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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 of Manitoba, 1966 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE i n THE FACULTY OF GRADUATE STUDIES Department of Health Care and Epidemiology We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1976 (c) Josephine Mary Hannay 1976 In p resent ing t h i s t he 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 reference and study. I f u r t h e r agree tha t permiss ion for ex tens i ve copying o f t h i s t he s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r ep re sen ta t i ve s . It i s understood that copying or p u b l i c a t i o n of t h i s t he s i s f o r f i n a n c i a l ga in s h a l l not be al lowed without my w r i t t e n permi s s ion . Department of HEALTH CARE AND EPIDEMIOLOGY The U n i v e r s i t y of B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 SEPTEMBER, 1976. ABSTRACT This study was conceived as a thesis in partial fulfilment of the requirements for a master's degree in Health Services Planning at the University of British Col-umbia. The growing demand for evaluation of health care programs constituted the rationale of the study. It appears that the current high level of interest in 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 for program administrators. In order to make intelligent decisions re-lative to the commitment of resources, programs designed to achieve these objectives must be evaluated. The program sel-ected for this evaluative study was the University of British Columbia Student Health Service. The study was designed in three phases: one, a background review and preparatory period; two, an on-site survey of a l l of the dimensions of the Health Service includ-ing 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. i i i Based on the researcher's past experience in reviewing Canadian health care institutions for standards and practices, the method employed was an accreditation-type survey using documentary evidence, interviews, and observa-tions. Evaluation of the Health Service f a c i l i t i e s and functions was done in terms of the American College Health Association's Recommended Standards and Practices for 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 for change in view of the variance between the Standards and the study findings. Consideration was given to the appropriateness 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 in the Standards and those thought to be applicable in Canada, recommendations or sugg-estions for change were adapted to suit 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 for a College Health Program re-commended 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 is intended as a planning document to have u t i l i t y for the Health Service at U.B.C. and for future research in college health programs in Canada. V PREFACE Because of the current high level of interest in 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 in order to assure a continued high standard of service, the U.B.C. Health Service was selected for the conduct of an evaluative study. No other assessment of i t s organization and operation has ever been carried out in the fifty-one 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 willing-ness to cooperate with a study of i t s program, i t is an t i c i -pated that recommendations for change w i l l be well received by the Health Service. Factual information on the characteristics and operations of the Health Service is presented in this thesis in such a manner that the solutions to problems or deficien-cies are presumed to be self-evident. Statements of recomm-endation are made throughout the main text; those made in 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 v i a hospital consultant, administrator, teacher, and nurse. The statements on Ethical and Professional Relationships, supplemental to the Standards, have been applied in only-two areas thought to be appropriate, Medical Records and Mental Health. The voluminous amount of detail contained in the text which follows has been l e f t in for several reasons. One, i t is the only written account of the U.B.C. Health Service on record; two, the independent assessment of i t s programs may serve as a guide to the Health Service for re-viewing i t s organization and operation internally; and three, the description of individual programs, services, and support-ing functions may be used as a point of reference for devel-oping programs. v i i TABLE OF CONTENTS PAGE ABSTRACT i i PREFACE v TABLE OF CONTENTS v i i LIST OF TABLES x ACKNOWLEDGEMENT x i DEDICATION x i i PART I BACKGROUND OF THE STUDY 1 CHAPTER 1 Introduction 2 2 Objectives, Design, and 7 Methodology of the Study 2.1 Objectives of the Study 7 2.2 Design of the Study 8 2.3 Methodology of the Study 12 2.4 About the Standards 15 3 Review of the Literature 19 3.1 The Development of Organized 19 Student Health Services 3.2 Other Developments 22 3.3 Program Evaluation 26 PART II CONTENTS OF THE STUDY 32 4 History and Background of the 33 U.B.C. Health Service 5 General Information 56 5.1 The I n s t i t u t i o n 56 5.2 Composition of the 58 I n s t i t u t i o n a l Community 5.3 Organization and Administration 62 v i i i CHAPTER PAGE 6 Health Programs: Services 66 and A c t i v i t i e s 6.1 Outpatient Services 66 6.2 Inpatient Services 79 6.3 Records 94 6.4 Laboratory Services 103 6.5 Radiological Services 106 6.6 Pharmacy (Medication Service)113 6.7 Dental Services 116 6.8 Mental Health 122 6.9 A t h l e t i c Medicine 134 6.10 Rehabilitation/Physical 140 Medicine 6.11 Health Promotion/Preventive 148 Medicine 6.12 Occupational Health 152 6.13 Environmental Health 153 and Safety 6.14 Provisions f o r Emergencies/ 157 Disasters 6.15 Health Education 162 6.16 Research 170 6.17 Communications 171 6.18 Extramural Resources 175 6.19 Special Problems 178 7 Health Personnel: Q u a l i f i c a t i o n s , 181 Duties, and Education 7.1 Medical Staff 182 7.2 Outpatient Department Staff 185 7.3 Hospital Staff 186 7.4 Nursing 188 7.5 Other Professionals 190 7.6 S e c r e t a r i a l / C l e r i c a l Staff 192 7.7 Support Staff 194 8 Physical Plant 196 8.1 Location 196 8.2 Design and Construction 196 8.3 Maintenance 199 i x CHAPTER PAGE 9 Business Management 201 9.1 Financing 201 9.2 Budget Planning 204 9.3 Business Procedures 210 9.4 Personnel: P o l i c i e s and 211 Procedures PART III CONCLUSIONS OF THE STUDY 213 10 Summary and Recommendations ' 214 10.1 Summary of Services 214 10.2 Summary of Recommendations 217 10.3 Implications f o r Planning 235 LITERATURE CITED 237 APPENDICES 241 X LIST OF TABLES TABLE PAGE l a Student Registration 1954-1960 52 Ib Student Registration 1964-1970 52 II Total Number of V i s i t s to Health Service 53 1954-1975 III Health Service Hospital U t i l i z a t i o n 54 1954-1975 IV Summary of Services 1954-1975 55 V Total Enrolment 1969-1976 59 VI Percent - Male and Female 60 VII Patient Census A p r i l 28, 1976 83 VIII Workload i n Unit Values Per Month - Lab. 105 IX Annual Workload i n Unit Values - X-Ray 109 X Psychiatric Service Census By Sex 128 XI Psychiatric Service Census By Country 129 of B i r t h XII Statement of U.B.C.'s A n c i l l a r y Operations 207 f o r the Year Ending March, 1974 xi ACKNOWLEDGEMENT Grateful appreciation is expressed to the follow-ing people for their assistance in the preparation and con-duct of this study: To my thesis committee: Dr. C.J.G. (Cort) MacKenzie, Head of the Department of Health Care and Epidemiology; Dr. Anne Crichton, Professor in the Division of Health Services Planning; and Mrs.Helen Elfert, Assistant Professor in the School of Nursing, University of British Columbia, for their advice and guidance. To Dr. Michel Vernier, Chairman of the Division of Epidemiology and Biometry, for suggesting student health services as an area for study; to Dr. Archie Johnson, Director of the U.B.C. Health Service, and his staff whose cooperation made this study possible; and to a l l those who contributed to the accumulation of data. To my friend, Carol Perch, who generously offered to type the f i r s t draft of the manuscript, and to my sister-in-law, Lynne Hannay, who diligently typed the f i n a l copy. To my parents and friends for their encouragement; and to my husband, Rick, and my sons, Mark and John, for their patience and understanding through completion of my studies. This work was supported In part by the Manitoba Health Services Commission whose assistance is gratefully acknowledged. x i i This study is dedicated to Miss Muriel Upshall and others who pioneered in the development of student health services in Canadian universities. 1 PART I BACKGROUND OF THE STUDY 2 CHAPTER I  INTRODUCTION The methods by which the health services seek to attain their basic objectives - promotion of health and well-being, prevention of illness and disabili t y , and care in the community - are changing and w i l l continue to change as social conditions alter. Both government and voluntary organizations have planned and established pro-grams to implement these objectives and the costs have been monumental. Economists have expressed concern about the escalation of health care costs because of their in-creasing share of the G.N.P. relative to other kinds of expenditures and because i t is not clear that Canadians are deriving any greater benefits in terms of increased health, well-being, or productivity. This suggests that the industry is becoming increasingly inefficient 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 sc i e n t i f i c measures for relieving pain, preventing or curing illness, and postponing death; i t is incumbent upon every society to economize in the use of scarce resources. 3 Thus, in terms of planning social change to better u t i l i z e our resources, i t has been suggested that: " A l l social institutions or subsystems, whether medical, educational, religious, economic, or p o l i t i c a l , are re-quired to provide "proof" of their legitimacy and effect-iveness in order to justify society's continued support. The demand that some attempt be made to determine the effectiveness of public service and social action pro-grams has become increasingly insistent. It is this renewed interest in a long neglected aspect of social research, the evaluation study, that provided the impetus for the current study. In the determination of an appropriate health care program in 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 university setting is particularly conducive to teaching this specific population about i t s responsibility for making provisions in the case of illness and for maintaining i t s own well-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 social changes in our time. 4 It stated: " ... Reference was made to the possible earlier physical maturity and generally later school-leaving age with a consequently later entry into the labour force hut a tendency for earlier family formation. This goes hand in hand with improving economic levels of parents and more money available from public sources for continued education to f i l l the demand for higher educational levels in the present and future labour force. The responsibilities of the adolescent and his role in the community are thus reduced in some respects, while increased demands are made in others resulting in stresses which cannot f a i l to be refl e c t -ed in the health status of this group." (5. - p . 313) The university has a unique opportunity as well as an obligation to use this period of continuing change and remarkable f l e x i b i l i t y in the lives of students to promote sound health concepts which form the basis for continuing environmental adaptation and provide stimulus for the most efficient u t i l i z a t i o n of our resources. But universities today face many of the same dilemmas as their off-campus counterparts. Rising costs are causing i n s t i t u -tions to reevaluate the specific 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 responsibility for health service programs in the institution and provides general knowledge for administrators and educators con-cerning health services in universities. Further,such 5 evaluation can provide guidelines for action by planners of other university or college health service f a c i l i t i e s . If new health knowledge is to be incorporated into health programs, current activities must be evaluated to determine what reallocation of resources i s necessary, while new activ i t i e s must be carefully planned and eval-uated before they are put into practice. Since i t s inception, the U.B.C. Health Service has seen many changes in 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 hospital 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 last decade have been mainly in the areas of family planning, birth control, and counseling, particularly sex counseling, and psychiatric assessment regarding problems of adaptation to a changing society in which the work ethic is being challenged and the generation gap seems great to many in the student age group. Since universal hospital and medical insurance coverage is presumed to have resulted in more students seeking health care from private practi-tioners, and in better health generally, i t appears that there is a shift toward more preventive practices taking 6 place in 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 1 issues raised on the campus, such as the development of the Health Sciences Centre, a family prac-tice teaching unit, and environmental surveillance and control of hazardous conditions. Whether the Health Service should have become involved in 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 institution 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 is whether these can appropriately be applied both to American and Canadian student health services since the Canadian context has been changing in a different manner from that of the United States. This thesis attempts to consider the appropriateness 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 this study is to further improvement of existing health programs and provide a point of reference for developing programs. The primary objective is to evaluate a health care program with a view to providing consultative guid-ance in terms of specific recommendations for standards and practices. The intermediate objective is to evaluate a well-developed student health service in the Canadian context. The operational goals of the study ares i) to describe the development of organized student health services, i i ) to objectively assess the scope (extent and kinds) of services presently provided at U.B.C. i i i ) to recommend ways to more effectively or effi c i e n t l y coordinate the planning and provision of such ser-vices, including their coordination with other services. 8 iv) to make suggestions for their future develop-ment with implications for planning. 2.2 Design of the Study The study was designed in three phases: one, a background review and preparatory periods two, 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 func-tions ; 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 in the areas of program evaluation and student health services. A search of the archives relative to the U.B.C. Health Service included annual reports dating back to 1955 and historical documents back to 193&. Health Service records were scanned in 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 collection of baseline data. (This is one of the recommended areas for change.) In preparing for the on-site survey contact was made by letter and telephone with the American College 9 Health Association in Evanston, I l l i n o i s , and with one of i t s standards officers at the University of California 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-ly borrowed from the Student Health Service at Simon Fraser University. Preliminary discussions were held with the Dir-ector and Supervisor of the Health Service for permission to conduct the survey, and with the U.B.C. Registrar to verify the f e a s i b i l i t y of doing the study. Others were contacted for the purpose of gathering relevant informa-tion in connection with the study. In alphabetical order, the following were the i n i t i a l contacts made in the pre-paratory phase: American College - Evanston, I l l i n o i s Health Association Miss K. Boyle - Supervisor, U.B.C. Health Service Miss Dora Hart - Statistician, U.B.C. Office of Academic Planning Dr. A.M. Johnson - Director, U.B.C. Health Service Mrs. Barbara Kelly - 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, S.F.U. Student Health Service Dr. Maurice Osborne Jr. Director, Student Health Service, U.C.L.A. Mr. J.E.A. Parnall - Registrar, U.B.C. Miss A. Stalker Head, Occupational Therapy Department, U.B.C. Health Sciences Centre Psychiatric Unit 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 staffs, 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 in 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 Psychiatrist Mr. A. Boschalk - Area Supervisor, Operations and Maintenance Division, Department.of Physical Plant, U.B.C. Miss K. Boyle Supervisor Dr. CA. Brumwell Assistant Director 11 Mrs. S. Chambers Mr. H.A. Crawford Miss A. F e l l Dr. D. Goresky Miss M. Harrison Dr. A.M. Johnson Mrs. P. Jones Dr. M. Kwan Mrs. C. Longstaff Mrs. E. McVey Dr. S.E. Marks Mrs. P. M i l l e r Mrs. P. Morley Mrs. J . Morrey Dr. R.K.L. Percival-Smith-Dr. J»M':>:Robinson Dr. C.J. Schwarz Mrs. J. Sutton Mrs. Taylor Mr. H. Tumaitis Dr. E.W. Vogt Dr. M. Williamson C l i n i c Nurse and Inservice Education Coordinator Fire Prevention O f f i c e r , University Endowment Lands Fi r e Department C l i n i c Nurse Physician X-Ray Technician Director Head Nurse, Hospital Psychiatric Resident C l i n i c Nurse C l i n i c Nurse Counsellor, Faculty of Education, U.B.C. Pharmacist, U.B.C. Community Health Centre Housekeeping Assistant C l i n i c Nurse Physician Chairman, Di v i s i o n of Public Health Practice, U.B.C. Chief P s y c h i a t r i s t , St. Paul's Hospital; Former Consultant P s y c h i a t r i s t , U.B.C. Health Service Laboratory Technician Medical Record Lib r a r i a n , Vancouver General Hospital Phys i o the rap i s t Vice-President, Faculty and Student A f f a i r s , U.B.C. Director of Continuing Education, Faculty of Dentistry, 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 janitor, and members of the Hospital nursing staff. Several more weeks were required for the colla-tion and interpretation of the collected data and findings of the survey, and for 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 institutions for standards and practices, the method used for 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 -ties and functions was done in terms of a set of recommended standards and practices for a college health program. Data was collected to provide a comprehensive body of descriptive information concerning health services in the university, and interpreted to make recommendations for change in view of the variance between recommended standards and actual find-ings. The method used was generally patterned on that of Knutson's'' c r i t i c a l review in the evaluation of program 13 progress. This approach provides guidelines for the conduct of program activities and i s especially useful to those responsible for on-going public health programs. It's principles and techniques can also be applied during the process of program planning and development to improve the quality of decisions made. It requires c r i t i c a l app-ra i s a l involving the systematic application of the best available techniques and approaches for the purpose of ferreting out program weaknesses and detecting ways of reorienting efforts along more profitable lines. It i s a means of identifying barriers that l i e ahead and of finding ways of removing them before they disrupt the program. Some of the methods which may be applied for this purpose are discussions, interviews, questionnaires, s t a t i s t i c a l data, or any other available techniques of evaluation. The c r i t i c a l factor is 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 yield information useful in guiding the program. Using the prescribed standards, some of the issues explored in this c r i t i c a l review were the follow-ing! 14 Have the needs, wants, or concerns the program is intended to serve been adequately identified? Has the public to be served been represented in defining the needs? Have the objectives of the program been spec i f i -cally defined and written down? Are they part of the overall objectives and p h i l -osophy of the institution? Are they kept current by being directly related to existing concerns, and are they understood and accepted? Are the methods and approaches employed in the program adequate for the purposes of the program? Are significant barriers to success identified and corrective actions taken? What is i t that has made the program succeed or f a i l ? Or what did i t accomplish in terms of origin a l l y unforeseen objectives? To what extent has the community's total problem been solved by this pro-gram? Or i s i t directed only to a minority? Can the same end result be achieved at a lower cost What changes in techniques or methods could have improved i t s effectiveness? How do the services under study compare with local or national standards? 15 To the extent that valid and reliable answers were obtained to these questions of progress evaluation and the results of this 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 for 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 in 1969. They define the scope of well-developed college health programs and the importance of coordination among the program components, and they present general guide-lines for evaluating the quality of specific services. Because of the many variables of size, location, composition of student body, and institutional goals and resources among the wide variety of colleges and univer-s i t i e s , specific numerical standards, such as the ratio 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 for comprehensive health programsfor the academic community. In this context i t is considered that the Standards apply to Canadian university health services. The Standards subscribe to the following: Goals of a comprehensive health program for the academic community: "1. To promote and maintain those conditions which w i l l permit and encourage each individual to realize optimum physical, emotional, i n t e l l -ectual, and social well-being. 2. To control those factors in the community and i t s environment which may compromise this well-being. 3. To guide the individual in the acceptance of health as a positive value in l i f e . k. To stimulate the capacity of the individual to make healthful adaptations to the environment." (6. - p. 1) Objectives of a comprehensive health program for the academic community: "1. Organizing staff and f a c i l i t i e s for: (a) Prevention of health hazards and problems for a l l members of the academic community (including identification and recognition of potential problems prior to their dev-elopment) . (b) Early recognition of developing problems (including, in the c l i n i c a l area, presymptom diagnosis of potential illness and use of screening procedures). (c) Prompt and effective remedial action in the presence of recognized health problems (for instance, high-quality care, readily 17 available under conditions which encourage timely and appropriate use). (d) Rehabilitation of a l l members of the commu-nity who have health handicaps, acute or chronic, to maximum attainable restoration of well-being and function. (e) Education of members of the community for healthful livi n g , including concern for both individual and community well-being. This is to encompass development of both content and methods for health education. (f) Control of environmental factors influenc-ing health. This should include the elimina-tion or control of noxious or harmful elements (physical and emotional) and the insurance of a creative climate which encourages develop-ment of health and well-being. 2. Encouraging use of resources under conditions which promote their effectiveness. 3. Promoting participation among components of the community (students, faculty, staff, administra-tion, health services) in the interest of devel-oping goals and objectives and of sharing satis-factions and problems, including the development of ethical standards for relationships which re-cognize the need to handle certain types of in-formation with discretion and confidentiality. 4. Recognition of the importance of the performance of research for i t s dynamic influence on the health program. 5. Continuous program evaluation, including specific attention to high quality. 6. Coordinating the health resources of the instit u -tion with those of the community beyond. 7. Developing and promoting health career opportuni-ties. " (6. - p.p. 1 - 2 ) 18 The Standards r e f l e c t an active response to change i n educational goals and methods and to changing concepts and r i s i n g aspirations f o r health i n the United States. Not only did the Standards become the basis f o r considerable improvement i n e x i s t i n g health programs and a point of reference f o r developing programs, but they became the structure f o r evaluating and c e r t i f y i n g college health programs by the American College Health Association. Acknowledging the difference i n the funding mechanisms between American and Canadian health care programs, consideration of our national Medicare plan suggests many implications f o r u t i l i z a t i o n of the Health Service which are discussed i n the report of the survey. 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 have been adapted to s u i t the Canadian context. Generally, however, the areas of investigation were found to have the same concerns and problems. 19 CHAPTER 3  REVIEW OF THE LITERATURE 3.1 The Development of Organized Student Health Services 8' 9 The beginnings of student health services in North America were concerned with methods of mass physical educa-tion patterned on those already popular in Germany and Scandinavia. Intercollegiate and, later, intramural sports were offshoots of physical education and important compon-ents of student health. 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 depart-ment in 1859. Emphasis was given to the elements of envir-onmental hygiene. These growing concerns with physical welfare were the forerunners of what is today called health education. Medical service in the form of limited care and infirmaries for sick students was the last cornerstone to be introduced for the promotion and maintenance of student health. In some colleges this was organized by the students 20 themselves but, i n most, health services originated with one of the other programs. Only i n a few organizations were health services introduced as an o v e r a l l plan. Epidemics of communicable diseases i n colleges hastened the development of student health services i n the United States i n the early part of t h i s century, some-times referred to as the Sanitation Era. In addition, the poor physical standards of Americans i n the F i r s t World War stimulated considerable i n t e r e s t i n student health and, subsequently, i n health promotion i n the post-war period, the res u l t s of which were the extension of e x i s t -ing services. Second World War experience with physical f i t -ness programs further accentuated the necessity of c o r r e l -ating a l l of the elements of physical education, personal hygiene, and medical service to maintain s a t i s f a c t o r y standards of health and functional performance. To the present day i t i s advocated that any factors a f f e c t i n g the physical or mental health of college students f a l l s within the province of the student health 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 phy s i c a l education and t r a i n i n g . Even before the advent of the 21 National Health Service in Great Britain in 19^8, a report on i t s medical schools"'""'" recommended a properly organized student health service in 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 staff. Illness 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 in Great Britain, found that between 12 and 15% of a l l university students failed to graduate. He pointed out that academic l i f e predisposes to the creation of strains which can lead to examination failure, partly explained by the psychological and emotional trauma which may affect students when they leave the security and protection of home and school. Overseas students were found to be even more isolated from their familiar back-ground thereby constituting a special problem relative to mental health. However, the value of compulsory routine medical examinations and procedures such as mass miniature radiography were questioned, and various ways in which student health services could be improved were suggested. Generally, i t was found that the cost of univer-sity education was such that Britain, with i t s limited resources, could not afford to waste human intellect, 22 particularly i f such waste originated from social and psychological factors which could be prevented by app-ropriate health services. It was thus concluded that there was an urgent and pressing need for 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 definite area of a basic program which developed not by planning, but through t r i a l and error in response to specific needs for the promotion and maintenance of the health of students. 3.2 Other Developments In 1920 representatives from fifty-three colleges and universities in the United States formed the American Student Health Association whose name was changed in 1948 to the American College Health Associa-tion, hereinafter referred to as the A.C.H.A. Article II of the Association's Constitution describes i t s pur-pose as follows: VThe purpose of this Association is the establish-ment of an o f f i c i a l and authorized organization through which educational institutions may work for the promotion of health, the prevention of disease, and the care of illness in college and 1 ? university students." 23 A fifty-year history of the A.C.H.A. (1920-1970) was produced by Boynton^, a former president of the Asso-ciation, and appears in the June 1971 issue of The Journal of the American College Health Association. The Journal of the A.C.H.A., so renamed in 1962, has been the o f f i c i a l publication of the Association since 1958 when i t origin-ated as a bulletin called Student Medicine. The U.B.C. Health Service i s a member of the Pacific 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 this a f f i l i a t e Association, described in Article II of i t s Constitution and By-Laws, is as follows: "The purpose of this Association is to provide in the Pacific Basin an organization in which institu-tions of higher education, other organizations and interested individuals may work together to promote health in i t s broadest aspects for students and a l l - i k other members of the college community." No reference can be found in the literature pertaining to the Canadian counterpart of the A.C.H.A., The Canadian Association of College Health Services. It is held to be an informal organization which conducts annual meetings of student health services personnel from across Canada for the purpose of exchanging ideas and in-formation. 24 A five-year Medline search of bibliographic citations relating to student health services, conducted for this study by the U.B.C.'s Woodward Biomedical Library, revealed only one reference specifically indexed as Cana-dian. This was a three-year study of the u t i l i z a t i o n of health services at Dalhousie University in Halifax from 1969 to 1972. 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 in North America. No corresponding publication was found to be produced by the Canadian Association. Approximately 86 references in the search were concerned with psychiatric problems, mental health, c l i n i -cal psychology, or psychological counseling of students. Other references related to drug abuse, sex counseling, birth control and/or abortion, and a substantial number to dental services, c l i n i c a l studies and attitudinal sur-veys. Very few references pertained to the organization, operation, or evaluation of student health services per se, although the need for, and lack of, evaluation is stressed throughout the literature. Only one other Canadian study was found in the literature. It was the 1967 Report on Health and Psychiatric 25 Services on Canadian Campuses produced for The Canadian Union of Students by a former Consultant Psychiatrist at the U.B.C. Health Service. This document records that the oldest student health service in Canada was established at Mount St. Bernard College in Nova Scotia in the year 1884. Three other Canadian campuses were reported to have had student health services for over f i f t y years. It was found that health services were provided on 77.5% of Canadian university campuses, 38.8$ with infirmary f a c i l i t i e s , and kk.9f° provided psychiatric services. 17 One local study ' was discovered to have been conducted in 1971 by two students at the Simon Fraser University on an Opportunities for Youth grant. Although not published, a copy of the study was obtained for refer-ence from one of the students involved in the project which was primarily designed to promote the development of student health services at that university. 18 Another local health survey in 1971 found that students at both colleges and universities in British Columbia reported l i t t l e concern about physical health but placed more emphasis on situational, 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 efficient program to deal with minor emergencies, and consultative resources to assist students in coping with their financial, academic/career and emotional/social problems. 19 Finally, 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 specified information through evaluation procedures would help the health care admin-istrator to have a clearer basis for making decisions for program changes, and that the accountability demon-strated in a l l functions of the campus services surveyed should be one of the most important factors for 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 in the health care literature comprise a very broad range of elements: concepts; general issues; principles; methods; indices; and specific studies. But reviews of programs in 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 pro-gram act 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 effectiveness and program e f f i c i e n c y i n evaluat-ing the performance of a program, that i s , to what extent were objectives attained as a r e s u l t of a c t i v i t i e s (program effectiveness) and at what cost (program e f f i c i e n c y ) . 22 Roemer presented a survey of the l i t e r a t u r e addressed to the various problems encountered i n evaluat-ing health service programs and suggested a framework f o r analysis of the evaluation of various systems or subsystems of health organizations. His framework was based on the premise that a program can be evaluated i n the context of short, i n t e r -mediate , or long-term horizons and that several phenomena within each l e v e l may be defined and measured. 23 7 24 MacMahon et a l . , J Knutson, Levey and Loomba, and various other authors have described what they consider to be the necessary p r i n c i p l e s or steps i n the process of evaluation. James J developed four categories f o r evaluat-ing public health programs. Methods of health care evalua-t i o n have been compiled i n a book of readings and exercises, 26 published at McMaster University. 27 Schulberg and his colleagues ' endorsed Knutson's organizational and personally-oriented reasons f o r evalua-t i o n , supporting the view that the purpose of evaluation 28 i s related to the subsequent u t i l i z a t i o n of the findings. They classified program evaluation models into two cate-gories, the goal-attainment and systems models, and they discussed the characteristics and limitations of each as they affect the implementation of program research findings. Evidence that evaluation research is closely related to program planning can be found in James' des-cription of a circular evaluation process in the goal-attainment model. Etzioni found that the systems model establishes the degree to which a program realizes i t s goals under a given set of conditions, that i s , a balanced distribution of resources among a l l organizational object-ives, not simply the satisfaction of any one goal. Thus the systems model requires considerable knowledge of the way in which an organization functions. One advantage is that much more collected data is included in the analy-sis than is possible in classical research design? another is i t s a b i l i t y to offer the program administrator guidance for implementing change. 29 Schulberg and Baker 7 suggested that organiza-tions should establish planning divisions to assist the feedback of research findings to the program administrator and to insure translation of research into practice. It 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 for planning. In terms of practical input, i t was generally found that evaluation in the health f i e l d has been con-ducted in the sense of comparing achievements with goals established in the planning phase. Action research which contributes much to program progress was not found to substitute for controlled studies which measure program achievement, but long-range controlled studies, on the other hand, did not yield 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 for a more meaningful definition of evaluation and a more use-f u l system for classifying, comparing, and making more cumulative the many evaluation studies in public service and social action programs. Tripodi-^ and his colleagues util i z e d a range of sources in 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 for conducting evaluative studies. They also found to be 30 valuable Suchman's consideration of the strengths and weaknesses of various designs used in evaluative research. His rejection of one correct design for experimental re-search emphasized that "the wide range of existing evalua-tion studies needs systematic classification according to significant c r i t e r i a of content and method." (4. - p.7) But Knutson,'' Reinke,-^2 and others, have con-tended that health care programs are not like laboratory experiments; they seldom start and end at specific pre-determined 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 collect-ing data is in i t s e l f an educational process which may influence and even change the behavior of program per-sonnel. Indeed, the task of increasing the probability of more efficient and effective health services presents a real challenge to program planning, development and evaluation. Wessen-^ 3 has suggested that the activity of evaluation should be part of administrative routine in a well-run organization. However,the process of evalua-tion is often problematic and requires careful analysis and formulation of methodology for i t s conduct. Particu-l a r l y important is the task of developing more sensitive 31 measures of the relative effectiveness of health services. Although excellent designs for such research have evolved in 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 pro-grams. One of the d i f f i c u l t i e s is to specify precisely what should be the target outcomes against which success or failure should be measured. Another is to create a setting controlled enough that the effects of a specific program can be separated from incidental effects. S t i l l another is the d i f f i c u l t y and expense of maintaining follow-up over the period necessary to demonstrate program effects. In addition, there is the need to validly interpret and successfully apply the findings of evaluation. Wessen-^ noted that perhaps the principal impedi-ment to the implementation of evaluation is beyond the sphere of s c i e n t i f i c technique. It may l i e in the reluc-tance of persons and organizations to face the criticism which may be implied in impartial evaluation. But, when an evaluative study is conducted, i t can lead to further research questions which may uncover new insights of real importance for the advancement of professional theory and practice. 32 PART II CONTENTS OF THE STUDY 33 CHAPTER 4 HISTORY AND BACKGROUND OF THE U.B.C. HEALTH SERVICE The information acquired f o r t h i s chapter was obtained from two sources: one was the o r i g i n a l h i s t o r i c a l 34 reports and papers-' documented by Miss E.M. Upshall, P.H.N. , Nursing Supervisor of the Health Service from 1936 to December, 35 1971; the other was the Annual Reports of the Health S e r v i c e ^ from 1954-55 to 1974-75. Reports could not be located f o r the years 1958-59. I960 through 1964, and 1970-71. Informa-t i o n f o r 1970-71 was 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 report. Because of the vast amount of h i s t o r i c a l data found i n the reports and papers, the selected highlights have been summarized by date to present an overview of developments and trends i n the Health Service over the years. These are pre-sented i n a p o i n t - l i k e manner, followed by four tables depict-ing annual r e g i s t r a t i o n , Health Service v i s i t s , Hospital u t i l i -zation, and a summary of services. HISTORICAL SUMMARY: 1915 - Inception of the University of B r i t i s h Columbia. (This date was a c t u a l l y documented as 1912 but the U.B.C. Calendar states i t to be 1915.) 