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Evaluative study of the University of British Columbia student health service Hannay, Josephine Mary 1976

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AN EVALUATIVE STUDY OF THE UNIVERSITY OF BRITISH COLUMBIA STUDENT HEALTH SERVICE by JOSEPHINE MARY HANNAY R. N. B. N. U n i v e r s i t y o f Manitoba, 1966  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE STUDIES Department o f H e a l t h Care and Epidemiology  We accept t h i s t h e s i s as conforming to t h e r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA August, 1976  (c) J o s e p h i n e Mary Hannay  1976  In p r e s e n t i n g t h i s t h e s i s  in p a r t i a l f u l f i l m e n t o f the requirements f o r  an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree t h a t p e r m i s s i o n  f o r e x t e n s i v e copying o f t h i s  thesis  f o r s c h o l a r l y purposes may be g r a n t e d by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s .  I t i s understood that copying o r p u b l i c a t i o n  o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my written  permission.  Department o f  HEALTH CARE AND EPIDEMIOLOGY  The U n i v e r s i t y o f B r i t i s h Columbia 2075 W e s b r o o k P l a c e V a n c o u v e r , Canada V6T 1W5  SEPTEMBER, 1976.  ABSTRACT  This study was  conceived as a thesis i n p a r t i a l  f u l f i l m e n t of the requirements f o r a master's degree i n Health Services Planning at the University of B r i t i s h Columbia.  The growing demand f o r evaluation of health care  programs constituted the rationale of the study.  It appears  that the current high l e v e l of i n t e r e s t i n program evaluation in the health care f i e l d i s due to two reasons:  one,  the  health sector has become one of the largest segments of the economy and therefore i t s size demands formal evaluation; and two,  the ultimate objectives of health are so complex  that they present serious measurement problems f o r program administrators.  In order to make i n t e l l i g e n t decisions re-  l a t i v e to the commitment of resources, programs designed to achieve these objectives must be evaluated. ected f o r t h i s evaluative study was  The program s e l -  the University of B r i t i s h  Columbia Student Health Service. The study was  designed i n three phases:  background review and preparatory period;  two,  one,  a  an on-site  survey of a l l of the dimensions of the Health Service including  i t s f a c i l i t i e s , services, and supporting functions;  and  three, a written report of the findings and interpretation of the c o l l e c t e d data with recommendations f o r change.  iii  Based on the researcher's past experience i n reviewing Canadian health care i n s t i t u t i o n s f o r standards and practices, the method employed was an accreditation-type survey using documentary evidence, tions.  interviews, and observa-  Evaluation of the Health Service f a c i l i t i e s and  functions was done i n terms of the American College Health Association's Recommended Standards and Practices f o r a College Health Program.  Data was collected to provide a  comprehensive body of descriptive information  concerning  health services at the University, and interpreted to make recommendations f o r change i n view of the variance between the Standards and the study findings. given to the appropriateness  Consideration was  of using American  standards  as well as to the achievement of them at U.B.C. To the extent that pertinent differences existed between recommendations contained i n the Standards and those thought to be applicable i n Canada, recommendations or suggestions f o r change were adapted to s u i t the Canadian context. Generally, however, the areas of investigation were found to have the same concerns and problems. It was concluded  that the U.B.C. Health Service meets  the Standards and Practices f o r a College Health Program recommended by the American College Health Association, and that the Standards can appropriately be applied to Canadian, as well as to American, student health services.  iv  This study i s intended as a planning  document  to have u t i l i t y f o r the Health Service at U.B.C. and f o r future research i n college health programs i n Canada.  V  PREFACE  Because of the current high l e v e l of i n t e r e s t i n the topic of health program evaluation, and the writer's view that continuing evaluation of a l l publicly-funded health programs should be required i n order to assure a continued high standard of service, the U.B.C. Health Service was selected f o r the conduct of an evaluative study.  No other  assessment of i t s organization and operation has ever been carried out i n the f i f t y - o n e years since i t s inception and the conditions under which i t has been operating have changed during that time.  Because of the apparent desire of the  Health Service to seek improvement and an expressed w i l l i n g ness to cooperate with a study of i t s program, i t i s a n t i c i pated that recommendations f o r change w i l l be well received by the Health Service. Factual information on the c h a r a c t e r i s t i c s and operations of the Health Service i s presented  i n t h i s thesis  in such a manner that the solutions to problems or d e f i c i e n cies are presumed to be self-evident.  Statements of recomm-  endation are made throughout the main text; those made i n the concluding chapter originated either from the standards used to evaluate the Health Service or from the writer's experience  and knowledge of the health care f i e l d gained as  vi  a hospital consultant, administrator, teacher, and  nurse.  The statements on E t h i c a l and Professional Relationships, supplemental to the Standards, have been applied i n onlytwo areas thought to be appropriate, Medical Records and Mental Health. The voluminous amount of d e t a i l contained i n the text which follows has been l e f t i n f o r several reasons. One,  i t i s the only written account of the U.B.C. Health  Service on record; programs may  two,  the independent assessment of i t s  serve as a guide to the Health Service f o r re-  viewing i t s organization and operation i n t e r n a l l y ;  and three,  the description of i n d i v i d u a l programs, services, and ing functions may oping programs.  support-  be used as a point of reference f o r devel-  vii  TABLE OF CONTENTS PAGE ABSTRACT  i i  PREFACE  v  TABLE OF CONTENTS  v i i  LIST OF TABLES  x  ACKNOWLEDGEMENT  xi  DEDICATION PART I  x i i 1  BACKGROUND OF THE STUDY  CHAPTER 1  Introduction  2  2  O b j e c t i v e s , Design, and Methodology o f the Study  7  2.1 2.2 2.3 2.4 3  O b j e c t i v e s o f the Study Design o f the Study Methodology o f the Study About the Standards  Review o f the L i t e r a t u r e  19  3.1  19  3.2 3.3  The Development o f Organized Student H e a l t h S e r v i c e s Other Developments Program E v a l u a t i o n  H i s t o r y and Background o f the U.B.C. H e a l t h  5  General  22 26 32  PART I I CONTENTS OF THE STUDY 4  7 8 12 15  33  Service  Information  56  5.1  The I n s t i t u t i o n  56  5.2 5.3  Composition o f the 58 O r g aI nn is zt ai tt iu ot ni o nand d m i n i s t r a t i o n 62 a l ACommunity  viii  CHAPTER 6  PAGE H e a l t h Programs: S e r v i c e s and A c t i v i t i e s 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19  7  Outpatient Services 66 Inpatient Services 79 Records 94 Laboratory S e r v i c e s 103 Radiological Services 106 Pharmacy (Medication Service)113 Dental S e r v i c e s 116 Mental H e a l t h 122 A t h l e t i c Medicine 134 Rehabilitation/Physical 140 Medicine H e a l t h Promotion/Preventive 148 Medicine Occupational Health 152 Environmental H e a l t h 153 and S a f e t y P r o v i s i o n s f o r Emergencies/ 157 Disasters H e a l t h Education 162 Research 170 Communications 171 Extramural Resources 175 S p e c i a l Problems 178  H e a l t h P e r s o n n e l : Q u a l i f i c a t i o n s , 181 D u t i e s , and Education 7.1 7.2 7.3 7.4 7.5 7.6 7.7  8  66  Medical S t a f f O u t p a t i e n t Department S t a f f Hospital Staff Nursing Other P r o f e s s i o n a l s Secretarial/Clerical Staff Support S t a f f  182 185 186 188 190 192 194  Physical Plant  196  8.1 8.2 8.3  196 196 199  Location Design and C o n s t r u c t i o n Maintenance  ix  CHAPTER 9  PAGE Business Management  201  9.1 9.2 9.3 9.4  201 204 210 211  Financing Budget P l a n n i n g Business Procedures Personnel: P o l i c i e s and Procedures  PART I I I CONCLUSIONS OF THE STUDY 10  213  Summary and Recommendations '  214  10.1 10.2  Summary o f S e r v i c e s Summary o f Recommendations  214 217  10.3  Implications f o r Planning  235  LITERATURE CITED  237  APPENDICES  241  X  LIST OF TABLES  TABLE  PAGE  la  Student R e g i s t r a t i o n 1954-1960  52  Ib  Student R e g i s t r a t i o n 1964-1970  52  II  T o t a l Number o f V i s i t s t o H e a l t h S e r v i c e  53  1954-1975 III  Health Service Hospital U t i l i z a t i o n  54  1954-1975 IV  Summary o f S e r v i c e s  V  T o t a l Enrolment 1969-1976  59  VI  Percent - Male and Female  60  VII  P a t i e n t Census A p r i l 28, 1976  83  VIII  Workload  IX  Annual Workload  X  P s y c h i a t r i c S e r v i c e Census By Sex  128  XI  P s y c h i a t r i c S e r v i c e Census By Country of B i r t h Statement o f U.B.C.'s A n c i l l a r y Operations f o r the Year Ending March, 1974  129  XII  1954-1975  i n U n i t Values P e r Month - Lab. i n U n i t Values - X-Ray  55  105 109  207  xi  ACKNOWLEDGEMENT  Grateful appreciation i s expressed to the following people f o r t h e i r assistance i n the preparation and conduct of t h i s study: To my thesis committee:  Dr. C.J.G. (Cort) MacKenzie,  Head of the Department of Health Care and Epidemiology;  Dr.  Anne Crichton, Professor i n the Division of Health Services Planning; and Mrs.Helen E l f e r t , Assistant Professor i n the School of Nursing, University of B r i t i s h Columbia, f o r t h e i r advice and guidance. To Dr. Michel Vernier, Chairman of the Division of Epidemiology and Biometry, f o r suggesting student health services as an area f o r study; to Dr. Archie Johnson, Director of the U.B.C. Health Service, and his s t a f f whose cooperation made this study possible; and to a l l those who contributed to the accumulation of data. To my f r i e n d , Carol Perch, who generously offered to type the f i r s t draft of the manuscript, and to my s i s t e r in-law, Lynne Hannay, who d i l i g e n t l y typed the f i n a l copy. To my parents and friends f o r t h e i r encouragement; and to my husband, Rick, and my sons, Mark and John, f o r t h e i r patience and understanding through completion of my studies. This work was supported I n part by the Manitoba Health Services Commission whose assistance i s g r a t e f u l l y acknowledged.  xii  This study i s dedicated to Miss Muriel Upshall and others pioneered  who  i n the development  of student health services i n Canadian u n i v e r s i t i e s .  1  PART I  BACKGROUND OF THE STUDY  2  CHAPTER I INTRODUCTION  The methods by which the health services seek to attain t h e i r basic objectives - promotion of health and well-being, prevention  of i l l n e s s and d i s a b i l i t y , and  care i n the community - are changing and w i l l continue to change as s o c i a l conditions a l t e r .  Both government and  voluntary organizations have planned and established programs to implement these objectives and the costs have been monumental.  Economists have expressed concern about  the escalation of health care costs because of t h e i r i n creasing share of the G.N.P. r e l a t i v e to other kinds of expenditures and because i t i s not c l e a r that Canadians are deriving any greater benefits i n terms of increased health, well-being, or productivity.  This suggests that  the industry i s becoming increasingly i n e f f i c i e n t at a rapid r a t e .  1 , 2  One expert-^ claims that no nation, however affluent, can afford to apply a l l of the known s c i e n t i f i c measures f o r r e l i e v i n g pain, preventing or curing i l l n e s s , and postponing death; i t i s incumbent upon every society to economize i n the use of scarce  resources.  3  Thus, i n terms of planning s o c i a l change to better u t i l i z e our resources, i t has been suggested that: " A l l s o c i a l i n s t i t u t i o n s or subsystems, whether medical, educational, r e l i g i o u s , economic, or p o l i t i c a l , are r e quired to provide "proof" of t h e i r legitimacy and e f f e c t iveness i n order to j u s t i f y society's continued support. The demand that some attempt be made to determine the effectiveness of public service and s o c i a l action programs has become increasingly i n s i s t e n t .  I t i s this  renewed interest i n a long neglected aspect of s o c i a l research, the evaluation study, that provided the impetus f o r the current study. In the determination of an appropriate health care program i n which to conduct the study, concern  over  the adequacy of student health care prompted an in-depth evaluation of the U.B.C. Health Service.  The u n i v e r s i t y  setting i s p a r t i c u l a r l y conducive to teaching this s p e c i f i c population about i t s r e s p o n s i b i l i t y f o r making provisions in the case of i l l n e s s and f o r maintaining i t s own w e l l being.  Moreover, the 15 - 24 age group, which comprises  the majority of college students, was pointed out by the Royal Commission on Health Services-' to be the age group most profoundly affected by the s o c i a l changes i n our time.  4  It stated: " ... Reference was made to the possible e a r l i e r physical maturity and generally l a t e r school-leaving age with a consequently l a t e r entry into the labour force hut a tendency f o r e a r l i e r family formation. This goes hand i n hand with improving economic l e v e l s of parents and more money available from public sources for continued education to f i l l the demand f o r higher educational l e v e l s i n the present and future labour force. The r e s p o n s i b i l i t i e s of the adolescent and his role i n the community are thus reduced i n some respects, while increased demands are made i n others r e s u l t i n g i n stresses which cannot f a i l to be r e f l e c t ed i n the health status of this group." (5. - p . 313) The u n i v e r s i t y has a unique opportunity as well as an obligation to use t h i s period of continuing change and remarkable f l e x i b i l i t y i n the l i v e s of students to promote sound health concepts which form the basis f o r continuing environmental adaptation and provide stimulus for the most e f f i c i e n t u t i l i z a t i o n of our resources.  But  u n i v e r s i t i e s today face many of the same dilemmas as t h e i r off-campus counterparts.  Rising costs are causing i n s t i t u -  tions to reevaluate the s p e c i f i c services provided as well as methods for financing the services.  The evaluation of  one aspect of the university program, the student health service, indicates the wide range of r e s p o n s i b i l i t y f o r health service programs i n the i n s t i t u t i o n and provides general knowledge for administrators and educators concerning health services i n u n i v e r s i t i e s .  Further,such  5  evaluation can provide guidelines f o r action by planners of other u n i v e r s i t y or college health service f a c i l i t i e s . I f new health knowledge i s to be incorporated into health programs, current a c t i v i t i e s must be evaluated to determine what r e a l l o c a t i o n of resources i s necessary, while new a c t i v i t i e s must be c a r e f u l l y planned and evaluated before they are put into practice. Since i t s inception, the U.B.C. Health Service has seen many changes i n the organization and methods of delivery of Canadian health care programs.  As there are  now health insurance plans covering almost a l l of the population's needs for medical services and h o s p i t a l care, the role of the Health Service has had to change to meet new demands upon i t .  Student demands which have emerged  in the l a s t decade have been mainly i n the areas of family planning, b i r t h control, and counseling, p a r t i c u l a r l y sex counseling, and psychiatric assessment regarding problems of adaptation to a changing society i n which the work ethic i s being challenged and the generation gap seems great to many i n the student age group.  Since u n i v e r s a l h o s p i t a l  and medical insurance coverage i s presumed to have resulted i n more students seeking health care from private p r a c t i tioners, and i n better health generally, i t appears that there i s a s h i f t toward more preventive practices taking  6  place i n the Health Service which had i t s beginning  as  a Public Health Unit. The Health Service has also seen a number of other health issues raised on the campus, such as the 1  development of the Health Sciences Centre, a family pract i c e teaching unit, and environmental surveillance and control of hazardous conditions.  Whether the Health Service  should have become involved i n these developments  concerning  the health of the community as a whole, or remained as i t has, a service unit, are questions that have had to be answered as the i n s t i t u t i o n has been changing around the service.  The underlying preventive aspects of the service,  however, emphasize that the organization and functions of the programs require review to keep them up-to-date and effective. The standards^ used to evaluate the Health Service were developed for American college health programs.  One  question which arises i s whether these can appropriately be applied both to American and Canadian student  health  services since the Canadian context has been changing i n a d i f f e r e n t manner from that of the United States. thesis attempts to consider the appropriateness  This  of the  standards as well as the achievement of them at U.B.C.  7  CHAPTER 2 OBJECTIVES, DESIGN, AND METHODOLOGY OF THE STUDY  2.1  Objectives of the Study The broad purpose of t h i s study i s to further  improvement of existing health programs and provide a point of reference f o r developing programs. The primary objective i s to evaluate a health care program with a view to providing consultative guidance i n terms of s p e c i f i c recommendations f o r standards and practices. The intermediate objective i s to evaluate a welldeveloped  student health service i n the Canadian context. The operational goals of the study ares  i)  to describe the development of organized  student  health services, ii)  to objectively assess the scope (extent and kinds) of services presently provided at U.B.C.  iii)  to recommend ways to more e f f e c t i v e l y or e f f i c i e n t l y coordinate the planning and provision of such services, including t h e i r coordination with other services.  8  iv)  to make suggestions f o r t h e i r future development with implications f o r planning.  2.2  Design of the Study The study was designed i n three phases: one,  a background review and preparatory periods two, an ons i t e survey of a l l of the dimensions of the Health Service including i t s f a c i l i t i e s , services, and supporting functions ; and three, a written report of the findings and interpretation of the collected data with recommendations for change. Several months were spent reviewing the l i t e r a ture i n the areas of program evaluation and student health services.  A search of the archives r e l a t i v e to the U.B.C.  Health Service included annual reports dating back to 1955 and h i s t o r i c a l documents back to 193&.  Health Service  records were scanned i n an attempt to produce patterns or trends but the method of f i l i n g and storing records in the Health Service precluded the orderly c o l l e c t i o n of baseline data.  (This i s one of the recommended areas  for change.) In preparing f o r the on-site survey contact was made by l e t t e r and telephone with the American College  9  Health Association i n Evanston, I l l i n o i s , and with one of i t s standards o f f i c e r s at the University of C a l i f o r n i a in Los Angeles.  A copy of the standards used to evaluate  college health programs and other relevant material were ordered but never received.  The standards were subsequent-  l y borrowed from the Student Health Service at Simon Fraser University. Preliminary discussions were held with the Director and Supervisor of the Health Service f o r permission to conduct the survey, and with the U.B.C. Registrar to v e r i f y the f e a s i b i l i t y of doing the study.  Others were  contacted f o r the purpose of gathering relevant information i n connection with the study.  In alphabetical order,  the following were the i n i t i a l contacts made i n the preparatory phase: American College Health Association  -  Evanston,  Illinois  Miss K. Boyle  -  Supervisor, U.B.C. Health Service  Miss Dora Hart  -  S t a t i s t i c i a n , U.B.C. Office of Academic Planning  Dr. A.M. Johnson  -  Director, U.B.C. Health Service  Mrs. Barbara K e l l y  -  Member, Management Committee, U.B.C. Health Sciences Centre  Mr. R.F. Kissner  -  Co-author, S.F.U. Report on University Health Needs  10  -  Dr. E. Lipinsky  Director, Student Health Service, U.C.L.A.  Dr. Maurice Osborne J r . -  Mr. J.E.A. Parnall  Director, S.F.U. Student Health Service  Registrar, U.B.C. Head, Occupational Therapy Department, U.B.C. Health Sciences Centre Psychiatric Unit  Miss A. Stalker  -  Miss E.M. Upshall  Retired, Former Supervisor, U.B.C. Health Service  The second phase of the study comprised several weeks to conduct the on-site review of the Health Service f a c i l i t i e s and functions.  In the course of the survey,  interviews and discussions took place with members of the medical, nursing, and support s t a f f s , and others  concerned  with the delivery of student health services on the U.B.C. campus.  Contacts were made with the following people,  l i s t e d i n alphabetical order.  Except where otherwise  noted, a l l are Health Service personnel. Mrs. P. Barnes  -  Secretary to the Director  Mrs. Belward  -  Senior Office Clerk  Dr. M. Beiser  -  Consultant P s y c h i a t r i s t  Mr. A. Boschalk  -  Area Supervisor, Operations and Maintenance Division, Department.of Physical Plant, U.B.C.  Miss K. Boyle  Supervisor  Dr. C A . Brumwell  Assistant Director  11  Mrs. Mr.  S. Chambers H.A.  Crawford  C l i n i c Nurse and I n s e r v i c e Education C o o r d i n a t o r F i r e Prevention O f f i c e r , U n i v e r s i t y Endowment Lands F i r e Department  Miss A. F e l l  C l i n i c Nurse  Dr.  Physician  D. Goresky  Miss M. H a r r i s o n  X-Ray T e c h n i c i a n  Dr. A.M. Johnson  Director  Mrs.  Head Nurse, H o s p i t a l  P. Jones  Dr. M. Kwan  Psychiatric  Mrs.  C. L o n g s t a f f  C l i n i c Nurse  Mrs.  E. McVey  C l i n i c Nurse  Resident  Dr. S.E. Marks  C o u n s e l l o r , F a c u l t y of Education, U.B.C.  Mrs.  P. M i l l e r  Pharmacist, U.B.C. Community H e a l t h Centre  Mrs.  P. Morley  Housekeeping A s s i s t a n t  Mrs.  J . Morrey  C l i n i c Nurse  Dr. R.K.L. P e r c i v a l - S m i t h -  Physician  Dr. J»M':>:Robinson  Chairman, D i v i s i o n o f P u b l i c H e a l t h P r a c t i c e , U.B.C.  Dr. C.J. Schwarz  Chief P s y c h i a t r i s t , St. Paul's H o s p i t a l ; Former Consultant P s y c h i a t r i s t , U.B.C. H e a l t h S e r v i c e  Mrs.  J . Sutton  Laboratory T e c h n i c i a n  Mrs.  Taylor  M e d i c a l Record L i b r a r i a n , Vancouver General H o s p i t a l  Mr.  H. Tumaitis  Phys i o the rap i s t  Dr. E.W. Vogt  Vice-President, Faculty and Student A f f a i r s , U.B.C.  Dr. M. W i l l i a m s o n  D i r e c t o r of Continuing Education, F a c u l t y o f D e n t i s t r y , U.B.C.  12  Brief contact was  also made with a l l Health  Service c l e r i c a l personnel, the j a n i t o r , and members of the Hospital nursing s t a f f . Several more weeks were required f o r the  colla-  t i o n and interpretation of the c o l l e c t e d data and findings of the survey, and f o r completion of the written report to conclude phase three of the study.  2.3  Methodology of the Study Based on the researcher's past experience  in  reviewing Canadian health care i n s t i t u t i o n s f o r standards and p r a c t i c e s , the method used f o r this study was  an accre-  ditation-type survey using documentary evidence,  interviews,  and observations.  Evaluation of the Health Service f a c i l i -  t i e s and functions was  done i n terms of a set of recommended  standards and practices f o r a college health program. was  Data  c o l l e c t e d to provide a comprehensive body of descriptive  information concerning health services i n the u n i v e r s i t y , and interpreted to make recommendations f o r change i n view of the variance between recommended standards and actual f i n d ings. The method used was  generally patterned on that  of Knutson's'' c r i t i c a l review i n the evaluation of program  13  progress.  This approach provides guidelines f o r the  conduct of program a c t i v i t i e s and i s e s p e c i a l l y useful to those responsible f o r on-going public health programs. It's  p r i n c i p l e s and techniques  can also be applied during  the process of program planning and development to improve the q u a l i t y of decisions made.  I t requires c r i t i c a l app-  r a i s a l involving the systematic application of the best available techniques  and approaches f o r the purpose of  f e r r e t i n g out program weaknesses and detecting ways of reorienting e f f o r t s along more p r o f i t a b l e l i n e s .  It is  a means of i d e n t i f y i n g b a r r i e r s that l i e ahead and of f i n d i n g ways of removing them before they disrupt the program.  Some of the methods which may  be applied f o r  this purpose are discussions, interviews, questionnaires, statistical evaluation.  data, or any other available techniques  of  The c r i t i c a l f a c t o r i s not the technique  to use but the kinds of questions to explore.  During  the operational phase of a program, objective measures of evaluation such as observational studies or surveys may  be used to y i e l d information useful i n guiding the  program. Using the prescribed standards,  some of the  issues explored i n t h i s c r i t i c a l review were the following!  14  Have the needs, wants, or concerns the program i s intended to serve been adequately i d e n t i f i e d ? Has the public to be served been represented i n defining the needs? Have the objectives of the program been s p e c i f i c a l l y defined and written down? Are they part of the o v e r a l l objectives and p h i l osophy of the i n s t i t u t i o n ? Are they kept current by being d i r e c t l y related to existing concerns, and are they understood and accepted? Are the methods and approaches employed i n the program adequate f o r the purposes of the program? Are s i g n i f i c a n t barriers to success i d e n t i f i e d and corrective actions taken? What i s i t that has made the program succeed or fail?  Or what did i t accomplish i n terms of o r i g i n  a l l y unforeseen objectives?  To what extent has the  community's t o t a l problem been solved by t h i s program?  Or i s i t directed only to a minority?  Can the same end r e s u l t be achieved at a lower cost What changes i n techniques or methods could have improved i t s effectiveness? How do the services under study compare with l o c a l or national standards?  15  To the extent that v a l i d and r e l i a b l e answers were obtained to these questions of progress evaluation and the results of t h i s evaluation applied, the l i k e l i hood of program success i s considered to be increased.  2.4  About the Standards The instrument used to evaluate the Health  Service was the Recommended Standards and Practices f o r a College Health Program^, hereinafter referred to as the Standards. The Standards were f i r s t published by the American College Health Association, and revised i n 1969.  They define the scope of well-developed college  health programs and the importance  of coordination among  the program components, and they present general guidel i n e s f o r evaluating the q u a l i t y of s p e c i f i c services. Because of the many variables of s i z e , location, composition of student body, and i n s t i t u t i o n a l goals and resources among the wide variety of colleges and univers i t i e s , s p e c i f i c numerical standards, such as the r a t i o of physicians to students, the number of beds and the cost of the program, have been omitted from the revised Standard Rather, reliance has been placed upon the statement of goal  16  and objectives f o r comprehensive health programsfor the academic community.  In t h i s context i t i s considered  that the Standards apply to Canadian university health services. The Standards subscribe to the following: Goals of a comprehensive health program f o r the academic community: "1.  To promote and maintain those conditions which w i l l permit and encourage each i n d i v i d u a l to r e a l i z e optimum p h y s i c a l , emotional, i n t e l l ectual, and s o c i a l well-being.  2.  To control those factors i n the community and i t s environment which may compromise t h i s wellbeing.  3.  To guide the i n d i v i d u a l i n the acceptance of health as a positive value i n l i f e .  k.  To stimulate the capacity of the i n d i v i d u a l to make healthful adaptations to the environment." (6. - p. 1)  Objectives of a comprehensive health program f o r the academic community: "1.  Organizing s t a f f and f a c i l i t i e s f o r : (a)  Prevention of health hazards and problems for a l l members of the academic community (including i d e n t i f i c a t i o n and recognition of p o t e n t i a l problems p r i o r to t h e i r development) .  (b)  Early recognition of developing problems (including, i n the c l i n i c a l area, presymptom diagnosis of p o t e n t i a l i l l n e s s and use of screening procedures).  (c)  Prompt and effective remedial action i n the presence of recognized health problems (for instance, high-quality care, r e a d i l y  17  available under conditions which encourage timely and appropriate use). (d)  Rehabilitation of a l l members of the commun i t y who have health handicaps, acute or chronic, to maximum attainable restoration of well-being and function.  (e)  Education of members of the community f o r healthful l i v i n g , including concern f o r both i n d i v i d u a l and community well-being. This i s to encompass development of both content and methods f o r health education.  (f)  Control of environmental factors influencing health. This should include the elimination or control of noxious or harmful elements (physical and emotional) and the insurance of a creative climate which encourages development of health and well-being.  2.  Encouraging use of resources under conditions which promote t h e i r effectiveness.  3.  Promoting p a r t i c i p a t i o n among components of the community (students, f a c u l t y , s t a f f , administrat i o n , health services) i n the interest of developing goals and objectives and of sharing s a t i s factions and problems, including the development of e t h i c a l standards f o r relationships which recognize the need to handle certain types of i n formation with d i s c r e t i o n and c o n f i d e n t i a l i t y .  4.  Recognition of the importance of the performance of research f o r i t s dynamic influence on the health program.  5.  Continuous program evaluation, including s p e c i f i c attention to high q u a l i t y .  6.  Coordinating the health resources of the i n s t i t u t i o n with those of the community beyond.  7.  Developing and promoting health career opportunities. " (6. - p.p. 1 - 2 )  18  The  Standards r e f l e c t  change i n e d u c a t i o n a l goals  an a c t i v e response to  and methods and  to changing  concepts and r i s i n g a s p i r a t i o n s f o r h e a l t h i n the States.  Not  considerable  United  only d i d the Standards become the b a s i s f o r improvement i n e x i s t i n g h e a l t h programs  a p o i n t of r e f e r e n c e  f o r developing  programs, but  they  became the s t r u c t u r e f o r e v a l u a t i n g and  certifying  h e a l t h programs by the American C o l l e g e  Health  Acknowledging the d i f f e r e n c e i n the mechanisms between American and  and  college  Association. funding  Canadian h e a l t h  care  programs, c o n s i d e r a t i o n of our n a t i o n a l Medicare p l a n suggests many i m p l i c a t i o n s f o r u t i l i z a t i o n of the S e r v i c e which are d i s c u s s e d To the extent  i n the r e p o r t of the  Health survey.  t h a t p e r t i n e n t d i f f e r e n c e s e x i s t e d between  recommendations contained  i n the Standards and  those  thought to be a p p l i c a b l e i n Canada, recommendations or suggestions f o r change have been adapted to s u i t Canadian context.  Generally,  the  however, the areas of  i n v e s t i g a t i o n were found to have the same concerns problems.  and  19  CHAPTER 3 REVIEW OF THE LITERATURE  3.1  The Development of Organized Student Health S e r v i c e s ' 8  9  The beginnings of student health services i n North America were concerned with methods of mass p h y s i c a l educat i o n patterned on those already popular i n Germany and Scandinavia.  Intercollegiate and, l a t e r , intramural sports  were offshoots of physical education and important ents of student health.  compon-  These were introduced at Harvard  University as early as 1825; by i860 most American colleges had gymnasia and the relevant equipment.  Amherst was the  f i r s t American college to broaden the concept of physical education and personal hygiene by developing such a department i n 1859.  Emphasis was given to the elements of envir-  onmental hygiene.  These growing concerns with p h y s i c a l  welfare were the forerunners of what i s today c a l l e d health education. Medical service i n the form of limited care and infirmaries f o r s i c k students was the l a s t cornerstone to be introduced f o r the promotion and maintenance of student health.  In some colleges t h i s was organized by the students  20  themselves but, i n most, h e a l t h s e r v i c e s o r i g i n a t e d w i t h one  o f the o t h e r programs.  Only i n a few  were h e a l t h s e r v i c e s i n t r o d u c e d  organizations  as an o v e r a l l p l a n .  Epidemics o f communicable diseases  i n colleges  hastened the development o f student h e a l t h s e r v i c e s i n the United  States  i n the e a r l y p a r t o f t h i s century, some-  times r e f e r r e d t o as the S a n i t a t i o n E r a .  In a d d i t i o n , the  poor p h y s i c a l standards o f Americans i n the F i r s t World War s t i m u l a t e d and,  considerable  i n t e r e s t i n student  health  subsequently, i n h e a l t h promotion i n the post-war  period,  the r e s u l t s o f which were the extension  of e x i s t -  ing services. Second World War experience w i t h p h y s i c a l ness programs f u r t h e r accentuated the n e c e s s i t y  fit-  of c o r r e l -  a t i n g a l l o f the elements o f p h y s i c a l e d u c a t i o n ,  personal  hygiene, and medical s e r v i c e to m a i n t a i n s a t i s f a c t o r y standards o f h e a l t h and f u n c t i o n a l performance.  To the  p r e s e n t day i t i s advocated t h a t any f a c t o r s a f f e c t i n g the p h y s i c a l o r mental h e a l t h o f c o l l e g e students w i t h i n the province  o f the student h e a l t h  falls  service.  Although almost a century l a t e r , B r i t i s h student health services followed  the same course as i n American  u n i v e r s i t i e s through an i n i t i a l i n t e r e s t i n p h y s i c a l e d u c a t i o n and t r a i n i n g .  Even before the advent o f the  21  National Health Service i n Great B r i t a i n i n 19^8, a report on i t s medical schools"'""'" recommended a properly organized student health service i n which treatment was not to be included but which was to be mainly preventive in character, free and available to a l l students and s t a f f . I l l n e s s found among students was to be dealt with by the insuring public agency, the National Health Service. o  Mair , who produced the f i r s t comprehensive account of student health services i n Great B r i t a i n , found that between 12 and 15% of a l l university students f a i l e d to graduate.  He pointed out that academic l i f e predisposes  to the creation of strains which can lead to examination f a i l u r e , p a r t l y explained by the psychological and emotional trauma which may a f f e c t students when they leave the security and protection of home and school.  Overseas students were  found to be even more isolated from t h e i r f a m i l i a r background thereby constituting a s p e c i a l problem r e l a t i v e to mental health.  However, the value of compulsory routine  medical examinations and procedures such as mass miniature radiography were questioned, and various ways i n which student health services could be improved were suggested. Generally, i t was found that the cost of univers i t y education was such that B r i t a i n , with i t s l i m i t e d resources, could not afford to waste human i n t e l l e c t ,  22  p a r t i c u l a r l y i f such waste originated from s o c i a l and psychological factors which could be prevented by appropriate health services. there was  I t was  thus concluded that  an urgent and pressing need f o r an appraisal  of student health services, where they existed. At the present time a l l student health services appear to f i t into some d e f i n i t e area of a basic program which developed not by planning, but through t r i a l  and  error i n response to s p e c i f i c needs f o r the promotion and maintenance of the health of students.  3.2  Other Developments In 1920  representatives from f i f t y - t h r e e  colleges and u n i v e r s i t i e s i n the United States formed the American Student Health Association whose name was changed i n 1948  to the American College Health Associa-  t i o n , hereinafter referred to as the A.C.H.A.  Article  II of the Association's Constitution describes i t s purpose as follows: VThe purpose of t h i s Association i s the e s t a b l i s h ment of an o f f i c i a l and authorized organization through which educational i n s t i t u t i o n s may work f o r the promotion of health, the prevention of disease, and the care of i l l n e s s i n college a n d university students." 1?  23  A f i f t y - y e a r history of the A.C.H.A. (1920-1970) was produced by Boynton^, a former president of the Assoc i a t i o n , and appears i n the June 1971 issue of The Journal of the American College Health Association.  The Journal  of the A.C.H.A., so renamed i n 1962, has been the o f f i c i a l publication of the Association since 1958 when i t o r i g i n ated as a b u l l e t i n c a l l e d Student Medicine. The U.B.C. Health Service i s a member of the P a c i f i c Coast College Health Association, an a f f i l i a t e of the A.C.H.A., the Director of the service being an individual member of the A.C.H.A.  The purpose of t h i s  a f f i l i a t e Association, described i n A r t i c l e II of i t s Constitution and By-Laws, i s as follows: "The purpose of t h i s Association i s to provide i n the P a c i f i c Basin an organization i n which i n s t i t u tions of higher education, other organizations and interested individuals may work together to promote health i n i t s broadest aspects f o r students and a l l - i k other members of the college community." No reference can be found i n the l i t e r a t u r e pertaining to the Canadian counterpart of the A.C.H.A., The Canadian Association of College Health Services. I t i s held to be an informal organization which conducts annual meetings of student health services personnel from across Canada f o r the purpose of exchanging ideas and i n formation.  24  A five-year Medline search of bibliographic c i t a t i o n s r e l a t i n g to student health services, conducted f o r t h i s study by the U.B.C.'s Woodward Biomedical Library, revealed only one reference s p e c i f i c a l l y indexed as Canadian.  This was  a three-year study of the u t i l i z a t i o n of  health services at Dalhousie 1969  to 1972.  University i n Halifax from  More than one-half of the 248  citations  generated by the search were from The Journal of the American College Health Association, the primary source of information pertaining to student health services i n North America.  No corresponding  publication was  found  to be produced by the Canadian Association. Approximately 86 references i n the search were concerned with p s y c h i a t r i c problems, mental health, c l i n i c a l psychology, or psychological counseling of students. Other references related to drug abuse, sex  counseling,  b i r t h control and/or abortion, and a substantial number to dental services, c l i n i c a l studies and a t t i t u d i n a l surveys.  Very few references pertained to the organization,  operation, or evaluation of student health services per se, although the need f o r , and lack of, evaluation i s stressed throughout the l i t e r a t u r e . Only one other Canadian study was found i n the literature.  I t was  the 1967  Report on Health and P s y c h i a t r i c  25  Services on Canadian Campuses produced f o r The Canadian Union of Students by a former Consultant P s y c h i a t r i s t at the U.B.C. Health Service.  This document records  that the oldest student health service i n Canada was established at Mount St. Bernard College i n Nova Scotia in the year 1884.  Three other Canadian campuses were  reported to have had student health services f o r over f i f t y years.  I t was  found that health services were  provided on 77.5% of Canadian u n i v e r s i t y campuses, 38.8$ with infirmary f a c i l i t i e s , and kk.9f° provided p s y c h i a t r i c services. 17  One l o c a l study ' was  discovered to have been  conducted i n 1971 by two students at the Simon Fraser University on an Opportunities f o r Youth grant. not published, a copy of the study was ence from one of the students  Although  obtained f o r r e f e r -  involved i n the project which  was primarily designed to promote the development of student health services at that u n i v e r s i t y . 18  Another l o c a l health survey  i n 1971  found that  students at both colleges and u n i v e r s i t i e s i n B r i t i s h Columbia reported l i t t l e concern about physical health but placed more emphasis on s i t u a t i o n a l , psychological, and emotional concerns.  The survey thus concluded that  the p r i o r i t i e s of a college health service should be an  26  e f f i c i e n t program to deal with minor emergencies, and consultative resources to a s s i s t students i n coping t h e i r f i n a n c i a l , academic/career and  with  emotional/social  problems. 19  F i n a l l y , a recent survey  7  of mental health  and related f a c i l i t i e s on the U.B.C. campus suggested that the obtaining of s p e c i f i e d information through evaluation procedures would help the health care admini s t r a t o r to have a clearer basis f o r making decisions f o r program changes, and that the accountability demonstrated i n a l l functions of the campus services surveyed should be one of the most important factors f o r continued support of programs and expansion and change within the programs.  The findings of the current study endorse  the conclusions and recommendations of that survey. 3.3  Program Evaluation Discussions of evaluation i n the health care  l i t e r a t u r e comprise a very broad range of elements: concepts; general issues; p r i n c i p l e s ; methods; indices; and s p e c i f i c studies.  But reviews of programs i n many  areas have revealed a paucity of both conceptualization and s c i e n t i f i c research on the effectiveness of most program a c t i v i t i e s .  27 20  21  Deniston et a l .  '  d i f f e r e n t i a t e d between  program e f f e c t i v e n e s s and program e f f i c i e n c y i n  evaluat-  i n g the performance of a program, t h a t i s , to what  extent  were o b j e c t i v e s a t t a i n e d as a r e s u l t of a c t i v i t i e s  (program  e f f e c t i v e n e s s ) and a t what c o s t (program e f f i c i e n c y ) . 22 Roemer  presented a survey of the  literature  addressed to the v a r i o u s problems encountered i n i n g h e a l t h s e r v i c e programs and  suggested a framework f o r  a n a l y s i s of the e v a l u a t i o n of v a r i o u s of h e a l t h  evaluat-  systems or subsystems  organizations. His framework was  program can be  evaluated  based on the premise t h a t a  i n the context  mediate , or long-term h o r i z o n s  and  of s h o r t ,  inter-  t h a t s e v e r a l phenomena  w i t h i n each l e v e l may be d e f i n e d and measured. 23 7 MacMahon et a l . , Knutson, Levey and J  Loomba,  and v a r i o u s other authors have d e s c r i b e d what they to be the n e c e s s a r y p r i n c i p l e s or steps evaluation.  James  J  Methods of h e a l t h care  t i o n have been compiled i n a book of readings and published  at McMaster U n i v e r s i t y .  consider  i n the process of  developed f o u r c a t e g o r i e s f o r  i n g p u b l i c h e a l t h programs.  24  evaluatevalua-  exercises,  26 27  Schulberg and  h i s colleagues  ' endorsed Knutson's  o r g a n i z a t i o n a l and p e r s o n a l l y - o r i e n t e d reasons f o r t i o n , supporting  the view t h a t the purpose of  evalua-  evaluation  28  i s related to the subsequent u t i l i z a t i o n of the findings. They c l a s s i f i e d program evaluation models into two categories, the goal-attainment  and systems models, and they  discussed the c h a r a c t e r i s t i c s and l i m i t a t i o n s of each as they affect the implementation of program research findings. Evidence that evaluation research i s c l o s e l y related to program planning can be found i n James' desc r i p t i o n of a c i r c u l a r evaluation process i n the goalattainment model.  Etzioni  found that the systems model  establishes the degree to which a program r e a l i z e s i t s goals under a given set of conditions, that i s , a balanced d i s t r i b u t i o n of resources among a l l organizational objectives, not simply the s a t i s f a c t i o n of any one goal.  Thus  the systems model requires considerable knowledge of the way i n which an organization functions.  One advantage  i s that much more c o l l e c t e d data i s included i n the analys i s than i s possible i n c l a s s i c a l research design? another i s i t s a b i l i t y to o f f e r the program administrator guidance f o r implementing change. 29  Schulberg and Baker  7  suggested that organiza-  tions should e s t a b l i s h planning d i v i s i o n s to a s s i s t the feedback of research findings to the program administrator and to insure t r a n s l a t i o n of research into practice. I t was thought that feedback can be enhanced by the design  29 of evaluation procedures which appropriately f i t the scheduled  decision-making needs of an organization, and  which have data available at a time when they can be used f o r planning. In terms of p r a c t i c a l input, i t was generally found that evaluation i n the health f i e l d has been conducted i n the sense of comparing achievements with goals established i n the planning phase.  Action research which  contributes much to program progress was not found to substitute f o r controlled studies which measure program achievement, but long-range controlled studies, on the other hand, did not y i e l d early feedback.  Indeed, i t  has been found necessary to f i r s t determine which method w i l l best serve the purposes defined. Both Suchman^ and Herzog^  0  have aimed f o r a  more meaningful d e f i n i t i o n of evaluation and a more usef u l system f o r c l a s s i f y i n g , comparing, and making more cumulative the many evaluation studies i n public service and s o c i a l action programs. T r i p o d i - ^ and his colleagues u t i l i z e d a range of sources i n the development of evaluation guidelines and suggested the use of Herzog's "do's and don'ts" of research to provide a good, general point of view f o r conducting  evaluative studies.  They also found to be  30 valuable Suchman's consideration of the strengths and weaknesses of various designs used i n evaluative research. His rejection of one correct design f o r experimental research emphasized that "the wide range of e x i s t i n g evaluat i o n studies needs systematic c l a s s i f i c a t i o n according to s i g n i f i c a n t c r i t e r i a of content and method."  (4. - p.7)  But Knutson,'' Reinke,-^ and others, have con2  tended that health care programs are not l i k e laboratory experiments; they seldom s t a r t and end at s p e c i f i c predetermined points.  Baselines and f i n a l measurements  cannot be clear-cut, nor can measurements be  completely  independent when the process of interviewing or c o l l e c t ing data i s i n i t s e l f an educational process which may influence and even change the behavior of program personnel.  Indeed, the task of increasing the p r o b a b i l i t y  of more e f f i c i e n t and effective health services presents a r e a l challenge to program planning, development and evaluation. Wessen-^3 has suggested  that the a c t i v i t y of  evaluation should be part of administrative routine i n a well-run organization.  However,the process of evalua-  tion i s often problematic and requires careful analysis and formulation of methodology f o r i t s conduct.  Particu-  l a r l y important i s the task of developing more sensitive  31  measures of the r e l a t i v e effectiveness of health services. Although excellent designs for such research have evolved i n c l i n i c a l tests and t r i a l s , such methods have not yet frequently been applied to the effectiveness of whole programs.  One  of the d i f f i c u l t i e s i s to specify p r e c i s e l y  what should be the target outcomes against which success or f a i l u r e should be measured.  Another i s to create a  s e t t i n g controlled enough that the effects of a s p e c i f i c program can be separated from i n c i d e n t a l e f f e c t s . another i s the d i f f i c u l t y and expense of maintaining  Still follow-  up over the period necessary to demonstrate program e f f e c t s . In addition, there i s the need to v a l i d l y interpret and successfully apply the findings of evaluation. Wessen-^ noted that perhaps the p r i n c i p a l impediment to the implementation of evaluation i s beyond the sphere of s c i e n t i f i c technique.  I t may  tance of persons and organizations which may  l i e i n the r e l u c -  to face the c r i t i c i s m  be implied i n impartial evaluation.  But, when  an evaluative study i s conducted, i t can lead to further research questions which may  uncover new  insights of r e a l  importance f o r the advancement of professional theory and practice.  32  PART I I  CONTENTS OF THE STUDY  33 CHAPTER 4 HISTORY AND  BACKGROUND OF  THE  U.B.C. HEALTH SERVICE  The  i n f o r m a t i o n a c q u i r e d f o r t h i s chapter  obtained from two  sources:  34  r e p o r t s and papers-' Nursing  one was  the o r i g i n a l  documented by Miss E.M.  was  historical  U p s h a l l , P.H.N. ,  S u p e r v i s o r of the H e a l t h S e r v i c e from 1936  to December, 35  1971;  the other was  the Annual Reports of the H e a l t h  from 1954-55 to 1974-75.  Reports c o u l d not be l o c a t e d f o r  the years 1958-59. I960 through 1964, t i o n f o r 1970-71 was  Service^  and  1970-71.  Informa-  found, however, i n the comparative ana-  l y s i s of s t a t i s t i c s i n the 1971-72 r e p o r t . Because of the v a s t amount of h i s t o r i c a l data found i n the r e p o r t s and papers, the s e l e c t e d h i g h l i g h t s have been summarized by date to present  an overview of developments These are  and  trends  i n the H e a l t h S e r v i c e over the y e a r s .  sented  i n a p o i n t - l i k e manner, f o l l o w e d by f o u r t a b l e s d e p i c t -  i n g annual r e g i s t r a t i o n , H e a l t h S e r v i c e v i s i t s ,  pre-  Hospital u t i l i -  z a t i o n , and a summary of s e r v i c e s . HISTORICAL SUMMARY: 1915  - I n c e p t i o n of the U n i v e r s i t y of B r i t i s h Columbia. ( T h i s date was  a c t u a l l y documented as 1912  U.B.C. Calendar s t a t e s i t to be 1915.)  but  the  34  - M e d i c a l D i r e c t o r of the Vancouver School  Board  appointed to examine U n i v e r s i t y s t u d e n t s . i n a t i o n s were performed  i n the evening a t the  Vancouver General H o s p i t a l O.P.D. u n t i l Students  Exam-  examined were a l l new  1936.  U.B.C. r e g i s t r a n t s ,  women p a r t i c i p a t i n g i n the major a t h l e t i c s ,  and  students whose p h y s i c a l c o n d i t i o n had been unsati s f a c t o r y i n the p r e v i o u s year. 1925  - U.B.C. moved to i t s p r e s e n t West P o i n t Grey campus. - Winter s e s s i o n student p o p u l a t i o n : session:  1984,  summer  394.  - Student H e a l t h S e r v i c e commenced w i t h the a p p o i n t ment of a Medical H e a l t h O f f i c e r by an O r d e r - i n Council. 1927  - P r o v i n c i a l Board of H e a l t h appointed f i r s t  Public  H e a l t h Nurse f o r the U n i v e r s i t y a r e a , f o l l o w i n g a measles epidemic. - P r o v i s i o n o f a three-room  o f f i c e i n the  Auditorium  b u i l d i n g allowed f o r the continuous o p e r a t i o n of a f u l l - t i m e H e a l t h U n i t on the  campusessentially  a p r e v e n t i v e and d i a g n o s t i c s e r v i c e w i t h no  provi-  sion f o r s i c k students. - Promotion and maintenance of the h e a l t h of the students  through:  - h e a l t h a p p r a i s a l of a l l new  students  - encouragement to c o n s u l t w i t h p r i v a t e p h y s i c i a n s f o r e a r l y advice and treatment  of d e f e c t s found  35  - p r e v e n t i o n and c o n t r o l of communicable d i s e a s e s through immunization and g e n e r a l - emergency f i r s t - a i d treatment  sanitation  and g e n e r a l h e a l t h  advice. - formal health teaching 1928- 29  - 77.7% o f students r e p o r t e d t o have been v a c c i n a t e d f o r smallpox a t some time d u r i n g t h e i r l i v e s .  1929- 30  - P o i n t Grey Reserve became known as the U n i v e r s i t y Endowment Lands  1932  (U.E.L.).  - Epidemic o f smallpox i n Vancouver; e x t r a v a c c i n a tions given.  1935-36  - P h y s i c a l Education organized on a v o l u n t a r y b a s i s at U.B.C. i n response to"the need o f the student body f o r a s y s t e m a t i c p h y s i c a l a c t i v i t y program". Emphasis was on i n t r a m u r a l a t h l e t i c s as the geog r a p h i c a l l o c a t i o n o f U.B.C. p r e c l u d e d major intercollegiate  1936  competition.  - M e t r o p o l i t a n H e a l t h Committee, organized by the P r o v i n c i a l M.H.O., p r o v i d e d a g e n e r a l i z e d p u b l i c h e a l t h program f o r G r e a t e r Vancouver and b e n e f i t s of e x t r a s e r v i c e s and f a c i l i t i e s o f the l a r g e r o r g a n i z a t i o n f o r the U n i v e r s i t y area. - Appointment o f Miss U p s h a l l as P u b l i c Health Nurse; r e t i r e d  1971.  - I n t r o d u c t i o n o f c l e r i c a l and other a d d i t i o n a l s t a f f t o the H e a l t h S e r v i c e .  36  1936-37  -  T u b e r c u l o s i s occupied f i r s t p l a c e as cause of for  death o f c o l l e g e - a g e persons; e a r l y d i a g n o s i s and treatment  p r o j e c t planned - 24 cases o f  a c t i v e pulmonary T.B. d i s c o v e r e d a t U.B.C. b e t ween 1937 and 1945, but r a t e of i n f e c t i o n down. - Serious a t t e n t i o n given to i n f e c t i o u s diseases; f a i l u r e t o r e p o r t t o nurse r e s u l t e d i n e x c l u s i o n from the U n i v e r s i t y . - Student p o p u l a t i o n : 1938  2,216.  - P s y c h i a t r i c c o n s u l t a t i v e s e r v i c e commenced w i t h an average o f one v i s i t p e r p a t i e n t .  1939-1945  - Second World War.  1941-42  - T.A.B.T. v a c c i n e g i v e n t o a l l B a c t e r i o l o g y students s t u d y i n g the Typhoid  1945  organism.  - H e a l t h S e r v i c e expanded t o a converted army hut w i t h i n c r e a s e d space and p e r s o n n e l . - Two-year compulsory P h y s i c a l Education i n order t o graduate;  m e d i c a l recheck  required required  i n second year to determine p h y s i c a l c a p a c i t y for  the program.  - Expansion o f campus e a t i n g establishments and temporary b u i l d i n g s . - Increased H e a l t h S e r v i c e r e s p o n s i b i l i t y f o r campus s a n i t a t i o n , f o r example, p h y s i c a l examinat i o n o f food  handlers.  37  - Formation o f P r e s i d e n t ' s Committee on Student H e a l t h S e r v i c e and H e a l t h Education,  with r e -  p r e s e n t a t i o n from a l l other i n t e r e s t e d departments . - H e a l t h S e r v i c e acted as L i a i s o n O f f i c e r between the medical  departments o f D.V.A. and students  on g r a n t s .  Treatments g i v e n under i n s t r u c t i o n s  of D.V.A. medical  staff  (e.g.  a n t i - a l l e r g e n and  p e n i c i l l e n ) ; same p o l i c y f o r students  under care  of p r i v a t e p h y s i c i a n s . 1946  - Smallpox scare i n Vancouver; e x t r a v a c c i n a t i o n clinics  1947  held.  - A l l students p a r t i c i p a t i n g i n competitive r e q u i r e d t o have a y e a r l y medical  sports  examination;  r e f e r r e d t o f a m i l y p h y s i c i a n s f o r necessary  treat-  ment o f d e f e c t s found. - Follow-up o f d e f e c t s by t i c k l e r - f i l e method, u s i n g a form sent t o students  a s k i n g them t o  r e p o r t back t o H e a l t h S e r v i c e . - Student p o p u l a t i o n :  8,600, more than double  1945 census due to D.V.A. c r e d i t s . - Review o f t e n y e a r s s i n c e 1937 r e v e a l e d : - t o t a l number o f p h y s i c a l examinations i n c r e a s e d  350%. - t o t a l number o f p h y s i c a l examinations of new students,  e x c l u d i n g e x - s e r v i c e members, i n c r e a s e d 188$  38  t o t a l number of v i s i t s to the H e a l t h S e r v i c e increased  517%.  t o t a l number of c o n s u l t a t i o n s by the M.H.Q.. increased -  70%.  m e d i c a l examination  r e s u l t s were used as an  index of student h e a l t h and to determine  trends  such as i n c r e a s e i n h e i g h t of male s t u d e n t s . -  A.C.H.A.'s T h i r d N a t i o n a l Conference  on H e a l t h  i n C o l l e g e s , a t which U.B.C.'s Dean of Medicine was  a committee chairman, u r g e n t l y recommended  the p r o v i s i o n of d e n t a l d i a g n o s t i c and t i c services. t h i s care was warrants  It stated: proved  "The  importance  d u r i n g World War  t h i s recommendation."  therapeuof  I I and  The u n i t r e c o r d  system a l s o recommended f o r a l l student H e a l t h Services. 1950  -  U.B.C., M c G i l l , Toronto, and one o t h e r Canadian u n i v e r s i t y belonged  t o the American C o l l e g e H e a l t h  Association. T.B.  program appeared  the c o n t i n e n t ; 6,149  to be one  of the b e s t on  chest x-rays taken d u r i n g  the p r e v i o u s s e s s i o n w i t h n i n e newly cases of pulmonary  diagnosed  T.B.  Smallpox v a c c i n a t i o n compulsory; 93.6%  of  new  students a l r e a d y v a c c i n a t e d on e n t r y to U n i v e r s i t y , w i t h immunization year.  and f o l l o w - u p done d u r i n g the  39  - T.A.B.T. g i v e n t o a l l f i r s t - y e a r  Bacteriology  students. 1951  - H e a l t h S e r v i c e moved t o present  location i n  Wesbrook B u i l d i n g , w i t h i n t r o d u c t i o n o f t h e r a p e u t i c s e r v i c e , c l i n i c a l l a b and x-ray u n i t . - H o s p i t a l opened; i s o l a t i o n o f communicable diseases  considered  important i n the p r e v e n t i o n  of epidemics i n the dorms and r e s i d e n c e s . 1952  - U.E.L. p u b l i c h e a l t h s e r v i c e , e x c l u s i v e o f the U n i v e r s i t y campus, t r a n s f e r r e d to U n i t of the M e t r o p o l i t a n  #3  H e a l t h Committee.  - H o s p i t a l i n c l u d e d i n B.C. H o s p i t a l Insurance p l a n , a l l o w i n g the admission o f non-students. - P r o v i n c i a l Board o f H e a l t h Survey Chest U n i t incorporated  i n t o x-ray u n i t t o s e r v i c e West  P o i n t Grey as w e l l as U.B.C. 1955-56  - H e a l t h p a t t e r n s showed an i n c r e a s e i n r e s p i r a t o r y i n f e c t i o n s (the l a r g e s t group o f c o n d i t i o n s seen) and s k i n c o n d i t i o n s , a decrease i n the number of a c c i d e n t s r e p o r t e d , and T.B. s t i l l  o f concern  w i t h 3,128  students  chest x-rays taken and 21  under r e g u l a r s u r v e i l l a n c e . student  There were 11 non-  H o s p i t a l deaths.  - Revaccinations  f o r smallpox were the g r e a t e s t  number o f immunizations g i v e n ; others were f o r typhoid,  s c a r l e t f e v e r , staph.,  a l l e r g i e s , and  c h o l e r a ; B.C.G. s t i l l being done.  40  - Three home v i s i t s made, one to a R u r a l Youth Training  School.  - 480 doses o f a n t i b i o t i c s g i v e n . 1957-58  - Epidemic 1957.  o f A s i a t i c i n f l u e n z a i n Sept./Oct.,  caused marked i n c r e a s e i n the percentage  of r e s p i r a t o r y d i s e a s e s d e a l t with. - A l l o t h e r disease c a t e g o r i e s showed a decrease from o t h e r y e a r s , i n d i c a t i n g no major h e a l t h problems. - Summer s c h o o l enrolment i n c r e a s e d 93-7% which considerably increased Health Service  attendance.  - Students g i v e n o p t i o n o f having U n i v e r s i t y entrance m e d i c a l examinations  by f a m i l y p h y s i c i a n s .  - Disease s t a t i s t i c s excluded o u t p a t i e n t s under M.S.I, o r p r i v a t e c a r e . - S a l k v a c c i n e made a v a i l a b l e by P r o v i n c i a l H e a l t h Department f o r mass p o l i o v a c c i n a t i o n c l i n i c s . - 2,872 chest x-rays taken, i n c l u d i n g a l l c o n t a c t s of f i v e cases o f a c t i v e pulmonary T.B. d i s c o v e r e d i n one f a c u l t y ; f o u r admitted  to the sanatorium,  73 under r e g u l a r s u r v e i l l a n c e . - Department o f B a c t e r i o l o g y began p r o v i s i o n o f a n t i b i o t i c s e n s i t i v i t y s e r v i c e w i t h 66 cases. - 31 home v i s i t s made, i n c l u d i n g dorms and r e s i d e n c e s . - 10 students admitted treatment;  12 s t a f f  to Hospital f o r p s y c h i a t r i c admissions.  41  Expansion  of psychiatric service  planned.  D i r e c t o r p a r t i c i p a t e d i n M e d i c a l S e r v i c e and A d m i n i s t r a t i o n s e c t i o n o f A.C.H.A. Annual Meeting;  reported valuable material applicable  to U.B.C. o p e r a t i o n gained from U.S. H e a l t h Service  Directors.  Nursing S u p e r v i s o r r e a p p o i n t e d T r e a s u r e r o f Canadian P u b l i c H e a l t h A s s o c i a t i o n , B.C. Branch. 1959-60  -  Expansion  o f p s y c h i a t r i c s e r v i c e by f o r m a t i o n o f  D i v i s i o n of P s y c h i a t r y t o handle the wide range of student problems p r e s e n t i n g i n the emotional and p s y c h i a t r i c f i e l d s . -  A n a l y s i s o f decreased student absences from c l a s s e s confirmed g e n e r a l good h e a l t h o f students r e p o r t e d by decreased H e a l t h S e r v i c e attendance, except f o r p s y c h i a t r i c  service.  9 off-campus deaths, one s u i c i d e ; one student who d i e d o f a heart a t t a c k while s k i i n g had been r e s t r i c t e d i n p h y s i c a l a c t i v i t y by the H e a l t h S e r v i c e . 954 chest x-rays taken, 1 a c t i v e case o f pulmonary T.B. -  admitted t o sanatorium.  P o l i c y changes i n c l u d e d : r o u t i n e chest survey x-rays on new students d i s c o n t i n u e d because o f r e c e n t concern w i t h r a d i a t i o n exposure; tuberculin tests  o n l y those w i t h p o s i t i v e  x-rayed.  42  - H e a l t h S e r v i c e excuses  f o r absence from P.E.  c l a s s e s no l o n g e r r e q u i r e d , w i t h a r e s u l t a n t decrease  i n P.E. student  visits.  - Requirement f o r readmission t o c l a s s  slip  f o l l o w i n g 3 days absence due t o i l l n e s s changed to one week; r e s u l t e d i n decrease  o f 'new v i s i t s '  by n e a r l y '50%. - M e d i c a l care and i n v e s t i g a t i o n g i v e n i n c r e a s e d a t t e n t i o n i n workload;  more space and s t a f f  r e q u i r e d w i t h i n c r e a s i n g student The  enrolment.  c h a r t i n Appendix l a p r e s e n t s a comparison o f  student r e g i s t r a t i o n s and t o t a l v i s i t s f o r i l l n e s s o r observ a t i o n , f o r the years 1945 to I960.  Appendix Ib p r e s e n t s  the same comparison f o r the years I960 to 1970. - H e a l t h S e r v i c e r e p o r t e d to be g a i n i n g recogn i t i o n as p r o g r e s s i v e department; U n i v e r s i t y of Melbourne p a t t e r n i n g h e a l t h program a f t e r U.B.C.'s; D i r e c t o r i n v i t e d t o speak on U.B.C. H e a l t h S e r v i c e a t the B r i t i s h Student O f f i c e r s ' A s s o c i a t i o n annual  Health  conference.  - F i r s t A.C.H.A. annual meeting i n Canada; D i r e c t o r p a r t i c i p a t e d i n both business and c l i n i c a l s e s s i o n s a t Toronto. 1964-65  - Introduction of physiotherapy  service.  - Present A s s i s t a n t D i r e c t o r , i n t e r e s t e d i n p r e v e n t i v e and c u r a t i v e a t h l e t i c medicine, t h a t department a t Harvard  University.  visited  43  - Plans made to conduct examination  comprehensive  i n c l u d i n g E.K.G., of P.E.  delayed because o f space and s t a f f - Clinic  initial Majors;  shortage.  s t a r t e d f o r students w i t h emotional p r o -  blems r e l a t e d t o adjustment expansion  of c l i n i c  a t the U n i v e r s i t y ;  planned.  - T o t a l O.P.D. student attendance  unchanged a l -  though U.B.C. r e g i s t r a t i o n i n c r e a s e d . - Student admissions student admissions  to H o s p i t a l decreased, increased.  - M e d i c a l S e r v i c e s P l a n announced by  Provincial  Government; i n c r e a s e i n students covered some form of p r e - p a i d medical care C o n s i d e r a t i o n g i v e n to b i l l i n g for  by  (M.S.I.).  insurance schemes  s e r v i c e s rendered to student p a t i e n t s ,  a fee f o r those w i t h no comprehensive 1965-66  non-  - Total v i s i t s 50% more new  and  coverage.  and numbers r e p o r t i n g i n c r e a s e d ; p a t i e n t s seen by p s y c h i a t r i s t s  i n p r e v i o u s year.  than  Need to expand p s y c h i a t r i c  service projected. - Student  admissions  student admissions - I n f l u e n z a epidemic  to H o s p i t a l i n c r e a s e d ; nondecreased. r e p o r t e d i n Feb./March,  - C o n t i n u i n g i n f o r m a l d i s c u s s i o n s on l i f e h e l d i n student r e s i d e n c e s ; i n c r e a s e d w i t h o t h e r departments.  1966.  problems liaison  44  - Present Nursing Supervisor attended course on New Perspectives i n College Health Nursing i n Colorado. - Consultant P s y c h i a t r i s t attended annual A.C.H.A. meeting i n C a l i f o r n i a ; Survey of Health and Psyc h i a t r i c Services on Canadian Campuses conducted f o r the C.U.S. - New Physiotherapy Department opened i n the War Memorial Gymnasium with a f u l l - t i m e therapist. - A l l students n o t i f i e d with spring marks of end of M.S.I, contract with U.B.C.; B.C.M.P. offered comprehensive coverage at lower rate. 1966-67  - Federal Medicare announced f o r July 1968; feefor-service to be charged f o r medical care provided at July 1, 1967.  Concern expressed regard-  ing u t i l i z a t i o n of Health Service by students who might opt f o r private medical care. - 3-month e l i g i b i l i t y f o r B.C. Hospital Insurance not applicable to those i n province as students only; University Health and Accident Plan a v a i l able f o r foreign students. - Increased emphasis on p s y c h i a t r i c service, esse n t i a l l y a short-term procedure; 51 students admitted to Hospital f o r psychiatric  treatment;  problem of L.S.D. complications subsiding but increased attention to marijuana use expected;  45  talks on drug abuse given by s t a f f to student groups, on and o f f campus; continuing  informal  discussions i n male and female residences primari l y concerned sex education; with Counseling  regular meetings held  Service and, occasionally, Housing  Administration; budget requested f o r c l i n i c a l psychologist (nursing counselor or p s y c h i a t r i c s o c i a l worker). - F i r s t organizational meetings (Toronto and Washington) of Canadian Association of College  Health  Services, a united e f f o r t toward uniformity i n the method of providing health services i n Canada. 1967-68  - Medicare i n B.C.  July, 1968;  a c q u i s i t i o n of cov-  erage encouraged by s t a f f ; fee-for-service operation required more c l e r i c a l work. - F i r s t compulsory health and hospital insurance introduced f o r non-B.C. residents by Board of Governors' r u l i n g . - Need to expand service forecast although workload remained  constant.  - Compulsory entrance physical examination no longer required (because of Medicare), but suggested as valuable. - Intake of p s y c h i a t r i c service l e v e l l e d o f f with estimated 2% of student population treated during previous s i x years but 5% requiring help;  increase  46  in private p s y c h i a t r i s t s and r e f e r r a l s due to medical insurance coverage; weekly meetings held with other campus counseling services f o r increased understanding of student problems, non-breach of confidence seen i n i n t e r d i s c i p l i n a r y approach; 73 admissions to Health Service Hospital, 4 transfers to V.G.H. Psychiatric Unit; Consultant P s y c h i a t r i s t participated i n Federal/ P r o v i n c i a l conferences on drug abuse. - Good attendance at informal sex education sessions. - F i r s t meeting of Health Service Directors of a l l B.C. u n i v e r s i t i e s f o r the purpose of developing one common medical history record to f a c i l i t a t e transfer of students; annual meetings planned. 1968  - Health Sciences Centre Psychiatric Unit opened on campus.  1968-69  - Increased student r e g i s t r a t i o n did not show corresponding increase i n Health Service workload; more students thought to be consulting private physicians because of universal health insurance, but only 90$ of student population appeared to have adequate medical coverage. - Entrance physical examinations abandoned. A graphical picture of the number of students r e -  ceiving medical examinations f o r the years 1928, 1938, and  47  1944  through 1956,  i s presented i n Appendix I l a .  c h a r t f o r the years 1945 lib.  through i960 i s shown i n Appendix  Appendix I I I shows the number of new  students who  m i t t e d r e q u i r e d medical f o l d e r s a t enrolment 1958  through 1969,  t i o n s performed  The same  sub-  f o r the years  i n c l u d i n g the number of p h y s i c a l examina-  by the H e a l t h S e r v i c e and by p r i v a t e d o c t o r s .  The l a s t y e a r r e f l e c t s the d i s c o n t i n u a t i o n o f entrance - Operation Doorstep:  physicals.  v o l u n t a r y chest x-ray  l a b . t e s t i n p l a c e of compulsory  and  tuberculin  test;  only 6$ of students found to have p o s i t i v e t u b e r c u l i n s and no new  cases of T.B.  found i n two y e a r s .  - Orthopedic and Dermatology c l i n i c s commenced. - P s y c h i a t r i c s e r v i c e continued to be r e s p o n s i b l e f o r about 2$ of the student p o p u l a t i o n ; 51  stu-  dents admitted to the H o s p i t a l , 7 to o t h e r psyc h i a t r i c u n i t s ; 2 students were known to have committed s u i c i d e w i t h 2 others  unconfirmed,  c o n s i d e r e d low by s t a t i s t i c s of s t u d i e s done elsewhere. 1969-70  - O v e r a l l average  i n c r e a s e of 20$  l o a d w i t h an i n c r e a s e of 40$  i n c l i n i c work-  in allergy  injections  g i v e n ; problems f e l t i n space b e i n g used to maximum. - Dermatology and Orthopedic c l i n i c s r e p o r t e d s u c c e s s f u l w i t h a 25$ Gynecology  clinic  i n c r e a s e i n attendance;  planned.  48  - Student days i n H o s p i t a l d e c l i n i n g d e s p i t e i n c r e a s i n g enrolment;  healthier population  assumed r e s p o n s i b l e as w e l l as h i g h e r academic entrance requirements  of U n i v e r s i t y .  - L i a i s o n w i t h D i r e c t o r of Housing, of  as l a r g e p a r t  H e a l t h S e r v i c e work a s s o c i a t e d w i t h students  l i v i n g i n residences. - No major changes i n p s y c h i a t r i c s e r v i c e ; chotherapy  psy-  sessions increasing.  - 10 student deaths r e p o r t e d , the l a s t y e a r t o be i n c l u d e d i n annual r e p o r t s . 1971  - Community H e a l t h Centre opened on campus.  1971-72  - Miss U p s h a l l r e t i r e d ; Miss Boyle  appointed  Nursing S u p e r v i s o r . - F o u r t h f u l l - t i m e p h y s i c i a n appointed. - S t a t i s t i c a l r e p o r t i n g changed s i g n i f i c a n t l y ; f a c u l t y and s t a f f attendance  a t Community H e a l t h  Centre r e f l e c t e d i n f i g u r e s . - H e a l t h S e r v i c e s e e i n g students only, but cont i n u e d as a campus emergency c e n t e r because o f lab.  and x-ray  facilities.  - P a t r o l v e h i c l e s a c t i n g as campus ambulances. - H o s p i t a l workload patient  unchanged but fewer student  days.  - No major h e a l t h problems o r epidemics.  49  - O.P.D. p a i n t e d and some new f u r n i s h i n g s purchased. - Very few students c o n s i d e r e d n o t adequately p r o t e c t e d hy h e a l t h i n s u r a n c e ; compulsory hosp i t a l and m e d i c a l insurance f o r non-Canadian students at  ( i n o r d e r t o complete  registration  U n i v e r s i t y ) considered e f f e c t i v e r e g u l a t i o n  f o r p r o t e c t i n g students f i n a n c i a l l y i n case o f illness. - L i v e - i n Resident o n - c a l l s e r v i c e f o r H o s p i t a l discontinued. 1972- 73  - Workload unchanged; l i t t l e abuse observed;  evidence o f drug  i n c i d e n c e o f v e n e r e a l disease  r e p o r t e d low while o t h e r segments o f the commu n i t y had a marked i n c r e a s e ; new s p e c i a l i s t clinic  s e r v i c e s planned w i t h i n p u t from  staff  members. - H o s p i t a l Head Nurse r e t i r e d ; succeeded  by p r e s e n t  Head Nurse, experienced i n I n t e n s i v e Care. - Mental H e a l t h U n i t opened i n space vacated by the Department o f H e a l t h Care and Epidemiology; space i n O.P.D. eased by move o f p s y c h i a t r i c 1973- 74  service.  - S t a t i s t i c s showed a 10% o v e r a l l i n c r e a s e i n c l i n i c visits,  w i t h a 22% i n c r e a s e i n treatments and  c o u n s e l i n g by nurses, thought of  t o be b e t t e r use  t h e i r t r a i n i n g and p r o f e s s i o n a l s k i l l s .  50  - Space problems expressed; s p e c i a l  clinics  i n c l u d e d two Opthalmology and one Ear, Nose, Throat c l i n i c p e r week; s p e c i a l equipment r e q u i r e d f o r c l i n i c s s a i d to preclude other use of space; but more complete medical care aimed for. - P s y c h i a t r i c s e r v i c e showed s l i g h t i n c r e a s e over p r e v i o u s year. - H o s p i t a l i n c r e a s e i n p a t i e n t days due to nonstudents; student admissions  unchanged.  - H o s p i t a l r e d e c o r a t e d ; some beds r e p l a c e d . - Disease c l a s s i f i c a t i o n s r e l a t i v e l y unchanged i n order o f g e n i t o - u r i n a r y , a l l e r g i e s and misce l l a n e o u s , bones and a c c i d e n t s , s k i n c o n d i t i o n s , and eye, ear, nose and t h r o a t c a t e g o r i e s ; g e n e r a l p a t t e r n o f student use o f H e a l t h S e r v i c e maintained. 1974-75  - O v e r a l l s t a t i s t i c s comparable t o p r e v i o u s y e a r s ' experience; 33$ i n c r e a s e i n treatments  and coun-  s e l i n g by nurses; s t r a i n on space and p e r s o n n e l r e p o r t e d due to crowded f a c i l i t i e s and s p e c i a l c l i n i c s ; w i n t e r s e s s i o n enrolment:  22,035.  - New x-ray equipment i n s t a l l e d ; survey chest u n i t not r e t a i n e d w i t h r e s u l t a n t decrease  i n number  of f i l m s taken; T.B. s c r e e n i n g s e r v i c e p r o v i d e d by mobile u n i t from Willow Chest  Center.  51  - Length-of-stay i n Hospital shortened; alternatives and plans discussed to more e f f e c t i v e l y use the Hospital. - Consultant P s y c h i a t r i s t , Dr. Schwarz, resigned a f t e r 11 years, to become Head of Psychiatry at St. Paul's Hospital; successor experienced in crosscultural and s o c i a l psychiatry. - Mature approach of students to drug usage noted in contrast to previous years, p a r t i c u l a r l y t h e i r reluctance to take a n t i b i o t i c s , a s p i r i n , and tranquillizers. - Annual conference of P a c i f i c Coast College Health Association held i n Vancouver, co-hosted by U.B.C, Simon Fraser, University of V i c t o r i a , B.C.I.T., and Vancouver Community College.  Tables l a and Ib give the U.B.C  student r e g i s t r a t i o n f o r  the years 1954 - I960 and 1964 - 1970.  As mentioned pre-  viously, no reports were located f o r I960 through Annual enrolment since 1970  1964.  i n Chapter 5, on the i n s t i t u -  t i o n a l community, i s from a d i f f e r e n t source and therefore not included here.  52  TABLE l a STUDENT REGISTRATION 1954 - I960  1954-55 1955-56 1956-57 1957-58 1958-59 1959-60  YEAR WINTER SESSION  5,914  6,403  7,699  8,986  NO  SUMMER SESSION  1,161  1,420  1,810  3,507  FIGURES  TOTAL  7,075  7,823  9,509  12,493  10,642 3,828 14,470  AVAILABLE  TABLE Ib STUDENT REGISTRATION 1964 - 1970  1964-65 1965-66 1966-67 1967-68 1968-69 1969-70  YEAR WINTER SESSION  15,489  16,337  17,219  18,426  21,717  22,382  SUMMER SESSION  6,220  6,230  5,943  5.216  5,664  5,627  21,709  22,567  23,162  23,642  27,381  28,009  TOTAL  SOURCE:  H e a l t h S e r v i c e Annual The  Reports.  f o l l o w i n g t a b l e i n d i c a t e s the number o f student  v i s i t s t o the Health S e r v i c e d u r i n g the l a t e f i f t i e s , s i x t i e s , and i n t o the s e v e n t i e s .  over the  The remarkable i n c r e a s e i n  1971-72 i s thought to be due t o the change i n method o f s t a t i s t i c a l reporting.  53  TABLE I I TOTAL NUMBER OF VISITS TO HEALTH SERVICE 1954 - 1975 1954-55  1955-56  1956-57  1957-58  1958-59  1959-60  23,244  23,956  32,676  37,827  MISSING  30,364  1963-64  1964-65  1965-66  1966-67  1967-68  1968-69  29,808  31,628  35,868  37,228  36,778  32,108  1969-70  1970-71  1971-72  1972-73  1973-74  1974-75  38,620  MISSING  51,308  52,069  56,979  56,741  SOURCE:  H e a l t h S e r v i c e Annual Reports.  The next two t a b l e s g i v e a v e r y g e n e r a l overview Hospital u t i l i z a t i o n years 1954-1975-  o f the  and a summary o f s e r v i c e s f o r the  The i n t r o d u c t i o n of a p h y s i o t h e r a p y  s e r v i c e can be seen i n corresponding f i g u r e s f o r 1964-65. and l a t e r ing  ;  i n Table IV. The change i n s t a t i s t i c a l r e p o r t -  i n 1971-72 i s r e f l e c t e d i n the f i g u r e s f o r treatments  and c o n s u l t a t i o n s w i t h nurses, and i n the absence o f o t h e r f i g u r e s s i n c e t h a t time.  TABLE I I I  HEALTH SERVICE HOSPITAL UTILIZATION 1954 - 1975 1  1954 1955 1956 1957 1959 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 -60 -66 -68 -56 -58 -74 : "75 -55 -57 -67 -69 -70 -71 -72 -65 -73  YEAR  NUMBER OF ADMISSIONS  818  825  807  919  731  812  862  694  677  599  585  602  531  535  559  552  NUMBER OF STUDENT ADMISSIONS  503  533  481  642  457  509  608  447  465  407  365  426  327  327  275  320  NUMBER OF PATIENT DAYS AVERAGE NUMBER OF DAYS PER PATIENT AVERAGE NUMBER OF PATIENTS PER DAY  SOURCE:  5647 6029 5835 6574 5539 5450 4901 4652 4526 4255 4045 3680 3921 3959 5477 4036  6.8  7.3  7.1  6.7  8 . 8 6.57, 5.74 7.84 6.76 7.04 6 . 8 9 6.15 7.26 7 . 6 9 10. Of5 7 . 9 1  1 5 . 4 1 6 . 4 1 6 . 0 1 8 . 0 1 5 . 1 1 5 . 2 1 3 . 4 1 2 . 7 1 2 . 3 1 1 . 6 11.0 1 0 . 0 1 0 . 7 9 . 8  H e a l t h S e r v i c e Annual  Reports.  15.0 11.1  TABLE IV YEAR NO. OF CONSULT'S WITH H.S. PHYSICIANS  1954 4,996 -55 1955 5,549 -56 1956 6,714 -57 1957; 6,546 -58 1959 6,940 -60 1964 13,282 -65 1965 14,674 -66 1966 -67 14,353 1967 13,451 -68 1968 -69 14,237 1969 16,709 -7° 1970 16,707 -21 1971 18,730 -72 1972 -73 18,047 1973 19,773 1974 19,266 -75  , NO.OF NEW STUiDENTS !EXAMINED BY H.S. PHYSICIAN (  2,114  NO. OF NEW STUDENTS EXAMINED BY FAMILY PHYSICIAN  19  2,870  SUMMARY OF SERVICES 1954 - 1975  NO. OF TREATMENTS & CONSULT'S WITH NURSES  NO. OF STUDENTS REFERRED TO DENTISTS & OUTSIDE DOCTORS  NO. OF STUDENTS REC'VING CONSULT'S WITH PSYCHIATRISTS  NO. OF STUDENT CONSULT'S WITH PSYCHIATRISTS  NO. OF LAB & X-RAY PROCEDURES  NO. OF PHYSIOTHERAPY TREATMENTS  NO. OF DOSES OF IMMUNIZATIONS GIVEN  12,332  990  26  11,334  125  1,709  13,670  985  54  12,667  38  1,866  10,535  713  31  108  15.337  212  9,835  ; 2,078  1,217  13,385  483  47  178  15,406  238  6,158  891  2,530  11.556  618  124  1,123  10,367  237  4,895  61  4,673  18,553  774  253  1,075  12,209  559  4,842  170  4,356  19,038  829  284  1,626  11,922 1,250  4,741  372  5,073  18,648  822  355  2,479  12,386 1,246  5.372  219  4,762  20,460  704  372  2,239  10,771 1.338  5,019  115  3,051  18,560  350  383  1,938  9,158 1,134  4,385  222  3.079  22,756  842  427  2,809  14,367 1,268  4,636  2,331  12,621 1,264  5,356  5,687  394  2,482  11,405 1,696  3,902  6,635  343  2,672  12,692 1.849  4,233  8,099  341  2,803  13,841 1,637  4,315  10,866  357  1,907  12,404 1,618  4,781  56  CHAPTER 5 GENERAL INFORMATION  5.1  The I n s t i t u t i o n The University of B r i t i s h Columbia opened i n  the autumn of 1915  i n temporary quarters on part of the  s i t e of the General Hospital i n the City of Vancouver. After several years' delay caused by the F i r s t World War,  the University commenced work on i t s permanent  campus i n Point Grey at the beginning of the 1925-26 session. The University operates under the authority of the U n i v e r s i t i e s Act of the Province umbia (B.C.R.S. 1974,  C 157).  of B r i t i s h Col-  I t i s composed of a  Chancellor, a Convocation, a Board of Governors, a Senate, and the F a c u l t i e s .  I t has i n i t s own r i g h t  and name the power to grant degrees established i n accordance with the provisions of the U n i v e r s i t i e s Act. The Board of Governors i s composed of f i f t e e n members including the Chancellor, the President,  two  f a c u l t y members, eight persons appointed by the Lieutenant-Governor- in-Council, two of whom are nominees  57  of the Alumni Association, Association,  two members of the Student  and one f u l l - t i m e employee of the Univer-  s i t y who i s not a f a c u l t y member. The University i s deemed to be non-sectarian and n o n - p o l i t i c a l i n p r i n c i p l e .  I t s goals and objectives  are considered to be embodied i n the following excerpt from the U n i v e r s i t i e s Act: "Each university s h a l l , so f a r as and to the f u l l extent which i t s resources from time to time permit . . . (a) establish and maintain colleges, schools, i n s t i t u t e s , f a c u l t i e s , departments, chairs, and courses of instruction? (b) provide i n s t r u c t i o n in a l l branches of knowledge? (c) establish f a c i l i t i e s f o r the pursuit of o r i g i n a l research i n a l l branches of knowledge? (d) establish fellowships, scholarships, exhibitions, bursaries, prizes, rewards, and pecuniary and other aids to f a c i l i t a t e or encourage proficiency i n the subjects taught i n the university and o r i g i n a l research i n a l l branches of knowledge? (e) provide a program of continuing education i n a l l academic and c u l t u r a l f i e l d s throughout the Province? and (f) generally promote and carry on the work of a university i n a l l i t s branches, through the co-operative e f f o r t of the board, senate, and other constituent parts of the university." (36 - p. 9) Instruction i s offered i n each of twelve f a c u l t i e s and eight schools.  Graduate work i s offered by the  Faculty of Graduate Studies including the School of Community and Regional Planning and the Institutes of Animal Resource Ecology, Applied Mathematics and S t a t i s t i c s , Astronomy and Space Science, Industrial Relations, national Relations,  and Oceanography.  Inter-  58  I t can be seen t h a t the i n t e r e s t s and  activities  of the i n s t i t u t i o n a l community are broad and d i v e r s e , thus p r e c l u d i n g the cohesiveness of s m a l l e r c o l l e g e s and  uni-  versities.  an  The seaport l o c a t i o n of U.B.C. a l s o has  e f f e c t i n the enrolment  of students from the P a c i f i c  Rim  c o u n t r i e s and Great B r i t a i n , as w e l l as from a c r o s s Canada and the U n i t e d S t a t e s , a l l of whom have an i n f l u e n c e on the programs and a c t i v i t i e s of the H e a l t h S e r v i c e which was  developed  to p r o v i d e h e a l t h care to a l l students  who  seek or r e q u i r e i t .  5.2  Composition  of the I n s t i t u t i o n a l Community  A c o n t i n u i n g census of students i s a v a i l a b l e from the O f f i c e of Academic P l a n n i n g , which i s c o n s i d e r e d e s s e n t i a l f o r the development of an a p p r o p r i a t e h e a l t h program.  The census p r o v i d e s i n f o r m a t i o n concerning  the t o t a l number of students, male and female,  full-  time, p a r t - t i m e , and e x t e n s i o n c r e d i t , graduate  and  undergraduate,  s e n i o r c i t i z e n s , and f o r e i g n s t u d e n t s .  Other p e r t i n e n t data r e l a t e to enrolment  of a l l students  by age and sex, f a c u l t y and y e a r l e v e l , age of students e n t e r i n g f o r the f i r s t  time, r e g i s t r a t i o n by  country  of c i t i z e n s h i p , and f o r e i g n students by type of v i s a . No p r o f i l e of f i n a n c i a l r e s o u r c e s i s a v a i l a b l e  but  59  i n f o r m a t i o n concerning predominant and m i n o r i t y s o c i a l backgrounds can be determined  from the census  statistics.  Such data should be reviewed a n n u a l l y by the H e a l t h S e r v i c e i n an attempt  t o p r o j e c t a student body i n c r e a s e  or decrease, t r e n d s , and p o s s i b l e areas t h a t would r e q u i r e the p l a n n i n g o r expansion o f new and e x i s t i n g services. The f o l l o w i n g t a b l e s b r i e f l y  enumerate the  s t u d e n t . p o p u l a t i o n f o r the years 1969 - 1976.  I t should  be noted t h a t the source o f these f i g u r e s i s d i f f e r e n t from the source o f f i g u r e s quoted  TABLE  V:  i n the p r e v i o u s chapter.  TOTAL ENROLMENT 1969-1976  Calendar Year  Male  Female  1969-70  13,000  7,767  20,767  1970-71  13.027  7,910  1971-72  12,247  7,579  20,937 19,826  1972-73 1973-74  11,817  7,3^9  19,166  12,050  8,050  20,100  1974-75 1975-76  13,028  9,007 9,726  22,035  13.253  Total*  22,979  * F u l l - t i m e and p a r t - t i m e , n o t i n c l u d i n g e x t e n s i o n c r e d i t and correspondence.  60  TABLE VI  PERCENT - MALE AND FEMALE  :  Calendar Year  Male  Female  1969-70  62.6%  1970-71 1971-72  62.2 61.8  37.4% 37.8 38.2  1972-73 1973-74  61.7 60.0  38.3 40.0  1974-75 1975-76  59.1 57.7  40.9 42.3  Source:  Total 100.0% 100.0 100.0 100.0 100.0 100.0 100.0  Office of Academic Planning  I t i s noted that the percentage of female students (graduate and undergraduate),  i s increasing  steadily. A three-year summary of ages of a l l students and percent of t o t a l i s found i n the appendices as Appendix IV.  A review of other data on enrolment f o r  the years 1971 - 1976 shows that, f o r each year, the majority of students are between the ages of 18 and 22 years (58% i n 1975-76).  The greatest number of students  f o r any age i n 1975-76 was 19 years, the youngest high number i n f i v e years.  In previous years the greatest  numbers were 20 and 21 years of age.  I t appears that  a younger student body, and an increasing female popu-  61  lation,  c o u l d h a v e many i m p l i c a t i o n s f o r t h e H e a l t h  S e r v i c e programs  provided.  A p p e n d i x V, Age o f S t u d e n t s First  Time 1975-76, shows t h e g r e a t e s t number o f f i r s t  enrolees The  Entering f o r the  t o be 18 y e a r s  o f a g e , 47$ o f t h o s e  being  t o t a l number o f c l o s e t o 7,000 new s t u d e n t s ,  one-third of the t o t a l  female.  or nearly  enrolment, i n d i c a t e s an a r e a o f  i n t e r e s t t o t h e H e a l t h S e r v i c e i n terms o f s c r e e n i n g for  h e a l t h problems and f o r h e a l t h  education.  Other a v a i l a b l e s t a t i s t i c s from the O f f i c e o f A c a d e m i c P l a n n i n g r e c o r d t h a t , o f t h e 22,979  students  e n r o l e d i n 1975-76, 1 9 , 2 7 2 (83.86$) w e r e C a n a d i a n , 2,848 (12.39$) were i m m i g r a n t s t u d e n t s , foreign students students). the t o t a l  on a s t u d e n t v i s a  Visitors,  a n d 572 (2.48$) w e r e (76$ o f t h o s e  d i p l o m a t i c and o t h e r students  graduate  made up  registration. Total i n t e r n a t i o n a l students  bered  being  f o r 1975-76 num-  3,889 w i t h 1,385 f r o m T h i r d W o r l d C o u n t r i e s .  Figures  d a t i n g b a c k t o 1957-58 a r e a v a i l a b l e f o r r e g i s t r a t i o n b y c o n t i n e n t and c o u n t r y  of citizenship.  Discrepancies i n  t o t a l f i g u r e s a r e t h o u g h t t o be due t o d i f f e r e n c e s i n s t a t i s t i c a l print-out information. S p e c i a l programs f o r s c r e e n i n g , d i s e a s e tion,  detec-  a n d s p e c i a l s e r v i c e s , a r e recommended a s a p p r o p r i a t e  62  f o r large groups of international students where indicated. Information could not be obtained on the number of married and single students, nor on the number of faculty and employees which make up the t o t a l i n s t i t u t i o n a l community.  The l a t t e r group i s not considered  of consequence to the Health Service whose primary concern i s the student population.  5.3  Organization and Administration The By-Laws of the University Health Service  Hospital provide a clear statement of the i n s t i t u t i o n ' s r e s p o n s i b i l i t y i n the area of student health.  The By-  Laws are attached i n f u l l as Appendix VI of this report. The eight sections of the By-Laws have been detailed ass  Definitions; Board of Management; Officers  of the Board; Committees of the Board; Director; Audit of Accounts; Medical Staff; and Amendments. of each section are outlined i n Appendix VI.  The A r t i c l e s Approval  was given to the By-Laws by the Board of Governors on December 1st, 1952. In order f o r this p o l i c y statement to serve as a guide f o r the development of operating p o l i c i e s f o r the health program, i t should be reviewed and revised from time to time.  63  No s u c h s t a t e m e n t i s known t o e x i s t f o r t h e Health  Service  Outpatient  f e r r e d t o a s t h e O.P.D.  Department, h e r e i n a f t e r r e I t i s recommended i n t h e S t a n d a r d s  that reasonably d e t a i l e d p o l i c y statements should developed t o include personal and  the three main program  areas:  health s e r v i c e ; environmental s u r v e i l l a n c e  c o n t r o l ; and h e a l t h e d u c a t i o n .  I t i s further re-  commended t h a t t h e p o l i c y s t a t e m e n t s s h o u l d w i t h the assistance  of students,  t i o n , p r i o r to approval  ttees of students, representatives  be  f a c u l t y , and  formulated administra-  by t h e a d m i n i s t r a t i o n and t h e  governing board of the i n s t i t u t i o n .  possible  be  One o r more  commi-  f a c u l t y , a d m i n i s t r a t i o n , s t a f f and  o f t h e g o v e r n i n g b o a r d , as w e l l as t h e  i n c l u s i o n o f members o f l o c a l m e d i c a l a n d h e a l t h -  related organizations,  c a n s e r v e as a r e v i e w and  advisory  mechanismi t h r o u g h w h i c h t h e h e a l t h n e e d s o f t h e c o m m u n i t y can  be i d e n t i f i e d a n d r e c o m m e n d a t i o n s c o n c e r n i n g t h e h e a l t h  p r o g r a m c a n be made p e r i o d i c a l l y , a t l e a s t a n n u a l l y . i s recommended t h a t t h e H e a l t h s e r v e i n an a d v i s o r y  capacity  Service  Director  on any s u c h r e v i e w  It  should committee.  B r o a d s u p p o r t f o r t h e p r o g r a m c a n f u r t h e r be a c h i e v e d  through  c o n t i n u a l l i a i s o n w i t h the h e a l t h s e r v i c e s o f s i m i l a r l o c a l i n s t i t u t i o n s , p a r t i c u l a r l y Simon F r a s e r  University.  64  At the present time, the Health Service Director i s responsible to the Vice-President i n charge of Faculty and Student A f f a i r s whose span of control appears so broad as to allow only d i l u t e d concern f o r each of his areas of r e s p o n s i b i l i t y .  This i s incompat-  i b l e with a l e v e l of administration which w i l l guarantee continual v i g i l a n c e over the requirements of the Health Service and provide r e a l i s t i c support f o r a l l program components. The Director reports b r i e f l y to the Board of Management each month as a perfunctory duty.  I t appears  that very l i t t l e communication between the Health Service and the. administration either exists or i s encouraged; the Health Service prefers to remain autonomous.  It is  recommended, however, that the open l i n e s of communication, universally espoused as a measure of good management, are essential to the Director i n carrying out his delegated authority to make professional appointments, to e s t a b l i s h Health Service functions and a c t i v i t i e s , and to develop the health program as a support f o r the entire community. The Standards recommend that the Director accept as one of his primary r e s p o n s i b i l i t i e s the promotion of complete cooperation and coordination among the various departments, o f f i c e s , i n d i v i d u a l s , and other  resources,  65  both on and o f f the campus, which can make a contribution to the t o t a l health program.  I t i s considered  imperative,  therefore, f o r the Director to produce regular reports concerning the a c t i v i t i e s and services of the Health Service, and to ensure c i r c u l a t i o n  of such reports to  a l l department of the i n s t i t u t i o n concerned with the health of the campus community.  66  CHAPTER 6 HEALTH PROGRAMS:  6,1 A.  Outpatient  SERVICES AND  ACTIVITIES  Services  OBJECTIVES B r i e f l y s t a t e d , the purpose of the  S e r v i c e i s to p r o v i d e  Health  f o r the h e a l t h needs of the  d u r i n g t h e i r time on campus.  Nearly  complete  students  outpatient  care i s a v a i l a b l e as a d i r e c t s e r v i c e of the h e a l t h gram through the p r o v i s i o n of p r e v e n t i v e , t h e r a p e u t i c and  pro-  diagnostic,  some r e h a b i l i t a t i v e s e r v i c e s .  I n d i v i d u a l o b j e c t i v e s are documented f o r both o u t p a t i e n t and  i n p a t i e n t s e r v i c e s and  interchangeable.  are  relatively  Those p e r t a i n i n g to the  ambulatory  care u n i t are the f o l l o w i n g : * 1.  To p r o v i d e  a P u b l i c H e a l t h U n i t on campus w i t h  c u l a r s u p e r v i s i o n of communicable d i s e a s e s and  partisanita-  tion. 2.  To p r o v i d e  o u t p a t i e n t s e r v i c e s , i n c l u d i n g emergency  s e r v i c e , minor surgery 3.  To m a i n t a i n treatment.  and follow-up  care.  adequate f a c i l i t i e s f o r d i a g n o s i s  and  6?  4.  To a s s i s t with student adjustment and counseling problems.  5.  To seek and maintain the confidence of the students so that they w i l l be encouraged to present and discuss t h e i r most sensitive problems.  6.  To teach and promote good health habits.  7.  To help the student attend h i s classes with as l i t t l e time loss as possible i n order to achieve his academic goals.  8.  To t r a i n a l l personnel i n the area of student health and welfare.  9.  To a s s i s t i n research a c t i v i t i e s when requested to do so, f o r example by supplying material f o r v i r a l studies, particularly  mononucleosis.  10. To help integrate the health program with the central administration and other departments, thus providing a service to both the student body and the University. *(Adapted from the Health Service Administrative Manual.) These objectives comply with the Standards i n that the O.P.D. serves both c l i n i c a l and educational functions.  