History of Nursing in Pacific Canada

Report of proceedings of the annual convention of the British Columbia Hospitals' Association. British Columbia Hospitals' Association 1924

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 British Columbia
Hospital Association
Including the proceedings of the
Seventh Annual Convention held in
the Empress Hotel, Victoria, B. C.
August 28th 29th & 30th, 1924
A. H. timms, printer irtTV   Vancouver, b. C A Dependable Diet
CORRECTLY BALANCED
EASILY ASSIMILATED
CLEANLY   PREPARED
HORLICK'S MALTED MILK
RICH UNIFORM MILK
CHOICE WHEAT EXTRACT
HARDY   BARLEY   MALT
HORLICK'S MALTED MILK CO.
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.    1922
SPECIALISTS IN
Nitrous-Oxide and
Gas Machines
AND
Nitrous Oxide Gas of Quality.
ASH TEMPLE CO. LTD.
801 London Building
Vancouver, B. C.   British Columbia Hospitals
Association
Officers and Executive Committee of the British Columbia
Hospitals Association for 1924-25.
Provincial    Secretary,
Honorary   President—The     Honorable,     the
Parliament Buildings, Victoria, B.C.
Honorary Life Member—Dr. M. T. MacEachern, American College of
Surgeons, 40 East Brie St., Chicago.
President—Charles  Graham,  Esq.,  Canadian  Collieries,  Cumberland,
Vancouver Island, B.C.
First Vice-President—Dr. G. B. Brown, Earle Block, Nanaimo, B. C.
Second Vice-President—E. S. Withers, Esq., General Manager, Royal
Columbian Hospital, New Westminster, B.C.
Treasurer—George   Haddon,    Esq.,   Business   Superintendent,   Vancouver General Hospital, Vancouver, B.C.
Secretary—Ethel Johns, Dept. of Nursing and Health, University of
B. C, Vancouver, B.C.
Members of the Executive Committee in addition to the above:
For Vancouver Island—George McGregor, Esq., President, Board of
Directors, Provincial Royal Jubilee Hospital, Victoria, B. C.
For Vancouver—Rev. W. P. O'Boyle, 646 Richards Street, Vancouver.
For Coast Mainland—Dr. George Darby, Bella Bella, B. C.
For  Fraser  Valley—Dr.  A.  D.  Buchanan,   352  Hospital  Street,   New
Westminster.
For Yale Cariboo—M. D. Grimmett, 1435 15th Ave. W., Vancouver, B.C.
For   Okanagan—George   Binger,   Esq.,   Secretary,   Kelowna   General
Hospital, Kelowna, B.C.
For   Kootenay   West—George  Johnstone,  Esq.,   Secretary,  Kootenay
Lake General Hospital, Nelson, B.C.
For Kootenay East—Mother Nazareth, Superior, St. Eugene Hospital,
Cranbrook.
Grand  Trunk  Pacific—Harry Birch,  Esq.,  Secretary,  Prince. Rupert
General Hospital, Prince Rupert, B.C.
Convenors of Standing Committees: and therefore members
of the Executive Committee:
Medical Affairs—Dr. F.  C. Bell, General Superintendent, Vancouver
General Hospital.
Business Affairs—R. A. Bethune, Esq., Secretary, Royal Inland Hos-
j  pital, Kamloops, B.C.
Nursing Affairs—Miss Pauline Rose,  Superintendent, Nanaimo Hospital, Nanaimo, B.C.
^"Constitution and Bylaws—J. H. McVety, Esq., 714 Richards St., Van-
■ couver.
'Convener   of   Committee   on   Municipal   Affairs—J.   J.   Banfield,   327
Seymour Street, Vancouver. OFFICERS, 1923-24
Honorary President Hon. J. D. MacLean, Provincial Secretary.
Honorary Life Member Dr. M. T. MacEachern, Chicago
President .'. Charles   Graham,   Cumberland
First Vice-President , George  Haddon,  Vancouver
Second Vice-President E. S. Withers, New Westminster
Secretary....Miss E. Johns, University of British Columbia, Vancouver
Treasurer Mrs. M. E. Johnson, Bute St. Hospital, Vancouver
EXECUTIVE  COMMITTEE
Dr. H. C. Wrinch, Hazelton.