34 - Medical Director of the Vancouver School Board appointed to examine University students. Exam-inations were performed i n the evening at the Vancouver General Hospital O.P.D. u n t i l 1936. Students examined were a l l new U.B.C. registrants, 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 physical condition had been unsat-i s f a c t o r y i n the previous year. 1925 - U.B.C. moved to i t s present West Point Grey campus. - Winter session student population: 1984, summer session: 394. - Student Health Service commenced with the appoint-ment of a Medical Health O f f i c e r by an Order-in-Council. 1927 - P r o v i n c i a l Board of Health appointed f i r s t Public Health Nurse f o r the University area, following a measles epidemic. - Provision of a three-room o f f i c e i n the Auditorium building allowed f o r the continuous operation of a f u l l - t i m e Health Unit on the c a m p u s e s s e n t i a l l y a preventive and diagnostic service with no p r o v i -sion f o r s i c k students. - Promotion and maintenance of the health of the students through: - health appraisal of a l l new students - encouragement to consult with private physicians f o r early advice and treatment of defects found 35 - prevention and control of communicable diseases through immunization and general sanitation - emergency f i r s t - a i d treatment and general health advice. - formal health teaching 1928- 29 - 77.7% of students reported to have been vaccinated f o r smallpox at some time duringtheir l i v e s . 1929- 30 - Point Grey Reserve became known as the University Endowment Lands (U.E.L.). 1932 - Epidemic of smallpox i n Vancouver; extra vaccina-tions given. 1935-36 - Physical Education organized on a voluntary basis at U.B.C. i n response to"the need of the student body f o r a systematic physical a c t i v i t y program". Emphasis was on intramural a t h l e t i c s as the geo-graphical l o c a t i o n of U.B.C. precluded major i n t e r c o l l e g i a t e competition. 1936 - Metropolitan Health Committee, organized by the Pr o v i n c i a l M.H.O., provided a generalized public health program f o r Greater Vancouver and benefits of extra services and f a c i l i t i e s of the lar g e r organization f o r the University area. - Appointment of Miss Upshall as Public Health Nurse; r e t i r e d 1971. - Introduction of c l e r i c a l and other additional s t a f f to the Health Service. 36 1936-37 - Tuberculosis occupied f i r s t place as cause of death of college-age persons; project planned f o r early diagnosis and treatment - 24 cases of active pulmonary T.B. discovered at U.B.C. bet-ween 1937 and 1945, but rate of i n f e c t i o n down. - Serious attention given to infectious diseases; f a i l u r e to report to nurse resulted i n exclusion from the University. - Student population: 2,216. 1938 - Psychiatric consultative service commenced with an average of one v i s i t per patient. 1939-1945 - Second World War. 1941-42 - T.A.B.T. vaccine given to a l l Bacteriology students studying the Typhoid organism. 1945 - Health Service expanded to a converted army hut with increased space and personnel. - Two-year compulsory Physical Education required i n order to graduate; medical recheck required i n second year to determine physical capacity f o r the program. - Expansion of campus eating establishments and temporary buildings. - Increased Health Service r e s p o n s i b i l i t y f o r campus sanitation, f o r example, physical examina-t i o n of food handlers. 37 - Formation of President's Committee on Student Health Service and Health Education, with re-presentation from a l l other interested depart-ments . - Health Service acted as Liaison O f f i c e r between the medical departments of D.V.A. and students on grants. Treatments given under instructions of D.V.A. medical s t a f f (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 private physicians. 1946 - Smallpox scare i n Vancouver; extra vaccination c l i n i c s held. 1947 - A l l students p a r t i c i p a t i n g i n competitive sports required to have a yearly medical examination; referred to family physicians f o r necessary t r e a t -ment of defects found. - Follow-up of defects by t i c k l e r - f i l e method, using a form sent to students asking them to report back to Health Service. - Student population: 8,600, more than double 1945 census due to D.V.A. cr e d i t s . - Review of ten years since 1937 revealed: - t o t a l number of physical examinations increased 350%. - t o t a l number of physical examinations of new students, excluding ex-service members, increased 188$ 38 t o t a l number of v i s i t s to the Health Service increased 517%. t o t a l number of consultations by the M.H.Q.. increased 70%. - medical examination re s u l t s were used as an index of student health and to determine trends such as increase i n height of male students. - A.C.H.A.'s Third National Conference on Health i n Colleges, at which U.B.C.'s Dean of Medicine was a committee chairman, urgently recommended the provision of dental diagnostic and therapeu-t i c services. I t stated: "The importance of t h i s care was proved during World War II and warrants t h i s recommendation." The unit record system also recommended f o r a l l student Health Services. 1950 - U.B.C., McGill, Toronto, and one other Canadian univer s i t y belonged to the American College Health Association. T.B. program appeared to be one of the best on the continent; 6,149 chest x-rays taken during the previous session with nine newly diagnosed cases of pulmonary T.B. Smallpox vaccination compulsory; 93.6% of new students already vaccinated on entry to University, with immunization and follow-up done during the year. 39 - T.A.B.T. given to a l l f i r s t - y e a r Bacteriology students. 1951 - Health Service moved to present l o c a t i o n i n Wesbrook Building, with introduction of thera-peutic service, c l i n i c a l lab and x-ray unit. - Hospital opened; i s o l a t i o n of communicable diseases considered important i n the prevention of epidemics i n the dorms and residences. 1952 - U.E.L. public health service, exclusive of the University campus, transferred to Unit #3 of the Metropolitan Health Committee. - Hospital included i n B.C. Hospital Insurance plan, allowing the admission of non-students. - P r o v i n c i a l Board of Health Survey Chest Unit incorporated into x-ray unit to service West Point Grey as well as U.B.C. 1955-56 - Health patterns showed an increase i n r e s p i r a -tory infections (the largest group of conditions seen) and skin conditions, a decrease i n the number of accidents reported, and T.B. s t i l l of concern with 3,128 chest x-rays taken and 21 students under regular surveillance. There were 11 non-student Hospital deaths. - Revaccinations f o r smallpox were the greatest number of immunizations given; others were f o r typhoid, s c a r l e t fever, staph., a l l e r g i e s , and cholera; B.C.G. s t i l l being done. 40 - Three home v i s i t s made, one to a Rural Youth Training School. - 480 doses of a n t i b i o t i c s given. 1957-58 - Epidemic of A s i a t i c influenza i n Sept./Oct., 1957. caused marked increase i n the percentage of respiratory diseases dealt with. - A l l other disease categories showed a decrease from other years, i n d i c a t i n g no major health problems. - Summer school enrolment increased 93-7% which considerably increased Health Service attendance. - Students given option of having University ent-rance medical examinations by family physicians. - Disease s t a t i s t i c s excluded outpatients under M.S.I, or private care. - Salk vaccine made available by P r o v i n c i a l Health Department f o r mass po l i o vaccination c l i n i c s . - 2,872 chest x-rays taken, including a l l contacts of f i v e cases of active pulmonary T.B. discovered i n one facul t y ; four admitted to the sanatorium, 73 under regular surveillance. - Department of Bacteriology began provision of a n t i b i o t i c s e n s i t i v i t y service with 66 cases. - 31 home v i s i t s made, including dorms and residences. - 10 students admitted to Hospital f o r p s y c h i a t r i c treatment; 12 s t a f f admissions. 41 Expansion of ps y c h i a t r i c service planned. Director p a r t i c i p a t e d i n Medical Service and Administration section of A.C.H.A. Annual Meeting; reported valuable material applicable to U.B.C. operation gained from U.S. Health Service Directors. Nursing Supervisor reappointed Treasurer of Canadian Public Health Association, B.C. Branch. 1959-60 - Expansion of psy c h i a t r i c service by formation of Divisi o n of Psychiatry to handle the wide range of student problems presenting i n the emotional and p s y c h i a t r i c f i e l d s . - Analysis of decreased student absences from classes confirmed general good health of students reported by decreased Health Service attendance, except f o r p s y c h i a t r i c service. 9 off-campus deaths, one suicide; one student who died of a heart attack while s k i i n g had been re-s t r i c t e d i n physical a c t i v i t y by the Health Service. 954 chest x-rays taken, 1 active case of pulmonary T.B. admitted to sanatorium. - Policy changes included: routine chest survey x-rays on new students discontinued because of recent concern with r a d i a t i o n exposure; only those with p o s i t i v e tuberculin tests x-rayed. 42 - Health Service excuses f o r absence from P.E. classes no longer required, with a resultant decrease i n P.E. student v i s i t s . - Requirement f o r readmission to class s l i p following 3 days absence due to i l l n e s s changed to one week; resulted i n decrease of 'new v i s i t s ' by nearly '50%. - Medical care and investigation given increased attention i n workload; more space and s t a f f required with increasing student enrolment. The chart i n Appendix l a presents a comparison of student re 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 or obser-vation, f o r the years 1945 to I960. Appendix Ib presents the same comparison f o r the years I960 to 1970. - Health Service reported to be gaining recog-n i t i o n as progressive department; University of Melbourne patterning health program a f t e r U.B.C.'s; Director in v i t e d to speak on U.B.C. Health Service at the B r i t i s h Student Health O f f i c e r s ' Association annual conference. - F i r s t A.C.H.A. annual meeting i n Canada; Dir-ector 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 sessions at Toronto. 1964-65 - Introduction of physiotherapy service. - Present Assistant Director, interested i n pre-ventive and curative a t h l e t i c medicine, v i s i t e d that department at Harvard University. 43 - Plans made to conduct comprehensive i n i t i a l examination including E.K.G., of P.E. Majors; delayed because of space and s t a f f shortage. - C l i n i c started f o r students with emotional pro-blems related to adjustment at the University; expansion of c l i n i c planned. - Total O.P.D. student attendance unchanged a l -though U.B.C. r e g i s t r a t i o n increased. - Student admissions to Hospital decreased, non-student admissions increased. - Medical Services Plan announced by P r o v i n c i a l Government; increase i n students covered by some form of pre-paid medical care (M.S.I.). Consideration given to b i l l i n g insurance schemes f o r services rendered to student patients, and a fee f o r those with no comprehensive coverage. 1965-66 - Total v i s i t s and numbers reporting increased; 50% more new patients seen by p s y c h i a t r i s t s than i n previous year. Need to expand ps y c h i a t r i c service projected. - Student admissions to Hospital increased; non-student admissions decreased. - Influenza epidemic reported i n Feb./March, 1966. - Continuing informal discussions on l i f e problems held i n student residences; increased l i a i s o n with other departments. 44 - Present Nursing Supervisor attended course on New Perspectives in College Health Nursing in Colorado. - Consultant Psychiatrist attended annual A.C.H.A. meeting in California; Survey of Health and Psy-chiatric Services on Canadian Campuses conducted for the C.U.S. - New Physiotherapy Department opened in the War Memorial Gymnasium with a full-time therapist. - A l l students notified 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 for July 1968; fee-for-service to be charged for medical care pro-vided 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 for private medical care. - 3-month e l i g i b i l i t y for B.C. Hospital Insurance not applicable to those in province as students only; University Health and Accident Plan avail-able for foreign students. - Increased emphasis on psychiatric service, ess-entially a short-term procedure; 51 students admitted to Hospital for psychiatric treatment; problem of L.S.D. complications subsiding but increased attention to marijuana use expected; 45 talks on drug abuse given by staff to student groups, on and off campus; continuing informal discussions in male and female residences primar-i l y concerned sex education; regular meetings held with Counseling Service and, occasionally, Housing Administration; budget requested for c l i n i c a l psy-chologist (nursing counselor or psychiatric social worker). - F i r s t organizational meetings (Toronto and Wash-ington) of Canadian Association of College Health Services, a united effort toward uniformity in the method of providing health services in Canada. 1967-68 - Medicare in B.C. July, 1968; acquisition of cov-erage encouraged by staff; fee-for-service opera-tion required more c l e r i c a l work. - F i r s t compulsory health and hospital insurance introduced for non-B.C. residents by Board of Governors' ruling. - Need to expand service forecast although work-load remained constant. - Compulsory entrance physical examination no longer required (because of Medicare), but suggested as valuable. - Intake of psychiatric service levelled off with estimated 2% of student population treated during previous six years but 5% requiring help; increase 46 in private psychiatrists and referrals due to medical insurance coverage; weekly meetings held with other campus counseling services for increased understanding of student problems, non-breach of confidence seen in interdiscip-linary approach; 73 admissions to Health Service Hospital, 4 transfers to V.G.H. Psychiatric Unit; Consultant Psychiatrist participated in Federal/ Provincial 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. universities for 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 registration did not show corr-esponding increase in 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 re-ceiving medical examinations for the years 1928, 1938, and 47 1944 through 1956, i s presented i n Appendix I l a . The same chart f o r the years 1945 through i960 i s shown i n Appendix l i b . Appendix III shows the number of new students who sub-mitted required medical folders at enrolment f o r the years 1958 through 1969, including the number of physical examina-tions performed by the Health Service and by private doctors. The l a s t year r e f l e c t s the discontinuation of entrance physicals. - Operation Doorstep: voluntary chest x-ray and lab. test i n place of compulsory tuberculin test; only 6$ of students found to have p o s i t i v e tuber-culins and no new cases of T.B. found i n two years. - Orthopedic and Dermatology c l i n i c s commenced. - Psychiatric service continued to be responsible f o r about 2$ of the student population; 51 stu-dents admitted to the Hospital, 7 to other psy-c h i a t r i c units; 2 students were known to have committed suicide with 2 others unconfirmed, considered low by s t a t i s t i c s of studies done elsewhere. 1969-70 - Overall average increase of 20$ i n c l i n i c work-load with an increase of 40$ i n a l l e r g y injections given; problems f e l t i n space being used to maxi-mum. - Dermatology and Orthopedic c l i n i c s reported successful with a 25$ increase i n attendance; Gynecology c l i n i c planned. 48 - Student days i n Hospital declining despite increasing enrolment; healthier population assumed responsible as well as higher academic entrance requirements of University. - Liaison with Director of Housing, as large part of Health Service work associated with students l i v i n g i n residences. - No major changes i n ps y c h i a t r i c service; psy-chotherapy sessions increasing. - 10 student deaths reported, the l a s t year to be included i n annual reports. 1971 - Community Health Centre opened on campus. 1971-72 - Miss Upshall r e t i r e d ; Miss Boyle appointed Nursing Supervisor. - Fourth f u l l - t i m e physician appointed. - S t a t i s t i c a l reporting 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 at Community Health Centre r e f l e c t e d i n figures. - Health Service seeing students only, but con-tinued as a campus emergency center because of lab. and x-ray f a c i l i t i e s . - P a t r ol vehicles acting as campus ambulances. - Hospital workload unchanged but fewer student patient days. - No major health problems or epidemics. 49 - O.P.D. painted and some new furnishings purchased. - Very few students considered not adequately protected hy health insurance; compulsory hos-p i t a l and medical insurance f o r non-Canadian students ( i n order to complete r e g i s t r a t i o n at University) considered e f f e c t i v e regulation f o r protecting students f i n a n c i a l l y i n case of i l l n e s s . - L i v e - i n Resident o n - c a l l service f o r Hospital discontinued. 1972- 73 - Workload unchanged; l i t t l e evidence of drug abuse observed; incidence of venereal disease reported low while other segments of the comm-unity had a marked increase; new s p e c i a l i s t c l i n i c services planned with input from s t a f f members. - Hospital Head Nurse r e t i r e d ; succeeded by present Head Nurse, experienced i n Intensive Care. - Mental Health Unit opened i n space vacated by the Department of Health Care and Epidemiology; space i n O.P.D. eased by move of ps y c h i a t r i c service. 1973- 74 - S t a t i s t i c s showed a 10% o v e r a l l increase i n c l i n i c v i s i t s , with a 22% increase i n treatments and counseling by nurses, thought to be better use of t h e i r t r a i n i n g and professional s k i l l s . 50 - Space problems expressed; s p e c i a l c l i n i c s included two Opthalmology and one Ear, Nose, Throat c l i n i c per week; spe c i a l equipment re-quired f o r c l i n i c s said to preclude other use of space; but more complete medical care aimed for. - Ps y c h i a t r i c service showed s l i g h t increase over previous year. - Hospital increase i n patient days due to non-students; student admissions unchanged. - Hospital redecorated; some beds replaced. - 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 in order of genito-urinary, a l l e r g i e s and misc-ellaneous, bones and accidents, skin conditions, and eye, ear, nose and throat categories; general pattern of student use of Health Service maintained. 1974-75 - Overall s t a t i s t i c s comparable to previous years' experience; 33$ increase i n treatments and coun-se l i n g by nurses; s t r a i n on space and personnel reported due to crowded f a c i l i t i e s and spe c i a l c l i n i c s ; winter session enrolment: 22,035. - New x-ray equipment i n s t a l l e d ; survey chest unit not retained with resultant decrease i n number of films taken; T.B. screening service provided by mobile unit from Willow Chest Center. 51 - Length-of-stay in Hospital shortened; alterna-tives and plans discussed to more effectively use the Hospital. - Consultant Psychiatrist, Dr. Schwarz, resigned after 11 years, to become Head of Psychiatry at St. Paul's Hospital; successor experienced in crosscultural and social psychiatry. - Mature approach of students to drug usage noted in contrast to previous years, particularly their reluctance to take antibiotics, aspirin, and tranquillizers. - Annual conference of Pacific Coast College Health Association held in Vancouver, co-hosted by U.B.C, Simon Fraser, University of Victoria, B.C.I.T., and Vancouver Community College. Tables l a and Ib give the U.B.C student registration for the years 1954 - I960 and 1964 - 1970. As mentioned pre-viously, no reports were located for I960 through 1964. Annual enrolment since 1970 in Chapter 5, on the in s t i t u -tional community, is from a different source and therefore not included here. 52 TABLE l a STUDENT REGISTRATION 1954 - I960 YEAR 1954-55 1955-56 1956-57 1957-58 1958-59 1959-60 WINTER SESSION 5,914 6,403 7,699 8,986 NO 10,642 SUMMER SESSION 1,161 1,420 1,810 3,507 FIGURES 3,828 TOTAL 7,075 7,823 9,509 12,493 AVAIL-ABLE 14,470 TABLE Ib STUDENT REGISTRATION 1964 - 1970 YEAR 1964-65 1965-66 1966-67 1967-68 1968-69 1969-70 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 TOTAL 21,709 22,567 23,162 23,642 27,381 28,009 SOURCE: Health Service Annual Reports. The following table indicates the number of student v i s i t s to the Health Service during the la t e f i f t i e s , over the s i x t i e s , and into the seventies. The remarkable increase i n 1971-72 i s thought to be due to the change i n method of s t a t i s t i c a l reporting. 53 TABLE II 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: Health Service Annual Reports. The next two tables give a very general overview of the Hospital u t i l i z a t i o n and a summary of services f o r the years 1954-1975- The introduction of a physiotherapy service can be seen i n corresponding figures f o r 1964-65. and l a t e r ; i n Table IV. The change i n s t a t i s t i c a l report-ing i n 1971-72 i s re f l e c t e d i n the figures f o r treatments and consultations with nurses, and i n the absence of other figures since that time. TABLE III HEALTH SERVICE HOSPITAL UTILIZATION 1954 - 1975 YEAR 1954 -55 1955 -56 1956 -57 1957 -58 1959 -60 1964 -65 1965 -66 1966 -67 1967 -68 1968 -69 1969 -70 1970 -71 1971 -72 1972 -73 1973 -74 1 1974 : "75 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 5647 6029 5835 6574 5539 5450 4901 4652 4526 4255 4045 3680 3921 3959 5477 4036 AVERAGE NUMBER OF DAYS PER PATIENT 6.8 7.3 7.1 6 .7 8 .8 6.57, 5.74 7.84 6.76 7.04 6.89 6.15 7.26 7.69 10. Of 5 7.91 AVERAGE NUMBER OF PATIENTS PER DAY 15.4 16.4 16.0 18.0 15.1 15.2 13.4 12.7 12.3 11.6 11.0 10.0 10.7 9 .8 15.0 11.1 SOURCE: Health Service Annual Reports. TABLE IV SUMMARY OF SERVICES 1954 - 1975 YEAR NO. OF CONSULT'S WITH H.S. PHYSICIANS , NO.OF (NEW STU-iDENTS !EXAMINED BY H.S. PHYSICIAN NO. OF NEW STU-DENTS EXAMINED BY FAMILY PHYSICIAN NO. OF TREAT-MENTS & CONSULT'S WITH NURSES NO. OF STUDENTS REFERRED TO DENT-ISTS & OUTSIDE DOCTORS NO. OF STUDENTS REC'VING CONSULT'S WITH PSY-CHIATRISTS NO. OF STUDENT CONSULT'S WITH PSY-CHIATRISTS NO. OF LAB & X-RAY PROCE-DURES NO. OF PHYSI-OTHER-APY TREAT-MENTS NO. OF DOSES OF IMM-UNIZA-TIONS GIVEN 1954 -55 4,996 12,332 990 26 11,334 125 1,709 1955 -56 5,549 2,114 19 13,670 985 54 12,667 38 1,866 1956 -57 6,714 2,870 10,535 713 31 108 15.337 212 9,835 1957; -58 6,546 ; 2,078 1,217 13,385 483 47 178 15,406 238 6,158 1959 -60 6,940 891 2,530 11.556 618 124 1,123 10,367 237 4,895 1964 -65 13,282 61 4,673 18,553 774 253 1,075 12,209 559 4,842 1965 -66 14,674 170 4,356 19,038 829 284 1,626 11,922 1,250 4,741 1966 -67 14,353 372 5,073 18,648 822 355 2,479 12,386 1,246 5.372 1967 -68 13,451 219 4,762 20,460 704 372 2,239 10,771 1.338 5,019 1968 -69 14,237 115 3,051 18,560 350 383 1,938 9,158 1,134 4,385 1969 -7° 16,709 222 3.079 22,756 842 427 2,809 14,367 1,268 4,636 1970 -21 16,707 2,331 12,621 1,264 5,356 1971 -72 18,730 5,687 394 2,482 11,405 1,696 3,902 1972 -73 18,047 6,635 343 2,672 12,692 1.849 4,233 1973 19,773 8,099 341 2,803 13,841 1,637 4,315 1974 -75 19,266 10,866 357 1,907 12,404 1,618 4,781 56 CHAPTER 5  GENERAL INFORMATION 5.1 The Institution The University of British Columbia opened in the autumn of 1915 in temporary quarters on part of the site of the General Hospital in 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 in Point Grey at the beginning of the 1925-26 session. The University operates under the authority of the Universities Act of the Province of British Col-umbia (B.C.R.S. 1974, C 157). It is composed of a Chancellor, a Convocation, a Board of Governors, a Senate, and the Faculties. It has in i t s own right and name the power to grant degrees established in accordance with the provisions of the Universities Act. The Board of Governors is composed of fifteen members including the Chancellor, the President, two faculty members, eight persons appointed by the Lieu-tenant-Governor- in-Council, two of whom are nominees 57 of the Alumni Association, two members of the Student Association, and one full-time employee of the Univer-sity who is not a faculty member. The University is deemed to be non-sectarian and non-political in principle. Its goals and objectives are considered to be embodied in the following excerpt from the Universities Act: "Each university shall, so far as and to the f u l l extent which i t s resources from time to time per-mit . . . (a) establish and maintain colleges, schools, institutes, faculties, departments, chairs, and courses of instruction? (b) provide instruction in a l l branches of knowledge? (c) establish f a c i l i -ties for the pursuit of original research in a l l branches of knowledge? (d) establish fellowships, scholarships, exhibitions, bursaries, prizes, re-wards, and pecuniary and other aids to f a c i l i t a t e or encourage proficiency in the subjects taught in the university and original research in a l l branches of knowledge? (e) provide a program of continuing education in a l l academic and cultural fields through-out the Province? and (f) generally promote and carry on the work of a university in a l l i t s branches, through the co-operative effort of the board, senate, and other constituent parts of the university." (36 - p. 9) Instruction is offered in each of twelve facul-ties and eight schools. Graduate work is offered by the Faculty of Graduate Studies including the School of Comm-unity and Regional Planning and the Institutes of Animal Resource Ecology, Applied Mathematics and Statistics, Astronomy and Space Science, Industrial Relations, Inter-national Relations, and Oceanography. 58 It can be seen that the interests and a c t i v i t i e s of the i n s t i t u t i o n a l community are broad and diverse, thus precluding the cohesiveness of smaller colleges and uni-v e r s i t i e s . The seaport l o c a t i o n of U.B.C. also has an eff e c t i n the enrolment of students from the P a c i f i c Rim countries and Great B r i t a i n , as well as from across Canada and the United States, a l l of whom have an influence on the programs and a c t i v i t i e s of the Health Service which was developed to provide health care to a l l students who seek or require i t . 5.2 Composition of the I n s t i t u t i o n a l Community A continuing census of students i s available from the Office of Academic Planning, which i s considered ess e n t i a l f o r the development of an appropriate health program. The census provides information concerning the t o t a l number of students, male and female, f u l l -time, part-time, and extension c r e d i t , graduate and undergraduate, senior c i t i z e n s , and foreign students. Other pertinent data relate to enrolment of a l l students by age and sex, f a c u l t y and year l e v e l , age of students entering 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 foreign 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 resources i s available but 59 information concerning predominant and minority s o c i a l backgrounds can be determined from the census s t a t i s t i c s . Such data should be reviewed annually by the Health Service i n an attempt to project a student body increase or decrease, trends, and possible areas that would re-quire the planning or expansion of new and exi s t i n g services. The following tables b r i e f l y enumerate the student.population f o r the years 1969 - 1976. I t should be noted that the source of these figures i s d i f f e r e n t from the source of figures quoted i n the previous chapter. TABLE V: TOTAL ENROLMENT 1969-1976 Calendar Year Male Female To t a l * 1969-70 13,000 7,767 20,767 1970-71 13.027 7,910 20,937 1971-72 12,247 7,579 19,826 1972-73 11,817 7,3^9 19,166 1973-74 12,050 8,050 20,100 1974-75 13,028 9,007 22,035 1975-76 13.253 9,726 22,979 * Full-time and part-time, not including extension c r e d i t and correspondence. 60 TABLE VI : PERCENT - MALE AND FEMALE Calendar Year Male Female Total 1969-70 62.6% 37.4% 100.0% 1970-71 62.2 37.8 100.0 1971-72 61.8 38.2 100.0 1972-73 61.7 38.3 100.0 1973-74 60.0 40.0 100.0 1974-75 59.1 40.9 100.0 1975-76 57.7 42.3 100.0 Source: Office of Academic Planning It is noted that the percentage of female students (graduate and undergraduate), is increasing steadily. A three-year summary of ages of a l l students and percent of total is found in the appendices as Appendix IV. A review of other data on enrolment for the years 1971 - 1976 shows that, for each year, the majority of students are between the ages of 18 and 22 years (58% in 1975-76). The greatest number of students for any age in 1975-76 was 19 years, the youngest high number in five years. In previous years the greatest numbers were 20 and 21 years of age. It appears that a younger student body, and an increasing female popu-61 l a t i o n , c o u l d have many i m p l i c a t i o n s f o r the H e a l t h S e r v i c e programs p r o v i d e d . Appendix V, Age o f S t u d e n t s E n t e r i n g f o r the F i r s t Time 1975-76, shows the g r e a t e s t number o f f i r s t e n r o l e e s t o be 18 y e a r s o f age, 47$ o f those b e i n g f e m a l e . The 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 , o r n e a r l y o n e - t h i r d of the t o t a l e nrolment, 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 the 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 f o r h e a l t h problems and f o r h e a l t h e d u c a t i o n . 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 Academic P l a n n i n g r e c o r d t h a t , o f the 22,979 s t u d e n t s e n r o l e d i n 1975-76, 19,272 (83.86$) were Canadian, 2,848 (12.39$) were immigrant s t u d e n t s , and 572 (2.48$) were f o r e i g n s t u d e n t s on a s t u d e n t v i s a (76$ o f thos e b e i n g g r a d u a t e s t u d e n t s ) . V i s i t o r s , d i p l o m a t i c and o t h e r s t u d e n t s made up the t o t a l r e g i s t r a t i o n . T o t a l i n t e r n a t i o n a l s t u d e n t s f o r 1975-76 num-be r e d 3,889 w i t h 1,385 from T h i r d World C o u n t r i e s . F i g u r e s d a t i n g back t o 1957-58 are a v a i l a b l e f o r r e g i s t r a t i o n by c o n t i n e n t and c o u n t r y o f c i t i z e n s h i p . D i s c r e p a n c i e s i n t o t a l f i g u r e s are thought 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 p r i n t - o u t i n f o r m a t i o n . 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 d e t e c -t i o n , and s p e c i a l s e r v i c e s , a r e recommended as a p p r o p r i a t e 62 for 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 total in s t i t u -tional community. The latter group is not considered of consequence to the Health Service whose primary con-cern is the student population. 5.3 Organization and Administration The By-Laws of the University Health Service Hospital provide a clear statement of the institution's responsibility in the area of student health. The By-Laws are attached in 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. The Articles of each section are outlined in Appendix VI. Approval was given to the By-Laws by the Board of Governors on December 1st, 1952. In order for this policy statement to serve as a guide for the development of operating policies for the health program, i t should be reviewed and revised from time to time. 63 No such statement i s known t o e x i s t f o r the H e a l t h S e r v i c e O u t p a t i e n t Department, h e r e i n a f t e r r e -f e r r e d t o as the O.P.D. I t i s recommended i n the Stan d a r d s t h a t r e a s o n a b l y d e t a i l e d p o l i c y s t a t e m e n t s s h o u l d be developed t o i n c l u d e the t h r e e main program a r e a s : p e r s o n a l h e a l t h s e r v i c e ; e n v i r o n m e n t a l 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 e d u c a t i o n . I t i s f u r t h e r r e -commended t h a t the p o l i c y s t a t e m e n t s s h o u l d be f o r m u l a t e d w i t h the a s s i s t a n c e o f s t u d e n t s , f a c u l t y , and a d m i n i s t r a -t i o n , p r i o r t o a p p r o v a l by the a d m i n i s t r a t i o n and the g o v e r n i n g board o f the i n s t i t u t i o n . One o r more commi-t t e e s o f s t u d e n t s , 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 r e p r e s e n t a t i v e s o f the g o v e r n i n g b oard, as w e l l as the p o s s i b l e i n c l u s i o n o f members of l o c a l m e d i c a l and h e a l t h -r e l a t e d o r g a n i z a t i o n s , can s e r v e as a r e v i e w and a d v i s o r y mechanismi t h r o u g h w h i c h the h e a l t h needs o f the community can be i d e n t i f i e d and recommendations c o n c e r n i n g the h e a l t h program can 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 t i s recommended t h a t the H e a l t h S e r v i c e D i r e c t o r s h o u l d s e r v e i n an a d v i s o r y c a p a c i t y on any such r e v i e w committee. Broad s u p p o r t f o r the program can f u r t h e r be a c h i e v e d t h r o u g h 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 U n i v e r s i t y . 64 At the present time, the Health Service Director is responsible to the Vice-President in charge of Faculty and Student Affairs whose span of control appears so broad as to allow only diluted concern for each of his areas of responsibility. This is incompat-ible with a level of administration which w i l l guarantee continual vigilance over the requirements of the Health Service and provide r e a l i s t i c support for a l l program components. The Director reports briefly to the Board of Management each month as a perfunctory duty. It 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 lines of communication, universally espoused as a measure of good management, are essential to the Director in carrying out his delegated authority to make professional appointments, to establish Health Service functions and ac t i v i t i e s , and to develop the health program as a support for the entire community. The Standards recommend that the Director accept as one of his primary responsibilities the promotion of complete cooperation and coordination among the various departments, offices, individuals, and other resources, 65 both on and off the campus, which can make a contribution to the total health program. It is considered imperative, therefore, for the Director to produce regular reports concerning the activities and services of the Health Service, and to ensure circulation of such reports to a l l department of the institution concerned with the health of the campus community. 66 CHAPTER 6 HEALTH PROGRAMS: SERVICES AND ACTIVITIES 6,1 Outpatient Services A. OBJECTIVES B r i e f l y stated, the purpose of the Health Service i s to provide f o r the health needs of the students during t h e i r time on campus. Nearly complete outpatient care i s available as a d i r e c t service of the health pro-gram through the provision of preventive, diagnostic, therapeutic and some r e h a b i l i t a t i v e services. Individual objectives are documented f o r both outpatient and inpatient services and are r e l a t i v e l y interchangeable. Those pertaining to the ambulatory care unit are the following:* 1. To provide a Public Health Unit on campus with p a r t i -cular supervision of communicable diseases and sanita-ti o n . 2. To provide outpatient services, including emergency service, minor surgery and follow-up care. 3. To maintain adequate f a c i l i t i e s f o r diagnosis and treatment. 6? 4. To assist 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 their most sensitive problems. 6. To teach and promote good health habits. 7. To help the student attend his classes with as l i t t l e time loss as possible in order to achieve his academic goals. 8. To train a l l personnel in the area of student health and welfare. 9. To assist in research activities when requested to do so, for example by supplying material for 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 in that the O.P.D. serves both c l i n i c a l and educational func-tions. In successfully applying the objectives of high quality 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, effective and humane treatment; and an appropriate explanation of 68 t h e i r health problems. Whereas students* expectations concerning health and medical care are r i s i n g , i t i s recommended that every opportunity be exploited to pursue eff e c t i v e health education. B. SCOPE AND AVAILABILITY There i s a clear statement defining those members of 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, including s p e c i a l circumstances which may apply. The statement i s contained i n both the U.B.C. Calendar and the Health Service brochure issued to a l l new reg-i s t r a n t s . The f a c i l i t y i s available to a l l students who take three or more units during e i t h e r the winter or summer session. Students r e g i s t e r i n g f o r the f i r s t time at the University and taking three or more units are re-quired to submit a medical questionnaire on an approved form (see Appendix VII) before r e g i s t r a t i o n can be com-pleted. The necessary forms are provided by the Health Service at the time of acceptance. The University reserves the right to request that a student have a medical examina-t i o n i f circumstances warrant i t and r e g i s t r a t i o n may be cancelled f o r students who do not comply with t h i s request. Graduate students studying on campus and a l l 69 students registered at Summer School are e l i g i b l e f o r necessary care at the Health Service. However, i n v e s t i -gation of pre-existing conditions which do not in t e r f e r e with current academic work i s not undertaken during the short summer session. Routine medical examinations are not provided except i n s p e c i a l circumstances which may apply to the f a c u l t i e s of Medicine, Dentistry, and Nurs-ing, or to a t h l e t i c programs. For detailed information r e l a t i n g to student e l i g i b i l i t y f o r hos p i t a l and medical insurance coverage, foreign students, etc., please r e f e r to Chapter 9, Business Management. The spouse and children or dependents of a student may receive health care at the Family Practice Unit i n the James Mather Building on campus. The Unit also provides service to f a c u l t y and s t a f f members. The hours of operation of the Health Service are 8:15 a.m. - 4:15 p.m., Monday to Friday, during the eight-month winter session, and 8:00 a.m. - 4:00 p.m. on the weekdays during the four-month summer session. The Hospital s t a f f handles a l l emergencies and outpatient complaints a f t e r hours and on weekends. Medical service i s provided at a l l times, using the pocket paging system i f necessary. When a member of the Health Service medical s t a f f i s not on c a l l , arrangements are made with a l o c a l private physician to cover the service. 