In successfully applying the objectives of high  q u a l i t y c l i n i c a l services, the Standards add that patients expect and deserve courteous reception and acceptancej expeditious and accurate diagnosis; prompt, e f f e c t i v e and humane treatment; and an appropriate explanation of  68  t h e i r h e a l t h problems.  Whereas students*  expectations  concerning h e a l t h and medical care are r i s i n g , i t i s recommended t h a t every o p p o r t u n i t y be e x p l o i t e d t o pursue e f f e c t i v e h e a l t h education.  B.  SCOPE AND AVAILABILITY There i s a c l e a r statement  d e f i n i n g those  members o f the i n s t i t u t i o n a l community who are e l i g i b l e f o r care, i n c l u d i n g s p e c i a l circumstances The  statement  i s contained i n both the U.B.C.  and the H e a l t h S e r v i c e brochure istrants.  which may apply. Calendar  i s s u e d t o a l l new r e g -  The f a c i l i t y i s a v a i l a b l e t o a l l students  who take three o r more u n i t s d u r i n g e i t h e r the w i n t e r o r summer s e s s i o n . Students  r e g i s t e r i n g f o r the f i r s t time a t  the U n i v e r s i t y and t a k i n g three o r more u n i t s are r e q u i r e d t o submit a m e d i c a l q u e s t i o n n a i r e on an approved form (see Appendix VII) before r e g i s t r a t i o n can be completed.  The necessary forms are p r o v i d e d by the H e a l t h  S e r v i c e a t the time o f acceptance.  The U n i v e r s i t y r e s e r v e s  the r i g h t t o request t h a t a student have a medical t i o n i f circumstances  examina-  warrant i t and r e g i s t r a t i o n may be  c a n c e l l e d f o r students who do n o t comply w i t h t h i s  request.  Graduate students s t u d y i n g on campus and a l l  69  students r e g i s t e r e d a t Summer School are e l i g i b l e f o r necessary care a t the H e a l t h S e r v i c e .  However, i n v e s t i -  g a t i o n o f p r e - e x i s t i n g c o n d i t i o n s which do n o t i n t e r f e r e w i t h c u r r e n t academic work i s n o t undertaken s h o r t summer s e s s i o n .  d u r i n g the  Routine medical examinations are  not p r o v i d e d except i n s p e c i a l circumstances which may apply t o the f a c u l t i e s o f Medicine, D e n t i s t r y , and Nursing,  o r t o a t h l e t i c programs.  For detailed information  r e l a t i n g t o student e l i g i b i l i t y f o r h o s p i t a l and medical insurance coverage, to  Chapter  f o r e i g n students, e t c . , p l e a s e  9, Business  refer  Management.  The spouse and c h i l d r e n o r dependents o f a student may r e c e i v e h e a l t h care a t the Family P r a c t i c e U n i t i n the James Mather B u i l d i n g on campus. a l s o p r o v i d e s s e r v i c e to f a c u l t y and s t a f f  The U n i t  members.  The hours o f o p e r a t i o n o f the H e a l t h S e r v i c e are 8:15 a.m.  - 4:15 p.m.,  Monday to F r i d a y , d u r i n g the  eight-month w i n t e r s e s s i o n , and 8:00 a.m.  - 4:00 p.m. on  the weekdays d u r i n g the four-month summer s e s s i o n .  The  H o s p i t a l s t a f f handles a l l emergencies and o u t p a t i e n t complaints a f t e r hours and on weekends.  Medical service  i s p r o v i d e d a t a l l times, u s i n g the pocket paging system i f necessary.  When a member o f the H e a l t h S e r v i c e medical  s t a f f i s n o t on c a l l , arrangements are made w i t h a l o c a l p r i v a t e p h y s i c i a n to cover the s e r v i c e .  70  Outpatients are seen either by appointment or on a walk-in basis since a great number of health problems of young adults are unpredictable and sudden in origin.  Generally, outpatient appointments and c l i n i c  hours are arranged so that students' loss of class time i s minimized.  I t was pointed out i n more than one i n -  stance that evening c l i n i c s would be convenient for both students and s t a f f .  I t was also reported that a  proposal r e l a t i n g to evening c l i n i c s was presented to the University administration and approved, but subsequently rejected by the R.N.A. B.C. f o r reasons not understood.  I t i s recommended that extended service  hours f o r such needs as considered appropriate by the s t a f f , f o r example immunizations or V.D.  control, be  pursued.  C.  PROGRAM It i s estimated that between 125 and 200  students are seen d a i l y at the Health Service during the winter session.  Services offered are preventive,  diagnostic, and therapeutic.  The following are a v a i l -  able ; 1.  Preventive Services: - periodic health evaluation of i n d i v i d u a l or speci a l i z e d groups where indicated, including athletes  71  and those where m e d i c a l h i s t o r i e s make such examinations  advisable  - p r o v i s i o n of immunizations f o r the p r e v e n t i o n of specific  diseases  - T u b e r c u l i n t e s t s and S c h i c k t e s t s as - pap  smears f o r c e r v i c a l  - c o n t r o l of epidemic  indicated  cancer  d i s e a s e s on the campus as  a d v i s e d by the Board of H e a l t h of the P r o v i n c e of  B.C.  - mental h e a l t h f a c i l i t i e s to cope w i t h  maladjust-  ments and emotional problems which, i f not n i z e d and t r e a t e d e a r l y , may  recog-  g i v e r i s e to more  s e r i o u s d i s t u r b a n c e s i n the f u t u r e . Diagnostic Services: - Medical c o n s u l t a t i o n - C l i n i c a l l a b o r a t o r y procedures  by a r e g i s t e r e d  technician - Radiography procedures  by a r e g i s t e r e d t e c h n i c i a n  under the s u p e r v i s i o n of a Consultant R a d i o l o g i s t Therapeutic S e r v i c e s : - M e d i c a l treatment  and n u r s i n g care f o r both ambula-  t o r y and h o s p i t a l p a t i e n t s - P s y c h i a t r i c assessment and -  treatment  Physiotherapy  - Drugs and medications  provided f o r i n p a t i e n t s ,  or  72  prescribed f o r outpatients and purchased at the Community Health Centre Pharmacy, or at a private drugstore, Special weekly c l i n i c s held during the winter session are the following: - Refraction c l i n i c - attended by a r e f r a c t i o n i s t arid an ophthalmologist from the Vancouver General Hospital. - Orthopedic c l i n i c - attended by an orthopedic s p e c i a l i s t and the physiotherapist, primarily for athletic  injuries.  - Ophthalmology c l i n i c - attended by an ophthalmolog i s t from a private c l i n i c , sometimes with a medical resident. - Gynecology c l i n i c - attended by a female gynecologist. - E.E.N.T. c l i n i c - attended by a s p e c i a l i s t and, at times, a resident. - Dermatology c l i n i c - attended by a dermatologist and two residents.  Presenting problems are generally  acne, yeast, fungus, and p i t o r i a s i s rosea. sample j a r of ointment  (One  i s given free of charge, others  are charged f o r since the Health Service must pay f o r the medications  supplied.)  A l l v i s i t s to s p e c i a l c l i n i c s are by appointment as they are held only on designated days.  73  S p e c i a l i s t are p a i d on a fee-per-time u s u a l l y by the h a l f - d a y .  Regular  by the H e a l t h S e r v i c e medical  clinics  basis  conducted  s t a f f i n c l u d e a weekly  gynecology c l i n i c w i t h three p h y s i c i a n s and the Nurses* Aide i n attendance,  and twice-weekly sessions f o r the  purpose of b i r t h c o n t r o l o r i e n t a t i o n s and v a g i n a l examinations.  G e n e r a l l y f o u r p e l v i c examinations  a one-hour l e c t u r e / d e m o n s t r a t i o n  and  can be performed i n  the two-hour c l i n i c p e r i o d . The b i r t h c o n t r o l o r i e n t a t i o n s e s s i o n i s u s u a l l y attended  by younger students who  c o n t r o l methods f o r the f i r s t time.  are u s i n g  Many b r i n g f r i e n d s  of both sexes so the l e c t u r e hours are f l e x i b l y to s u i t the group a t t e n d i n g .  designed  L e c t u r e s are g i v e n by  female p h y s i c i a n s on the v a r i o u s methods of b i r t h condoms and students who  I.U.D.'s are d i s p l a y e d and d i s c u s s e d . may  two  control; Older  have l o n g s t a n d i n g u n t r e a t e d problems  can be seen p r i v a t e l y .  Although not p u b l i c i z e d , the  s e s s i o n s are r e p o r t e d to be known by word-of-mouth and well  attended. The main t h r u s t of the O.P.D. s e r v i c e i s  c o n s i d e r e d to be b i r t h c o n t r o l and a t h l e t i c these  two  injuries,  areas r e p o r t e d l y r e q u i r i n g the major p o r t i o n  of medical a t t e n t i o n .  Thus i t was  suggested  t h a t more  emphasis i s b e i n g p l a c e d on student education and  pre-  74  ventive practices rather than on c r i s i s intervention. Obesity and n u t r i t i o n were also c i t e d as examples of concern i n the area of prevention through student education. It appears that there i s a s h i f t toward more public health practice taking place i n the Health Service which had i t s o r i g i n as a Public Health Unit.  This  movement i s thought to be due to the changing nature of s o c i a l problems or to the changing needs and expectations of the consumers of the service.  I t i s recommended,  therefore, that the structure and functions of the programs be reviewed and changed accordingly i n order to keep them e f f e c t i v e , timely and  streamlined.  Also, reasons f o r the decreasing student  utili-  zation and occupancy rate of the Hospital are not known although i t i s speculated that more students may  be  receiving treatment from private p r a c t i t i o n e r s or may i n better health generally.  Both of these aspects  be attributed to universal hospital and medical coverage.  be  may  insurance  Perhaps i t can be assumed that an increase i n  the preventive aspects i s , i n part, responsible f o r the decreased h o s p i t a l i z a t i o n of student patients.  In any  case, i t i s recommended that every patient contact  should  be recognized and used as an opportunity foreducation of the student concerning  the implications of his p a r t i c u l a r  75  problem, either physical or emotional, f o r i n d i v i d u a l and community health.  D.  RECORDS Appropriate  services.  records are kept of a l l outpatient  Individual health records include a notation  of each v i s i t to the c l i n i c , a b r i e f but pertinent history, physical findings, reports of s p e c i a l examinations and consultations to substantiate the  recorded  diagnosis, and a record of a l l treatments and medications. Cumulative s t a t i s t i c a l data are maintained to produce an annual report of program a c t i v i t i e s have been l i m i t e d i n recent years.  but these  I t i s recommended  that s t a t i s t i c a l reports be kept of a l l services, including patient i d e n t i f i c a t i o n and diagnosis, the number of patients seen by nurses, physicians and other therapists, the date and time of service, and other pertinent informat i o n which can be used i n periodic evaluations of the department to analyze the effectiveness of services, to determine budget requirements, and to plan future services. It i s further recommended that indexing of records be undertaken.  Additional d e t a i l s and recommendations  this area are found i n the section on Records.  concerning  76  E.  PERSONNEL The  O.P.D. appears to he s t a f f e d w i t h  suffi-  c i e n t p e r s o n n e l to assure student s u b s c r i b e r s of r e c e i v i n g reasonably prompt and  e f f i c i e n t care.  complement i s r e p o r t e d I t was  The  total  on i n Chapter 7. H e a l t h  clinic.  i s assigned  Each a l s o has  such as o r d e r i n g , izing.  One  of s c r e e n i n g rooms and  Personnel.  observed t h a t , i n a d d i t i o n to a s s i s t i n g  the p h y s i c i a n s w i t h treatments d u r i n g r e g u l a r hours, each R.N.  staff  clinic  to a s p e c i f i c s p e c i a l t y  a p a r t i c u l a r f u n c t i o n to perform  s t o c k i n g s u p p l i e s , c l e a n i n g , and  nurse i s r e s p o n s i b l e p a t i e n t s and  doctors.  immun-  f o r the t r i a g e f u n c t i o n  a s s i g n i n g them to  different  Because many of the nurses are  long-  term employees, i t i s suggested t h a t some interchange d u t i e s would provide  of  a v a r i e t y of f u n c t i o n s f o r each to  perform thereby l e s s e n i n g the p o s s i b i l i t y of monotonous routine.  In a d d i t i o n , i t i s recommended t h a t many of  the  c u s t o d i a l f u n c t i o n s being performed by the p r o f e s s i o n a l s t a f f should  be delegated  to the Nurses' Aide whose d u t i e s  i n c l u d e some t h a t are c o n s i d e r e d for  example ear s y r i n g i n g and  to be n u r s i n g  functions,  changing d r e s s i n g s .  workload i s not s u f f i c i e n t to f u l l y  occupy  Nurses, c o n s i d e r a t i o n dtould be g i v e n to the  I f the  Registered employment  of an L.P.N, or another Nurses' Aide when a p o s i t i o n on  77  the nursing s t a f f becomes vacant.  While such a change  may appear unfavourable to the department  at present,  the development and review of job descriptions f o r each p o s i t i o n should provide evidence of any need f o r change. Converse to the recommendation to vary the R.N. functions and r e s p o n s i b i l i t i e s , i t i s recommended that one person be delegated the r e s p o n s i b i l i t y and authority to f u l l y develop an e f f e c t i v e inservice education program f o r the growth and development of the t o t a l s t a f f , including the Hospital.  This p o s i t i o n i s thought  to require constancy i n order to be e f f e c t i v e and s a t i s fying.  F.  FACILITIES The Health Service i s c e n t r a l l y located i n the  West Wang of the three-storey Wesbrook Building.  The  O.P.D. comprises the main f l o o r , and the Hospital the t h i r d floor.  Part of the School of Nursing i s located on the  second f l o o r .  The diagram of the O.P.D. i n Appendix VIII  provides a v i s u a l understanding of the layout.  There are  6,500 square feet of space i n each of the two sections of the Health Service excluding the separate Mental Health Unit.  78 The  f u n c t i o n a l a c t i v i t i e s assigned  to each room  are o u t l i n e d b r i e f l y below. Rooms 106 and 108  Storage and J a n i t o r ' s C l o s e t  Rooms 110 and 110A  S t a f f Lounge ( C o n t a i n i n g Storage of Medical Records) and Washroom  Room 112  Supervisor's  Room 114  Main Reception Desk, Medical Records/ Business O f f i c e , and P a t i e n t s ' W a i t i n g Room  Rooms 116 & 116A  E.E.N.T. Rooms  Room l l 6 B  Laboratory.  Room l l 6 C  X-Ray C o r r i d o r ( F i l m F i l i n g & Storage)  Room 116D  X-Ray Reading Room and T e c h n i c i a n ' s Office  Room 118  Radiography Room  Room 118A  F i l m Developing Room  Room 118B  X-Ray Change Room  Room 120 & 124  Female Examination and Treatment Rooms  Room 122  Connecting Change and Washroom  Room 126, 128 & 130  Male Examination and Treatment S u i t e  Room 132  Orthopedic Treatment Room (For Back Ailments & I n j u r i e s )  Room 134  General Treatment Room (For Casts, Dressings, Hot Soaks, E a r S y r i n g i n g , Removal o f Warts, Drainage o f C y s t s , etc.) A l l £dirty" cases are t r e a t e d i n t h i s room which c o n t a i n s m u l t i p l e supplies. I t i s cleaned between cases but n o t fumigated.*  Room I36  Treatment Room f o r the A d m i n i s t r a t i o n o f A n t i - A l l e r g e n s (Antigen Serum i s R e f r i g e r a t e d i n the Room)  Room 138  Immunization Room where C l i n i c s are h e l d three times weekly ( B i o l o g i c a l S u p p l i e s are R e f r i g e r a t e d i n the Room)  Room 140  Minor Surgery Room  Room 142  Assistant Director's Office  Room 144  Director's Office  Room 146  Medical  Room 148  Nurses' Aide's Clean-Up and Storage Room  Office  Secretary's  Office  79  * I t i s recommended t h a t Room 134 be fumigated a f t e r treatment of a l l " d i r t y " cases and t h a t s u p p l i e s i n the room be kept to a minimum. While a t times the workload would appear t o exceed the space a l l o c a t i o n s , the department comprises a l l of the requirements f o r the d e l i v e r y o f comprehens i v e student services. quarters  h e a l t h care w i t h the exception  of dental  The l o c a t i o n of the Mental H e a l t h U n i t i n on the t h i r d f l o o r i s separate  from the m e d i c a l  c l i n i c as recommended i n the Standards. The is discussed  p o s s i b l e r e l o c a t i o n of the H e a l t h i n Chapter 8,  Physical Plant.  Service  In the event  of a move i t i s recommended t h a t p l a n n i n g f o r new  quarters  i n c l u d e a d e t a i l e d a n a l y s i s o f the f u n c t i o n s and s e r v i c e s to be provided,  p r o j e c t e d p a t i e n t l o a d s , estimated  patterns  of use, t r a f f i c flow, and s t a f f i n g p a t t e r n s f o r both r e g u l a r and  special services.  6.2  Inpatient  A.  OBJECTIVES The  Services  f o l l o w i n g o b j e c t i v e s were approved by the  U.B.C. Board o f D i r e c t o r s i n c o n s u l t a t i o n w i t h the members of i t s medical and a d m i n i s t r a t i v e  staff.  80  "1.  To p r o v i d e good h o s p i t a l s e r v i c e a t minimum expense to the p a t i e n t .  2.  To p r o v i d e good medical and n u r s i n g care.  3.  To accomodate the p a t i e n t comfortably i n cheerf u l a t t r a c t i v e surroundings.  4.  To m a i n t a i n adequate f a c i l i t i e s f o r d i a g n o s i s and treatment.  5.  To p r o v i d e good food  6.  To t r a i n a l l p e r s o n n e l i n the f i e l d of student h e a l t h and w e l f a r e .  7.  To p r o v i d e a P u b l i c H e a l t h U n i t on campus w i t h p a r t i c u l a r s u p e r v i s i o n o f communicable d i s e a s e s , s u p e r v i s i o n of s a n i t a t i o n .  8.  To t e a c h and promote good h e a l t h h a b i t s .  9.  To a s s i s t w i t h student adjustment and c o u n s e l i n g problems.  services.  10.  To p r o v i d e o u t p a t i e n t s e r v i c e s , i n c l u d i n g emergency s e r v i c e , minor surgery and follow-up c a r e .  11.  To a s s i s t i n r e s e a r c h a c t i v i t i e s when requested to do so - by s u p p l y i n g m a t e r i a l f o r v i r a l s t u d i e s ( p a r t i c u l a r l y f o r i n f e c t i o u s mononucleosis).  12.  To seek and maintain the confidence of the students. I f i t i s not obtained then the H e a l t h S e r v i c e w i l l cease to be of any use, as the students w i l l not go to i t f o r advice and help which may be s e r i o u s l y required.  13.  To help i n t e g r a t e the H e a l t h S e r v i c e s w i t h the A d m i n i s t r a t i o n and a l l departments of the U n i v e r s i t y , thus p r o v i d i n g a s e r v i c e to both the student body and the A d m i n i s t r a t i o n .  14.  To help the student a t t e n d h i s c l a s s e s w i t h l i t t l e time l o s s as p o s s i b l e . "  as~ ^'  7  As s t a t e d i n the p r e v i o u s s e c t i o n , these o b j e c t i v e s are i n t e r c h a n g e a b l e w i t h the o b j e c t i v e s of the o u t p a t i e n t services. In g e n e r a l , i t i s recommended t h a t the p r o v i s i o n of bed care on campus proves advantageous where i t can be  81  done economically.  I t i s w e l l r e c o g n i z e d , however, t h a t  the poor u t i l i z a t i o n o f the U.B.C. H e a l t h S e r v i c e H o s p i t a l i n r e c e n t years  (see Chapter  4) i n d i c a t e s t h a t i t s opera-  t i o n i s p r o h i b i t i v e l y expensive.  Serious c o n s i d e r a t i o n  should be g i v e n to c l o s i n g the f a c i l i t y and a r r a n g i n g a channel o f admission  t o community h o s p i t a l s .  For  students l i v i n g on campus, a r e s i d e n c e i n f i r m a r y c o u l d be e s t a b l i s h e d as an outreach s e r v i c e t o provide  inter-  mediate o r t e r t i a r y l e v e l s o f care comparable t o t h a t which they might r e c e i v e a t home.  Such care c o u l d apply,  f o r i n s t a n c e , to students w i t h communicable h e a l t h problems f o r which b r i e f i s o l a t i o n i s needed, but f o r which i s o l a t i o n i n a g e n e r a l h o s p i t a l c o u l d n o t be j u s t i f i e d . Others  c o u l d continue to a t t e n d c l a s s e s d u r i n g c o n v a l -  escence and r e t u r n to f u l l academic a c t i v i t y w i t h of a handicap  less  than would be l i k e l y i f they were r e c e i v i n g  c o n t i n u i n g care i n a community h o s p i t a l some d i s t a n c e from the campus.  Furthermore, student i l l n e s s e s o f t e n  occur i n r e p e t i t i v e seasonal epidemics  which can p r o v i d e  waves o f p a t i e n t s who cannot be accomodated i n the acutecare  institutions. While i t was n o t g e n e r a l l y known t o the H e a l t h  S e r v i c e s t a f f , some suggestion was made t h a t the H o s p i t a l might be c l o s e d d u r i n g the 19?6 summer s e s s i o n as a c o s t s a v i n g measure.  Such a move would have many i m p l i c a t i o n s ,  82  not the l e a s t o f which would be the p o s s i b l e l a y - o f f of s e v e r a l s t a f f members, u n l e s s they e l e c t e d f o r a leave-of-absence  concurrent w i t h t h e i r annual v a c a t i o n  to cover the p e r i o d o f c l o s u r e .  A second v i t a l  implica-  t i o n would be the p o s s i b i l i t y o f r e - f u n d i n g being d i s allowed by the B r i t i s h Columbia H o s p i t a l Insurance S e r v i c e (B.C.H.I.S.) a t the designated time of r e opening the u n i t .  B.  SCOPE OF SERVICES The accepted l e v e l o f bedcare  p r o v i d e d by the  H o s p i t a l i s g e n e r a l medical care without surgery i n a 26-bed ward.  At the time o f the o n - s i t e survey, the  p a t i e n t census was seven, w i t h only one student p a t i e n t . The  census was r e p o r t e d to be about s i x t e e n t o eighteen  d u r i n g the w i n t e r s e s s i o n .  P r i v a t e p a t i e n t s o f community  doctors have been granted admission f o r some years now i n an attempt  to o f f s e t the low occupancy r a t e ,  i a l l y i n the summer months.  P a t i e n t s are n o t admitted  under the age o f f o u r t e e n y e a r s ; i t was once but proved  impractical.  espec-  attempted  The f o l l o w i n g t a b l e d e s c r i b e s  the p a t i e n t census a t the time o f the review.  83  TABLE V I I : PATIENT CENSUS APRIL 28, Age o f Patient  Admission Diagnosis  1976  Date o f Admission  Attending Physician  Type o f Accommodation  23 y r s . ! Post-Mono-  26/4/76  Health Service  Single Room  39 y r s .  Lumbar Disc Degeneration  26/4/76  Private*  Single Room  88 y r s .  Back P a i n  18/4/76  Private  Double Occupancy  nucleosis  !  78 y r s .  21/4/76  Phlebitis L e f t Leg  Degeneration  Low Back P a i n , Not Yet Diagnosed  34 y r s .  Lumbar Disc Degeneration  Source: *  Double Occupancy  22/4/76  Private*  Multi-Bed Room  23/4/76  Private  Multi-Bed Room  11/12/75  Private*  Multi-Bed Room  1  27 y r s . , Lumbar D i s c  30 y r s .  Private  i j  U.B.C. H e a l t h S e r v i c e H o s p i t a l  The three p a t i e n t s w i t h Lumbar D i s c Degeneration a l l admitted  were  under the care of the same p h y s i c i a n , who  v i s i t s the ward only once a week.  This p h y s i c i a n was  84  also one of two doctors attending the patient with low back pain, not yet diagnosed.  Written h i s t o r i e s were  not completed f o r this doctor's patients.  A l l admissions were within ten days of the date of the on-site review with the exception of the patient who had been admitted nearly f i v e months before. The B.C.H.I.S. was reported to be aware of this long-stay patient but was continuing to pay the acute-care per diem rate.  The only student was the 23 year-old patient  with post-mononucleosis.  An eighth patient was admitted  during the review with a diagnosis of congestive heart f a i l u r e ; he was reported to have had previous admissions to the Hospital with the same diagnosis. The possible closure of the Hospital i s d i s cussed elsewhere i n this paper.  Reference i s also made  i n other sections to the r e s p o n s i b i l i t y of the medical s t a f f to t h e i r patients, the i n s t i t u t i o n , and the funding agency, the B.C.H.I.S. Neither medical nor paramedical students rotate through the Hospital.  In view of the shortage of c l i n i c a l  t r a i n i n g f a c i l i t i e s f o r the various professions, i t i s considered p r a c t i c a l that such use could be made of the Health Service.  A medical student could perform physical  examinations, write up h i s t o r i e s , a s s i s t i n prescribing  85  treatment, for  and f o l l o w up p a t i e n t s f o r p r i v a t e as w e l l as  Health Service physicians. I t appears t h a t a s i g n i f i c a n t number of  patients present evening may  themselves a t the H o s p i t a l d u r i n g  and n i g h t s h i f t s and  be seeking f i r s t - a i d  on weekends.  treatment  only; others w i t h comchest pain  or sudden onset of headache, e t c . , are requested i n H o s p i t a l overnight f o r observation.  t o remain  R e f u s a l s to remain  as are n o t i f i c a t i o n s of the d o c t o r on  In the case of a d i f f i c u l t  the  Some students  p l a i n t s of abdominal p a i n , nausea and v o m i t i n g ,  are recorded,  out-  call.  p a t i e n t , the campus p a t r o l  or  R.C.M.P. are a l e r t e d . A l o g book i s kept the H o s p i t a l a f t e r hours and formation  as date and  s t a t u s , age,  of a l l o u t p a t i e n t s seen a t c o n t a i n s such p e r t i n e n t i n -  time, name and  complaint  and  treatment  address, rendered,  marital disposi-  t i o n of case, means of t r a n s p o r t ( i . e . p a t r o l or cab), and  initials  of the a t t e n d i n g nurse o r doctor.  event of l e g a l i n q u i r i e s , f u l l w r i t t e n i n p l a c e of It and  analyzed  clinic  In the  s i g n a t u r e s should  be  initials.  i s recommended t h a t s t a t i s t i c s be  computed  r e g a r d i n g the number of p a t i e n t s seen a f t e r  hours, the types  of complaints  and  the  treatment  g i v e n , w i t h a view t o p l a n n i n g extended hours or s p e c i a l evening  clinics.  I f the o u t p a t i e n t c a s e - l o a d  increases  86  the demand on the H o s p i t a l s t a f f to a notable  degree,  such as l e a v i n g the H o s p i t a l p a t i e n t s without R.N. coverage f o r any l e n g t h o f time, then p l a n n i n g to meet that workload should be the r e s p o n s i b i l i t y o f the H e a l t h  Service. A r e c e n t a u d i t o f n a r c o t i c and c o n t r o l l e d  drugs was conducted by the N a r c o t i c s C o n t r o l D i v i s i o n . While i t was the only such i n s p e c t i o n i n three the r e p o r t was s a t i s f a c t o r y .  years,  Counter boxes are now  used f o r n a r c o t i c s and c o n t r o l l e d drugs.  Many o f the  other medications used f o r i n p a t i e n t s are kept i n ward stock so as t o e l i m i n a t e the n e c e s s i t y and cost o f i n d i v i d u a l p r e s c r i b i n g and packaging. Communication w i t h the Pharmacist i s r e p o r t e d to be good, a s s i s t a n c e having been g i v e n , i n the p r e p a r a t i o n of ward p o l i c i e s r e l a t i n g to drugs and medications. For example, whereas c e r t a i n p a t i e n t s matic, e t c . ) f o r m e r l y  (menopausal, a s t h -  kept and used t h e i r own medications  at the bedside (hormones, d i u r e t i c s , t r a n q u i l i z e r s , e t c . ) , t h i s p r a c t i c e i s no l o n g e r p e r m i t t e d . c a t i o n s are p r o v i d e d  A l l necessary medi-  f o r H o s p i t a l p a t i e n t s e i t h e r from  the ward s t o c k o r from the Pharmacy.  Some sample medi-  c a t i o n s such as F r o s s t 222's, a n t i h i s t a m i n e s , are a v a i l a b l e t o g i v e to o u t p a t i e n t s the hours t h a t the c l i n i c  and G r a v o l ,  i n the evening,  during  i s c l o s e d ; o r p r e s c r i p t i o n s may  87  be g i v e n out by the d o c t o r on  call.  P a t i e n t s with symptoms of v e n e r e a l disease be s t a r t e d on treatment  as i n d i c a t e d i n which case  t i o n s are g i v e n w i t h the medications.  may  instruc-  U s u a l l y , however,  these p a t i e n t s are r e f e r r e d to the D i v i s i o n of V.D. at  Control  828 West 10th Avenue, Vancouver.  C.  GENERAL OBSERVATIONS The use  of the kardex system i s a recent  v a t i o n ; n u r s i n g care p l a n s are now  inno-  b e i n g undertaken.  In-  d i v i d u a l c h a r t s and a mobile c h a r t c a r r i e r are a l s o r e c e n t additions. An emergency box tor,  c o n t a i n i n g an Ambu-bag i n h a l a -  r e s u s c i t a t o r , oxygen masks, and d i s p o s a b l e s y r i n g e s ,  has been s e t up w i t h i n s t r u c t i o n on i t s use g i v e n to the s t a f f by the Head Nurse.  Other d i s p o s a b l e equipment i s  g r a d u a l l y being i n t r o d u c e d where i t s need and economy are i n d i c a t e d , f o r i n s t a n c e , i n the care of p a t i e n t s i n i s o l a tion. The p r e s e n t i s o l a t i o n technique ing  involves  scrubb-  and gowning i n the s e p a r a t i o n room, a u t o c l a v i n g d i s h e s  and u t e n s i l s , f u m i g a t i n g the room a f t e r discharge of the p a t i e n t , and the use of c e r t a i n d i s p o s a b l e s u p p l i e s .  The  Head Nurse i n d i c a t e d tlie need f o r s p e c i f i c w r i t t e n guide-  88  l i n e s f o r i s o l a t i o n procedures to be used f o r each contagious disease.  A procedure manual and a medical manual  have been i n i t i a t e d by the Head Nurse; both appear to be useful guides to patient care. c e l l anemia was  A rare case of s i c k l e  reported to have been picked up because  of diagnostic information outlined i n the medical manual. Psychiatric ward rounds are conducted weekly with the Chief P s y c h i a t r i s t .  General c l i n i c s , with doc-  tors presenting t h e i r patients to the s t a f f , were abandoned because of the small number of s t a f f on duty or able to attend.  Hospital inservice education includes  a l l Health Service personnel. As noted elsewhere i n t h i s paper, the services of a consultant d i e t i t i a n would be b e n e f i c i a l f o r patients with special dietary needs, such as those with diabetes, ulcerative c o l i t i s , or obesity, as well as for the supervision of the food service.  D.  FACILITIES The diagram attached as Appendix IX provides  a v i s u a l blueprint of the ward layout.  89  The H o s p i t a l bed count i s as f o l l o w s : 3  -  2 - bed rooms  =  6 beds  1  -  4 - bed room  =  4 beds  1  -  5 - bed room  =  5 beds  1  -  6 - bed room  =  6 beds  4  -  s i n g l e rooms (isolation) e x t r a bed s e t up i n one o f the s i n g l e rooms  =  4 beds  =  1 bed*  1  -  TOTAL BEDS  *  26  The e x t r a bed s e t up i n a s i n g l e room should n o t be i n c l u d e d i n the o f f i c i a l bed count and the number o f r a t e d beds should, considered  standard  t h e r e f o r e , be only 25.  beds on a p e r diem r a t e b a s i s .  The H o s p i t a l u n i t appears t o be laid the  A l l are  out as seen i n the Diagram.  conveniently  On the west s i d e o f  c o r r i d o r , Rooms 330 and 334 and Rooms 348 and 352  are the f o u r i s o l a t i o n u n i t s , each c o n t a i n i n g a s i n k , t o i l e t and shower, w i t h s e p a r a t i o n rooms connecting set  o f two rooms.  each  The nurses' s t a t i o n , ward pharmacy,  k i t c h e n e t t e , l i n e n cupboard, supply  room and hopper room  are l o c a t e d midway down the west s i d e o f the c o r r i d o r . Room 354 has been assigned  as an o f f i c e f o r a p r i v a t e  p h y s i c i a n i n r e t u r n f o r h i s o n - c a l l s e r v i c e d u r i n g the evening and weekend  shifts.  He was r e p o r t e d  to see p r i v a t e  90  p a t i e n t s i n the o f f i c e during considered and  h i s time on duty, which i s  t o be an acceptable  practice i f Hospital  s u p p l i e s are n o t u t i l i z e d .  staff  Room 356 i s the emergency  f i r s t - a i d and treatment room where gynecology c l i n i c s are conducted.  Room 358 i s assigned  as an o f f i c e f o r the f u l l -  time s t a f f doctor, whose r e s p o n s i b i l i t i e s i n c l u d e the gynecology c l i n i c s , ing quarters  The room had once been used as s l e e p -  f o r the o n - c a l l medical r e s i d e n t s , but t h i s  p r a c t i c e was d i s c o n t i n u e d  i n 1972.  A l l o f the m u l t i p l e - b e d  rooms are l o c a t e d on the  east s i d e o f the c o r r i d o r as are the p a t i e n t s ' lounge and bathrooms, s t a f f lounge, two s m a l l storage s u p p l i e s , one f o r f l o w e r - a r r a n g i n g ) , main l i n e n supply  and storage  janitor's closet,  ( f o r both the H o s p i t a l and  the O.P.D.), and main ward k i t c h e n .  The p a t i e n t s ' lounge  opens onto a spacious outdoor balcony. t a l appears t o be generously l a i d out, and w e l l maintained. poorly  In a l l ,  the Hospi-  r e c e n t l y decorated,  I t i s unfortunate that i t i s so  utilized. Subject  few  rooms (one f o r  t o the c l o s i n g o f the H o s p i t a l , only a  recommendations can be made r e l a t i v e to the p h y s i c a l  facilities.  One i s t h a t , as f a r as p o s s i b l e , c l e a n and  d i r t y s u p p l i e s should  be kept separated.  The i d e a l  sit-  u a t i o n would be to have a " d i r t y " u t i l i t y room separate from the c l e a n supply  room.  The room designated  for  91  f l o w e r - a r r a n g i n g c o u l d be cleaned out and u t i l i z e d such, s i n c e the a c t i v i t y of c u t t i n g and watering i s no l o n g e r performed.  as  flowers  However, as the autoclave  and  b o i l e r are l o c a t e d i n the s i n g l e supply room, s t e r i l i z e d bundles  and equipment should be c a r e f u l l y s t o r e d , dated,  and p e r i o d i c a l l y t e s t e d to maintain t h e i r  sterility.  Second, d i s p o s a b l e shower c u r t a i n s should  be  used i n the s i n g l e rooms when p a t i e n t s are h o s p i t a l i z e d for  isolation.  being admitted,  F o r the s m a l l number o f such p a t i e n t s the s t e r i l i t y f a c t o r f a r outweighs  any  economies t h a t might be r e a l i z e d by u s i n g washable c u r t a i n s . T h i r d , the p o r t a b l e oxygen tanks which are maint a i n e d by the P h y s i c a l P l a n t , should be p r o p e r l y s t o r e d i n a m e t a l - l i n e d l o c k e d room on the o u t s i d e of the ing.  The  build-  present storage of tanks i n the j a n i t o r ' s  w i t h exposure to s u n l i g h t and p o s s i b l e c o l l i s i o n ,  closet,  i s consi-  dered dangerous i n terms of the p o s s i b i l i t y o f combustion or e x p l o s i o n . Fourth, a dishwasher should be obtained chase or donation)  (by pur-  f o r the main ward k i t c h e n where dishes  are washed and d r i e d by hand.  T h i s p r a c t i c e i s not c o n s i -  dered as s a t i s f a c t o r y as the modern method whereby dishes and u t e n s i l s are s t e r i l i z e d i n a dishwasher i f the  proper  temperature and water p r e s s u r e are maintained.  Considering  the c o n s i s t e n t l y low p a t i e n t census a domestic  machine would  92  probably  E.  suffice.  NURSING STAFF The  t o t a l H o s p i t a l s t a f f i s enumerated i n  Chapter 7, H e a l t h The  Head Nurse seems w e l l q u a l i f i e d f o r her  p o s i t i o n , having Supervisor  Personnel.  p r e v i o u s l y h e l d the p o s i t i o n of A s s i s t a n t  of the I n t e n s i v e Care U n i t and  U n i t at the Vancouver General H o s p i t a l . recent and  Coronary Care Many of  on-going changes i n s t i t u t e d by her appear  to be i n n o v a t i v e and w e l l - o r g a n i z e d .  Support and  ance f o r necessary changes must be forthcoming u l t i m a t e l y r e s p o n s i b l e f o r the Health ous  the  i n a c t i v i t y may  from those  S e r v i c e , or monoton-  r e s u l t i n the l o s s of v a l u a b l e  Of the f i v e R.N.'s, one  assist-  personnel.  i s the Head Nurse and  one  the permanent n i g h t nurse, l e a v i n g three to r o t a t e from days to evening s h i f t s .  T h i s r o t a t i o n means t h a t  the  three R.N.'s (as w e l l as the three L.P.N.'s) are working one week of evening duty to two i n f o u r weekends o f f .  weeks of days w i t h only  While t h i s i s not the most d e s i r a b l e  r o t a t i o n compared w i t h the s t r a i g h t Monday-to-Friday s h i f t worked by the O.P.D. s t a f f , i t i s c o n s i d e r e d than r o t a t i n g to the n i g h t s h i f t as w e l l as to days evenings.  one  day  1  better and  93  In accordance w i t h t h e Standards t h e r e i s a r e g i s t e r e d n u r s e on duty i n t h e H o s p i t a l a t a l l t i m e s . There i s a l s o e i t h e r an L.P.N, o r Nurses' Aide w o r k i n g under h e r d i r e c t s u p e r v i s i o n .  B r i e f l y , the r o t a t i o n i s :  2 R.N.'s ( i n c l u d i n g H.N.) 1 R.N.  and 1 L.P.N. and 1 L.P.N.  - DAYS - EVENINGS  1 R.N.  and 1 Nurses' Aide  - NIGHTS  The L.P.N.'s c a r r y o u t p a t i e n t t r e a t m e n t s h u t do n o t g i v e medications.  F o r m e r l y , t h e y were n o t g i v i n g any p a t i e n t  care which i s c o n s i d e r e d t o be a waste o f n u r s i n g a b i l i t y . A l i s t o f p r e s c r i b e d approved  d u t i e s s h o u l d be o b t a i n e d  from the L.P.N. A s s o c i a t i o n .  Bedside and u n i t c l e a n i n g  i s done by the n i g h t Nurses' A i d e and e v e n i n g L.P.N, w h i c h i s a c c e p t a b l e i f p a t i e n t care i s n o t n e g l e c t e d . q u e s t i o n a b l e t h a t c e r t a i n o f t h e housekeeper's  It is duties,  such as mending c u r t a i n s and c u l t i v a t i n g f l o w e r s f o r the b a l c o n y p l a n t e r s , a r e f u l l y time-consuming  i fs t i l l  valid.  A r e v i e w and u p - d a t i n g o f j o b s p e c i f i c a t i o n s would seem t o be i n o r d e r .  F.  RECORDS The a d m i t t i n g c l e r k , whose time i s shared w i t h  the M e n t a l H e a l t h U n i t , had s e c r e t a r i a l t r a i n i n g p r i o r t o  94  her on-tte-job t r a i n i n g r e g a r d i n g medical r e c o r d s .  In  a d d i t i o n to keeping the r e c o r d s , she a l s o keeps s t a t i s t i c a l accounts such as the day-to-day census p r o v i d e d by the Head Nurse and compiled i n t o monthly r e p o r t s f o r the Health Service Director. I t i s recommended t h a t s t a t i s t i c a l  reports  d e s c r i b i n g H o s p i t a l u t i l i z a t i o n should be continued. s p e c i a l predominance of student  i l l n e s s o r causes o f d i s -  a b i l i t y should be summarized and r e p o r t e d . should be kept a c c o r d i n g  Any  " A l l diagnoses  t o a g e n e r a l l y accepted  system  of nomenclature, p r e f e r a b l y the I n t e r n a t i o n a l C l a s s i f i c a t i o n o f Diseases,  Adapted."  (Standards Pg. 1 1 )  I t was noted t h a t one p r i v a t e p h y s i c i a n no medical h i s t o r y and no signed stay p a t i e n t s .  and  orders on one o f h i s l o n g -  T h i s i s not an acceptable  should be questioned  provided  p r a c t i c e and  by both the H e a l t h S e r v i c e D i r e c t o r  the B r i t i s h Columbia H o s p i t a l Insurance S e r v i c e which  provided  the acute-care  p e r diem r a t e f o r c l o s e t o a f i v e -  month p e r i o d .  6.3  RECORDS A preliminary health record  i s r e q u i r e d of a l l students  (see Appendix V I I )  e n r o l l e d f o r three u n i t s o r  more, as p a r t of the r e g i s t r a t i o n procedure.  The i n f o r -  95  mation contained t h e r e i n i s c o n f i d e n t i a l and cannot  he  r e l e a s e d from the H e a l t h S e r v i c e without the w r i t t e n perm i s s i o n of the student concerned.  Examination by a p h y s i -  c i a n i s not compulsory f o r U n i v e r s i t y entrance but i s s t r o n g l y recommended.  While  s p e c i a l exceptions  outlined  i n the U.B.C. Calendar p r e v i o u s l y a p p l i e d to the of  faculties  Medicine, Nursing, D e n t i s t r y and P h y s i c a l Education,  such entrance examinations  are no l o n g e r mandatory.  No student i s r e f u s e d admission to the because of a p h y s i c a l or emotional handicap, c o n d i t i o n i s under adequate medical care. such h e a l t h problems may  University  p r o v i d e d the  Knowledge of  even be used to a i d the  student  i n s u c c e s s f u l l y adapting to the p h y s i c a l and academic requirements for  of the i n s t i t u t i o n .  The primary purpose  g a t h e r i n g i n f o r m a t i o n concerning a student's p a s t  m e d i c a l h i s t o r y and c u r r e n t h e a l t h s t a t u s , i s to p r o v i d e a background f o r h e a l t h care which the student may while he i s a t t e n d i n g the U n i v e r s i t y .  In a d d i t i o n ,  require such  i n f o r m a t i o n can be used as a b a s i s f o r r e s e a r c h , epidem i o l o g i c a l s t u d i e s , and so f o r t h . A b l a n k e t p e r m i s s i o n f o r treatment  at the H e a l t h  S e r v i c e and f o r necessary r e f e r r a l s to p r i v a t e p h y s i c i a n s and o t h e r community f a c i l i t i e s , and endorsed  i s s i g n e d by the  by h i s parent or l e g a l guardian.  student  The  treat-  ment p e r m i t t e d and o u t l i n e d i n the student r e c o r d i n c l u d e s  96  routine health examinations, immunizations, diagnostic procedures, and treatment of i l l n e s s and/or i n j u r i e s . In the event of contention over the propriety of s p e c i f i c services, however, such permission granted i n advance would not be considered "informed consent".  I t i s re-  commended, therefore, that c l e a r l y defined p o l i c i e s be established regarding such contentious areas as p s y c h i a t r i c treatment, b i r t h control, abortion, s u r g i c a l procedures, hospital admission, l e g a l consent f o r underage patients, c o n f i d e n t i a l i t y of records, p r i v i l e g e of  communications,  reportable conditions, and the administration of drugs and blood transfusions. The Standards recommend that a unit record system be developed with entrance health information i n i t i a t i n g the patient's record which i s then maintained as a cumulative chronicle of his medical history while attending the University.  A l l v i s i t s to the Health Service and a l l s i g n i -  f i c a n t health services rendered elsewhere on campus should be recorded.  I t i s recommended that the following be i n -  cluded: - A record of a l l outpatient v i s i t s , and whether the student i s seen by a nurse, physician, or other therapist. - A l l diagnostic tests and procedures. - A l l consultations performed at the Health Service or f o r which a report i s available.  97  - A l l therapeutic and r e h a b i l i t a t i v e  procedures.  - A l l inpatient v i s i t s . - A l l s i g n i f i c a n t services. - An attempt should be made to include a record of services rendered by off-campus agencies i n order to provide some measure of follow-up f o r the student concerned. Inpatient records should be substantially more complete than recorded outpatient data and must include information concerning the present i l l n e s s , physical examination, past medical history, family and s o c i a l history, and reports of a l l supporting diagnostic examinations.  An admission diagnosis and proposed plan of t r e a t -  ment should be stated c l e a r l y .  A l l doctors' orders should  be written and signed by the attending physician, or i f given by telephone and signed by the nurse, should be countersigned by the doctor as soon as possible. notes and reports of special examinations  Progress  should be i n i t i a l e d  or signed by the attending physician and a f i n a l diagnosis must be given upon d i s p o s i t i o n of the patient and before the chart i s f i l e d .  As noted i n the previous section, the  private physician not f u l f i l i n g his professional obligation r e l a t i v e to medical records i s accountable to the Director of the Health Service and to the B.C.H.I.S. whose j o i n t res p o n s i b i l i t y i s to require complete record-keeping on a l l patients admitted to the Hospital. t h i s re-  Failure to comply with  98  quirement i n a g e n e r a l p u b l i c h o s p i t a l would l i k e l y r e s u l t i n the suspension the doctor  of a d m i t t i n g p r i v i l e g e s f o r  concerned. The manner i n which the o u t p a t i e n t medical  r e c o r d s are s t o r e d i n the s t a f f lounge o f the O.P.D. i s not c o n s i d e r e d s a t i s f a c t o r y i n terms o f m a i n t a i n i n g s t r i c t c o n f i d e n t i a l i t y a t a l l times.  While i t i s recog-  n i z e d t h a t storage space i s a t a premium, i t i s recommended t h a t a l l medical records be kept i n a secure  location  to which access i s c o n t r o l l e d and from which unauthorized p e r s o n n e l are excluded.  The employment o f a t l e a s t a  part-time or c o n s u l t a n t r e c o r d l i b r a r i a n i s d i s c u s s e d i n Chapter  7. H e a l t h P e r s o n n e l . In keeping w i t h the Standards,  the d e t a i l e d r e -  cords o f mental h e a l t h c o n s u l t a t i o n s and o t h e r problems are maintained  emotional  i n separate h e a l t h r e c o r d s which  are kept under s t r i n g e n t s u r v e i l l a n c e and a c c e s s i b l e only to members o f the Mental H e a l t h U n i t . note  Only an unobtrusive  i s made i n the g e n e r a l h e a l t h r e c o r d t h a t a d d i t i o n a l  i n f o r m a t i o n i s a v a i l a b l e i n the Mental  Health Unit  file.  I t i s recommended t h a t there be w r i t t e n d i r e c t i o n s s p e c i f y i n g the method by which medical records be processed,  will  t o whom they may be made a v a i l a b l e , and the  c o n d i t i o n s under which i n f o r m a t i o n from the records may be communicated to t h i r d p a r t i e s .  To r e i t e r a t e , no i n f o r m a t i o n  99  i s r e l e a s e d from the H e a l t h S e r v i c e without the w r i t t e n permission students, of parents  of the student  concerned.  In the case of minor  i t i s a d v i s a b l e t o have the a d d i t i o n a l consent before  information  i s released, e s p e c i a l l y i n  those s i t u a t i o n s i n v o l v i n g p o s s i b l e l e g a l a c t i o n . The l e n g t h of time medical records depends upon t h e i r u s e f u l n e s s  should be kept  f o r medical or l e g a l reasons  and upon the p r o v i n c i a l s t a t u t e of l i m i t a t i o n s . S e r v i c e D i r e c t o r advised  t h a t i s , s i x years  cords  f o r H o s p i t a l records.  r e g u l a t i o n s have been t e n years s i x years  Health  t h a t the B.C. p r o v i n c i a l r e g u l a -  t i o n s are f o l l o w e d , and t e n years  The  f o r outpatient r e In f a c t ,  these  f o r primary r e c o r d s and  f o r secondary r e c o r d s .  However, r e c e n t changes  i n the L i m i t a t i o n s Act and subsequent i m p l i c a t i o n s f o r the H o s p i t a l s Act have prompted requests  from h e a l t h care o r -  g a n i z a t i o n s to the Government f o r c l a r i f i c a t i o n of the r e g u l a t i o n s but no f i r m d e c i s i o n has been made to date i n t h i s regard.  I t i s considered  advisable,  therefore,  to keep a l l primary r e c o r d s , both i n p a t i e n t and o u t p a t i e n t , f o r a minimum of t e n years,  or u n t i l d e f i n i t i v e  regulations  have been s e t down. In a d d i t i o n to the cumulative p e r s o n a l r e c o r d s , s t a t i s t i c a l records  health  are kept of s e r v i c e s , and  annual r e p o r t s are prepared f o r review by the c e n t r a l administration.  S t a t i s t i c a l r e c o r d keeping has been n o t a b l y  100  l i m i t e d i n recent years and, t h e r e f o r e , i t i s recommended that a more d e t a i l e d method o f keeping s t a t i s t i c s he r e instituted.  