George MacGregor, Victoria.
Dr. G. Bell Brown, Nanaimo.
J. J. Banfield, Vancouver.
Rev. F'ather O'Boyle, Vancouver.
George Binger, Kelowna.
J.  H. McVety, Vancouver.
J. T. Robinson   (since deceased).
M. L. Grimmett, Merritt.
R. A. Bethune, Kamloops.
Miss J.  F. MacKenzie.
STANDING  COMMITTEES
Dr. H.
pital,
Dr. F.
Dr. W.
Dr. E.
Dr.   G.
land.
Medical   Affairs
C. Wrinch, Hazelton Hos-
Hazelton (Convener).
C. Bell, Vancouver.
B. Burnett, Vancouver.
M. Pearse, Victoria.
Business Affairs
R. A. Bethune, Royal Inland Hospital, Kamloops   (Convener)
G. T. Carver, Victoria.
E. S. Withers, New Westminster."
Dr. G. Bell Brown, Nanaimo.
K.  MaciNaughton,  Cumber-Arthur P. Glen, Ladysmith.
Nursing Affairs
Miss J. F. MacKenzie, Jubilee
Hospital, Victoria,   (Convener)
Miss K. B. Stott, New Westminster.
Miss  K. W. Ellis, Vancouver.
Sister Mary Anna, Victoria.
Miss A. L. Boggs, Kamloops.
Constitution  and  By-Laws
M.   L.   Grimmett,   Mterrittj,    (Convener.)
J. H. McVety, Vancouver.
George   Small,   New  Westminster.
Dr. H. R. Stores, Vancouver.
George McGregor, Victoria. The seventh convention of the British Columbia Hospitals Association was held under the distinguished patronage of his Honour the
Lieutenant Governor, Honourable Walter Cameron Nichol, in the
Empress Hotel, Victoria, August 28th, 29th and 30th, 1924. The ballroom was generously placed at the disposal of the Association by the
management of the hotel without charge and proved an excellent convention hall. Ample space was provided for the exhibits which were
a specially interesting feature and to which reference will be made
later.
The followin
?ates:
Abbotsford-Matsqui-Sumas Hospital.
Bute St. Hospital, Vancouver.
Chemainus General Hospital.
Chilliwack General Hospital.
Cumberland General Hospital.
Columbia Coast Mission Hospitals.
Hazelton Hospital.
Kelowna General Hospital.
Kings Daughters Hospital, Duncan.
Lady Minto  (Gulf Islands)  Hospital.
Ladysmith General Hospital.
Mission Memorial Hospital.
Nanaimo General Hospital.
Nicola Valley General Hospital, Merritt.
Penticton Hospital.
Provincial Sanitarium, Tranquille.
Provincial Royal Jubilee Hospital, Victoria.
Prince Rupert General Hospital.
Royal Columbian  Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Roycroft Private Hospital, Vancouver.
R. W. Large Memorial Hospital, Bella Bella.
St. Joseph's General Hospital, Comox.
St. Joseph's Hospital, Victoria.
St. Mary's Hospital, New Westminster.
St. Paul's Hospital, Vancouver.
Vancouver General Hospital.
Vernon Jubilee Hospital.
The following Women's Auxiliary groups were represented:
Chilliwack General Hospital Ladies Auxiliary.
Cumberland Hospital Ladies Auxiliary.
Nanaimo General Hospital Women's Auxilary.
Penticton Hospital Women's Auxiliary.
Provincial Royal Jubilee Hospital Women's Auxiliary.
St. Joseph's General Hospital, Comox Women's Auxiliary.
St. Joseph's Hospital, Victoria, Women's Auxiliary.
Vancouver General Hospital Women's Auxiliary.
The following public and professional bodies were represented:
The Provincial Government.
The British Columbia Medical Association.
The Graduate Nurses Association of British Columbia.
The Graduate Nurses Association of Victoria.
The  Department of Nursing and  Health,  University  of British
Columbia. Most interesting and instructive exhibits were prepared by the following.
Provincial Royal Jubilee Hospital, Victoria.
Vancouver General Hospital.
Victorian Order of Nurses, Victoria.
