Medical Officer, who has taken charge of cases which should have been dealt with by the Honorary Staff. His conduct in this respect has had the tacit consent of the Board. ■ BACTERIOLOGY. With respect to the alleged interferference by the senior medical officer with the Bacteriologist, Dr. Frost, the Commission finds the allegation proved, and is of the opinion that the culture by the latter of bacilli,, and specially of the anthrax bacillus, was fraught with danger to the patients he attended, and should have been most strictly prohibited. ADMISSION AND TREATMENT • OF PATIENTS. The practice, at present prevailing, of not admitting patients except in urgent and serious cases, without a doctor's order, is severely condemned as entailing needless suffering to patients presenting themselves for admi&sion. The Commissioners "fail to see why one of the resident staff should not determine whether the proposed patient should or should not be admitted." , The Board's practice of charging 4s 8d per day to each patient is also condemned, and stated to be in contravention of the rules of the institution and of the Hospitals and Charitable Institutions Act. The evidence showed that repeated demands were made for payment until the amount was paid, or remitted by the Board. This practice is reported to have tended to keep out the deserving poor and to retard the recovery of those who have entered. It has also encouraged well-to-do persons to make use of the Hospital to the exclusion of the poor. A remedy is suggested by the Commissioners, which is "to let it be known that in deserving cases no charge whatever is made, and that when a charge is made, it is in accordance with a rate fixed with reference to the means of the patient." DISMISSAL OF DR. NEIL. Regarding Dr. Neil's dismissal from the honorary staff, the finding is that its jusmication depends on whether Dr. Collins's method of operation in the Wallis White cass was in accordance with sound surgery. The Commission thinks it was not. The dismissal is stated to be without any justification, assuming that the Board had power to dismiss. FOOD SUPPLIED TO PATIENTS. No definite opinion is expressed regarding the quality of the food supplied to patients, concerning which the patients had made complaints. The report, however, suggests that the Matron should superintend the inspection and distribution of the food. OTHER MATTERS. The report also deals with other matters. The conduct of the male nurse or wa rdsman in leaving open a cupboard containing poisons, which resulted in one of the patients frequently administering hypodermic injections to others, is severely reprobated. With respect to the complaint of the Auckland division of the New Zealand Branch of the British Medical Association, that there has been a recurring tendency to the erection of an out-patients' department, the pommission finds that the rules have been strictly adhered to. The Commission also finds that most of the hospital records and other documents produced in evidence were incorrectly and carelessly kept. Instances of - carelessness jire given, and the responsibility is cast on the senior medical officer.