Such records are considered  invaluable f o r  r e p o r t i n g and a n a l y z i n g s e r v i c e s rendered,  making p r o j e c -  t i o n s f o r f u t u r e s e r v i c e s , p l a n n i n g e d u c a t i o n a l programs and  s t a f f i n g p a t t e r n s , and most i m p o r t a n t l y ,  for fore-  c a s t i n g student needs and demands i n terms of h e a l t h care. They are a l s o v i t a l l y important t u r e s and i n s u p p o r t i n g requests  i n explaining past  expendi-  f o r f u t u r e s e r v i c e s and  programs. The  Standards recommend t h a t every h e a l t h s e r v i c e  keep a d i a g n o s t i c index, p r e f e r a b l y coded a c c o r d i n g t o the I n t e r n a t i o n a l C l a s s i f i c a t i o n of Diseases,  f o r a l l outpat-  i e n t s , and t h a t an a c t i v e coded d i a g n o s t i c index be made mandatory f o r a l l i n p a t i e n t s e r v i c e s .  should  Furthermore,  l a r g e r i n s t i t u t i o n s such as U.B.C, which have access t o computer s e r v i c e s , are advised to develop a system f o r automatic p r o c e s s i n g o f t h i s i n f o r m a t i o n .  The implemen-  t a t i o n o f such a system does n o t seem unreasonable f o r the H e a l t h S e r v i c e and should be g i v e n s e r i o u s c o n s i d e r a t i o n , p a t r i c u l a r l y i n view of the p o s s i b i l i t y o f i n c o r p o r a t i o n of the H e a l t h S e r v i c e i n t o a new acute-care the campus.  D i a g n o s t i c indexes,  able l a b o r a t o r y and x-ray  H o s p i t a l on  including readily  i n f o r m a t i o n , should be reviewed  r e g u l a r l y , a n a l y z i n g f o r t r e n d s , unusual episodes ness, and frequency  retriev-  of i l l -  o f problems r e l a t i v e to young a d u l t s .  101  ETHICAL & PROFESSIONAL STANDARDS  As recommended, i t appears t h a t every e f f o r t i s made to m a i n t a i n the student's r o u t i n e r e c o r d f r e e o f i n f o r m a t i o n which might he used to h i s disadvantage. Standards recommend separate c o n f i d e n t i a l f i l e s e n t i a l l y compromising  data such as p s y c h i a t r i c  The  f o r potreports,  c o u n s e l l i n g data, r e s u l t s of p s y c h o l o g i c a l t e s t i n g , medical or  i n f o r m a t i o n r e l a t i n g t o v e n e r e a l d i s e a s e , pregnancy, drug usage, and p o l i c e r e p o r t s .  I n p a t i e n t r e c o r d s con-  t a i n i n g such data should he removed from r o u t i n e  filing  procedures on completion of treatment and s t o r e d i n confidential  files. In  the event o f the development of computerized  student r e c o r d s , and p a r t i c u l a r l y , of c e n t r a l i z e d data banks, i n a new campus H o s p i t a l , i t i s recommended t h a t experts be c o n s u l t e d i n the d e s i g n o f such systems f o r d e l i n e a t i o n and r e s o l u t i o n of problems o f c o n f i d e n t i a l i t y . Awareness of the problems which can a r i s e permits the s y s tem to be designed i n a manner which meets both the admini s t r a t i v e needs of the U n i v e r s i t y and the c o n f i d e n t i a l i t y of  Health Service records. In  the case o f student absences,  the H e a l t h  S e r v i c e does n o t have the a u t h o r i t y to p r o v i d e excuses for  missed examinations, but w i l l make recommendations  102  to the Registrar and the Dean of the appropriate faculty who in turn make the final decisions.  A medical certi-  ficate, signed either by a Health Service physician or the student's attending doctor, is required for absence from December or April examinations, but is not given by the Health Service for absence due to illness from classes, lectures, or labs.  On return to classes, the students are  expected to notify their instructors of any absence due to illness.  If an instructor wishes medical investiga-  tion to substantiate a student's reasons, he can contact the Health Service; a physician will then consult the student to determine reasons for absence, if the student has not already been seen at the center about"a specific illness.  In no circumstance, however, is specific or  detailed information concerning complaints or diagnosis, provided to faculty, administrators, or even parents, without the express permission of the patient involved.  It is  considered appropriate and sufficient for the Health Servic to simply verify a health problem responsible for a student absence from class or for other delays in meeting academic obligations. Reference was made to "The Buckley Amendment" (the Family Educational Rights and Privacy Act of 1975) which, in the United States is concerned with educational records, their privacy, and the rights of students to  103  c h a l l e n g e them f o r a l l e g e d l y i n c o r r e c t items. from the p r o v i s i o n s of "The  Exempted  Buckley Amendment", and  supported by the Recommended Standards  of the American  C o l l e g e H e a l t h A s s o c i a t i o n , are r e c o r d s on students or o l d e r , or students i n i n s t i t u t i o n s of  18  post-secondary  education, when such records are maintained  by  certain  h e a l t h p r o f e s s i o n a l s , are used o n l y f o r m e d i c a l care, and are not a v a i l a b l e t o anyone other than those p r o v i d i n g such care.  I f these c o n d i t i o n s are not met,  health  r e c o r d s become e d u c a t i o n a l records i n the sense of becoming s u b j e c t to the p r o v i s i o n s of the  legislation.  I t has been recommended, however, t h a t only i n an extremel y r a r e occurrence, such as when a p a t i e n t i s t r u l y homic i d a l or s u i c i d a l and r e f u s i n g treatment,  should the  c o n f i d e n t i a l i t y of r e c o r d s be v o i d e d .  6.4  LABORATORY SERVICES P r i o r to the development of l a b o r a t o r y f a c i l i t i e s  i n the H e a l t h Sciences Centre P s y c h i a t r i c U n i t , the H e a l t h S e r v i c e l a b o r a t o r y p r o v i d e d s e r v i c e to f a c u l t y and  staff  members as w e l l as to students.  However, p a t i e n t s seen  at the Family P r a c t i c e U n i t now  have t h e i r l a b work done  at the H e a l t h Sciences  Centre.  The H e a l t h S e r v i c e department i s s t a f f e d by a l i c e n s e d R e g i s t e r e d T e c h n o l o g i s t (Medical Laboratory)  who  104  was trained at the B.C.I.T. and the Vancouver General Hospital.  The facilities consist of one room adjacent  to the main reception area/waiting room, and very basic equipment as only simple procedures are performed in the department.  All supplies are ordered by the Technologist  which she assumes are included in the annual departmental budget.  Cost-consciousness is considered to be enhanced  where staff members are involved in the preparation of such budgets. The common tests performed are in the areas of hematology, urinalysis, microbiology, and clinical chemistry. The repertory of laboratory evaluations includes the following tests: - Hemoglobin Estimation - White Blood Count - Differential and Sedimentation Rate - Blood Glucose Determination - Platelets and Eosinophile Count - Red Cell Morphology - Routine Urinalysis - Pregnancy Testing - Mononucleosis Testing - E. C . G. - Yeast and Trichomonas Smears - Collection of blood specimens for tests ordered to be sent to the laboratory at the Vancouver General Hospital.  105  All  s p e c i m e n s s e n t o u t a r e d e l i v e r e d by t h e U.B.C. t r a n s p o r t a -  tion  service,  p a p smears b e i n g s e n t t o t h e C y t o l o g y L a b and  V.D.R.L.'s t o t h e P r o v i n c i a l The  annual  workload  shown i n t h e f o l l o w i n g 1972.  t h a n numbers o f p r o c e d u r e s from  f o r the l a s t  four years i s  f i g u r e s w h i c h were a v a i l a b l e  I t s h o u l d be n o t e d  procedures  Laboratory.  that  only  from  unit values are f a r greater  performed.  Combined l a b and x - r a y  1954 a r e d e p i c t e d i n T a b l e  IV, C h a p t e r  4.  TABLE V I I I WORKLOAD IN UNIT VALUES.PER MONTH - LAB  1976**  MONTH  1972  1973  1974  1975  Jan. «  11,217  12,006  13,744  16,236  13.352  Feb.  8,863  9,574  13,540  13.499  11,887  Mar.  8,587  11,963  14,216  13,310  13,140  Apr.  5,475  7,652  8,948  9,829  May  4,067  3,963  8,155  3,701  June  2,486  4,192  6,071  4,086  July  4,282  6,715  6,731  6,305  Aug.  4,615  6,598  6,910  4,476  Sept.  9,550  12,514  15,717*  12,035  Oct.  11,268  15,711  17,130*  15,015  Nov.  8,437  13,810  13,991*  11,052  Dec.  6,551  TOTAL  85,398  4,349  9,671  5,494  109,047  134,824  115,038  -  106  Source: *  Health Service Laboratory  There was  Records.  a r e p o r t e d measles epidemic d u r i n g the t h r e e  months i n d i c a t e d i n 1974,  a l t h o u g h i t was  still  b u s i e s t y e a r i n f o u r , even a c c o u n t i n g f o r the **  The f i g u r e s are i n c o m p l e t e f o r 1976  the epidemic.  s i n c e the o n - s i t e  c o l l e c t i o n of d a t a took p l a c e i n A p r i l . While i t can be seen t h a t the w o r k l o a d  is in-  c r e a s i n g each y e a r , a breakdown o f the f i g u r e s i n t o a c t u a l t e s t s performed  would be v a l u a b l e i n d e t e r m i n i n g e x a c t l y  what the demand was.  A l o g book and r e c o r d s are kept o f  a l l d e t e r m i n a t i o n s and f i l e d i n the p a t i e n t ' s c h a r t .  A'  system f o r the r e t r i e v a l of d a t a from l a b r e p o r t s , as w i t h a l l c l i n i c a l r e c o r d s , i s recommended f o r r e v i e w i n g the o v e r a l l work o f the l a b o r a t o r y , f o r s u p p o r t i n g the of  6.5  review  c l i n i c a l s e r v i c e s , and f o r c o n d u c t i n g r e s e a r c h .  RADIOLOGICAL SERVICES T h i s department i s o p e r a t e d p r i m a r i l y t o s e r v e  s t u d e n t s a t the U n i v e r s i t y , e i t h e r as o u t p a t i e n t s o r as p a t i e n t s i n the H e a l t h S e r v i c e H o s p i t a l .  They may  be r e -  f e r r e d e i t h e r by t h e i r own p r i v a t e d o c t o r o r by one o f the Health Service physicians.  The department a l s o p r o v i d e s  r a d i o l o g i c a l s e r v i c e s t o the H e a l t h S c i e n c e s Centre  Psy-  c h i a t r i c U n i t and the F a m i l y P r a c t i c e U n i t , and i s t o be used i n f u t u r e by the Extended  Care U n i t b e i n g c o n s t r u c t e d  107  on t h e campus.  As a convenience t o them, s e r v i c e i s g i v e n  t o employees o f t h e U n i v e r s i t y and, on o c c a s i o n , t o p a t i e n t s who have no c o n n e c t i o n w i t h t h e U n i v e r s i t y . A l l o u t p a t i e n t appointments a r e made by t h e o f f i c e ; i n s t r u c t i o n s and m e d i c a t i o n s a r e g i v e n by t h e c l e r i c a l o r by a nurse when n e c e s s a r y .  staff,  H o s p i t a l appointments a r e  made d i r e c t l y by t h e x - r a y department on r e c e i p t o f a r e q u i s i t i o n o r , i n emergencies, by phone.  A l l patients  must have a U.B.C. r e q u i s i t i o n ; r e f e r r a l s l i p s from p r i v a t e p h y s i c i a n s are attached t o the r e q u i s i t i o n s . S p e c i a l examinations which require p r e p a r a t i o n o f t h e p a t i e n t and w h i c h a r e c a r r i e d o u t o n l y a t s p e c i f i e d times a r e : - I n t r a v e n o u s Pyelogram  (I.V.P.)  - G a l l B l a d d e r (G.B. o r Cholecystogram) - Stomach and Duodenum (S. & D., Barium Meal, Upper G.I. T r a c t , o r Barium S w a l l o w ) * - Oesophagus (Same as f o r S. & D.)* - Colon (Large Bowel o r Barium Enema)* - *Fluoroscopy S p e c i a l i n s t r u c t i o n s r e g a r d i n g t i m e s , appointments, o r r e q u i r e m e n t s f o r these and o t h e r e x a m i n a t i o n s a r e a v a i l a b l e i n t h e department i n p r i n t e d form. Survey c h e s t p l a t e s a r e t a k e n a t a weekly  clinic  o r by appointment; as many as twenty can be booked f o r one  108  c l i n i c period.  For o t h e r x-rays, one-half hour i s allowed  f o r s i n g l e examinations appointments  and l o n g e r f o r m u l t i p l e exams.  Re-  f o r r a d i o l o g i c a l r e p o r t s are made w i t h p h y s i -  c i a n s f o r f o u r working  days a f t e r x-ray examinations  are  c a r r i e d out. In o r d e r of the g r e a t e s t to the l e a s t number o f procedures performed,  the f o l l o w i n g examinations  indicate  the type o f cases t r e a t e d : - Extremities - Chests - Skulls - Spines  3  About the Same Number  - S p e c i a l Views - I.V.P. - Abdomen -  G.B.  Minimal Number  - S. & D. - Fluoroscopy - Eosophagus - Colon - Small Bowel  The annual workload table.  s i n c e 1965  i s shown i n the f o l l o w i n g  109  TABLE I X ANNUAL WORK LOAD I N UNIT VALUES - X-RAY".' YEAR UNITS  1965  1966  1967  1968  1969  1970  1,453  1,459  1,394  1,443  1,600  1,873  $17,251  16,992  15,705  16,052  19.092  22,293  1971  1972  1973  1974  1975  2,036  2,020  2,018  2,154  2,220  8.04*  8.4  8. 8 * *  23.552  25.891  25,903  AVERAGE UNITS PER WORKING DAY AMOUNT BILLED  YEAR UNITS AVERAGE UNITS PER WORKING DAY AMOUNT BILLED  SOURCE: *  $23,832  23.497  H e a l t h S e r v i c e Radiology Records  Average d u r i n g t h e w i n t e r s e s s i o n J a n u a r y , F e b r u a r y , M a r c h / O c t o b e r , November, December, 1973  **  B a s e d on 250 w o r k i n g d a y s i n 1975-  =  10.7.  110  While the workload i n u n i t s has  been i n c r e a s -  i n g s t e a d i l y , the average u n i t s per working day three years recorded i n g amounts h i l l e d  appears q u i t e constant.  i n d i c a t e an i n c r e a s e  f o r the  The  increas-  i n non-students  examined. S p e c i a l g u i d e l i n e s f o r use the H e a l t h  Sciences  by  Centre P s y c h i a t r i c U n i t were drawn  up by the former Consultant Service.  of the f a c i l i t y  P s y c h i a t r i s t f o r the  Health  B r i e f l y , they f o l l o w the r u l e s of the Vancouver  General H o s p i t a l P s y c h i a t r i c U n i t whereby no r o u t i n e mission  chest p l a t e s are taken and  x-rays are  ad-  ordered  only f o r s p e c i f i c purposes by the p h y s i c i a n i n charge of the case.  Procedures a v a i l a b l e to the P s y c h i a t r i c  U n i t are a l l s t r a i g h t x-rays,  barium s e r i e s , and  I.V.P.  Other procedures requested must be d i s c u s s e d w i t h  the  x-ray t e c h n i c i a n .  report  forms are  Health  S e r v i c e r e q u i s i t i o n and  utilized.The  g u i d e l i n e s s t a t e t h a t , at the  time, the p a t i e n t i s t r a n s p o r t e d  appointed  to the H e a l t h  Service  accompanied by a nurse from the P s y c h i a t r i c U n i t should and  who  remain w i t h the p a t i e n t throughout the procedure  r e t u r n w i t h him  to the U n i t .  (Wet  f i l m s should  be  returned w i t h the nurse i f they have been s p e c i f i c a l l y requested by the p h y s i c i a n . )  I t was  p a t i e n t s are f r e q u e n t l y e s c o r t e d  noted, however, that  to the Health  Service  by  Ill  another p a t i e n t . p r a c t i c e and  T h i s i s considered  to be an unsafe  i t i s recommended t h a t the g u i d e l i n e s  rela-  t i v e to p a t i e n t t r a n s p o r t a t i o n be reviewed and r e i n f o r c e d . A w r i t t e n r e p o r t of each examination signed the Consultant  Radiologist i s f i l e d  patient f i l e .  D u p l i c a t e r e p o r t s are f i l e d w i t h the  rays i n the department, and  i n the  by  appropriate  a l s o i n a numerical  x-  file.  Another d u p l i c a t e i s forwarded to the source of r e f e r r a l , p r i v a t e d o c t o r or agency.  Health  Science  Centre  Psychia-  t r i c U n i t r e p o r t s are phoned over immediately when ready; Family  P r a c t i c e U n i t r e p o r t s are sent the  x-ray r e p o r t i s a v a i l a b l e .  Written  d i s p o s i t i o n of each r e p o r t and  same day  as  the  i n s t r u c t i o n s regarding  copy are a v a i l a b l e i n the  department. A d a i l y l o g book i s kept of a l l p a t i e n t s r e f e r r e d and  examined, and  a s t a t i s t i c a l r e c o r d i s compiled of a l l  x-ray procedures performed. explaining patterns  of use,  This record i s h e l p f u l i n i n p r o v i d i n g an  indirect  measure of the q u a l i t y of c l i n i c a l care being and  i n p r o j e c t i n g f u t u r e needs of the s e r v i c e . F i l m s are f i l e d n u m e r i c a l l y  ment f o r two in  provided,  years,  a basement f i l e  are considered About every two  c u l l e d , and  years  and  depart-  s t o r e d i n proper sequence  f o r three y e a r s .  obsolete  i n the x-ray  A f t e r f i v e years  sold for their silver  they  content.  the o l d e s t f i l m s are s o l d to make  112  room f o r new  ones.  Close s u r v e i l l a n c e i s kept on  f i l m s that are borrowed or taken out of the A record  i s kept of f i l m numbers and  and when they went out; are  s i z e , and  another check i s made when f i l m s  (Radiography) who  at the H e a l t h S e r v i c e supervision  has been employed  f o r s e v e r a l years.  She  t h a t the T e c h n i c i a n  at the U n i v e r s i t y .  It is  who  recognized  i s attempting to keep up-dated i n her  to make improvements i n her area,  comprehensive s t a t i s t i c a l The  works under  of a p r i v a t e Consultant R a d i o l o g i s t  holds a p r o f e s s o r s h i p  f i e l d and  Regist-  r e c e i v e d her t r a i n i n g  a t the Vancouver General H o s p i t a l and  such as more  record-keeping.  radiography room i s leaded as r e q u i r e d  by  the x-ray t a b l e i s a modern machine having been i n -  s t a l l e d i n 1974  a t a c o s t of some $40,000.00.  oper i s a l s o a recent model. and  of where  department i s s t a f f e d by a l i c e n s e d  ered T e c h n i c i a n  law;  department.  returned. The  the  any  devel-  X-ray equipment i s examined  c a l i b r a t e d at r e g u l a r i n t e r v a l s , and  i s done as r e q u i r e d by r e g u l a t i o n . f a c i l i t y are given  The  i n s e c t i o n 6.1,  badge m o n i t o r i n g  D e t a i l s of the Outpatient  physical  Services.  While the Standards suggest t h a t i t " i s not worthwhile e c o n o m i c a l l y to p r o v i d e r a d i o l o g i c a l s e r v i c e s d i r e c t l y i f an average of l e s s than ten p a t i e n t s pated d a i l y " , the s e r v i c e needs of i n p a t i e n t s and  is anticithe  con-  113  venience f o r outpatients the  i n this  f i n a n c i a l considerations.  instance  I t m u s t a l s o be remembered  t h a t U.B.C.'s n o n - s e m e s t e r s y s t e m c r e a t e s periods is  during  the w i n t e r  session  l e s s than  6.6  provided  heavier  peak  and t h a t t h e department  o p e r a t e d on a y e a r - r o u n d b a s i s .  s e r v i c e , the care  have o u t w e i g h e d  Without t h i s  by t h e H e a l t h  valuable  S e r v i c e w o u l d be  comprehensive.  PHARMACY (MEDICATION S E R V I C E ) The H e a l t h  Service  building i s directly  connected  t o t h e P h a r m a c e u t i c a l S c i e n c e s B u i l d i n g , and u n t i l y e a r s employed the s e r v i c e s o f a s m a l l d i s p e n s a r y location.  Presently,  only  l i e d by t h e d i s p e n s a r y . Health  same  i n p a t i e n t m e d i c a t i o n s a r e supp-  C e n t r e on campus now p r o v i d e s  campus w h i c h f i l l s  i n that  The P h a r m a c y a t t h e Community  at a reasonable charge. on  recent  the outpatient  service  There i s a l s o a p r i v a t e drug  store  p r e s c r i p t i o n s at approximately the  cost. P r e s c r i p t i o n s f o r s t u d e n t s a r e k e p t t o a minimum,  the major usage b e i n g  that of b i r t h control p i l l s .  problems and c o n d i t i o n s  Many  are t r e a t e d almost e x c l u s i v e l y  w i t h samples s u p p l i e d by the drug houses, f o r example, antibiotics.  This  courtesy  i s extremely h e l p f u l to the  s t u d e n t p a t i e n t s whose f u n d s a r e u s u a l l y l i m i t e d . generally recognized  I ti s  that today's students are quite  soph-  114  isticated  i n t e r m s o f d r u g s and  body s y s t e m s . that  their  Both the m e d i c a l  a remarkable  and  a r e now  be  g o o d ; h i s a s s i s t a n c e was  Hospital policies is  stated  refusing  helpful  r e g a r d i n g d r u g s and  was  staff  be  organized  and  ically  r e v i e w i n g those  medications  agents  t o be  by  dispensed  the p h y s i c i a n s f o r the  and  i n developing medications.  It  other therapeutic  c a r e and  treatment  or  of  ordered  patients,  the a d d i t i o n  or d e l e t i o n  o f items  Dir-  in  formulary.  for  the  ous  drugs  control  improper use  t i o n may medical  i n an use,  o f the  use  attempt  and  and  to minimize  to e s t a b l i s h  f o r example be  and  for inpatients  and  An  c o n c e r n i n g new  as f o r p a t i e n t e d u c a t i o n on  danger-  t h e use  other controlled  of  restrictions  programs f o r the  nursing staffs  and  the p o s s i b i l i t y  specific  "stop orders".  to i n i t i a t e  Narcotics  t o recommend m e a s u r e s  abuse o f t o x i c  of p a r t i c u l a r medications  patients,  well  and  with period-  t h e pharmacy s e r v i c e  Committee f u n c t i o n s a r e  the  charged  of  w i t h making recommendations t o the H e a l t h S e r v i c e  ector concerning the  to  reported  recommended, however, t h a t a pharmacy c o m m i t t e e  the m e d i c a l  by  the  o r p r e s c r i b e d f o r them.  C o m m u n i c a t i o n w i t h the p h a r m a c i s t to  on  nursing staffs  number o f s t u d e n t s  have d r u g s a d m i n i s t e r e d  effects  in  and  additional  outfunc-  education of  the  medications, o r abuse o f  as  drugs.  drugs ( H o s p i t a l )  115  are kept under appropriate security consistent with federal and provincial legal standards.  In general,  the number of persons handling the medications is restricted to those who have legal authority to do so, that is, the pharmacist, and medical and nursing personnel. A recent audit by the Narcotics Control Division, the first in over three years, showed satisfactory results. The following reference to drug control was extracted from the Health Service Hospital Manual: Control of Narcotics and Other Drugs Under the Dominion Opium and Narcotic Drug Act, there is a very rigid control of narcotics. A periodic audit of the books and records of hospitals as to supplies of narcotics is made by specially trained officers of the R.C.M.P.. The Control Regulations state: "A person who is in charge of a hospital shall: 1. Maintain the recorded information in such form as to enable an audit to be made and retain the records for a period of not less than two years from the making thereof. 2.  Produce to an inspector any books, records, or documents required by these regulations, to be kept.  3.  Permit an inspector to check all stocks of controlled drugs in the hospital." More information concerning the medication service  has been geven in section 6 . 2 ,  Inpatient Services.  116  6.7  DENTAL SERVICES The S t a n d a r d s recommend t h a t e v e r y  h e a l t h program should  college  make p r o v i s i o n f o r a p p r o p r i a t e  dental services, recognizing that teeth, t h e i r i n g s t r u c t u r e s , and o t h e r appropriate  treatment s i m i l a r to that provided  body systems. given it  o r a l t i s s u e s should  initial  supportbe  given  f o r other  S i m p l e d e n t a l a n d o r a l p r o b l e m s may be t r e a t m e n t by g e n e r a l m e d i c a l  i s important  s t a f f , but  t h a t p r o v i s i o n s be made f o r r e f e r r i n g  serious o r c o n t i n u i n g problems t o s t a f f d e n t i s t s o r t o specialists  i n t h e same manner t h a t m e d i c a l  referred to appropriate  specialists.  important  that resources  students,  a s y o u n g a d u l t s , may assume  problems are  I t i sespecially  be a v a i l a b l e t h r o u g h w h i c h  f o r t h e i r d e n t a l and o r a l  responsibility  care.  Those e l e m e n t s o f a d e n t a l p r o g r a m r e l a t e d t o p u b l i c h e a l t h and h e a l t h e d u c a t i o n able  should  be made  avail-  on t h e campus i n t h e same manner a s o t h e r e s s e n t i a l  o u t p a t i e n t s e r v i c e s , i f t h e h e a l t h p r o g r a m i s t o be comprehensive.  truly  In e s t a b l i s h i n g the dental h e a l t h s e r v i c e ,  p r o v i s i o n s should  be made f i r s t  f o r those s e r v i c e s which  are most e s s e n t i a l and w h i c h a r e w i t h i n t h e c a p a b i l i t y o f the  staff  resources. I t i s recommended i n t h e S t a n d a r d s t h a t t h e  f o l l o w i n g be c o n s i d e r e d  e s s e n t i a l d e n t a l s e r v i c e s and  117  financed  as an  i n t e g r a l p a r t of the h e a l t h program:  - Emergency Treatment - Diagnosis  and  Consultation  - P r o p h y l a x i s and  Preventive  - P a t i e n t Education - P r o t e c t i v e devices in  contact  Services  (Including Nutrition) f o r students  participating  sports.  O p t i o n a l s e r v i c e s , s u c h as d e f i n i t i v e r e s t o r a t i v e d e n t i s t r y s h o u l d be  f i n a n c e d by p r e p a i d  service basis. d e n t a l care may  insurance  o r on a f e e - f o r -  Desirable services offering  comprehensive  o r b e n e f i t s beyond the u s u a l l e v e l o f  be made a v a i l a b l e t h r o u g h p a r t i c i p a t i o n  care,  i n a prepay-  ment p l a n . In order  to promote r a p p o r t w i t h the  c o n s u l t a t i o n w i t h the m e d i c a l t h e c l a s s r o o m s and education,  residences,  be  provided  opportunity  the  clinical  i s t r y to provide  Service.  clinical  are g i v e n School.  w o u l d have the b e n e f i c i a l e x p e r i e n c e  instituted  i n t h e p u b l i c h e a l t h and i n the  An a l t e r n a t i v e  services f o r students,  convenience of the Dental  icipating  for patient  f a c i l i t i e s of the F a c u l t y of  i n t e r e s t s and n e e d s o f t h e s t u d e n t s o v e r the  from  i n a d e n t a l s u i t e which i s  i n t e g r a l p a r t of the H e a l t h  i s t o use  and  accessibility  i t i s recommended t h a t e s s e n t i a l s e r v i c e s where  possible, should an  staff,  students,  d e n t a l program.  Dent-  i f the  priority  Dental  of observing  students and  part-  e d u c a t i o n a l measures  118  I t i s f u r t h e r suggested t h a t a d e n t a l examinat i o n by a p r i v a t e  d e n t i s t s h o u l d be made a p a r t o f t h e  U n i v e r s i t y entrance requirements w i t h the necessary being mailed t o the student p r i o r t o r e g i s t r a t i o n .  forms Any  unusual d e n t a l o r o r a l c o n d i t i o n s o r items o f i n t e r e s t t o t h e H e a l t h S e r v i c e s t a f f s h o u l d be r e q u e s t e d i n s u c h f o r m s , and i n c o r p o r a t e d i n t o t h e w r i t t e n r e c o r d s .  Nota-  t i o n s o f e a c h e x a m i n a t i o n o r t r e a t m e n t r e n d e r e d s h o u l d be kept i n the student's cumulative h e a l t h r e c o r d .  Statistics  c o n c e r n i n g t h e number o f p a t i e n t s a n d u t i l i z a t i o n s h o u l d be a c c u m u l a t e d  and r e v i e w e d p e r i o d i c a l l y t o e v a l u a t e  t h e p r e s e n t p r o g r a m a n d t o p r o j e c t more e f f e c t i v e services.  of services  future  Nowhere i n t h e U.B.C. H e a l t h S e r v i c e r e c o r d i s  t h e r e space f o r q u e r i e s r e l a t i n g t o d e n t a l o r o r a l  health,  and o n l y up t o 1970 w e r e r e c o r d s k e p t o f t h e number o f r e f e r r a l s made t o d e n t i s t s a n d o u t s i d e d o c t o r s a s shown i n Table IV, Chapter The  4.  U.B.C. b r o c h u r e  i s s u e d t o a l l new a p p l i c a n t s ,  s t a t e s t h a t t h e f o l l o w i n g c a r e i s o f f e r e d by t h e F a c u l t y o f D e n t i s t r y t o a l l s t u d e n t s o f t h e U n i v e r s i t y who do n o t have, o r cannot  attend their family  dentist:  - Emergency t r e a t m e n t s u c h as t o o t h a c h e ,  fractured  t o o t h , o r s o r e gums; - Hygiene  t r e a t m e n t , f o r example, c l e a n i n g o f t e e t h ;  - Routine d e n t a l examination and treatment such as fillings,  e x t r a c t i o n s , and d e n t u r e s .  119  I t i s s t a t e d that these s e r v i c e s are o f f e r e d under c e r t a i n conditions.  One,  t h a t the p a t i e n t s r e q u i r i n g hygiene.or  r o u t i n e d e n t a l care must be screened to e s t a b l i s h b i l i t y f o r student u t i l i z a t i o n .  Two,  suita-  that the F a c u l t y of  D e n t i s t r y r e s e r v e s the r i g h t to s e l e c t only those p a t i e n t s whose treatment requirements are c o n s i s t e n t w i t h the needs of  i t s students and compatable  w i t h i t s t e a c h i n g program.  Three, t h a t there i s a s m a l l d e f r a y i n g charge f o r a l l forms of treatment c a r r i e d out i n the D e n t a l School. Students i n t e r e s t e d i n o b t a i n i n g a s c r e e n i n g appointment  " f o r r o u t i n e d e n t a l treatment or emergency  c a r e " or f o r d e n t a l hygiene.,  are a d v i s e d to c a l l i n p e r -  son-or to telephone the D e n t a l Sciences B u i l d i n g . advice appears  incongruous i n t h a t the urgent nature of  "emergency c a r e " would be r u l e d out by the for  This  s c r e e n i n g and making appointments.  requirements  Furthermore, i f  students were a l l to request i n i t i a l appointments s c r e e n i n g i n the event t h a t emergencies  might  for  arise,  e i t h e r the Dental School would be deluged w i t h such r e q u e s t s , or s c r e e n i n g would become a r i t u a l i s t i c  admission  procedure. The c o n d i t i o n of s e l e c t i o n appears to be  con-  t r a r y to the recommended Standards as o u t l i n e d above. I t was  l e a r n e d by t e l e p h o n i n g the D e n t a l School t h a t the  s e l e c t i o n of cases i s made a t commencement of the  fall  120  term from a l i s t  o f names and complaints r e g i s t e r e d over  the s p r i n g and summer months, and t h a t the cases s e l e c t e d are those t h a t comply w i t h the t e a c h i n g needs and r e q u i r e ments o f the s c h o o l .  Yet, d e s p i t e the f a c t t h a t  dental  s e r v i c e s t o students a t the i n s t i t u t i o n are v i r t u a l l y non-existent,  f r e e d e n t a l care was o f f e r e d to c h i l d r e n  i n the Vancouver a r e a t h i s summer by U.B.C^s F a c u l t y o f Dentistry.  A campus b u l l e t i n - ^  t h i r d summer i n s u c c e s s i o n , provided  reported  t h a t f o r the  the P r o v i n c i a l H e a l t h  Branch  money t o cover the c o s t o f the s e r v i c e . The  end  8  treatment p e r i o d , from May 3rd u n t i l the  o f J u l y , was t o cover between 1,200 and 1,500  c h i l d r e n from the Vancouver, Richmond and Surrey s e l e c t e d through t h e i r schools by p u b l i c d e n t a l officials.  Treatment was to be p r o v i d e d ,  school area health  under p r o f e s s i o n a l  s u p e r v i s i o n , by 28 students e n t e r i n g t h e i r f o u r t h and f i n a l y e a r i n D e n t i s t r y , 6 e n t e r i n g t h i r d year, and 11 e n t e r i n g the second and f i n a l y e a r o f the d e n t a l hygiene program. In the summer o f 1975, more than 1,200 c h i l d r e n were g i v e n treatment which ranged from p a r t i a l and f u l l dentures t o  121  education  on n u t r i t i o n and It  screening and  fluorides.  i s recommended t h a t p r o v i s i o n f o r  of students  he made w i t h i n t h e H e a l t h  t h a t a t l e a s t e m e r g e n c y c a s e s be  treatment to the  Dental  School.  a w o r k i n g r e l a t i o n s h i p must be Health  S e r v i c e and  the  Dental  e l o p i n g a program which w i l l dental health services.  I n any and  t o be  hensive  athletic facilities, tal  Service  h e a l t h care.  h e a l t h and  d e n t i s t s might  Service f o r screening e m p l o y e d on a f o r students  dev-  be  purposes,  part-time on  t r e m e n d o u s number o f presents  to f u l f i l  campus  an  dental obliga-  in providing  compre-  d o l l a r s spent f o r  U n i v e r s i t y ' s concern f o r the  hygiene of i t s students,  o f p h y s i c a l g r o w t h and  the  a l l of the e s s e n t i a l  In r e l a t i o n to the the  aims,  a concept worthy of i n v e s t i g a t i o n .  event, the  Health  these  w i t h a view to  provide  o r a l needs of c o l l e g e s t u d e n t s ,  t i o n f o r the  achieve  e s t a b l i s h e d between  evening dental c l i n i c  i s also considered  Service  r e f e r r e d f o r prompt  School  o r a d e n t a l h y g i e n i s t m i g h t be An  To  Consultant  r o t a t e d through the H e a l t h  basis.  dental  development, i s  vital  den-  components  deplorable.  122  And 6ampus H e a l t h consistent was  yet,  one o f t h e s p e c i f i c o b j e c t i v e s  of the  S c i e n c e s C e n t r e , w h i c h was p l a n n e d t o be  with  the broader objectives  of the University,  the following: "To p r o v i d e a h o s p i t a l a n d d e n t a l c l i n i c w h i c h w i l l set the highest p o s s i b l e standards of care f o r p a t i e n t s a n d w h i c h w i l l be s o s t a f f e d a n d e q u i p p e d as t o p r o v i d e c a r e f o r p a t i e n t s w i t h t h e m o s t com- „ p l e x and s e r i o u s d i s o r d e r s . "  This  objective  6.8  MENTAL HEALTH  A.  h a s y e t t o be a c h i e v e d .  OBJECTIVES"*' In accordance w i t h  objective vide  the Standards, the primary  o f t h e U.B.C. m e n t a l h e a l t h  p r o m p t r e c o g n i t i o n and e f f e c t i v e  service  i s to pro-  treatment o f those  members o f t h e i n s i t u t i o n a l c o m m u n i t y who a r e n o t a b l e t o cope e f f e c t i v e l y w i t h jected.  the stresses  t o w h i c h they a r e sub-  I t i s n o t e x p e c t e d t h a t t h e U n i v e r s i t y assume  o b l i g a t i o n f o r long-term therapy of disturbed  students.  Rather, i t i s suggested that the estimated 1 0 - 1 5 $ o f s t u d e n t s n e e d i n g some p r o f e s s i o n a l a s s i s t a n c e tional difficulties by  b r i e f contact  standing  e a c h y e a r , c a n be h e l p e d  with professionals  f o r emoeffectively  who h a v e a g o o d u n d e r -  o f t h e psycho-dynamics o f young a d u l t s .  Early  123  r e c o g n i t i o n and r e a d i l y a v a i l a b l e , a c c e s s i b l e can p r e v e n t  treatment  t h e f u r t h e r d e v e l o p m e n t o f many p o t e n t i a l l y  d i s a b l i n g emotional  problems.  A n o t h e r recommended o b j e c t i v e i s b e i n g through  t h e development o f a community p r e v e n t i v e  achieved mental  h e a l t h p r o g r a m , one t h a t v i e w s t h e e n t i r e i n s t i t u t i o n a l c o m m u n i t y a s an e n v i r o n m e n t i n w h i c h u n n e c e s s a r y o r i r r e l e v a n t s t r e s s e s a n d c r i s e s c a n be r e d u c e d o r m a t c h e d w i t h appropriate  adaptations.  term d i s a b i l i t y h e a l t h as c r i s i s  The p r e v e n t i o n  i s considered  of serious  t o be a s i m p o r t a n t  i n t e r v e n t i o n and  long-  t o mental  treatment.  I t i s s u g g e s t e d i n t h e S t a n d a r d s t h a t an u r b a n commuter i n s t i t u t i o n ,  s u c h a s U . B . C , may have t o d i r e c t  a d i s p r o p o r t i o n a t e amount o f t h e h e a l t h p r o g r a m  resources'  i n t h e a r e a o f m e n t a l h e a l t h i f r e a l n e e d s a r e t o be met. I t has been e s t i m a t e d  t h a t 80% o f t h e s t u d e n t s  the U n i v e r s i t y ' s Mental and  t h e o t h e r 20% l i v e  1975-76, 3 , 3 6 0 o r 14.6%  treated at  H e a l t h U n i t a r e commuter i n residences  students,  on t h e campus.  of the U n i v e r s i t y student  During  population  ( 2 3 , 0 0 0 ) l i v e d on c a m p u s . ^ 1  B.  FACILITIES The  adjacent Building.  Mental  H e a l t h U n i t was c o n s t r u c t e d  i n 1973.  t o t h e H e a l t h S e r v i c e H o s p i t a l i n t h e Wesbrook The s u i t e c o n s i s t s o f f o u r o f f i c e s a n d a m a i n  124  r e c e p t i o n / w a i t i n g room. decor in  The f u r n i s h i n g s a r e new a n d t h e  i s b r i g h t and p l e a s a n t ; c a r p e t i n g throughout  soundproofing  the f a c i l i t y .  Access  aids  to the unit i s  u n o b t r u s i v e w h i c h h e l p s s t u d e n t s f e e l a t ease and encourages u t i l i z a t i o n If  admitted  of the service. t o the H o s p i t a l , p a t i e n t s can u s u a l l y  be a c c o m o d a t e d i n a s i n g l e room t o p r o v i d e them w i t h and  r e l i e f from the s t r e s s e s o f s c h o o l .  mity of the Mental  facility C.  The c l o s e p r o x i -  Health Unit allows f o r close  t i o n by t h e p s y c h i a t r i c s t a f f .  rest  observa-  More i n f o r m a t i o n on t h e  i s contained i n Chapter  8, P h y s i c a l P l a n t .  SCOPE OF PROGRAM The  Mental  H e a l t h U n i t f u n c t i o n s as an i n t e g r a l  p a r t o f t h e H e a l t h S e r v i c e a l t h o u g h i t a p p e a r s t o have a fair  amount o f autonomy.  n i t i o n and t r e a t m e n t  I n o r d e r t o a s s u r e prompt  of students  i n n e e d o f c a r e f o r emo-  t i o n a l problems, the s e r v i c e operates gency b a s i s u s i n g a pocket-paging that the c l i n i c  i s n o t open.  on a 2 4 - h o u r emer-  system d u r i n g t h e hours  Most t r e a t m e n t  i s provided  on a s h o r t - t e r m b a s i s , c u r r e n t l y m o v i n g t o w a r d i n t e r v e n t i o n and p r e v e n t i o n .  recog-  No t r e a t m e n t  crises  i sprovided to  f a c u l t y o r s t a f f members. The  r e f e r r a l system t o t h e Mental  open a n d d i v e r s e .  Health Unit i s  3 2 $ of the students are s e l f - r e f e r r e d ;  125  4.11%  a r e r e f e r r e d by t h e S t u d e n t S e r v i c e s '  Counselling  O f f i c e a n d t h e Dean o f Women; m o s t a r e r e f e r r e d b y t h e medical  s t a f f of the Health  older students  attend  t h a t younger students  Service.  the Unit.  G e n e r a l l y , more  This r e f l e c t s the view  h a v e more p r o b l e m s b u t a r e more  i n h i b i t e d a n d , t h e r e f o r e , more r e l u c t a n t t o p r e s e n t  them-  selves f o r treatment. P a t i e n t s a r e h o s p i t a l i z e d o n l y when a b s o l u t e l y necessary. has  Occasionally, a seriously disturbed  been a d m i t t e d  to the Health  Sciences  student  Centre P s y c h i a t r i c  U n i t b u t t h e p s y c h i a t r i s t s p r e f e r t o use t h e H e a l t h H o s p i t a l because o f the stigma which i s attached  Service  to the  P s y c h i a t r i c U n i t by o t h e r s t u d e n t s ,  f a m i l i e s , and f r i e n d s .  The  s t a y s where r e l i e f  H o s p i t a l i s used f o r short-term  from environmental necessary.  pressures  Some s t u d e n t s  d u r i n g t h e day w h i l e  s u c h as e x a m i n a t i o n s ,  have c o n t i n u e d  remaining  is  to attend  classes  i n the H o s p i t a l overnight;  some have w r i t t e n e x a m i n a t i o n s on t h e H o s p i t a l w a r d . New p r o g r a m s b e i n g p l a n n e d i n c l u d e an O u t r e a c h service  i n campus r e s i d e n c e s .  held this year with residence f o r the s e r v i c e to begin  Regular  m e e t i n g s have been  a d v i s o r s t o make a r r a n g e m e n t s  i n the f a l l  of  1976.  Much o f t h e f o l l o w i n g i n f o r m a t i o n was  gleaned  19 from a questionnaire prepared campus f a c i l i t i e s  f o r a recent  survey  of  o f f e r i n g assistance t o students  with  126  mental h e a l t h problems.  The  survey  f i c a n t n u m b e r (42.6$) o f t h e  found t h a t a  signi-  population  sampled,  student  i n d i c a t e d t h a t t h e y had  experienced  a t the U n i v e r s i t y .  e p i d e m i o l o g i c a l study  incidence  (An  problems of  while the  o f p s y c h i a t r i c p r o b l e m s among t h e U.B.C. s t u -  d e n t p o p u l a t i o n f r o m J u l y 1975 prepared  life  t o J u n e 1976  by a P s y c h i a t r i c R e s i d e n t  a b l e by t h e  fall  o f 1976.)  and  i s being  s h o u l d be  avail-  Some p r e s e n t i n g p r o b l e m s  a s s o c i a t e d w i t h major mental i l l n e s s ,  f o r example, v o i c e s ,  h a l l u c i n a t i o n or o t h e r p s y c h o t i c symptomatology. problems r e l a t e to l o n e l i n e s s , accomodation, s e x u a l i m p o t e n c e , a n x i e t y and  t e n s i o n , and  Other  over-eating,  somatic  p l a i n t s t h a t are a c t u a l l y psychogenic i n o r i g i n . l e m s a r e d e a l t w i t h p e r s o n a l l y by but  Health Unit include: and  psychiatrists;  Sciences  private practitioners,  Prob-  the  staff,  well. the  Mental  psychologists  S e r v i c e O.P.D.; t h e  C e n t r e P s y c h i a t r i c U n i t ; and  (eg. C o u n s e l l i n g ) .  as  u s e d f o r r e f e r r a l s by  the H e a l t h  com-  the mental h e a l t h  r e f e r r a l s a r e made t o o t h e r r e s o u r c e s Other resources  are  Student  Health Services  S t u d e n t s who  miss or cancel a s e r i e s  of appointments a f t e r p r e s e n t i n g  themselves f o r s e r v i c e ,  a r e f o l l o w e d up by No  known a s s e s s m e n t o f t h e s e r v i c e s p r o v i d e d  t h e f a c i l i t y has use  letter.  them and no  e v e r b e e n c a r r i e d o u t by formal  e v a l u a t i o n has  the students  by who  b e e n done f r o m w i t h i n  127  the  Health  Service.-  questionnaires  L e t t e r s t o p a t i e n t s and consumer  a r e two m e t h o d s t h a t p r o v e u s e f u l t o p r o -  grams i n d e t e r m i n i n g  whether o r n o t they a r e f u l f i l l i n g  t h e n e e d s a n d demands o f t h e p o p u l a t i o n  they  A n o t h e r method i s s t u d e n t r e p r e s e n t a t i o n health council, discussed  serve.  on a U n i v e r s i t y  l a t e r i n t h i s Chapter.  Some  c o n c e r n was e x p r e s s e d t h a t t h e m e n t a l h e a l t h p r o g r a m i s unable t o reach a l l of the students needing help.  One  o f t h e r e a s o n s i s assumed t o be t h a t s t u d e n t s a r e a f r a i d of being  l a b e l l e d mentally  i l l i f they seek out the s e r -  vices of a psychiatrist. Among a h o s t o f f a c i l i t i e s were c o n s i d e r e d the  and s e r v i c e s  b y t h e s u r v e y t o be t h e m o s t n e e d e d on  U.B.C. campus i n a s s i s t i n g s t u d e n t s w i t h m e n t a l  p r o b l e m s were, one, a p s y c h i a t r i c s e r v i c e l o c a t e d m e d i c a l s e t t i n g and, two, g r e a t e r ing  that  facilities.  The f i r s t  co-ordination  i s extant,  health  i n a non-  of exist-  t h e second i s r e -  commended . Utilizing  t h e r i c h c l i n i c a l and e d u c a t i o n a l  experience of the Mental Health being  Unit, research  c a r r i e d out by a P s y c h i a t r i c Resident.  i s currently The u p - d a t e  o f an e a r l i e r s t u d y ^ p r e p a r e d by a f o r m e r H e a l t h Consultant  P s y c h i a t r i s t i s i n process.  I t i s hoped  an u p - d a t e o f a l l o f t h e s t u d e n t m e n t a l h e a l t h will  be a c c o m p l i s h e d .  Service that  services  U n o f f i c i a l f i n d i n g s t o date i n d i c a t e  128  t h a t a b o u t 1.5% o f t h e s t u d e n t p o p u l a t i o n i s s e e n i n the Mental H e a l t h U n i t each y e a r . t h a n male s t u d e n t s a r e seen w h i c h to the f a c t t h a t female  More f e m a l e i s thought  students  t o be due  students seek p s y c h i a t r i c  ment a t a n e a r l i e r age t h a n m a l e s t u d e n t s  (an average o f  two y e a r s ' y o u n g e r ) , p r o b a b l y b e c a u s e f e m a l e s ready t o seek help f o r t h e i r  treat-  a r e more  problems.  An e s t i m a t e d s e r v i c e c e n s u s f o r a t y p i c a l i s shown i n t h e f o l l o w i n g |  W——  .M,—  year  table: 1  I.- -..— —„•-— .... 1 .  • —« •. —~ "'  "  — ' •  "  TABLE X PSYCHIATRIC SERVICE CENSUS*BY SEX Percentage Seen  Number o f Patients  Number o f Students  MALE  152  12,939  1.174  FEMALE  188  8,985  2,092  TOTAL  340  21,924  1.551  SOURCE:  D r . M. Kwan, P s y c h i a t r i c  Resident.  F o r e i g n s t u d e n t s make up a h i g h e r r i s k g r o u p a s s e e n i n T a b l e X I , b u t more A m e r i c a n s t u d e n t s p r e s e n t themselves f o r service.  I t i s considered that t h i s aspect might  be due t o c u l t u r a l a n d s o c i a l  differences.  129  TABLE XI PSYCHIATRIC SERVICE CENSUS* BY COUNTRY OF BIRTH  Number of Patients  Number of Students  CANADA  204  18,035  FOREIGN  136  3,889  U.S."  58  806  OTHER THAN U.S.  78  3,083  SOURCE: *  The  Dr. M.  Kwan, P s y c h i a t r i c  1.131  3-497  7.196  2.530  Resident  f i g u r e s quoted i n the above two  unofficial  Percentage Seen  estimates of a t y p i c a l  t a b l e s are o n l y  year.  F u r t h e r breakdown of s t a t i s t i c s i n t o the f o l l o w ing  categories i s being considered:  countries; marital status; s i b l i n g ren;  stresses; l i f e  illness.  f o r e i g n , e.g. rank; number of  breakdown; complaints;  into child-  and s e v e r i t y of  T h i s ambitious p r o j e c t should p r o v i d e t h o u g h t f u l  i n s i g h t s i n t o the psychodynamics of young a d u l t s and students.  other  130  D.  RECORDS A p p r o p r i a t e records are kept separate  the g e n e r a l h e a l t h f o l d e r b u t v i s i t s U n i t and p r e s c r i b e d m e d i c a t i o n s record.  from  to the Mental  are noted  i n the outpatient  As recommended, a n d d i s c u s s e d i n o t h e r s e c t i o n s o f  t h i s paper, a l l records are kept If requested  strictly  by the s t u d e n t , a statement  garding treatment  rendered  confidential. i s forwarded r e -  o r recommended b y t h e p s y c h i a t r i s t ,  o r a s t u d e n t may r e v i e w h i s r e c o r d i f he r e q u e s t s Students  Health  must s i g n c o n s e n t  forms f o r the r e l e a s e of informa-  t i o n to a p r i v a t e p h y s i c i a n o r another not n o t i f i e d  of therapy  s p e c i f i c a l l y requested Indexing  t o do s o .  agency.  Parents are  administered to a student by t h e s t u d e n t  unless  concerned.  of charts i s p r e s e n t l y being  i n order t o r e p l a c e the log-book system.  undertaken  Indexing  of a l l  c h a r t s i s recommended f o r t h e H e a l t h S e r v i c e , t h e r e a s o n s : for  which are c i t e d  i n s e c t i o n 6.3,  Records.  The w o r k i s  b e i n g c a r r i e d o u t by t h e H o s p i t a l Ward C l e r k who s i b l e f o r admissions  and m e d i c a l  records.  i s respon-  As recommended i n  other s e c t i o n s of t h i s paper, the a s s i s t a n c e of a Medical R e c o r d L i b r a r i a n e i t h e r on a p a r t - t i m e o r c o n s u l t a n t b a s i s w o u l d be o f g r e a t b e n e f i t t o t h e s e r v i c e .  E.  PERSONNEL Limited psychiatric  s e r v i c e has been p r o v i d e d a t  t h e U n i v e r s i t y s i n c e 1938 when a C o n s u l t a n t  Psychiatrist  131  conducted  assessments on a half-day a week basis.  were usually seen f o r one v i s i t only.  Patients  When the consultant  time was increased to two half-days a week i n 1956, a l i m i t e d number of students were provided with psychotherapy.  The  need f o r a f u l l - t i m e service was thus demonstrated by the evidence of the extent of emotional problems among students. This awareness brought about by a s l i g h t expansion of the service resulted i n the appointment of a f u l l - t i m e Resident from the Department of Psychiatry i n September 1959, and year-round service has been available since that time. Since January 1965, there have been two Psychiatric Residents i n addition to the f u l l - t i m e Consultant P s y c h i a t r i s t and one part-time Consultant. The f u l l - t i m e Consultant i s a Professor of Psychiatry.  As the Chief P s y c h i a t r i s t , he divides h i s time  between supervising the Resident program, including research a c t i v i t i e s , conducting his own assessment and treatment of students, and planning new programs to expand the service. The Residents are senior medical personnel, usually i n t h e i r t h i r d year of residency, and have generally had a tour of duty through the Health Sciences Centre Psychiatric Unit before being assigned to the Health Service where they each spend one year working i n the Mental Health Unit. Current negotiations are taking place with the School of Social Work with a view to incorporating supervised s o c i a l work t r a i n i n g into the mental health program.  