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 is minimized. It was pointed out in more than one in-stance that evening clinics would be convenient for both students and staff. It was also reported that a proposal relating to evening cl i n i c s was presented to the University administration and approved, but subse-quently rejected by the R.N.A. B.C. for reasons not understood. It is recommended that extended service hours for such needs as considered appropriate by the staff, for example immunizations or V.D. control, be pursued. C. PROGRAM It is estimated that between 125 and 200 students are seen daily at the Health Service during the winter session. Services offered are preventive, diagnostic, and therapeutic. The following are avail-able ; 1. Preventive Services: - periodic health evaluation of individual or spec-ialized groups where indicated, including athletes 71 and those where medical h i s t o r i e s make such examinations advisable - provision of immunizations f o r the prevention of s p e c i f i c diseases - Tuberculin tests and Schick tests as indicated - pap smears f o r c e r v i c a l cancer - control of epidemic diseases on the campus as advised by the Board of Health of the Province of B.C. - mental health f a c i l i t i e s to cope with maladjust-ments and emotional problems which, i f not recog-nized and treated early, may give r i s e to more serious disturbances i n the future. Diagnostic Services: - Medical consultation - C l i n i c a l laboratory procedures by a registered technician - Radiography procedures by a registered technician under the supervision of a Consultant Radiologist Therapeutic Services: - Medical treatment and nursing care f o r both ambula-tory and hospital patients - Psychiatric assessment and treatment - Physiotherapy - Drugs and medications provided f o r inpatients, or 72 prescribed for outpatients and purchased at the Community Health Centre Pharmacy, or at a private drugstore, Special weekly cli n i c s held during the winter session are the following: - Refraction c l i n i c - attended by a refractionist arid an ophthalmologist from the Vancouver General Hospital. - Orthopedic c l i n i c - attended by an orthopedic specialist and the physiotherapist, primarily for athletic injuries. - Ophthalmology c l i n i c - attended by an ophthalmolo-gist 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 specialist 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 pitoriasis rosea. (One sample jar of ointment i s given free of charge, others are charged for since the Health Service must pay for the medications supplied.) A l l v i s i t s to special 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 paid on a fee-per-time basis usually by the half-day. Regular c l i n i c s conducted by the Health Service medical s t a f f include a weekly gynecology c l i n i c with three physicians and the Nurses* Aide i n attendance, and twice-weekly sessions f o r the purpose of b i r t h control orientations and vaginal examinations. Generally four p e l v i c examinations and a one-hour lecture/demonstration can be performed i n the two-hour c l i n i c period. The b i r t h control orientation session i s usually attended by younger students who are using control methods f o r the f i r s t time. Many bring friends of both sexes so the lecture hours are f l e x i b l y designed to s u i t the group attending. Lectures are given by two female physicians on the various methods of b i r t h control; condoms and I.U.D.'s are displayed and discussed. Older students who may have longstanding untreated problems can be seen p r i v a t e l y . Although not publicized, the sessions are reported to be known by word-of-mouth and well attended. The main thrust of the O.P.D. service i s considered to be b i r t h control and a t h l e t i c i n j u r i e s , these two areas reportedly requiring the major portion of medical attention. Thus i t was suggested that more emphasis i s being placed on student education and pre-74 ventive practices rather than on c r i s i s intervention. Obesity and nutrition were also cited as examples of concern in the area of prevention through student educa-tion. It appears that there is a shift toward more public health practice taking place in the Health Service which had i t s origin as a Public Health Unit. This movement is thought to be due to the changing nature of social problems or to the changing needs and expecta-tions of the consumers of the service. It is recommended, therefore, that the structure and functions of the pro-grams be reviewed and changed accordingly in order to keep them effective, timely and streamlined. Also, reasons for the decreasing student u t i l i -zation and occupancy rate of the Hospital are not known although i t is speculated that more students may be receiving treatment from private practitioners or may be in better health generally. Both of these aspects may be attributed to universal hospital and medical insurance coverage. Perhaps i t can be assumed that an increase in the preventive aspects i s , in part, responsible for the decreased hospitalization of student patients. In any case, i t is recommended that every patient contact should be recognized and used as an opportunity foreducation of the student concerning the implications of his particular 75 problem, either physical or emotional, for individual and community health. D. RECORDS Appropriate records are kept of a l l outpatient services. Individual health records include a notation of each v i s i t to the c l i n i c , a brief but pertinent history, physical findings, reports of special examina-tions 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 activities but these have been limited in recent years. It i s recommended that s t a t i s t i c a l reports be kept of a l l services, includ-ing patient identification and diagnosis, the number of patients seen by nurses, physicians and other therapists, the date and time of service, and other pertinent informa-tion which can be used in periodic evaluations of the department to analyze the effectiveness of services, to determine budget requirements, and to plan future services. It is further recommended that indexing of records be under-taken. Additional details and recommendations concerning this area are found in the section on Records. 76 E. PERSONNEL The O.P.D. appears to he s t a f f e d with s u f f i -cient personnel to assure student subscribers of receiving reasonably prompt and e f f i c i e n t care. The t o t a l s t a f f complement i s reported on i n Chapter 7. Health Personnel. I t was observed that, i n addition to a s s i s t i n g the physicians with treatments during regular c l i n i c hours, each R.N. i s assigned to a s p e c i f i c s p e c i a l t y c l i n i c . Each also has a p a r t i c u l a r function to perform such as ordering, stocking supplies, cleaning, and immun-i z i n g . One nurse i s responsible f o r the triage function of screening patients and assigning them to d i f f e r e n t rooms and doctors. Because many of the nurses are long-term employees, i t i s suggested that some interchange of duties would provide a variety of functions f o r each to perform thereby lessening the p o s s i b i l i t y of monotonous routine. In addition, i t i s recommended that many of the custodial functions being performed by the professional s t a f f should be delegated to the Nurses' Aide whose duties include some that are considered to be nursing functions, f o r example ear syringing and changing dressings. I f the workload i s not s u f f i c i e n t to f u l l y occupy Registered Nurses, consideration dtould be given to the employment of an L.P.N, or another Nurses' Aide when a p o s i t i o n on 77 the nursing staff becomes vacant. While such a change may appear unfavourable to the department at present, the development and review of job descriptions for each position should provide evidence of any need for change. Converse to the recommendation to vary the R.N. functions and responsibilities, i t is recommended that one person be delegated the responsibility and authority to f u l l y develop an effective inservice educa-tion program for the growth and development of the total staff, including the Hospital. This position is thought to require constancy in order to be effective and satis-fying. F. FACILITIES The Health Service is centrally located in the West Wang of the three-storey Wesbrook Building. The O.P.D. comprises the main floor, and the Hospital the third floor. Part of the School of Nursing is located on the second floor. The diagram of the O.P.D. in Appendix VIII provides a visual understanding of the layout. There are 6,500 square feet of space in each of the two sections of the Health Service excluding the separate Mental Health Unit. 78 The functional a c t i v i t i e s assigned to each room are outlined b r i e f l y below. Rooms 106 and 108 Rooms 110 and 110A Room 112 Room 114 Rooms 116 & 116A Room ll6B Room ll6C Room 116D Room 118 Room 118A Room 118B Room 120 & 124 Room 122 Room 126, 128 & 130 Room 132 Room 134 Room I36 Room 138 Room 140 Room 142 Room 144 Room 146 Room 148 Storage and Janitor's Closet Staff Lounge (Containing Storage of Medical Records) and Washroom Supervisor's Office Main Reception Desk, Medical Records/ Business O f f i c e , and Patients' Waiting Room E.E.N.T. Rooms Laboratory. X-Ray Corridor (Film F i l i n g & Storage) X-Ray Reading Room and Technician's Office Radiography Room Film Developing Room X-Ray Change Room Female Examination and Treatment Rooms Connecting Change and Washroom Male Examination and Treatment Suite Orthopedic Treatment Room (For Back Ailments & Injuries) General Treatment Room (For Casts, Dressings, Hot Soaks, Ear Syringing, Removal of Warts, Drainage of Cysts, etc.) A l l £dirty" cases are treated in t h i s room which contains multiple supplies. I t i s cleaned between cases but not fumigated.* Treatment Room f o r the Administration of Anti-Allergens (Antigen Serum i s Refrigerated i n the Room) Immunization Room where C l i n i c s are held three times weekly ( B i o l o g i c a l Supplies are Refrigerated i n the Room) Minor Surgery Room Assistant Director's Office Director's Office Medical Secretary's Office Nurses' Aide's Clean-Up and Storage Room 79 * It i s recommended that Room 134 be fumigated a f t e r treatment of a l l " d i r t y " cases and that supplies i n the room be kept to a minimum. While at times the workload would appear to 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 delivery of comprehen-sive student health care with the exception of dental services. The location of the Mental Health Unit i n quarters on the t h i r d f l o o r i s separate from the medical c l i n i c as recommended in the Standards. The possible relocation of the Health Service is discussed i n Chapter 8, Physical Plant. In the event of a move i t i s recommended that planning f o r new quarters include a detailed analysis of the functions and services to be provided, projected patient loads, estimated patterns of use, t r a f f i c flow, and s t a f f i n g patterns f o r both regular and s p e c i a l services. 6.2 Inpatient Services A. OBJECTIVES The following objectives were approved by the U.B.C. Board of Directors i n consultation with the members of i t s medical and administrative s t a f f . 80 "1. To provide good ho s p i t a l service at minimum expense to the patient. 2. To provide good medical and nursing care. 3. To accomodate the patient comfortably i n cheer-f u l a t t r a c t i v e surroundings. 4. To maintain adequate f a c i l i t i e s f o r diagnosis and treatment. 5. To provide good food services. 6. To t r a i n a l l personnel i n the f i e l d of student health and welfare. 7. To provide a Public Health Unit on campus with p a r t i c u l a r supervision of communicable diseases, supervision of sanitation. 8. To teach and promote good health habits. 9. To a s s i s t with student adjustment and counseling problems. 10. To provide outpatient services, including emergency service, minor surgery and follow-up care. 11. 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 - by supplying material for v i r a l studies ( p a r t i c u l a r l y f o r infectious mononucleosis). 12. To seek and maintain the confidence of the students. I f i t i s not obtained then the Health Service 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 seriously required. 13. To help integrate the Health Services with the Administration and a l l departments of the University, thus providing a service to both the student body and the Administration. 14. To help the student attend his classes with a s ~ 7 l i t t l e time loss as possible." ^' As stated i n the previous section, these objectives are interchangeable with the objectives of the outpatient services. In general, i t i s recommended that the provision of bed care on campus proves advantageous where i t can be 81 done economically. I t i s well recognized, however, that the poor u t i l i z a t i o n of the U.B.C. Health Service Hospital i n recent years (see Chapter 4) indicates that 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 consideration should be given to closing the f a c i l i t y and arranging a channel of admission to community hospitals. For students l i v i n g on campus, a residence infirmary could be established as an outreach service to provide i n t e r -mediate or t e r t i a r y l e v e l s of care comparable to that which they might receive at home. Such care could apply, f o r instance, to students with communicable health pro-blems fo 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 general hospital could not be j u s t i f i e d . Others could continue to attend classes during conval-escence and return to f u l l academic a c t i v i t y with l e s s of a handicap than would be l i k e l y i f they were receiving continuing care i n a community hospital some distance from the campus. Furthermore, student i l l n e s s e s often occur i n r e p e t i t i v e seasonal epidemics which can provide waves of patients who cannot be accomodated i n the acute-care i n s t i t u t i o n s . While i t was not generally known to the Health Service s t a f f , some suggestion was made that the Hospital might be closed during the 19?6 summer session as a cost-saving measure. Such a move would have many implications, 82 not the l e a s t of which would be the possible l a y - o f f of several s t a f f members, unless they elected f o r a leave-of-absence concurrent with t h e i r annual vacation to cover the period of closure. 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 of re-funding being d i s -allowed by the B r i t i s h Columbia Hospital Insurance Service (B.C.H.I.S.) at the designated time of re-opening the unit. B. SCOPE OF SERVICES The accepted l e v e l of bedcare provided by the Hospital i s general medical care without surgery i n a 26-bed ward. At the time of the on-site survey, the patient census was seven, with only one student patient. The census was reported to be about sixteen to eighteen during the winter session. Private patients of 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 rate, espec-i a l l y i n the summer months. Patients are not admitted under the age of fourteen years; i t was once attempted but proved impractical. The following table describes the patient census at the time of the review. 83 TABLE VII: PATIENT CENSUS APRIL 28, 1976 Age of Patient Admission Diagnosis Date of Admission Attending Physician Type of Accommo-dation 23 yrs. ! Post-Mono-nucleosis 26/4/76 Health Service Single Room 39 yrs. Lumbar Disc Degeneration 26/4/76 Private* Single Room 88 yrs. Back Pain 18/4/76 Private Double Occupancy 78 yrs. P h l e b i t i s Left Leg 21/4/76 1 ! Private Double Occupancy 27 yrs. , Lumbar Disc Degeneration 22/4/76 Private* Multi-Bed Room 30 yrs. Low Back i Pain, Not j Yet Diag-nosed 23/4/76 Private Multi-Bed Room 34 yrs. Lumbar Disc Degeneration 11/12/75 Private* Multi-Bed Room Source: U.B.C. Health Service Hospital * The three patients with Lumbar Disc Degeneration were a l l admitted under the care of the same physician, who v i s i t s the ward only once a week. This physician was 84 also one of two doctors attending the patient with low back pain, not yet diagnosed. Written histories were not completed for 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 five 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 failure; he was reported to have had previous admissions to the Hospital with the same diagnosis. The possible closure of the Hospital i s dis-cussed elsewhere in this paper. Reference i s also made in other sections to the responsibility of the medical staff to their patients, the institution, 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 training f a c i l i t i e s for the various professions, i t is considered practical that such use could be made of the Health Service. A medical student could perform physical examinations, write up histories, assist in prescribing 85 treatment, and follow up patients f o r private as well as f o r Health Service physicians. It appears that a s i g n i f i c a n t number of out-patients present themselves at the Hospital during the evening and night s h i f t s and on weekends. Some students may be seeking f i r s t - a i d treatment only; others with com-pla i n t s of abdominal pain, nausea and vomiting, chest pain or sudden onset of headache, etc., are requested to remain i n Hospital overnight f o r observation. Refusals to remain are recorded, as are n o t i f i c a t i o n s of the doctor on c a l l . In the case of a d i f f i c u l t patient, the campus p a t r o l or R.C.M.P. are alerted. A log book i s kept of a l l outpatients seen at the Hospital a f t e r hours and contains such pertinent i n -formation as date and time, name and address, marital status, age, complaint and treatment rendered, d i s p o s i -t i o n of case, means of transport ( i . e . p a t r o l or cab), and i n i t i a l s of the attending nurse or doctor. In the event of l e g a l i n q u i r i e s , f u l l signatures should be written i n place of i n i t i a l s . I t i s recommended that s t a t i s t i c s be computed and analyzed regarding the number of patients seen a f t e r c l i n i c hours, the types of complaints and the treatment given, with a view to planning extended hours or s p e c i a l evening c l i n i c s . I f the outpatient case-load increases 86 the demand on the Hospital s t a f f to a notable degree, such as leaving the Hospital patients without R.N. coverage f o r any length of time, then planning to meet that workload should be the r e s p o n s i b i l i t y of the Health Service. A recent audit of narcotic and controlled drugs was conducted by the Narcotics Control D i v i s i o n . While i t was the only such inspection i n three years, the report was s a t i s f a c t o r y . Counter boxes are now used f o r narcotics and controlled drugs. Many of the other medications used f o r inpatients are kept i n ward stock so as to eliminate the necessity and cost of i n -dividual prescribing and packaging. Communication with the Pharmacist i s reported to be good, assistance having been given,in the prepara-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 certain patients (menopausal, asth-matic, etc.) formerly 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 , etc.), t h i s practice i s no longer permitted. A l l necessary medi-cations are provided f o r Hospital patients either from the ward stock or from the Pharmacy. Some sample medi-cations such as Frosst 222's, antihistamines, and Gravol, are available to give to outpatients in the evening, during the hours that the c l i n i c i s closed; or prescriptions may 87 be given out by the doctor on c a l l . Patients with symptoms of venereal disease may be started on treatment as indicated i n which case i n s t r u c -tions are given with the medications. Usually, however, these patients are referred to the Div i s i o n of V.D. Control at 828 West 10th Avenue, Vancouver. C. GENERAL OBSERVATIONS The use of the kardex system i s a recent inno-vation; nursing care plans are now being undertaken. In-di v i d u a l charts and a mobile chart c a r r i e r are also recent additions. An emergency box containing an Ambu-bag inhala-tor, resuscitator, oxygen masks, and disposable syringes, has been set up with i n s t r u c t i o n on i t s use given to the s t a f f by the Head Nurse. Other disposable equipment i s gradually being introduced where i t s need and economy are indicated, f o r instance, i n the care of patients i n i s o l a -t i o n . The present i s o l a t i o n technique involves scrubb-ing and gowning i n the separation room, autoclaving dishes and u t e n s i l s , fumigating the room a f t e r discharge of the patient, and the use of c e r t a i n disposable supplies. The Head Nurse indicated tlie need f o r s p e c i f i c written guide-88 lines for isolation procedures to be used for each conta-gious disease. A procedure manual and a medical manual have been initiated by the Head Nurse; both appear to be useful guides to patient care. A rare case of sickle c e l l anemia was reported to have been picked up because of diagnostic information outlined in the medical manual. Psychiatric ward rounds are conducted weekly with the Chief Psychiatrist. General c l i n i c s , with doc-tors presenting their patients to the staff, were aban-doned because of the small number of staff on duty or able to attend. Hospital inservice education includes a l l Health Service personnel. As noted elsewhere in this paper, the services of a consultant dietitian would be beneficial for pat-ients 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 visual blueprint of the ward layout. 89 The Hospital bed count i s as follows: 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 - single rooms (i s o l a t i o n ) = 4 beds 1 - extra bed set up i n one of the single rooms = 1 bed* TOTAL BEDS 26 * The extra bed set up i n a single room should not be included i n the o f f i c i a l bed count and the number of rated beds should, therefore, be only 25. A l l are considered standard beds on a per diem rate basis. The Hospital unit appears to be conveniently l a i d out as seen i n the Diagram. On the west side of the corridor, Rooms 330 and 334 and Rooms 348 and 352 are the four i s o l a t i o n units, each containing a sink, t o i l e t and shower, with separation rooms connecting each set of two rooms. The nurses' station, ward pharmacy, kitchenette, l i n e n cupboard, supply room and hopper room are located midway down the west side of the corridor. Room 354 has been assigned as an o f f i c e f o r a private physician i n return f o r his o n - c a l l service during the evening and weekend s h i f t s . He was reported to see private 90 patients i n the o f f i c e during his time on duty, which i s considered to be an acceptable practice i f Hospital s t a f f and supplies are not u t i l i z e d . 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 include the gynecology c l i n i c s , The room had once been used as sleep-ing quarters f o r the on-call medical residents, but t h i s practice was discontinued i n 1972. A l l of the multiple-bed rooms are located on the east side of the corridor as are the patients' lounge and bathrooms, s t a f f lounge, two small storage rooms (one f o r supplies, one f o r flower-arranging), j a n i t o r ' s closet, main li n e n supply and storage (for both the Hospital and the O.P.D.), and main ward kitchen. The patients' lounge opens onto a spacious outdoor balcony. In a l l , the Hospi-t a l appears to be generously l a i d out, recently decorated, and well maintained. It i s unfortunate that i t i s so poorly u t i l i z e d . Subject to the closing of the Hospital, only a few recommendations can be made r e l a t i v e to the physical f a c i l i t i e s . One i s that, as f a r as possible, clean and d i r t y supplies should be kept separated. The i d e a l s i t -uation would be to have a " d i r t y " u t i l i t y room separate from the clean supply room. The room designated f o r 91 flower-arranging could be cleaned out and u t i l i z e d as such, since the a c t i v i t y of cutting and watering flowers i s no longer performed. However, as the autoclave and b o i l e r are located i n the single 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 stored, dated, and p e r i o d i c a l l y tested to maintain t h e i r s t e r i l i t y . Second, disposable shower curtains should be used i n the single rooms when patients are hospitalized f o r i s o l a t i o n . For the small number of such patients being admitted, the s t e r i l i t y f a c t o r f a r outweighs any economies that might be r e a l i z e d by using washable curtains. Third, the portable oxygen tanks which are main-tained by the Physical Plant, should be properly stored i n a metal-lined locked room on the outside of the b u i l d -ing. The present storage of tanks i n the jan i t o r ' s closet, with exposure to sunlight and possible c o l l i s i o n , i s consi-dered dangerous i n terms of the p o s s i b i l i t y of combustion or explosion. Fourth, a dishwasher should be obtained (by pur-chase or donation) f o r the main ward kitchen where dishes are washed and dried by hand. This practice i s not consi-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 pressure are maintained. Considering the consistently low patient census a domestic machine would 92 probably s u f f i c e . E. NURSING STAFF The t o t a l Hospital s t a f f i s enumerated i n Chapter 7, Health Personnel. The Head Nurse seems well q u a l i f i e d f o r her position, having previously held the p o s i t i o n of Assistant Supervisor of the Intensive Care Unit and Coronary Care Unit at the Vancouver General Hospital. Many of the recent and on-going changes i n s t i t u t e d by her appear to be innovative and well-organized. Support and a s s i s t -ance f o r necessary changes must be forthcoming from those ultimately responsible f o r the Health Service, or monoton-ous i n a c t i v i t y may r e s u l t i n the loss of valuable personnel. Of the f i v e R.N.'s, one i s the Head Nurse and one the permanent night nurse, leaving three to rotate from days to evening s h i f t s . This rotation means that the three R.N.'s (as well as the three L.P.N.'s) are working one week of evening duty to two weeks of days with only one i n four weekends of f . While t h i s i s not the most desirable rotation compared with the straight Monday-to-Friday day 1 s h i f t worked by the O.P.D. s t a f f , i t i s considered better than rotating to the night s h i f t as well as to days and evenings. 93 In accordance w i t h the Standards there i s a r e g i s t e r e d nurse on duty i n the H o s p i t a l at a l l times. There i s a l s o e i t h e r an L.P.N, or Nurses' Aide working under her 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.) and 1 L.P.N. - DAYS 1 R.N. and 1 L.P.N. - EVENINGS 1 R.N. and 1 Nurses' Aide - NIGHTS The L.P.N.'s ca r r y out p a t i e n t treatments hut do not give medications. Formerly, they were not g i v i n g any p a t i e n t care which i s considered to be a waste of n u r s i n g a b i l i t y . A l i s t of p r e s c r i b e d approved d u t i e s should be obtained 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' Aide and evening L.P.N, which i s acceptable i f p a t i e n t care i s not neglected. I t i s questionable that c e r t a i n of the housekeeper's d u t i e s , such as mending c u r t a i n s and c u l t i v a t i n g flowers f o r the balcony p l a n t e r s , are f u l l y time-consuming i f s t i l l v a l i d . A review and up-dating of job s p e c i f i c a t i o n s would seem to be i n order. F. RECORDS The admitting c l e r k , whose time i s shared w i t h the Mental Health 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 to 94 her on-tte-job t r a i n i n g regarding medical records. In addition to keeping the records, she also keeps s t a t i s -t i c a l accounts such as the day-to-day census provided by the Head Nurse and compiled into monthly reports f o r the Health Service Director. I t i s recommended that s t a t i s t i c a l reports describing Hospital u t i l i z a t i o n should be continued. Any spe c i a l predominance of student i l l n e s s or causes of d i s -a b i l i t y should be summarized and reported. " A l l diagnoses should be kept according to a generally accepted system of nomenclature, preferably the International C l a s s i f i c a -tion of Diseases, Adapted." (Standards Pg. 1 1 ) I t was noted that one private physician provided no medical history and no signed orders on one of his long-stay patients. This i s not an acceptable practice and should be questioned by both the Health Service Director and the B r i t i s h Columbia Hospital Insurance Service which provided the acute-care per diem rate f o r close to a f i v e -month period. 6.3 RECORDS A preliminary health record (see Appendix VII) i s required of a l l students enrolled f o r three units or more, as part of the r e g i s t r a t i o n procedure. The i n f o r -95 mation contained therein i s c o n f i d e n t i a l and cannot he released from the Health Service without the written per-mission of the student concerned. Examination by a physi-cian i s not compulsory f o r University entrance but i s strongly recommended. While special exceptions outlined i n the U.B.C. Calendar previously applied to the f a c u l t i e s of Medicine, Nursing, Dentistry and Physical Education, such entrance examinations are no longer mandatory. No student i s refused admission to the University because of a physical or emotional handicap, provided the condition i s under adequate medical care. Knowledge of such health problems may even be used to aid the student i n successfully adapting to the physical and academic requirements of the i n s t i t u t i o n . The primary purpose f o r gathering information concerning a student's past medical history and current health status, i s to provide a background f o r health care which the student may require while he i s attending the University. In addition, such information can be used as a basis f o r research, epide-miological studies, and so forth. A blanket permission f o r treatment at the Health Service and f o r necessary r e f e r r a l s to private physicians and other community f a c i l i t i e s , i s signed by the student and endorsed by his parent or l e g a l guardian. The treat-ment permitted and outlined i n the student record includes 96 routine health examinations, immunizations, diagnostic procedures, and treatment of illness and/or injuries. In the event of contention over the propriety of specific services, however, such permission granted in advance would not be considered "informed consent". It i s re-commended, therefore, that clearly defined policies be established regarding such contentious areas as psychiatric treatment, birth control, abortion, surgical procedures, hospital admission, legal consent for underage patients, confidentiality of records, privilege 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 is then maintained as a cumula-tive 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 signi-ficant health services rendered elsewhere on campus should be recorded. It i s recommended that the following be in-cluded: - A record of a l l outpatient v i s i t s , and whether the student is 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 for which a report is available. 97 - A l l therapeutic and rehabilitative procedures. - A l l inpatient v i s i t s . - A l l significant services. - An attempt should be made to include a record of services rendered by off-campus agencies in order to provide some measure of follow-up for the student concerned. Inpatient records should be substantially more complete than recorded outpatient data and must include information concerning the present illness, physical examination, past medical history, family and social history, and reports of a l l supporting diagnostic examina-tions. An admission diagnosis and proposed plan of treat-ment should be stated clearly. 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. Progress notes and reports of special examinations 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 disposition of the patient and before the chart is f i l e d . As noted in the previous section, the private physician not f u l f i l i n g his professional obligation relative to medical records is accountable to the Director of the Health Service and to the B.C.H.I.S. whose joint re-sponsibility is to require complete record-keeping on a l l patients admitted to the Hospital. Failure to comply with this re-98 quirement i n a general public hospital would l i k e l y r e s u l t i n the suspension of admitting p r i v i l e g e s f o r the doctor concerned. The manner i n which the outpatient medical records are stored i n the s t a f f lounge of the O.P.D. i s not considered s a t i s f a c t o r y i n terms of maintaining s t r i c t c o n f i d e n t i a l i t y at a l l times. While i t i s recog-nized that storage space i s at a premium, i t i s recommend-ed that a l l medical records be kept i n a secure l o c a t i o n to which access i s controlled and from which unauthorized personnel are excluded. The employment of at le a s t a part-time or consultant record l i b r a r i a n i s discussed i n Chapter 7. Health Personnel. In keeping with the Standards, the detailed re-cords of mental health consultations and other emotional problems are maintained i n separate health records which are kept under stringent surveillance and accessible only to members of the Mental Health Unit. Only an unobtrusive note i s made i n the general health record that additional information i s available i n the Mental Health Unit f i l e . It i s recommended that there be written direc-tions specifying the method by which medical records w i l l be processed, to whom they may be made available, and the conditions under which information 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 information 99 i s released from the Health Service without the written permission of the student concerned. In the case of minor students, i t i s advisable to have the additional consent of parents before information i s released, e s p e c i a l l y i n those situations involving possible l e g a l action. The length of time medical records should be kept depends upon t h e i r usefulness f o r medical or l e g a l reasons and upon the p r o v i n c i a l statute of l i m i t a t i o n s . The Health Service Director advised that the B.C. p r o v i n c i a l regula-tions are followed, that i s , s i x years f o r outpatient re-cords and ten years f o r Hospital records. In fa c t , these regulations have been ten years f o r primary records and s i x years f o r secondary records. However, recent changes i n the Limitations Act and subsequent implications f o r the Hospitals Act have prompted requests from health care or-ganizations to the Government f o r c l a r i f i c a t i o n of the regulations but no firm decision has been made to date i n t h i s regard. It i s considered advisable, therefore, to keep a l l primary records, both inpatient and outpatient, fo r a minimum of ten years, or u n t i l d e f i n i t i v e regulations have been set down. In addition to the cumulative personal health records, s t a t i s t i c a l records are kept of services, and annual reports are prepared f o r review by the central ad-ministration. S t a t i s t i c a l record keeping has been notably 100 l i m i t e d i n recent years and, therefore, i t i s recommended that a more detailed method of keeping s t a t i s t i c s he re-in s t i t u t e d . Such records are considered invaluable f o r reporting and analyzing services rendered, making projec-tions f o r future services, planning educational programs and s t a f f i n g patterns, and most importantly, f o r fore-casting student needs and demands i n terms of health care. They are also v i t a l l y important in explaining past expendi-tures and i n supporting requests f o r future services and programs. The Standards recommend that every health service keep a diagnostic index, preferably coded according to the International C l a s s i f i c a t i o n of Diseases, f o r a l l outpat-ients, and that an active coded diagnostic index should be made mandatory f o r a l l inpatient services. Furthermore, larger i n s t i t u t i o n s such as U.B.C, which have access to computer services, are advised to develop a system f o r automatic processing of t h i s information. The implemen-tatio n of such a system does not seem unreasonable f o r the Health Service and should be given serious consideration, 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 of incorporation of the Health Service into a new acute-care Hospital on the campus. Diagnostic indexes, including r e a d i l y r e t r i e v -able laboratory and x-ray information, should be reviewed regularly, analyzing f o r trends, unusual episodes of i l l -ness, and frequency of problems r e l a t i v e to young adults. 101 ETHICAL & PROFESSIONAL STANDARDS As recommended, i t appears that every e f f o r t i s made to maintain the student's routine record free of i n -formation which might he used to his disadvantage. The Standards recommend separate c o n f i d e n t i a l f i l e s f o r pot-e n t i a l l y compromising data such as psyc h i a t r i c reports, counselling data, re s u l t s of psychological testing, medi-ca l information r e l a t i n g to venereal disease, pregnancy, or drug usage, and police reports. Inpatient records con-taining such data should he removed from routine f i l i n g procedures on completion of treatment and stored i n con-f i d e n t i a l f i l e s . In the event of the development of computerized student records, and p a r t i c u l a r l y , of centralized data banks, i n a new campus Hospital, i t i s recommended that experts be consulted i n the design of such systems f o r delineation and resolution of problems of c o n f i d e n t i a l i t y . Awareness of the problems which can arise permits the sys-tem to be designed i n a manner which meets both the admin-i s t r a t i v e needs of the University and the c o n f i d e n t i a l i t y of Health Service records. In the case of student absences, the Health Service does not have the authority to provide excuses f o r 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, with-out 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 challenge them fo r allegedly incorrect items. Exempted from the provisions of "The Buckley Amendment", and supported by the Recommended Standards of the American College Health Association, are records on students 18 or older, or students i n i n s t i t u t i o n s of post-secondary education, when such records are maintained by cert a i n health professionals, are used only f o r medical care, and are not available to anyone other than those provid-ing such care. I f these conditions are not met, health records become educational records i n the sense of be-coming subject to the provisions of the l e g i s l a t i o n . It has been recommended, however, that only i n an extreme-l y rare occurrence, such as when a patient i s t r u l y homi-c i d a l or s u i c i d a l and refusing treatment, should the c o n f i d e n t i a l i t y of records be voided. 6.4 LABORATORY SERVICES P r i o r to the development of laboratory f a c i l i t i e s i n the Health Sciences Centre Psyc h i a t r i c Unit, the Health Service laboratory provided service to f a c u l t y and s t a f f members as well as to students. However, patients seen at the Family Practice Unit now have t h e i r lab work done at the Health Sciences Centre. The Health Service department i s staffed by a licensed Registered Technologist (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 follow-ing 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 A l l specimens sent out are d e l i v e r e d by the U.B.C. t r a n s p o r t a -t i o n s e r v i c e , pap smears being sent t o the Cytology Lab and V.D.R.L.'s to the P r o v i n c i a l Laboratory. The annual workload f o r the l a s t f o u r years i s shown i n the f o l l o w i n g f i g u r e s which were a v a i l a b l e only from 1972. I t should be noted t h a t u n i t v a l u e s are f a r g r e a t e r than numbers of procedures performed. Combined l a b and x-ray procedures from 1954 are d e p i c t e d i n Table IV, Chapter 4. TABLE V I I I WORKLOAD IN UNIT VALUES.PER MONTH - LAB MONTH 1972 1973 1974 1975 1976** Jan. « 11,217 12,006 13,744 1 6 , 2 3 6 1 3 . 3 5 2 Feb. 8 , 8 6 3 9,574 13,540 13.499 11,887 Mar. 8,587 11,963 14,216 1 3 , 3 1 0 13,140 Apr. 5,475 7 ,652 8,948 9,829 May 4 , 0 6 7 3,963 8 ,155 3 ,701 June 2,486 4,192 6 ,071 4,086 J u l y 4,282 6,715 6 ,731 6 ,305 Aug. 4 ,615 6,598 6 ,910 4,476 Sept. 9 , 5 5 0 12,514 15,717* 12,035 Oct. 11,268 15,711 1 7 , 1 3 0 * 1 5 , 0 1 5 Nov. 8,437 13,810 13,991* 11,052 Dec. 6 ,551 4,349 9,671 5,494 TOTAL 85,398 109,047 134,824 115,038 -106 Source: Health Service Laboratory Records. * There was a reported measles epidemic during the three months i n d i c a t e d i n 1974, although i t was s t i l l the b u s i e s t year i n f o u r , even accounting f o r the epidemic. ** The f i g u r e s are incomplete f o r 1976 since the o n - s i t e c o l l e c t i o n of data took place i n A p r i l . While i t can be seen that the workload i s i n -c r e a s i n g each year, a breakdown of 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 valuable i n determining e x a c t l y what the demand was. A l o g book and records are kept of a l l determinations and f i l e d i n the p a t i e n t ' s chart. A' system f o r the r e t r i e v a l of data 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 records, i s recommended f o r reviewing the o v e r a l l work of the l a b o r a t o r y , f o r supporting the review of c l i n i c a l s e r v i c e s , and f o r conducting research. 