Red Cross Work Shops.
Health Centre, Saanich.
Commercial exhibits were made by the following firms:—
Chandler and Fisher Co. Ltd., Surgical supplies.
B. C. Stevens Co., Surgical Supplies.
Victor X Ray Corporation  of Canada, Radiological and  X Ray
supplies.
Simmons Co., Adjustable Bed.
The experiment of last year in reducing the duration of the convention to two days was not repeated this year. Probably it was felt
that the charming surroundings and kindly hospitality afforded by
Victoria merited at least a three days visit. No meetings were held
in the evening and the consensus of opinion seemed to be that this
innovation was generally approved and should form a precedent for
future conventions.
The luncheons were, as usual, most popular. They afforded opportunities of visiting both the hospitals. The delegates very thoroughly enjoyed the joint luncheon arranged by the Rotary Club and did not
neglect the' golden chance of telling their troubles, financial and otherwise to a most sympathetic and interested group of business and professional men.
Many took the opportunity of visiting the Columbia Coast Mission
boat which was in harbour throughout the Convention. The Rev. John
Antle was most kind in according every privilege.
Very much to the regret of the members of the Association the
President, Mr. Charles Graham, of Cumberland, was prevented by
illness from being present. His place was taken, at the last moment,
by Mr. George Haddon, the First Vice-President, who conducted the
sessions in an admirable manner.
The local committee on arrangements consisting of .Mr. George
McGregor, President of the Jubilee Hospital, Dr. E. M. Pearse, stiperin-
tendent, and Miss J. F. Mackenzie, Director of Nursing, left nothing
undone which could add to the comfort and pleasure of the delegates.
The Superior and Sisters of St. Joseph's Hospital were equally kind
and hospitable. On the last afternoon of the Convention the Rotary
Club arranged for cars to take the visitors to the Butchart Gardens.
Tea was served and a pleasant social hour enjoyed.
It was inevitable that the sudden death of Dr. R. H. Mullin, on the
very day that he was to have addressed the convention, should, have
cast a shadow of regret over the meetings. The social activities which
had been planned were curtailed and in part abandoned in respect to
him. But the Convention carried on in the true hospital spirit, that
spirit which was so characteristic of the man whose passing is so severe
a loss to the cause he had at heart—the quest of health and the alleviation of human suffering.
In spite of all the convention was a success. The discussions
were frank and friendly and gave evidence of the slow development
of a true spirit of unity and mutual understanding.
Morning Session, Thursday, August 28th.
The meeting was called to order at 10 a.m.  by the First Vice
'President, Mr. George Haddon.
Reginald Hayward, Esq., Mayor of the City of Victoria, extended
—4— a very hearty welcome to the delegates which was cordially responded
to by Dr. H. C. Wrinch, M.L.A., of Hazelton.
The chairman referred regretfully to the illness of the President
MJr. Charles Graham of Cumberland and requested Mr. T. Mordy of
Cumberland to read the presidential address. The secretary was instructed to telegraph Mr. Graham conveying the sympathy of the
members and wishing him a speedy recovery.
PRESIDENTIAL ADDRESS
Ladies and Gentlemen:—
Today marks the opening of our seventh annual convention, the
very satisfactory attendance at which shows a growing realization on
the part of the hospitals of the need of getting together in an earnest
endeavour towards solving their common problems.
We are prone to think that the problems which confront us in our
individual hospitals, large or small are peculiar to ourselves and can
only be solved by ourselves in the light of our local experience, but the
major portion of the problems confronting us have a common base and
therefore a common solution. We have not yet clearly realized how
best to solve these problems, but as we gain in experience we are
gradually working towards their solution. With an organization such -
as this, provincial wide and affiliated with similar organizations national in their scope, the exchange of information as to operating conditions
and facts given frankly and in the proper spirit will help every hospital,
whatever its size may be and aid all hospital workers to know better
their field and work.
Before proceeding further I must refer to the great loss which the
hospital world has sustained in the sudden death of Mr. J. T. Robinson,
President of the Board of Directors of the Royal Inland Hospital,
Kamloops, and a members of the Executive of the British Columbia
Hospital Association. He was an untiring worker and his interest in
all matters pertaining to Hospitals was keen. The Association will
miss his advice and assistance and I am sure that the sincere sympathy of all members goes out to his relations.