It i s  132  anticipated that a supervisor from the School would accompany students rotating through the Unit, although some i n s t r u c t i o n would be offered by the medical s t a f f .  Achieve-  ment of this extension of the service should be commended. Further expansion should be encouraged to include the strength and perspectives of other d i s c i p l i n e s , such as psychiatric nursing and c l i n i c a l psychology through which an effective program of teamwork can be developed.  It i s  recommended i n the Standards that support be given to the concept of a team of p s y c h i a t r i s t s , psychologists, psychiat r i c s o c i a l workers, and p s y c h i a t r i c nurses to provide a broader spectrum of resources and to meet a wider variety of needs than any single d i s c i p l i n e alone. Other personnel include the Unit Secretary and the Hospital Ward Clerk who attends to admissions and medic a l records f o r the psychiatric service.  F.  ADMINISTRATIVE RELATIONSHIPS The Mental Health Unit functions as an area of  special interest within the Health Service with the Consultant P s y c h i a t r i s t i n charge of the program responsible to the Director of the Health Service. As recommended, the source of r e f e r r a l s to the service i s as open and diverse as possible with approximately one-third of the students being s e l f - r e f e r r e d .  It  133 is  i n t e r e s t i n g t h a t t h e r e h a s n e v e r b e e n a known  referral  19 from o r t o a r e l i g i o u s vealed the  that students  campus.  Although  a d v i s o r ; a campus s u r v e y  do n o t u s e t h e c h a p l a i n c y  s e r v i c e s on  m e n t i o n h a s b e e n made o f t h e U n i t ' s  l i a i s o n with other resources residence  has r e -  s u c h a s t h e Dean o f Women a n d  a d v i s o r s , i t i s recommended t h a t g r e a t e r  co-ordina-  t i o n o f e x i s t i n g s e r v i c e s be p r o m o t e d . G.  ETHICAL AND PROFESSIONAL  RELATIONSHIPS  The recommended s c r u p u l o u s principles  observance o f the  o f c o n f i d e n t i a l i t y and t h e r a r e  circumstances  u n d e r w h i c h t h e y may be b r e a c h e d a r e d i s c u s s e d i n s e c t i o n 6.3,  Records.  Specifically,  t h e S t a n d a r d s recommend t h a t  m a t i o n about d i a g n o s i s and t r e a t m e n t to p r o f e s s i o n a l personnel "(a)  i n detail  should  o n l y be  under the f o l l o w i n g  inforgiven  circumstances:  With the student's w r i t t e n permission that of h i s parents o r l e g a l guardian minor).  ( a s w e l l as i f he i s a  (b)  I f t h e s t u d e n t ' s i l l n e s s has been s e v e r e to r e q u i r e h i s withdrawal from school.  (c)  Only a f t e r s h a r i n g w i t h the student, o r h i s pare n t s , t h e i n f o r m a t i o n w h i c h i s t o be t r a n s m i t t e d . " (6.  I t i s recommended t h a t , when p o s s i b l e , s t a t e m e n t s to p s y c h i a t r i c treatment (or former student)  be s u b m i t t e d  enough  - p.59) relating  d i r e c t l y t o the  i n v o l v e d a n d t h a t he be r e q u e s t e d  ward t h e statement t o t h e a p p r o p r i a t e  agency o r source  student to forhimself.  134  6.9 A.  ATHLETIC MEDICINE OBJECTIVES The  Standards  s t a t e t h a t the H e a l t h S e r v i c e  should be r e s p o n s i b l e f o r p r o v i d i n g medical s u p e r v i s i o n of the p h y s i c a l education and a t h l e t i c programs, cally  including: "(a)  B.  specifi-  S u p e r v i s i o n of the p h y s i c a l q u a l i f i c a t i o n s f o r a l l p a r t i c i p a n t s i n the p h y s i c a l education and a t h l e t i c programs.  (b)  P r o v i s i o n f o r treatment and r e h a b i l i t a t i o n of students i n j u r e d d u r i n g p a r t i c i p a t i o n . ,  (c)  P r o v i s i o n of m e d i c a l guidance vities .  (d)  S u p e r v i s i o n of r e c o r d keeping f o r a l l a c c i d e n t s and i n j u r i e s , i n c l u d i n g adherence to standard terminology f o r c l a s s i f i c a t i o n of a c c i d e n t s and injuries.  (e)  Co-operation w i t h the p h y s i c a l education or a t h l e t i c department i n d e v e l o p i n g a program f o r injury prevention.  (f)  Co-operation w i t h the p h y s i c a l education o r a t h l e t i c department i n the t r a i n i n g of p e r s o n n e l i n v o l v e d i n the care and r e h a b i l i t a t i o n of i n j u r e d athletes." ( 6 . - p.21)  for training  acti-  THE ATHLETIC MEDICINE PROGRAM The  t o t a l program of care and i t s f i n a n c i a l  support  appear to be arranged c o - o p e r a t i v e l y by the H e a l t h S e r v i c e and the Department of A t h l e t i c s as recommended i n the P h y s i c a l examinations  Standards.  f o r admission to U.B.C. are no l o n g e r  mandatory, although the student brochure  s t i l l advises that  135  "students e n r o l l i n g f o r a B.P.E. degree, or B.Ed,  degree  with a major i n Physical Education, are required to have a supplementary medical examination  relevant to p a r t i c i p a t i o n  i n t h e i r a c t i v i t y courses" by the Health Service physicians. I n i t i a l l y a l l Physical Education students were examined yearly; l a t e r only f i r s t year students were seen.  At the  present time physicals are performed only i n s p e c i a l circumstances, or i f the student or faculty requests that an examination be carried out. Candidates  f o r the sports programs are given  physical examinations on an i n d i v i d u a l basis, f o r instance, i f there i s a known health problem.  A review i s made of the  health information submitted f o r each incoming student  who  intends to p a r t i c i p a t e and clearance i s granted to those whose records show no clear contraindications to unrestricted activities.  However, participants i n heavy contact or high-  r i s k sports are examined annually.  Three physicians are  usually employed f o r an afternoon at the beginning of the f a l l term to conduct physical examinations on candidates f o r the f o o t b a l l teams.  Other high-risk sports requiring s p e c i a l  consideration are hockey, rugby, scuba-diving and sky-diving. Appendix X i s the guideline used f o r a Health Assessment of the Basic Scuba Diver.  Appendix XI provides instructions  to the medical examiner r e l a t i n g to the Medical Examination for Evaluation of Physical Fitness to Participate i n Sport Parachuting.  136  The U n i v e r s i t y ' s a t h l e t i c p r o g r a m was by t h e H e a l t h the  Service  A s s i s t a n t D i r e c t o r , who f u n c t i o n s  team p h y s i c i a n , t o i n c l u d e  the f o l l o w i n g  Field  Baseball  Golf  Squash  Basketball  Gymnastics  Swimming  Bowling  Ice  Tennis  Cricket  Judo  Track & F i e l d  Curling  Rowing  Volleyball  Cycling  Rugby  Weightlifting  Cross  Sailing  Wrestling  Country  Hockey  as  activities:  Badminton  Soccer  Hockey  Skiing  Football  Other a c t i v i t i e s are  reported  reported  by t h e P h y s i o t h e r a p i s t  f i g u r e - s k a t i n g , fencing, trampoline,  and d i v i n g .  The  extremely busy n a t u r e o f the a t h l e t i c program i s indeed apparent. The S t a n d a r d s recommend t h a t t h e r e  be  organized  m e d i c a l s u p e r v i s i o n o f b o t h i n t r a m u r a l and i n t e r c o l l e g i a t e s p o r t s programs by p h y s i c i a n s s p e c i a l i n t e r e s t and s k i l l  a n d o t h e r p e r s o n n e l who  i n t h i s area of medical  have  care.  Such s u p e r v i s i o n  i s s t a t e d t o be i m p o r t a n t f o r t h e p r e v e n -  tion of possible  i n j u r y t o those w i t h p h y s i c a l  the p r e v e n t i o n  of exacerbation  limitations,  o f known e x i s t i n g h e a l t h  b l e m s , and t h e p r o v i s i o n o f p r o m p t c a r e  pro-  f o r t h o s e who a r e  injured. Medical i s not organized  s u p e r v i s i o n o f s p o r t s p r o g r a m s a t U.B.C. by t h e H e a l t h  Service, although a triage  137  of three physicians i s i n attendance at the center on weekends f o r home games.  At one time the University paid  $25.00 per game f o r a physician to be i n attendance.  Curr-  ently, the School of Physical Education and Recreation has a budget f o r game coverage by an Orthopedic Resident or some other person of s i m i l a r q u a l i f i c a t i o n s .  An occasional  complaint has been registered i f an injury has occurred at a weekend game with no doctor i n attendance, but Conference Rules require that a physician be present f o r heavy contact sports such as f o o t b a l l or ice hockey.  The Physiotherapist  i s also i n attendance at many of the weekend sports events and i s well trained i n handling the injured.  A l l news r e -  leases concerning the nature and extent of i n j u r i e s to athletes are made by the University Information O f f i c e r . The stadium contains press and t e l e v i s i o n f a c i l i t i e s and a f u l l y equipped t r a i n i n g room i n addition to other amenities.  Injured athletes who are not transferred d i r e c t l y to  the Hospital or to the Physiotherapy Department f o r t r e a t ment, are advised to report to the Health Service at 8:15 the following morning.  Appropriate f i r s t - a i d equipment and  means of transportation are reported to be available at a l l times where a t h l e t i c events and practices take place. The campus ambulance i s available on a 24-hour basis,.staffed by F i r e Department personnel who are a l l experienced Aid  Attendants.  First-  138  The P h y s i o t h e r a p y  Treatment Centre i s l o c a t e d  i n t h e Gymnasium ( a c r o s s f r o m t h e H e a l t h accomodates t h e A t h l e t i c School  and R e c r e a t i o n .  s u i t e i s equipped w i t h treatment  p h y s i c a l therapy  which  Department, and o f f i c e s o f t h e  of P h y s i c a l Education  therapy  Service)  m o d a l i t i e s , a source  p u l l e y s , and i s o m e t r i c b a r s .  The p h y s i o -  tables, various  of ice,  weights,  D e t a i l e d information i s g i v e n  i n t h e f o l l o w i n g s e c t i o n 6.10,  Rehabilitation/Physical  Medi-  cine . Records o f i n d i v i d u a l p a t i e n t treatments are maintained  i n the Physiotherapy  Health Service f o r c l i n i c s the  student's  keeping  It  and treatment  health folder.  i s also given  Department; v i s i t s  to the  are recorded i n  F u r t h e r i n f o r m a t i o n on r e c o r d -  i n the next s e c t i o n .  i s recommended t h a t t e r m i n o l o g y  used  should  be c o n s i s t e n t w i t h t h e S t a n d a r d N o m e n c l a t u r e o f A t h l e t i c I n j u r i e s , t h a t d a t a be k e p t c o n c e r n i n g injuries, Athletic  and t h a t p e r i o d i c j o i n t reviews Department and-the H e a l t h  developing  C.  the occurrence  programs f o r i n j u r y  of  be made b y t h e  Service w i t h a view to  prevention.  PERSONNEL The A s s i s t a n t D i r e c t o r o f t h e H e a l t h  not  have t h e o f f i c i a l  title  his  i n t e r e s t and e x p e r i e n c e ,  Service  does  o f Team P h y s i c i a n b u t , t h r o u g h h a s become m o s t i n v o l v e d i n  139  the  provision of medical supervision  f o r athletes.  He i s  a member o f b o t h t h e C a n a d i a n Academy o f S p o r t M e d i c i n e and with  the Canadian A s s o c i a t i o n  of Sports Sciences.  t h e A t h l e t i c s and R e c r e a t i o n  Medical Association,  He l i a s e s  C o m m i t t e e o f t h e B.C.  and m a i n t a i n s c l o s e  co-operation  with  the  P h y s i c a l E d u c a t i o n Department, and t h e A t h l e t i c s  and  s t u d e n t t r a i n e r s , as w e l l as t h e P h y s i o t h e r a p i s t . In assuming the r e p o n s i b i l i t y f o r m e d i c a l  v i s i o n , the Assistant Director takes part  Trainer  super-  i n physical  exam-  i n a t i o n s o f a t h l e t e s , i n t h e weekend t r i a g e u n i t a t t h e Health  Service,  a t t e n d s some, b u t n o t a l l , o f t h e o f f i c i a l  games, a n d s u p e r v i s e s athletes  t h e c a r e and r e h a b i l i t a t i o n o f i n j u r e d  and o t h e r s t u d e n t s .  I n a d d i t i o n , an  specialist  conducts a weekly c l i n i c  ients with  athletic  injuries  orthopedic  i n w h i c h 20 t o 25 p a t -  (mainly  knees, shoulders,  a n k l e s ) a r e seen i n about a two-hour  and  period.  A t h l e t i c t r a i n e r s , as recommended i n t h e S t a n d a r d s , are  subject  to supervision  (in  t h i s case the A s s i s t a n t D i r e c t o r )  l a t i n g to the recognition,  by t h e H e a l t h  care,  Service  Director  in a l l activities re-  and r e h a b i l i t a t i o n o f i n -  j u r e d a t h l e t e s and o t h e r s t u d e n t s . r e s p o n s i b i l i t i e s o f t h e Head T r a i n e r  In general,  t h e recommended  are the f o l l o w i n g :  (1)  A s s i s t i n g i n t h e c o n d i t i o n i n g and t r a i n i n g o f a t h l e t e s .  (2)  A d v i s i n g i n t h e p u r c h a s e and p r o p e r u s e o f p r o t e c t i v e equipment.  (3)  F i t t i n g and a p p l y i n g  (4)  S u p e r v i s i n g t h e r e c o g n i t i o n and c a r e o f i n j u r e d a t h l e t e s by t h e t r a i n i n g s t a f f .  protective  equipment.  140  As recommended, these functions are performed by the trainers at U.B.C.  The application of protective  equipment includes duties such as taping before and a f t e r games.  No treatments are given by the trainers even though  devices f o r treating are available i n the sports areas, f o r example, the whirlpool bath at the stadium.  The Physiothera-  p i s t who plays a very v i t a l role i n the area of a t h l e t i c medicine i s reported on i n the following section.  6.10 A.  REHABILITATION/PHYSICAL MEDICINE OBJECTIVES The Standards recommend that the University should  assure the a v a i l a b i l i t y of r e h a b i l i t a t i o n services f o r students, f a c u l t y , and s t a f f who have suffered impairment of function as a r e s u l t of i l l n e s s , accident, work or academic program, and f o r students with a physical, emotional, or s o c i a l handicap.  I t i s also considered  appropriate  f o r the  University to e s t a b l i s h s p e c i f i c standards f o r physical and emotional health as a prerequisite to acceptance i n s p e c i a l programs and a c t i v i t i e s , and to l i m i t acceptance of seriously handicapped students i n programs which have s p e c i a l requirements.  In general, every handicapped applicant to U.B.C.  i s considered  on an i n d i v i d u a l basis.  141  B.  PROGRAM Other than  the design  o r m o d i f i c a t i o n o f some  campus b u i l d i n g s t o a l l o w a c c e s s capped, to e x p e d i t e r a m p s , and i s not  t r a v e l b e t w e e n f l o o r s by  to provide  handicapped.  I t w o u l d be  elevators or  rehabilitation  activities  of  h e l p f u l t o have a p r o f i l e experiences  s e v e r i t y of d i s a b i l i t i e s  and  others, i n  however, t h e r e  i s a good  program of p h y s i c a l therapy w h i c h aims a t p r o v i d i n g r e s t o r a t i o n o f f u n c t i o n t o a l l who  that  C.  The  type  create r e h a b i l i t a t i o n services.  area of p h y s i c a l medicine,  or d i s a b i l i t y .  the  of  r e g a r d i n g the  among s t u d e n t s  o r d e r t o a p p r o p r i a t e l y p l a n and In the  a special  t r a n s p o r t a t i o n and  e x i s t i n g p r o b l e m s and p a s t and  handi-  accomodating t o i l e t f a c i l i t i e s , i t  known w h e t h e r U.B.C. has  program f o r housing,  by t h e p h y s i c a l l y  have s u f f e r e d  full  illness  remainder of t h i s s e c t i o n r e p o r t s  on  department.  FACILITIES The  Physiotherapy  Treatment Centre  t h e l o w e r l e v e l o f t h e Gymnasium w h i c h was t h e 1954  B r i t i s h E m p i r e Games.  The  i s located  on  constructed f o r  department c o n s i s t s of  f o u r rooms p l u s t h e b a t h r o o m w i t h s h o w e r , t o i l e t ,  sink,  saunas.  treatment  The  b e n c h e s , two  outer treatment  room c o n t a i n s t h r e e  u l t r a - s o u n d machines, a diathermy  machine,  and  142  v a r i o u s m o d a l i t i e s s u c h as w e i g h t s , p u l l e y s , collator  packs,  and  the t h e r a p i s t ' s desk.  (mostly knees, menisectomies,  and  Hydro-  Sports  injuries  e t c . ) and p a t i e n t s w i t h f r o z e n  s h o u l d e r syndrome a r e t r e a t e d h e r e . A second violet  lamps, head p u l l e y ,  F e m a l e p a t i e n t s and this  treatment  room has  two  c h a i r , s c r e e n , and  ultra-  weights.  back problems are u s u a l l y t r e a t e d i n  room as i t i s r a t h e r more p r i v a t e .  w i t h acne a r e r e f e r r e d from Clinic  benches,  for ultra-violet  A l s o many s t u d e n t s  the H e a l t h S e r v i c e Dermatology  treatments  here.  The  third  treat-  ment room c o n t a i n s a w h i r l p o o l b a t h , a hand/arm b a t h , contrast bath packs,  ( h o t / c o l d ) , and  a fridge  and  a  freezer for ice  e t c . ; t h e f o u r t h room i s u s e d f o r s u p p l i e s s u c h  c r u t c h e s , v i b r a t o r , h a i r c l i p p e r , and Two  tapes.  n o t a b l e d e f i c i e n c i e s are apparent  physical facility.  One  t h e d e p a r t m e n t , and  the second  must be managed by  as  i n the  i s t h a t t h e r e a r e no w i n d o w s i n i s the number of s t a i r s #  that  i n j u r e d and d i s a b l e d s t u d e n t s i n o r d e r t o  g e t down t o t h e d e p a r t m e n t f o r t r e a t m e n t .  D.  PERSONNEL The  nician  d e p a r t m e n t i s manned by one  ( P - h y s i o t h e r a p y ) whose t i m e  H e a l t h S e r v i c e and Recreation.  R e g i s t e r e d Tech-  i s d i v i d e d between the  the School of P h y s i c a l Education  His s a l a r y i s budgeted through both  and  departments,  143  and  he r e p o r t s  the  P h y s i c a l E d u c a t i o n D e p a r t m e n t Head. The  trained  t o both the Health  Physiotherapist  i n Zurich,  a t U.B.C.  D i r e c t o r and  i s very w e l l q u a l i f i e d having  Switzerland,  f y i n g course followed  Service  and t a k e n a Canadian q u a l i -  by b o t h w r i t t e n and o r a l e x a m i n a t i o n s  He i s a n a c t i v e member o f t h e C a n a d i a n  of P h y s i o t h e r a p i s t s ,  B.C. D i v i s i o n , a r e p o r t e d  Association  condition of  employment a t t h e U n i v e r s i t y , a n d o f t h e B.C. H e a l t h Association  f o r paramedical groups.  After thirteen  Sciences years'  e x p e r i e n c e a t t h e V a n c o u v e r G e n e r a l H o s p i t a l , he j o i n e d t h e Athletic  D e p a r t m e n t i n 1965 b e c a u s e o f an i n t e r e s t i n s p o r t s  and  student medicine.  E.  PHYSIOTHERAPY PROGRAM I t was i n d i c a t e d t h a t t h e U n i v e r s i t y ' s l a r g e  intra-  m u r a l a n d e x t r a m u r a l a t h l e t i c p r o g r a m s a r e t o o much f o r one Physiotherapist. football, teams.  Male s p o r t s  two s o c c e r ,  Female s p o r t s  c o n s i s t o f f i v e r u g b y , two  two b a s k e t b a l l a n d f o u r v o l l e y b a l l include  figure-skating, a field  team, a n d f o u r . v o l l e y b a l l t e a m s . to the P h y s i o t h e r a p i s t swimming, f e n c i n g , ing,  trampoline,  Other a c t i v i t i e s  are wrestling,  i c e and f i e l d  hockey, trampoline,  o f concern  judo, t r a c k and f i e l d ,  hockey, g o l f , s k i i n g , c u r l -  g y m n a s t i c s , and d i v i n g .  i s a v e r y busy p e r i o d  hockey  The f o o t b a l l s e a s o n  a n d f r o m December u n t i l s p r i n g , i c e  a n d o t h e r gym a c t i v i t i e s  require  first-  144  aid  for injuries.  B e t w e e n 35  t o 40  or t r e a t e d d a i l y  i n the w i n t e r  is also reported  t o be  p a t i e n t s may  session.  The  be  seen  summer s e s s i o n  b u s y w i t h many t e a c h e r s  receiving  treatment. T h e r e i s no but  the p r e s c r i b e d  g u i d e l i n e s of the  of P h y s i o t h e r a p i s t s  and  These i n c l u d e  the  injuries,  simple  and  a diagnosis by  the  job d e s c r i p t i o n f o r the  the  B.C.  first-aid.  The  and  Health  Service  H o s p i t a l but  on t h e  student population.  athletes  taking  does p r o v i d e  the  from the  department i s considered  (and  wait, and  s e r v i c e to  the  concentrated  R e f e r r a l s o f f campus a r e  generally  occasionally,  P h y s i c a l Education student i s r e f e r r e d to a p r i v a t e  have b e e n r e c e i v e d  to  chances.  h i s m a i n work l o a d i s  made t o t h e V a n c o u v e r G e n e r a l H o s p i t a l b u t ,  and  said  t h e r a p i s t remains f i r m  t h e r a p i s t , p r i m a r i l y as a c o u r t e s y .  making  scope  u n w i l l i n g to  t o succumb t o s t u d e n t demands by Physiotherapist  sports  treatment i s r e j e c t e d  Some s t u d e n t s a r e  "tough"), or impatient  The  routine  r e s p o n s i b i l i t y of  e i t h e r because they are  example, f o r x - r a y s .  refuses  followed.  wishes to remain w i t h i n the  l i m i t a t i o n s of h i s p r o f e s s i o n .  for  The  or of g i v i n g non-prescribed  r e s i s t t h i s stand,  Association  D i v i s i o n are  treatment of a l l r e f e r r a l s ,  t h e r a p i s t who  therefore  Canadian  therapist  Requests f o r  physio-  treatment  Workers' Compensation Board, strictly  athletic.  a  There i s  involvement i n r e h a b i l i t a t i o n programs f o r handicapped  but no  students  145  although treatment i s provided  f o r any i n j u r i e s , and f o r  special conditions l i k e cystic f i b r o s i s .  F o r example,  two  students with t h i s c o n d i t i o n received p o s t u r a l d r a i n -  age  t r e a t m e n t s f o r two y e a r s .  As p r e v i o u s l y mentioned,  r e f e r r a l s from t h e Dermatology C l i n i c a r e a l s o  treated.  Because o f the s t a i r s l e a d i n g down t o t h e d e p a r t ment, p a t i e n t s may r e q u i r e a s s i s t a n c e  i n getting  there.  Emergencies from t h e Gym o r P h y s i c a l E d u c a t i o n Department, such as f r a c t u r e s , a r e t a k e n down by s t r e t c h e r .  Ifa  f r a c t u r e i s c o n f i r m e d by a p h y s i c i a n , t h e p a t i e n t i s t r a n s f e r r e d t o t h e Vancouver G e n e r a l H o s p i t a l .  First-aid  treat-  ment f o r f r a c t u r e s c o n s i s t s o f e l e v a t i o n , compression, and ice.  Other f i r s t - a i d i n c l u d e s :  A s p i r i n for pain  p h y s i c i a n permission) o r r e f e r r a l t o the Health  (with Service  f o r s t r o n g e r m e d i c a t i o n such as F r o s s t 292; Desenex powder f o r a t h l e t e ' s f o o t ; and t h e a p p l i c a t i o n o f t e n s o r s . and  Cardiac  e p i l e p t i c p a t i e n t s have a l s o been seen i n t h e department  before t r a n s f e r o r release. t h e r a p i s t include teaching  Other a c t i v i t i e s o f t h e P h y s i o f i r s t - a i d and s p o r t s massage t o '  t h i r d and f o u r t h y e a r P h y s i c a l E d u c a t i o n S t u d e n t s , and a t t e n d i n g the weekly c l i n i c a t t h e H e a l t h p e d i c Surgeon.  S e r v i c e w i t h t h e Ortho-  S t u d e n t s seen a t t h e c l i n i c are m o s t l y r e -  f e r r a l s f o r physiotherapy. Discussions  have t a k e n p l a c e r e g a r d i n g  the r o t a t i o n  of P h y s i c a l E d u c a t i o n s t u d e n t s t h r o u g h t h e department as p a r t  146  of  their training.  to  this  effect,  W h i l e n o p l a n s have b e e n  developed  i t i s c o n s i d e r e d t o he a w o r t h w h i l e  cept i n terms o f t h e v a l u a b l e aspects o f p r a c t i c a l as w e l l a s t h e p o s s i b l e a s s i s t a n c e w h i c h for  the t h e r a p i s t by s t u d e n t s .  contraining  c o u l d be p r o v i d e d  He w o u l d , h o w e v e r ,  likely  r e q u i r e an a d d i t i o n a l P h y s i o t h e r a p i s t t o c a r r y t h e p r e s e n t workload,  and a s s i s t a n c e from t h e m e d i c a l s t a f f  paration of instructional material.  i n the pre-  I t i s recommended t h a t  advanced students i n t h e School o f R e h a b i l i t a t i o n participate clinical  F.  i n t h e p h y s i o t h e r a p y program as p a r t o f t h e i r  training.  RECORDS AND COMMUNICATIONS Visits  or  Medicine  t o t h e department a r e e i t h e r by appointment  on a d r o p - i n b a s i s .  The a p p o i n t m e n t t i m e t a b l e i s a p p r o x i -  mate o n l y a s t h e P h y s i o t h e r a p i s t t r i e s schedule.  to maintain a f l e x i b l e  He k e e p s a d a i l y r e c o r d o f a l l v i s i t s  name, d a t e , a n d s o u r c e  of referral;  individual  cards a r e used t o r e c o r d p a t i e n t p r o g r e s s notes.  including attendance Monthly  s t a t i s t i c a l r e p o r t s a r e s u b m i t t e d t o t h e H e a l t h S e r v i c e and to  the School of P h y s i c a l Education.  Report  A copy o f t h e Monthly  o f P h y s i o t h e r a p y T r e a t m e n t s i s shown i n A p p e n d i x X I I . The  number o f t r e a t m e n t s  a d m i n i s t e r e d i s broken  down i n t o r e f e r r a l s f r o m t h e H e a l t h S e r v i c e a n d a t h l e t i c injuries.  F o r e x a m p l e , o f t h e 150 p a t i e n t s t r e a t e d i n A p r i l  1976, 48 w e r e r e f e r r e d f r o m  t h e H e a l t h S e r v i c e a n d 35 w e r e  147  athletic  injuries.  s p r i n g examination  These r e l a t i v e l y  low figures  time a t the U n i v e r s i t y .  the breakdown o f t r e a t m e n t s gories i s considered  In addition,  into the various sports  cate-  h e l p f u l i n i n d i c a t i n g areas of concern  for injury prevention.  T a b l e I V i n C h a p t e r 4 shows t h e  a n n u a l number o f p h y s i o t h e r a p y . t r e a t m e n t s 1954 t o 1975-  reflect  rendered  from  The m a r k e d i n c r e a s e i n 1 9 6 5 - 6 6 r e f l e c t s t h e  employment o f t h e P h y s i o t h e r a p i s t a n d t h e p r o v i s i o n o f a f u l l service. No c o l l e c t i o n s o r b i l l i n g medical  insurance  c o l l e c t i o n s a r e made t h r o u g h t h e H e a l t h  S e r v i c e , and a t t e n d a n c e r e c o r d s f o r the School  of patients are necessary;  provide  of P h y s i c a l Education.  P h y s i o t h e r a p i s t i n budget p r e p a r a t i o n s  a picture of costs Involvement o f the consists of pre-audit  d i s c u s s i o n s w i t h t h e D i r e c t o r s o f t h e two d e p a r t m e n t s and  arrangements f o r purchasing  s u p p l i e s and equipment.  Communication w i t h a l l p h y s i c i a n s , t r a i n e r s a n d c o a c h e s , was r e p o r t e d  specialists,  t o be g o o d .  Requests f o r  the P h y s i o t h e r a p i s t ' s o p i n i o n r e g a r d i n g a p l a y e r ' s f o r a game a r e r e s p e c t e d ,  concerned,  and t h e c o - o p e r a t i o n  readiness  of the Health  S e r v i c e D i r e c t o r and s t a f f i s a p p r e c i a t e d .  In a l l ,  t h a t t h i s department i s o p e r a t i n g a t a very  high  i t appears  level.  148  6.11  A.  HEALTH PROMOTION/PREVENTIVE MEDICINE  OBJECTIVES The  Standards r e c o g n i z e  h e a l t h and the p r e v e n t i o n elements of any  t h a t the p r o m o t i o n of  of i l l n e s s are the e s s e n t i a l  comprehensive community h e a l t h program.  To be e f f e c t i v e , t h e r e must be c o o r d i n a t i o n and  integra-  t i o n of programs f o r p e r s o n a l h e a l t h s e r v i c e s , environment a l c o n t r o l , e p i d e m i o l o g i c a l i n v e s t i g a t i o n , community educat i o n f o r h e a l t h , systems developments, and o t h e r s . a l l of these areas of p r o f e s s i o n a l i n t e r e s t are  While  embodied  i n the U n i v e r s i t y ' s programs, t h e r e i s no known c e n t r a l d i v i s i o n f o r c o o r d i n a t i n g them i n t o an a c t i v e  general  h e a l t h program.  B.  PROGRAMAs r e p o r t e d  i n o t h e r s e c t i o n s of t h i s paper,  every s t u d e n t i s asked to have an e v a l u a t i o n of h i s h e a l t h s t a t u s p r i o r t o a d m i s s i o n t o the U n i v e r s i t y . ance her  i s expected to p r o v i d e  After  accept-  d e t a i l e d and c o n f i d e n t i a l  i n f o r m a t i o n c o n c e r n i n g h i s p a s t m e d i c a l h i s t o r y and p r e s e n t h e a l t h s t a t u s t o the H e a l t h S e r v i c e . i s kept c o n f i d e n t i a l and  his  AIL i n f o r m a t i o n  i s used t o h e l p meet the academic  and p e r s o n a l needs of the s t u d e n t and t o p r e v e n t the opment of c i r c u m s t a n c e s w h i c h might compromise the  devel-  health  149  of the student  o r o t h e r members o f t h e i n s t i t u t i o n a l  community. The f o l l o w i n g p r e v e n t i v e by  the Health  s e r v i c e s are o f f e r e d  S e r v i c e i n c o m p l i a n c e w i t h t h e recommended  Standards: 1.  Periodic health evaluation of individual or s p e c i a l i z e d g r o u p s where i n d i c a t e d , i n c l u d i n g a t h l e t e s and those such examinations  2.  h i s t o r i e s make  advisable.  The p r o v i s i o n o f i m m u n i z a t i o n s f o r t h e p r e v e n t i o n of s p e c i f i c  3.  where m e d i c a l  diseases.  T u b e r c u l i n t e s t s and S c h i c k  t e s t s throughout the  year. 4.  C o n t r o l of epidemic diseases  on t h e campus a s  a d v i s e d by the Board o f H e a l t h of B r i t i s h 5.  Columbia.  Mental health f a c i l i t i e s ments a n d e m o t i o n a l ected  of the Province  early t  t o cope w i t h  maladjust-  problems, which, i f not c o r r -  may g i v e r i s e t o more s e r i o u s d i s t u r b -  ances i n the f u t u r e . U.B.C. e n t r a n c e x-ray  or negative  admission. facilities  requirements s p e c i f y a  t u b e r c u l i n t e s t w i t h i n s i x months o f  The D i v i s i o n o f T.B. C o n t r o l p r o v i d e s s p e c i a l f o r t u b e r c u l o s i s d e t e c t i o n f o r a two-week  d u r i n g t h e w i n t e r s e s s i o n and a l l s t u d e n t s a v a i l themselves of the f a c i l i t y . a v a i l a b l e at the Health hours. students  chest  Through review  period  are advised to  Tuberculin t e s t s are  Service during the s p e c i a l c l i n i c of entrance  health records,  w i t h a p o s i t i v e t u b e r c u l i n t e s t c a n be  those  identified  150  and  t h e i r h e a l t h s t a t u s reviewed  on a n i n d i v i d u a l b a s i s .  A f o l l o w - u p t u b e r c u l o s i s s c r e e n i n g program (weekly x-ray  clinic)  chest  i s provided f o r a l l students, the i n t e r v a l  being v a r i a b l e f o r those  subject to special risk, f o r  example, n u r s i n g and m e d i c a l  students.  t i o n o f a new x - r a y m a c h i n e i n 1974, Thus t h e m o b i l e  With  the i n s t a l l a -  the survey  chest  unit  was  removed.  pus  once o r t w i c e a y e a r f o r T.B. s k i n t e s t i n g s a n d x -  raying of positive by  the Sanatorium  T.B. t e s t i n g u n i t i s on cam-  reactors.  A recent press release issued  B o a r d o f B.C. s t a t e d t h a t T.B.  x-ray  s c r e e n i n g p r o g r a m s w o u l d s o o n be d i s c o n t i n u e d b e c a u s e o f t h e i r diseconomy i n r e l a t i o n The  requirements  to their relative  f o r smallpox vaccinations w i t h i n  f i v e years p r i o r to admission, brochure,  isstill  stated i n the student  b u t t h e y a r e no l o n g e r b e i n g g i v e n by the P r o v i n c i a l  H e a l t h Department.  A t t h e p r e s e n t t i m e , t h e r e a p p e a r s t o be  a dichotomy i n a l l medical for  value.  circles  concerning v a c c i n a t i o n  smallpox. C h o l e r a and typhus v a c c i n e s a r e n o t g i v e n f r e e  o f c h a r g e b u t may be p u r c h a s e d a t any pharmacy. where i n d e f e n s e the f a l l  While  at the Health Service or  p r e p a r a t i o n s a r e b e i n g made  every-  o f t h e t h r e a t e n i n g swine f l u pandemic i n  o f 1976, n o p r e p a r a t o r y s t e p s have y e t b e e n  by t h e U n i v e r s i t y .  taken  The H e a l t h S e r v i c e h a s b e e n a d v i s e d  an a l l o t m e n t o f v a c c i n e w i l l  that  be made a v a i l a b l e f o r h i g h - r i s k  151  groups of students i s known and  no  and  s t a f f , b u t no  d i r e c t i v e s have been  I t i s considered  other  information  given.  unwise f o r the  health  ions t o r e l a x t h e i r v i g i l a n c e i n p r o t e c t i n g the against be  known h e a l t h h a z a r d s and  continued  i n an  a concerted  attempt to eradicate  recommend t h a t e a c h i n s t i t u t i o n s h o u l d and  extracurricular activities  s p e c i a l r e q u i r e m e n t s may  be  professions, education, B o t h a c a d e m i c and  professcommunity  effort  should  The  Standards  them.  survey i t s academic  to determine those f o r which  appropriate,  athletics,  f o r example,  health  o c e a n o g r a p h y , and f o r e s t r y .  r e s e a r c h programs should  be  reviewed  to  determine the presence of h e a l t h hazards f o r which prevent i v e m e a s u r e s , s u c h as It  immunization, should  i s u r g e n t l y recommended, t h e r e f o r e , t h a t  begin  be  instituted.  preparations  i m m e d i a t e l y t o combat t h e p o s s i b l e w i d e - s p r e a d  break of the  disease  out-  known as s w i n e f l u .  I t i s f u r t h e r recommended t h a t s p e c i a l p r o g r a m s be  d e v e l o p e d f o r s u r v e i l l a n c e and  pilations  o f known e x i s t i n g d i s e a s e s  l e p s y , and  chronic  Periodic screening to i d e n t i f y  The  t o p r e v e n t com-  s u c h as d i a b e t e s ,  c a r d i o v a s c u l a r or pulmonary o r d e t e c t i o n programs are  students  endemic d i s e a s e s , diseases.  education  and  others  with chronic  s u c h as s u b c l i n i c a l d i a b e t e s  r e l a t i o n s h i p o f d i e t and  vascular disability,  disease.  also or  epi-  advised  locally,and  e x e r c i s e to  of smoking to cardiopulmonary  dental cardiodisease,  152  and  o f d r u g a b u s e t o e m o t i o n a l h e a l t h , a r e some o f t h e  areas being  researched i n which the Health  promote p o s i t i v e  6.12  efforts  toward f u t u r e  S e r v i c e can  community  health.  OCCUPATIONAL HEALTH The  recommended o b j e c t i v e s o f a n  h e a l t h program a r e c i t e d  occupational  i n t h e Standards as t h e f o l l o w -  ing: 1.  To i d e n t i f y p r e v i o u s l y u n r e c o g n i z e d i l l n e s s , ability,  2.  To a s s i s t sistent or  3.  or other  limitation.  i n p l a c i n g s t a f f i n work s i t u a t i o n s con-  w i t h t h e i r p h y s i c a l and e m o t i o n a l c a p a c i t i e s  limitations.  To p r o v i d e  emergency o r d e f i n i t i v e  connected i n j u r i e s 4.  dis-  To e s t a b l i s h  care  f o r work-  and i l l n e s s .  a preventive  program, i n c l u d i n g  i m m u n i z a t i o n , and s t a n d a r d s f o r s a f e use o f equipment. 5.  To p r e s e n t an e d u c a t i o n a l  program concerning  occu-  p a t i o n a l h a z a r d s a n d s t r e s s e s a n d t h e means f o r avoiding  o r coping  v / i t h them.  While i t i s agreed that occupational be  recognized  a s an i n t e g r a l  health  part of the i n s t i t u t i o n ' s  should health  p r o g r a m , t h i s component i s d e s i g n e d t o p r o t e c t a n d p r o m o t e the  h e a l t h of the f a c u l t y  sidered  and s t a f f and i s ,  therefore,'con-  t o be b e y o n d t h e s c o p e o f t h e s t u d e n t ' s H e a l t h  I t i s assumed, h o w e v e r , t h a t c e r t a i n an o c c u p a t i o n a l of the Health  essential  h e a l t h p r o g r a m do i n d e e d a p p l y  Service  Service.  elements o f t o the s t a f f  i fthey are t o e f f e c t i v e l y  participate  153  i n the p r o v i s i o n o f h e a l t h care For  t o t h e s t u d e n t body.  e x a m p l e , i t i s assumed t h a t t h e members o f t h e H e a l t h  Service tive  staff  are motivated t o a v a i l themselves o f preven-  health practices f o r personal  h e a l t h maintenance, and  t o p a r t i c i p a t e a c t i v e l y i n t h e development o f an  environ-  ment w h i c h p r o m o t e s h e a l t h f u l l i v i n g . Other elements o f an o c c u p a t i o n a l  health  program,  s u c h as t h e c o n t r o l o f e n v i r o n m e n t a l h e a l t h h a z a r d s w h i c h b e n e f i t t h e community as a w h o l e , a r e c o n s i d e r e d responsibility  of the i n s t i t u t i o n i n general  cussed i n d e t a i l in this  6.13 A.  t o be t h e  and a r e d i s -  i n t h e f o l l o w i n g s e c t i o n and e l s e w h e r e  paper.  ENVIRONMENTAL HEALTH AND SAFETY OBJECTIVES I f t h e U n i v e r s i t y i s t o make g o o d u s e o f i t s  personal goal,  and p h y s i c a l r e s o u r c e s  i t s academic  i t i s recommended t h a t t h e i n s t i t u t i o n a s s u r e s  t i n u i n g c l o s e and c r i t i c a l trol  i n reaching  con-  s u r v e i l l a n c e and e f f e c t i v e con-  o f a l l e n v i r o n m e n t a l f a c t o r s w h i c h may i n f l u e n c e t h e  h e a l t h a n d s a f e t y o f members o f t h e i n s t i t u t i o n a l Among t h e f a c t o r s c o n s i d e r e d  t o be s u b j e c t  community.  to control are  t h o s e r e l a t e d t o t h e community as a w h o l e , s u c h as s a n i t a tion  (food preparation  and waste d i s p o s a l ) , t h o s e i n v o l v i n g  154  s p e c t a c u l a r hazards o r contaminants, those r e l a t e d to physical disasters  ( f i r e ) , and those r e l a t e d to a v a r i e t y  of  o c c u p a t i o n a l h e a l t h and s a f e t y problems.  of  l e s s obvious problems,  A multitude  such as n o i s e and crowding,  also  have an empact upon human ecology. A combination of r e s o u r c e s from the U n i v e r s i t y , from l o c a l , p r o v i n c i a l , and f e d e r a l h e a l t h  departments,  and from i n d u s t r y can be used e f f e c t i v e l y to p r o v i d e necessary s e r v i c e s , c o n s u l t a t i o n , and support.  I t i s recomm-  ended, however, t h a t the U n i v e r s i t y s h o u l d c o - o r d i n a t e and d i r e c t the program of s u r v e i l l a n c e and c o n t r o l to meet i t s needs e f f e c t i v e l y and  B.  efficiently.  PROGRAM Because of the p l u r a l i t y of departments  concerned  w i t h the c o n t r o l of environmental h e a l t h and s a f e t y hazards, the  scope of such a program, and the f a c t t h a t the a u t h o r i t y  to make r e l a t e d p o l i c i e s r e s t s w i t h the c e n t r a l a d m i n i s t r a t i o n as an agent o f the governing body, t h i s s e c t i o n , as recommended i n the Standards, i s beyond the realm o f the H e a l t h S e r v i c e as such.  I t i s , however, incumbent  upon  those r e s p o n s i b l e f o r the H e a l t h S e r v i c e to seek and observe p o l i c y statements r e g a r d i n g areas of concern i n t h i s d e p a r t ment such as standards and codes r e l a t i n g to r a d i o l o g i c a l h e a l t h , i n d u s t r i a l h e a l t h , s a f e t y and i n j u r y c o n t r o l ,  fire  155  p r o t e c t i o n , s a n i t a t i o n , and g e n e r a l  environmental  control  of the working c o n d i t i o n s .  Further,  of the department t o r e p o r t  t o t h e p r o p e r a u t h o r i t y any  suspect hazards before all  i t i s the r e s p o n s i b i l i t y  t h e y become c l i n i c a l l y  important,  c o m p l a i n t s o f i l l n e s s w h i c h may p o s s i b l y r e l a t e t o  inadequate standards  (eg. food  handling,  control of radia-  t i o n ) , any known o r s u s p e c t e d o u t b r e a k o f c o m m u n i c a b l e o r reportable  disease,  a n d an a n a l y s i s o f a l l t r e a t e d  with periodic s t a t i s t i c a l preventive  summaries and recommendations f o r  measures. Presently  a t U.B.C. t h e r e  a p p o i n t e d by t h e P r e s i d e n t , above-mentioned f a c t o r s . Fire Prevention various  i s one c o m m i t t e e ,  which i s concerned w i t h the  I t i s the Safety,  S e c u r i t y , and  Committee c o m p r i s e d o f r e p r e s e n t a t i v e s  T r a f f i c and S e c u r i t y , P a t r o l , P o l l u t i o n Control, Health Service, Administration, Health  Health  from  campus d e p a r t m e n t s a n d u n i o n s i n c l u d i n g H o u s i n g ,  Food S e r v i c e s , P h y s i c a l P l a n t , T r a d e s , Truck  The  accidents  Service  Radiation  Drivers,  P r o t e c t i o n and  C a r e and E p i d e m i o l o g y , t h e H e a l t h F a c u l t y and S t u d e n t  Nursing  Supervisor  O f f i c e r are s p e c i a l advisors  Representatives.  a n d t h e campus  t o t h e Committee.  Medical Monthly  meetings are held f o r the purposes of d i s c u s s i n g concerns of e n v i r o n m e n t a l h e a l t h and s a f e t y a n d o f r e c o m m e n d i n g c h a n g e s o r improvements t o t h e P r e s i d e n t ' s was d e s c r i b e d  office.  as n o m i n a l , t h e meetings as  The C o m m i t t e e unenthusiastic  156  and the i s s u e s as  trivial.  I t i s , however, c o n s i d e r e d t h a t the mechanism f o r a dynamic program of environmental  h e a l t h and s a f e t y  e x i s t s w i t h i n the Committee, a l b e i t the number of members render i t cumbersome.  The  f u n c t i o n of such a Committee i s  to i n v e s t i g a t e , r e p o r t , and recommend; enforcement of recommendations i s the r e s p o n s i b i l i t y of the administration.  I t i s important,  too t h a t  central environmental  h e a l t h and s a f e t y a c t i v i t i e s be c l o s e l y c o o r d i n a t e d w i t h o t h e r program components i n h e a l t h e d u c a t i o n and h e a l t h service. The  campus M e d i c a l H e a l t h O f f i c e r , who  i s attached  to the Department of H e a l t h Care and Epidemiology, w i t h i n the p r o v i n c i a l s t a t u t o r y requirements a h e a l t h y environment.  operates  to m a i n t a i n  These p e r t a i n to sewage, water,  waste d i s p o s a l , and so f o r t h .  A P u b l i c Health Inspector,  seconded from the Boundary H e a l t h U n i t , v i s i t s the campus twice weekly to i n s p e c t the food establishments r e q u i r e d areas.  and  other  Meetings of the M e d i c a l H e a l t h O f f i c e r ' s  C o u n c i l are attended twice a year w i t h recommendations being made to the H e a l t h M i n i s t e r .  The  t o p i c of swine  f l u immunizations has not been d i s c u s s e d by t h i s  committee  to date. Only minimal i n f o r m a t i o n c o u l d be obtained from the P h y s i c a l P l a n t .  Briefly,  i n the past few y e a r s , a l l  157  buildings with has  on t h e campus have b e e n i n s p e c t e d a n d u p g r a d e d ,  an e m p h a s i s on s a f e t y .  An e m e r g e n c y l i g h t i n g s y s t e m  been implemented f o r d i s a s t e r a r e a s , s t a i r w e l l s , c o r r i -  d o r s , and o t h e r s u c h a r e a s i n accordance w i t h  the P r o v i n c i a l  B u i l d i n g Code.  C e i l i n g s p r i n k l i n g s y s t e m s have /been i n s t a l l e d  in a l l required  areas i n c l u d i n g waste d i s p o s a l  rooms.  A  campus d i s a s t e r p l a n was p r e s u m e d t o e x i s t .  6.14  PROVISIONS FOR  EMERGENCIES/DISASTERS  I t i s recommended t h a t program s h o u l d i n c l u d e  every college  specific written  health  provisions f o r  m e e t i n g a wide v a r i e t y o f emergencies s u c h as i n j u r i e s t o i n d i v i d u a l s and groups, sudden e p i d e m i c i l l n e s s ing required  bed c a r e ) ,  tion of buildings  multiple  (including  o r mass c a s u a l t i e s ,  the Health S e r v i c e ) ,  community d i s a s t e r s , and g e n e r a l c i v i l I t i s important therefore, up  to provide detailed  ment o f f a c i l i t i e s , for transportation  that  (includevacua-  local  defence problems.  d i s a s t e r p l a n s be drawn  i n s t r u c t i o n s regarding the deploy-  e q u i p m e n t , and p e r s o n n e l , of patients  arrangements  and c a s u a l t i e s , and t h e i n -  volvement of outside agencies o r resources foreach of the contingencies indicated be  widely circulated, practiced  regularly. and  above.  Such d i s a s t e r p l a n s  should  p e r i o d i c a l l y , and updated  A l l personnel involved,  s u c h as d o c t o r s ,  nurses  f i r e m a r s h a l l s , m u s t be p r e p a r e d f o r t h e u n e x p e c t e d a n d  158  know w h a t i s e x p e c t e d o f them. plans and  should  he c o - o r d i n a t e d  the province,  i z a t i o n or c i v i l  Institutional  w i t h those  U.B.C.  o f t h e community  f o r example t h e Emergency Measures Organdefence.  I t a p p e a r s t h a t no f o r m a l for  emergency-  General  disaster plan  exists  knowledge o f any s u c h p l a n by t h e  Health Service,Medical Health  Officer, Physical Plant,  and  i s minimal,  Fire  Department p e r s o n n e l  assumed b y most o f t h o s e in  f o r some y e a r s .  O f f i c e r reported  The campus  that, while having  i n p u t i n t o t h e p l a n , he h a s r e c e i v e d r e q u e s t s departments f o r d i s a s t e r plans fire  or information  and s a f e t y r u l e s and r e g u l a t i o n s .  from the Family  from  various  regarding  These h a v e come  The F a c u l t y o f D e n t i s t r y was  t o r e q u i r e a c t i o n i n t h i s a r e a as w e l l .  a p p e a r t h a t more a c t i o n i s e x p e c t e d o f t h e F i r e Officer but i t i s suspected  t a t i o n o f any p l a n s  I t would Prevention  that bureaucratic constraints  are r e s p o n s i b l e f o r the delay  or  little  P r a c t i c e U n i t and t h e H e a l t h S e r v i c e b u t  have n o t b e e n f o l l o w e d up. claimed  i t is  i n t e r v i e w e d t h a t a p l a n has been  the developmental process  Fire Prevention  although  i n production  or policies relating  and implemen-  to d i s a s t e r s and/  emergencies. I t was r e v e a l e d b y t h e F i r e P r e v e n t i o n  Officer  t h a t i n s o f a r a s t h e U.B.C. Endowment L a n d s c o m p r i s e a regional district,  municipal  zoning  regulations are not  159  a p p l i c a b l e and there In place for  a r e , t h e r e f o r e , no f i r e  t h e r e o f , t h e U n i v e r s i t y Senate has g i v e n  the use o f the P r o v i n c i a l F i r e  and S a f e t y  Two o t h e r m a n u a l s a r e a l s o u s e d t o p r o v i d e fire  bylaws.  and s a f e t y .  direction  Regulations.  guidelines f o r  They a r e t h e 1975 N a t i o n a l F i r e  Code  o f C a n a d a a n d t h e 1975 N a t i o n a l B u i l d i n g Code o f C a n a d a . No U n i v e r s i t y d i r e c t o r a t e e x i s t s t o p r o v i d e t h e F i r e Department w i t h r u l e s and r e g u l a t i o n s r e g a r d i n g i t s a u t h o r i t y and r e s p o n s i b i l i t i e s . while  that  the U n i v e r s i t y i s r e s p o n s i b l e t o the Department o f  Education, the  I t was r e p o r t e d  t h e F i r e Department i s under t h e a u t h o r i t y o f  Department o f t h e Environment. W h i l e t h e j u r i s d i c t i o n o f t h e campus F i r e  ment i n c l u d e s a p p r o x i m a t e l y  22,000 d a y s t u d e n t s ,  the t o t a l  population f o r which i t i s responsible i s reported i n t h e range o f 35,000.  I n a d d i t i o n t o a l l o f the  t i o n a l b u i l d i n g s , s t r u c t u r e s and r e s i d e n c e s ,  Depart-  t o be institu-  the j u r i s d i c -  t i o n ^ i n c l u d e s 435 homes l o c a t e d o u t s i d e t h e p e r i m e t e r o f the  campus, two s c h o o l s  three  campus c h u r c h e s w i t h d a y - c a r e c e n t r e s , t h e U n i v e r s i t y  G o l f Club, and  (one e l e m e n t a r y a n d one s e c o n d a r y ) ,  f o u r t e e n apartment b l o c k s / h i g h r i s e b u i l d i n g s ,  twenty-two r e t a i l  V i l l a g e Shopping  o u t l e t s l o c a t e d i n the U n i v e r s i t y  Centre.  The s t a f f o f t h e F i r e D e p a r t m e n t a r e a l l f i r s t , second o r t h i r d c l a s s f i r s t - a i d  attendants;  there are  l6o  g e n e r a l l y t h i r t e e n men  on d u t y d u r i n g t h e day  shift  includ-  i n g the t h r e e e x e c u t i v e o f f i c e r s j t h e F i r e C h i e f , A s s i s t a n t Fire  C h i e f and  Fire Prevention Officer.  