6.5 RADIOLOGICAL SERVICES This department i s operated p r i m a r i l y to serve students at 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 or as p a t i e n t s i n the Health Service 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 doctor or by one of the Health Service p h y s i c i a n s . The department a l s o provides r a d i o l o g i c a l s e r v i c e s to the Health Sciences Centre Psy-c h i a t r i c U n it and the Family P r a c t i c e U n i t , and i s to be used i n f u t u r e by the Extended Care Unit being constructed 107 on the campus. As a convenience to them, s e r v i c e i s given to employees of the U n i v e r s i t y and, on occasion, to p a t i e n t s who have no connection w i t h the U n i v e r s i t y . A l l o u t p a t i e n t appointments are made by the o f f i c e ; i n s t r u c t i o n s and medications are given by the c l e r i c a l s t a f f , or by a nurse when necessary. H o s p i t a l appointments are made d i r e c t l y by the x-ray department on r e c e i p t of a r e q u i s i t i o n or, i n emergencies, by phone. A l l p a t i e n t s 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 to the r e q u i s i t i o n s . S p e c i a l examinations which re q u i r e p r e p a r a t i o n of the p a t i e n t and which are c a r r i e d out only at s p e c i f i e d times are: - Intravenous Pyelogram (I.V.P.) - G a l l Bladder (G.B. or Cholecystogram) - Stomach and Duodenum (S. & D., Barium Meal, Upper G.I. Tract, or Barium Swallow)* - Oesophagus (Same as f o r S. & D.)* - Colon (Large Bowel or Barium Enema)* - *Fluoroscopy S p e c i a l i n s t r u c t i o n s regarding times, appointments, or requirements f o r these and other examinations are a v a i l a b l e i n the department i n p r i n t e d form. Survey chest p l a t e s are taken at a weekly c l i n i c or by appointment; as many as twenty can be booked f o r one 108 c l i n i c period. For other x-rays, one-half hour i s allowed f o r single examinations and longer f o r multiple exams. Re-appointments f o r r a d i o l o g i c a l reports are made with physi-cians f o r four working days a f t e r x-ray examinations are carried out. In order of the greatest to the l e a s t number of procedures performed, the following examinations indicate the type of cases treated: - Extremities 3 - Chests - Skulls - Spines - Special Views - I.V.P. - Abdomen - G.B. - S. & D. - Fluoroscopy - Eosophagus - Colon - Small Bowel About the Same Number Minimal Number The annual workload since 1965 i s shown i n the following table. 109 TABLE IX ANNUAL WORK LOAD IN UNIT VALUES - X-RAY".' YEAR 1965 1966 1967 1968 1969 1970 UNITS 1,453 1,459 1,394 1,443 1,600 1,873 AVERAGE UNITS PER WORKING DAY AMOUNT BILLED $17,251 16,992 15,705 16,052 19 .092 22,293 YEAR 1971 1972 1973 1974 1975 UNITS 2,036 2,020 2,018 2,154 2,220 AVERAGE UNITS PER WORKING DAY 8.04* 8.4 8. 8** AMOUNT BILLED $23,832 23.497 23.552 25.891 25,903 SOURCE: H e a l t h S e r v i c e R a d i o l o g y Records * Average d u r i n g the 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 , March/October, November, December, 1973 = 10 .7 . ** Based on 250 w o r k i n g days i n 1975-110 While the workload i n units has been increas-ing s t e a d i l y , the average units per working day f o r the three years recorded appears quite constant. The increas-ing amounts h i l l e d indicate an increase in non-students examined. Special guidelines f o r use of the f a c i l i t y by the Health Sciences Centre Psychiatric Unit were drawn up by the former Consultant P s y c h i a t r i s t f o r the Health Service. B r i e f l y , they follow the rules of the Vancouver General Hospital Psychiatric Unit whereby no routine ad-mission chest plates are taken and x-rays are ordered only f o r s p e c i f i c purposes by the physician i n charge of the case. Procedures available to the Psychiatric Unit are a l l straight x-rays, barium series, and I.V.P. Other procedures requested must be discussed with the x-ray technician. Health Service r e q u i s i t i o n and report forms are u t i l i z e d . -The guidelines state that, at the appointed time, the patient i s transported to the Health Service accompanied by a nurse from the Psychiatric Unit who should remain with the patient throughout the procedure and return with him to the Unit. (Wet films should be returned with the nurse i f they have been s p e c i f i c a l l y requested by the physician.) I t was noted, however, that patients are frequently escorted to the Health Service by I l l another patient. This i s considered to be an unsafe practice and i t i s recommended that the guidelines r e l a -t i v e to patient transportation be reviewed and reinforced. A written report of each examination signed by the Consultant Radiologist i s f i l e d i n the appropriate patient f i l e . Duplicate reports are f i l e d with the x-rays i n the department, and also i n a numerical f i l e . Another duplicate i s forwarded to the source of r e f e r r a l , private doctor or agency. Health Science Centre Psychia-t r i c Unit reports are phoned over immediately when ready; Family Practice Unit reports are sent the same day as the x-ray report i s available. Written instructions regarding d i s p o s i t i o n of each report and copy are available i n the department. A d a i l y log book i s kept of a l l patients referred and examined, and a s t a t i s t i c a l record i s compiled of a l l x-ray procedures performed. This record i s h e l p f u l i n explaining patterns of use, i n providing 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, and i n projecting future needs of the service. Films are f i l e d numerically i n the x-ray depart-ment fo r two years, culled, and stored i n proper sequence in a basement f i l e f o r three years. After f i v e years they are considered obsolete and sold f o r t h e i r s i l v e r content. About every two years the oldest films are sold to make 112 room f o r new ones. Close surveillance i s kept on any films that are borrowed or taken out of the department. A record i s kept of f i l m numbers and s i z e , and of where and when they went out; another check i s made when fi l m s are returned. The department i s staffed by a licensed Regist-ered Technician (Radiography) who received her t r a i n i n g at the Vancouver General Hospital and has been employed at the Health Service f o r several years. She works under the supervision of a private Consultant Radiologist who holds a professorship at the University. It i s recognized that the Technician i s attempting to keep up-dated i n her f i e l d and to make improvements i n her area, such as more comprehensive s t a t i s t i c a l record-keeping. The radiography room i s leaded as required by law; the x-ray table i s a modern machine having been i n -s t a l l e d i n 1974 at a cost of some $40,000.00. The devel-oper i s also a recent model. X-ray equipment i s examined and calibrated at regular i n t e r v a l s , and badge monitoring is done as required by regulation. Details of the physical f a c i l i t y are given in section 6.1, Outpatient Services. While the Standards suggest that i t " i s not worthwhile economically to provide r a d i o l o g i c a l services d i r e c t l y i f an average of less than ten patients i s a n t i c i -pated d a i l y " , the service needs of inpatients and the con-113 v e n i e n c e f o r o u t p a t i e n t s i n t h i s i n s t a n c e have outweighed the f i n a n c i a l c o n s i d e r a t i o n s . I t must a l s o be remembered t h a t U.B.C.'s non-semester system c r e a t e s h e a v i e r peak p e r i o d s d u r i n g the w i n t e r s e s s i o n and t h a t the department i s o p e r a t e d on a y e a r - r o u n d b a s i s . W i t h o u t t h i s v a l u a b l e s e r v i c e , the care p r o v i d e d by the H e a l t h S e r v i c e would be l e s s than comprehensive. 6.6 PHARMACY (MEDICATION SERVICE) The H e a l t h S e r v i c e b u i l d i n g i s d i r e c t l y connected t o the 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 r e c e n t 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 i n t h a t l o c a t i o n . P r e s e n t l y , o n l y i n p a t i e n t m e d i c a t i o n s a re supp-l i e d by the d i s p e n s a r y . The Pharmacy a t the Community H e a l t h C e n t r e on campus now p r o v i d e s the o u t p a t i e n t s e r v i c e a t a r e a s o n a b l e charge. There i s a l s o a p r i v a t e drug s t o r e on campus w h i c h f i l l s p r e s c r i p t i o n s a t a p p r o x i m a t e l y the same c o s t . P r e s c r i p t i o n s f o r s t u d e n t s are kept t o a minimum, the major usage b e i n g t h a t o f b i r t h c o n t r o l p i l l s . Many problems and c o n d i t i o n s are t r e a t e d a l m o s t 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, a n t i b i o t i c s . T h i s c o u r t e s y i s e x t r e m e l y h e l p f u l t o the s t u d e n t p a t i e n t s whose funds a r e u s u a l l y l i m i t e d . I t i s g e n e r a l l y r e c o g n i z e d t h a t t o d a y ' s s t u d e n t s are q u i t e soph-114 i s t i c a t e d i n terms of drugs and t h e i r e f f e c t s on the body systems. Both the medical and n u r s i n g s t a f f s s t a t e d t h a t a remarkable number of students are now r e f u s i n g to have drugs ad m i n i s t e r e d or p r e s c r i b e d f o r them. Communication w i t h the pharmacist was r e p o r t e d to be good; h i s a s s i s t a n c e was h e l p f u l i n d e v e l o p i n g H o s p i t a l p o l i c i e s r e g a r d i n g drugs and medications. I t i s recommended, however, t h a t a pharmacy committee of the medical s t a f f be organized and charged w i t h p e r i o d -i c a l l y r e v i e w i n g those medications and other t h e r a p e u t i c agents to be dispensed by the pharmacy s e r v i c e or ordered by the p h y s i c i a n s f o r the care and treatment of p a t i e n t s , and w i t h making recommendations to the H e a l t h S e r v i c e D i r -e c t o r concerning the a d d i t i o n or d e l e t i o n of items i n the formulary. Committee f u n c t i o n s are to recommend measures f o r the c o n t r o l of the use and abuse of t o x i c and danger-ous drugs i n an attempt to minimize the p o s s i b i l i t y of improper use, and to e s t a b l i s h s p e c i f i c r e s t r i c t i o n s i n the use of p a r t i c u l a r medications f o r i n p a t i e n t s and out-p a t i e n t s , f o r example "stop o r d e r s " . An a d d i t i o n a l func-t i o n may be to i n i t i a t e programs f o r the education of the m e d i c a l and n u r s i n g s t a f f s concerning new medications, as w e l l as f o r p a t i e n t education on the use or abuse of drugs. N a r c o t i c s and o t h e r c o n t r o l l e d 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 rest-ricted 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 con-trolled 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 Stan d a r d s recommend t h a t e v e r y c o l l e g e h e a l t h program s h o u l d make p r o v i s i o n f o r a p p r o p r i a t e d e n t a l s e r v i c e s , r e c o g n i z i n g t h a t t e e t h , t h e i r s u p p o r t -i n g s t r u c t u r e s , and o t h e r o r a l t i s s u e s s h o u l d be g i v e n a p p r o p r i a t e t r e a t m e n t s i m i l a r t o t h a t p r o v i d e d f o r o t h e r body systems. Simple d e n t a l and o r a l problems may be g i v e n i n i t i a l t r e a t m e n t by g e n e r a l m e d i c a l s t a f f , b u t i t i s i m p o r t a n t 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 s e r i o u s 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 s p e c i a l i s t s i n the same manner t h a t m e d i c a l problems are r e f e r r e d t o a p p r o p r i a t e s p e c i a l i s t s . I t i s e s p e c i a l l y i m p o r t a n t t h a t r e s o u r c e s be a v a i l a b l e t h r o u g h w h i c h s t u d e n t s , as young a d u l t s , may assume r e s p o n s i b i l i t y f o r t h e i r d e n t a l and o r a l c a r e . Those elements o f a d e n t a l program 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 s h o u l d be made a v a i l -a b l e on the campus i n the same manner as 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 the h e a l t h program i s t o be t r u l y comprehensive. I n e s t a b l i s h i n g the d e n t a l h e a l t h s e r v i c e , p r o v i s i o n s s h o u l d be made f i r s t f o r those s e r v i c e s w h i c h are most e s s e n t i a l and w h i c h are w i t h i n the c a p a b i l i t y o f the s t a f f r e s o u r c e s . I t i s recommended i n t h e S t a n d a r d s t h a t the 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 f i n a n c e d as an i n t e g r a l p a r t o f the h e a l t h program: - Emergency Treatment - D i a g n o s i s and C o n s u l t a t i o n - P r o p h y l a x i s and P r e v e n t i v e S e r v i c e s - P a t i e n t E d u c a t i o n ( I n c l u d i n g N u t r i t i o n ) - P r o t e c t i v e d e v i c e s f o r s t u d e n t s p a r t i c i p a t i n g i n c o n t a c t s p o r t s . O p t i o n a l s e r v i c e s , such 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 i n s u r a n c e o r on a f e e - f o r -s e r v i c e b a s i s . D e s i r a b l e s e r v i c e s o f f e r i n g comprehensive d e n t a l c a r e o r b e n e f i t s beyond the u s u a l l e v e l o f c a r e , may 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 i n a p r e p a y -ment p l a n . I n o r d e r t o promote r a p p o r t w i t h t h e s t u d e n t s , c o n s u l t a t i o n w i t h the m e d i c a l s t a f f , a c c e s s i b i l i t y from the c l a s s r o o m s and r e s i d e n c e s , and o p p o r t u n i t y f o r p a t i e n t e d u c a t i o n , 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 p o s s i b l e , s h o u l d be p r o v i d e d i n a d e n t a l s u i t e w h i c h i s an i n t e g r a l p a r t o f the H e a l t h S e r v i c e . An a l t e r n a t i v e i s t o use the c l i n i c a l f a c i l i t i e s o f the F a c u l t y o f Dent-i s t r y t o p r o v i d e c l i n i c a l s e r v i c e s f o r s t u d e n t s , i f the i n t e r e s t s and needs o f the s t u d e n t s are g i v e n p r i o r i t y o v e r the convenience of t h e D e n t a l S c h o o l . D e n t a l s t u d e n t s would have the b e n e f i c i a l e x p e r i e n c e o f o b s e r v i n g and p a r t -i c i p a t i n g i n the p u b l i c h e a l t h and e d u c a t i o n a l measures i n s t i t u t e d i n the d e n t a l program. 118 I t i s f u r t h e r s u g g e s t e d t h a t a d e n t a l examina-t 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 the U n i v e r s i t y e n t r a n c e r e q u i r e m e n t s w i t h the n e c e s s a r y forms b e i n g m a i l e d t o the s t u d e n t p r i o r t o r e g i s t r a t i o n . Any u n u s u a l 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 the 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 such f o r m s , and i n c o r p o r a t e d i n t o the w r i t t e n r e c o r d s . Nota-t i o n s o f each 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 s t u d e n t ' s c u m u l a t i v e h e a l t h r e c o r d . S t a t i s t i c s c o n c e r n i n g the number o f p a t i e n t s and u t i l i z a t i o n o f s e r v i c e s s h o u l d be accumulated 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 the p r e s e n t program and t o p r o j e c t more e f f e c t i v e f u t u r e s e r v i c e s . Nowhere i n the 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 h e a l t h , and o n l y up t o 1970 were r e c o r d s k e p t o f the number o f r e f e r r a l s made t o d e n t i s t s and o u t s i d e d o c t o r s as shown i n Table IV, C h a p t e r 4. The 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 the f o l l o w i n g c a r e i s o f f e r e d by the 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 the U n i v e r s i t y who do n o t have, o r cannot a t t e n d t h e i r f a m i l y d e n t i s t : - Emergency t r e a t m e n t s u c h as t o o t h a c h e , f r a c t u r e d 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 ; - R o u t i n e d e n t a l e x a m i n a t i o n and t r e a t m e n t s u c h as f i l l i n g s , 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 stated that these services are offered under cert a i n conditions. One, that the patients requiring hygiene.or routine dental care must be screened to e s t a b l i s h s u i t a -b i l i t y f o r student u t i l i z a t i o n . Two, that the Faculty of Dentistry reserves the r i g h t to select only those patients whose treatment requirements are consistent with the needs of i t s students and compatable with i t s teaching program. Three, that there i s a small defraying charge f o r a l l forms of treatment carried out i n the Dental School. Students interested i n obtaining a screening appointment "for routine dental treatment or emergency care" or f o r dental hygiene., are advised to c a l l i n per-son-or to telephone the Dental Sciences Building. This advice appears incongruous i n that the urgent nature of "emergency care" would be ruled out by the requirements f o r screening and making appointments. Furthermore, i f students were a l l to request i n i t i a l appointments f o r screening i n the event that emergencies might a r i s e , either the Dental School would be deluged with such requests, or screening would become a r i t u a l i s t i c admission procedure. The condition of selection appears to be con-trary to the recommended Standards as outlined above. I t was learned by telephoning the Dental School that the selection of cases i s made at commencement of the f a l l 120 term from a l i s t of names and complaints registered over the spring and summer months, and that the cases selected are those that comply with the teaching needs and require-ments of the school. Yet, despite the f a c t that dental services to students at the i n s t i t u t i o n are v i r t u a l l y non-existent, free dental care was offered to children i n the Vancouver area t h i s summer by U.B.C^s Faculty of Dentistry. A campus bu l l e t i n - ^ 8 reported that f o r the t h i r d summer i n succession, the P r o v i n c i a l Health Branch provided money to cover the cost of the service. The treatment period, from May 3rd u n t i l the end of July, was to cover between 1,200 and 1,500 school children from the Vancouver, Richmond and Surrey area selected through t h e i r schools by public dental health o f f i c i a l s . Treatment was to be provided, under professional supervision, by 28 students entering t h e i r fourth and f i n a l year i n Dentistry, 6 entering t h i r d year, and 11 entering the second and f i n a l year of the dental hygiene program. In the summer of 1975, more than 1,200 children were given treatment which ranged from p a r t i a l and f u l l dentures to 121 e d u c a t i o n on n u t r i t i o n and f l u o r i d e s . I t i s recommended t h a t p r o v i s i o n f o r d e n t a l s c r e e n i n g o f s t u d e n t s he made w i t h i n t h e H e a l t h S e r v i c e and t h a t a t l e a s t emergency cases be r e f e r r e d f o r prompt t r e a t m e n t t o the D e n t a l S c h o o l . To a c h i e v e t h e s e aims, a w o r k i n g r e l a t i o n s h i p must be e s t a b l i s h e d between the H e a l t h S e r v i c e and the D e n t a l S c h o o l w i t h a v i e w t o dev-e l o p i n g a program w h i c h w i l l p r o v i d e a l l o f the e s s e n t i a l d e n t a l h e a l t h s e r v i c e s . C o n s u l t a n t d e n t i s t s might be r o t a t e d t h r o u g h th e H e a l t h S e r v i c e f o r s c r e e n i n g p u r p o s e s , o r a d e n t a l h y g i e n i s t might be employed on a p a r t - t i m e b a s i s . An e v e n i n g d e n t a l c l i n i c f o r s t u d e n t s on campus i s a l s o c o n s i d e r e d t o be a c oncept worthy o f i n v e s t i g a t i o n . I n any e v e n t , the tremendous number o f d e n t a l and o r a l needs o f c o l l e g e s t u d e n t s , p r e s e n t s an o b l i g a -t i o n f o r the H e a l t h S e r v i c e t o f u l f i l i n p r o v i d i n g compre-h e n s i v e h e a l t h c a r e . I n r e l a t i o n t o the d o l l a r s spent f o r a t h l e t i c f a c i l i t i e s , the U n i v e r s i t y ' s c o n c e r n f o r the den-t a l h e a l t h and h y g i e n e of i t s s t u d e n t s , v i t a l components o f p h y s i c a l growth and development, i s d e p l o r a b l e . 122 And y e t , one o f the s p e c i f i c o b j e c t i v e s o f the 6ampus H e a l t h 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 c o n s i s t e n t w i t h the b r o a d e r o b j e c t i v e s o f the U n i v e r s i t y , was the f o l l o w i n g : "To p r o v i d e a h o s p i t a l and d e n t a l c l i n i c w h i c h w i l l s e t the h i g h e s t p o s s i b l e s t a n d a r d s of c a r e f o r p a t i e n t s and w h i c h w i l l be so s t a f f e d and equipped 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 the most com- „ p l e x and s e r i o u s d i s o r d e r s . " T h i s o b j e c t i v e has y e t t o be a c h i e v e d . 6.8 MENTAL HEALTH A. OBJECTIVES"*' I n accordance w i t h the S t a n d a r d s , the p r i m a r y o b j e c t i v e o f the U.B.C. men t a l h e a l t h s e r v i c e i s t o p r o -v i d e prompt r e c o g n i t i o n and e f f e c t i v e t r e a t m e n t o f those members o f the i n s i t u t i o n a l community who are 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 the s t r e s s e s t o w h i c h they a re sub-j e c t e d . I t i s n o t ex p e c t e d t h a t the U n i v e r s i t y assume o b l i g a t i o n f o r l o n g - t e r m t h e r a p y o f d i s t u r b e d s t u d e n t s . R a t h e r , i t i s s u g g e s t e d t h a t the e s t i m a t e d 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 f o r emo-t i o n a l d i f f i c u l t i e s each y e a r , can be h e l p e d e f f e c t i v e l y by b r i e f c o n t a c t w i t h p r o f e s s i o n a l s who have a good under-s t a n d i n g o f the psycho-dynamics o f young a d u l t s . E a r l y 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 t r e a t m e n t can p r e v e n t the f u r t h e r development o f many p o t e n t i a l l y d i s a b l i n g e m o t i o n a l problems. Another recommended o b j e c t i v e i s b e i n g a c h i e v e d t h r o u g h the development o f a community p r e v e n t i v e m e n t a l h e a l t h program, one t h a t views the e n t i r e i n s t i t u t i o n a l community as an environment 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 and c r i s e s can be reduced o r matched w i t h a p p r o p r i a t e a d a p t a t i o n s . The p r e v e n t i o n o f s e r i o u s l o n g -term d i s a b i l i t y i s c o n s i d e r e d t o be as i m p o r t a n t t o m e n t a l h e a l t h as c r i s i s i n t e r v e n t i o n and t r e a t m e n t . I t i s s u g g e s t e d i n the Standards t h a t an urban commuter i n s t i t u t i o n , s u ch as 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 the h e a l t h program r e s o u r c e s ' i n t he a r e a o f m e n t a l h e a l t h i f r e a l needs 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 the s t u d e n t s t r e a t e d a t the U n i v e r s i t y ' s M e n t a l H e a l t h U n i t are commuter s t u d e n t s , and the o t h e r 20% l i v e i n r e s i d e n c e s on the campus. D u r i n g 1975-76, 3 , 3 6 0 o r 14.6% o f the U n i v e r s i t y s t u d e n t p o p u l a t i o n ( 2 3 , 0 0 0 ) l i v e d on campus. 1^ B. FACILITIES The M e n t a l H e a l t h U n i t was c o n s t r u c t e d i n 1 9 7 3 . a d j a c e n t t o the H e a l t h S e r v i c e H o s p i t a l i n the Wesbrook B u i l d i n g . 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 and a main 124 r e c e p t i o n / w a i t i n g room. The f u r n i s h i n g s are new and the dec o r 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 t h r o u g h o u t a i d s i n s o u n d p r o o f i n g the f a c i l i t y . Access t o the u n i t 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 en-courages u t i l i z a t i o n o f the s e r v i c e . I f a d m i t t e d 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 accomodated i n a s i n g l e room t o p r o v i d e them w i t h r e s t 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 . The c l o s e p r o x i -m i t y o f the M e n t a l H e a l t h U n i t a l l o w s f o r c l o s e o b s e r v a -t i o n by the p s y c h i a t r i c s t a f f . More i n f o r m a t i o n on the f a c i l i t y i s c o n t a i n e d i n C h a p t e r 8, P h y s i c a l P l a n t . C. SCOPE OF PROGRAM The M e n t a l 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 appears t o have a f a i r amount o f autonomy. I n o r d e r t o a s s u r e prompt r e c o g -n i t i o n and t r e a t m e n t o f s t u d e n t s i n need o f care f o r emo-t i o n a l p r oblems, the s e r v i c e o p e r a t e s on a 24-hour emer-gency b a s i s u s i n g a p o c k e t - p a g i n g system d u r i n g the hours t h a t the c l i n i c i s n o t open. Most t r e a t m e n t i s p r o v i d e d 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 moving toward c r i s e s i n t e r v e n t i o n and p r e v e n t i o n . No t r e a t m e n t i s p r o v i d e d t o 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 the M e n t a l H e a l t h U n i t i s open and d i v e r s e . 3 2 $ o f the s t u d e n t s are s e l f - r e f e r r e d ; 125 4.11% are r e f e r r e d by the Student S e r v i c e s ' C o u n s e l l i n g O f f i c e and the Dean o f Women; most are r e f e r r e d by the m e d i c a l s t a f f o f the H e a l t h S e r v i c e . G e n e r a l l y , more o l d e r s t u d e n t s a t t e n d the U n i t . T h i s r e f l e c t s the v i e w t h a t younger s t u d e n t s have more problems b u t are more i n h i b i t e d and, 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-s e l v e s f o r t r e a t m e n t . P a t i e n t s are 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 n e c e s s a r y . O c c a s i o n a l l y , a s e r i o u s l y d i s t u r b e d s t u d e n t has been a d m i t t e d t o the H e a l t h S c i e n c e s Centre P s y c h i a t r i c U n i t but the p s y c h i a t r i s t s p r e f e r t o use the H e a l t h S e r v i c e H o s p i t a l because o f the s t i g m a w h i c h i s a t t a c h e d t o 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 H o s p i t a l i s used f o r s h o r t - t e r m s t a y s where r e l i e f f rom e n v i r o n m e n t a l p r e s s u r e s s u c h as e x a m i n a t i o n s , i s n e c e s s a r y . Some s t u d e n t s have c o n t i n u e d t o a t t e n d c l a s s e s d u r i n g the day w h i l e r e m a i n i n g i n the H o s p i t a l o v e r n i g h t ; some have w r i t t e n e x a m i n a t i o n s on the H o s p i t a l ward. New programs 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 s e r v i c e i n campus r e s i d e n c e s . R e g u l a r meetings have been h e l d t h i s y e a r w i t h r e s i d e n c e a d v i s o r s t o make arrangements f o r the s e r v i c e t o b e g i n i n the f a l l o f 1976. Much o f the f o l l o w i n g i n f o r m a t i o n was g l e a n e d 19 from a q u e s t i o n n a i r e p r e p a r e d f o r a r e c e n t s u r v e y o f campus f a c i l i t i e s o f f e r i n g a s s i s t a n c e t o s t u d e n t s w i t h 126 m e n t a l h e a l t h problems. The s u r v e y found t h a t a s i g n i -f i c a n t number (42.6$) o f the s t u d e n t p o p u l a t i o n sampled, i n d i c a t e d t h a t t h e y had e x p e r i e n c e d l i f e problems w h i l e a t the U n i v e r s i t y . (An e p i d e m i o l o g i c a l s t u d y o f t h e i n c i d e n c e o f p s y c h i a t r i c problems among the U.B.C. s t u -dent p o p u l a t i o n from J u l y 1975 t o June 1976 i s b e i n g p r e p a r e d by a P s y c h i a t r i c R e s i d e n t and s h o u l d be a v a i l -a b l e by the f a l l o f 1976.) Some p r e s e n t i n g problems are a s s o c i a t e d w i t h major m e n t a l 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 o r o t h e r p s y c h o t i c symptomatology. Other problems r e l a t e t o l o n e l i n e s s , accomodation, o v e r - e a t i n g , s e x u a l impotence, a n x i e t y and t e n s i o n , and s o m a t i c com-p l a i n t s t h a t are a c t u a l l y p s y c h o g e n i c i n o r i g i n . P r o b -lems are d e a l t w i t h p e r s o n a l l y by the m e n t a l h e a l t h s t a f f , b u t r e f e r r a l s are made t o o t h e r r e s o u r c e s as w e l l . O t her r e s o u r c e s used f o r r e f e r r a l s by the M e n t a l H e a l t h U n i t i n c l u d e : p r i v a t e p r a c t i t i o n e r s , p s y c h o l o g i s t s and p s y c h i a t r i s t s ; the H e a l t h S e r v i c e O.P.D.; the H e a l t h S c i e n c e s C e n t r e P s y c h i a t r i c U n i t ; and the Student S e r v i c e s (eg. C o u n s e l l i n g ) . S t u d e n t s who miss o r c a n c e l a s e r i e s o f 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 , are f o l l o w e d up by l e t t e r . No known assessment o f the s e r v i c e s p r o v i d e d by the f a c i l i t y has e v e r been c a r r i e d out by the s t u d e n t s who use them and no f o r m a l e v a l u a t i o n has been done from w i t h i n 127 the H e a l t h Service.- L e t t e r s t o p a t i e n t s and consumer q u e s t i o n n a i r e s are two methods t h a t prove 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 th e y a r e f u l f i l l i n g t he needs and demands o f the p o p u l a t i o n t hey s e r v e . 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 on a U n i v e r s i t y h e a l t h c o u n c i l , d i s c u s s e d l a t e r i n t h i s Chapter. Some conc e r n was e x p r e s s e d t h a t the men t a l h e a l t h program i s unable t o r e a c h a l l o f the s t u d e n t s n e e d i n g h e l p . One of the re a s o n s i s assumed t o be t h a t s t u d e n t s a re a f r a i d o f b e i n g l a b e l l e d m e n t a l l y i l l i f t h e y seek out the s e r -v i c e s o f a p s y c h i a t r i s t . Among a h o s t o f f a c i l i t i e s and s e r v i c e s t h a t were c o n s i d e r e d by the s u r v e y t o be the most needed on the 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 h e a l t h problems 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 i n a non-m e d i c a l s e t t i n g and, two, g r e a t e r c o - o r d i n a t i o n o f e x i s t -i n g f a c i l i t i e s . The f i r s t i s e x t a n t , the second i s r e -commended . U t i l i z i n g the r i c h c l i n i c a l and e d u c a t i o n a l e x p e r i e n c e o f the M e n t a l H e a l t h U n i t , r e s e a r c h i s c u r r e n t l y b e i n g c a r r i e d out by a P s y c h i a t r i c R e s i d e n t . The up-date 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 fo r m e r H e a l t h S e r v i c e C o n s u l t a n t P s y c h i a t r i s t i s i n p r o c e s s . I t i s hoped t h a t an up-date o f a l l o f the s t u d e n t m e n t a l h e a l t h s e r v i c e s w i l l be a c c o m p l i s h e d . 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 about 1.5% o f the s t u d e n t p o p u l a t i o n i s seen i n the M e n t a l H e a l t h U n i t each y e a r . More female s t u d e n t s t h a n male s t u d e n t s are seen w h i c h i s thought t o be due t o the f a c t t h a t female s t u d e n t s seek p s y c h i a t r i c t r e a t -ment a t an e a r l i e r age tha n male 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 because f e m a l e s are more ready t o seek h e l p f o r t h e i r problems. An e s t i m a t e d s e r v i c e census f o r a t y p i c a l y e a r i s shown i n the f o l l o w i n g t a b l e : | W — — .M,— 1 I.- -..— —„•-— . . . . 1 . • —« •. —~ "' " — ' • " TABLE X PSYCHIATRIC SERVICE CENSUS*BY SEX Number o f P a t i e n t s Number o f St u d e n t s P e r c e n t a g e Seen MALE FEMALE 152 188 12,939 8,985 1.174 2,092 TOTAL 340 21,924 1.551 SOURCE: Dr. M. Kwan, P s y c h i a t r i c R e s i d e n t . 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 group as seen i n Table X I , b u t more American s t u d e n t s p r e s e n t them-s e l v e s f o r s e r v i c e . I t i s c o n s i d e r e d t h a t t h i s a s p e c t might be due t o c u l t u r a l and s o c i a l d i f f e r e n c e s . 129 TABLE XI PSYCHIATRIC SERVICE CENSUS* BY COUNTRY OF BIRTH Number of Patients Number of Students Percentage Seen CANADA 204 18 ,035 1 . 1 3 1 FOREIGN 1 3 6 3 , 8 8 9 3 - 4 9 7 U.S." 5 8 8 0 6 7 . 1 9 6 OTHER THAN U.S. 78 3 , 0 8 3 2 . 5 3 0 SOURCE: Dr. M. Kwan, Psychiatric Resident * The figures quoted i n the above two tables are only u n o f f i c i a l estimates of a t y p i c a l year. Further breakdown of s t a t i s t i c s into the follow-ing categories i s being considered: foreign, e.g. into countries; marital status; s i b l i n g rank; number of c h i l d -ren; stresses; l i f e breakdown; complaints; and severity of i l l n e s s . This ambitious project should provide thoughtful insights into the psychodynamics of young adults and other students. 130 D. RECORDS A p p r o p r i a t e r e c o r d s a re kept s e p a r a t e from 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 t o the M e n t a l H e a l t h 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 are n o t e d i n the o u t p a t i e n t r e c o r d . As recommended, and 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 p a p e r , a l l r e c o r d s a re kept s t r i c t l y c o n f i d e n t i a l . I f r e q u e s t e d by the s t u d e n t , a statement i s f o r w a r d e d r e -g a r d i n g t r e a t m e n t r e n d e r e d o r recommended by the 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 t o do so. Stud e n t s must s i g n consent forms f o r the r e l e a s e o f i n f o r m a -t i o n t o a p r i v a t e p h y s i c i a n o r a n o t h e r agency. P a r e n t s are no t n o t i f i e d of t h e r a p y a d m i n i s t e r e d t o a s t u d e n t u n l e s s s p e c i f i c a l l y r e q u e s t e d by the s t u d e n t concerned. I n d e x i n g o f c h a r t s i s p r e s e n t l y b e i n g u n d e r t a k e n i n o r d e r t o r e p l a c e the log-book system. I n d e x i n g of a l l c h a r t s i s recommended f o r the H e a l t h S e r v i c e , the reasons: f o r w h i c h are c i t e d i n s e c t i o n 6.3, Records. The work i s b e i n g c a r r i e d out by the H o s p i t a l Ward C l e r k who i s r e s p o n -s i b l e f o r a d m i s s i o n s and m e d i c a l r e c o r d s . As recommended i n o t h e r s e c t i o n s o f t h i s paper, the a s s i s t a n c e of a M e d i c a l Record 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 would be o f g r e a t b e n e f i t t o the s e r v i c e . E. PERSONNEL L i m i t e d p s y c h i a t r i c s e r v i c e has been p r o v i d e d a t the 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 P s y c h i a t r i s t 131 conducted assessments on a half-day a week basis. Patients were usually seen for one v i s i t only. When the consultant time was increased to two half-days a week in 1956, a limited number of students were provided with psychotherapy. The need for a full-time service was thus demonstrated by the evidence of the extent of emotional problems among students. This awareness brought about by a slight expansion of the service resulted in the appointment of a full-time Resident from the Department of Psychiatry in September 1959, and year-round service has been available since that time. Since January 1965, there have been two Psychiatric Residents in addition to the full-time Consultant Psychiatrist and one part-time Consultant. The full-time Consultant is a Professor of Psy-chiatry. As the Chief Psychiatrist, he divides his time between supervising the Resident program, including research ac 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 in their third 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 in the Mental Health Unit. Current negotiations are taking place with the School of Social Work with a view to incorporating supervised social work training into the mental health program. It is 132 anticipated that a supervisor from the School would acc-ompany students rotating through the Unit, although some instruction would be offered by the medical staff. Achieve-ment of this extension of the service should be commended. Further expansion should be encouraged to include the strength and perspectives of other disciplines, 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 is recommended in the Standards that support be given to the concept of a team of psychiatrists, psychologists, psychia-t r i c social workers, and psychiatric nurses to provide a broader spectrum of resources and to meet a wider variety of needs than any single discipline alone. Other personnel include the Unit Secretary and the Hospital Ward Clerk who attends to admissions and medi-cal records for the psychiatric service. F. ADMINISTRATIVE RELATIONSHIPS The Mental Health Unit functions as an area of special interest within the Health Service with the Consul-tant Psychiatrist in charge of the program responsible to the Director of the Health Service. As recommended, the source of referrals to the service is as open and diverse as possible with approxi-mately one-third of the students being self-referred. It 133 i s i n t e r e s t i n g t h a t t h e r e has n e v e r been a known r e f e r r a l 19 from o r t o a r e l i g i o u s a d v i s o r ; a campus su r v e y has r e -v e a l e d t h a t s t u d e n t s do n o t use the c h a p l a i n c y s e r v i c e s on the campus. A l t h o u g h mention has been made o f t h e U n i t ' s l i a i s o n w i t h o t h e r r e s o u r c e s such as the Dean o f Women and r e s i d e n c e a d v i s o r s , i t i s recommended t h a t g r e a t e r c o - o r d i n a -t i o n o f e x i s t i n g s e r v i c e s be promoted. G. ETHICAL AND PROFESSIONAL RELATIONSHIPS The recommended s c r u p u l o u s observance o f the p r i n c i p l e s of c o n f i d e n t i a l i t y and the r a r e c i r c u m s t a n c e s under w h i c h t h e y may be breached are d i s c u s s e d i n d e t a i l i n s e c t i o n 6.3, Records. S p e c i f i c a l l y , the Standards recommend t h a t i n f o r -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 s h o u l d o n l y be g i v e n t o p r o f e s s i o n a l p e r s o n n e l under the f o l l o w i n g c i r c u m s t a n c e s : "(a) W i t h the s t u d e n t ' s w r i t t e n p e r m i s s i o n (as w e l l as t h a t o f h i s p a r e n t s o r l e g a l g u a r d i a n i f he i s a m i n o r ) . (b) I f the s t u d e n t ' s i l l n e s s has been se v e r e enough t o r e q u i r e h i s w i t h d r a w a l from s c h o o l . (c) Only a f t e r s h a r i n g w i t h the s t u d e n t , o r h i s p a r -e n t s , the 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. - p.59) 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 r e l a t i n g t o p s y c h i a t r i c t r e a t m e n t be s u b m i t t e d d i r e c t l y t o the s t u d e n t ( o r f o r m e r s t u d e n t ) i n v o l v e d and t h a t he be r e q u e s t e d t o f o r -ward the statement t o the a p p r o p r i a t e agency o r s o u r c e h i m s e l f . 134 6.9 ATHLETIC MEDICINE A. OBJECTIVES The Standards state that the Health Service should be responsible f o r providing medical supervision of the physical education and a t h l e t i c programs, s p e c i f i -c a l l y including: "(a) Supervision of the physical q u a l i f i c a t i o n s f o r a l l participants i n the physical education and a t h l e t i c programs. (b) Provision f o r treatment and r e h a b i l i t a t i o n of students injured during p a r t i c i p a t i o n . , (c) Provision of medical guidance f o r t r a i n i n g a c t i -v i t i e s . (d) Supervision of record keeping f o r a l l accidents and i n j u r i e s , including adherence to standard terminology f o r c l a s s i f i c a t i o n of accidents and i n j u r i e s . (e) Co-operation with the physical education or ath-l e t i c department in developing a program f o r injury prevention. (f) Co-operation with the physical education or a t h l e t i c department i n the t r a i n i n g of personnel involved i n the care and r e h a b i l i t a t i o n of injured athletes." (6. - p.21) B. 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 co-operatively by the Health Service and the Department of A t h l e t i c s as recommended i n the Standards. Physical examinations f o r admission to U.B.C. are no longer mandatory, although the student brochure s t i l l advises that 135 "students enrolling for a B.P.E. degree, or B.Ed, degree with a major in Physical Education, are required to have a supplementary medical examination relevant to participation in their activity courses" by the Health Service physicians. I n i t i a l l y a l l Physical Education students were examined yearly; later only f i r s t year students were seen. At the present time physicals are performed only in special circum-stances, or i f the student or faculty requests that an exam-ination be carried out. Candidates for the sports programs are given physical examinations on an individual basis, for instance, i f there is a known health problem. A review is made of the health information submitted for each incoming student who intends to participate and clearance is granted to those whose records show no clear contraindications to unrestricted act i v i t i e s . However, participants in heavy contact or high-risk sports are examined annually. Three physicians are usually employed for an afternoon at the beginning of the f a l l term to conduct physical examinations on candidates for the football teams. Other high-risk sports requiring special consideration are hockey, rugby, scuba-diving and sky-diving. Appendix X is the guideline used for a Health Assessment of the Basic Scuba Diver. Appendix XI provides instructions to the medical examiner relating to the Medical Examination for Evaluation of Physical Fitness to Participate in Sport Parachuting. 