The work of the Executive will doubtless be dealt with by Miss
Johns in her report so I will only touch briefly on our efforts to secure
some further Government aid.
For the past two years we have met the Government with requests
and resolutions passed by the Association. We have on each occasion
been flatly turned down. Not only have we been turned down but on
each occasion we have had something taken away from us.
Before appearing before the Government on the last occasion we
had a conference with some of the Executive of the Union of B. C.
Municipalities. While the session was friendly enough we did not get
much sympathy. The Union of B. C. Municipalities is frankly not
interested in anything that might mean the expenditure of money by
them.
The Municipalities conducted a very strong lobby during the past
two years and got something from the Government each year, but
everything they obtained was at the expense of the Hospitals. First
the Government gave them 10 per cent, of the liquor profits originally
intended for Hospital purposes. Last year at the request of the Municipalities the Government reinserted the word "indigent" into the Act,
thus practically relieving the Municipalities of all responsibility for the
class of patient from the cities, who cannot or will not pay for hospital service.
In looking over the program for this convention I feel sure that
you will have a very interesting session.   A careful  and  thorough discussion of the various papers will prove of the utmost benefit to
^Hospital organizations throughout the Province.
From the business point of view there are three very important
items on the program, just as important as that of finance which is
usually given the most prominent position.
First, The Legal Liability of Hospitals in British Columbia is to
be the subject of an address by Mr. R. L. Reid, K.C.
Second. Round Table Conference, some aspects of the Provincial
Government Regulations Governing the Granting of Public Aid to
Hospitals.
Third.   Responsibility for Maintainance of Isolation Hospitals.
These subjects are well worthy of the most serious consideration
and discussion by the delegates and I trust that out of the discussion
will come a policy which can be adopted by the Association for the
guidance of hospitals in these very .important matters.
I am extremely sorry that I cannot be with you on this occasion
but the state of my health will not permit.
I trust however that the Convention will be the most successful
yet held and that each delegate will go home feeling that he has gained
omething and that the Convention has accomplished something towards
better Hospital service.
With my best wishes for a successful Convention.
CHARLES GRAHAM,
President.
The minutes of all executive meetings held since the last Annual
Meeting were read by the secretary and on motion of Mr. T. Mordy,
seconded by Mr. E. S. Withers were declared to be correct.
The secretary then read her annual report.
REPORT OF THE SECRETARY
1923-24.
Mr. President, Members of the British Columbia Hospitals Association:
The report of the Secretary is submitted herewith.
Meetings of the Executive Committee:
Five meetings of the Executive Committee have taken place as
follows:
On August 31st, 1923, at the Incola Hotel, Penticton, at the close
of the sixth convention of the association.
On September 21st, 1923, at the Vancouver General Hospital.
On November 6th, 1923, at the Vancouver General Hospital.
On November 15th, 1923, at the Vancouver General Hospital.
On April 22nd, 1924, at the Vancouver General Hospital.
A resume of business transacted at these meetings may 'be of
interest as showing the activities of the Association during the past
year.
The meeting held in Penticton dealt with matters of routine arising
out of the convention. A committee was appointed to act in advisory
capacity to the Secretary in the preparation of resolutions to be submitted first to the membership of the Association and later, after due
revision, to the Provincial Government. The members of this Committee were, Messrs. George Haddon, J. H. McVety, and E. S. Withers.
—6— At the second meeting held on September 21st, 1923, Mr. Charles
Graham, the new President, occupied the chair. .Dr. F. C. Bell, Superintendent of the Vancouver General Hospital, and Dr. M. T. MacEachern
were also present. The tentative questionnaire and covering letter
regarding resolutions passed at the Convention in Penticton were submitted by the Secretary, approved without change, and ordered to be
forwarded to the various hospitals.   These were as follows:
(a) Are you in favor of an increase in the schedule of grants
made to hospitals under- the hospital act as outlined in the accompanying resolution?
(b) Are you in favor of the suggestion that a hospital commission
be appointed?