o f f i c e r s a r e on c a l l  evenings  c o n s i d e r a b l y f e w e r men form of o r i e n t a t i o n  on d u t y .  (fire  s t a f f t u r n o v e r i s low, n o t been g i v e n a h i g h Although  and  Two  executive  weekends when t h e r e  are  A l l h a v e b e e n g i v e n some  safety films,  etc.) but s i n c e  continuing inservice education  the  has  priority.  t h e U n i v e r s i t y p o p u l a t i o n and  workload  have i n c r e a s e d o v e r the y e a r s , t h e F i r e Department space and hall  s t a f f have n o t  i s being planned,  i s n o t known. new  increased proportionately.  I t was  f a c i l i t y w o u l d be  however, b u t the d a t e suggested  toward it. tic  fire-  completion  t h a t the l o c a t i o n of  considered  i n t e r m s o f m o v i n g f i r e m e n and  equipment  t h e c e n t e r c o r e as o p p o s e d t o m o v i n g o u t w a r d  Furthermore, fields,  the suggested  stadium  the  l 6 t h Avenue and W e s b r o o k P l a c e ,  w h i c h i s . p e r i p h e r a l t o t h e m a i n campus b u t more e f f i c a c i o u s  of  A new  and  arena,  site  from  i s c l o s e to the  athle-  and w i t h i n e a s y r e a c h o f  the  campus H o s p i t a l . The  f i r e h a l l h o u s e s two  fire  campus a m b u l a n c e , an E c o n o l i n e v a n w i t h equipment.  B a c k , h e a d and  been s p e c i f i e d .  and  the  resuscitation  s p i n a l i n j u r i e s are  d i r e c t l y to the Vancouver General H o s p i t a l has  engines  transported  H o s p i t a l unless St.  Only minor i n j u r i e s are  Paul's taken  161  to  the Health Service.  I t was n o t e d t h a t t h e F i r e  Depart-  ment v i e w s t h e H e a l t h S e r v i c e i n t e r m s o f " h a n d - a i d s a n d first-aid". for  T h e r e w o u l d a p p e a r t o he a g r e a t n e e d  communication  b e t w e e n t h e two d e p a r t m e n t s  H e a l t h S e r v i c e t o reshape  either  o r f o r the  i t s image.  The f o l l o w i n g n o t i c e f r o m a May 1976 i s s u e o f U.B.C. R e p o r t s e x p l a i n s t h e c u r r e n t s t a t u s o f t h e c i t y ' s new e m e r g e n c y number r e l a t i v e  t o t h e U n i v e r s i t y campus.  "U.B.C, RETAINS OWN EMERGENCY NUMBERS The C i t y o f V a n c o u v e r ' s new e m e r g e n c y t e l e p h o n e number - 911 - went i n t o o p e r a t i o n o n May 1 b u t i t d o e s n o t a p p l y on t h e U.B.C. campus o r i n t h e U n i v e r s i t y Endowment L a n d s . In case o f f i r e o r a major emergency i n v o l v i n g i n j u r y on campus o r i n t h e U.E.L., c a l l t h e U n i v e r s i t y Endowment L a n d s F i r e D e p a r t m e n t , 228-4567. They w i l l n o t i f y t h e U.B.C. H e a l t h S e r v i c e a n d t h e campus T r a f f i c a n d S e c u r i t y department, i f n e c e s s a r y . The U.E.L. F i r e D e p a r t m e n t a l s o o p e r a t e s a n a m b u l a n c e s e r v i c e 24 h o u r s a d a y . T h e r e i s a $5. c h a r g e f o r i t s u s e . I f y o u c a n ' t g e t t o a phone, r i n g i n a f i r e a l a r m at t h e n e a r e s t f i r e alarm box. T h i s w i l l b r i n g a f i r e t r u c k t o t h e scene and a n ambulance w i l l f o l l o w i n about t h r e e minutes. The U.E.L. F i r e Department a l s o p r o v i d e s i n h a l a t o r and r e s c u e services. Minor emergencies and f i r s t - a i d a r e handled by t h e U n i v e r s i t y p a t r o l - 228-4721 - o r t h e p e r s o n s i n v o l v e d c a n be d i r e c t e d t o t h e U n i v e r s i t y H e a l t h S e r v i c e i n t h e Wesbrook B u i l d i n g a t t h e c o r n e r o f U n i v e r s i t y B o u l e v a r d and t h e East M a l l . You can a l e r t t h e H e a l t h S e r v i c e i n advance b y c a l l i n g  228-2525.  The U n i v e r s i t y d e t a c h m e n t o f t h e RCMP w i l l a l s o respond i n case o f emergencies. T h e i r number i s 224-1322 f r o m 8 a.m. t o 5 p.m. A t o t h e r h o u r s k c a l l 666-3198."  0  162  It p l a n be  i s recommended t h a t an a r e a - w i d e  developed  initiated,  poste  haste;  i t s a p p r o v a l by  i f a p l a n has  c l u d e c o o r d i n a t e d e f f o r t s by t h e f i r e m e n t a l p e r s o n n e l , R.C.M.P., and  o t h e r concerned  environgroups  and  as t h e E m e r g e n c y M e a s u r e s O r g a n i z a t i o n , Red  While  h i g h l y improbable,  i s necessary  and  i n any  event  s h o u l d be  Cross,  and  of a  7^7 imposs-  the key  word  disaster plan.  Education  i s f u r t h e r recommended t h a t t h e I n s e r v i c e  c o o r d i n a t o r r e q u e s t a s s i s t a n c e from the  Fire  P r e v e n t i o n O f f i c e r i n d e v e l o p i n g a program of f i l m s , and d e m o n s t r a t i o n s  of f i r e  safety consciousness  A.  and  important.  the h y p o t h e t i c a l event  P r e p a r a t i o n f o r any  It  6.15  or  resources,  c r a s h i n g on o r n e a r t h e U.B.C. campus i s n o t an  ibility.  be  p l a n must i n -  s a f e t y and  L i a i s o n w i t h other agencies  Vancouver General H o s p i t a l ,  jet  The  campus as w e l l as t h e m e d i c a l , n u r s i n g  Hospital staffs. such  a l r e a d y been  the U n i v e r s i t y Senate s h o u l d  e x p e d i t e d f o r immediate implementation.  i n d i v i d u a l s on  disaster  talks  f i g h t i n g equipment, e t c . , to  to a l l personnel  teach  i n the H e a l t h S e r v i c e .  HEALTH EDUCATION OBJECTIVES One  o f the most i m p o r t a n t  o b j e c t i v e s of a h e a l t h  program i s the development of a resource f o r i n f l u e n c i n g  the  163  health behavior of students and  as a c t i v e p a r t i c i p a n t s  (and o t h e r s ) b o t h as i n d i v i d u a l s i n t h e community.  I t i s consis-  tent with the goals of higher education f o r the University to support the  a p r o g r a m o f h e a l t h e d u c a t i o n f o r a l l members o f  i n s t i t u t i o n a l community, f a c u l t y and s t a f f as w e l l as  students.  Such a program should d i f f e r from o t h e r  of the c u r r i c u l u m i n t h a t , r a t h e r than  areas  just presenting  facts  f o r t h e a c q u i s i t i o n o f i n f o r m a t i o n w h i c h may h a v e l i t t l e o r no  impact  upon l i f e  p a t t e r n s , i t s h o u l d c r e a t e an a t t i t u d e  of i n t e r e s t and c u r i o s i t y toward The  U.B.C.'s c o u r s e s  health.  of instruction i n various  f a c u l t i e s a n d d e p a r t m e n t s i n c l u d e many c o u r s e s p e r t a i n i n g to concepts dren,  o f h e a l t h and h e a l t h e d u c a t i o n r e l a t i n g t o c h i l -  those w i t h l e a r n i n g d i s a b i l i t i e s ,  the handicapped,  the aged, f a m i l i e s , and o t h e r s p e c i a l groups. not  one g e n e r a l c o u r s e  o f h e a l t h e d u c a t i o n a p p e a r s t o be  o f f e r e d i n a n y p r o g r a m o u t l i n e d i n t h e U.B.C.  B.  Nevertheless,  Calendar.  PROGRAM The  Standards  suggest  a University health education  the following inclusions i n  program:  "-Formal h e a l t h t e a c h i n g through  organized  courses.  -Informal l e a r n i n g experiences through h e a l t h s e r v i c e s and a w i d e v a r i e t y o f o t h e r i n f o r m a l a s s o c i a t i o n s . -Programmed d e v e l o p m e n t a n d r e s e a r c h i n t o t h e means f o r c r e a t i n g a g r e a t e r impact upon h e a l t h b e h a v i o r . " (6. - p. 33)  164  I t i s recommended t h a t t h e have a c o u r s e o r c o u r s e s i n p e r s o n a l a v a i l a b l e to a l l f a c u l t i e s , basic  information  pointed  out p r e v i o u s l y  k n o w l e d g e a b l e and and,  therefore,  receptive  and  should  community  health,  t h r o u g h w h i c h s t u d e n t s can  about p e r s o n a l  t h e i r h e a l t h b e h a v i o r may  University  be  h e a l t h and  attain  through which  influenced positively.  As  i n t h i s paper, today's students  i n t e r e s t e d i n the  i t i s considered  to health education  a r e a o f human e c o l o g y  that not  but  are  only are  they  they expect i t to  be  provided. Recommended o b j e c t i v e s o f a b a s i c f o r m a l course  health  are:  "(1)  To d e v e l o p u n d e r s t a n d i n g o f t h e f u n c t i o n s a l l p a r t s o f t h e human o r g a n i s m and t h e i r r e l a t i o n s h i p w i t h the environment.  of inter-  (2)  To d e v e l o p a t t i t u d e s w h i c h w i l l m o t i v a t e t h e i n d i v i d u a l t o c o o p e r a t e w i t h t h e community i n group programs f o r h e a l t h p r o t e c t i o n .  (3)  To  (4)  To h e l p t h e i n d i v i d u a l become an i n t e l l i g e n t c o n s u m e r o f h e a l t h i n f o r m a t i o n and s e r v i c e s .  (5)  To c r e a t e i n t h e i n d i v i d u a l a c o n t i n u i n g t o l e a r n more a b o u t h e a l t h .  (6)  To h e l p d e v e l o p s k i l l h e a l t h problems."  i n d u c e b e h a v i o r w h i c h p r o m o t e s optimum  R e s p o n s i b i l i t y f o r the g a t e d t o any  health.  desire  i n d e f i n i n g and s o l v i n g (6. - p. 33) h e a l t h c o u r s e may  be  academic department b e s t s u i t e d i n terms  q u a l i f i e d p r o f e s s i o n a l s t a f f and  commitment t o  of  providing  high-level i n s t r u c t i o n i n personal  and  community  H o w e v e r , t o be  and  coordination  e f f e c t i v e , planning  dele-  health. of  the  165  course staff and  (or courses) require  time f o r d e f i n i n g n e e d s ,  planning  Health  course  content,  physical iology,  education,  to p r o v i d e  valuable  community It  course the  political  i s recommended t h a t concepts r e l a t i n g  community.  health  beginning  Reference  that  care  deviations  i s made i n o t h e r  to the opportunities a t each student  through  the s p i r a l l -  areas of t h i s  with  must be made t o p r o v i d e  consumer  be c u r t a i l e d .  f o rinformal  contact  resources;  the u n i v e r s a l  level will  costs  health of  a n d community;  serving  only  a t the student  health  controversial issues;  school,  organizations  I t i s considered  effort  sciences,  emotional;  and s a f e t y ; p u b l i c h e a l t h  escalation of health  Every  soc-  development o f  a n d community h e a l t h ;  between t h e f a m i l y ,  even w o r l d  presented  t o the t o t a l  s o c i a l problems;  environmental health  relative  a basic personal  p h y s i c a l , m e n t a l , and  to personal  relationships  ing  as t h e h e a l t h  f o r p o s i t i v e health behavior;  from normal h e a l t h ;  education  psychology,  i n s i g h t i n t o t h e dynamics o f i n d i v i d u a l  college student,  attitudes  home e c o n o m i c s ,  science,  as w e l l  the c u r r i c u l a  living.  include  motivation  and  methodology and e v a l u a t i o n .  education,  and u r b a n p l a n n i n g ,  allocation of  establishing objectives,  i n s t r u c t i o n may be c o r r e l a t e d w i t h  of a r e a s such as b i o l o g y ,  and  an a p p r o p r i a t e  health  the Health  professional  paper education Service. counsel  166  and to help the student understand his health problem; this should be a criterion upon which professional staff are appointed.  Health Service personnel should also be  able to make valuable contributions to formal health courses.  In addition, certain professionals, for example  the Mental Health Unit staff, are in a strategic position to promote informal health-oriented sessions in dormitories, fraternities, sororities, or other special groups such as preprofessional student organizations.  The Mental Health  Unit is currently planning similar outreach programs, as mentioned in section 6.8, Mental Health. Effective informal health instruction can also be achieved through inservice education of staff members such as food handlers, counselors, health instructors, faculty advisors, administrators, and residence advisors. But again, there should be overall coordination of all facets of health education. It is recommended that a student/facuity University health council composed of representatives from all departments concerned with student health be organized to define and recommend solutions for college health problems, and to further institution-wide interest and participation in the promotion of health.  Extramural health organizations  may also have representation on the council.  Many recommenda-  19 tions of a recent campus survey regarding student health  167  needs r e l a t e t o the area  of informal health  More d e t a i l s a r e d i s c u s s e d Health  Service  education.  i n s e c t i o n 6.17,  records  should  Communications.  he u s e d t o p r o v i d e  data f o ra continuing evaluation of the h e a l t h  education  o p p o r t u n i t i e s i n t h e department, and a l s o f o r d e t e r m i n i n g needed emphasis i n t h e i n s e r v i c e e d u c a t i o n search  i n t o t h e means f o r c r e a t i n g a g r e a t e r  health behavior  C.  program.  i s discussed  Re-  i m p a c t upon  i n s e c t i o n 6.16,  Research.  I N S E R V I C E EDUCATION Because t h e H e a l t h  function  i s recognized  presentation  as h a v i n g  of information  i n t h i s s e c t i o n concerning present  time,  i n t h e O.P.D. also a C l i n i c a l  education  b r o a d e r scope than the  t o nurses only,  i ti s included  health education.  U n t i l the  Nurse i n a d d i t i o n t o h e r r e g u l a r  The f u l l - t i m e g e n e r a l  duties  p r a c t i t i o n e r who i s  I n s t r u c t o r i n the D i v i s i o n of Family  Faculty of Medicine,  education  inservice  t h i s f u n c t i o n has been t h e r e s p o n s i b i l i t y  o f one R e g i s t e r e d  tice,  Service  Prac-  performs the (informal) i n s e r v i c e  f u n c t i o n f o r the medical  staff.  The Head N u r s e  of the H o s p i t a l c a r r i e s that r e s p o n s i b i l i t y f o rh e r u n i t . T h e r e i s some s h a r i n g o f c e r t a i n i n s e r v i c e i n f o r m a t i o n a n d activities,  b u t more d e v e l o p m e n t o f a s o u n d e d u c a t i o n a l  pro-  gram i s needed t o improve t h e w o r k i n g r e l a t i o n s h i p s w i t h i n  168  the e n t i r e Health S e r v i c e . A r e g u l a r one-hour p e r i o d has been  allotted  e a c h week d u r i n g t h e w i n t e r s e s s i o n f o r i n s e r v i c e e d u c a tion  i n t h e O.P.D.  Some o f t h e t o p i c s c o v e r e d  year  included thef o l l o w i n g : - C l i n i c a l Areas - a l l e r g i e s , and  i n the past  acne, diabetes  (insulin,  u r i n e - t e s t i n g ) , V.D. C o n t r o l ,  ammenorrhoea, c a r d i o p u l m o n a r y citation,  resus-  trauma, p s y c h i a t r y , w a r t s ,  common eye d i s e a s e s , d i a g n o s i s a n d management o f c e r v i c a l nutrition, - General  Areas -  and death  problem-oriented  erosions,  and d y i n g .  medical  records,  s e x u a l c o m m u n i c a t i o n , team a p p r o a c h (C.A.R.S.), l e g a l  aspects  of nursing,  communications, i n t e r v i e w i n g , and a street  clinic.  - Departmental Tours - p h y s i o t h e r a p y ,  r a d i o l o g y , and  laboratory with a of routine  demonstration  procedures.  - M e e t i n g s - one g e n e r a l m e e t i n g o f a l l t h e s t a f f ( t h e first and  s e s s i o n o f t h e 1975-76 w i n t e r  one n u r s e s '  t h e 1976  spring  - S p e c i a l T a l k s and R e p o r t s  meeting  term),  (near t h e end o f  term). - China and  (School o f Nursing),  Health Service  attend-  ance a t c o n v e n t i o n s i n Seattle  (Emergency  arid H a w a i i  (Pacific  Care), Coast  College Health Association).  169  In a l l of the above i n s e r v i c e meetings, approp r i a t e resource speakers, The R.N.  video tapes, or f i l m s were used.  r e s p o n s i b l e f o r making such arrangements t r i e d to  be p r e s e n t at a l l s e s s i o n s i n order to be of the same mind as the other s t a f f i n attendance. not i n v o l v e d i n r e g u l a r l y scheduled i t was  The  t a l k s or f i l m s because,  e x p l a i n e d , they have t h e i r own I t was  Hospital staff i s  orientation.  l e a r n e d t h a t the i n s e r v i c e f u n c t i o n i s to  be shared i n f u t u r e by a l l of the nurses  i n the O.P.D.  While i t i s r e c o g n i z e d t h a t input i n t o the program from a l l p e r s o n n e l should be encouraged, i t i s recommended t h a t the assignment of r e s p o n s i b i l i t y f o r s t a f f development through  i n s e r v i c e education be g i v e n to one member, app-  r o p r i a t e l y prepared  and p e r s o n a l l y i n t e r e s t e d i n t h i s  In order to p r o p e r l y develop  area.  a s u i t a b l e program of education,  he/she must keep abreast of new  developments i n the  content  and methods of the h e a l t h s c i e n c e s and h e a l t h i n s t r u c t i o n , p a r t i c u l a r l y as they p e r t a i n to students. on t h i s s u b j e c t i s found  More d i s c u s s i o n  i n s e c t i o n 6.1, O u t p a t i e n t S e r v i c e s .  I t i s a l s o recommended t h a t a c o n t i n u i n g c l o s e working r e l a t i o n s h i p be maintained  w i t h other departments,  u n i t s , or resources i n v o l v e d i n h e a l t h education, or i n f o r m a l , f o r example the I n s e r v i c e Education of the R.N.A.B.C.  formal Committee  170  6.16  RESEARCH While the H e a l t h S e r v i c e e x i s t s p r i m a r i l y to meet  the h e a l t h needs of young a d u l t s , i n c l u d i n g both p h y s i c a l  and  emotional h e a l t h problems, i t o f f e r s a unique o p p o r t u n i t y  to  study disease p a t t e r n s  i n a d d i t i o n to the dynamics of develop-  ment under r e l a t i v e l y w e l l - c o n t r o l l e d c o n d i t i o n s .  Opportuni-  t i e s f o r r e s e a r c h which w i l l c o n t r i b u t e to the p h y s i c a l w e l f a r e , emotional h e a l t h , and  e d u c a t i o n a l p o t e n t i a l of students,  is  recommended as being c o n s i s t e n t w i t h the primary purpose of the H e a l t h  Service. C e r t a i n r e s e a r c h p r o j e c t s concerning  gram have been d i s c u s s e d  the h e a l t h  elsewhere i n t h i s paper, but i t i s  recommended t h a t plans be formulated  f o r continuing  research  p r o j e c t s i n other areas of the program r e q u i r i n g study that these plans be supported by the Health central administration. t i o n and  and  S e r v i c e and  the  I t i s r e i t e r a t e d t h a t more i n t e g r a -  c o o r d i n a t i o n of r e s e a r c h p r o j e c t s being  undertaken  by v a r i o u s departments throughout the U n i v e r s i t y , are quired.  pro-  re-  I t i s important, t h e r e f o r e , t h a t f u t u r e plans  for  r e s e a r c h i n the H e a l t h S e r v i c e be v e r i f i e d with other concerned departments i n order to a v o i d p o s s i b l e d u p l i c a t i o n and  to g a i n any  search  assistance available.  i s to be accepted  h e a l t h program and  Furthermore, i f r e -  as an important f u n c t i o n of  i s to be r e a l i s t i c ,  time and  adjustments must be made and f i n a n c i a l allotments  the  personnel invested  i n the departmental budget. As recommended i n the Standards, the U n i v e r s i t y has  a statement of p o l i c y concerning  humans i n r e s e a r c h .  the involvement of  A l l c l i n i c a l r e s e a r c h and i n v e s t i g a -  t i o n s i n v o l v i n g human s u b j e c t s must be duly approved an e s t a b l i s h e d committee which assures of the p o l i c y have been met  t h a t the  by  conditions  p r i o r to the s t a r t of the p r o j e c t s .  171  6.17  COMMUNICATIONS  The important  S t a n d a r d s c o n s i d e r t h a t one o f t h e m o s t  determinants  of the o v e r a l l success  of the health  program i n meeting t h e needs o f i t s s u b s c r i b e r s i s t h e e f f ectiveness  o f c o m m u n i c a t i o n s w i t h i n , among, a n d b e y o n d t h e  v a r i o u s u n i t s o f t h e program. Health  Service reviewed,  In n e a r l y a l l areas o fthe  t h e r e was an e x p r e s s e d  improved communications.  need f o r  The f o l l o w i n g s u g g e s t i o n s a r e  put  f o r t h t o achieve  t h i s aim:  A.  INTERNAL COMMUNICATIONS P e r s o n a l meetings o f department heads,  and  o t h e r s who s h a r e r e s p o n s i b i l i t y f o r H e a l t h  vities, vals.  Service  The D i r e c t o r a n d S u p e r v i s o r before  should gain advice  establishing basic  d e c i s i o n s o r announcing o p e r a t i o n a l o r procedural  should  acti-  s h o u l d be h e l d a t r e g u l a r , i f o n l y p e r i o d i c , i n t e r -  various unit personnel  Regular  supervisors,  policy changes.  nursing s t a f f meetings, i n c l u d i n g the H o s p i t a l be h e l d a n d i n c l u d e e d u c a t i o n a l  Medical  staff,  i n f o r m a t i o n and p r o -  f e s s i o n a l a s s o c i a t i o n ( e g . R.N.A.B.C.) a c t i v i t i e s ouncements.  from  s t a f f meetings should  and ann-  be p l a n n e d t o  i n c l u d e t h e M e n t a l H e a l t h U n i t and p e r i o d i c r e p r e s e n t a t i o n from the F a c u l t y o f D e n t i s t r y , the Family Department o f H e a l t h  Care and E p i d e m i o l o g y ,  Practice Unit, the the D i v i s i o n of  172  P u b l i c H e a l t h P r a c t i c e , and t h e s i x d i v i s i o n s o f t h e Health  Sciences  Centre,  particularly  the D i v i s i o n of  Health  S e r v i c e s R e s e a r c h and Development.  Developments  or i n f o r m a t i o n r e s u l t i n g from these  meetings should  shared  personnel.  w i t h t h e n u r s i n g and s u p p o r t  importance of communications w i t h the o f f i c e discussed  i n C h a p t e r 7, H e a l t h P e r s o n n e l .  be  The  staff i s  Minutes or  t a p e s kept o f m e e t i n g s a r e v a l u a b l e as a r e c o r d o f d e l i b e r a t i o n s and f o r t h e i n f o r m a t i o n o f t h o s e An u p - d a t e o f t h e H e a l t h is provided incurred are  unable to attend.  Service brochure  t o a l l new a p p l i c a n t s i s r e q u i r e d .  which  Expenses  i n the p u b l i c a t i o n of such i n f o r m a t i o n a l b u l l e t i n s  justified  i n dividends paid through increased  t i o n of the service.  utiliza-  Supplemental t o the information  culated through the student  brochure,  should  be  cir-  increased  a t t e n d a n c e a t U n i v e r s i t y r e g i s t r a t i o n by t h e H e a l t h  Service  staff.  W h i l e one n u r s e i s a l r e a d y r e s p o n s i b l e f o r c h e c k i n g  medical  and h o s p i t a l i n s u r a n c e  tration,  coverage, e t c . , during  t h i s w o u l d seem t o be an i d e a l o p p o r t u n i t y  s t a f f members t o meet t h e s t u d e n t s  regis-  f o r more  i n f o r m a l l y a s w e l l as t o  promote f u l l e r exposure o f t h e a v a i l a b l e h e a l t h s e r v i c e s t o an  increasing student  population.  Employee p e r f o r m a n c e e v a l u a t i o n s d i s c u s s e d where i n t h i s p a p e r p r o v i d e cation.  else-  a v e h i c l e f o r two-way communi-  While not always a p l e a s a n t  procedure,  evaluations  173  may  o f t e n be used as an o p p o r t u n i t y t o r e v i e w a s t a f f  g r i e v a n c e or c o m p l a i n t .  P o s i t i v e e v a l u a t i o n s , however,  can g i v e employees a sense of p r o d u c t i v e involvement  in  the s e r v i c e . I n the a r e a of i n s e r v i c e e d u c a t i o n , a f o u r week communications workshop was of 1 9 7 6  i n April/May  by an E d u c a t i o n a l P s y c h o l o g i s t i n the F a c u l t y  of E d u c a t i o n .  While some i n t e r n a l r e s i s t a n c e t o the  p r o p o s a l of the workshop was was  conducted  f i r s t encountered,  almost complete attendance  there  of a l l H e a l t h S e r v i c e p e r -  s o n n e l , i n c l u d i n g the d o c t o r s , the H o s p i t a l s t a f f , and o f f duty employees.  S i n c e attendance  was  v o l u n t a r y , the t u r n -  out i n d i c a t e d a g e n e r a l f e l t need f o r i m p r o v i n g communicat i o n s i n the H e a l t h S e r v i c e .  Such use of a v a i l a b l e campus  r e s o u r c e s and the p l a n n i n g o f the workshop are i n n o v a t i v e and commendable.  I t i s recommended t h a t a f o l l o w - u p r e v i e w  be done by the H e a l t h - S e r v i c e to determine  positive influences  brought about by the s e s s i o n s i n the a r e a of i n t e r n a l communications. A s t u d e n t / f a c u i t y h e a l t h c o u n c i l , as d i s c u s s e d in section 6.15,  H e a l t h E d u c a t i o n , can h e l p to  the d i r e c t i o n of the h e a l t h program.  determine  I t i s c o n s i d e r e d app-  r o p r i a t e f o r the consumers of care t o have a s i g n i f i c a n t v o i c e i n d e t e r m i n i n g the s e r v i c e s w h i c h are to be p r o v i d e d and t o i n d i c a t e the l e v e l o f support w h i c h they are w i l l i n g  174  to provide.  Informed, r e s p o n s i b l e consumers can be v e r y  h e l p f u l i n s h a p i n g programs which a c t u a l l y meet t h e i r needs and w h i c h w i l l j u s t i f y t h e i r  B.  support.  EXTERNAL COMMUNICATIONS The  image and e f f e c t i v e n e s s o f the H e a l t h  Service  w i l l be c o n s i d e r a b l y enhanced t h r o u g h channels o f s h a r i n g i n f o r m a t i o n between i t s s t a f f and the academic, a d m i n i s t r a t i v e , and p e r s o n n e l  s e r v i c e areas o f t h e U n i v e r s i t y . I t  i s recommended, t h e r e f o r e , t h a t as many members o f the H e a l t h S e r v i c e s t a f f as p o s s i b l e be i n v o l v e d i n campuswide committees as w e l l as i n f o r m a l g a t h e r i n g s . e s p e c i a l l y important  This i s  f o r r e s p o n s i b l e p r o f e s s i o n a l employees.  An a g g r e s s i v e  e f f o r t i s r e q u i r e d to achieve  measure o f c o o r d i n a t i o n w i t h o t h e r campus f a c i l i t i e s  a which  19  o f f e r student  services.  The r e c e n t s u r v e y  of mental  h e a l t h and r e l a t e d f a c i l i t i e s on the campus found t h a t problems i n o f f e r i n g s e r v i c e s are m a i n l y  related to a  l a c k o f communication between f a c i l i t i e s and w i t h  students,  and t h a t a l a c k o f communication between s e r v i c e s appears t o r e s u l t i n i g n o r a n c e o f s p e c i f i c s e r v i c e s o f f e r e d by each f a c i l i t y . Every f a c i l i t y s u r v e y e d , i n c l u d i n g the H e a l t h S e r v i c e , f e l t t h a t they p r o v i d e adequate d i r e c t and i n d i r e c t i n f o r m a t i o n r e g a r d i n g t h e i r s e r v i c e s ; t h i s was  175  c o n t r a d i c t e d by t h e s t u d e n t s ' s u g g e s t i o n f o r i m p r o v e d advertisement  of present f a c i l i t i e s .  dicated l i t t l e facilities for  Students  r e f e r r a l between f a c i l i t i e s  s t a t e d t h a t t h e y do r e f e r .  also i n -  whereas t h e  Facilities  surveyed  the study included: The  Health Service  The  H e a l t h Sciences Centre  Community H e a l t h C e n t r e The  Psychiatric  Unit  (Family Practice  Unit)  Dean o f Women  Student  Services  Ombudsman Residence  Advisors  Chaplaincy  Services  Women's O f f i c e Psychology  Department  I n t e r n a t i o n a l House Speakeasy The  study  concluded  t h a t campus f a c i l i t i e s  must  t a k e a more a c t i v e a n d r e s p o n s i b l e p a r t i n i d e n t i f y i n g types o f problems, causes,  and p r e v e n t i o n , and t h a t t h e  e f f e c t i v e n e s s o f s p e c i f i c programs i s o f secondary  import-  ance t o t o t a l n e e d s b e i n g met. Extramural next  6.18  communications are d i s c u s s e d i n the  section.  EXTRAMURAL RESOURCES The  Standards  advise that continuing e f f o r t s  s h o u l d be made t o c o o r d i n a t e a n d i n t e g r a t e on a n d o f f -  176  campus r e s o u r c e s  w i t h a view t o c r e a t i n g a network of  complementary s e r v i c e s which w i l l  r e s u l t i n a comprehen-  s i v e h e a l t h p r o g r a m , w i t h a minimum o f d u p l i c a t i o n o f effort  ( a n d e x p e n s e ) a n d no a b s e n c e o f some s e r v i c e s . A large  i n s t i t u t i o n with well-developed  health  p r o g r a m s , s u c h a s U . B . C , i s i n a p o s i t i o n t o s h a r e many of i t s s e r v i c e s w i t h few  outside  Health  t h e off-campus community and r e q u i r e s  agencies to contribute  to i t s Health  p r o f e s s i o n a l s , however, w i l l  contact  Service.  b e n e f i t through  w i t h p r o f e s s i o n a l a s s o c i a t i o n s and c l o s e  relationships with psychologists,  outside  doctors,  close  working  d e n t i s t s , nurses,  s o c i a l w o r k e r s , and b u s i n e s s l e a d e r s , t o  exchange i n f o r m a t i o n  and e v a l u a t e  present o r planned s e r v i c e s .  the effectiveness of  I n addition, both the o f f -  campus c o m m u n i t y a n d t h e H e a l t h  S e r v i c e may r e c e i v e  assis-  tance from t h e i n s t i t u t i o n ' s s p e c i a l i z e d programs, f o r example i n t h e a r e a s o f p s y c h o l o g i c a l guidance, o r environmental  testing,  child  health.  A l t h o u g h c e r t a i n p r o f e s s i o n a l and e d u c a t i o n a l c o n f e r e n c e s a r e a t t e n d e d by t h e H e a l t h example t h e P a c i f i c  Coast College  ings, the service i n general  Service  Health  staff, f o r  A s s o c i a t i o n meet-  a p p e a r s t o be p r o f e s s i o n a l l y  i s o l a t e d i n t e r m s o f common i n v o l v e m e n t i n p r o g r a m opment, r e s e a r c h , strength  and o t h e r  devel-  a c t i v i t i e s which can provide  a n d new p e r s p e c t i v e s  t o t h e program.  Iti s re-  177  commended, t h e r e f o r e , t h a t c o o p e r a t i v e  a c t i v i t y be under-  taken with the h e a l t h s e r v i c e s of other U n i v e r s i t i e s and Colleges  i n B r i t i s h Columbia, p a r t i c u l a r l y the lower main-  l a n d , to share resources public relations.  and  i n f o r m a t i o n and  To g i v e an example, the recent produc-  t i o n of Recommended Standards and Mental Health  to improve  Practice for University  S e r v i c e s , prepared by the D i r e c t o r of the  Simon F r a s e r U n i v e r s i t y H e a l t h Service, f o r the  Canadian  P s y c h i a t r i c A s s o c i a t i o n ' s P r o f e s s i o n a l Standards  and  P r a c t i c e C o u n c i l , were unknown to the Mental H e a l t h s t a f f at U.B.C.  P r o f e s s i o n a l communication i n s i m i l a r  s i t u a t i o n s would be f r u i t f u l to s t a f f and  students  alike.  I t i s f u r t h e r recommended t h a t the H e a l t h use  every o p p o r t u n i t y  i n d u s t r i a l resources  community.  For  example,  follow-up  are r e f e r r e d off-campus f o r a b o r t i o n s .  i s an area of r e s e a r c h t h a t can be personnel,  and  are a v a i l a b l e f o r use by the U n i v e r s i t y  a c t i v e involvement i s r e q u i r e d f o r the s t a f f to who  Service  to l e a r n what p u b l i c , v o l u n t a r y ,  community as w e l l as by the g e n e r a l  students  Unit  c a r r i e d on by  This  nursing  under medical d i r e c t i o n , and would provide  c h a l l e n g i n g change of a c t i v i t y f o r nurses now  a  spending v a l -  uable p r o f e s s i o n a l time on housekeeping•functions. Other resource to v i s i t the H e a l t h  agencies can be v i s i t e d or  invited  S e r v i c e f o r a f i r s t - h a n d o r i e n t a t i o n and  to d i s c u s s common problems of students  and young a d u l t s .  For example, the Women's C o l l e c t i v e or s i m i l a r c l i n i c s ,  178  the Vancouver C h i l b i r t h A s s o c i a t i o n and General H o s p i t a l ' s new  abortion  the  Vancouver  f a c i l i t y , would a l l p r o v i d e  i n s i g h t i n t o the problems of young women today.  Comm-  u n i c a t i o n w i t h the campus Family P r a c t i c e U n i t w i l l r e v e a l problems of the which may  be  further  c h i l d r e n or spouse of a student  the u n d e r l y i n g  cause of h i s h e a l t h problem.  In a l l matters of communication or c o n s u l t a t i o n , the f i d e n t i a l i t y of i n f o r m a t i o n  must, of course, be  Whenever p o s s i b l e , H e a l t h S e r v i c e should p a r t i c i p a t e i n the agencies, p l a n n i n g not  maintained.  s t a f f members  a c t i v i t i e s of extramural community  c o u n c i l s , and  the l i k e .  Such involvement  only enhances p r o f e s s i o n a l knowledge f o r the  of p r a c t i c e , but i n t e r e s t , and  serves to generate new  to renew i n s t i t u t i o n a l  stimulate  pride. consultant  re-  i n areas of concern  such as the c l o s i n g of the H o s p i t a l .  i s the purpose of t h a t resource agency to serve the programs of B r i t i s h Columbia i n need of a s s i s t a n c e  6.19  and  s e r v i c e s of the B.C.H.I.S. be  quested to a s s i s t the H e a l t h S e r v i c e or u n c e r t a i n t y ,  improvement  ideas, to  I t i s f i n a l l y suggested t h a t the management engineering  con-  It health  or  advice.  SPECIAL PROBLEMS  The  only concern d i s c u s s e d  i n the  Standards under  t h i s heading r e l a t e s to i n t e r n a t i o n a l students. ments f o r f o r e i g n students a p p l y i n g  to U.B.C. are  The  require-  outlined  179  in  Chapter  9,  and m e d i c a l  Business  Management, as p e r t a i n s t o  insurance coverage.  hospital  Other entrance r e q u i r e -  m e n t s a r e t h e same as t h o s e  f o r a l l other students.  special statistics  of f o r e i g n students  are kept  t h e H e a l t h S e r v i c e , a l t h o u g h m e n t i o n has to  do  dents, at  statistical  attending  b e e n made o f  plans  a c c o u n t i n g of v a r i o u s c a t e g o r i e s of  i n c l u d i n g f o r e i g n s t u d e n t s , who  the Mental  No  Health Unit.  receive  stu-  treatment  Similar statistical  accounting  i n t h e O.P.D. w o u l d p r o v i d e u s e f u l i n f o r m a t i o n f o r f u t u r e p l a n n i n g o f h e a l t h n e e d s , and It  i s recommended.  i s a l s o recommended i n t h e S t a n d a r d s  that a l l  p r o f e s s i o n a l s of the H e a l t h S e r v i c e s h o u l d l e a r n the t u r a l and  r e l i g i o u s backgrounds of i n t e r n a t i o n a l  i n o r d e r t o a p p r e c i a t e how toward  these  p h y s i c i a n s , medicine,  and  students  influence their health.  cul-  attitudes  Initial  health  e v a l u a t i o n s p r o v i d e t h e H e a l t h S e r v i c e s t a f f w i t h an  opp-  o r t u n i t y t o become f a m i l i a r w i t h some o f t h e p r o b l e m s  of  s o c i a l acceptance,  of  apprehension  climatic  c h a n g e , and  other sources  or i n s e c u r i t y which handicap  many new  foreign  students. I n f o r m a t i o n p e r t a i n i n g t o t h e campus a g e n c y most concerned  w i t h i n t e r n a t i o n a l students  U.B.C. C a l e n d a r .  I t s t a t e s t h a t t h e I n t e r n a t i o n a l House  p r o v i d e s a s o c i a l and  c u l t u r a l centre f o r both  and members o f t h e g r e a t e r w o r l d major concerns  i s c o n t a i n e d i n the  c o m m u n i t y , one  i n v o l v i n g t h e r e c e p t i o n and  students of i t s  orientation  180 o f new s t u d e n t s  t o campus l i f e .  The I n t e r n a t i o n a l  P r o g r a m C o m m i t t e e i s most i m p o r t a n t requests;  t h e Board o f D i r e c t o r s has e q u a l  from f a c u l t y ,  student  and community s o c i a l  i s recommended t h a t t h e H e a l t h national information the  i n articulating  planning  centre  student  representation systems.  Service u t i l i z e  and o t h e r  Students'  It  the i n t e r -  of i t s resources  in  and p r o v i s i o n o f h e a l t h s e r v i c e s f o r l a r g e  groups of f o r e i g n students, section of t h i s  paper.  as m e n t i o n e d i n a n e a r l i e r  181  CHAPTER 7 HEALTH PERSONNEL;  QUALIFICATIONS,  DUTIES. AND  The and  following l i s t  EDUCATION  of H e a l t h S e r v i c e  personnel  t h e i r q u a l i f i c a t i o n s i s an e x t r a c t from the 1 9 7 6  U.B.C.  Calendar: The A.M.  U n i v e r s i t y Health  Service:  Johnson, M.D., F.R.C.P.(C), D i r e c t o r of U n i v e r s i t y H e a l t h S e r v i c e and H e a l t h S e r v i c e H o s p i t a l .  C. A. Brumwell, M.D.  (Brit. Col.),  Assistant Director.  D. J . Farquhar, M.D.  (Brit. Col.),  Physician,  D. Goresky, M.D.  (Alta.),  Physician.  R.K.L. P e r c i v a l - S m i t h , M.B., R. Ree, M.  M.D.  part-time.  B.S.  (Cantab.),  Physician.  (Brit. Col.), Physician.  B e i s e r , M.D. ( B r i t . C o l . ) , Diploma (A.B.P.N.), Consultant Psychiatrist.  S. M i l l e r , M.D. , CM., M.Sc, Consultant R a d i o l o g i s t . J.R. Mclver, M.B., Ch.B. tant R a d i o l o g i s t . D.J.  Dundee, M.D.,  K. Boyle,  R.N.,  P. Jones, R.N., R.T.  H. T u m a i t i s ,  Radiologist.  Supervisor.  R.T.  (X-Ray). (Lab.) (Physio.).  In a d d i t i o n , a l l s p e c i a l t y c l i n i c s are attended duly q u a l i f i e d and  Consul-  Head Nurse, H o s p i t a l .  M. H a r r i s o n , R.T. J . Sutton,  (Glasgow), C.R.C.P. (C),  Consultant  Nursing  D.R.T. ( M c G i l l ) , C.R.CP.(C),  by  physicians  licensed in their particular f i e l d  and  whose appointments have been approved by the governing body. The  t o t a l employed s t a f f i n numbers i s g i v e n under the  head-  182  ings of M e d i c a l S t a f f , Outpatient Hospital Staff.  Abbreviations  time, and P.T., meaning  7.1  Department  S t a f f and  used are F.T., meaning  full-  part-time.  MEDICAL STAFF  DIRECTOR  - l A Time - H o s p i t a l - 3/4 Time - O.P.D.  ASSISTANT DIRECTOR  - 8/10 Time - H e a l t h  Service  - P r i v a t e Part-Time - ExtendedCare GENERAL PRACTITIONERS  - 1 F.T. - 2 - 7/10 Time - 1 - 1/2 Time, Winter Session Only ( S e p t a l - May 1)  CONSULTANT PSYCHIATRISTS  .... - 1 - 8/10 Time - 1 - 2/10 Time  PSYCHIATRIC RESIDENTS  - 2 F.T. ( V a r i e s each year but generally  2.)  A l l are members of the F a c u l t y of Medicine a t U.B.C.  They  are remunerated by s a l a r y which i s p a i d t o the U n i v e r s i t y by the B.C. M e d i c a l P l a n .  D e t a i l s of remuneration and p e r -  q u i s i t e s as o u t l i n e d i n the Standards were not obtained. The r e g u l a t i o n s  governing the H e a l t h  D i r e c t o r and medical s t a f f are contained of the U n i v e r s i t y H e a l t h S e r v i c e  Service  i n the Bylaws  H o s p i t a l and read as  follows: SECTION 5  ARTICLE 1  The a d m i n i s t r a t i o n  of the h o s p i t a l s h a l l be the  r e s p o n s i b i l i t y of the D i r e c t o r who s h a l l be appointed by the Board.  183  SECTION 5 The  ARTICLE  11  D i r e c t o r s h a l l be g i v e n s u f f i c i e n t  c a r r y o u t t h e d u t i e s imposed  authority to  on h i m b y t h e B o a r d a n d  he s h a l l be i n c o m p l e t e c h a r g e o f a l l d e p a r t m e n t s a n d activities  of the h o s p i t a l subject t o the d i r e c t i o n  and c o n t r o l o f t h e B o a r d a n d t h e A d m i n i s t r a t i v e  Committee.  SECTION 7 A R T I C L E 1 The  B o a r d s h a l l a p p o i n t a M e d i c a l S t a f f composed o f  members o f t h e C o l l e g e o f P h y s i c i a n s a n d S u r g e o n s o f B r i t i s h Columbia and s h a l l ensure t h a t a p r o p e r m e d i c a l staff  o r g a n i z a t i o n i s s e t up a n d m a i n t a i n e d .  SECTION 7  ARTICLE  11  In m e d i c o - a d m i n i s t r a t i v e m a t t e r s , the M e d i c a l S t a f f s h a l l a c t i n an a d v i s o r y c a p a c i t y t h r o u g h i t s r e p r e s e n t a t i o n on t h e J o i n t A d v i s o r y C o m m i t t e e . SECTION 7  ARTICLE  Appointments the  111  t o t h e M e d i c a l S t a f f may be made o n l y b y  B o a r d a n d f o r a t e r m n o t e x c e e d i n g one y e a r o r  f o r a p o r t i o n o f a y e a r when a member i s s o a p p o i n t e d i n the i n t e r i m o f r e g u l a r annual appointments. SECTION 7  ARTICLE IV  R u l e s o r r e g u l a t i o n s g o v e r n i n g t h e method o f a p p o i n t ment a n d o r g a n i z a t i o n a n d a c t i v i t i e s o f t h e M e d i c a l S t a f f s h a l l be p r o m u l g a t e d b y t h e B o a r d f r o m t i m e t o t i m e a n d s h a l l n o t become e f f e c t i v e u n t i l t h e y have been a p p r o v e d by t h e L i e u t e n a n t - G o v e r n o r i n C o u n c i l . (See " B y l a w s " - A p p e n d i x V I ) T h e r e w o u l d a p p e a r t o be no f o r m a l w r i t t e n p e r t a i n i n g t o the medical s t a f f These would  include  policies  as o u t l i n e d i n t h e Standards.  job descriptions d e f i n i n g the primary  184  responsibilities  and c o l l a t e r a l  duties  o f e a c h member;  a d e s c r i p t i o n o f t h e work schedule f o r f u l l staff;  and s t a t e m e n t s r e g a r d i n g  and p a r t - t i m e  supervision,  evaluation of  performance, terms o f reappointment and j o b s e c u r i t y , m o t i o n o r advancement, and o u t s i d e regarding in  employment.  n i g h t , weekend and v a c a t i o n  both the Hospital The  pro-  Notices  coverage, are posted  a n d t h e O.P.D.  nucleus of f u l l  o r near f u l l - t i m e medical  s t a f f members whose p r i m a r y o r i e n t a t i o n a n d r e s p o n s i b i l i t y are  t o the U n i v e r s i t y , provides the c o n t i n u i t y o f care  required given  to avoid  a fragmented s e r v i c e .  Consideration i s  t o t h e i n d i v i d u a l i n t e r e s t s and c a p a b i l i t i e s o f each  s t a f f member w h i c h i s a p p a r e n t i n t h e c l i n i c a l which each p r e s i d e s ,  areas  over  and i n acknowledged s t a f f s a t i s f a c t i o n .  Teamwork a p p e a r s t o be i n e f f e c t a s t h e w o r k - l o a d i s g e n e r a l l y c o n d u c t e d on a s h a r e d b a s i s  until  completion.  students admitted t o the Hospital the  physician  the  Director also carries a f u l l  come u n d e r t h e c a r e o f  who a t t e n d e d t h e p a t i e n t  i n t h e O.P.D., a n d  patient  In terms o f p r o f e s s i o n a l ortunity  F o r example,  work-load.  i m p r o v e m e n t , e v e r y opp-  i n t h i s d i r e c t i o n w o u l d seem t o be a v a i l a b l e t o t h e  s t a f f members.  Clinical  research  i s conducted i n s p e c i a l  i n t e r e s t areas, such as b i r t h c o n t r o l ; attendance a t outs i d e p r o f e s s i o n a l programs i s p e r m i t t e d ; r e v i e w i s promoted through s t a f f  and i n f o r m a l  discussions,  peer  review of  185  clinical  p r o b l e m s , and i n s e r v i c e  have a c c e s s all  education.  Staff  members  t o t h e Woodward B i o m e d i c a l L i b r a r y w h i c h h o u s e s  of the recent t e x t s , p e r i o d i c a l s ,  aids currently  and o t h e r e d u c a t i o n a l  available.  While  the Standards  include dental staff  under  t h i s s e c t i o n , no comment c a n be made s i n c e a n y d e n t a l s e r v i c e o f f e r e d i s i n the Dental School part of the Health Service.  and i s n o t a c o m p o s i t e  D i s c u s s i o n and recommendations  on t h i s s u b j e c t a r e c o n t a i n e d i n C h a p t e r  6, s e c t i o n 6.7,  Dental Services.  7.2  OUTPATIENT  DEPARTMENT STAFF  NURSING SUPERVISOR  - 1/2 Time  REGISTERED NURSES  - 3 F.T. - 2 S e s s i o n a l ( i e F.T. S e p t . 1 - May 1)  NURSES' A I D E (Housekeeping A s s i s t a n t I )  - 1 F.T.  REGISTERED TECHNICIAN (Radiology)  - 1 F.T.  REGISTERED TECHNICIAN (Laboratory)  - 1 F.T.  REGISTERED TECHNICIAN (Physiotherapy)  - 1/2 Time ( 1 / 2 Time D e p a r t ment o f P h y s i c a l E d u c a t i o n and R e c r e a t i o n )  CLERK I  - 1 F.T. ( M e d i c a l B i l l i n g Switchboard)  Supposedly shared i time w i t h the Hospital but i t s requirements are minimal.  &  - 2 Sessional (Miscellaneous Duties)  186  CLERK I I  - 2 F.T.  CLERK IV  - 1 F.T. ( S e c r e t a r y t o the D i r e c t o r )  SECRETARY I I I  - 1 F.T. ( A t t a c h e d t o t h e Mental Health Unit but budgeted t h r o u g h O.P.D.)  There had p r e v i o u s l y been a p a r t - t i m e n u t r i t i o n i s t on a v o l u n t e e r b a s i s i n t h e department.  C u r r e n t l y , however,  i f n u t r i t i o n a l advice o r counseling i s requested the s t u d e n t  or required,  i s r e f e r r e d t o t h e Home Economics Department  or t o t h e Food S e r v i c e s t a f f o f h i s r e s p e c t i v e r e s i d e n c e , for instance, regarding a special  d i a b e t i c or reducing  At h e r own r e q u e s t , a s t u d e n t  i n t h e U.B.C.  diet. School  of N u r s i n g was d o i n g f i e l d work i n the department a t t h e time o f t h e r e v i e w .  7.3  HOSPITAL STAFF  NURSING SUPERVISOR  - 1/2 Time  REGISTERED NURSES  - 5 F.T. ( I n c l u d e s Head Nurse & permanent Night Nurse) - 2 P.T. c a s u a l n i g h t  L.P.N.'s  relief  - 3 F.T. (Days & Evenings Only) - O c c a s i o n a l P.T. - S h i f t Relief  NURSES' AIDE  - 1 F.T. - N i g h t S h i f t - P.T. C a s u a l R e l i e f  JANITOR  - 1 F.T.  - Student r e l i e f on weekends and h o l i d a y s .  18?  HOUSEKEEPING ASSISTANT I I  - 1  F.T.  DIETARY AIDES  - 1  F.T.  - 1 - 1 / 2  Time, p l u s  relief.  (This service i s leased f r o m t h e Campus F o o d S e r v i c e s Department.) ADMITTING CLERK  - 1 F.T. - S h a r e d w i t h Mental Health Unit.  A l l p r o f e s s i o n a l or c e r t i f i e d personnel p r i a t e l y t r a i n e d and  the  have been a p p r o -  are l i c e n s e d according  to t h e i r  pective p r o v i n c i a l or j u r i s d i c t i o n a l regulatory  res-  bodies.  While the Standards suggest t h a t U n i v e r s i t y trained nurses gain s p e c i a l i n s i g h t into v i t a l p r o b l e m s t h r o u g h t h e i r own  experience  demic program, i t i s c o n s i d e r e d ( p u b l i c ) h e a l t h and community are  student  with a rigorous  here t h a t knowledge  a keen i n t e r e s t i n the  s u f f i c i e n t f o r good s t u d e n t  of  institutional health care.  terms of e x t r a - p r e p a r a t i o n , b o t h the H e a l t h S e r v i c e v i s o r and the  t h r o u g h the  Unit Administration Extension Canadian H o s p i t a l A s s o c i a t i o n .  n e a r l y a l l s t a f f members have had  the to  and  Super-  Course o f f e r e d In a d d i t i o n ,  the o p p o r t u n i t y  to  the  O.P.D. N u r s e s ' A i d e was  i n c e n t i v e bonus, the v a l u e  t h i s category  At  reported  a t t e n d i n g a four-week communications workshop.  t h a n as an  attend  seminars p e r t a i n i n g to c o l l e g e h e a l t h .  time of the review be  In  t h e H o s p i t a l Head N u r s e have s u c c e s s f u l l y c o m p l e t e d  Nursing  conferences  aca-  Other  of such a seminar f o r  o f employee i s q u e s t i o n a b l e .  The  nursing  staff  188  a l s o has access to the t e x t s , j o u r n a l s , and other p r o f e s s i o n a l r e f e r e n c e s c o n t a i n e d i n the Biomedical L i b r a r y . 7.4  NURSING Recommended o b j e c t i v e s and o p p o r t u n i t i e s f o r the  n u r s i n g s e r v i c e i n the h e a l t h program are the f o l l o w i n g t "To p a r t i c i p a t e i n p o l i c y and program development f o r the h e a l t h s e r v i c e and t o i n t e r p r e t the p o l i c i e s and programs t o the h e a l t h s e r v i c e s t a f f , students, f a c u l t y , and o t h e r members o f the c o l l e g e community To p a r t i c i p a t e i n i n t e r p r e t i n g t o the c o l l e g e community the extent and l i m i t a t i o n s o f s e r v i c e a v a i l a b l e a t the health center To r e c r u i t and p r o v i d e o r i e n t a t i o n f o r new members of the n u r s i n g s e r v i c e ; t o p r o v i d e c o n t i n u i n g educat i o n and e v a l u a t i o n o f performance f o r a l l members of the n u r s i n g s t a f f To p r o v i d e p a t i e n t care on the b a s i s o f m e d i c a l d i a g n o s i s and treatment d i r e c t e d by the p h y s i c i a n s To evaluate n u r s i n g p r a c t i c e s and t o seek new and more e f f e c t i v e ways o f u t i l i z i n g the t a l e n t s o f n u r s i n g personnel To p a r t i c i p a t e i n l i a i s o n between the c o l l e g e h e a l t h s e r v i c e and h e a l t h agencies i n the community To i n i t a i a t e and implement programs f o r n u r s i n g personnel development To p a r t i c i p a t e i n the development o f i n s e r v i c e educat i o n a l o p p o r t u n i t i e s f o r the e n t i r e h e a l t h s e r v i c e s t a f f and t o encourage a l l members o f the n u r s i n g s t a f f to p a r t i c i p a t e i n program p l a n n i n g To p a r t i c i p a t e i n p l a n n i n g f o r emergency/disaster care To p a r t i c i p a t e i n i n f o r m a l h e a l t h c o u n s e l i n g and educat i o n f o r p e r s o n a l and community h e a l t h . " (6. - p.41)  189  In addition to providing t r a d i t i o n a l nursing services i n the Health Service, nurses are i n a p o s i t i o n to p o s i t i v e l y influence the health attitudes and behavior of students and other members of the community.  