136 The U n i v e r s i t y ' s a t h l e t i c program was r e p o r t e d by the H e a l t h S e r v i c e 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 as the 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 a c t i v i t i e s : Badminton B a s e b a l l B a s k e t b a l l B o w l i n g C r i c k e t C u r l i n g C y c l i n g C r o s s C o u n t r y F o o t b a l l F i e l d Hockey G o l f Gymnastics I c e Hockey Judo Rowing Rugby S a i l i n g S k i i n g S o c c e r Squash Swimming Te n n i s T r a c k & F i e l d V o l l e y b a l l W e i g h t l i f t i n g W r e s t l i n g O t her a c t i v i t i e s r e p o r t e d by the P h y s i o t h e r a p i s t are f i g u r e - s k a t i n g , f e n c i n g , t r a m p o l i n e , and d i v i n g . The e x t r e m e l y busy n a t u r e o f the a t h l e t i c program i s i n d e e d a pparent. The Standards recommend t h a t t h e r e be o r g a n i z e d 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 and o t h e r p e r s o n n e l who have s p e c i a l i n t e r e s t and s k i l l i n t h i s a r e a o f m e d i c a l c a r e . 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 the p r e v e n -t i o n o f p o s s i b l e i n j u r y t o those w i t h p h y s i c a l l i m i t a t i o n s , the p r e v e n t i o n o f e x a c e r b a t i o n o f known e x i s t i n g h e a l t h p r o -blems, and the p r o v i s i o n o f prompt c a r e f o r those who are i n j u r e d . M e d i c a l s u p e r v i s i o n o f s p o r t s programs a t U.B.C. i s n o t o r g a n i z e d by the H e a l t h S e r v i c e , a l t h o u g h a t r i a g e 137 of three physicians is in attendance at the center on weekends for home games. At one time the University paid $25.00 per game for a physician to be in attendance. Curr-ently, the School of Physical Education and Recreation has a budget for game coverage by an Orthopedic Resident or some other person of similar qualifications. An occasional complaint has been registered i f an injury has occurred at a weekend game with no doctor in attendance, but Conference Rules require that a physician be present for heavy contact sports such as football or ice hockey. The Physiotherapist is also in attendance at many of the weekend sports events and i s well trained in handling the injured. A l l news re-leases concerning the nature and extent of injuries to ath-letes are made by the University Information Officer. The stadium contains press and television f a c i l i t i e s and a f u l l y equipped training room in addition to other ameni-ties. Injured athletes who are not transferred directly to the Hospital or to the Physiotherapy Department for treat-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 athletic events and practices take place. The campus ambulance is available on a 24-hour basis,.staffed by Fire Department personnel who are a l l experienced F i r s t -Aid Attendants. 138 The P h y s i o t h e r a p y Treatment C e n t r e i s l o c a t e d i n t he Gymnasium ( a c r o s s from the H e a l t h S e r v i c e ) w h i c h accomodates the A t h l e t i c Department, and o f f i c e s o f t h e S c h o o l of 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 . The p h y s i o -t h e r a p y s u i t e i s equipped w i t h t r e a t m e n t t a b l e s , v a r i o u s p h y s i c a l t h e r a p y m o d a l i t i e s , a sour c e o f i c e , w e i g h t s , p u l l e y s , and i s o m e t r i c b a r s . D e t a i l e d information i s g i v e n i n the f o l l o w i n g s e c t i o n 6.10, R e h a b i l i t a t i o n / P h y s i c a l Medi-c i n e . Records o f i n d i v i d u a l p a t i e n t t r e a t m e n t s a re m a i n t a i n e d i n the P h y s i o t h e r a p y Department; v i s i t s t o the H e a l t h S e r v i c e f o r c l i n i c s and t r e a t m e n t a re r e c o r d e d i n the s t u d e n t ' s h e a l t h f o l d e r . 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 -k e e p i n g i s a l s o g i v e n i n the n e x t s e c t i o n . I t i s recommended t h a t t e r m i n o l o g y used s h o u l d be c o n s i s t e n t w i t h the S t a n d a r d Nomenclature 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 kept c o n c e r n i n g the o c c u r r e n c e o f i n j u r i e s , and t h a t p e r i o d i c j o i n t r e v i e w s be made by the A t h l e t i c Department and-the H e a l t h S e r v i c e w i t h a v i e w t o d e v e l o p i n g programs f o r i n j u r y p r e v e n t i o n . C. PERSONNEL The A s s i s t a n t D i r e c t o r o f the H e a l t h S e r v i c e does n o t have the o f f i c i a l t i t l e o f Team P h y s i c i a n b u t , t h r o u g h h i s i n t e r e s t and e x p e r i e n c e , has become most i n v o l v e d i n 1 3 9 t h e p r o v i s i o n o f m e d i c a l s u p e r v i s i o n f o r a t h l e t e s . He i s a member o f b o t h the Canadian Academy o f S p o r t M e d i c i n e and the Canadian A s s o c i a t i o n o f S p o r t s S c i e n c e s . He l i a s e s w i t h the A t h l e t i c s and R e c r e a t i o n Committee o f the B.C. M e d i c a l A s s o c i a t i o n , and m a i n t a i n s c l o s e c o - o p e r a t i o n w i t h the P h y s i c a l E d u c a t i o n Department, and the A t h l e t i c s T r a i n e r and s t u d e n t t r a i n e r s , as w e l l as the P h y s i o t h e r a p i s t . I n 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 s u p e r -v i s i o n , t h e A s s i s t a n t D i r e c t o r t a k e s p a r t i n p h y s i c a l exam-i n a t i o n s o f a t h l e t e s , i n the weekend t r i a g e u n i t a t the H e a l t h S e r v i c e , a t t e n d s some, b u t n o t a l l , o f the o f f i c i a l games, and s u p e r v i s e s the car 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 a t h l e t e s 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 o r t h o p e d i c s p e c i a l i s t conducts a weekly c l i n i c i n w h i c h 20 t o 25 p a t -i e n t s w i t h a t h l e t i c i n j u r i e s ( m a i n l y knees, s h o u l d e r s , and a n k l e s ) a r e seen i n about a two-hour p e r i o d . A t h l e t i c t r a i n e r s , as recommended i n the S t a n d a r d s , are s u b j e c t t o s u p e r v i s i o n by the H e a l t h S e r v i c e D i r e c t o r ( i n t h i s case the A s s i s t a n t D i r e c t o r ) i n a l l a c t i v i t i e s r e -l a t i n g t o t h e r e c o g n i t i o n , 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 a t h l e t e s and o t h e r s t u d e n t s . I n g e n e r a l , the recommended r e s p o n s i b i l i t i e s o f the Head T r a i n e r are t h e f o l l o w i n g : (1) A s s i s t i n g i n the 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 the purchase and p r o p e r use 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 p r o t e c t i v e equipment. (4) S u p e r v i s i n g the 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 the t r a i n i n g s t a f f . 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 after games. No treatments are given by the trainers even though devices for treating are available in the sports areas, for example, the whirlpool bath at the stadium. The Physiothera-pist who plays a very v i t a l role in the area of athletic medi-cine is reported on in the following section. 6.10 REHABILITATION/PHYSICAL MEDICINE A. OBJECTIVES The Standards recommend that the University should assure the availability of rehabilitation services for stu-dents, faculty, and staff who have suffered impairment of function as a result of illness, accident, work or academic program, and for students with a physical, emotional, or social handicap. It is also considered appropriate for the University to establish specific standards for physical and emotional health as a prerequisite to acceptance in special programs and act i v i t i e s , and to limit acceptance of seriously handicapped students in programs which have special require-ments. In general, every handicapped applicant to U.B.C. is considered on an individual basis. 141 B. PROGRAM Other t h a n the d e s i g n 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 by the p h y s i c a l l y h a n d i -capped, t o e x p e d i t e t r a v e l between f l o o r s by e l e v a t o r s o r ramps, and t o p r o v i d e accomodating t o i l e t f a c i l i t i e s , i t i s n o t known whether U.B.C. has a s p e c i a l r e h a b i l i t a t i o n program f o r h o u s i n g , t r a n s p o r t a t i o n and a c t i v i t i e s o f the handicapped. I t would be h e l p f u l t o have a p r o f i l e o f e x i s t i n g problems and p a s t e x p e r i e n c e s r e g a r d i n g the type and s e v e r i t y o f d i s a b i l i t i e s among s t u d e n t s and o t h e r s , i n 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 c r e a t e r e h a b i l i t a t i o n s e r v i c e s . I n the a r e a o f p h y s i c a l m e d i c i n e , however, t h e r e i s a good program of p h y s i c a l t h e r a p y w h i c h aims a t p r o v i d i n g f u l l 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 have s u f f e r e d i l l n e s s o r d i s a b i l i t y . The remainder of t h i s s e c t i o n r e p o r t s on t h a t department. C. FACILITIES 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 on the l o w e r l e v e l o f the Gymnasium wh i c h was c o n s t r u c t e d f o r the 1954 B r i t i s h Empire Games. The department c o n s i s t s o f f o u r rooms p l u s the bathroom w i t h shower, t o i l e t , s i n k , and saunas. The o u t e r t r e a t m e n t room c o n t a i n s t h r e e t r e a t m e n t benches, two u l t r a - s o u n d machines, a d i a t h e r m y machine, 142 v a r i o u s m o d a l i t i e s such as w e i g h t s , p u l l e y s , and Hydro-c o l l a t o r p a c k s , and the t h e r a p i s t ' s desk. S p o r t s i n j u r i e s ( m o s t l y knees, m e n i s e c t o m i e s , 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 are t r e a t e d here. A second t r e a t m e n t room has two benches, u l t r a -v i o l e t lamps, head p u l l e y , c h a i r , s c r e e n , and w e i g h t s . Female p a t i e n t s and back problems are u s u a l l y t r e a t e d i n t h i s room as i t i s r a t h e r more p r i v a t e . A l s o many s t u d e n t s w i t h acne are r e f e r r e d from the H e a l t h S e r v i c e Dermatology C l i n i c f o r u l t r a - v i o l e t t r e a t m e n t s here. The t h i r d t r e a t -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 , a c o n t r a s t b a t h ( h o t / c o l d ) , and a f r i d g e and f r e e z e r f o r i c e p a c k s , e t c . ; the f o u r t h room i s used f o r s u p p l i e s such as 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 t a p e s . Two n o t a b l e d e f i c i e n c i e s are apparent i n the p h y s i c a l f a c i l i t y . One i s t h a t t h e r e a r e no windows i n the department, and the second i s the #number o f s t a i r s t h a t must be managed by 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 the department f o r t r e a t m e n t . D. PERSONNEL The department i s manned by one R e g i s t e r e d Tech-n i c i a n (P-hysiotherapy) whose time i s d i v i d e d between the H e a l t h S e r v i c e and t h e S c h o o l 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 . H i s s a l a r y i s budgeted t h r o u g h b o t h departments, 143 and he r e p o r t s t o b o t h the H e a l t h S e r v i c e D i r e c t o r and the P h y s i c a l E d u c a t i o n Department Head. The P h y s i o t h e r a p i s t i s v e r y w e l l q u a l i f i e d h a v i n g t r a i n e d i n Z u r i c h , S w i t z e r l a n d , and t a k e n a Canadian q u a l i -f y i n g c o u r s e f o l l o w e d 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 a t U.B.C. He i s an a c t i v e member o f the Canadian A s s o c i a t i o n o f 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 c o n d i t i o n o f employment a t the U n i v e r s i t y , and o f the B.C. H e a l t h S c i e n c e s A s s o c i a t i o n f o r p a r a m e d i c a l groups. A f t e r t h i r t e e n y e a r s ' e x p e r i e n c e a t the Vancouver G e n e r a l H o s p i t a l , he j o i n e d the A t h l e t i c Department i n 1965 because o f an i n t e r e s t i n s p o r t s and s t u d e n t m e d i c i n e . E. PHYSIOTHERAPY PROGRAM I t was i n d i c a t e d t h a t the U n i v e r s i t y ' s l a r g e i n t r a -m u r a l and e x t r a m u r a l a t h l e t i c programs are too much f o r one P h y s i o t h e r a p i s t . Male s p o r t s c o n s i s t o f f i v e rugby, two f o o t b a l l , two s o c c e r , two b a s k e t b a l l and f o u r v o l l e y b a l l teams. Female s p o r t s i n c l u d e f i g u r e - s k a t i n g , a f i e l d hockey team, and f o u r . v o l l e y b a l l teams. Other a c t i v i t i e s o f c o n c e r n t o the P h y s i o t h e r a p i s t are w r e s t l i n g , j u d o , t r a c k and f i e l d , swimming, f e n c i n g , i c e and f i e l d hockey, g o l f , s k i i n g , c u r l -i n g , t r a m p o l i n e , g y m n a s t i c s , and d i v i n g . The f o o t b a l l season i s a v e r y busy p e r i o d and from December u n t i l s p r i n g , i c e hockey, t r a m p o l i n e , and o t h e r gym a c t i v i t i e s r e q u i r e f i r s t -144 a i d f o r i n j u r i e s . Between 35 t o 40 p a t i e n t s may be seen o r t r e a t e d d a i l y i n the w i n t e r s e s s i o n . The summer s e s s i o n i s a l s o r e p o r t e d t o be busy w i t h many t e a c h e r s r e c e i v i n g t r e a t m e n t . There i s no job d e s c r i p t i o n f o r the t h e r a p i s t but the p r e s c r i b e d g u i d e l i n e s o f the Canadian A s s o c i a t i o n o f P h y s i o t h e r a p i s t s and the B.C. D i v i s i o n are f o l l o w e d . These i n c l u d e the t r e a t m e n t o f a l l r e f e r r a l s , r o u t i n e s p o r t s i n j u r i e s , and s i m p l e f i r s t - a i d . The r e s p o n s i b i l i t y o f making a d i a g n o s i s o r o f g i v i n g n o n - p r e s c r i b e d t r e a t m e n t i s r e j e c t e d by the t h e r a p i s t who wishes t o remain w i t h i n t h e scope and l i m i t a t i o n s o f h i s p r o f e s s i o n . Some s t u d e n t s are s a i d t o r e s i s t t h i s s t a n d , e i t h e r because t h e y are a t h l e t e s (and t h e r e f o r e " t o u g h " ) , o r i m p a t i e n t and u n w i l l i n g t o w a i t , f o r example, f o r x - r a y s . The t h e r a p i s t remains f i r m and r e f u s e s t o succumb t o s t u d e n t demands by t a k i n g chances. The P h y s i o t h e r a p i s t does p r o v i d e s e r v i c e t o the H e a l t h S e r v i c e H o s p i t a l but h i s m a i n work l o a d i s c o n c e n t r a t e d on the s t u d e n t p o p u l a t i o n . R e f e r r a l s o f f campus are g e n e r a l l y made t o the Vancouver G e n e r a l H o s p i t a l b u t , o c c a s i o n a l l y , a P h y s i c a l E d u c a t i o n s t u d e n t i s r e f e r r e d t o a p r i v a t e p h y s i o -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 . Requests f o r t r e a t m e n t have been r e c e i v e d from the Workers' Compensation Board, but the department i s c o n s i d e r e d s t r i c t l y a t h l e t i c . There i s no i n v o l v e m e n t i n r e h a b i l i t a t i o n programs f o r handicapped s t u d e n t s 145 although treatment i s provided f o r any i n j u r i e s , and f o r s p e c i a l c o n d i t i o n s l i k e c y s t i c f i b r o s i s . For example, two students w i t h t h i s c o n d i t i o n r e c e i v e d p o s t u r a l d r a i n -age treatments f o r two years. As p r e v i o u s l y mentioned, r e f e r r a l s from the Dermatology C l i n i c are al s o t r e a t e d . Because of the s t a i r s l e a d i n g down to the depart-ment, p a t i e n t s may require a s s i s t a n c e i n g e t t i n g there. Emergencies from the Gym or P h y s i c a l Education Department, such as f r a c t u r e s , are taken down by s t r e t c h e r . I f a f r a c t u r e i s confirmed by a p h y s i c i a n , the p a t i e n t i s t r a n s -f e r r e d to the Vancouver General H o s p i t a l . F i r s t - a i d t r e a t -ment f o r f r a c t u r e s c o n s i s t s of e l e v a t i o n , compression, and i c e . Other f i r s t - a i d i n c l u d e s : A s p i r i n f o r p a i n (with p h y s i c i a n permission) or r e f e r r a l to the Health Service f o r stronger medication 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 the a p p l i c a t i o n of tensors. Cardiac and 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 the department before t r a n s f e r or re l e a s e . Other a c t i v i t i e s of the Physio-t h e r a p i s t include teaching f i r s t - a i d and sports massage to' t h i r d and f o u r t h year P h y s i c a l Education Students, and attend-i n g the weekly c l i n i c at the Health Service w i t h the Ortho-pedic Surgeon. Students seen at the c l i n i c are mostly r e -f e r r a l s f o r physiotherapy. Discussions have taken place regarding the r o t a t i o n of P h y s i c a l Education students through the department as p a r t 146 o f t h e i r t r a i n i n g . W h i l e no p l a n s have been d e v e l o p e d t o t h i s e f f e c t , 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 con-cept i n terms o f the v a l u a b l e a s p e c t s o f p r a c t i c a l t r a i n i n g as w e l l as the p o s s i b l e a s s i s t a n c e w h i c h c o u l d be p r o v i d e d f o r the t h e r a p i s t by s t u d e n t s . He would, however, l i k e l y 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 the p r e s e n t w o r k l o a d , and a s s i s t a n c e from the m e d i c a l s t a f f i n the p r e -p a r a t i o n o f i n s t r u c t i o n a l m a t e r i a l . I t i s recommended t h a t advanced s t u d e n t s i n the S c h o o l o f R e h a b i l i t a t i o n M e d i c i n e p a r t i c i p a t e i n the 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 c l i n i c a l t r a i n i n g . F. RECORDS AND COMMUNICATIONS V i s i t s t o the department a re e i t h e r by appointment o r on a d r o p - i n b a s i s . The appointment t i m e t a b l e i s a p p r o x i -mate o n l y as the P h y s i o t h e r a p i s t t r i e s t o m a i n t a i n a f l e x i b l e s c h e d u l e . He keeps a d a i l y r e c o r d o f a l l v i s i t s i n c l u d i n g name, d a t e , and so u r c e o f r e f e r r a l ; i n d i v i d u a l a t t e n d a n c e c a r d s are used t o r e c o r d p a t i e n t p r o g r e s s n o t e s . Monthly s t a t i s t i c a l r e p o r t s are s u b m i t t e d t o the H e a l t h S e r v i c e and t o the S c h o o l o f P h y s i c a l E d u c a t i o n . A copy o f the Monthly Report of P h y s i o t h e r a p y Treatments i s shown i n Appendix 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 from the H e a l t h S e r v i c e and a t h l e t i c i n j u r i e s . F o r example, o f the 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 were r e f e r r e d from the H e a l t h S e r v i c e and 35 were 147 a t h l e t i c i n j u r i e s . These r e l a t i v e l y low f i g u r e s r e f l e c t s p r i n g e x a m i n a t i o n time a t the U n i v e r s i t y . I n a d d i t i o n , the breakdown o f t r e a t m e n t s i n t o the v a r i o u s s p o r t s c a t e -g o r i e s i s c o n s i d e r e d h e l p f u l i n i n d i c a t i n g a r e a s o f c o n c e r n f o r i n j u r y p r e v e n t i o n . T a b l e IV i n Chapter 4 shows the an 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 r e n d e r e d from 1954 t o 1975- The marked i n c r e a s e i n 1 9 6 5 - 6 6 r e f l e c t s the employment o f the P h y s i o t h e r a p i s t and the p r o v i s i o n o f a f u l l s e r v i c e . No c o l l e c t i o n s o r b i l l i n g o f p a t i e n t s a re n e c e s s a r y ; m e d i c a l i n s u r a n c e c o l l e c t i o n s a r e made t h r o u g h the H e a l t h S e r v i c e , and at t e n d a n c e r e c o r d s p r o v i d e a p i c t u r e o f c o s t s f o r the S c h o o l o f P h y s i c a l E d u c a t i o n . Involvement o f the 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 c o n s i s t s o f p r e - a u d i t d i s c u s s i o n s w i t h the D i r e c t o r s o f the two departments concerned, and arrangements f o r p u r c h a s i n g 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 , s p e c i a l i s t s , t r a i n e r s and coaches, was r e p o r t e d t o be good. 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 r e a d i n e s s f o r a game are r e s p e c t e d , and the c o - 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 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 . I n a l l , i t appears t h a t t h i s department i s o p e r a t i n g a t a v e r y h i g h l e v e l . 148 6.11 HEALTH PROMOTION/PREVENTIVE MEDICINE A. OBJECTIVES The Standards recognize t h a t the promotion of h e a l t h and the prevention of i l l n e s s are the e s s e n t i a l elements of any comprehensive community h e a l t h program. To be e f f e c t i v e , there must be c o o r d i n a t i o n and i n t e g r a -t i o n of programs f o r personal h e a l t h s e r v i c e s , environmen-t 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 educa-t i o n f o r h e a l t h , systems developments, and others. While 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 embodied i n the U n i v e r s i t y ' s programs, there 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. PROGRAM-As reported i n other s e c t i o n s of t h i s paper, every student 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 status p r i o r to admission to the U n i v e r s i t y . A f t e r accept-ance her i s expected to provide 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 concerning h i s past medical h i s t o r y and h i s present h e a l t h s t a t u s to the Health S e r v i c e . AIL i n f o r m a t i o n i s kept c o n f i d e n t i a l and i s used to help meet the academic and personal needs of the student and to prevent the d e v e l -opment of circumstances which might compromise the h e a l t h 149 o f the s t u d e n t o r o t h e r members o f the 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 s e r v i c e s are o f f e r e d by the H e a l t h S e r v i c e i n compliance w i t h the recommended S t a n d a r d s : 1. P e r i o d i c h e a l t h e v a l u a t i o n o f i n d i v i d u a l o r s p e c i a l i z e d groups 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 where m e d i c a l h i s t o r i e s make such e x a m i n a t i o n s a d v i s a b l e . 2. 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 the p r e v e n t i o n o f s p e c i f i c d i s e a s e s . 3. 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 t h r o u g h o u t the y e a r . 4. C o n t r o l o f epidemic d i s e a s e s on the campus as a d v i s e d by the Board o f H e a l t h o f the P r o v i n c e o f B r i t i s h Columbia. 5. M e n t a l h e a l t h f a c i l i t i e s t o cope w i t h m a l a d j u s t -ments and e m o t i o n a l problems, w h i c h , i f n o t c o r r -e c t e d e a r l y t - 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 r e q u i r e m e n t s s p e c i f y a c h e s t x - r a y o r n e g a t i v e 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 a d m i s s i o n . 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 a c i l i t i e s 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 p e r i o d d u r i n g the 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 are a d v i s e d t o a v a i l t h emselves o f the f a c i l i t y . T u b e r c u l i n t e s t s are a v a i l a b l e a t the H e a l t h S e r v i c e d u r i n g the s p e c i a l c l i n i c h o u rs. Through r e v i e w o f e n t r a n c e h e a l t h r e c o r d s , those s t u d e n t s 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 can be i d e n t i f i e d 150 and t h e i r h e a l t h s t a t u s r e v i e w e d on an 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 c h e s t x - r a y c l i n i c ) i s p r o v i d e d f o r a l l s t u d e n t s , the i n t e r v a l b e i n g v a r i a b l e f o r those s u b j e c t t o s p e c i a l r i s k , f o r example, n u r s i n g and m e d i c a l s t u d e n t s . W i t h the i n s t a l l a -t i o n of a new x - r a y machine i n 1974, the s u r v e y c h e s t u n i t was removed. Thus the m o b i l e T.B. t e s t i n g u n i t i s on cam-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 and x-r a y i n g o f p o s i t i v e r e a c t o r s . A r e c e n t p r e s s r e l e a s e i s s u e d by the Sanatorium Board o f B.C. s t a t e d t h a t T.B. x - r a y s c r e e n i n g programs would soon be d i s c o n t i n u e d because o f t h e i r diseconomy i n r e l a t i o n t o t h e i r r e l a t i v e v a l u e . The r e q u i r e m e n t s f o r s m a l l p o x v a c c i n a t i o n s w i t h i n f i v e y e a r s p r i o r t o a d m i s s i o n , i s s t i l l s t a t e d i n the s t u d e n t b r o c h u r e , but t h e y are 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. At the p r e s e n t t i m e , t h e r e appears t o be a dichotomy i n a l l m e d i c a l c i r c l e s c o n c e r n i n g v a c c i n a t i o n f o r s m a l l p o x . C h o l e r a and typhus v a c c i n e s a re n o t g i v e n f r e e o f charge b u t may be pu r c h a s e d a t the H e a l t h S e r v i c e o r a t any pharmacy. W h i l e p r e p a r a t i o n s a re b e i n g made e v e r y -where i n defense o f the t h r e a t e n i n g swine f l u pandemic i n the f a l l o f 1976, no p r e p a r a t o r y s t e p s have y e t been t a k e n by the U n i v e r s i t y . The H e a l t h S e r v i c e has been a d v i s e d t h a t an a l l o t m e n t o f v a c c i n e w i l l 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 s t u d e n t s and s t a f f , but no o t h e r i n f o r m a t i o n i s known and no d i r e c t i v e s have been g i v e n . I t i s c o n s i d e r e d unwise f o r the h e a l t h p r o f e s s -i o n s 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 community a g a i n s t known h e a l t h h a zards and a c o n c e r t e d e f f o r t s h o u l d be c o n t i n u e d i n an attempt t o e r a d i c a t e them. The S t a n d a r d s recommend t h a t each i n s t i t u t i o n s h o u l d s u r v e y i t s academic and e x t r a c u r r i c u l a r a c t i v i t i e s t o determine t h o s e f o r w h i c h s p e c i a l r e q u i r e m e n t s may be a p p r o p r i a t e , f o r example, h e a l t h p r o f e s s i o n s , e d u c a t i o n , a t h l e t i c s , oceanography, and f o r e s t r y . Both academic and r e s e a r c h programs s h o u l d be r e v i e w e d t o determine the p r e s e n c e of h e a l t h h a z a r d s f o r w h i c h p r e v e n -t i v e measures, such as i m m u n i z a t i o n , s h o u l d be i n s t i t u t e d . I t i s u r g e n t l y recommended, t h e r e f o r e , t h a t p r e p a r a t i o n s b e g i n i m m e d i a t e l y t o combat the p o s s i b l e w i d e - s p r e a d o u t -b r e a k o f the d i s e a s e known as swine 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 programs 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 e d u c a t i o n t o p r e v e n t com-p i l a t i o n s o f known e x i s t i n g d i s e a s e s such as d i a b e t e s , e p i -l e p s y , and c h r o n i c c a r d i o v a s c u l a r o r pulmonary d i s e a s e . P e r i o d i c s c r e e n i n g o r d e t e c t i o n programs are a l s o a d v i s e d t o i d e n t i f y s t u d e n t s and o t h e r s w i t h c h r o n i c o r l o c a l l y , -endemic d i s e a s e s , such as s u b c l i n i c a l d i a b e t e s and d e n t a l d i s e a s e s . The r e l a t i o n s h i p o f d i e t and e x e r c i s e t o c a r d i o -v a s c u l a r d i s a b i l i t y , o f smoking t o c a r d i o p u l m o n a r y d i s e a s e , 152 and o f drug abuse t o e m o t i o n a l h e a l t h , are some o f the a r e a s b e i n g r e s e a r c h e d i n w h i c h t h e H e a l t h S e r v i c e can promote p o s i t i v e e f f o r t s toward f u t u r e community h e a l t h . 6.12 OCCUPATIONAL HEALTH The recommended o b j e c t i v e s o f an o c c u p a t i o n a l h e a l t h program are c i t e d i n the Stand a r d s as the f o l l o w -i n g : 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 , d i s -a b i l i t y , o r o t h e r l i m i t a t i o n . 2. To a s s i s t 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-s i s t e n t 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 o r l i m i t a t i o n s . 3. To p r o v i d e emergency o r d e f i n i t i v e c a r e f o r work-connected i n j u r i e s and i l l n e s s . 4. To e s t a b l i s h a p r e v e n t i v e 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 c o n c e r n i n g occu-p a t i o n a l h a zards and s t r e s s e s and the means f o r a v o i d i n g o r c o p i n g v / i t h them. While i t i s agreed t h a t o c c u p a t i o n a l h e a l t h s h o u l d be r e c o g n i z e d as an i n t e g r a l p a r t o f the i n s t i t u t i o n ' s h e a l t h program, t h i s component i s d e s i g n e d t o p r o t e c t and promote the h e a l t h o f the f a c u l t y and s t a f f and i s , t h e r e f o r e , ' c o n -s i d e r e d t o be beyond the scope o f the s t u d e n t ' s H e a l t h S e r v i c e . I t i s assumed, however, t h a t c e r t a i n e s s e n t i a l elements o f an o c c u p a t i o n a l h e a l t h program do i n d e e d a p p l y t o the s t a f f o f the H e a l t h S e r v i c e i f t h e y are t o e f f e c t i v e l y p a r t i c i p a t e 153 i n the p r o v i s i o n o f h e a l t h c a r e t o the s t u d e n t body. F o r example, i t i s assumed t h a t the members o f t h e H e a l t h S e r v i c e s t a f f are m o t i v a t e d t o a v a i l t hemselves o f p r e v e n -t i v e h e a l t h p r a c t i c e s f o r p e r s o n a l 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 the development o f an e n v i r o n -ment w h i c h promotes 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 h e a l t h program, such as the 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 the community as a whole, a re c o n s i d e r e d t o be the r e s p o n s i b i l i t y o f the i n s t i t u t i o n i n g e n e r a l and are d i s -c u s sed i n d e t a i l i n the f o l l o w i n g s e c t i o n and elsewhere i n t h i s paper. 6.13 ENVIRONMENTAL HEALTH AND SAFETY A. OBJECTIVES I f the U n i v e r s i t y i s t o make good use o f i t s p e r s o n a l and p h y s i c a l r e s o u r c e s i n r e a c h i n g i t s academic g o a l , i t i s recommended t h a t the i n s t i t u t i o n a s s u r e s con-t i n u i n g c l o s e and c r i t i c a l s u r v e i l l a n c e and e f f e c t i v e con-t r o l 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 the h e a l t h and s a f e t y o f members o f the i n s t i t u t i o n a l community. Among the 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 t o c o n t r o l are those r e l a t e d t o the community as a whole, such as s a n i t a -t i o n ( f o o d p r e p a r a t i o n 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 spectacular hazards or contaminants, those related to physical disasters ( f i r e ) , and those related to a var i e t y of occupational health and safety problems. A multitude of less obvious problems, such as noise and crowding, also have an empact upon human ecology. A combination of resources from the University, from l o c a l , p r o v i n c i a l , and federal health departments, and from industry can be used e f f e c t i v e l y to provide nec-essary services, consultation, and support. It i s recomm-ended, however, that the University should co-ordinate and d i r e c t the program of surveillance and control to meet i t s needs e f f e c t i v e l y and e f f i c i e n t l y . B. PROGRAM Because of the p l u r a l i t y of departments concerned with the control of environmental health and safety hazards, the scope of such a program, and the f a c t that the authority to make related p o l i c i e s rests with the central administra-t i o n as an agent of the governing body, t h i s section, as recommended i n the Standards, i s beyond the realm of the Health Service as such. It i s , however, incumbent upon those responsible f o r the Health Service to seek and observe p o l i c y statements regarding areas of concern i n t h i s depart-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 health, i n d u s t r i a l health, safety and injury control, f i r e 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 e n v i r o n m e n t a l c o n t r o l o f the w o r k i n g c o n d i t i o n s . F u r t h e r , i t i s the r e s p o n s i b i l i t y o f the department t o r e p o r t t o the p r o p e r a u t h o r i t y any s u s p e c t h a z a r d s b e f o r e t h e y become c l i n i c a l l y i m p o r t a n t , a l l 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 inad e q u a t e s t a n d a r d s (eg. f o o d h a n d l i n g , c o n t r o l o f r a d i a -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 communicable o r r e p o r t a b l e d i s e a s e , and an a n a l y s i s o f a l l t r e a t e d a c c i d e n t s w i t h p e r i o d i c s t a t i s t i c a l summaries and recommendations f o r p r e v e n t i v e measures. P r e s e n t l y a t U.B.C. t h e r e i s one committee, a p p o i n t e d by the P r e s i d e n t , w h i c h i s concerned w i t h the above-mentioned f a c t o r s . I t i s the S a f e t y , S e c u r i t y , and F i r e P r e v e n t i o n Committee comprised o f r e p r e s e n t a t i v e s from v a r i o u s campus departments and u n i o n s i n c l u d i n g H ousing, Food S e r v i c e s , P h y s i c a l P l a n t , T rades, Truck D r i v e r s , T r a f f i c and S e c u r i t y , P a t r o l , R a d i a t i o n P r o t e c t i o n and P o l l u t i o n C o n t r o l , H e a l t h Care and E p i d e m i o l o g y , the H e a l t h S e r v i c e , A d m i n i s t r a t i o n , F a c u l t y and Student R e p r e s e n t a t i v e s . The H e a l t h S e r v i c e N u r s i n g S u p e r v i s o r and the campus M e d i c a l H e a l t h O f f i c e r a r e s p e c i a l a d v i s o r s t o the Committee. M o n t h l y meetings are h e l d f o r the purposes o f d i s c u s s i n g concerns o f 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 and o f recommending changes o r improvements t o the P r e s i d e n t ' s o f f i c e . The Committee was d e s c r i b e d as n o m i n a l , the meetings as u n e n t h u s i a s t i c 156 and the issues as t r i v i a l . It i s , however, considered that the mechanism f o r a dynamic program of environmental health and safety exists within the Committee, a l b e i t the number of members render i t cumbersome. The function of such a Committee i s to investigate, report, and recommend; enforcement of recommendations i s the r e s p o n s i b i l i t y of the central administration. I t i s important, too that environmental health and safety a c t i v i t i e s be c l o s e l y coordinated with other program components i n health education and health service. The campus Medical Health O f f i c e r , who i s attached to the Department of Health Care and Epidemiology, operates within the p r o v i n c i a l statutory requirements to maintain a healthy environment. These pertain to sewage, water, waste disposal, and so f o r t h . A Public Health Inspector, seconded from the Boundary Health Unit, v i s i t s the campus twice weekly to inspect the food establishments and other required areas. Meetings of the Medical Health O f f i c e r ' s Council are attended twice a year with recommendations being made to the Health Minister. The topic of swine f l u immunizations has not been discussed by t h i s committee to date. Only minimal information could be obtained from the Physical Plant. B r i e f l y , i n the past few years, a l l 157 b u i l d i n g s on the campus have been i n s p e c t e d and upgraded, w i t h an emphasis on s a f e t y . An emergency l i g h t i n g system has 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 such ar e a s i n accordance w i t h t h e 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 systems have /been i n s t a l l e d i n a l l r e q u i r e d a r e a s 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 presumed t o e x i s t . 6.14 PROVISIONS FOR EMERGENCIES/DISASTERS I t i s recommended t h a t e v e r y c o l l e g e h e a l t h program s h o u l d i n c l u d e s p e c i f i c w r i t t e n p r o v i s i o n s f o r meeting a wide v a r i e t y o f emergencies such 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 epidemic i l l n e s s ( i n c l u d -i n g r e q u i r e d bed c a r e ) , m u l t i p l e o r mass c a s u a l t i e s , evacua-t i o n o f b u i l d i n g s ( i n c l u d i n g the H e a l t h S e r v i c e ) , l o c a l community d i s a s t e r s , and g e n e r a l c i v i l defence problems. I t i s i m p o r t a n t t h e r e f o r e , t h a t d i s a s t e r p l a n s be drawn up t o p r o v i d e d e t a i l e d i n s t r u c t i o n s r e g a r d i n g the d e p l o y -ment o f f a c i l i t i e s , equipment, and p e r s o n n e l , arrangements f o r t r a n s p o r t a t i o n o f p a t i e n t s and c a s u a l t i e s , and the i n -volvement o f o u t s i d e a g e n c i e s o r r e s o u r c e s f o r e a c h o f the c o n t i n g e n c i e s i n d i c a t e d above. Such d i s a s t e r p l a n s s h o u l d be w i d e l y c i r c u l a t e d , p r a c t i c e d p e r i o d i c a l l y , and updated r e g u l a r l y . A l l p e r s o n n e l i n v o l v e d , such as d o c t o r s , n u r s e s and f i r e m a r s h a l l s , must be p r e p a r e d f o r the unexpected and 158 know what i s e x p e c t e d o f them. I n s t i t u t i o n a l emergency-p l a n s s h o u l d he c o - o r d i n a t e d w i t h those of the community and t h e p r o v i n c e , f o r example the Emergency Measures Organ-i z a t i o n or c i v i l d efence. I t appears t h a t no f o r m a l d i s a s t e r p l a n e x i s t s f o r U.B.C. G e n e r a l knowledge o f any such p l a n by the H e a l t h S e r v i c e , M e d i c a l H e a l t h O f f i c e r , P h y s i c a l P l a n t , and F i r e Department p e r s o n n e l i s m i n i m a l , a l t h o u g h i t i s assumed by most o f those i n t e r v i e w e d t h a t a p l a n has been i n the d e v e l o p m e n t a l p r o c e s s f o r some y e a r s . The campus F i r e P r e v e n t i o n O f f i c e r r e p o r t e d t h a t , w h i l e h a v i n g l i t t l e i n p u t i n t o the p l a n , he has r e c e i v e d r e q u e s t s from v a r i o u s departments f o r d i s a s t e r p l a n s o r i n f o r m a t i o n r e g a r d i n g f i r e and s a f e t y r u l e s and r e g u l a t i o n s . These have come from the F a m i l y P r a c t i c e U n i t and the H e a l t h S e r v i c e but have n o t been f o l l o w e d up. The F a c u l t y o f D e n t i s t r y was c l a i m e d 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 . I t would appear t h a t more a c t i o n i s ex p e c t e d o f the F i r e P r e v e n t i o n O f f i c e r b u t i t i s s u s p e c t e d t h a t b u r e a u c r a t i c c o n s t r a i n t s are r e s p o n s i b l e f o r the d e l a y i n p r o d u c t i o n and implemen-t a t i o n o f any p l a n s o r p o l i c i e s r e l a t i n g t o d i s a s t e r s and/ o r emergencies. I t was r e v e a l e d by the F i r e P r e v e n t i o n O f f i c e r t h a t i n s o f a r as the U.B.C. Endowment Lands comprise a r e g i o n a l d i s t r i c t , m u n i c i p a l z o n i n g r e g u l a t i o n s a re n o t 159 a p p l i c a b l e and t h e r e a r e , t h e r e f o r e , no f i r e b ylaws. I n p l a c 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 d i r e c t i o n f o r 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 R e g u l a t i o n s . Two o t h e r manuals are a l s o used t o p r o v i d e g u i d e l i n e s f o r f i r e and s a f e t y . They are the 1975 N a t i o n a l F i r e Code o f Canada and the 1975 N a t i o n a l B u i l d i n g Code o f Canada. 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 the 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 . I t was r e p o r t e d t h a t w h i l e 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 E d u c a t i o n , the F i r e Department i s under the a u t h o r i t y o f the Department o f the Environment. Whi l e the j u r i s d i c t i o n o f the campus F i r e D e p a r t -ment i n c l u d e s a p p r o x i m a t e l y 22,000 day s t u d e n t s , the t o t a l p o p u l a t i o n f o r wh i c h i t i s r e s p o n s i b l e i s r e p o r t e d t o be 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 i n s t i t u -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 , 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 the p e r i m e t e r o f the campus, two s c h o o l s (one e l e m e n t a r y and one s e c o n d a r y ) , t h r e e campus churches w i t h day-care c e n t r e s , the U n i v e r s i t y G o l f C l u b , 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 , and twenty-two r e t a i l 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 V i l l a g e Shopping C e n t r e . The s t a f f o f the F i r e Department are 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 a t t e n d a n t s ; t h e r e are l6o g e n e r a l l y t h i r t e e n men on duty d u r i n g the day s h i f t i n c l u d -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 F i r e C h i e f and F i r e P r e v e n t i o n O f f i c e r . Two e x e c u t i v e o f f i c e r s are on c a l l e venings and weekends when t h e r e are c o n s i d e r a b l y fewer men on duty. A l l have been g i v e n some form of o r i e n t a t i o n ( f i r e s a f e t y f i l m s , e t c . ) b u t s i n c e the s t a f f t u r n o v e r i s low, c o n t i n u i n g i n s e r v i c e e d u c a t i o n has n o t been g i v e n a h i g h p r i o r i t y . A l t h o u g h the U n i v e r s i t y p o p u l a t i o n and w o r k l o a d have i n c r e a s e d o v e r the y e a r s , the F i r e Department space and s t a f f have n o t i n c r e a s e d p r o p o r t i o n a t e l y . A new f i r e -h a l l i s b e i n g p l a n n e d , however, but the d a t e of c o m p l e t i o n i s n o t known. I t was s u g g e s t e d t h a t the l o c a t i o n o f the new f a c i l i t y would be l 6 t h Avenue and Wesbrook P l a c e , w h i c h i s . p e r i p h e r a l t o the main campus b u t c o n s i d e r e d more e f f i c a c i o u s i n terms o f moving f i r e m e n and equipment toward the c e n t e r c o r e as opposed t o moving outward from i t . F u r t h e r m o r e , the s u g g e s t e d s i t e i s c l o s e t o the a t h l e -t i c f i e l d s , s t a d i u m and a r e n a , and w i t h i n easy 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 houses two f i r e e n g i n e s and the campus ambulance, an E c o n o l i n e van w i t h r e s u s c i t a t i o n equipment. Back, head and s p i n a l i n j u r i e s are t r a n s p o r t e d d i r e c t l y t o the Vancouver G e n e r a l H o s p i t a l u n l e s s S t . P a u l ' s H o s p i t a l has been s p e c i f i e d . Only minor i n j u r i e s are t a k e n 161 t o t h e H e a l t h S e r v i c e . I t was n o t e d t h a t the F i r e D e part-ment views the H e a l t h S e r v i c e i n terms o f "hand-aids and f i r s t - a i d " . There would appear t o he a g r e a t need e i t h e r f o r communication between the two departments o r f o r the H e a l t h S e r v i c e t o reshape i t s image. The f o l l o w i n g n o t i c e f rom a May 1976 i s s u e o f U.B.C. Re p o r t s e x p l a i n s the c u r r e n t s t a t u s o f the c i t y ' s new emergency number r e l a t i v e t o the 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 Vancouver's new emergency 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 on May 1 b u t i t does n o t a p p l y on the U.B.C. campus o r i n the U n i v e r s i t y Endowment Lands. 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 the U.E.L., c a l l the U n i v e r s i t y Endowment Lands F i r e Department, 228-4567. They w i l l n o t i f y the U.B.C. H e a l t h S e r v i c e and the campus T r a f f i c and 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 Department a l s o o p e r a t e s an ambulance s e r v i c e 24 hours a day. There i s a $5. charge f o r i t s use. I f you 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 a t the n e a r e s t f i r e a l a r m 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 the scene and an ambulance w i l l f o l l o w i n about t h r e e m i n u t e s . 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 resc u e s e r v i c e s . M i n o r emergencies and f i r s t - a i d a r e h a n d l e d by the U n i v e r s i t y p a t r o l - 228-4721 - o r the persons i n -v o l v e d can be d i r e c t e d t o the 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 the Wesbrook B u i l d i n g a t the 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 the E a s t 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 by c a l l i n g 228-2525. The U n i v e r s i t y detachment o f the 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 from 8 a.m. t o 5 p.m. At o t h e r h o u r s k 0 c a l l 666-3198." 162 I t i s recommended t h a t an area-wide d i s a s t e r p l a n be d e v e l o p e d p o s t e h a s t e ; i f a p l a n has a l r e a d y been i n i t i a t e d , i t s a p p r o v a l by the U n i v e r s i t y Senate s h o u l d be e x p e d i t e d f o r immediate i m p l e m e n t a t i o n . The p l a n must i n -c l u d e c o o r d i n a t e d e f f o r t s by the f i r e s a f e t y and e n v i r o n -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 groups o r i n d i v i d u a l s on campus as w e l l as the m e d i c a l , n u r s i n g and H o s p i t a l s t a f f s . L i a i s o n w i t h o t h e r a g e n c i e s and r e s o u r c e s , such as the Emergency Measures O r g a n i z a t i o n , Red C r o s s , and Vancouver G e n e r a l H o s p i t a l , i s n e c e s s a r y and i m p o r t a n t . W h i l e h i g h l y i m p r o b a b l e , the h y p o t h e t i c a l event o f a 7^7 j e t c r a s h i n g on o r n e a r the U.B.C. campus i s n o t an imposs-i b i l i t y . P r e p a r a t i o n f o r any event s h o u l d be the key word i n any d i s a s t e r p l a n . I t i s f u r t h e r recommended t h a t the I n s e r v i c e E d u c a t i o n 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 F i r e 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 , t a l k s and d e m o n s t r a t i o n s o f f i r e f i g h t i n g equipment, e t c . , t o t e a c h s a f e t y c o n s c i o u s n e s s t o a l l p e r s o n n e l i n the H e a l t h S e r v i c e . 6.15 HEALTH EDUCATION A. 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 o f a h e a l t h program i s the development of a r e s o u r c e f o r i n f l u e n c i n g the 163 h e a l t h b e h a v i o r o f s t u d e 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 and as a c t i v e p a r t i c i p a n t s i n the community. I t i s c o n s i s -t e n t w i t h the g o a l s o f h i g h e r e d u c a t i o n f o r the U n i v e r s i t y t o s u p p o r t a program 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 the 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 s t u d e n t s . Such a program s h o u l d d i f f e r from o t h e r a r e a s o f the c u r r i c u l u m i n t h a t , r a t h e r than j u s t p r e s e n t i n g f a c t s f o r the 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 have 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 o f i n t e r e s t and c u r i o s i t y toward h e a l t h . The U.B.C.'s c o u r s e s o f i n s t r u c t i o n i n v a r i o u s f a c u l t i e s and departments 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 t o c o n c e p t s 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 -d r e n , 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 , t he 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. N e v e r t h e l e s s , n o t one g e n e r a l course o f h e a l t h e d u c a t i o n appears t o be o f f e r e d i n any program o u t l i n e d i n the U.B.C. C a l e n d a r . B. PROGRAM The Standards suggest the f o l l o w i n g i n c l u s i o n s i n a U n i v e r s i t y h e a l t h e d u c a t i o n program: "-Formal h e a l t h t e a c h i n g t h r o u g h o r g a n i z e d c o u r s e s . - I n f o r m a l l e a r n i n g e x p e r i e n c e s t h r o u g h h e a l t h s e r v i c e s and a wide 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 development and r e s e a r c h i n t o the 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 the U n i v e r s i t y s h o u l d 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 and community h e a l t h , a v a i l a b l e t o a l l f a c u l t i e s , t h r o u g h w h i c h s t u d e n t s can a t t a i n b a s i c i n f o r m a t i o n about p e r s o n a l h e a l t h and t h r o u g h w h i c h t h e i r h e a l t h b e h a v i o r may be i n f l u e n c e d p o s i t i v e l y . As p o i n t e d out p r e v i o u s l y i n t h i s p a p e r , t o d a y ' s s t u d e n t s are knowledgeable and i n t e r e s t e d i n t h e a r e a o f human e c o l o g y and, t h e r e f o r e , i t i s c o n s i d e r e d t h a t n o t o n l y are t h e y r e c e p t i v e t o h e a l t h e d u c a t i o n b u t t hey e x p e c t i t to be p r o v i d e d . 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 h e a l t h c o u r s e a r e : "(1) To d e v e l o p u n d e r s t a n d i n g o f the f u n c t i o n s o f a l l p a r t s o f the human organism and t h e i r i n t e r -r e l a t i o n s h i p w i t h the environment. (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 the 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 induce b e h a v i o r w h i c h promotes optimum h e a l t h . (4) To h e l p the i n d i v i d u a l become an i n t e l l i g e n t consumer of 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 the i n d i v i d u a l a c o n t i n u i n g d e s i r e t o l e a r n more about h e a l t h . (6) To h e l p d e v e l o p s k i l l i n d e f i n i n g and s o l v i n g h e a l t h problems." (6. - p. 33) R e s p o n s i b i l i t y f o r the h e a l t h c o u r s e may be d e l e -g a t e d t o any academic department b e s t s u i t e d i n terms o f 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 p r o v i d i n g h i g h - l e v e l i n s t r u c t i o n i n p e r s o n a l and community h e a l t h . However, t o be e f f e c t i v e , p l a n n i n g and c o o r d i n a t i o n o f the 165 course (or courses) r e q u i r e an a p p r o p r i a t e a l l o c a t i o n of s t a f f time f o r d e f i n i n g needs, e s t a b l i s h i n g o b j e c t i v e s , and p l a n n i n g course content, methodology and e v a l u a t i o n . H e a l t h 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 the c u r r i c u l a of areas such as b i o l o g y , education, home economics, p h y s i c a l education, p o l i t i c a l s c i e n c e , psychology, soc-i o l o g y , and urban p l a n n i n g , as w e l l as the h e a l t h s c i e n c e s , to p r o v i d e v a l u a b l e i n s i g h t i n t o the dynamics of i n d i v i d u a l and community l i v i n g . I t i s recommended t h a t a b a s i c p e r s o n a l h e a l t h course i n c l u d e concepts r e l a t i n g to the t o t a l h e a l t h of the c o l l e g e student, p h y s i c a l , mental, and emotional; m o t i v a t i o n f o r p o s i t i v e h e a l t h behavior; development of a t t i t u d e s to p e r s o n a l and community h e a l t h ; d e v i a t i o n s from normal h e a l t h ; s o c i a l problems; c o n t r o v e r s i a l i s s u e s ; r e l a t i o n s h i p s between the f a m i l y , s c h o o l , and community; environmental h e a l t h and s a f e t y ; p u b l i c h e a l t h r e s o u r c e s ; and even world h e a l t h o r g a n i z a t i o n s s e r v i n g the u n i v e r s a l community. I t i s co n s i d e r e d t h a t only through consumer education b e g i n n i n g at the student l e v e l w i l l the s p i r a l l -i n g e s c a l a t i o n of h e a l t h care c o s t s be c u r t a i l e d . Reference i s made i n oth e r areas of t h i s paper r e l a t i v e to the o p p o r t u n i t i e s f o r i n f o r m a l h e a l t h education presented at each student c o n t a c t w i t h the He a l t h S e r v i c e . Every e f f o r t must be made to pr o v i d e p r o f e s s i o n a l 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 Univer-sity 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 a r e a of i n f o r m a l h e a l t h e d u c a t i o n . More d e t a i l s are d i s c u s s e d i n s e c t i o n 6 . 1 7 , Communications. H e a l t h S e r v i c e r e c o r d s s h o u l d he used t o p r o v i d e d a t a f o r a c o n t i n u i n g e v a l u a t i o n o f the h e a l t h e d u c a t i o n o p p o r t u n i t i e s i n the department, and a l s o f o r d e t e r m i n i n g needed emphasis i n the i n s e r v i c e e d u c a t i o n program. Re-s e a r c h i n t o the 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 i s d i s c u s s e d i n s e c t i o n 6 . 1 6 , Research. C. INSERVICE EDUCATION Because the H e a l t h S e r v i c e i n s e r v i c e e d u c a t i o n f u n c t i o n i s r e c o g n i z e d as h a v i n g b r o a d e r scope t h a n the p r e s e n t a t i o n o f i n f o r m a t i o n t o n u r s e s o n l y , i t i s i n c l u d e d i n t h i s s e c t i o n c o n c e r n i n g h e a l t h e d u c a t i o n . U n t i l the p r e s e n t t i m e , t h i s f u n c t i o n has been the 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 Nurse i n a d d i t i o n t o h e r r e g u l a r d u t i e s i n the O.P.D. The f u l l - t i m e g e n e r a l p r a c t i t i o n e r who i s a l s o a C l i n i c a l I n s t r u c t o r i n the D i v i s i o n o f F a m i l y P r a c -t i c e , F a c u l t y o f M e d i c i n e , p e r f o r m s t h e ( i n f o r m a l ) i n s e r v i c e e d u c a t i o n f u n c t i o n f o r the m e d i c a l s t a f f . The Head Nurse o f the H o s p i t a l c a r r i e s t h a t r e s p o n s i b i l i t y f o r h e r u n i t . There 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 and a c t i v i t i e s , b u t more development o f a sound e d u c a t i o n a l p r o -gram i s needed t o improve the 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 t h e e n t i r e H e a l t h 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 a l l o t t e d each week d u r i n g the 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 educa-t i o n i n the O.P.D. Some o f the t o p i c s c o v e r e d i n t h e p a s t y e a r i n c l u d e d the f 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 , acne, d i a b e t e s ( i n s u l i n , and 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 r e s u s -c i t a t i o n , 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 and management o f c e r v i c a l e r o s i o n s , n u t r i t i o n , and dea t h and d y i n g . - G e n e r a l Areas - p r o b l e m - o r i e n t e d m e d i c a l r e c o r d s , s e x u a l communication, team approach (C.A.R.S.), l e g a l a s p e c t s o f n u r s i n g , communications, i n t e r v i e w i n g , and a s t r e e t c l i n i c . - D e p a r t m e n t a l Tours - p h y s i o t h e r a p y , r a d i o l o g y , and l a b o r a t o r y w i t h a d e m o n s t r a t i o n o f r o u t i n e p r o c e d u r e s . - Meeti n g s - one g e n e r a l meeting o f a l l the s t a f f ( t h e f i r s t s e s s i o n o f the 1975-76 w i n t e r t e r m ) , and one n u r s e s ' m e e t i n g ( n e a r the end o f the 1976 s p r i n g t e r m ) . - S p e c i a l T a l k s and R e p o r t s - C h i n a ( S c h o o l o f N u r s i n g ) , and H e a l t h S e r v i c e a t t e n d -ance a t c o n v e n t i o n s i n S e a t t l e (Emergency C a r e ) , arid H a w a i i ( P a c i f i c Coast C o l l e g e H e a l t h A s s o c i a t i o n ) . 169 In a l l of the above inservice meetings, appro-priate resource speakers, video tapes, or films were used. The R.N. responsible f o r making such arrangements t r i e d to be present at a l l sessions i n order to be of the same mind as the other s t a f f i n attendance. The Hospital s t a f f i s not involved i n regularly scheduled talks or films because, i t was explained, they have t h e i r own orientation. It was learned that the inservice function i s to be shared i n future by a l l of the nurses in the O.P.D. While i t i s recognized that input into the program from a l l personnel should be encouraged, i t i s recommended that 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 inservice education be given to one member, app-ro p r i a t e l y prepared and personally interested i n t h i s area. In order to properly develop a suitable program of education, he/she must keep abreast of new developments i n the content and methods of the health sciences and health 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 pertain to students. More discussion on t h i s subject i s found i n section 6.1, Outpatient Services. It i s also recommended that a continuing close working rela t i o n s h i p be maintained with other departments, units, or resources involved in health education, formal or informal, f o r example the Inservice Education Committee of the R.N.A.B.C. 170 6.16 RESEARCH While the Health Service exists primarily to meet the health needs of young adults, including both physical and emotional health problems, i t offers a unique opportunity to study disease patterns i n addition to the dynamics of develop-ment under r e l a t i v e l y well-controlled conditions. Opportuni-t i e s f o r research which w i l l contribute to the physical welfare, emotional health, and educational p o t e n t i a l of students, i s recommended as being consistent with the primary purpose of the Health Service. Certain research projects concerning the health pro-gram have been discussed elsewhere i n t h i s paper, but i t i s recommended that plans be formulated f o r continuing research projects i n other areas of the program requiring study and that these plans be supported by the Health Service and the central administration. It i s r e i t e r a t e d that more integra-t i o n and coordination of research projects being undertaken by various departments throughout the University, are re-quired. It i s important, therefore, that future plans f o r research i n the Health Service be v e r i f i e d with other con-cerned departments i n order to avoid possible duplication and to gain any assistance available. Furthermore, i f re-search i s to be accepted as an important function of the health program and i s to be r e a l i s t i c , time and personnel adjustments must be made and f i n a n c i a l allotments invested in the departmental budget. As recommended i n the Standards, the University has a statement of p o l i c y concerning the involvement of humans in research. A l l c l i n i c a l research and investiga-tions involving human subjects must be duly approved by an established committee which assures that the conditions of the p o l i c y have been met p r i o r to the s t a r t of the projects. 171 6.17 COMMUNICATIONS The Standards c o n s i d e r t h a t one o f the most i m p o r t a n t d e t e r m i n a n t s o f the o v e r a l l s u c c e s s o f the h e a l t h program i n meeting the needs o f i t s s u b s c r i b e r s i s the e f f -e c t i v e n e s s o f communications w i t h i n , among, and beyond the v a r i o u s u n i t s of the program. I n n e a r l y a l l a r e a s o f the H e a l t h S e r v i c e r e v i e w e d , t h e r e was an e x p r e s s e d need f o r improved communications. The f o l l o w i n g s u g g e s t i o n s are put f o r t h t o a c h i e v e t h i s aim: A. INTERNAL COMMUNICATIONS P e r s o n a l 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 , 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 -v a l s . The D i r e c t o r and S u p e r v i s o r s h o u l d g a i n a d v i c e from v a r i o u s u n i t p e r s o n n e l b e f o r e e s t a b l i s h i n g b a s i c p o l i c y 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 p r o c e d u r a l changes. R e g u l a r n u r s i n g s t a f f m e e t i n g s , i n c l u d i n g the H o s p i t a l s t a f f , s h o u l d be h e l d and i n c l u d e e d u c a t i o n a l 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 (eg. R.N.A.B.C.) a c t i v i t i e s and ann-ouncements. M e d i c a l s t a f f meetings s h o u l d be p l a n n e d t o i n c l u d e the 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 F a m i l y P r a c t i c e U n i t , the Department o f H e a l t h Care and E p i d e m i o l o g y , the D i v i s i o n o f 172 P u b l i c H e a l t h P r a c t i c e , and the s i x d i v i s i o n s o f the H e a l t h S c i e n c e s C e n t r e , p a r t i c u l a r l y the D i v i s i o n o f H e a l t h S e r v i c e s R esearch and Development. 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 s h o u l d be sha r e d w i t h the n u r s i n g and s u p p o r t p e r s o n n e l . The importance o f communications w i t h the o f f i c e s t a f f i s d i s c u s s e d 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 . M i n u t e s o r tapes kept o f meetings are 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 the i n f o r m a t i o n o f those unable t o a t t e n d . An up-date of the H e a l t h S e r v i c e b r o c h u r e w h i c h i s p r o v i d e d 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 . Expenses i n c u r r e d i n the p u b l i c a t i o n o f such i n f o r m a t i o n a l b u l l e t i n s are j u s t i f i e d i n d i v i d e n d s p a i d t h r o u g h i n c r e a s e d u t i l i z a -t i o n o f the s e r v i c e . S u p p l e m e n t a l t o the i n f o r m a t i o n c i r -c u l a t e d t h r o u g h the s t u d e n t b r o c h u r e , s h o u l d be i n c r e a s e d 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 the H e a l t h S e r v i c e s t a f f . W h i l e one nurse 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 m e d i c a l and h o s p i t a l i n s u r a n c e c overage, e t c . , d u r i n g r e g i s -t r a t i o n , t h i s would seem t o be an i d e a l o p p o r t u n i t y f o r more s t a f f members t o meet the s t u d e n t s i n f o r m a l l y as w e l l as t o 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 t o an i n c r e a s i n g s t u d e n t p o p u l a t i o n . Employee performance e v a l u a t i o n s d i s c u s s e d e l s e -where i n t h i s p a per p r o v i d e a v e h i c l e f o r two-way communi-c a t i o n . W h i l e n ot always a p l e a s a n t p r o c e d u r e , e v a l u a t i o n s 173 may o f t e n be used as an opportunity to review a s t a f f grievance or complaint. P o s i t i v e e v a l u a t i o n s , however, can give employees a sense of productive involvement i n the s e r v i c e . In the area of i n s e r v i c e education, a f o u r -week communications workshop was conducted i n April/May of 1 9 7 6 by an Educational P s y c h o l o g i s t i n the F a c u l t y of Education. While some i n t e r n a l r e s i s t a n c e to the proposal of the workshop was f i r s t encountered, there was almost complete attendance of a l l Health Service per-sonnel, i n c l u d i n g the doctors, the H o s p i t a l s t a f f , and o f f -duty employees. Since 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 general f e l t need f o r improving communica-t i o n s i n the Health Service. Such use of a v a i l a b l e campus resources and the planning of the workshop are innovative and commendable. I t i s recommended that a follow-up review be done by the Health-Service to determine p o s i t i v e i n f l u e n c e s brought about by the sessions i n the area of i n t e r n a l communi-ca t i o n s . 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 discussed i n s e c t i o n 6 . 1 5 , Health Education, can help to determine the d i r e c t i o n of the h e a l t h program. I t i s considered app-r o p r i a t e f o r the consumers of care to have a s i g n i f i c a n t v oice i n determining the s e r v i c e s which are to be provided and to i n d i c a t e the l e v e l of support which they are w i l l i n g 174 t o provide. Informed, re s p o n s i b l e consumers can be very h e l p f u l i n shaping programs which a c t u a l l y meet t h e i r needs and which w i l l j u s t i f y t h e i r support. B. EXTERNAL COMMUNICATIONS The image and e f f e c t i v e n e s s of the Health Service w i l l be considerably enhanced through channels of sharing 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 personnel s e r v i c e areas of the 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 of the Health Service 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 campus-wide committees as w e l l as in f o r m a l gatherings. This i s e s p e c i a l l y important f o r responsible p r o f e s s i o n a l employees. An aggressive e f f o r t i s re q u i r e d to achieve a measure of c o o r d i n a t i o n w i t h other campus f a c i l i t i e s which 19 o f f e r student s e r v i c e s . The recent survey 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 that problems i n o f f e r i n g s e r v i c e s are mainly r e l a t e d to a la c k of communication between f a c i l i t i e s and w i t h students, and that a l a c k of communication between s e r v i c e s appears to r e s u l t i n ignorance of 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 surveyed, i n c l u d i n g the Health S e r v i c e , f e l t t hat they provide 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 regarding 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 the s t u d e n t s ' s u g g e s t i o n f o r improved a d v e r t i s e m e n t of p r e s e n t f a c i l i t i e s . S t u d e n t s a l s o i n -d i c a t e d l i t t l e r e f e r r a l between f a c i l i t i e s whereas the 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 . F a c i l i t i e s s u r v e y e d f o r t he s t u d y i n c l u d e d : The H e a l t h S e r v i c e The H e a l t h S c i e n c e s C e n t r e P s y c h i a t r i c U n i t Community H e a l t h Centre ( F a m i l y Practice U n i t ) The Dean o f Women Student S e r v i c e s Ombudsman Residence A d v i s o r s C h a p l a i n c y S e r v i c e s Women's O f f i c e P s y c h o l o g y Department I n t e r n a t i o n a l House Speakeasy The s t u d y c o n c l u d e d t h a t campus f a c i l i t i e s must tak e a more a c t i v e and 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 t y p e s o f problems, causes, and p r e v e n t i o n , and t h a t the 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 of secondary i m p o r t -ance t o t o t a l needs b e i n g met. E x t r a m u r a l communications are d i s c u s s e d i n the ne x t s e c t i o n . 6.18 EXTRAMURAL RESOURCES The Standards a d v i s e t h a t c o n t i n u i n g 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 and i n t e g r a t e on and o f f -176 campus r e s o u r c e s w i t h a v i e w t o c r e a t i n g a network o f 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 program, w i t h a minimum o f d u p l i c a t i o n o f e f f o r t (and expense) and no absence o f some s e r v i c e s . A l a r g e i n s t i t u t i o n w i t h w e l l - d e v e l o p e d h e a l t h programs, such as U.B.C, i s i n a p o s i t i o n t o sh a r e many of i t s s e r v i c e s w i t h the off-campus community and r e q u i r e s few o u t s i d e a g e n c i e s t o c o n t r i b u t e t o i t s H e a l t h S e r v i c e . H e a l t h p r o f e s s i o n a l s , however, w i l l b e n e f i t t h r o u g h c l o s e c o n t a c t 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 w o r k i n g r e l a t i o n s h i p s w i t h o u t s i d e d o c t o r s , d e n t i s t s , n u r s e s , p s y c h o l o g i s t s , 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 the e f f e c t i v e n e s s o f p r e s e n t o r p l a n n e d s e r v i c e s . I n a d d i t i o n , b o t h the o f f -campus community and the H e a l t h S e r v i c e may r e c e i v e a s s i s -tance from the 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 the areas o f p s y c h o l o g i c a l t e s t i n g , c h i l d g u i d a n c e , o r e n v i r o n m e n t a l h e a l t h . 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 are a t t e n d e d by the H e a l t h S e r v i c e s t a f f , f o r example the P a c i f i c Coast C o l l e g e H e a l t h A s s o c i a t i o n meet-i n g s , the s e r v i c e i n g e n e r a l appears 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 terms of common i n v o l v e m e n t i n program d e v e l -opment, r e s e a r c h , and o t h e r a c t i v i t i e s w h i c h can p r o v i d e s t r e n g t h and new p e r s p e c t i v e s t o the program. I t i s r e -177 commended, therefore, that cooperative a c t i v i t y be under-taken 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, p a r t i c u l a r l y the lower main-land, to share resources and information and to improve public r e l a t i o n s . To give an example, the recent produc-t i o n of Recommended Standards and Practice f o r University Mental Health Services, prepared by the Director of the Simon Fraser University Health Service, f o r the Canadian Psychiatric Association's Professional Standards and Practice Council, were unknown to the Mental Health Unit s t a f f at U.B.C. Professional communication i n s i m i l a r situations would be f r u i t f u l to s t a f f and students a l i k e . It i s further recommended that the Health Service use every opportunity to learn what public, voluntary, 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. For example, active involvement i s required f o r the s t a f f to follow-up students who are referred off-campus fo r abortions. This i s an area of research that can be carried on by nursing personnel, under medical d i r e c t i o n , and would provide a challenging change of a c t i v i t y f o r nurses now spending v a l -uable professional time on housekeeping•functions. Other resource agencies can be v i s i t e d or i n v i t e d to v i s i t the Health Service f o r a first-hand orientation and to discuss common problems of students and young adults. For example, the Women's Coll 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 Association and the Vancouver General Hospital's abortion f a c i l i t y , would a l l provide new insight into the problems of young women today. Comm-unication with the campus Family Practice Unit w i l l further reveal problems of the children or spouse of a student which may be the underlying cause of his health problem. In a l l matters of communication or consultation, the con-f i d e n t i a l i t y of information must, of course, be maintained. Whenever possible, Health Service s t a f f members should 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, planning councils, and the l i k e . Such involvement not only enhances professional knowledge f o r the improvement of practice, but serves to generate new ideas, to stimulate inte r e s t , and to renew i n s t i t u t i o n a l pride. It i s f i n a l l y suggested that the consultant and management engineering services of the B.C.H.I.S. be re-quested to a s s i s t the Health Service in areas of concern or uncertainty, such as the closing of the Hospital. It i s the purpose of that resource agency to serve the health programs of B r i t i s h Columbia i n need of assistance or advice. 6.19 SPECIAL PROBLEMS The only concern discussed i n the Standards under t h i s heading relates to international students. The require-ments fo r foreign students applying to U.B.C. are outlined 179 i n C h a pter 9, B u s i n e s s Management, as p e r t a i n s t o h o s p i t a l and m e d i c a l i n s u r a n c e coverage. Other e n t r a n c e r e q u i r e -ments are the same as t h o s e f o r a l l o t h e r s t u d e n t s . No s p e c i a l s t a t i s t i c s are kept o f f o r e i g n s t u d e n t s a t t e n d i n g the H e a l t h S e r v i c e , a l t h o u g h mention has been made of p l a n s t o do s t a t i s t i c a l 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 o f s t u -d e n t s , 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 r e c e i v e t r e a t m e n t a t the M e n t a l H e a l t h U n i t . S i m i l a r s t a t i s t i c a l a c c o u n t i n g i n the O.P.D. would 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 needs, and i s recommended. I t i s a l s o recommended i n the S t a n d a r d s t h a t a l l p r o f e s s i o n a l s o f 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 c u l -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 s t u d e n t s i n o r d e r t o a p p r e c i a t e how t h e s e i n f l u e n c e t h e i r a t t i t u d e s toward p h y s i c i a n s , m e d i c i n e , and h e a l t h . I n i t i a l h e a l t h e v a l u a t i o n s p r o v i d e the 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 of the problems o f s o c i a l a c c e p t a n c e , c l i m a t i c change, and o t h e r s o u r c e s of a p p r e h e n s i o n o r i n s e c u r i t y w hich handicap many new f o r e i g n s t u d e n t s . I n f o r m a t i o n p e r t a i n i n g t o the campus agency most concerned w i t h i n t e r n a t i o n a l s t u d e n t s i s c o n t a i n e d i n the U.B.C. C a l e n d a r . I t s t a t e s t h a t the 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 c e n t r e f o r b o t h s t u d e n t s and members of the g r e a t e r w o r l d community, one of i t s major concerns i n v o l v i n g the r e c e p t i o n and o r i e n t a t i o n 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 S t u d e n t s ' Program Committee i s most i m p o r t a n t i n a r t i c u l a t i n g s t u d e n t r e q u e s t s ; the Board o f D i r e c t o r s has e q u a l r e p r e s e n t a t i o n from f a c u l t y , s t u d e n t and community s o c i a l systems. I t i s recommended t h a t the H e a l t h S e r v i c e u t i l i z e t he i n t e r -n a t i o n a l i n f o r m a t i o n c e n t r e and o t h e r o f i t s r e s o u r c e s i n the p l a n n i n g 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 s t u d e n t s , as mentioned i n an e a r l i e r s e c t i o n o f t h i s paper. 181 CHAPTER 7 HEALTH PERSONNEL; QUALIFICATIONS, DUTIES. AND EDUCATION The following l i s t of Health Service personnel and t h e i r q u a l i f i c a t i o n s i s an extract from the 1 9 7 6 U.B.C. Calendar: The University Health Service: A.M. Johnson, M.D., F.R.C.P.(C), Director of University Health Service and Health Service Hospital. C. A. Brumwell, M.D. ( B r i t . Col.), Assistant Director. D. J. Farquhar, M.D. ( B r i t . Col.), Physician, part-time. D. Goresky, M.D. ( A l t a . ) , Physician. R.K.L. Percival-Smith, M.B., B.S. (Cantab.), Physician. R. Ree, M.D. ( B r i t . Col.), Physician. M. Beiser, M.D. ( B r i t . Col.), Diploma (A.B.P.N.), Con-sultant P s y c h i a t r i s t . S. M i l l e r , M.D. , CM., M.Sc, D.R.T. (McGill), C.R.CP.(C), Consultant Radiologist. J.R. Mclver, M.B., Ch.B. (Glasgow), C.R.C.P. (C), Consul-tant Radiologist. D.J. Dundee, M.D., Consultant Radiologist. K. Boyle, R.N., Nursing Supervisor. P. Jones, R.N., Head Nurse, Hospital. M. Harrison, R.T. (X-Ray). J. Sutton, R.T. (Lab.) H. Tumaitis, R.T. (Physio.). In addition, a l l s p e c i a l t y c l i n i c s are attended by physicians duly q u a l i f i e d and licensed i n t h e i r p a r t i c u l a r 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 given under the head-182 ings of Medical Staff, Outpatient Department Staff and Hospital Staff. Abbreviations used are F.T., meaning f u l l -time, and P.T., meaning part-time. 7.1 MEDICAL STAFF DIRECTOR - l A Time - Hospital - 3/4 Time - O.P.D. ASSISTANT DIRECTOR - 8/10 Time - Health Service - Private Part-Time - Extended-Care 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. (Varies each year but generally 2.) A l l are members of the Faculty of Medicine at U.B.C. They are remunerated by salary which i s paid to the University by the B.C. Medical Plan. Details of remuneration and per-q u i s i t e s as outlined i n the Standards were not obtained. The regulations governing the Health Service Director and medical s t a f f are contained i n the Bylaws of the University Health Service Hospital and read as follows: SECTION 5 ARTICLE 1 The administration of the hospital s h a l l be the r e s p o n s i b i l i t y of the Director who s h a l l be appointed by the Board. 183 SECTION 5 ARTICLE 11 The 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 a u t h o r i t y t o c a r r y out the d u t i e s imposed on him by the Board and he s h a l l be i n complete charge of a l l departments and a c t i v i t i e s o f the h o s p i t a l s u b j e c t t o the d i r e c t i o n and c o n t r o l o f the Board and the A d m i n i s t r a t i v e Committee. SECTION 7 ARTICLE 1 The Board 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 the C o l l e g e o f P h y s i c i a n s and Surgeons 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 s t a f f o r g a n i z a t i o n i s s e t up and m a i n t a i n e d . SECTION 7 ARTICLE 11 I n 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 the J o i n t A d v i s o r y Committee. SECTION 7 ARTICLE 111 Appointments t o the M e d i c a l S t a f f may be made o n l y by the Board and f o r a term n ot 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 so 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 a n n u a l appointments. SECTION 7 ARTICLE IV Rules o r r e g u l a t i o n s g o v e r n i n g the method o f a p p o i n t -ment and o r g a n i z a t i o n and a c t i v i t i e s of the M e d i c a l S t a f f s h a l l be promulgated by the Board from time t o time and 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 approved by the 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 "Bylaws" - Appendix VI) There would appear t o be no f o r m a l w r i t t e n p o l i c i e s p e r t a i n i n g t o the m e d i c a l s t a f f as o u t l i n e d i n the S t a n d a r d s . These would i n c l u d e j o b d e s c r i p t i o n s d e f i n i n g the p r i m a r y 184 r e s p o n s i b i l i t i e s and c o l l a t e r a l d u t i e s o f each member; a d e s c r i p t i o n o f the work s c h e d u l e f o r f u l l and p a r t - t i m e s t a f f ; and st a t e m e n t s r e g a r d i n g s u p e r v i s i o n , e v a l u a t i o n o f performance, terms o f reap p o i n t m e n t and job s e c u r i t y , p r o -m o t i o n o r advancement, and o u t s i d e employment. N o t i c e s r e g a r d i n g n i g h t , weekend and v a c a t i o n c o verage, are p o s t e d i n b o t h the H o s p i t a l and the O.P.D. The n u c l e u s o f f u l l o r n e a r f u l l - t i m e m e d i c a l 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 and 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 , p r o v i d e s the c o n t i n u i t y o f c a r e r e q u i r e d t o a v o i d a fragmented s e r v i c e . C o n s i d e r a t i o n i s g i v e n t o the 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 which i s apparent i n the c l i n i c a l a r e a s o v e r w h i c h each p r e s i d e s , and i n acknowledged s t a f f s a t i s f a c t i o n . Teamwork appears t o be i n e f f e c t as the w o r k - l o a d i s g e n e r a l l y conducted on a sh a r e d b a s i s u n t i l c o m p l e t i o n . F o r example, s t u d e n t s a d m i t t e d t o the H o s p i t a l come under t h e care o f the p h y s i c i a n who a t t e n d e d the p a t i e n t i n the O.P.D., and the D i r e c t o r a l s o c a r r i e s a f u l l p a t i e n t w o r k - l o a d . I n terms o f p r o f e s s i o n a l improvement, e v e r y opp-o r t u n i t y i n t h i s d i r e c t i o n would seem t o be a v a i l a b l e t o the s t a f f members. C l i n i c a l r e s e a r c h i s conducted i n s p e c i a l i n t e r e s t a r e a s , such as b i r t h c o n t r o l ; a t t e n d a n c e a t o u t -s 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 ; and i n f o r m a l p e e r r e v i e w i s promoted t h r o u g h s t a f f d i s c u s s i o n s , r e v i e w o f 185 c l i n i c a l p roblems, and i n s e r v i c e e d u c a t i o n . S t a f f members have a c c e s s t o the Woodward B i o m e d i c a l L i b r a r y w h i c h houses a l l o f the r e c e n t t e x t s , p e r i o d i c a l s , and o t h e r e d u c a t i o n a l a i d s c u r r e n t l y a v a i l a b l e . W h i l e the Standards i n c l u d e d e n t a l s t a f f under t h i s s e c t i o n , no comment can be made s i n c e any 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 D e n t a l S c h o o l and 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 . D i s c u s s i o n and recommendations on t h i s s u b j e c t are 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, D e n t a l S e r v i c e s . 