It cannot  be stressed strongly enough what a great opportunity l i e s i n t h e i r d a i l y patient contacts to turn health care into an educational experience which can have a l a s t i n g  impact  upon the l i v e s of students and others with whom they are i n contact.  The valuable resource and unique  contribution  of the nursing personnel must be recognized both by those responsible f o r the service and by the nurses  themselves.  So important i s the nurse's p o s i t i o n of influence to the student welfare, that to consider i t l i g h t l y or not at a l l i s to abdicate r e s p o n s i b i l i t y .  Every nurse i n the depart-  ment should, therefore, through education, experience, or special interest i n the health problems of young adults, attempt to develop improved c l i n i c a l s k i l l s and to become a more effective model f o r health education. While job descriptions and tools f o r evaluating i n d i v i d u a l performance are said to be i n the  developmental  stages, these are considered a p r i o r i guidelines f o r the nursing s t a f f .  Written statements of nursing responsib-  i l i t i e s within the Health Service and college community, of d e t a i l s of the work schedule, of l i n e s of authority, and of personnel p o l i c i e s , job s e c r i t y and c r i t e r i a f o r  190  e v a l u a t i o n and promotion should be c l e a r l y d e f i n e d and r e g u l a r l y updated.  Such instruments  o f o r g a n i z a t i o n and  management c o n t r i b u t e n o t only to the f u l f i l m e n t o f the above s t a t e d o b j e c t i v e s but t o s t a f f s a t i s f a c t i o n and the overcoming o f unnecessary I t was observed  misunderstandings.  t h a t a g r e a t number o f non-nurs-  i n g c u s t o d i a l f u n c t i o n s are performed by the p r o f e s s i o n a l nursing s t a f f .  While i t i s r e c o g n i z e d t h a t the "peak and  v a l l e y " type o f demand on the s e r v i c e w i l l r e s u l t i n p e r iods o f i d l e time, care must be taken t o a v o i d u s i n g h i g h l y q u a l i f i e d p e r s o n n e l f o r t a s k s which can be delegated t o the Nurses' A i d e s , housekeeping a s s i s t a n t , o r c l e r i c a l  staff.  F o r t h i s reason, each member should be d i r e c t l y i n v o l v e d i n the development o f h i s / h e r own job d e s c r i p t i o n and s p e c i f i c a t i o n s , w i t h a view t o s e e k i n g new and more e f f e c t ive ways o f u t i l i z i n g the t a l e n t s o f n u r s i n g p e r s o n n e l .  7.5  OTHER PROFESSIONALS Included i n the p r o f e s s i o n a l s t a f f are the three  R.T.'s (x-ray, l a b , and p h y s i o t h e r a p y ) .  The R.N. r e s p o n s i -  b l e f o r the i n s e r v i c e e d u c a t i o n program might be c o n s i d e r e d as the h e a l t h educator,  a l b e i t more outreach programs are  needed to promote campus-wide h e a l t h education.  F o r these  other p r o f e s s i o n a l s t a f f members, as f o r medical and n u r s i n g , there should be w r i t t e n job d e s c r i p t i o n s d e f i n i n g t h e i r  primary  191  r e s p o n s i b i l i t i e s and any c o l l a t e r a l duties, statements of the supervision which each can expect to receive, and the means f o r evaluating t h e i r performance, the terms of appointment, and personnel p o l i c i e s .  Remuneration i s thought to be  competitive with other opportunities f o r s i m i l a r l y trained professionals, and opportunities f o r continuing professional improvement are made available.  I t i s recommended that each  member should be encouraged to maintain contact with his/her professional organization and to subscribe to the l i t e r a t u r e pertaining to each respective area of interest or a c t i v i t y . It i s recommended that the Health Service would achieve benefit from the assistance of a dentist or dental hygienist, and a medical record l i b r a r i a n , even on a parttime or consultant basis.  The f i r s t i s considered  vitally  important to student well-being, and the second to correct use and maintenance of medical information. As the periods of adolescence and young adulthood are described as the "forgotten-age"  r e l a t i v e to n u t r i t i o n  and the formulation of good eating habits, the concept of a consultant n u t r i t i o n i s t or d i e t i t i a n i n the department i s extremely worthwhile.  The reestablishment  of such a service  should be given due consideration. As the health program increases i n scope and comp l e x i t y , and p a r t i c u l a r l y i n the advent of a new Hospital,  192 it  i s recommended t h a t an a s s i s t a n t to the D i r e c t o r ,  experienced i n h o s p i t a l or m e d i c a l a d m i n i s t r a t i o n , be appointed.  Some o f the major r e s p o n s i b i l i t i e s and p r o j e c t s  of the D i r e c t o r t h a t can be d e l e g a t e d o r shared by such  an  a s s i s t a n t are i n the areas of p o l i c y development, program p l a n n i n g , budgeting, and d i r e c t i o n of the p r o f e s s i o n a l staff.  The Standards  recommend the establishment of t h i s  p o s i t i o n f o r a h e a l t h program which i s r e s p o n s i b l e f o r 7,500 or more s u b s c r i b e r s and which attempts  to p r o v i d e a compre-  hensive h e a l t h s e r v i c e .  7.6  SECRETARIAL/CLERICAL STAFF Because of t h e i r c r i t i c a l p o s i t i o n i n the communi-  c a t i o n system, i t i s recommended t h a t a l l members of the s e c r e t a r i a l / c l e r i c a l s t a f f r e c e i v e c a r e f u l and  detailed  o r i e n t a t i o n concerning a l l f a c e t s of the H e a l t h S e r v i c e . The t u r n o v e r of c l e r i c a l employees appears  h i g h , which might  be due  o r t o some c o n f l i c t  to the s e s s i o n a l employment of two,  i n the main o f f i c e area. s a i d to need improving.  I n t e r p e r s o n a l communications are I f s t a f f s a t i s f a c t i o n and work per-  formance are t o be promoted, the s t a f f must be kept as promptly  informed  as p o s s i b l e of a l l p e r s o n n e l , program, o r proced-  u r a l changes and o t h e r matters f o r which they are expected have accurate i n f o r m a t i o n .  I t i s important  t h a t the  to  urgency  of m a i n t a i n i n g s t r i c t c o n f i d e n t i a l i t y of i n f o r m a t i o n be under-  193 stood, that the reception of patients and telephone  inquiries  be handled i n an a l e r t and courteous manner, and that d i s cussion of even common patient problems be discouraged a l l times.  at  The Standards suggest that the need f o r continu-  ing inservice education  i s more imperative  f o r t h i s group  than f o r any other group of the s t a f f . While there would appear to be an adequate number of s e c r e t a r i a l / c l e r i c a l s t a f f , as mentioned previously a medical record l i b r a r i a n would be an invaluable asset to the service i n terms of coding, f i l i n g , storing, and  retriev-  ing medical information, and i n s t i t u t i n g a unit record system to replace the present alphabetical system. formation  filing  Such i n -  i s necessary not only f o r s t a t i s t i c a l purposes,  but f o r future planning and research.  The magnitude of the  r e s p o n s i b i l i t y of properly maintained f i l e s , therefore, requires a person who  i s competently and appropriately trained  f o r the task. Again, there i s an observed need f o r c l e a r l y  de-  fined job descriptions, including primary r e s p o n s i b i l i t i e s and a n c i l l a r y duties, as well as the means of performance evaluation and opportunities f o r advancement.  A manual of  procedures r e l a t i n g to communications and other matters of concern to the c l e r i c a l s t a f f i s required.  194  7.7  SUPPORT STAFF The standard of housekeeping,  sanitation,  and  maintenance appears h i g h i n a l l areas of the H e a l t h S e r v i c e . The number of p e r s o n n e l i n t h i s a r e a t h e r e f o r e i s c o n s i d e r e d to be  satisfactory. The o n l y two  job d e s c r i p t i o n s found i n the d e p a r t -  ment were those f o r the Nurses' Aide (Housekeeping I) i n the O.P.D., and the Housekeeping Hospital.  Assistant  A s s i s t a n t I I i n the  These two employees are long-term and t h e i r f u n c -  t i o n s are f a i r l y  interchangeable.  I t i s suggested t h a t the  Nurses' Aide's f u n c t i o n of r e c o r d i n g data on  requisitions  and l a b e l s b e f o r e d e l i v e r i n g specimens t o the l a b , be d e l e t e d from her s p e c i f i c a t i o n of d u t i e s as i t would not appear t o be c o n s i s t e n t w i t h her p o s i t i o n , nor s a f e i n terms of p o s s i b l e e r r o r s of r e c o r d i n g . now  performed  Rather, c e r t a i n c u s t o d i a l  activities  by the n u r s i n g s t a f f might be t r a d e d o f f f o r  the r e s p o n s i b i l i t y of l a b e l i n g  specimens.  I t i s not understood why  the Nurses' Aide was  attend-  i n g a four-week communications seminar a t the time of the ons i t e review of the H e a l t h S e r v i c e .  T h i s type of e d u c a t i o n a l  a c t i v i t y would have b e t t e r b e n e f i t e d one of the  secretarial/  c l e r i c a l or p r o f e s s i o n a l members of the s t a f f .  I t i s recommend-  ed, however, t h a t maintenance p e r s o n n e l should be w e l l  informed  concerning the measures they must observe to a s s i s t i n the p r e v e n t i o n and c o n t r o l of i n f e c t i o u s and communicable d i s e a s e s .  195  It i s , therefore, essential that they have both an i n i t i a l and a continuing course of inservice  instruction.  196  CHAPTER 8 PHYSICAL PLANT  8.1  LOCATION The Health Service i s conveniently located i n the  West Wing of the Weshrook Building near the center of the campus where i t i s r e a d i l y accessible from both academic and r e s i d e n t i a l areas.  I t comprises the up-to-date Out-  patient Department on the main f l o o r together with the twenty-six bed Hospital and Mental Health Unit on the t h i r d floor.  The o f f i c e s of the Director and Assistant Director  are located immediately adjacent to the O.P.D.  Nearly a l l  f a c i l i t i e s used f o r d i r e c t patient care are found i n the same building or within areas e a s i l y accessible from the service as recommended i n the Standards.  8.2  DESIGN AND CONSTRUCTION The present Health Service evolved slowly through  various locations on the campus u n t i l 1951 when the Health Service Hospital was incorporated into the program and the present f a c i l i t i e s were i n i t i a t e d .  The diagrams i n Appendices  VIII and IX provide v i s u a l layouts of the O.P.D. and the Hospital.  Although some measure of p s y c h i a t r i c service has been  197  provided  f o r students  s i n c e 1938, the separate  H e a l t h U n i t was opened i n 1973 adjacent on the t h i r d f l o o r .  Mental  t o the H o s p i t a l  T h i s space was made a v a i l a b l e by the  r e l o c a t i o n o f the Department o f H e a l t h Care and Epidemiology to the new James Mather B u i l d i n g i n December 1972. As noted e a r l i e r there a r e 6,500 square f e e t o f space on each o f the two f l o o r s o f the s e r v i c e , the Mental H e a l t h U n i t .  excluding  I f the a n t i c i p a t e d p o l i t i c a l d e c i -  s i o n i s made t o c o n s t r u c t a new 230-bed acute care h o s p i t a l on the U n i v e r s i t y campus, the s p e c u l a t i o n i s t h a t the H e a l t h S e r v i c e w i l l be r e l o c a t e d i n t h a t f a c i l i t y .  The r a t i o n a l e  f o r b u i l d i n g a new h o s p i t a l i s t o double the enrolment o f the medical s c h o o l from 80 t o 160 students  i n order t o meet  the growing shortage of Canadian t r a i n e d d o c t o r s .  In p l a n n -  i n g f o r t h i s event, the H e a l t h S e r v i c e D i r e c t o r has requested a space a l l o t m e n t  o f 10,000 square f e e t f o r t r a n s f e r o f the  O.P.D. f u n c t i o n s only, an i n c r e a s e of 3,500 square f e e t over the present  outpatient f a c i l i t y .  In r e a l i t y , the i n c r e a s e  would amount t o g r e a t e r than t h a t amount as the l a b and x-ray f u n c t i o n s would be performed by those departments o f the new hospital.  The D i r e c t o r a n t i c i p a t e s t h a t a bed a l l o c a t i o n  would be made f o r the e x c l u s i v e use by students,  but an exact  number i s d i f f i c u l t t o f o r e c a s t s i n c e the H o s p i t a l i s so p o o r l y utilized.  In any case, the U n i v e r s i t y has i n d i c a t e d t h a t i t  can use the space i n the Wesbrook B u i l d i n g f o r other purposes.  198  A t r a n s f e r o f the Mental  H e a l t h U n i t would seem  i l l o g i c a l i n economic terms as i t i s r e l a t i v e l y new, conv e n i e n t l y l o c a t e d , comfortably f u r n i s h e d , s a t i s f a c t o r y i n s i z e , and a p p a r e n t l y w e l l u t i l i z e d by the s t u d e n t s .  Other  than the need f o r f r e e communication between s t a f f members of the d i f f e r e n t d i v i s i o n s o f the H e a l t h S e r v i c e , the f u n c t i o n s and a c t i v i t i e s o f the Mental H e a l t h U n i t seem f a i r l y autonomous and would n o t l i k e l y s u f f e r a marked  decrease  i n student use i f the l o c a t i o n remained constant.  Further-?  more, the p r e s e n t plans to d e c e n t r a l i z e the p s y c h i a t r i c s e r v i c e through outreach programs i n the v a r i o u s r e s i d e n c e s and dorms g i v e a d d i t i o n a l support t o t h i s argument. I f and when a d e c i s i o n i s announced r e l a t i v e to a new h o s p i t a l and t r a n s f e r o f the H e a l t h S e r v i c e , p l a n n i n g should begin immediately  f o r the student h e a l t h program.  B a s i c d e c i s i o n s must be made concerning those s e r v i c e s which w i l l be p r o v i d e d , the s u b s c r i b e r s t o be served, and o t h e r resources a v a i l a b l e .  D e t a i l e d p r o j e c t i o n s must be made o f  s e r v i c e l o a d s , s t a f f i n g p a t t e r n s , s u p p o r t i n g s e r v i c e s and p e r s o n n e l , and r e c e i p t , s t o r a g e , and flow o f s u p p l i e s .  Func-  t i o n a l design must be g i v e n f i r s t p r i o r i t y i n order t o encourage optimum use o f s e r v i c e s and t o promote the e f f i c i e n t use o f r e s o u r c e s .  I t i s recommended t h a t such  p l a n n i n g w i l l r e q u i r e a f u l l - t i m e appointee  important  from the H e a l t h  S e r v i c e t o the H o s p i t a l B u i l d i n g Committee i f the needs o f t h i s department are t o be s a t i s f a c t o r i l y r e p r e s e n t e d .  This  199  p o s i t i o n might w e l l be combined w i t h t h a t of an to  the D i r e c t o r , as recommended i n the l a s t  8.3  assistant  chapter.  MAINTENANCE I t would appear t h a t the p r e s e n t f a c i l i t i e s meet  the standards approved used.  f o r the purposes  Recommended a u x i l i a r y f i r e p r o t e c t i o n i s p r o v i d e d  by automatic  s p r i n k l e r s , appropriate f i r e extinguishers  p r o p e r l y p l a c e d and maintained, Trash and o t h e r combustibles and stairways are observed One  f o r which they are  r e a l hazard observed  and an i n t e r n a l alarm system.  are removed promptly;  corridors  to be unobstructed a t a l l times.  d u r i n g the i n s p e c t i o n was  the  storage of oxygen tanks i n the open J a n i t o r ' s c l o s e t w i t h i n the H o s p i t a l ward on the t h i r d f l o o r .  The warm and sometimes  sunny l o c a t i o n of the tanks and the p r o b a b i l i t y of bumping them w i t h f l o o r - w a s h i n g equipment, make the tanks s u b j e c t to  e x p l o s i o n or combustion and, t h e r e f o r e , extremely  hazard-  ous even though they are p r o p e r l y chained to the w a l l .  It  i s recommended t h a t the r e g u l a t i o n s f o r safe storage of comb u s t i b l e s and e x p l o s i v e s be f o l l o w e d , t h a t i s , a c o o l , m e t a l - l i n e d and l o c k e d storage compartment a c c e s s i b l e  dark, from  the e x t e r i o r of the b u i l d i n g . I t i s assumed t h a t r e f r i g e r a t i o n , emergency power, f i r e  ventilation,  equipment, and o t h e r support systems  200  are s u b j e c t t o r e g u l a r maintenance, i n s p e c t i o n s and t r i a l s . A l l work i s r e q u i s i t i o n e d t o the Campus P h y s i c a l P l a n t and c a r r i e d out by the v a r i o u s  trades as i n d i c a t e d .  These i n  t u r n are s u b j e c t t o the r u l e s and r e g u l a t i o n s o f t h e i r r e s p e c t i v e unions.  In the event o f a power f a i l u r e , the  emergency power system should be able t o m a i n t a i n adequate l i g h t i n g i n an emergency treatment room, the c o r r i d o r s and stairways, and  nursing  laboratory The  s t a t i o n , and the medical r e c o r d s ,  x-ray  areas. budget f o r b u i l d i n g maintenance such as f l o o r s ,  w a l l s , windows, plumbing, and e l e v a t o r s , i s submitted through the P h y s i c a l P l a n t .  Maintenance o f a r t i c l e s i n s t a l l e d o r  purchased by the O.P.D. o r H o s p i t a l i s the f i n a n c i a l responsibility for  o f the department.  P e r diem f i n a n c i n g i s p r o v i d e d  the H o s p i t a l by the B.C.H.I.S.  regarding  Additional  s a f e t y and maintenance, has been g i v e n  6 under Environmental H e a l t h Emergencies/Disasters.  information i n Chapter  and Safety and P r o v i s i o n s f o r  201  CHAPTER 9 BUSINESS MANAGEMENT  9.1  FINANCING The  H e a l t h S e r v i c e H o s p i t a l i s owned and  by the U n i v e r s i t y .  I t i s f i n a n c e d p r i m a r i l y by the  operated British  Columbia H o s p i t a l Insurance S e r v i c e through the standard  per  diem r a t e e s t a b l i s h e d on the b a s i s of the annual budget,  and  i n a s m a l l way  by the d a i l y co-insurance  p a i d by the p a t i e n t s .  Donations and bequests made to the U n i v e r s i t y a l s o a s s i s t i n f i n a n c i n g the h e a l t h program. The  one  d o l l a r - a - d a y co-insurance  has been p a i d  by p r i v a t e p a t i e n t s p e r s o n a l l y , but the U n i v e r s i t y has s i d i z e d student half.  sub-  p a t i e n t s by making the payment on t h e i r  In the s p r i n g of t h i s year,  c i a l Government i n t r o d u c e d f o u r d o l l a r s - a - d a y and  1976,  however, the  be-  Provin-  an i n c r e a s e of the co-insurance  to  i t has not as y e t been announced whether  the U n i v e r s i t y intends to meet the i n c r e a s e d subsidy.  This  d e c i s i o n i s expected to be p a r t of the overall-' c o n s i d e r a t i o n being g i v e n to c l o s i n g the H o s p i t a l s i n c e the i n c r e a s e likely  discourage  i t s use f o r r e h a b i l i t a t i o n of  p a t i e n t s as w e l l as f o r Before  will  long-stay  students.  the i n t r o d u c t i o n of B.C.H.I.S. and  the source of funds f o r the h e a l t h program was  Medicare,  p a r t of  the  202  composite f e e l e v i e d by the U n i v e r s i t y f o r s e v e r a l purposes, for  example student d o r m i t o r i e s , the H e a l t h S e r v i c e H o s p i t a l ,  and the ambulatory s e r v i c e s . expected  Now, however, students are  t o c a r r y insurance coverage o r they a r e b i l l e d f o r  services provided.  The f o l l o w i n g i n f o r m a t i o n i s p r o v i d e d i n  the c u r r e n t U.B.C.  Calendar.^  (a)  Hospital  Insurance  (i)  Students who are c l a s s i f i e d as r e s i d e n t s o f B.C. are e n t i t l e d t o B.C. H o s p i t a l Insurance benefits.  (ii)  Students who are n o t c l a s s i f i e d as r e s i d e n t s of B.C. are n o t e l i g i b l e f o r payment o f h o s p i t a l c o s t s under the B r i t i s h Columbia H o s p i t a l Service.  E n q u i r i e s r e g a r d i n g e l i g i b i l i t y f o r r e s i d e n c e may be made d u r i n g U n i v e r s i t y r e g i s t r a t i o n , a t the H e a l t h S e r v i c e o f f i c e , o r by t e l e p h o n i n g the B.C.H.I.S. o f f i c e . A l l Canadian p r o v i n c e s accept r e s p o n s i b i l i t y f o r h o s p i t a l c o s t s f o r t h e i r students a t t e n d i n g the U n i v e r s i t y o f B r i t i s h Columbia p r o v i d e d the h o s p i t a l insurance premiums (where r e q u i r e d ) have been p a i d , or u n t i l the student i s accepted as a permanent r e s i dent o f B.C. Students who a t t e n d U.B.C. and are n o t r e s i dents o f Canada are r e q u i r e d t o produce evidence o f adequate s i c k n e s s and h o s p i t a l insurance before r e g i s t r a t i o n can be considered complete. Non-resident s t u dents can purchase a M e d i c a l and H o s p i t a l P l a n a t the time o f r e g i s t r a t i o n . T h i s p r o v i d e s acceptable s i c k ness and h o s p i t a l insurance w i t h no D e d u c t i b l e . The r a t e s f o r 1975-76 were $110.00 f o r a s i n g l e student and $225.00 f o r a married student f o r 12-month coverage. These r a t e s are s u b j e c t to y e a r l y change. .Ob)  Sickness  Insurance  I t i s a d v i s a b l e f o r a l l B.C. r e s i d e n t s t o have coverage under the M e d i c a l S e r v i c e s P l a n o f B.C.  203  Unmarried students whose parents are e n r o l l e d i n the M.S.P.B.C. are i n s u r e d as dependents u n t i l t h e i r 21st birthday. The coverage may he continued i f t h e student i s i n f u l l - t i m e attendance a t u n i v e r s i t y and mainly dependent on h i s p a r e n t s , but the P l a n must be n o t i f i e d of these f a c t s , otherwise coverage ceases on the 21st birthday. For students who are n o t covered by t h e i r p a r e n t s ' medical insurance p l a n , the f o l l o w i n g plans are a v a i l a b l e : (i)  M e d i c a l S e r v i c e s P l a n o f B.C.: Students covered by t h i s P l a n as i n d i v i d u a l s u b s c r i b e r s may be e l i g i b l e f o r a subsidy.  Students who have n o t e s t a b l i s h e d r e s i d e n c y ... are not able t o purchase t h i s p l a n . Coverage should be maintained i n the home P r o v i n c e . F u r t h e r d e t a i l s may be obtained a t the H e a l t h S e r v i c e o f f i c e or from the M.S.P.B.C. (Medical S e r v i c e s P l a n o f B.C.). (ii)  Non-Canadian Resident H o s p i t a l - M e d i c a l P l a n : ... Students covered by an approved insurance p l a n w i t h a non-Canadian c a r r i e r w i l l be b i l l e d d i r e c t l y f o r s e r v i c e s r e c e i v e d . R e c e i p t s should then be submitted by the student t o the insurance company f o r reimbursement. Students who a l l o w t h e i r insurance to l a p s e w i l l be b i l l e d d i r e c t l y . Out-of-Canada students are r e q u i r e d t o have coverage  f o r both h o s p i t a l and p h y s i c i a n c a r e .  They may purchase com-  bined h o s p i t a l and medical insurance through a p r i v a t e p l a n , i f o t h e r adequate coverage i s n o t c a r r i e d .  A brochure  out-  l i n i n g b e n e f i t s o f the p l a n and the c u r r e n t year's premium r a t e s may be obtained a t the H e a l t h S e r v i c e .  Students are  a d v i s e d t o a t t e n d t o t h i s e a r l y so t h a t the insurance can commence as soon as p o s s i b l e a f t e r t h e i r a r r i v a l i n B.C. In g e n e r a l i t i s c o n s i d e r e d t h a t prepayment o f d i r e c t p e r s o n a l s e r v i c e s encourages optimum use o f s e r v i c e s a t the time t h a t they are needed.  204  9.2 A.  BUDGET PLANNING OUTPATIENT DEPARTMENT T h i s department i s f i n a n c e d by an a l l o c a t i o n from  the g e n e r a l funds o f the u n i v e r s i t y .  The departmental budget  i s determined each y e a r by the p r e v i o u s y e a r ' s budget,  chang-  i n g s a l a r i e s , o p e r a t i n g expenses, and the need t o r e p l a c e o r update e x i s t i n g equipment.  The budget review i s c a r r i e d out  by r e p r e s e n t a t i v e s o f the P r e s i d e n t ' s o f f i c e , the Finance Department,  and the H e a l t h S e r v i c e .  The l a s t a v a i l a b l e annual o p e r a t i n g budget was f o r the f i s c a l y e a r 1974-75, determined i n 1973. S a l a r i e s and Wages Drugs M e d i c a l and S u r g i c a l S u p p l i e s  I t i s as f o l l o w s :  $279,422.00 1,800.00 4,080.00  Travel - Staff Training  4,320.00 1,680.00 360.00 2,640.00 4,800.00 1,180.00 500.00  Repairs & Maintenance  1,080.00  X-ray S u p p l i e s Laboratory Supplies Housekeeping S u p p l i e s Laundry Office Supplies, P r i n t i n g , e t c . Travel  TOTAL  The c o s t o f unbudgeted  $301,862.00  items, such as s a l a r y i n c r e a s e s and  f r i n g e b e n e f i t s brought i n by new c o n t r a c t n e g o t i a t i o n s , was borne by the g e n e r a l U n i v e r s i t y budget u n t i l the f o l l o w i n g f i s c a l year.  205  I t appears t h a t s a l a r i e s and wages make up roughly  92.5% o f the t o t a l o p e r a t i n g budget.  portionate  This  f i g u r e may be due to s e v e r a l reasons.  disproOne, the  B.C.M.P. i s b i l l e d through the U n i v e r s i t y which r e c e i v e s the payments and i n t u r n reimburses the m e d i c a l s t a f f on a s a l a r i e d b a s i s , r e f l e c t e d i n the f i g u r e f o r s a l a r i e s and wages.  Two,  no p h y s i c a l p l a n t maintenance such as heat, l i g h t s , water, e t c . i s shown i n the budget.  Three, no a d m i n i s t r a t i v e  costs  on b e h a l f  o f the employees are shown, such as W.C.B., l i f e  insurance  and M.S.A.; and f o u r , no food c o s t s are n e c e s s a r y  i n an o u t p a t i e n t  service.  In any case, when the a c t u a l c o s t s  f o r d i r e c t p a t i e n t s e r v i c e s , t h a t i s , drugs, medical and s u r g i c a l s u p p l i e s , and l a b and x-ray s u p p l i e s , add up t o only a f r a c t i o n o f the t o t a l budget (3.9%) the f i g u r e f o r s a l a r i e s and wages appears t o be an overwhelmingly l a r g e percentage.  B.  HOSPITAL The  funds f o r t h i s budget, as p r e v i o u s l y  reported,  are d e r i v e d from the B.C.H.I.S. p e r diem payments.  A l l Hos-  p i t a l beds are c l a s s i f i e d as p u b l i c and t h e r e f o r e  only the  standard  administered  p e r diem r a t e i s p a i d .  These funds are  by the U n i v e r s i t y w i t h budget d e f i c i t s being made up from the general  U n i v e r s i t y funds.  F o r example, i n the f i s c a l y e a r  ending March 31, 1974, the H e a l t h  Service Hospital  incurred  206  a d e f i c i t of $12,878. that had to he subsidized out of general University revenues.  The information i n Table XII,  copied from the October JO, 1974 issue of the U.B.C. Reports indicates that the Health Service Hospital d e f i c i t accounted f o r 57.7% of the t o t a l d e f i c i t from a l l U.B.C. a n c i l l a r y enterprise sources.  No other statements were obtainable  f o r other years' operations but i t i s assumed that the Hospital has had an operating d e f i c i t f o r some time.  207  TABLE X I I STATEMENT OF U.B.C.'S ANCILLARY OPERATIONS FOR THE YEAR ENDED MARCH 31, 1974 HEALTH SERVICE HOSPITAL  TOTAL ALL SOURCES  REVENUE • Sales  $  R e n t a l s and Meal Passes H o s p i t a l Revenue  -  -  $4,184,040. 3,838,727.  230,898.  230,898.  $230,898.  $8,253,665.  $  $2,758,658.  EXPENDITURE Cost o f Merchandise  Sold  S a l a r i e s and Wages  -  154,533.  2,410,009.  7,082.  132,466.  29,314.  29,314.  4,051.  326,640.  Other Operating Expenditures  19,833.  786,458.  Development o f F a c i l i t i e s  28,963.  66,105.  Fringe Benefits (including Board Allowance) Dietary Service Utilities  Debt Repayment, i n c l u d i n g Interest  $243,776.  Net Operating Margin f o r Year  ($12,878.)  Reserved f o r Future Debt Repayment  $  -  Accumulated Reserve from P r e v i o u s Years Reserved f o r Future Development Excess o f Income over Expenditure f o r the Year Ended March 31,1974 SOURCE:  1,799,452. $8,309,102. ($55,437.)  $ 156,005.  -  122,877.  ($12,878.)  ($22,309.)  U.B.C. Reports, October 30, 1974.  208  Budget reviews are conducted i n the same manner as are those f o r the O u t p a t i e n t Department.  Figures a v a i l -  able f o r t h i s r e p o r t were a l s o taken from the 1974-75 H e a l t h S e r v i c e o p e r a t i n g budget. S a l a r i e s and Wages  $176,954.00  General Expenditure: Medical & S u r g i c a l Supplies Drugs X-ray S u p p l i e s M e d i c a l Records & L i b r a r y Laboratory S u p p l i e s  1,460.00 2,614.00 1,540.00 300.00 1,100.00  Administration: Postage Office Supplies, P r i n t i n g , etc. Telephone & Telegraph Workmens Compensation Board Travel L i a b i l i t y Insurance L i f e Insurance & M.S.A. Membership - B.C. H o s p i t a l A s s o c i a t i o n Short-Term T r a i n i n g Courses C o l l e c t i o n Fees Co-Insurance f o r Students  175-00 550.00 450.00 200.00 500.00 96.00 7,850.00 500.00 75.00 50.00 1,400.00  General S e r v i c e : Dietary-Food - C e n t r a l K i t c h e n Charges -Other Expenses Laundry Bedding & L i n e n Housekeeping S u p p l i e s  7,254.00 2,392.00 300.00 3,000.00 1,000.00 500.00  Physical Plant: Fuel Electricity F i r e Insurance Premium Maintenance - B u i l d i n g & Grounds Water  1,200.00 1,650.00 250.00 1,000.00 750.00  Equipment Replacement: Equipment & F u r n i s h i n g s  1,000.00  TOTAL  $216,110.00  209  While  there are many more items making up  the  H o s p i t a l budget than the O.P.D. budget, the f i g u r e f o r s a l a r i e s and wages which approximates 81.9$ budget, i s s t i l l  thought  of the  total  to be h i g h compared to the average  p u b l i c h o s p i t a l i n which s a l a r i e s and wages are estimated at approximately  70$  o f the o p e r a t i n g budget, p a r t i c u l a r l y  when s e v e r a l o t h e r items shown are s t a f f b e n e f i t s such as life  insurance.  In terms of d i r e c t p a t i e n t care, t h a t i s ,  g e n e r a l expenditures  (minus medical r e c o r d s and  library  expense) and g e n e r a l s e r v i c e s , the budget expenditures estimated to be $21,160.00, again only a f r a c t i o n of  are  (9.79$)  the t o t a l budget. I t i s assumed t h a t any trimming  of expenses o r  r e q u i r e d b u d g e t - c u t t i n g would have to be done i n the a r e a of s a l a r i e s and wages. t i n g budget i n c r e a s e was  Since the U n i v e r s i t y ' s 1976-77 operar e c e n t l y announced i n the Vancouver  Sun to be about o n e - t h i r d of the amount i t o r i g i n a l l y  requested  and about one-half the amount of i t s r e v i s e d request, i t i s a n t i c i p a t e d t h a t a l l e x i s t i n g programs w i l l be asked to c u r t a i l expenses.  This w i l l r e q u i r e a concerted e f f o r t of a l l  s t a f f members of the h e a l t h program i f a h i g h standard of s e r v i c e i s to be  maintained.  The Standards  recommend t h a t program and budget  p r e p a r a t i o n should be a r e s p o n s i b i l i t y of the H e a l t h S e r v i c e D i r e c t o r , working c l o s e l y w i t h h i s s t a f f a t a l l l e v e l s .  It  210  has been recommended throughout t h i s r e p o r t t h a t members of the Health  S e r v i c e s t a f f should be i n v o l v e d i n the p l a n n -  i n g and p r e p a r a t i o n  o f t h e i r v a r i o u s areas o f the departmental  budget, f o r example, l a b and x-ray,aand t h a t s t a t i s t i c a l mation r e l a t i n g t o u t i l i z a t i o n o f s e r v i c e s should  be used as  a b a s i s f o r budget p r o j e c t i o n s as w e l l as f o r developing program models.  infor-  sound  Only a f t e r program and budget estimates have  been determined a t the departmental l e v e l , should  discussions  take p l a c e w i t h the c e n t r a l a d m i n i s t r a t i o n o r f i n a n c e  office  of the U n i v e r s i t y .  9.3  BUSINESS PROCEDURES S e c t i o n 2 A r t i c l e 2 o f the H e a l t h  Bylaws s t a t e s  Service  Hospital  that:  " F u l l c o n t r o l o f the r e c e i p t s and expenditures o f the h o s p i t a l s h a l l be v e s t e d i n the Board." Section 6 A r t i c l e 1 states  that:  "The accounts o f the h o s p i t a l s h a l l be deemed t o be "accounts o f the Board" as s p e c i f i e d i n S e c t i o n of the " B r i t i s h Columbia U n i v e r s i t y A c t " and s h a l l be a u d i t e d i n the manner p r o v i d e d t h e r e i n . " Although l i t t l e t h i s area,  information  c o u l d be obtained i n  i t i s recommended i n the Standards t h a t a l l a c t i -  v i t i e s of the h e a l t h program should  be organized  business a f f a i r s conducted a c c o r d i n g of business management.  t o accepted p r i n c i p l e s  While i t i s recognized  q u a l i t y o f p a t i e n t care, t e a c h i n g ,  and t h e i r  t h a t the  community s e r v i c e , o r  211  r e s e a r c h must never be s a c r i f i c e d f o r economy, i t i s s t a t e d t h a t a concern f o r h e a l t h should never be  justi-  f i c a t i o n f o r waste, i n e f f i c i e n c y , o r mismanagement.  It  i s recommended t h a t g u i d e l i n e s f o r b u s i n e s s procedures i n the H e a l t h  S e r v i c e , i n c l u d i n g the H o s p i t a l be prepared,  d e f i n i n g how  the f o l l o w i n g f u n c t i o n s should be  -  Preparation  -  Maintenance o f Accounts  -  Procurement, Storage, and and Equipment  -  Maintenance of B u i l d i n g and  performed:  of Budgets  Custody, Loan, and  D i s t r i b u t i o n of  Supplies  Equipment  Charges f o r Equipment  Decision-making p r o c e s s e s i n v o l v i n g s u p e r v i s o r s , employees o r others, i n the f o r m u l a t i o n and r e commendation of b u s i n e s s p o l i c i e s and procedures. -  9.4  O p e r a t i o n a l statements such as s a l a r y s t a t u s of each employee f o r whom the b u s i n e s s o f f i c e maintains a record.  PERSONNEL POLICIES AND The  PROCEDURES  Standards recommend t h a t a l l u n i t s of  h e a l t h program e s t a b l i s h and  observe a h i g h standard  p e r s o n n e l p o l i c i e s and procedures.  s t a f f s should  a job d e s c r i p t i o n o u t l i n i n g q u a l i f i c a t i o n s , and  for  I t i s recommended i n  other s e c t i o n s of t h i s paper t h a t every p o s i t i o n on p r o f e s s i o n a l and n o n - p r o f e s s i o n a l  the  the  have  responsibilities  d u t i e s , manner of s u p e r v i s i o n o r l i n e of a u t h o r i t y ,  o p p o r t u n i t i e s f o r advancement, i f any.  and  I t i s f u r t h e r recomm-  ended t h a t c l e a r l y understood procedures f o r p e r i o d i c (at l e a s t  212  annual) performance e v a l u a t i o n o f each employee, p r o f e s s i o n a l and n o n - p r o f e s s i o n a l , be developed  and implemented.  Written  e v a l u a t i o n s should be d i s c u s s e d w i t h the s t a f f member concerned f o l l o w i n g h i s p e r s o n a l review to encouraging  o f the e v a l u a t i o n , with a view  s t a f f growth and development, improved commu-  n i c a t i o n s , and j o b s a t i s f a c t i o n . While i t i s recommended t h a t there should be r e a d i l y a v a i l a b l e i n f o r m a t i o n f o r a l l s t a f f members concerning the p e r q u i s i t e s and/or l i m i t a t i o n s f o r each p o s i t i o n , the H e a l t h S e r v i c e personnel  are g e n e r a l l y guided by t h e i r p r o f e s s i o n a l  or union c o n t r a c t s .  The f o l l o w i n g are the g u i d e l i n e s c o n s u l t e d !  R e g i s t e r e d Nurses  RNABC  Contract  L i c e n s e d P r a c t i c a l Nurses  Union 116 C o n t r a c t  Nurses' Aides  Union 116 C o n t r a c t  Housekeeping S t a f f  Union 116 C o n t r a c t  S e r v i c e Workers  Union 116 C o n t r a c t  Registered Technicians  H e a l t h Sciences A s s o c i a t i o n Contract  Clerical Staff  AUCE Contract  (Association of  U n i v e r s i t y C l e r i c a l Employees) I t i s f i n a l l y recommended t h a t the H e a l t h S e r v i c e develop w r i t t e n departmental  p o l i c i e s r e g a r d i n g payment o f  p r o f e s s i o n a l a s s o c i a t i o n f e e s , payment o f expenses t o meetings and conferences,  and i n s e r v i c e education o p p o r t u n i t i e s .  213  PART I I I  CONCLUSIONS OF THE STUDY  214  CHAPTER 10 SUMMARY AND RECOMMENDATIONS  10.1  SUMMARY OF SERVICES The  of  Standards recommend t h a t the h e a l t h program  every c o l l e g e and u n i v e r s i t y , r e g a r d l e s s o f s i z e ,  comprise s e r v i c e s i n three broad program a r e a s t  medical and  o t h e r h e a l t h s e r v i c e s , i n c l u d i n g community-oriented s e r v i c e s ; environmental  primary  i s on the medical  preventive  h e a l t h and s a f e t y ; and e d u c a t i o n f o r  h e a l t h f u l p e r s o n a l and community The  should  living.  emphasis o f the U.B.C. H e a l t h S e r v i c e  and o t h e r h e a l t h s e r v i c e s , w i t h some comm-  unity-oriented preventive s e r v i c e s .  A program f o r e n v i r o n -  mental h e a l t h and s a f e t y i s n o t a composite p a r t o f the H e a l t h S e r v i c e although  i t does have r e p r e s e n t a t i o n on an  i n s t i t u t i o n a l committee concerned w i t h t h a t area. for  h e a l t h f u l p e r s o n a l and community l i v i n g  Education  i s not fomalized,  but i n f o r m a l h e a l t h education, a d v i c e , and c o u n s e l i n g , a r e made p o s s i b l e through  d i r e c t student  S e r v i c e v i s i t s and s p e c i a l purpose The  contact during Health  clinics.  range o f m e d i c a l and o t h e r h e a l t h s e r v i c e s  i n c l u d e s d i a g n o s t i c , t h e r a p e u t i c , and some r e h a b i l i t a t i v e s e r v i c e s ; a l l c l i n i c a l s e r v i c e s e i t h e r provided o r prescribed by the H e a l t h S e r v i c e appear to be o f the h i g h e s t q u a l i t y .  215  Provision i s made f o r meeting emergencies on an i n d i v i d u a l basis, while group emergencies are generally referred o f f campus.  Outpatient  and inpatient services are well  provided  f o r and give recognition to the integration of care f o r emotional and physical i l l n e s s . The effectiveness of both outpatient and inpatient personal health services i s supported by such other services as laboratory, radiology, pharmacy, and physical therapy. A t h l e t i c medicine i s provided  f o r and mental health care  is a major element of the o v e r a l l program. i s considered  Dental medicine  to be a severe deficiency i n the provision of  comprehensive health services to the students, s t a f f and other personnel i n this large i n s t i t u t i o n .  Preventive  health  services are given s p e c i a l consideration, but the promotion of health and the prevention  of d i s a b i l i t y should be broad-  ened through a structured campus-wide health education program. Although an i n s t i t u t i o n a l plan f o r meeting emergencies and disasters i s reported to be i n the developmental process, no evidence of such planning  i s apparent.  While an  i n s t i t u t i o n a l committee does exist i n concern of environmental surveillance to control those factors which may  compromise  physical and emotional health, a dynamic plan of action i s required to implement and evaluate t h i s broad program area. Responsibility f o r the program, however, rests with the University administration and not the Health Service.  216  The same i s true f o r the t h i r d broad program area, the promotion of education f o r h e a l t h f u l i n d i v i d u a l and community l i v i n g .  There i s an observed need f o r a discrete, w e l l -  coordinated, and well-supported  program of health  for a l l members of the i n s t i t u t i o n a l community.  education Planning  for such a program i s required on both a departmental and an administrative l e v e l . In addition to the above major elements of the Health Service, research into the dynamics of the health of young adults and of the complex i n t e r r e l a t i o n s h i p s of students, f a c u l t y , and s t a f f , i s recommended as an i n t e g r a l part of a health program which purports to be comprehensive or progressive, as described i n the Standards. In general, i t i s concluded that the U.B.C. Health Service meets the standards and practices recommended f o r a college health program as set down by the American College Health Association, and that the Standards can appropriately be applied to Canadian, as well as to American, student  health  services.  found  Where n o n - a p p l i c a b i l i t y of the Standards was  to exist i n the conduct of the study, explanations have been given i n the text or recommendations have been adapted to s u i t the Canadian context.  217  10.2  SUMMARY OF RECOMMENDATIONS One of the operational goals of t h i s study was  to recommend ways to more e f f e c t i v e l y or e f f i c i e n t l y coordinate the planning and provision of health services at U.B.C, including t h e i r coordination with other services. Recommendations, some of which may now he i n e f f e c t , are made i n a concern for greater u t i l i z a t i o n of the services available, increased e f f i c i e n c y i n the d i s p o s i t i o n of mate r i e l and manpower resources, and the advancement of prof e s s i o n a l knowledge and practice.  The ultimate objective  i s to further patient and personnel s a t i s f a c t i o n  through  improved health programs. Statements of recommendation and suggestions f o r change have been discussed i n some d e t a i l the p r i n c i p a l text of the study.  throughout  The following recommenda-  tions, developed bn the basis of the findings and conclusions of the study and presented i n a summarized form f o r ease of reading and reference, either originate from the recommended Standards used to evaluate the Health Service or are adaptations to accepted Canadian standards. IT IS RECOMMENDED THAT: ADMINISTRATION AND PLANNING 1.  The University reevaluate the importance of student health services i n view of i t s objectives i n providing health care to students, of universal insurance and  218  r i s i n g health care costs, of changing p o l i t i c a l p h i l o sophies, and of changes which have evolved around the Health Service i n recent years. 2.  The organization and functions of the services he reviewed regularly and changed accordingly i n order to keep them e f f e c t i v e , timely, and  3.  up-to-date.  Census data r e l a t i n g to the composition of the student be enrolment, from the Office of Academic Planning, reviewed annually i n order to project trends of increase or decrease i n the number and type (e.g. age and sex) of students, and to i d e n t i f y possible areas requiring the planning or expansion of new  4.  or e x i s t i n g services.  The International House information center and other of i t s resources be used to plan and provide special services, such as screening or disease detection, f o r large groups of foreign students where indicated.  5.  The Health Service Hospital be closed and the space be used f o r other purposes; students requiring acute inpatient care be referred to community hospitals; outreach programs be developed i n campus residences to include infirmary beds f o r students not requiring acute hospital care,  6.  The Bylaws of the University Health Service Hospital be reviewed and revised as necessary.  219  7.  Statements o f p o l i c y be developed i n support medical care and treatment p r o v i d e d  o f the  f o r students, and  of the H e a l t h S e r v i c e r e s p o n s i b i l i t y f o r environmental s u r v e i l l a n c e and c o n t r o l , and h e a l t h 8.  education.  In the event o f f u t u r e r e l o c a t i o n o f the H e a l t h planning  Service,  f o r new f a c i l i t i e s be undertaken t o i n c l u d e a  d e t a i l e d a n a l y s i s o f the f u n c t i o n s and s e r v i c e s t o be provided,  p r o j e c t e d p a t i e n t l o a d s , estimated  patterns  of use, t r a f f i c flow, and s t a f f i n g p a t t e r n s f o r both r e g u l a r and s p e c i a l s e r v i c e s . 9.  A f u l l - t i m e appointee t o the H o s p i t a l BuiJLding Committee be made from the H e a l t h S e r v i c e t o s a t i s f a c t o r i l y  repre-  sent i t s needs; such a..- p l a n n i n g p o s i t i o n p o s s i b l y being combined w i t h t h a t o f an a s s i s t a n t to the D i r e c t o r experienced  i n h o s p i t a l or medical administration.  BUSINESS MANAGEMENT 10.  Regular r e p o r t s o f a c t i v i t i e s and s e r v i c e s be produced and  c i r c u l a t e d t o a l l departments o f the i n s t i t u t i o n  concerned w i t h the h e a l t h o f the campus community. 11.  Program budget p r e p a r a t i o n be a r e s p o n s i b i l i t y o f the D i r e c t o r working c l o s e l y w i t h h i s s t a f f t o determine budget estimates  a t the departmental l e v e l ,  before  d i s c u s s i o n s w i t h the U n i v e r s i t y a d m i n i s t r a t i o n o r finance  office.  220  12.  S t a f f members be involved i n the planning and preparat i o n of t h e i r various areas of the departmental budget to promote cost-consciousness 5 s t a t i s t i c a l information r e l a t i n g to u t i l i z a t i o n of services be used as a basis f o r budget projections as well as f o r developing sound program models.  13.  Guidelines be developed to define how the business functions of the Health Service, including the Hospital, should be performed.  14.  Job descriptions be developed f o r every s t a f f p o s i t i o n , outlining q u a l i f i c a t i o n s , r e s p o n s i b i l i t i e s and duties, manner of supervision or l i n e of authority, and opport u n i t i e s f o r advancement, i f any; each s t a f f member be involved i n the development of his/her own job desc r i p t i o n and s p e c i f i c a t i o n s with a view to seeking new and more e f f e c t i v e ways of u t i l i z i n g personnel talents and c a p a b i l i t i e s ; custodial functions currently performed by the professional nursing s t a f f be delegated to the nursing assistants.  15.  Clearly understood procedures f o r periodic (at l e a s t annual) performance evaluation of each s t a f f member be developed and implemented? written evaluations be d i s cussed with s t a f f members a f t e r personal review of t h e i r individual evaluation, with a view to encouraging s t a f f  221  growth, and development, improved communications, and 16.  job  satisfaction.  W r i t t e n departmental p o l i c i e s be developed  regarding  payment of p r o f e s s i o n a l a s s o c i a t i o n f e e s , payment of expenses to meetings and conferences,  and i n s e r v i c e  educational opportunities. 17.  S t a t i s t i c a l r e p o r t s of a l l s e r v i c e s i n c l u d i n g H o s p i t a l u t i l i z a t i o n be kept f o r p e r i o d i c e v a l u a t i o n s to  analyze  the e f f e c t i v e n e s s of s e r v i c e s , t o determine budget r e quirements, and  to p l a n f u t u r e s e r v i c e s .  OUTPATIENT SERVICE 18.  The H e a l t h S e r v i c e and U n i v e r s i t y a d m i n i s t r a t i o n develop plans to encourage g r e a t e r u t i l i z a t i o n of primary s e r v i c e s to  19.  The  care  students.  