7.2 OUTPATIENT DEPARTMENT STAFF NURSING SUPERVISOR REGISTERED NURSES NURSES' AIDE (Housekeeping A s s i s t a n t I ) REGISTERED TECHNICIAN ( R a d i o l o g y ) REGISTERED TECHNICIAN ( L a b o r a t o r y ) REGISTERED TECHNICIAN ( P h y s i o t h e r a p y ) CLERK I - 1/2 Time - 3 F.T. - 2 S e s s i o n a l ( i e F.T. Sept. 1 - May 1) - 1 F.T. - 1 F.T. Supposedly s h a r e d i time w i t h the H o s p i t a l b u t i t s - 1 F.T. r e q u i r e m e n t s are m i n i m a l . - 1/2 Time (1/2 Time Dep 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 ) - 1 F.T. ( M e d i c a l B i l l i n g & Sw i t c h b o a r d ) - 2 S e s s i o n a l ( M i s c e l l a n e o u s D u t i e s ) 186 CLERK I I - 2 F.T. CLERK IV - 1 F.T. (Secretary to the D i r e c t o r ) SECRETARY I I I - 1 F.T. (Attached to the Mental Health Unit but budgeted through O.P.D.) There had p r e v i o u s l y been a part-time n u t r i t i o n i s t on a volunteer b a s i s i n the 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 or counseling i s requested or r e q u i r e d , the student i s r e f e r r e d to the Home Economics Department or to the Food Service s t a f f of h i s r e s p e c t i v e residence, f o r instance, regarding a s p e c i a l d i a b e t i c or reducing d i e t . At her own request, a student i n the U.B.C. School of Nursing was doing f i e l d work i n the department at the time of the review. 7.3 HOSPITAL STAFF NURSING SUPERVISOR - 1/2 Time REGISTERED NURSES - 5 F.T. (Includes Head Nurse) Nurse & permanent Night - 2 P.T. casual n i g h t r e l i e f L.P.N.'s - 3 F.T. (Days & Evenings Only) - Occasional P.T. - S h i f t R e l i e f NURSES' AIDE - 1 F.T. - Night S h i f t - P.T. Casual 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 r e l i e f . ( T h i s s e r v i c e i s l e a s e d from the Campus Food S e r v i c e s Department.) ADMITTING CLERK - 1 F.T. - Shared w i t h the M e n t a l H e a l t h U n i t . A l l p r o f e s s i o n a l o r c e r t i f i e d p e r s o n n e l have been appro-p r i a t e l y t r a i n e d and a r e l i c e n s e d a c c o r d i n g t o t h e i r r e s -p e c t i v e p r o v i n c i a l o r j u r i s d i c t i o n a l r e g u l a t o r y b o d i e s . t r a i n e d n u r s e s g a i n s p e c i a l i n s i g h t i n t o v i t a l s t u d e n t problems t h r o u g h t h e i r own e x p e r i e n c e w i t h a r i g o r o u s a c a -demic program, i t i s c o n s i d e r e d here t h a t knowledge o f ( p u b l i c ) h e a l t h and a keen i n t e r e s t i n the i n s t i t u t i o n a l community are s u f f i c i e n t f o r good s t u d e n t h e a l t h c a r e . I n 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 Super-v i s o r and the H o s p i t a l Head Nurse have s u c c e s s f u l l y completed the N u r s i n g U n i t A d m i n i s t r a t i o n E x t e n s i o n Course o f f e r e d t h r o u g h the Canadian H o s p i t a l A s s o c i a t i o n . I n a d d i t i o n , n e a r l y a l l s t a f f members have had the o p p o r t u n i t y t o a t t e n d c o n f e r e n c e s and seminars p e r t a i n i n g t o c o l l e g e h e a l t h . At the time of the r e v i e w the O.P.D. Nurses' A i d e was r e p o r t e d to be a t t e n d i n g a four-week communications workshop. Other t h a n as an i n c e n t i v e bonus, the v a l u e o f such a s e m i n a r f o r t h i s c a t e g o r y o f employee i s q u e s t i o n a b l e . The n u r s i n g s t a f f W h i l e the S t a n d a r d s s u g g e s t t h a t U n i v e r s i t y 188 also has access to the texts, journals, and other pro-f e s s i o n a l references contained i n the Biomedical Library. 7.4 NURSING Recommended objectives and opportunities f o r the nursing service i n the health program are the following 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 health service and to interpret the p o l i c i e s and programs to the health service s t a f f , students, f a c u l t y , and other members of the college community To p a r t i c i p a t e i n interpreting to the college community the extent and l i m i t a t i o n s of service available at the health center To r e c r u i t and provide orientation f o r new members of the nursing service; to provide continuing educa-t i o n and evaluation of performance f o r a l l members of the nursing s t a f f To provide patient care on the basis of medical diag-nosis and treatment directed by the physicians To evaluate nursing practices and to seek new and more ef f e c t i v e ways of u t i l i z i n g the talents of nursing personnel To p a r t i c i p a t e i n l i a i s o n between the college health service and health agencies i n the community To i n i t a i a t e and implement programs f o r nursing per-sonnel development To pa r t i c i p a t e i n the development of inservice educa-t i o n a l opportunities f o r the entire health service s t a f f and to encourage a l l members of the nursing s t a f f to par t i c i p a t e i n program planning To p a r t i c i p a t e i n planning f o r emergency/disaster care To p a r t i c i p a t e i n informal health counseling and educa-t i o n f o r personal and community health." (6. - p.41) 189 In addition to providing traditional nursing services in the Health Service, nurses are in a position to positively 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 in their daily patient contacts to turn health care into an educational experience which can have a lasting impact upon the lives of students and others with whom they are in contact. The valuable resource and unique contribution of the nursing personnel must be recognized both by those responsible for the service and by the nurses themselves. So important is the nurse's position of influence to the student welfare, that to consider i t lightl y or not at a l l is to abdicate responsibility. Every nurse in the depart-ment should, therefore, through education, experience, or special interest in 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 for health education. While job descriptions and tools for evaluating individual performance are said to be in the developmental stages, these are considered a p r i o r i guidelines for the nursing staff. Written statements of nursing responsib-i l i t i e s within the Health Service and college community, of details of the work schedule, of lines of authority, and of personnel policies, job secrity and c r i t e r i a for 190 evaluation and promotion should be c l e a r l y defined and regularly updated. Such instruments of organization and management contribute not only to the fu l f i l m e n t of the above stated objectives but to s t a f f s a t i s f a c t i o n and the overcoming of unnecessary misunderstandings. It was observed that a great number of non-nurs-ing custodial functions are performed by the professional nursing s t a f f . While i t i s recognized that the "peak and va l l e y " type of demand on the service w i l l r e s u l t i n per-iods of i d l e time, care must be taken to avoid using highly q u a l i f i e d personnel f o r tasks which can be delegated to the Nurses' Aides, housekeeping assistant, or c l e r i c a l s t a f f . For t h i s reason, each member should be d i r e c t l y involved i n the development of his/her own job description and sp 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 -ive ways of u t i l i z i n g the talents of nursing personnel. 7.5 OTHER PROFESSIONALS Included i n the professional s t a f f are the three R.T.'s (x-ray, lab, and physiotherapy). The R.N. responsi-ble f o r the inservice education program might be considered as the health educator, a l b e i t more outreach programs are needed to promote campus-wide health education. For these other professional s t a f f members, as f o r medical and nursing, there should be written job descriptions defining t h e i r primary 191 responsibilities and any collateral duties, statements of the supervision which each can expect to receive, and the means for evaluating their performance, the terms of appoint-ment, and personnel policies. Remuneration is thought to be competitive with other opportunities for similarly trained professionals, and opportunities for continuing professional improvement are made available. It is recommended that each member should be encouraged to maintain contact with his/her professional organization and to subscribe to the literature pertaining to each respective area of interest or activity. It is recommended that the Health Service would achieve benefit from the assistance of a dentist or dental hygienist, and a medical record librarian, even on a part-time or consultant basis. The f i r s t is considered v i t a l l y 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" relative to nutrition and the formulation of good eating habits, the concept of a consultant nutritionist or dietitian in the department is extremely worthwhile. The reestablishment of such a service should be given due consideration. As the health program increases in scope and com-plexity, and particularly in the advent of a new Hospital, 192 i t i s recommended that an assistant to the Director, experienced i n hospital or medical administration, be appointed. Some of the major r e s p o n s i b i l i t i e s and projects of the Director that can be delegated or shared by such an assistant are i n the areas of p o l i c y development, program planning, budgeting, and d i r e c t i o n of the professional s t a f f . The Standards recommend the establishment of t h i s p o s i t i o n f o r a health program which i s responsible f o r 7,500 or more subscribers and which attempts to provide a compre-hensive health service. 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-cation system, i t i s recommended that 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 receive careful and detailed orientation concerning a l l facets of the Health Service. The turnover of c l e r i c a l employees appears high, which might be due to the sessional employment of two, or to some c o n f l i c t i n the main o f f i c e area. Interpersonal communications are said to need improving. I f s t a f f s a t i s f a c t i o n and work per-formance are to be promoted, the s t a f f must be kept informed as promptly as possible of a l l personnel, program, or proced-u r a l changes and other matters f o r which they are expected to have accurate information. It i s important that the urgency of maintaining s t r i c t c o n f i d e n t i a l i t y of information be under-193 stood, that the reception of patients and telephone inquiries be handled in an alert and courteous manner, and that dis-cussion of even common patient problems be discouraged at a l l times. The Standards suggest that the need for continu-ing inservice education is more imperative for this group than for any other group of the staff. While there would appear to be an adequate number of secretarial/clerical staff, as mentioned previously a medical record librarian would be an invaluable asset to the service in terms of coding, f i l i n g , storing, and retriev-ing medical information, and instituting a unit record f i l i n g system to replace the present alphabetical system. Such in-formation i s necessary not only for s t a t i s t i c a l purposes, but for future planning and research. The magnitude of the responsibility of properly maintained f i l e s , therefore, re-quires a person who is competently and appropriately trained for the task. Again, there is an observed need for clearly de-fined job descriptions, including primary responsibilities and ancillary duties, as well as the means of performance evaluation and opportunities for advancement. A manual of procedures relating to communications and other matters of concern to the c l e r i c a l staff is required. 194 7.7 SUPPORT STAFF The standard of housekeeping, sanitation, and maintenance appears high i n a l l areas of the Health Service. The number of personnel i n t h i s area therefore i s considered to be s a t i s f a c t o r y . The only two job descriptions found i n the depart-ment were those f o r the Nurses' Aide (Housekeeping Assistant I) i n the O.P.D., and the Housekeeping Assistant II i n the Hospital. These two employees are long-term and t h e i r func-tions are f a i r l y interchangeable. It i s suggested that the Nurses' Aide's function of recording data on r e q u i s i t i o n s and labels before d e l i v e r i n g specimens to the lab, be deleted from her s p e c i f i c a t i o n of duties as i t would not appear to be consistent with her po s i t i o n , nor safe i n terms of possible errors of recording. Rather, cert a i n custodial a c t i v i t i e s now performed by the nursing s t a f f might be traded 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. It i s not understood why the Nurses' Aide was attend-ing a four-week communications seminar at the time of the on-s i t e review of the Health Service. This type of educational a c t i v i t y would have better benefited one of the s e c r e t a r i a l / c l e r i c a l or professional members of the s t a f f . I t i s recommend-ed, however, that maintenance personnel should 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. 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 in the West Wing of the Weshrook Building near the center of the campus where i t is readily accessible from both academic and residential areas. It comprises the up-to-date Out-patient Department on the main floor together with the twenty-six bed Hospital and Mental Health Unit on the third floor. The offices 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 for direct patient care are found in the same building or within areas easily accessible from the service as recommended in 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 initiated. The diagrams in Appendices VIII and IX provide visual layouts of the O.P.D. and the Hos-p i t a l . Although some measure of psychiatric service has been 197 provided f o r students since 1938, the separate Mental Health Unit was opened i n 1973 adjacent to the Hospital on the t h i r d f l o o r . This space was made available by the relocation of the Department of Health Care and Epidemiology to the new James Mather Building i n December 1972. As noted e a r l i e r there are 6,500 square feet of space on each of the two f l o o r s of the service, excluding the Mental Health Unit. I f the anticipated p o l i t i c a l deci-sion i s made to construct a new 230-bed acute care h o s p i t a l on the University campus, the speculation i s that the Health Service w i l l be relocated i n that f a c i l i t y . The rationale f o r building a new hos p i t a l i s to double the enrolment of the medical school from 80 to 160 students i n order to meet the growing shortage of Canadian trained doctors. In plann-ing f o r t h i s event, the Health Service Director has requested a space allotment of 10,000 square feet f o r transfer of the O.P.D. functions only, an increase of 3,500 square feet over the present outpatient f a c i l i t y . In r e a l i t y , the increase would amount to greater than that amount as the lab and x-ray functions would be performed by those departments of the new hospi t a l . The Director anticipates that a bed a l l o c a t i o n would be made f o r the exclusive use by students, but an exact number i s d i f f i c u l t to forecast since the Hospital i s so poorly u t i l i z e d . In any case, the University has indicated that i t can use the space i n the Wesbrook Building f o r other purposes. 198 A transfer of the Mental Health Unit 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, con-veniently located, comfortably furnished, s a t i s f a c t o r y i n si z e , and apparently well u t i l i z e d by the students. Other than the need f o r free 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 of the Health Service, the func-tions and a c t i v i t i e s of the Mental Health Unit seem f a i r l y autonomous and would not l i k e l y s u f f e r a marked decrease i n student use i f the lo c a t i o n remained constant. Further-? more, the present plans to decentralize the p s y c h i a t r i c service through outreach programs i n the various residences and dorms give additional support to thi s argument. I f and when a decision i s announced r e l a t i v e to a new hospital and transfer of the Health Service, planning should begin immediately f o r the student health program. Basic decisions must be made concerning those services which w i l l be provided, the subscribers to be served, and other resources available. Detailed projections must be made of service loads, s t a f f i n g patterns, supporting services and personnel, and receipt, storage, and flow of supplies. Func-t i o n a l design must be given f i r s t p r i o r i t y i n order to en-courage optimum use of services and to promote the e f f i c i e n t use of resources. I t i s recommended that such important planning w i l l require a f u l l - t i m e appointee from the Health Service to the Hospital Building Committee i f the needs of th i s department are to be s a t i s f a c t o r i l y represented. This 199 p o s i t i o n might well be combined with that of an assistant to the Director, as recommended i n the l a s t chapter. 8.3 MAINTENANCE It would appear that the present f a c i l i t i e s meet the standards approved f o r the purposes f o r which they are used. Recommended a u x i l i a r y f i r e protection i s provided by automatic sprinklers, appropriate f i r e extinguishers properly placed and maintained, and an i n t e r n a l alarm system. Trash and other combustibles are removed promptly; corridors and stairways are observed to be unobstructed at a l l times. One r e a l hazard observed during the inspection was the storage of oxygen tanks i n the open Janitor's closet within the Hospital ward on the t h i r d f l o o r . The warm and sometimes sunny location of the tanks and the p r o b a b i l i t y of bumping them with floor-washing equipment, make the tanks subject to explosion or combustion and, therefore, extremely hazard-ous even though they are properly chained to the wall. I t i s recommended that the regulations f o r safe storage of com-bustibles and explosives be followed, that i s , a cool, dark, metal-lined and locked storage compartment accessible from the exterior of the building. I t i s assumed that r e f r i g e r a t i o n , v e n t i l a t i o n , emergency power, f i r e equipment, and other support systems 200 are subject to regular maintenance, inspections and t r i a l s . A l l work i s requisitioned to the Campus Physical Plant and carried out by the various trades as indicated. These i n turn are subject to the rules and regulations of t h e i r respective unions. In the event of a power f a i l u r e , the emergency power system should be able to maintain adequate l i g h t i n g i n an emergency treatment room, the corridors and stairways, nursing station, and the medical records, x-ray and laboratory areas. The budget f o r building maintenance such as f l o o r s , walls, windows, plumbing, and elevators, i s submitted through the Physical Plant. Maintenance of a r t i c l e s i n s t a l l e d or purchased by the O.P.D. or Hospital i s the f i n a n c i a l respon-s i b i l i t y of the department. Per diem financing i s provided f o r the Hospital by the B.C.H.I.S. Additional information regarding safety and maintenance, has been given i n Chapter 6 under Environmental Health and Safety and Provisions f o r Emergencies/Disasters. 201 CHAPTER 9  BUSINESS MANAGEMENT 9.1 FINANCING The Health Service Hospital i s owned and operated by the University. I t i s financed primarily by the B r i t i s h Columbia Hospital Insurance Service through the standard per diem rate established on the basis of the annual budget, and i n a small way by the d a i l y co-insurance paid by the patients. Donations and bequests made to the University also a s s i s t i n financing the health program. The one dollar-a-day co-insurance has been paid by private patients personally, but the University has sub-sid i z e d student patients by making the payment on t h e i r be-half. In the spring of t h i s year, 1976, however, the Provin-c i a l Government introduced an increase of the co-insurance to four dollars-a-day and i t has not as yet been announced whether the University intends to meet the increased subsidy. This decision i s expected to be part of the overall-' consideration being given to closing the Hospital since the increase w i l l l i k e l y discourage i t s use f o r r e h a b i l i t a t i o n of long-stay patients as well as f o r students. Before the introduction of B.C.H.I.S. and Medicare, the source of funds f o r the health program was part of the 202 composite fee l e v i e d by the University f o r several purposes, f o r example student dormitories, the Health Service Hospital, and the ambulatory services. Now, however, students are expected to carry insurance coverage or they are b i l l e d f o r services provided. The following information i s provided i n the current U.B.C. Calendar.^ (a) Hospital Insurance (i) Students who are c l a s s i f i e d as residents of B.C. are e n t i t l e d to B.C. Hospital Insurance benefits. ( i i ) Students who are not c l a s s i f i e d as residents of B.C. are not e l i g i b l e f o r payment of hospi-t a l costs under the B r i t i s h Columbia Hospital Service. Enquiries regarding e l i g i b i l i t y f o r residence may be made during University r e g i s t r a t i o n , at the Health Service o f f i c e , or by telephoning the B.C.H.I.S. o f f i c e . A l l Canadian provinces accept r e s p o n s i b i l i t y f o r h o spital costs f o r t h e i r students attending the University of B r i t i s h Columbia provided the hos p i t a l insurance premiums (where required) have been paid, or u n t i l the student i s accepted as a permanent r e s i -dent of B.C. Students who attend U.B.C. and are not r e s i -dents of Canada are required to produce evidence of adequate sickness and hospital insurance before r e g i s -t r a t i o n can be considered complete. Non-resident stu-dents can purchase a Medical and Hospital Plan at the time of r e g i s t r a t i o n . This provides acceptable s i c k -ness and hospital insurance with no Deductible. The rates f o r 1975-76 were $110.00 f o r a single student and $225.00 f o r a married student f o r 12-month cover-age. These rates are subject to yearly change. .Ob) Sickness Insurance It i s advisable f o r a l l B.C. residents to have coverage under the Medical Services Plan of B.C. 203 Unmarried students whose parents are enrolled i n the M.S.P.B.C. are insured as dependents u n t i l t h e i r 21st birthday. The coverage may he continued i f the student i s i n f u l l - t i m e attendance at uni v e r s i t y and mainly dependent on his parents, but the Plan 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 not covered by t h e i r parents' medical insurance plan, the following plans are a v a i l a b l e : -(i ) Medical Services Plan of B.C.: Students covered by t h i s Plan as i n d i v i d u a l subscribers may be e l i g i b l e f o r a subsidy. Students who have not established residency ... are not able to purchase t h i s plan. Coverage should be maintained i n the home Province. Further d e t a i l s may be obtained at the Health Service o f f i c e or from the M.S.P.B.C. (Medical Services Plan of B.C.). ( i i ) Non-Canadian Resident Hospital-Medical Plan: ... Students covered by an approved insurance plan with 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 services received. Receipts should then be submitted by the student to the insurance company f o r reimbursement. Students who allow t h e i r insurance to lapse w i l l be b i l l e d d i r e c t l y . Out-of-Canada students are required to have coverage f o r both hospital and physician care. They may purchase com-bined hospital and medical insurance through a private plan, i f other adequate coverage i s not carried. A brochure out-l i n i n g benefits of the plan and the current year's premium rates may be obtained at the Health Service. Students are advised to attend to t h i s early so that the insurance can commence as soon as possible a f t e r t h e i r a r r i v a l i n B.C. In general i t i s considered that prepayment of d i r e c t personal services encourages optimum use of services at the time that they are needed. 204 9.2 BUDGET PLANNING A. OUTPATIENT DEPARTMENT This department i s financed by an a l l o c a t i o n from the general funds of the university. The departmental budget i s determined each year by the previous year's budget, chang-ing s a l a r i e s , operating expenses, and the need to replace or update existing equipment. The budget review i s ca r r i e d out by representatives of the President's o f f i c e , the Finance Department, and the Health Service. The l a s t available annual operating budget was f o r the f i s c a l year 1974-75, determined i n 1973. I t i s as follows: Salaries and Wages $279,422.00 Drugs 1,800.00 Medical and Surgical Supplies 4,080.00 X-ray Supplies 4,320.00 Laboratory Supplies 1,680.00 Housekeeping Supplies 360.00 Laundry 2,640.00 Office Supplies, P r i n t i n g , etc. 4,800.00 Travel 1,180.00 Travel - Staff Training 500.00 Repairs & Maintenance 1,080.00 TOTAL $301,862.00 The cost of unbudgeted items, such as salary increases and fringe benefits brought i n by new contract negotiations, was borne by the general University budget u n t i l the following f i s c a l year. 205 It appears that s a l a r i e s and wages make up roughly 92.5% of the t o t a l operating budget. This dispro-portionate figure may be due to several reasons. One, the B.C.M.P. i s b i l l e d through the University which receives the payments and i n turn reimburses the medical s t a f f on a s a l a r i e d basis, r e f l e c t e d i n the figure f o r s a l a r i e s and wages. Two, no physical plant maintenance such as heat, l i g h t s , water, etc. i s shown i n the budget. Three, no administrative costs on behalf of the employees are shown, such as W.C.B., l i f e insurance and M.S.A.; and four, no food costs are necessary i n an outpatient service. In any case, when the actual costs f o r d i r e c t patient services, that i s , drugs, medical and sur g i c a l supplies, and lab and x-ray supplies, add up to only a f r a c t i o n of the t o t a l budget (3.9%) the figure f o r s a l a r i e s and wages appears to be an overwhelmingly large percentage. B. HOSPITAL The funds f o r th i s budget, as previously reported, are derived from the B.C.H.I.S. per diem payments. A l l Hos-p i t a l beds are c l a s s i f i e d as public and therefore only the standard per diem rate i s paid. These funds are administered by the University with budget d e f i c i t s being made up from the general University funds. For example, i n the f i s c a l year ending March 31, 1974, the Health Service Hospital incurred 206 a deficit of $12,878. that had to he subsidized out of general University revenues. The information in Table XII, copied from the October JO, 1974 issue of the U.B.C. Reports indicates that the Health Service Hospital def i c i t accounted for 57.7% of the total deficit from a l l U.B.C. ancillary enterprise sources. No other statements were obtainable for other years' operations but i t is assumed that the Hospital has had an operating deficit for some time. 207 TABLE XII STATEMENT OF U.B.C.'S ANCILLARY OPERATIONS  FOR THE YEAR ENDED MARCH 31, 1974 HEALTH SERVICE TOTAL ALL HOSPITAL SOURCES REVENUE • Sales $ - $4,184,040. Rentals and Meal Passes - 3,838,727. Hospital Revenue 230,898. 230,898. $230,898. $8,253,665. EXPENDITURE Cost of Merchandise Sold $ - $2,758,658. Salaries and Wages 154,533. 2,410,009. Fringe Benefits (including Board Allowance) 7,082. 132,466. Dietary Service 29,314. 29,314. U t i l i t i e s 4,051. 326,640. Other Operating Expenditures 19,833. 786,458. Development of F a c i l i t i e s 28,963. 66,105. Debt Repayment, including Interest - 1,799,452. $243,776. $8,309,102. Net Operating Margin f o r Year ($12,878.) ($55,437.) Reserved f o r Future Debt Repayment $ - $ Accumulated Reserve from Previous Years 156,005. Reserved f o r Future Development - 122,877. Excess of Income over Expenditure f o r the Year Ended March 31,1974 ($12,878.) ($22,309.) SOURCE: U.B.C. Reports, October 30, 1974. 208 Budget reviews are conducted i n the same manner as are those f o r the Outpatient Department. Figures a v a i l -able f o r th i s report were also taken from the 1974-75 Health Service operating budget. Salaries and Wages $176,954.00 General Expenditure: Medical & Surgical Supplies 1,460.00 Drugs 2,614.00 X-ray Supplies 1,540.00 Medical Records & Library 300.00 Laboratory Supplies 1,100.00 Administration: Postage 175-00 Office Supplies, P r i n t i n g , etc. 550.00 Telephone & Telegraph 450.00 Workmens Compensation Board 200.00 Travel 500.00 L i a b i l i t y Insurance 96.00 L i f e Insurance & M.S.A. 7,850.00 Membership - B.C. Hospital Association 500.00 Short-Term Training Courses 75.00 Col l e c t i o n Fees 50.00 Co-Insurance f o r Students 1,400.00 General Service: Dietary-Food 7,254.00 -Central Kitchen Charges 2,392.00 -Other Expenses 300.00 Laundry 3,000.00 Bedding & Linen 1,000.00 Housekeeping Supplies 500.00 Physical Plant: Fuel 1,200.00 E l e c t r i c i t y 1,650.00 Fi r e Insurance Premium 250.00 Maintenance - Building & Grounds 1,000.00 Water 750.00 Equipment Replacement: Equipment & Furnishings 1,000.00 TOTAL $216,110.00 209 While there are many more items making up the Hospital budget than the O.P.D. budget, the figure f o r s a l a r i e s and wages which approximates 81.9$ of the t o t a l budget, i s s t i l l thought to be high compared to the average public hospital i n which s a l a r i e s and wages are estimated at approximately 70$ of the operating budget, p a r t i c u l a r l y when several other items shown are s t a f f benefits such as l i f e insurance. In terms of d i r e c t patient care, that i s , general expenditures (minus medical records and l i b r a r y expense) and general services, the budget expenditures are estimated to be $21,160.00, again only a f r a c t i o n (9.79$) of the t o t a l budget. I t i s assumed that any trimming of expenses or required budget-cutting would have to be done i n the area of s a l a r i e s and wages. Since the University's 1976-77 opera-t i n g budget increase was recently announced i n the Vancouver Sun to be about one-third 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 revised request, i t i s anticipated that a l l exi s t i n g programs w i l l be asked to cur-t a i l expenses. This w i l l require a concerted e f f o r t of a l l s t a f f members of the health program i f a high standard of service i s to be maintained. The Standards recommend that program and budget preparation should be a r e s p o n s i b i l i t y of the Health Service Director, working c l o s e l y with his s t a f f at a l l l e v e l s . I t 210 has been recommended throughout t h i s report that members of the Health Service s t a f f should be involved i n the plann-ing and preparation of t h e i r various areas of the departmental budget, f o r example, lab and x-ray,aand that s t a t i s t i c a l i n f o r -mation r e l a t i n g to u t i l i z a t i o n of services should be used as a basis f o r budget projections as well as for developing sound program models. Only a f t e r program and budget estimates have been determined at the departmental l e v e l , should discussions take place with the central administration or finance o f f i c e of the University. 9.3 BUSINESS PROCEDURES Section 2 A r t i c l e 2 of the Health Service Hospital Bylaws states that: " F u l l control of the receipts and expenditures of the hosp i t a l s h a l l be vested i n the Board." Section 6 A r t i c l e 1 states that: "The accounts of the hospital s h a l l be deemed to be "accounts of the Board" as s p e c i f i e d i n Section of the " B r i t i s h Columbia University Act" and s h a l l be audited i n the manner provided therein." Although l i t t l e information could be obtained i n th i s area, i t i s recommended i n the Standards that a l l a c t i -v i t i e s of the health program should be organized and t h e i r business a f f a i r s conducted according to accepted p r i n c i p l e s of business management. While i t i s recognized that the qu a l i t y of patient care, teaching, community service, or 211 research must never be s a c r i f i c e d f o r economy, i t i s stated that a concern f o r health should never be j u s t i -f i c a t i o n f o r waste, i n e f f i c i e n c y , or mismanagement. I t i s recommended that guidelines f o r business procedures i n the Health Service, including the Hospital be prepared, defining how the following functions should be performed: - Preparation of Budgets - Maintenance of Accounts - Procurement, Storage, and D i s t r i b u t i o n of Supplies and Equipment - Maintenance of Building and Equipment Custody, Loan, and Charges f o r Equipment Decision-making processes involving supervisors, employees or others, i n the formulation and re-commendation of business p o l i c i e s and procedures. - Operational statements such as salary status of each employee f o r whom the business o f f i c e main-tains a record. 9.4 PERSONNEL POLICIES AND PROCEDURES The Standards recommend that a l l units of the health program e s t a b l i s h and observe a high standard f o r personnel p o l i c i e s and procedures. I t i s recommended i n other sections of t h i s paper that every p o s i t i o n on the professional and non-professional s t a f f s should have a job description o u t l i n i n g 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 opportunities f o r advancement, i f any. I t i s further recomm-ended that c l e a r l y understood procedures f o r periodic (at l e a s t 212 annual) performance evaluation of each employee, professional and non-professional, be developed and implemented. Written evaluations should be discussed with the s t a f f member concerned following his personal review of the evaluation, with a view to encouraging s t a f f growth and development, improved commu-nications, and job s a t i s f a c t i o n . While i t i s recommended that there should be r e a d i l y available information f o r a l l s t a f f members concerning the perquisites and/or l i m i t a t i o n s f o r each pos i t i o n , the Health Service personnel are generally guided by t h e i r professional or union contracts. The following are the guidelines consulted! Registered Nurses RNABC Contract Licensed P r a c t i c a l Nurses Union 116 Contract Nurses' Aides Union 116 Contract Housekeeping S t a f f Union 116 Contract Service Workers Union 116 Contract Registered Technicians Health Sciences Association Contract C l e r i c a l S t a ff AUCE Contract (Association of University C l e r i c a l Employees) It i s f i n a l l y recommended that the Health Service develop written departmental p o l i c i e s regarding payment of professional association fees, payment of expenses to meet-ings and conferences, and inservice education opportunities. 2 1 3 PART III CONCLUSIONS OF THE STUDY 214 CHAPTER 10  SUMMARY AND RECOMMENDATIONS 10.1 SUMMARY OF SERVICES The Standards recommend that the health program of every college and university, regardless of s i z e , should comprise services i n three broad program areast medical and other health services, including community-oriented preventive services; environmental health and safety; and education f o r health f u l personal and community l i v i n g . The primary emphasis of the U.B.C. Health Service i s on the medical and other health services, with some comm-unity-oriented preventive services. A program f o r environ-mental health and safety i s not a composite part of the Health Service although i t does have representation on an i n s t i t u t i o n a l committee concerned with that area. Education f o r h e a l t h f u l personal and community l i v i n g i s not fomalized, but informal health education, advice, and counseling, are made possible through d i r e c t student contact during Health Service v i s i t s and sp e c i a l purpose c l i n i c s . The range of medical and other health services includes diagnostic, therapeutic, and some r e h a b i l i t a t i v e services; a l l c l i n i c a l services eit h e r provided or prescribed by the Health Service appear to be of the highest q u a l i t y . 215 Provision is made for meeting emergencies on an individual basis, while group emergencies are generally referred off-campus. Outpatient and inpatient services are well provided for and give recognition to the integration of care for emotional and physical illness. The effectiveness of both outpatient and inpatient personal health services i s supported by such other services as laboratory, radiology, pharmacy, and physical therapy. Athletic medicine is provided for and mental health care is a major element of the overall program. Dental medicine is considered to be a severe deficiency in the provision of comprehensive health services to the students, staff and other personnel in this large institution. Preventive health services are given special consideration, but the promotion of health and the prevention of disability should be broad-ened through a structured campus-wide health education pro-gram. Although an institutional plan for meeting emerg-encies and disasters is reported to be in the developmental process, no evidence of such planning is apparent. While an institutional committee does exist in concern of environmental surveillance to control those factors which may compromise physical and emotional health, a dynamic plan of action is required to implement and evaluate this broad program area. Responsibility for the program, however, rests with the University administration and not the Health Service. 216 The same is true for the third broad program area, the promotion of education for healthful individual and comm-unity liv i n g . There is an observed need for a discrete, well-coordinated, and well-supported program of health education for a l l members of the institutional community. Planning for such a program is required on both a departmental and an administrative level. 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 interrelationships of students, faculty, and staff, is recommended as an integral part of a health program which purports to be comprehensive or progressive, as described in the Standards. In general, i t is concluded that the U.B.C. Health Service meets the standards and practices recommended for 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. Where non-applicability of the Standards was found to exist in the conduct of the study, explanations have been given in the text or recommendations have been adapted to suit the Canadian context. 217 10.2 SUMMARY OF RECOMMENDATIONS One of the operational goals of this study was to recommend ways to more effectively or effi c i e n t l y co-ordinate the planning and provision of health services at U.B.C, including their coordination with other services. Recommendations, some of which may now he in effect, are made in a concern for greater u t i l i z a t i o n of the services available, increased efficiency in the disposition of mat-er i e l and manpower resources, and the advancement of pro-fessional knowledge and practice. The ultimate objective is to further patient and personnel satisfaction through improved health programs. Statements of recommendation and suggestions for change have been discussed in some detail throughout the principal text of the study. The following recommenda-tions, developed bn the basis of the findings and conclusions of the study and presented in a summarized form for ease of reading and reference, either originate from the recomm-ended 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 in view of i t s objectives in providing health care to students, of universal insurance and 218 rising health care costs, of changing p o l i t i c a l philo-sophies, and of changes which have evolved around the Health Service in recent years. 2. The organization and functions of the services he re-viewed regularly and changed accordingly in order to keep them effective, timely, and up-to-date. 3. Census data relating to the composition of the student be enrolment, from the Office of Academic Planning, review-ed annually in order to project trends of increase or decrease in the number and type (e.g. age and sex) of students, and to identify possible areas requiring the planning or expansion of new or existing services. 4. 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, for large groups of foreign students where indicated. 5. The Health Service Hospital be closed and the space be used for other purposes; students requiring acute inpatient care be referred to community hospitals; out-reach programs be developed in campus residences to include infirmary beds for students not requiring acute hospital care, 6. The Bylaws of the University Health Service Hospital be reviewed and revised as necessary. 219 7. Statements of po l i c y be developed i n support of the medical care and treatment provided f o r students, and of the Health Service r e s p o n s i b i l i t y f o r environmental surveillance and control, and health education. 8. In the event of future r e l o c a t i o n of the Health Service, planning f o r new f a c i l i t i e s be undertaken to include a detailed analysis of the functions and services to be provided, projected patient loads, estimated patterns of use, t r a f f i c flow, and s t a f f i n g patterns f o r both regular and spe c i a l services. 9. A f u l l - t i m e appointee to the Hospital BuiJLding Committee be made from the Health Service to s a t i s f a c t o r i l y repre-sent i t s needs; such a..- planning p o s i t i o n possibly being combined with that of an assistant to the Director ex-perienced i n hospital or medical administration. BUSINESS MANAGEMENT 10. Regular reports of a c t i v i t i e s and services be produced and c i r c u l a t e d to a l l departments of the i n s t i t u t i o n concerned with the health of the campus community. 11. Program budget preparation be a r e s p o n s i b i l i t y of the Director working c l o s e l y with his s t a f f to determine budget estimates at the departmental l e v e l , before discussions with the University administration or finance o f f i c e . 220 12. Staff members be involved in the planning and prepara-tion of their various areas of the departmental budget to promote cost-consciousness 5 s t a t i s t i c a l information relating to u t i l i z a t i o n of services be used as a basis for budget projections as well as for 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 for every staff position, outlining qualifications, responsibilities and duties, manner of supervision or line of authority, and oppor-tunities for advancement, i f any; each staff member be involved in the development of his/her own job des-cription and specifications with a view to seeking new and more effective ways of u t i l i z i n g personnel talents and capabilities; custodial functions currently performed by the professional nursing staff be delegated to the nursing assistants. 15. Clearly understood procedures for periodic (at least annual) performance evaluation of each staff member be developed and implemented? written evaluations be dis-cussed with staff members after personal review of their individual evaluation, with a view to encouraging staff 221 growth, and development, improved communications, and job s a t i s f a c t i o n . 16. Written departmental p o l i c i e s be developed regarding payment of professional association fees, payment of expenses to meetings and conferences, and inservice educational opportunities. 17. S t a t i s t i c a l reports of a l l services including Hospital u t i l i z a t i o n be kept f o r periodic evaluations to analyze the effectiveness of services, to determine budget re-quirements, and to plan future services. OUTPATIENT SERVICE 18. The Health Service and University administration develop plans to encourage greater u t i l i z a t i o n of primary care services to students. 19. The outpatient services be extended to include evening c l i n i c s and weekend coverage f o r the provision of emer-gency care, s p e c i a l c l i n i c s and increased counseling, to better u t i l i z e the space available during periods of heavy t r a f f i c flow and i n s t i t u t i o n a l growth, and to allow new programs to be introduced into the service as considered appropriate by the s t a f f and by student demands. 20. S t a t i s t i c s be computed and analyzed r e l a t i v e to the number of patients now seen a f t e r c l i n i c hours, the 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 in advance of predictable problems or occurrences in order to meet the demands for service with manpower and other resources, for example, influenza immuni-zation c l i n i c s . 22. A concerted effort be continued to eradicate known or suspected health hazards to the community; pre-parations be made immediately to combat the possible wide-spread outbreak of the disease known as swine fiLu. 23. Special programs be developed for surveillance and education to prevent complications of known existing diseases such as diabetes, epilepsy, and chronic card-iovascular or pulmonary disease; periodic screening or detection programs be developed to identify students (and others) with chronic or locally endemic diseases, such as subclinical diabetes or dental diseases. 24. The scope of the existing health appraisal program be increased through an emphasis on health education. 25. Students who present themselves for service be followed-up in the manner used by the Community Health Centre, 223 i.e. by checking on referrals made to other sources and by checking patients attending the service for unrelated problems; a l l referrals to community re-sources be followed-up within a reasonable period of time in order to record outcomes or to take further appropriate action i f necessary; a proper form be dev-eloped to promote two-way communication with referral sources. 26. Because of the increasing competition for c l i n i c a l teaching f a c i l i t i e s for students in the health pro-fessions, the Health Service be used to provide val-uable c l i n i c a l experience in public health and preven-tive medicine, mental health, birth 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 position on the nursing staff becomes vacant, the development and re-view of position job descriptions providing evidence of the need for change; a l i s t of prescribed approved duties be obtained from the L.P.N. Association. 28. Room 134 in the outpatient c l i n i c be fumigated after treatment of a l l "dirty" cases, and supplies and other items subject to contamination be kept to a minimum in the room. 224 HOSPITAL 29. Subject to the Hospital remaining open, clean and dirty supply rooms be separated; the room designated for flower-arranging be considered for use as a "dirty" u t i l i t y room; ster i l i z e d bundles and equipment in the "clean" supply room be carefully stored, dated, and periodically tested for maintenance of s t e r i l i t y . 30. 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 in the Hospital is considered dangerous in terms of the possibility of combustion or explosion. 31. Disposable shower curtains be used in the single rooms for patients on isolation technique. 32. A dishwasher be obtained (by purchase or donation) for the ward kitchen, a domestic machine being considered suitable in view §f the low patient census. 33. Written guidelines of isolation techniques for specific contagious diseases be produced with the assistance of the Inservice Education Coordinator; the work already done to prepare medical and procedure manuals be comm-ended. 225 SUPPORTING SERVICES 34. The guidelines relative to patient transportation from the Health Sciences Centre Psychiatric Unit to the x-ray service be reviewed and reinforced. 35. The efforts of the X-Ray Technician to participate in educational developments in her f i e l d be recognized. 36. A Pharmacy Committee of the medical staff be organized to review the prescribing and use of medications and other therapeutic agents in the care and treatment of students, and to recommend additions or deletions in the drug formulary. 37. The provision of dental screening be made available to students and at least emergency cases be referred for prompt treatment to the Dental School; consideration be given to retaining a consultant dentist and/or den-t a l hygienist, and to providing an evening dental c l i n i c for students. 38. The number of referrals made to dentists and outside doctors be recorded as a basis for 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 disciplines such as psychiatric nursing, social 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 jointly with the Athletic Department for the purpose of developing programs of injury prevention. 42. Advanced students in the School of Rehabilitation Medicine be encouraged to participate in the physio-therapy program as part of their c l i n i c a l training. 43. The Physiotherapy Treatment Centre be recognized as operating at a high level of performance. 44. The services of a consultant or part-time dietitian be considered to supervise the Hospital food service and the special nutritional needs of both inpatients and outpatients. MEDICAL RECORDS 45. Written histories, physical examinations, signed orders, discharge summaries and f i n a l diagnoses, be required for 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 in the staff lounge be kept in a secure location to which access is 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 third parties. 49. Clearly defined policies be established regarding poss-ible contentious areas such as psychiatric treatment, birth control, abortion, surgical procedures, hospital admission, legal consent for underage patients, confid-entiality of records, privilege of communications, re-portable conditions, and the administration of drugs. 50. Periodic chart reviews be made to provide an indirect measure of the quality of c l i n i c a l care being provided. 51. A system for the retrieval of data from a l l c l i n i c a l records, for example, lab. and x-ray reports, be dev-eloped for reviewing the overall work of the service, for supporting the review of c l i n i c a l performance, and for 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 illness or causes of disability? presenting 228 problems or complaints be broken down and categorized by disease c l a s s i f i c a t i o n s f o r future research and planning. 53. Automatic processing of medical information be invest-igated i n advance of the possible relocation of the Health Service to a new campus hospital with a cen-t r a l i z e d data bank. 54. A consultant or part-time Medical Record L i b r a r i a n be retained. ENVIRONMENTAL HEALTH AND SAFETY 55. The Health Service seek and observe p o l i c y statements regarding standards and codes r e l a t i n g to f i r e protec-t i o n , safety and 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 health, sanitation, and general environ-mental control of working conditions. 56. An area-wide disaster plan be developed and implemented without further delay; coordinated e f f o r t s of the f i r e safety and environmental personnel, R.C.M.P., medical, nursing and Hospital personnel, other concerned groups on campus, and o f f campus resources such as the Emergency Measures Organization, Red Cross, and Vancouver General Hospital be included. (Sample emergency/disaster plans are available from the American College Health Association.) 229 HEALTH EDUCATION 57. Every patient contact be recognized and used as an opportunity for education of the student concerning the implications of his particular problem, physical or emotional, for personal and community health; con-sumer education at the student level be regarded as a means of curtailing the escalation of health care costs. 58. Every nurse in the department, through education, ex-perience , or special interest in 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 for health education. 59. A course (or courses) be developed in personal and community health and hygiene through which students in a l l faculties can attain basic health information and through which their health behavior may be i n f l u -enced positively. 60. A student/facuity health council be organized to define and recommend solutions for University health problems and to further campus-wide interest and participation 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 for continuing evaluation of health education opportunities and for determining inservice education programs. 62. The responsibility for staff development through effective inservice education be delegated to one staff member, appropriately trained and personally committed to this area of interest. 63. The maintenance personnel receive both an i n i t i a l and a continuing course of inservice instruction in order to be well informed concerning the measures they must observe to assist in the prevention and control of infectious and communicable diseases. 64. Assistance be requested from the Fire Prevention Officer to develop an inservice education program of f i r e and safety consciousness for a l l Health Service personnels the c l i n i c a l resources of the Pharmacy be used for edu-cation on new medications. 65. Other health=related campus resources be uti l i z e d , such as the Dental School, the Community Health Centre, and the School of Nursing to gain valuable assistance in developing policies and procedures, and in short courses of inservice instruction, for example psychiatry for Health Service nurses interested in participating in the mental health outreach programs. 231 66. A working rela t i o n s h i p be maintained with other depart-ments or resources involved i n health education, such as the inservice education committee of the R.N.A.B.C. COMMUNICATIONS 67. 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 communication system, 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 receive c a r e f u l and detailed orientation concerning a l l facets of the Health Service f o r which they are expected to have information; 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 be developed. 68. Meetings of department heads, supervisors, and others who share r e s p o n s i b i l i t y f o r Health Service a c t i v i t i e s be held at regular, i f only periodic, i n t e r v a l s . 69. Regular nursing s t a f f meetings, including the Hospital s t a f f , be held and include educational and professional association a c t i v i t i e s and announcements. 70. Medical s t a f f meetings be planned to include the Mental Health Unit and periodic representation from other cam-pus health-related departments, with developments or information r e s u l t i n g from these meetings shared with the nursing and support personnel. 232 71. Minutes or tapes of meetings be kept f o r the information of those unable to attend. 72. The Health Service brochure provided to a l l new r e g i s -trants be updated; the A.C.H.A.'s Health Information Series comprised of eight brochures be considered f o r d i s t r i b u t i o n to patients and members of the campus comm-unity. 73. Health Service s t a f f attendance at annual r e g i s t r a t i o n be increased to promote f u l l e r exposure of the available health services to the increasing student population. 74. Employee performance evaluations be used as a means f o r two-way communication. 75. The planning and attendance of the recent communications workshop be commended; a follow-up review of the work-shop be done to determine p o s i t i v e influences brought about i n the area of i n t e r n a l communications, 76. Health Service s t a f f be involved i n campus-wide committees and informal gatherings as f a r as possible i n an e f f o r t to promote recognition of the services available. 77. Investigation be made into the possible production of a short audio-visual f i l m of the Health Service by the University T.V. or photographic department, to be used by health education s t a f f and during the orientation of new students to the campus. 233 EXTRAMURAL RESOURCES 78. Working relationships be established with community health-related agencies and individuals to assist the students to make maximum use of such resources; for example, liaison with Planned Parenthood and similar agencies be sought for birth control and pregnancy counseling. 79. Every opportunity be used to learn what public, vol-untary, and industrial resources are available for use by the University community as well as by the general community. 80. Staff members participate in the activities of extra-mural community agencies and planning councils when-ever possible, to stimulate professional activity. 81. Each professional staff member be encouraged to main-tain contact with his/her professional organization and to subscribe to the literature pertaining to each respective area of interest or activity. 82. Cooperative activity be undertaken with the health services of other universities and colleges in British Columbia to share resources and information, and to promote public relations. 234 83. Active participation in 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 assist or advise in areas of uncertainty or concern to the Health Service, for example, medical records and nutritional counseling. EVALUATION AND RESEARCH 85. Periodic evaluation of existing Health Service programs be conducted in an attempt to upgrade the quality of the programs; evaluative studies be carried out to determine the effectiveness 6f specific services; con-tinuous monitoring of the level of student health be done through record-keeping and data analysis. 86. Plans be formulated for continuing research projects in areas of the Health Service requiring study and the plans be supported and financed by the University admin-istration. 87. Consideration be given to continuing internal audits using the A.C.H.A. self-evaluation guide. 235 10.3 IMPLICATIONS FOR PLANNING The goal of any health service is the improvement of levels of health in the community. A fundamental issue is whether and to what degree coordination and integration of activities should he achieved. In other words, we need to know how a rational system of planning and administration of health programs can he attained in order to achieve i t s goals. But changes in the nature of social problems, in the character of medical technology, in the structure and func-tion of health services, and in the needs and expectations of the public have pressured organizations into planning and developing programs much broader than the traditional health services. This enlargement of scope has created a complexity of problems in organization and resources which demand con-tinuous evaluation and reformulation. Planning and evaluation are inseparable concepts and yet i t is only in recent years that serious attention has been given to the evaluation of health services, to measuring the progress of plans and programs and the achieve-ment of their goals. While health regulatory agencies have identified standards as a basis for planning and evaluating programs, their guaranteed continued quality and the greater accountability demanded can only be provided with major support through more advanced evaluative research. When an evaluative study is conducted i t can lead to further research questions 236 which may y i e l d new insights of r e a l importance to the advancement of professional theory and practice. The U.B.C. Health Service, as an old established program, has the t r a d i t i o n a l support of both the University administration and a public which has become accustomed to i t s services. In order to make the services relevant to student needs and demands, they must be c a r e f u l l y planned and evaluated before they are put into e f f e c t or before resources are allocated. S c i e n t i f i c health planning, pre-d i c t i o n of changing health needs, and evaluation, a l l re-quire a baseline description of health problems and t h e i r magnitude, and of groups which have high rates of such pro-blems and are, therefore, i n the greatest need of health care. Thus, support of the University i s required i n estab-l i s h i n g a mechanism f o r continuing feedback of both the changing needs and the constraints of the i n s t i t u t i o n a l community,that i s i n planning an e f f e c t i v e organization f o r the delivery of health services. This study i s intended as a planning document f o r u t i l i z a t i o n by the U.B.C. Health Service and f o r future research i n other college health programs. 237 LITERATURE CITED 1. Evans, Robert G., and Walker, Hugh D. Public P o l i c y Problems i n the Canadian Health  Services Industry. Discussion Paper No. 41, Department of Economics, University of B r i t i s h Columbia, June 1970. 2. Fuchs, V.F. "Why Health Economics", Mount Sinai Journal of Medicine. Volume XL, Number 4, July - August 1972. 3. Klarman, H. The Economics of Health. Columbia University Press, New York, 1965• 4. Suchman, Edward A. Evaluative Research: P r i n c i p l e s and Practice i n Public Service and S o c i a l Action Programs. Russell Sage Foundation, New York, N.Y., 1967, p. 2. 5. Kohn, Robert The Health of The Canadian People. Royal Commission on Health Services. Queen's Printer, Ottawa, 1965. 6. "Recommended Standards and Practices f o r a College Health Program, Including a Statement on E t h i c a l and Professional Relationships", American College Health Association, Revised 1969, i n The Journal  of the American College Health Association. Vol. 18, October, 1969, p.p. 1 - 66. 7. Knutson, Andie L. "Evaluation f o r What?" Program Evaluation i n the Health F i e l d s . H. Schulberg et a l , editors. Behavioral Publications, New York, N.Y., 1969, p.p. 42 - 50. 8. Mair, A. Student Health Services in Great B r i t a i n and Northern Ireland. Pergamon Press, Toronto, 9. Ralph, I.F. Student Health and Student Health Services Dissertation, University of Edinburgh, Scotland, 1959. (quoted i n Mair, p. 4) 238 10. Canuteson, R.I. "Looking Ahead in College Health", Proceedings of the Twenty-Fourth Annual Meeting, American Student Health Association, Minneapolis, Minnesota, May 1946, Bulletin No. 2?, Cumulative Index. The Journal-Lancet, Minneapolis, Minnesota, p.p. 7 - 8 . 11. Goodenough, Sir Wm. Macnamara, Report of the Inter-departmental Committee on Medical Schools, 1944. Interdepartmental Committee on Medical Schools, Great Britain and Scotland, London, H.M. Stationery Office, 1944. 12. Proceedings of the Twenty-Fourth Annual Meeting, American Student Health Association. Minneapolis, Minnesota, May 1946, Bulletin No. 27, Cumulative Index. The Journal-Lancet, Minneapolis, Minnesota, p. 95. 13. Boynton, Ruth E. "The F i r s t Fifty 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 Pacific Coast College Health Association As Amended 19 October 1974", Proceedings of the Thirty-Eighth Annual  Meeting of the Pacific 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. "Utilization of the Student Health C l i n i c " , The Journal of the American College Health Assoc-iation. Volume 21, June 1973, p.p. 477 - 482. ,16. Schwarz, Conrad J. Report on Health and Psychiatric  Services on Canadian Campuses. Prepared for The Canadian Union of Students, January 1967. 17. Kissner, R.F., and Murdoch, W.D. A Report on Univer-sity Health Needs. Simon Fraser University Project, 1971. 18. Tunner, Alex "Student Perceptions of Need for College Health Services", Proceedings of the Thirty-Eighth  Annual Meeting ofthe Pacific 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 Existing 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 Exist-ing Services. A Course Paper in Community Psy-chology 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, April 196"o\ P.p. 323 - 335. 21. Deniston, O.L.\ Rosenstock, I.M.f Welch, W.; and Getting, V.A. "Evaluation of Program Efficiency", 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 in the Evaluation of Community Mental Health Programs", in H.C. Schulberg et al., 1 9 6 9 . 24. Levey, Samuel and Loomba, N. Paul Health Care Ad-ministration? A Managerial Perspective. J.B. Lippincott Company, Toronto, 1973. 25. James, George "Evaluation in 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 for 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 in the Health Fields. Behav-ior a l Publications, New York, N.Y., 1969. 28. Etzioni, Amitai "Two Approaches to Organizational Analysis: A Critique and a Suggestion", in H.C. Schulberg et a l , p.p. 101 - 120. 240 29- Schulberg, H.C. and Baker, F. "Program Evaluation Models and the Implementation of Research Find-ings" , i n H.C. Schulberg et a l , p.p. 562 - 572. 30. Herzog, Elizabeth Some Guidelines for Evaluative Research. U.S. Department of Health, Education, and Welfare, Social Security Administration, Children's Bureau, 1959. 31. " Trip o d i , Tony; F e l l i n , P h i l l i p ; and Meyer, Henry J. The Assessment of S o c i a l Research; Guidelines f o r the Use of Research i n So c i a l Work and Soc i a l Science. F.E. Peacock Publishers, Inc., Itasca, I l l i n o i s , 1969. 32. Reinke, Wm. A. Health Planning t Qualitative Aspects and Quantitative Techniques. The Johns Hopkins University, School of Hygiene and Public Health, Department of International Health, Baltimore, Maryland, 1972. 33. Wessen, A.F. "On the Scope and Methodology of Research i n Public Health Practice", S o c i a l Science and  Medicine. Vol. 6, 1972, p.p. 469 - 490. 34. Upshall, E.M. H i s t o r i c a l Reports and Papers on the U.B.C. Health Service dating back to 1936, obtained inppersonal interview with Miss Upshall. 35. Annual Reports of the U.B.C. Health Service, 1955-56 to 1974-75. from the Health Service Director, Wesbrook Building, and the Woodward Biomedical Library (Medical Morgue). 36. U.B.C. Calendar 1976/77, Vancouver. 37. Policy and Procedure Manual. University Health Service Hospital and Student Health Service, Wesbrook Building, University of B r i t i s h Columbia, Vancouver, B.C. 38. U.B.C. Reports. Vol. 22, No. 17, May 5, 1976, Vancouver. 39. Detwiller, L.F. "New Health Sciences Centre f o r B.C.", Canadian Hospital. February 1963. 40. U.B.C. Reports. Vol. 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 COMPARATIVE CHART OF STUDENT REGISTRATIONS: TOTAL VISITS FOR ILLNESS OR FOR OBSERVATION 20000 19000 18000 17000 16000 15000 14000 13000 12000 11000 10000 9000 8000 7000; 6000! 5000 From F a l l 1945 - S p r i n g 19*0 No. o f students r e g i s t e r e d during w i n t e r s e s s i o n 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 •Mi 4 5 - 4 6 4 6 - 4 7 4 7 - 4 8 48-49 49-50 50-51 51-52 52-53 53-54 54-55 55-56 56-57 5,7-58 .58 -59 59-60 243 APPENDIX Ib COMPARATIVE CHART OF STUDENT REGISTRATIONS» TOTAL VISITS FOR ILLNESS OR FOR OBSERVATION I960 - 1970 28,000 27,000 26,000 25,000 24,000 23,000 22,000 21,000 20,000 19,000 18,000 17,000 16,000 15,000 14,000 13,000 12,000 11,000 10,000 • COMPARATIVE CHART OF STUDENT REGISTRATIONS: TOTAL VISITS FOR ILLNESS OR FOR OBSERVATION From F a l l 1960 - Spring 1970 No of students registered during winter session. Total no. of v i s i t s for i l l n e s s or for observation J H I .1 - Hi..',. I 1 i l l l ni l ' i •< ' ' i H ' ' ' M 60-61 1.1^6262-6363-64 6 4 - 6 5 6 5 - 6 6 6 6 - 6 7 67-68 68-69 69-70 ro 245 APPENDIX H a CHART SHOWING NO. OF STUDENTS RECEIVING  MEDICAL EXAMINATIONS  1928 - 1955 CH/Jfl II FALL - SPRING- 1 9 5 5 . \ 247 APPENDIX l i b CHART SHOWING NO. OF STUDENTS RECEIVING  MEDICAL EXAMINATIONS  1945 - I960 CHART II CHART SHOWING NO. OF STUDENTS RECEIVING MEDICAL EXAMINATIONS 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 57-8 '.58-9 59-60 249 APPENDIX III CHART SHOWING NO.OF NEW STUDENTS WHO  SUBMITTED REQUIRED MEDICAL FOLDERS 1958 - 1969 i,500 " CHART I I CHART SHOWING NO. OF NEW STUDENTS WHO SUBMITTED REQUIRED MEDICAL FOLDERS Examinations: H.S. P.D. FALL 1958 - SPRING 1969 Folder Only j " / / 6,000 5,500 5,000! • 4,500 4,000 3,500 3,000 j 2,500 2,000 1,500 1,000 500 ro CN O o m in I I !: i I ! CM T] m vO ! i ; i I ! i I ii i i i 1 !! I o CO OO o-! I I 1 ' i i j I ! i CO as ro m I i i i I ! t • I I i ! o ! I m o ! i i ! i ! i i I ! I i ! 1 ! i ! I i j i j i i ! in 5485 V, / / I £263 | V0 •051 58-59 59-60, 60-61 61-62 62-63 63-64 64-65 65-66 66-67 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 total Age 1973-74 15 years and under 35 16 years of age 21 17 years 242 18 years 2,331 19 years 2,559 20 years 2,620 21 years 2,592 22 years 2,084 23 years 1,580 24 years 1,182 25 years 879 26 years 784 27 years 529 28 years 421 29 years 339 30 years 279 31-35 years of age 775 36-40 years of age 338 41-45 years of age 233 46-50 years of age 142 51-55 years of age 73 56-60 years of age 36 61 years and over 15 not known 11 Percent of Total .1 1.2 11.6 12.7 13.0 T2T9" 10.4 7.9 5.9 4.4 3.8 2.6 2.1 1.7 1.4 3.9 1.7 1.2 .7 .4 .2 1974-75 36 11 243 2,514 2,688 2,666 2,781 1,559 1,267 1,093 797 759 548 409 328 962 369 247 161 102 47 63 35 Percent of Total .2% .05 1.1 11.5 12.3 12.2 12.7 TOT? 7.1 5.8 5.0 3.6 3.4 2.5 1.9 1.5 4.4 1.7 1.1 .7 .5 .2 .3 .1 1975-76 2,798 2,769 2,389 1,743 1,267 1,037 877 715 644 502 347 1,063 419 251 163 95 37 171 130 •Excluding 111 Medical Residents for which data i s not available. Data back to 1963-64 available. May 18, 1976 DH/dc Percent of Total .02% .9 10.7 12.6 12.2 12.1 10.4 7.6 5.5 4.5 3.8 3.1 2.8 2.2 1.5 4.6 1.8 1.1 .7 .4 .2 .7 .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% Women 8,050 40.0 8,985 41.0 9,726 42.3 20,100 100.0% 21,924* 100.0% 22,979 100.0% 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 3 16 years — — — 3 17 years - — — 92 18 years - — 1,203 19 years — ; 545 20 years - — — 328 21 years 214 22 years - 204 23 years - 199 24 years — — 144 25 years 153 26 years - ~ 126 27 years — — — 97 28 years - - - - 100 29 years — 82 30 years 43 31 years — 50 32 years 31 33 years — 29 34 years 28 35 years 18 36 years 15 37 years 9 38 years 10 39 years 11 40 years -— 6 41 years — — — — 4 42 years — 7 43 years • 5 44 years 4 45 years — 5 46 years 6 47 years 2 48 years — — — 1 49 years : 2 Female 2 113 .067 Sex Not Known 255 163 152 126 111 86 91 64 79 59 47 35 30 24 14 22 17 9 8 9 11 9 8 10 10 5 7 2 5 7 2 1 3 1 Total 5 206 2.271 583 377 357 325 255 239 217 163 180 144 91 85 6 1 . 53 42 40 32 19 18 20 17 13 15 15 14 10 13 4 6 9 Percent Female 50.0% 40.0 54.9 47.0 43.6 43.7 43.2 42.6 38.8 43.5 36.0 41.9 39.3 43.9 41.0 51.6 41.2 49.2 45.3 33.3 55.0 53.1 47.4 44.4 45.0 64.7 69.2 53.3 66.7 71.4 50.0 53.8 50.0 83.3 77.8 2 255 1975/76 Present Age Male Female Sex Not Known Total Percent Female 50 - 55 years - - -— 8 24 - 32 75;0% 56 years and oyer — — -________ 7 12 - 19 63.2 10 14 43 23.3 Total 3,816 3,131 26 6,973 44.9% Data back to 1963/64 also available June 3, 1976 DH/mw 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, administra-tion 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 is 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: (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. * '. ' • 2-2 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 fixed by the Chainnan of tho Board and shal l be n o t i f i e d to every member thereof as provided herein. 2-4 In addition to the regular r.eetings herein provided, special meetings of the Board r_ay be« ciiUed at any tir.c by the Chairman and s h a l l be called by him upon receipt of the written request of any 3 Eembero of the Board. No business other than that stated i n tho notice of meeting shall bo transacted at any cpccic.1 meeting of the Board. ./•:'.;_ '.. •""•'' ." 2-5 Written notice of a l l meetings of tho Beard s h a l l be delivered or nailed to each member thereof at least seven days beforo the date of the meeting and any notice regarding a special meeting of the Board s h a l l D t a t o t h e business ' for which the meeting i s c a l l e d . 2-6 At any sooting'of the Board five members sh 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 after the approval of these by-laws by the Lieutenant-Governor : i n Council at a time and place fixed 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 delivered or mailed to each member of tho Board at le a s t 7 days p r i o r t o the date of the meeting.. ' . . . . . „. . - ... -- ' .•' '-' Officers of the Board . '. ' .''' -. '.' 3- 1 The Board s h a l l , at i t s f i r s t meeting, elect or'appoint a Ch-irman and such other o f f i c e r s as are deemed necessary to conduct the meetings of t h e Board-and properly carry out i t s business. The Officers so elected s h a l l serve --V u.'itil the conclusion of the f i r s t annual meeting of t h e Board. . ... 3-2 At every annual meeting of the Board the members s h a l l elect o r appoint a new-slate of off i c e r s to servo u n t i l the conclusion of t h e next annual meeting a nd any o f f i c e r whose term i s about to expire may be re-elected as an o f f i c e r of • the Board f o r a further tern. , •_.....-*.' 3- 3 Vacancies occurring among the of f i c e r s may b e f i l l e d f or t h e unexpired term b y the Beard. ';' . ;•':. • '."•'./ ;""' ' "\.s "' Corr-Titteos of the Board \:S::': '" V . - - ; 4-1 The Eoard may appoint an Administrative Committee to attend to the" day to day management and operation of the hospital. The membership of the Administrative . Committee s h a l l be comprised of a Chairman, who shal l be t h e Dean of the' Faculty of Medicine of the University; a Secretary, who s h a l l be the Director of the University Health Service Hospital, and 3 other-, persons appointed by the-Board. 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 Staff. The Chairman of t h e . Acjoinistrative Committee s h a l l be one_of. tho.Board's appointees a nd he 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 to tino appoint such other committees as are deemed necessary and advisable. - . ... . . • 4-4 The Board s h a l l delegate to 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 fo r which tho co.-^aittee. was established, cavo and except t h o control of t h o receipts 'and expenditures of the hospital which shall remain vested s o l e l y i n tho Board.. • . , - •'-. ' Director < . • ; -. ..• ,. 5-1 Tho administration of tho hospital shall be tho re s p o n s i b i l i t y of the Diroctor who shal l be appointed by tho Board. . •"• 260 APPENDIX VII STUDENT HEALTH SERVICE MEDICAL RECORD MAIL TO THE H E A L T H SERVICE AS SOON AS POSSIBLE. THE LAST A C C E P T A B L E DATEi IS REGISTRATION WEEK 261 THE UNIVERSITY OF BRITISH COLUMBIA STUDENT HEALTH SERVICE PLEASE READ CAREFULLY, COMPLETE, AND SIGN WHERE INDICATED FORM 30 T H E I N F O R M A T I O N R E Q U E S T E D H E R E I N IS R E Q U I R E D O F A L L S T U D E N T S E N R O L L E D F O R 3 U N I T S O R M O R E , A S P A R T O F T H E R E G I S T R A T I O N P R O C E D U R E . THIS INFORMATION IS CONFIDENT AL, IT CANNOT BE R E L E A S E D FROM THE STUDENT HEALTH S E R V I C E WITHOUT WRITTEN PERMISSiON OF THE STUDENT CONCERNED. THE INFORMATION GIVEN IS F R E Q U E N T L Y USED TO AID THE STUDENT IN SOLVING HEALTH P R O B L E M S . NO STUDENT IS REFUSED ADMISSION TO U . B . C . B E C A U S E OF A PHYSICAL OR EMOTIONAL HANDICAP, PROVIDED THE CONDITION IS UNDER ADEQUATE MEDICAL C A R E . EXAMI -NATION BY A PHYSICIAN IS NOT COMPULSORY FOR UNIVERSITY ENTRANCE BUT IS STRONGLY R E C O M M E N D E D . (SEE CALENDAR FOR F A C U L T Y EXCEPTIONS. ) T O C , T u c k l T ,„ r u r O F R O U T I N E H E A L T H E X A M I N A T I O N S , I M M U N I Z A T I O N S , D I A G N O S T I C P R O C E D U R E S , T R E A T M E N T O F I L L N E S S E S A N ^ / O ^ R ^ N J^UR I E S P E R M ^ S K)^N Ma HE^EBT <^ R A N T E D TO T R E A T " T H E S T U D E N T N A M E D A B O V E A T T H E S T U D E N T H E A L T H S E R V I C E A N D T O M A K E N E C E S S A R Y R E F E R R A L S T O P R I V A T E P H Y S I C I A N S A N D O T H E R C O M M U N I T Y F A C I L I T I E S . .S IGNATURE OF STUDENT_ P A R E N T A L E N D O R S E M E N T SIGNATURE OF PARENT OR L E G A L GUARDIAN PLAN NAME GROUP NO. INDENTIFICATION NO. | DEP. MEDICAL INSURANCE YES • FILL IN DETAILS NO r~J HAVE YOU APPLIED? YES ["J NO [~J ALL 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. AN APPROVED PLAN FOR MEDICAL AND HOSPITAL INSURANCE IS COMPULSORY FOR ALL STUDENTS FROM OUT OF CANADA. N. B. SEE CALENDAR OR HEALTH SERVICE BROCHURE FOR FURTHER DETAILS. AFTER INSURANCE IS PURCHASED EITHER SEND OR TAKE THE ABOVE MEDICAL INSURANCE INFORMATION TO THE HEALTH SERVICE. FOR HEALTH SERVICE USE: DATE RECEIVED RECALLED FOR BY DATE REPORTED STVUINI NOI1VDI03VN 3 S 0 0 31VO s n v u i N i NOI1VDI03IN 3S0Q 3 1 * 0 A T NO 3Sn nVXNBWlHVdBQ BOd 3UriS01DN3 33S •S3N ' S 3 « n S 0 T D N 3 33S •S3N " 31V0 :3SI1 TV1N3 I«UHV d3Q BOJ _ , „ „ _ 1 J — — 3N0 1SVT 30 31V0 :AVB-X 1S3H0 3 JV 1 d d l H S N O H V T 3 U • S3A Q ON < S IS OTH 3M3 S fl i 3 A 113V 3 O 3 SV 0 V i 0 1OV IN 00 3 SOTD V N 3 3 8 f\ 0 A 3 AV H _ — - — — — • ' — :U3H10 - (31V1S U O 3 DN I A O H d) 3H3HM" •03N (V IH3HlHdia ) XDIHDS — 3 N13 3 V A CB-D-S) S I S O n n D H S B f U •03N 1S31 NIHS CB-1) minatiasru U3H10 " 0 3 3 « 0 3 N I-3M S3IM3S ( 1 B V 1 ) s n N V i 3 1 V 0 I OH d A l ' 0 3 D H 0 J N I - 3 H HinOH A9 " ~ NIO IbO 3 N I 0 0 V A ' Q 3 1 V N I D D V A 3 « -a3DUOJNI-3U " 03DH0JNI -3H " ' a 3 0 H O J N I - 3 « " i 3 > V l " S3IH3S (BV1) O l O H d A l SNOI1D3TNI S l i n 3 A H O n O d — S3I113S S0NV131 S 3 I « 3 S V IH3HlHdlO N0I1VNID0VA l O d l l V W IVNIDIdO l N 3 0 n i S 3 H 1 AB a313Td>NOD 3B 01 SXS31 QNV SNOI1V Z INOWtNl : D N I M O n O J 3 H 1 JO S31V0 'XObddV 3 A I 0 262 M I S S M f ) . M R S . M O N T H Y E A R B I R T H D A T E S T U D E N T N U M B E R M A R I T A L S T A T U S S. M. W. D. S. ( C I R C L E ) G I V E N N A M E S — U N D E R L I N E O N E U S E D PLEASE PRINT ALL INFORMATION IN BLOCK LETTERS C O U N T R Y O F B I R T H . V A N C O U V E R A D D R E S S P E R M A N E N T H O M E A D D R E S 5 . E N R O L L I N G I N F A C U L T Y O R S C H O O L -L A S T S C H O O L O R C O L L E G E A T T E N D E D . A C A D E M I C Y E A R : 1 , 2 , 3 , 4 . 5 : M . A . , P . H . D . D E P T . ( C I R C L E ) H O M E 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 F A T H E R M O T H E R C O U N T R Y O F B I R T H nrrHP ATin N IF D E C E A S E D G I V E C A U S E __ PERSONAL HISTORY HT. H A V E Y O U E V E R H A D ( Y E S OR NO) D I A B E T E S E P I L E P S Y O T H E R I L L N E S S : F T . R H E U M A T I C F E V E R P S Y C H I A T R I C T R E A T M E N T C O M M E N T S O N A B O V E : . I N J U R I E S : , O P E R A T I O N S : W H A T M E D I C A T I O N A R E Y O U T A K I N G R E G U L A R L Y ? N.B. A L L E R G I E S ( E S P E C I A L L Y T O M E D I C A T I O N S ) . 0 0 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 ? ( C I R C L E W H I C H ) H E A D A C H E S O R E T H R O A T S I N U S E S E A R S E Y E S C O M M E N T S O N A B O V E : . L U N G S H E A R T B L O O D P R E S S U R E B O D Y W E I G H T E M O T I O N S I N D I G E S T I O N C O N S T I P A T I O N R E C T A L B L E E D I N G U R I N A T I O N G Y N E C O L O G I C A L P R O B L E M S A R E Y O U 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 I N P H Y S I C A L A C T I V I T I E S ? I F N O T E X P L A I N . S I G N A T U R E T O T H E E X A M I N I N G D O C T O R : P L E A S E N O T E B E L O W A N Y C O N D I T I O N S W H I C H Y O U C O N S I D E R S I G N I F I C A N T . W E S H A L L B E H A P P Y T O H A V E Y O U R A D V I C E I N T H E C A R E O F T H I S S T U D E N T W H I L E A T U N I V E R S I T Y . Y O U R F E E I S T H E 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 . T H A N K Y O U . 0 A T E _ . I N S . W T . H E A R I N G : N O R M A L • A B N O R M A L • L B S . V I S I O N L . 2 0 / _ L E N S E S L . 2 0 / . . R . 2 0 / . _ R . 2 0 / . N O R M A L A B N O R M A L 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 Y S T E M S K I N B O N E S A N D J O 1 N T S H E A R T F E E T A B D O M E N N E R V O U S S Y S T E M U R I N E : P R O T E I N _ O P T I O N A L : V D R L . N . B . A L L E R G I E S O R S E N S I T I V I T I E S , P L E A S E S T A T E A B N O R M A L I T I E S 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 : . I F 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 : . 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 I N 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 VIII 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 C o n t r a i n d i c a t i o n s Spontaneous pneumothorax d i a t h e s i s A c t i v e pulmonary disease B r o n c h i t i s B r o n c h i e c t a s i s Asthma Pneumonia A i r t r a p p i n g l e s i o n s , lung c y s t s or b a l l v a l v e l e s i o n s on X-ray Convulsive d i s o r d e r d i a t h e s i s , syncope, narcolepsy B r i t t l e diabetes or i n s u l i n shock d i a t h e s i s Drug or 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 ea r s , s i n u s e s , lungs High R i s k Conditions Impaired pulmonary reserve Pregnancy Obesity H i s t o r y of thoracotomy H i s t o r y 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 Sinus and middle^ear blockage caused by hay fever or other 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 or middle ear blockage or chest i n f e c t i o n M e d i c a t i o n or 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 A l c o h o l i c i n t o x i c a t i o n -Misc e l l a n e o u s Factors Age Young Experience Old A r t e r i o s c l e r o s i s A r t h r i t i s P e r s o n a l i t y P e r s o n a l m o t i v a t i o n A p p r o p r i a t e m o t i v a t i o n Accident proheness Impulsive behavior H y p e r a c t i v i t y L e a r n i n g 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 this period treatments were administered to patients referred by the Student Health Service. During the same period treatments were administered to students suffering athletic injuries. In addition to the above, the l i s t below shows the number of students treated for each sport. Badminton Basketball Field Hockey Football Gymnastics Ice Hockey Judo P.E. Rugby Soccer Track & Field Wrestling Other DATE: PHYSIOTHERAPIST H.S. 4 

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