o u t p a t i e n t s e r v i c e s be extended to i n c l u d e  evening  c l i n i c s and weekend coverage f o r the p r o v i s i o n of emergency c a r e , s p e c i a l c l i n i c s and  increased  counseling,  to b e t t e r u t i l i z e the space a v a i l a b l e d u r i n g of heavy t r a f f i c flow and a l l o w new  periods  i n s t i t u t i o n a l growth, and  programs to be i n t r o d u c e d i n t o the s e r v i c e as  c o n s i d e r e d a p p r o p r i a t e by the s t a f f and by student 20.  to  S t a t i s t i c s be computed and analyzed number of p a t i e n t s now  r e l a t i v e to the  seen a f t e r c l i n i c hours, the  demands.  222  types of complaints, and the treatment given, with a view to planning extended service hours or special evening c l i n i c s as indicated. 21.  Preventive programs be developed and publicized well i n advance of predictable problems or occurrences i n order to meet the demands f o r service with manpower and other resources, f o r example, influenza immunization c l i n i c s .  22.  A concerted e f f o r t be continued to eradicate known or suspected health hazards to the community; preparations be made immediately  to combat the possible  wide-spread outbreak of the disease known as swine fiLu. 23.  Special programs be developed f o r surveillance and education to prevent complications of known existing diseases such as diabetes, epilepsy, and chronic cardiovascular or pulmonary disease; periodic screening or detection programs be developed to i d e n t i f y students (and others) with chronic or l o c a l l y endemic diseases, such as s u b c l i n i c a l diabetes or dental diseases.  24.  The scope of the e x i s t i n g health appraisal program be increased through an emphasis on health education.  25.  Students who present themselves f o r service be followedup i n the manner used by the Community Health Centre,  223 i.e. by checking on r e f e r r a l s made to other sources and by checking patients attending the service f o r unrelated problems; a l l r e f e r r a l s to community resources be followed-up within a reasonable period of time i n order to record outcomes or to take further appropriate action i f necessary; a proper form be developed to promote two-way communication with r e f e r r a l sources. 26.  Because of the increasing competition f o r c l i n i c a l teaching f a c i l i t i e s f o r students i n the health professions, the Health Service be used to provide v a l uable c l i n i c a l experience i n public health and preventive medicine, mental health, b i r t h control, disease control, injury prevention, and health counseling.  27.  Consideration be given to the employment of an L.P.N, or an additional Nurses' Aide when a p o s i t i o n on the nursing s t a f f becomes vacant, the development and review of p o s i t i o n job descriptions providing evidence of the need f o r change; a l i s t of prescribed approved duties be obtained from the L.P.N. Association.  28.  Room 134 i n the outpatient c l i n i c be fumigated a f t e r treatment of a l l " d i r t y " cases, and supplies and other items subject to contamination be kept to a minimum i n the room.  224  HOSPITAL 29.  Subject to the Hospital remaining open, clean and d i r t y supply rooms be separated; the room designated f o r flower-arranging be considered f o r use as a " d i r t y " u t i l i t y room; s t e r i l i z e d bundles and equipment i n the "clean" supply room be c a r e f u l l y stored, dated, and periodically  30.  tested f o r maintenance of s t e r i l i t y .  Portable oxygen tanks be properly stored according to authorized safety regulations such as those followed by,, the Health Sciences Centre; the present storage of tanks i n the Hospital i s considered dangerous i n terms of the p o s s i b i l i t y of combustion or explosion.  31.  Disposable shower curtains be used i n the single rooms f o r patients on i s o l a t i o n  32.  technique.  A dishwasher be obtained (by purchase or donation) f o r the ward kitchen, a domestic machine being considered suitable i n view §f  33.  the low patient census.  Written guidelines of i s o l a t i o n techniques f o r s p e c i f i c contagious diseases be produced with the assistance of the Inservice Education Coordinator; the work already done to prepare medical and procedure manuals be commended.  225 SUPPORTING SERVICES 34.  The guidelines r e l a t i v e to patient transportation from the Health Sciences Centre Psychiatric Unit to the xray service be reviewed and reinforced.  35.  The e f f o r t s of the X-Ray Technician to p a r t i c i p a t e i n educational developments i n her f i e l d be recognized.  36.  A Pharmacy Committee of the medical s t a f f be organized to review the prescribing and use of medications  and  other therapeutic agents i n the care and treatment of students, and to recommend additions or deletions i n the drug formulary. 37.  The provision of dental screening be made available to students and at least emergency cases be referred f o r prompt treatment to the Dental School; consideration be given to retaining a consultant dentist and/or dent a l hygienist, and to providing an evening dental c l i n i c for  38.  students.  The number of r e f e r r a l s made to dentists and outside doctors be recorded as a basis f o r planning future services.  39.  The undertaking by the Mental Health Unit of outreach programs and research into the psychodynamics of college students be commended.  226  40.  Expansion of the psychiatric service to include other d i s c i p l i n e s such as psychiatric nursing, s o c i a l work, and c l i n i c a l psychology, be encouraged to develop the team concept and a broader spectrum of resources.  41.  Periodic reviews of recorded data be made j o i n t l y with the A t h l e t i c Department f o r the purpose of developing programs of injury prevention.  42.  Advanced students i n the School of Rehabilitation Medicine be encouraged to participate i n the physiotherapy program as part of t h e i r c l i n i c a l t r a i n i n g .  43.  The Physiotherapy Treatment Centre be recognized as operating at a high l e v e l of performance.  44.  The services of a consultant or part-time d i e t i t i a n be considered to supervise the Hospital food service and the s p e c i a l n u t r i t i o n a l needs of both inpatients and outpatients.  MEDICAL RECORDS 45.  Written h i s t o r i e s , p h y s i c a l examinations,  signed orders,  discharge summaries and f i n a l diagnoses, be required f o r a l l patients admitted to the Hospital. 46.  A unit record system be developed and indexing of charts be  undertaken.  22?  47.  Medical records now stored i n the s t a f f lounge be kept in a secure location to which access i s controlled and from which unauthorized personnel are excluded.  48.  Written directions be produced specifying the method by which records are processed, to whom they may be made available, and the conditions under which information from them may be communicated to t h i r d parties.  49.  Clearly defined p o l i c i e s be established regarding possible contentious areas such as psychiatric treatment, b i r t h control, abortion, s u r g i c a l procedures, hospital admission, l e g a l consent f o r underage patients, confide n t i a l i t y of records, p r i v i l e g e of communications, r e portable conditions, and the administration of drugs.  50.  Periodic chart reviews be made to provide an i n d i r e c t measure of the q u a l i t y of c l i n i c a l care being provided.  51.  A system f o r the r e t r i e v a l of data from a l l c l i n i c a l records, f o r example, lab. and x-ray reports, be developed f o r reviewing the o v e r a l l work of the service, f o r supporting the review of c l i n i c a l performance, and f o r conducting research.  52.  A more detailed method of s t a t i s t i c a l accounting be reinstated? s t a t i s t i c a l reports of Hospital u t i l i z a t i o n be continued, summarizing any special predominance of student i l l n e s s or causes of d i s a b i l i t y ? presenting  228  problems o r complaints  be broken down and  categorized  by d i s e a s e c l a s s i f i c a t i o n s f o r f u t u r e r e s e a r c h  and  planning. 53.  Automatic p r o c e s s i n g of medical  i n f o r m a t i o n be i n v e s t -  i g a t e d i n advance of the p o s s i b l e r e l o c a t i o n of the H e a l t h S e r v i c e to a new  campus h o s p i t a l w i t h a cen-  t r a l i z e d data bank. 54.  A c o n s u l t a n t o r part-time M e d i c a l Record L i b r a r i a n be r e t a i n e d .  ENVIRONMENTAL HEALTH AND 55.  SAFETY  The H e a l t h S e r v i c e seek and observe p o l i c y statements r e g a r d i n g standards t i o n , s a f e t y and  and codes r e l a t i n g to f i r e  protec-  injury control, r a d i o l o g i c a l health,  i n d u s t r i a l h e a l t h , s a n i t a t i o n , and g e n e r a l  environ-  mental c o n t r o l of working c o n d i t i o n s . 56.  An area-wide d i s a s t e r p l a n be developed and without  implemented  f u r t h e r delay; c o o r d i n a t e d e f f o r t s of the  s a f e t y and environmental  fire  p e r s o n n e l , R.C.M.P., medical,  n u r s i n g and H o s p i t a l p e r s o n n e l , o t h e r concerned groups on campus, and o f f campus resources such as the Emergency Measures O r g a n i z a t i o n , Red Cross, and Vancouver H o s p i t a l be  General  included.  (Sample emergency/disaster  plans are a v a i l a b l e from  the American C o l l e g e H e a l t h A s s o c i a t i o n . )  229  HEALTH EDUCATION 57.  Every patient contact be recognized and used as an opportunity f o r education of the student  concerning  the implications of h i s p a r t i c u l a r problem, physical or emotional, f o r personal and community health; consumer education at the student l e v e l be regarded as a means of c u r t a i l i n g the escalation of health care costs. 58.  Every nurse i n the department, through education, experience , or special interest i n the health problems of young adults, attempt to develop improved c l i n i c a l s k i l l s and to become a more effective model f o r health education.  59.  A course (or courses) be developed  i n personal and  community health and hygiene through which students in a l l f a c u l t i e s can attain basic health information and through which t h e i r health behavior may be i n f l u enced p o s i t i v e l y . 60.  A student/facuity health council be organized to define and recommend solutions f o r University health problems and to further campus-wide interest and p a r t i c i p a t i o n in the promotion of health; consideration be given to resurrecting the President's Committee on Student Health Service and Health Education.  230  61.  Health Service records he used to provide data f o r continuing evaluation of health education opportunities and f o r determining inservice education programs.  62.  The r e s p o n s i b i l i t y f o r s t a f f development through effective inservice education be delegated to one s t a f f member, appropriately trained and personally committed to t h i s area of interest.  63.  The maintenance personnel receive both an i n i t i a l and a continuing course of inservice i n s t r u c t i o n i n order to be well informed concerning the measures they must observe to a s s i s t i n the prevention and control of infectious and communicable diseases.  64.  Assistance be requested from the F i r e Prevention O f f i c e r to develop an inservice education program of f i r e and safety consciousness f o r a l l Health Service personnels the c l i n i c a l resources of the Pharmacy be used f o r education on new  65.  medications.  Other health=related campus resources be u t i l i z e d , such as the Dental School, the Community Health Centre, and the School of Nursing to gain valuable assistance i n developing p o l i c i e s and procedures, and i n short courses of inservice instruction, f o r example psychiatry f o r Health Service nurses interested i n p a r t i c i p a t i n g i n the mental health outreach programs.  231  66.  A working r e l a t i o n s h i p be maintained w i t h other departments o r resources i n v o l v e d i n h e a l t h education,  such  as the i n s e r v i c e e d u c a t i o n committee o f the R.N.A.B.C. COMMUNICATIONS 67.  Because o f t h e i r c r i t i c a l p o s i t i o n i n the communication system, a l l members o f the s e c r e t a r i a l / c l e r i c a l r e c e i v e c a r e f u l and d e t a i l e d o r i e n t a t i o n  staff  concerning  a l l f a c e t s o f the H e a l t h S e r v i c e f o r which they are expected  t o have i n f o r m a t i o n ; a manual o f procedures  r e l a t i n g t o communications and other matters  of concern  to the c l e r i c a l s t a f f be developed. 68.  Meetings o f department heads, s u p e r v i s o r s , and o t h e r s who share r e s p o n s i b i l i t y f o r H e a l t h S e r v i c e a c t i v i t i e s be h e l d a t r e g u l a r , i f only p e r i o d i c ,  69.  Regular n u r s i n g s t a f f meetings,  intervals.  i n c l u d i n g the H o s p i t a l  s t a f f , be h e l d and i n c l u d e e d u c a t i o n a l and p r o f e s s i o n a l a s s o c i a t i o n a c t i v i t i e s and announcements. 70.  M e d i c a l s t a f f meetings be planned t o i n c l u d e the Mental H e a l t h U n i t and p e r i o d i c r e p r e s e n t a t i o n from o t h e r campus h e a l t h - r e l a t e d departments, w i t h developments o r i n f o r m a t i o n r e s u l t i n g from these meetings shared w i t h the n u r s i n g and support p e r s o n n e l .  232  71.  Minutes o r tapes of meetings be kept f o r the of those unable to  72.  information  attend.  The H e a l t h S e r v i c e brochure p r o v i d e d  to a l l new  t r a n t s be updated; the A.C.H.A.'s H e a l t h  regis-  Information  S e r i e s comprised of e i g h t brochures be c o n s i d e r e d  for  d i s t r i b u t i o n to p a t i e n t s and members of the campus community. 73.  H e a l t h S e r v i c e s t a f f attendance at annual r e g i s t r a t i o n be i n c r e a s e d to promote f u l l e r exposure of the a v a i l a b l e h e a l t h s e r v i c e s to the i n c r e a s i n g student  74.  population.  Employee performance e v a l u a t i o n s be used as a means f o r two-way communication.  75.  The p l a n n i n g and attendance o f the r e c e n t workshop be commended; a f o l l o w - u p  communications  review o f the work-  shop be done to determine p o s i t i v e i n f l u e n c e s brought about i n the area of i n t e r n a l communications, 76.  H e a l t h S e r v i c e s t a f f be i n v o l v e d i n campus-wide committees and  informal gatherings  as f a r as p o s s i b l e i n an  effort  to promote r e c o g n i t i o n of the s e r v i c e s a v a i l a b l e . 77.  I n v e s t i g a t i o n be made i n t o the p o s s i b l e p r o d u c t i o n  of  a s h o r t a u d i o - v i s u a l f i l m of the H e a l t h S e r v i c e by  the  U n i v e r s i t y T.V.  o r photographic  by h e a l t h education new  students  department, to be used  s t a f f and d u r i n g the o r i e n t a t i o n of  to the campus.  233  EXTRAMURAL RESOURCES 78.  Working relationships be established with community health-related agencies and individuals to a s s i s t the students to make maximum use of such  resources;  f o r example, l i a i s o n with Planned Parenthood and s i m i l a r agencies be sought f o r b i r t h control and pregnancy 79.  counseling.  Every opportunity  be used to learn what public, v o l -  untary, and i n d u s t r i a l resources are available f o r use by the University community as well as by the general community. 80.  Staff members p a r t i c i p a t e i n the a c t i v i t i e s of extramural community agencies and planning councils whenever possible, to stimulate professional a c t i v i t y .  81.  Each professional s t a f f member be encouraged to maint a i n contact with his/her professional and to subscribe  organization  to the l i t e r a t u r e pertaining to each  respective area of interest or a c t i v i t y . 82.  Cooperative a c t i v i t y be undertaken with the health services of other u n i v e r s i t i e s and colleges i n B r i t i s h Columbia to share resources and information, promote public r e l a t i o n s .  and to  234  83.  Active p a r t i c i p a t i o n i n the Canadian Association of College Health Services be used to develop the depth and breadth of health programs at the University.  84.  The consultation and management engineering services of the B.C.H.I.S. be requested  to a s s i s t or advise i n  areas of uncertainty or concern to the Health Service, f o r example, medical records and n u t r i t i o n a l counseling. EVALUATION AND RESEARCH 85.  Periodic evaluation of e x i s t i n g Health Service programs be conducted i n an attempt to upgrade the q u a l i t y of the programs; evaluative studies be c a r r i e d out to determine the effectiveness 6f s p e c i f i c services; continuous monitoring  of the l e v e l of student health be  done through record-keeping 86.  Plans be formulated  and data analysis.  f o r continuing research projects  i n areas of the Health Service requiring study and the plans be supported and financed by the University administration. 87.  Consideration be given to continuing i n t e r n a l audits using the A.C.H.A. self-evaluation guide.  235  10.3  IMPLICATIONS FOR PLANNING The goal of any health service i s the improvement  of l e v e l s of health i n the community.  A fundamental issue  i s whether and to what degree coordination and integration of a c t i v i t i e s should he achieved. to know how  In other words, we need  a r a t i o n a l system of planning and  administration  of health programs can he attained i n order to achieve i t s goals.  But changes i n the nature of s o c i a l problems, i n the  character of medical technology, i n the structure and t i o n of health services, and i n the needs and  func-  expectations  of the public have pressured organizations into planning  and  developing programs much broader than the t r a d i t i o n a l health services.  This enlargement of scope has created a  complexity  of problems i n organization and resources which demand continuous evaluation and  reformulation.  Planning and evaluation are inseparable concepts and yet i t i s only i n recent years that serious attention has been given to the evaluation of health services, to measuring the progress of plans and programs and the ment of t h e i r goals.  achieve-  While health regulatory agencies have  i d e n t i f i e d standards as a basis f o r planning and evaluating programs, t h e i r guaranteed continued q u a l i t y and the greater accountability demanded can only be provided with major support through more advanced evaluative research.  When an evaluative  study i s conducted i t can lead to further research  questions  236  which may  y i e l d new  i n s i g h t s of r e a l importance to  advancement of p r o f e s s i o n a l theory The program, has  the t r a d i t i o n a l support  i t s services.  and  evaluated  of both the U n i v e r s i t y  a p u b l i c which has become accustomed to  In order to make the s e r v i c e s r e l e v a n t to  needs and  resources  and p r a c t i c e .  U.B.C. H e a l t h S e r v i c e , as an o l d e s t a b l i s h e d  a d m i n i s t r a t i o n and  student  the  demands, they must be c a r e f u l l y planned  before  they are put  are a l l o c a t e d .  into e f f e c t or  before  S c i e n t i f i c health planning,  d i c t i o n of changing h e a l t h needs, and  evaluation, a l l re-  q u i r e a b a s e l i n e d e s c r i p t i o n of h e a l t h problems and magnitude, and  pre-  their  of groups which have h i g h r a t e s of such pro-  blems and are, t h e r e f o r e , i n the g r e a t e s t need of h e a l t h care.  Thus, support  of the U n i v e r s i t y i s r e q u i r e d i n estab-  l i s h i n g a mechanism f o r c o n t i n u i n g feedback of both the changing needs and  the c o n s t r a i n t s of the  community,that i s i n p l a n n i n g an e f f e c t i v e  institutional organization  f o r the d e l i v e r y of h e a l t h s e r v i c e s . T h i s study i s intended  as a p l a n n i n g  document  f o r u t i l i z a t i o n by the U.B.C. H e a l t h S e r v i c e and r e s e a r c h i n other c o l l e g e h e a l t h programs.  f o r future  237  LITERATURE CITED  1.  Evans, Robert G., and Walker, Hugh D. P u b l i c P o l i c y Problems i n the Canadian H e a l t h S e r v i c e s Industry. D i s c u s s i o n Paper No. 41, Department of Economics, U n i v e r s i t y of B r i t i s h Columbia, June 1970.  2.  Fuchs, V.F. "Why H e a l t h Economics", Mount S i n a i J o u r n a l of Medicine. Volume XL, Number 4, J u l y - August 1972.  3.  Klarman, H. The Economics of H e a l t h . U n i v e r s i t y Press, New York, 1965•  4.  Suchman, Edward A. E v a l u a t i v e Research: Principles and P r a c t i c e i n P u b l i c S e r v i c e and S o c i a l A c t i o n Programs. R u s s e l l Sage Foundation, New York, N.Y., 1967, p. 2.  5.  Kohn, Robert The H e a l t h of The Canadian People. Royal Commission on H e a l t h S e r v i c e s . Queen's P r i n t e r , Ottawa, 1965.  6.  "Recommended Standards and P r a c t i c e s f o r a C o l l e g e H e a l t h Program, I n c l u d i n g a Statement on E t h i c a l and P r o f e s s i o n a l R e l a t i o n s h i p s " , American C o l l e g e H e a l t h A s s o c i a t i o n , Revised 1969, i n The J o u r n a l of the American C o l l e g e H e a l t h A s s o c i a t i o n . V o l . 18, October, 1969, p.p. 1 - 66.  7.  Knutson, Andie L. " E v a l u a t i o n f o r What?" Program E v a l u a t i o n i n the H e a l t h F i e l d s . H. Schulberg e t a l , e d i t o r s . B e h a v i o r a l P u b l i c a t i o n s , New York, N.Y., 1969, p.p. 42 - 50.  8.  Mair, A. Student H e a l t h S e r v i c e s i n Great and Northern I r e l a n d . Pergamon P r e s s ,  9.  Ralph, I.F. Student H e a l t h and Student H e a l t h S e r v i c e s D i s s e r t a t i o n , U n i v e r s i t y of Edinburgh, S c o t l a n d , 1959. (quoted i n Mair, p. 4)  Columbia  Britain Toronto,  238  10.  Canuteson, R.I. "Looking Ahead i n College Health", Proceedings of the Twenty-Fourth Annual Meeting, American Student Health Association, Minneapolis, Minnesota, May 1946, B u l l e t i n No. 2?, Cumulative Index. The Journal-Lancet, Minneapolis, Minnesota, p.p. 7-8.  11.  Goodenough, S i r Wm. Macnamara, Report of the Interdepartmental Committee on Medical Schools, 1944. Interdepartmental Committee on Medical Schools, Great B r i t a i n and Scotland, London, H.M. Stationery O f f i c e , 1944.  12.  Proceedings of the Twenty-Fourth Annual Meeting, American Student Health Association. Minneapolis, Minnesota, May 1946, B u l l e t i n No. 27, Cumulative Index. The Journal-Lancet, Minneapolis, Minnesota, p. 95.  13.  Boynton, Ruth E. "The F i r s t F i f t y Years: A History of the American College Health Association", The Journal of the American College Health Association. Volume 19, June 1971, p.p. 269 285.  14.  "Constitution and By-Laws Of The P a c i f i c Coast College Health Association As Amended 19 October 1974", Proceedings of the Thirty-Eighth Annual Meeting of the P a c i f i c Coast College Health Association, an A f f i l i a t e of the American College Health Association. Vancouver, B.C., 1974, p. xlv.  15.  Gold, J.H. " U t i l i z a t i o n of the Student Health C l i n i c " , The Journal of the American College Health Associ a t i o n . Volume 21, June 1973, p.p. 477 - 482.  ,16.  17.  Schwarz, Conrad J . Report on Health and P s y c h i a t r i c Services on Canadian Campuses. Prepared f o r The Canadian Union of Students, January 1967. Kissner, R.F., and Murdoch, W.D. A Report on Univers i t y Health Needs. Simon Fraser University Project, 1971.  18.  Tunner, Alex "Student Perceptions of Need f o r College Health Services", Proceedings of the Thirty-Eighth Annual Meeting ofthe P a c i f i c Coast College Health Association,^an A f f i l i a t e of the American College Health Association, Vancouver, B.C., 1974. p.p. 28 - 34.  239  19.  McKee, W. Nickason, M. ,• and Stalker, A. A Diagnostic Reconnaissance Survey of E x i s t i n g U.B.C. Mental Health F a c i l i t i e s and Related Services and of Student Knowledge. Use, and Evaluation of E x i s t ing Services. A Course Paper i n Community Psychology 420, U.B.C, 1975-76.  20.  Deniston, O.L.j Rosenstock, I.M.» and Getting, V.A. "Evaluation of Program Effectiveness", Public Health Reports. Vol. 83, No. 4, A p r i l 196"o\ P.p. 323 - 335.  21.  Deniston, O.L.\ Rosenstock, I.M.f Welch, W.; and Getting, V.A. "Evaluation of Program E f f i c i e n c y " , Public Health Reports, Vol. 83, No. 7, July 1968, p.p. 603 - 610.  22.  Roemer, M.I. "Evaluation of Health Service Programs and Levels of Measurement", Public Health Reports, Vol. 82, July 1968.  23.  MacMahon, B. et a l . "Principles i n the Evaluation of Community Mental Health Programs", i n H.C. Schulberg et a l . , 1 9 6 9 .  24.  Levey, Samuel and Loomba, N. Paul Health Care Administration? A Managerial Perspective. J.B. Lippincott Company, Toronto, 1973.  25.  James, George "Evaluation i n Public Health Practice", American Journal of Public Health, Vol. 52, 1962, p.p. 1145 - 1154.  26.  Methods of Health Care^Evaluation. 2nd edition. Readings and exercises developed f o r the National Health Grant Health Care Evaluation Seminars, edited by David L. Sackett and Marjorie S. Baskin. Published at McMaster University, Hamilton, Ontario, 1973.  27.  Schulberg, Herbert C.j Sheldon, Alan; and Baker, Frank Program Evaluation i n the Health F i e l d s . Behavi o r a l Publications, New York, N.Y., 1969.  28.  E t z i o n i , Amitai "Two Approaches to Organizational Analysis: A Critique and a Suggestion", i n H.C. Schulberg et a l , p.p. 101 - 120.  }  240  29-  Schulberg, H.C. and Baker, F. "Program E v a l u a t i o n Models and the Implementation o f Research F i n d i n g s " , i n H.C. Schulberg e t a l , p.p. 562 - 572.  30.  Herzog, E l i z a b e t h Some G u i d e l i n e s f o r E v a l u a t i v e Research. U.S. Department o f H e a l t h , E d u c a t i o n , and Welfare, S o c i a l S e c u r i t y A d m i n i s t r a t i o n , C h i l d r e n ' s Bureau, 1959.  31. " T r i p o d i , Tony; F e l l i n , P h i l l i p ; and Meyer, Henry J . The Assessment o f S o c i a l Research; G u i d e l i n e s f o r the Use o f Research i n S o c i a l Work and S o c i a l S c i e n c e . F.E. Peacock P u b l i s h e r s , Inc., I t a s c a , I l l i n o i s , 1969. 32.  Reinke, Wm. A. H e a l t h P l a n n i n g t Q u a l i t a t i v e Aspects and Q u a n t i t a t i v e Techniques. The Johns Hopkins U n i v e r s i t y , School o f Hygiene and P u b l i c Health, Department o f I n t e r n a t i o n a l H e a l t h , B a l t i m o r e , Maryland, 1972.  33.  Wessen, A.F. "On the Scope and Methodology o f Research i n P u b l i c H e a l t h P r a c t i c e " , S o c i a l Science and Medicine. V o l . 6, 1972, p.p. 469 - 490.  34.  U p s h a l l , E.M. H i s t o r i c a l Reports and Papers on the U.B.C. H e a l t h S e r v i c e d a t i n g back t o 1936, obtained i n p p e r s o n a l i n t e r v i e w w i t h Miss U p s h a l l .  35.  Annual Reports o f the U.B.C. H e a l t h S e r v i c e , 1955-56 t o 1974-75. from the H e a l t h S e r v i c e D i r e c t o r , Wesbrook B u i l d i n g , and the Woodward Biomedical L i b r a r y ( M e d i c a l Morgue).  36.  U.B.C. Calendar 1976/77, Vancouver.  37.  P o l i c y and Procedure Manual. U n i v e r s i t y H e a l t h S e r v i c e H o s p i t a l and Student H e a l t h S e r v i c e , Wesbrook B u i l d i n g , U n i v e r s i t y o f B r i t i s h Columbia, Vancouver, B.C.  38.  U.B.C. Reports. V o l . 22, No. 17, May 5, 1976, Vancouver.  39.  D e t w i l l e r , L.F. "New H e a l t h S c i e n c e s Centre f o r B.C.", Canadian H o s p i t a l . February 1963.  40.  U.B.C. Reports. V o l . 22, No. 17, May 5, 1976, Vancouver.  241  APPENDIX l a  COMPARATIVE CHART OF STUDENT REGISTRATIONS: TOTAL VISITS FOR ILLNESS OR FOR OBSERVATION  1945 - I960  CHART I  20000  COMPARATIVE CHART OF STUDENT REGISTRATIONS:  From F a l l 1945 - S p r i n g  TOTAL V I S I T S FOR ILLNESS OR FOR OBSERVATION  No. o f s t u d e n t s r e g i s t e r e d during winter session  19*0  19000  11 1 I T o t a l no. o f v i s i t s f o r U-i—' i l l n e s s o r f o r o b s e r v a t i o n  18000 17000 16000 15000 14000 13000 12000 11000 10000 9000 8000 7000; 6000! 5000  •Mi  45-4646-4747-48  48-49  49-50  50-51  51-52  52-53  53-54  54-55  55-56  56-57  5,7-58 . 5 8 - 5 9  59-60  243  APPENDIX Ib  COMPARATIVE CHART OF STUDENT REGISTRATIONS» TOTAL VISITS FOR ILLNESS OR FOR OBSERVATION  I960 - 1970  COMPARATIVE  28,000  • No of students  CHART  OF  STUDENT  REGISTRATIONS:  TOTAL VISITS  FOR  ILLNESS  OR  FOR  OBSERVATION  From F a l l 1960 - Spring 1970 registered during winter session.  T o t a l no. of v i s i t s  for i l l n e s s or for observation  27,000 26,000 25,000 24,000 23,000 22,000 21,000 20,000 ro  19,000 18,000 17,000 16,000 15,000 14,000 13,000 12,000 11,000 10,000 J H I .1 60-61  - Hi..',. I ill l nil 1.1^6262-6363-64 1  ' i< • ' ' i H ' ' 'M 67-68 64-6565-6666-67  68-69  69-70  245  APPENDIX  Ha  CHART SHOWING NO. OF STUDENTS RECEIVING MEDICAL EXAMINATIONS 1928 - 1955  CH/Jfl I I FALL  - SPRING- 1 9 5 5 .  \  247  APPENDIX l i b  CHART SHOWING NO. OF STUDENTS RECEIVING MEDICAL EXAMINATIONS  1945 - I960  CHART SHOWING NO. OF STUDENTS RECEIVING MEDICAL EXAMINATIONS  CHART II  FALL 1945 - SPRING 19*0  45-6  46-7  47-8  48-9  49-50  50-1  51-2  52-3 -53-4  54-5  55-6  56-7  5 7 - 8 '.58-9  59-60  249  APPENDIX I I I  CHART SHOWING NO.OF NEW STUDENTS WHO SUBMITTED REQUIRED MEDICAL FOLDERS  1958 - 1969  CHART I I Examinations:  CHART SHOWING NO. OF NEW STUDENTS WHO SUBMITTED REQUIRED MEDICAL FOLDERS FALL 1958 - SPRING 1969 Folder Only j " / / P.D. H.S.  i,500 " 6,000  5485  V,  5,500 ! I  I I  5,000!  !: i  •  //I  ! i i  T] ! I  4,500 I!  £263 |  0  ! i V ! i  ! i i I ! i I ;  4,000  1  I  I i  3,500  ii  ii iii  3,000  1  j  'i  i I ! I  i  I !  tI I •  j I  i!  i! !i! I 1  2,500  ijij  •051  ii!  !! I  2,000  ! i  1,500 1,000 500  ro CN O  58-59  m in 59-60, 60-61 o  m  CM  61-62  vO  62-63  o CO OO  o63-64  CO  as  ro m 64-65  o 65-66  m o 66-67  in 67-68  68-69  251  APPENDIX IV  THREE YEAR SUMMARY OF AGE OF ALL STUDENTS AND PERCENT OF TOTAL  252 THE UNIVERSITY OF BRITISH COLUMBIA Three year summary of age of a l l students and percent of t o t a l  Age  1973-74  Percent of Total  Percent of Total  Percent of Total  1974-75 36 11 243 2,514 2,688  .2% .05 1.1 11.5 12.3 2,798 2,769 2,389 1,743 1,267  12.2 12.1 10.4 7.6 5.5  1975-76  15 16 17 18 19  years and under years of age years years years  35 21 242 2,331 2,559  .1 1.2 11.6 12.7  20 21 22 23 24  years years years years years  2,620 2,592 2,084 1,580 1,182  13.0 T2T9" 10.4 7.9 5.9  2,666 2,781 1,559 1,267  12.2 12.7 TOT? 7.1 5.8  25 26 27 28 29  years years years years years  879 784 529 421 339  4.4 3.8 2.6 2.1 1.7  1,093 797 759 548 409  5.0 3.6 3.4 2.5 1.9  1,037 877 715 644 502  4.5 3.8 3.1 2.8 2.2  30 years  279  1.4  328  1.5  347  1.5  31-35 years of age  775  3.9  962  4.4  1,063  4.6  36-40 years of age  338  1.7  369  1.7  419  1.8  41-45 years of age  233  1.2  247  1.1  251  1.1 .7  .02% .9 10.7 12.6  46-50 years of age  142  .7  161  .7  163  51-55 years of age  73  .4  102  .5  95  .4  47  .2  37  .2  .2  56-60 years of age  36  61 years and over  15  63  .3  171  .7  not known  11  35  .1  130  .6  Total  20,100  100.0%  21,924  100.0%  22,979  100.0%  Men  12,050  60.0%  12,939  59.0%  13,253  57.7%  8,050  40.0  8,985  41.0  9,726  42.3  100.0%  21,924*  100.0%  Women  20,100  22,979  •Excluding 111 Medical Residents f o r which data i s not a v a i l a b l e . Data back to 1963-64 a v a i l a b l e . May 18, 1976 DH/dc  100.0%  253  APPENDIX V  AGE OF STUDENTS ENTERING FOR THE FIRST TIME  1975 - 1976  THE UNIVERSITY OF BRITISH COLUMBIA Age of Students Entering for the First Time 1975/76  Present Age  Mai e  Under 16 years 16 17 18 19 20  years years years years years  21 22 23 24 25  years years years years years  26 27 28 29 30  years years years years years  31 32 33 34 35  years years years years years  36 37 38 39 40  years years years years years  41 42 43 44 45  years years years years years  46 47 48 49  years years years years  Total  Percent Female 50.0%  3  — -  — — — — -  —  — ;  -  — — -  —  — -  — — ---—  ~  —  — —  -— — — — — •  —  —  —  Female  Sex Not Known  :  — —  3 92 1,203 545 328  2 113 .067  5 206 2.271  255  583  40.0 54.9 47.0 43.6 43.7  214 204 199 144 153  163 152 126 111 86  377 357 325 255 239  43.2 42.6 38.8 43.5 36.0  126 97 100 82 43  91 64 79 59 47  217 163 180 144 91  41.9 39.3 43.9 41.0 51.6  50 31 29 28 18  35 30 24 14 22  85 53 42 40  41.2 49.2 45.3 33.3 55.0  15 9 10 11 6  17 9 8 9 11  32 19 18 20 17  53.1 47.4 44.4 45.0 64.7  4 7 5 4 5  9 8 10 10 5  13 15 15 14 10  69.2 53.3 66.7 71.4 50.0  6 2 1 2  7 2 5 7  13 4 6 9  53.8 50.0 83.3 77.8  2 1 3 1  61.  2  255 1975/76  Present Age 50 - 55 years 56 years and oyer  Total  - - -— — — - ________  Male  Female  8  24  7  3,816  Data back to 1963/64 also available June 3, 1976 DH/mw  Sex Not Known  Total  Percent Female  32  75;0%  12  -  19  63.2  10  14  43  23.3  3,131  26  6,973  44.9%  256  APPENDIX VI  BY-LAWS OF THE UNIVERSITY HEALTH SERVICE HOSPITAL, VANCOUVER. B.C.  BY-LAWS OF THE UNIVERSITY HEALTH SERVICE HOSPITAL, VANCOUVER. B. C.  Whereas the University of British Columbia was incorporated under the "British Columbia University Act" which provides that tho management, administration and control of the property, revenue, business and affairs of the said University shall be vested in the Board of Governors, • And'\;hereas tho said Board of Governors deems i t necessary and advisable •to establish a hospital on tho grounds of the said Universit-7, to bo known as the "University Health Service Hospital",' for the purposes of treating and caring for persons suffering from illness or disabilities or other conditions which require that they receive acute hospital care, to carry cn educational activities related to the care of sick and injured persons and to promote and carry on scientific research in the treatment of disease. * . ' '" . And whereas i t i s necessary to constitute a Board of Management and to •prescribe - by-laws for -th© proper carrying - out • of '"the administration and "operation of the said hospital pursuant to the provisions of the Hospital Act. • Therefore, by virtue of the powers vested in i t under the "British Columbia University Act" tho E.ard o:' Governors of the University of British Columbia hereby enacts the following by-laws for the administration and operation of the.University Health Service Hospital. „. -•  ; -  ; BY-LAWS  ' / ' ; '- - - ''"' :  ;  1  :  Definitions 1-1  In these by-laws, unless the context otherwise i-equires»"Adainistrative Corzaiittee" neans tho committee appointed pursuant to these by-laws to administer the affairs of the hospital undor the direction of the Board of Management, "Board of.Governors" ceans the Board of Governors of the University of ..British Columbia constituted under and appointed • pursuant to the provisions of the "British Columbia University Act." "Hospital" Eoans.the University Health Service Hospital, Vancouver, B. C." "University" neans the University of British C o l u m b i a , . '  '" -'  . "  Board of Management  2-1- -*he- hospital ahall-bo operated and administered .by- a Board of-Kanagecant, hereinafter called the "Board", comprising the following persons:  2-2  (a)  The ntirbcrs of the Board of Governors.  (b)  The Dean of the Faculty of Medicine of the University of British Columbia.  (c)  A representative of the Provincial Government of British Columbia appointed pursuant to tho provisions of the' Hospital Act who may be a jnenber of tho Beard of Governors. * '. ' •  Full control of the receipts and expenditures of the hoopital shall bo vested in the Board.  2-3  Regular meetings of the Board s h a l l bo held 'once each month and the annual nesting of tho Board s h a l l be held i n tho nonth of February each year. The date and place of such meetings s h a l l be f i x e d by the Chainnan o f tho Board and s h a l l be n o t i f i e d t o every member thereof as provided h e r e i n .  2-4  In a d d i t i o n t o the regular r.eetings herein provided, s p e c i a l meetings o f the Board r_ay be« ciiUed at any tir.c by the Chairman and s h a l l be c a l l e d by him upon receipt of the w r i t t e n request of any 3 Eembero of the Board. No business other than that stated i n tho n o t i c e of meeting s h a l l bo transacted a t any cpccic.1 meeting of the Board. ./•:'.;_ '.. •""•'' ."  2-5  Written notice of a l l meetings o f tho Beard s h a l l be delivered or n a i l e d t o each member thereof a t l e a s t seven days beforo the date of the meeting and any notice regarding a s p e c i a l meeting of the Board s h a l l D t a t o t h e business f o r which the meeting i s c a l l e d .  '  2-6  At any sooting'of the Board f i v e members s h a l l constitute a quorua.  2- 7  Notwithstanding any other provision contained herein the Board s h a l l hold i t s f i r s t 7-ecting a f t e r the approval of these by-laws by the Lieutenant-Governor i n Council a t a time and place f i x e d by the Chairman of the Board of Governors. Notice of tho time and place at which the f i r s t meeting i s to be held s h a l l b e d e l i v e r e d or mailed t o each member of tho Board a t l e a s t 7 days p r i o r t o the date of the meeting.. ' ..... „ . . - ... -- ' .•' ' '  ..'-; ^' '.'  :  O f f i c e r s of the Board  . '..  '  .''' -. '.'  3-1  The Board s h a l l , a t i t s f i r s t meeting, e l e c t or'appoint a Ch-irman and such other o f f i c e r s as are deemed necessary t o conduct the meetings of t h e Boardand properly carry out i t s business. The O f f i c e r s so elected s h a l l serve --V u.'itil the conclusion of t h e f i r s t annual meeting of t h e Board. . ...  3-2  At every annual meeting o f the Board the members s h a l l e l e c t o r appoint a news l a t e of o f f i c e r s t o servo u n t i l the conclusion of t h e next annual meeting a n d any o f f i c e r whose term i s about t o expire may be re-elected as an o f f i c e r of the Board f o r a further t e r n . , •_.....-*.'  • 3- 3  Vacancies occurring among the o f f i c e r s may b e f i l l e d f o r t h e unexpired term b y t h e Beard. ';' . ;•':. • '."•'./ ;""' ' "\. "' s  Corr-Titteos of the Board 4-1  \:S :' :  :  '"  V . --  ;  The Eoard may appoint an Administrative Committee t o attend t o the" day t o day management and operation of the h o s p i t a l . The membership of the Administrative . Committee s h a l l be comprised of a Chairman, who s h a l l be t h e Dean of the' Faculty of Medicine of t h e University; a Secretary, who s h a l l be t h e D i r e c t o r of t h e U n i v e r s i t y Health Service Hospital, and 3 other-, persons appointed by theBoard. The Administrative Committee "shall meet at t h e c a l l of t h e Chairman.  4-2  There s h a l l b e a Joint Advisory Committee consisting of a n equal number o f members appointed by the Board and the Kedical S t a f f . The Chairman of t h e . Acjoinistrative Committee s h a l l be one_of. tho.Board's appointees a n d h e s h a l l , b e e x o f f i c i o the Chairman of the Joint Advisory Ccmaittee. ...  4-3  The Board may from tlrze t o t i n o appoint such other committees as a r e d e e m e d necessary and advisable. - . ... . . •  4-4  The Board s h a l l delegate t o each committee appointed pursuant t o these by-laws such powers as i t deems necessary f o r tho proper carrying out of t h e purposes f o r which tho co.-^aittee. was established, cavo and except t h o c o n t r o l o f t h o r e c e i p t s 'and expenditures of the h o s p i t a l which s h a l l remain vested s o l e l y i n tho Board.. •. , • ' .  5-1  ' Director  < . • ; -. ..• ,.  Tho administration of tho h o s p i t a l s h a l l be tho r e s p o n s i b i l i t y o f the D i r o c t o r who s h a l l be appointed by tho Board. . •"•  260  APPENDIX V I I  STUDENT HEALTH SERVICE MEDICAL RECORD  261 THE  MAIL T O THE H E A L T H SERVICE AS SOON AS P O S S I B L E . THE LAST A C C E P T A B L E D A T E i IS R E G I S T R A T I O N WEEK T  H  E  INFORMATION  REGISTRATION  STUDENT HEALTH SERVICE P L E A S E READ C A R E F U L L Y , C O M P L E T E , AND SIGN WHERE  REQUESTED  PROCEDURE.  PERMISSiON  OF T H E S T U D E N T  IS  ADMISSION TO U . B . C .  REFUSED  NATION  BY A P H Y S I C I A N  T  A N^/O^R ^  N J^UR I E S  REFERRALS  O  ,  T  u  c  k  THE  l  ,„ r u r  T  Ma  PHYSICIANS  HE^EBT  IT CANNOT  I N F O R M A T I O N GIVEN IS F R E Q U E N T L Y OR EMOTIONAL  FOR U N I V E R S I T Y  O F ROUTINE  <^R A N T E D  AND O T H E R  O F A L LSTUDENTS  IS C O N F I D E N T A L ,  B E C A U S E OF A P H Y S I C A L  .SIGNATURE  PARENTAL  IS R E Q U I R E D  INFORMATION  CONCERNED.  P E R M ^ S K)^N  TO P R I V A T E  HEREIN  THIS  IS NOT C O M P U L S O R Y  C  TO  HEALTH E  STUDENT  TO AID T H E  ABOVE  STUDENT  RECOMMENDED.  INDICATED  OR MORE, HEALTH  IN SOLVING  ASPART  STUDENT  H E A L T H P R O B L E M S . NO S T U D E N T ADEQUATE MEDICAL  PROCEDURES, HEALTH  O F T H E  S E R V I C E WITHOUT W R I T T E N  CARE. EXAMI-  ( S E E C A L E N D A R FOR F A C U L T Y  DIAGNOSTIC  AT THE  TREATMENT  SERVICE  AND TO  EXCEPTIONS.)  O F  MAKE  ILLNESSES NECESSARY  FACILITIES.  OF S T U D E N T _  SIGNATURE  MEDICAL INSURANCE  UNITS  T H E STUDENT  CONDITION IS UNDER  IMMUNIZATIONS,  NAMED  FOR 3  FROM  PROVIDED THE  B U T IS S T R O N G L Y  EXAMINATIONS,  TREAT"TH  COMMUNITY  USED  HANDICAP,  ENTRANCE  ENROLLED  BE R E L E A S E D  ENDORSEMENT  YES  F O R M 30  U N I V E R S I T Y O F BRITISH C O L U M B I A  INDENTIFICATION NO.  GROUP NO.  PLAN NAME  O F P A R E N T OR L E G A L GUARDIAN  | DEP.  •  FILL IN DETAILS NO ALL  r~J HAVE YOU APPLIED?  YES ["J  NO  [~J  STUDENTS WHO ARE NOT COVERED BY MEDICAL INSURANCE ARE ADVISED TO ENROL IN UNIVERSITY APPROVED MEDICAL PLAN. STUDENTS WHO HAVE  LIVED IN B. C. FOR ONE YEAR MAY BE ELIGIBLE FOR A SUBSIDY OF THEIR PREMIUMS IN THE B. C. MEDICAL PLAN. HOSPITAL INSURANCE DETAILS.  FOR  IS COMPULSORY FOR ALL STUDENTS FROM OUT OF CANADA.  AN APPROVED PLAN FOR MEDICAL AND  N. B. SEE CALENDAR OR HEALTH SERVICE BROCHURE FOR FURTHER  AFTER INSURANCE IS PURCHASED EITHER SEND OR TAKE THE ABOVE MEDICAL INSURANCE INFORMATION TO THE HEALTH SERVICE.  STVUINI  31*0  3S0Q  NOI1VDI03IN  snvuiNi  31VO  3S00  NOI1VDI03VN  DATE REPORTED  BY  RECALLED FOR  HEALTH SERVICE USE: DATE RECEIVED  A T NO 3Sn nVXNBWlHVdBQ BOd 3UriS01DN3 3 3 S  _  ,„„_ 3 JV  dlHSNOHVT3U  •  S3A  1  1  J  —  —  ( 3 1 V 1 S U O 3 DN I A O H d)  < S IS OTH 3M3 S fl i 3 A 113V - —  — —  •  3H3HM"  S3IM3S ( 1 B V 1 ) s n N V i 3 1  '03DH0JNI-3H  V 0 I OH d A l a3DUOJNI-3U "  ' a30HOJNI-3« "  l N 3 0 n i S 3 H 1 A B a313Td>NOD 3B 0 1  '  —  •03N 1 S 3 1 NIHS CB-1)  03DH0JNI-3H "  NIO IbO 3NI00VA  BOJ  1S3H0  :U3H10  — 3 N13 3 V A CB-D-S) S I S O n n D H S B f U  HinOH A9 "  ~  :AVB-X  3 O 3 SV 0 V i 0 1OV I N 00 3 SOTD V N 3 3 8 f\ 0 A 3 AV H  •03N ( V I H 3 H l H d i a ) XDIHDS  " 0 3 3 « 0 3 N I-3M  :3SI1 T V 1 N 3 I « U H V d3Q  3N0 1 S V T 30 31V0  d  Q ON  _ — -  31V0  •S3N "  ' S3«nS0TDN3 33S  •S3N  ' Q31VNIDDVA3«  -  S X S 3 1 QNV S N O I 1 V Z INOWtNl  i3>Vl "  minatiasru U3H10  S 3 I H 3 S (BV1) SNOI1D3TNI —  OlOHdAl  Slin3AHOnOd S3I113S S 0 N V 1 3 1  S3I«3S  VIH3HlHdlO  N0I1VNID0VA l O d l l V W  IVNIDIdO  : D N I M O n O J 3 H 1 JO S 3 1 V 0 ' X O b d d V  3AI0  262 Mf).  MISS  M R S . Y E A R  M O N T H B I R T H  M A R I T A L  GIVEN  NAMES—UNDERLINE  ONE  S T A T U S  M.  S.  USED  W.  D.  S T U D E N T  D A T E  S.  ( C I R C L E )  PLEASE PRINT ALL INFORMATION IN BLOCK LETTERS VANCOUVER  ADDRESS  P E R M A N E N T  H O M E  E N R O L L I N G  L A S T  IN  H O M E  O R  C O U N T R Y  O F  B I R T H  .  A D D R E S 5 .  F A C U L T Y  S C H O O L  N U M B E R  OR  C O L L E G E  A C A D E M I C  S C H O O L -  Y E A R :  1 , 2 , 3 , 4 . 5 :  M . A . ,  P . H . D .  D E P T .  ( C I R C L E )  A T T E N D E D .  P H Y S I C I A N  N A M E  &  A D D R E S S  O F  N E X T  O F  K I N  FAMILY HISTORY  ,  MOTHER  FATHER  T O  T H E  E X A M I N I N G  P L E A S E W E  COUNTRY  OF  BIRTH  N O T E  S H A L L  B E  W H I L E  A T  T H A N K  Y O U .  D O C T O R :  B E L O W  A N Y  H A P P Y  TO  U N I V E R S I T Y .  C O N D I T I O N S  H A V E Y O U R  Y O U R F E E  W H I C H  A D V I C E  IS  T H E  Y O U  IN  C O N S I D E R  T H E  S I G N I F I C A N T .  C A R E  O F  T H I S  R E S P O N S I B I L I T Y  O F  T H E  S T U D E N T S T U D E N T .  nrrHP ATin N IF  DECEASED  GIVE  CAUSE  0 A T E  PERSONAL HISTORY HT. HAVE  YOU  EVER  HAD  (YES  OR  F T .  .INS.  R H E U M  NO)  DIABETES  A T I C  •  A B N O R M A L  N O R M A L  OTHER I L L N E S S : A B O V E :  L.  2 0 / _  .R.  2 0 /  .  L E N S E S L .  2 0 / .  _R.  2 0 /  .  V I S I O N  •  T R E A T M E N T  EPILEPSY  O N  L B S .  W T .  H E A R I N G :  F E V E R  N O R M A L  P S Y C H I A T R I C  C O M M E N T S  _  __  N O R M A L  A B N O R M A L  E . E . N . T .  H E R N I A  L U N G S  G . U .  S K I N  B O N E S  H E A R T  F E E T  A B D O M E N  N E R V O U S  A B N O R M A L  . S Y S T E M  I N J U R I E S : ,  OPERATIONS:  W H A T Y O U  M E D I C A T I O N T A K I N G  ( E S P E C I A L L Y  T O  P R O T E I N  Y O U  H A V E  A N Y  P R O B L E M S  W I T H  A N Y  O F  T H E  F O L L O W I N G ?  N . B .  W H I C H )  A L L E R G I E S  S E N S I T I V I T I E S ,  H E A D A C H E  L U N G S  I N D I G E S T I O N  S O R E  H E A R T  C O N S T I P A T I O N  T H R O A T  _  M E D I C A T I O N S ) . O P T I O N A L :  0 0  S Y S T E M  A R E  U R I N E :  ( C I R C L E  JO 1 N T S  R E G U L A R L Y ?  A L L E R G I E S  N.B.  A N D  B L O O D  P R E S S U R E  E A R S  B O D Y  E Y E S  E M O T I O N S  R E C T A L  .  OR P L E A S E  S T A T E  A B N O R M A L I T I E S S I N U S E S  V D R L  F O R  O B S E R V A T I O N  O R  T R E A T M E N T : .  B L E E D I N G  U R I N A T I O N  W E I G H T  G Y N E C O L O G I C A L  C O M M E N T S  O N  A B O V E :  P R O B L E M S  .  IF  A R E  IF  Y O U  N O T  A B L E  T O  P A R T I C I P A T E  A C T I V E L Y  IN  P H Y S I C A L  Y O U  A D V I S E  S O M E  L I M I T A T I O N  O F  A C T I V I T Y ,  P L E A S E  N O T E :  .  A C T I V I T I E S ?  E X P L A I N .  S I G N A T U R E  S I G N A T U R E  S E E  B A C K  P A G E  A N D  G I V E ,  D E T A I L S  O F  I M M U N I Z A T I O N  A N D  T E S T S  W I L L  T H E  P H Y S I C I A N  P L E A S E  M A I L  IN  T H E  S E L F - A D D R  E S S E D  E N V E L O P E  263  APPENDIX V I I I  DIAGRAM OF HEALTH SERVICE OUTPATIENT DEPARTMENT  265  APPENDIX IX  DIAGRAM OF HEALTH SERVICE HOSPITAL  26?  APPENDIX X  HEALTH ASSESSMENT OF THE BASIC SCUBA DIVER  268 HEALTH ASSESSMENT OF THE BASIC SCUBA DIVER  Absolute Contraindications Spontaneous pneumothorax d i a t h e s i s A c t i v e pulmonary d i s e a s e Bronchitis Bronchiectasis Asthma Pneumonia A i r t r a p p i n g l e s i o n s , l u n g c y s t s o r b a l l v a l v e l e s i o n s on X - r a y C o n v u l s i v e d i s o r d e r d i a t h e s i s , syncope, n a r c o l e p s y B r i t t l e d i a b e t e s o r i n s u l i n shock d i a t h e s i s Drug o r a l c o h o l a d d i c t i o n A c t i v e sinus or ear disease P l a s t i c s t r u t i n middle ear conductive c h a i n I n a b i l i t y to c l e a r pressure d i f f e r e n c e s i n ears, s i n u s e s , lungs High Risk Conditions I m p a i r e d pulmonary r e s e r v e Pregnancy Obesity H i s t o r y o f thoracotomy History of myocardial i n f a r c t i o n Temporarily D i s q u a l i f y i n g  Conditions  S i n u s and m i d d l e ^ e a r b l o c k a g e caused by hay f e v e r o r o t h e r a l l e r g y R e s p i r a t o r y t r a c t i n f e c t i o n w i t h sinus o r middle ear blockage o r chest i n f e c t i o n M e d i c a t i o n o r t o x i c s t a t e which i n t e r f e r e s w i t h normal d i v i n g Alcoholic intoxication Miscellaneous  Factors  Age Young Experience Old Arteriosclerosis Arthritis Personality Personal motivation Appropriate motivation A c c i d e n t proheness Impulsive behavior Hyperactivity Learning d i s a b i l i t i e s  269  APPENDIX XI  MEDICAL EXAMINATION FOR EVALUATION OF PHYSICAL FITNESS TO PARTICIPATE IN SPORT PARACHUTING  271  APPENDIX XII  MONTHLY REPORT OF PHYSIOTHERAPY TREATMENTS  1  ?  272  MONTHLY REPORT OF PHYSIOTHERAPY TREATMENTS  Period: During t h i s period were administered to  treatments patients referred by the Student  Health Service. During the same period  treatments were administered  to students suffering a t h l e t i c i n j u r i e s . In addition to the above, the l i s t below shows the number of students treated f o r each sport. Badminton  P.E.  Basketball  Rugby  F i e l d Hockey  Soccer  Football  Track & F i e l d  Gymnastics  Wrestling  Ice Hockey  Other  Judo  DATE: H.S. 4  PHYSIOTHERAPIST  

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