(c) Are you in favor of the suggestion that the hospitals act be
amended to provide that municipalities must, within seven days either
accept or repudiate responsibility for patients resident within their
borders?
(d) Are you in favor of the suggestion that an increased rate be
charged for patients entering hospitals under the Workmen's Compensation Board as set forth in the accompanying resolution?
(e) Is your institution willing to delegate to the Executive a
Legislative Committee of the British Columbia Hospitals Association
power to negotiate on your behalf in connection with the matters dealt
with in the accompanying resolutions.
At the meeting held on November 6th, the Secretary reported a
tabulated analysis of the replies received to the foregoing questionnaire:
60; total replies received:    42;  un-
Total questionnaires issued:
answered:    16.
Of those failing to reply, five hospitals are more or less privately
owned and operated. Three are very small and frequently closed. On
the whole therefore the replies received might justly be considered to
reflect hospital opinion throughout the province.
All replies received approved the recommendation that increased
grants be made to hospitals by the Provincial Government.
Eleven objected to the appointment of a hospital commission.
Four objected to a time limit being set which would force municipalities either to accept or repudiate responsibility for patients within
a given period.
Four objected outright to any advance being made in the rates
charged the Workmen's Compensation Board. Several other institutions, while not actively opposed, cast grave doubts upon the advisability of such action being taken.
The Executive Committee after consideration of this report crystallized its findings into a statement which was placed before the Provincial Secretary on November 20th, by a committee consisting of the
President, Mr. Charles Graham of Cumberland, Messrs. George Haddon,
and J. Banfield of Vancouver, Dr. G. B. Brown of Nanaimo, Mr. George
McGregor of Victoria and Mr. E. S. Withers of New Westminster.
Owing to the pronounced opposition to the appointment of a
hospital commission and to the division of opinion as to the increase of
rates to be charged the Workmen's Compensation Board, both these
proposals were omitted from the final draft and the statement included
only such material as had the unanimous support of the hospitals of
the Province, viz:
1st.    That an increase of fifty cents (50c) per diem be granted
to the public hospitals in this Province in addition to the amount
set outrin the sliding.scale.
2nd.    That the Hospital Act be amended to provide that all muni-
—7— cipalities shall, upon receiving notice of the admittance  of a
patient, and within a period of fourteen  (14)  days, notify the
hospital that the said municipality is either responsible or otherwise for the care of such patient.
And further, in the event of the municipality being not liable, that
such information as may be in its possession shall be given
to the hospital to enable it to follow up the account.
3rd.    That legacies to hospitals be exempted from Sucession and
Probate Duties.
4th. That Clause 19 of the Act to Amend to Poll Tax Act, 1920 be
amended to provide that monies collected from the Poll Tax in
any municipality shall be definitely apportioned in equal amount
to hospitals and schools, and that monies so granted to hospitals
shall be in addition to other grants made.
And further, that monies collected by Cities or Municipalities
under this Act be distributed on or before the 31st day of January
in each year.
In support of the request contained in paragraph 4, it is pointed
out that a division of the funds on an equal basis is justified insofar as
hospitals are concerned, municipalities being given certain power to
fix the rates for school purposes, whilst hospitals have to depend upon
raising money from independent sources.
The delegation also arranged with the Legislative Committee of
the Union of B. C. Municipalities for a joint meeting at which a full and
frank discussion of mutual problems took place.
With the possible exception of a better understanding with the
Union, the efforts above described were almost without result. In spite
of the fact that the hospitals displayed a united front and that their
claims were urged with energy and conviction, only one of the requests
was granted—that dealing with the remission of legacy duty.
The Executive Meeting held in April, 1924, dealt with convention
plans and need not be considered further.
Interest in the Association has been well sustained during the
year. The Annual Report met with a measure of approval. Its cos*t
was greatly reduced in comparison with other years and this reduction
was accomplished without impairing its interest or value. Requests
for copies have been received from many parts of Canada and the
United States, especially from governmental departments. Requests
from individual hospitals for information have been received and dealt
with through the Secretary's office. In one instance a tentative constitution and by-laws for the governing of a hospital had to be prepared
at short notice.
Sixty hospitals appear in the Secretary's official lists and of these
over fifty are in good standing. Summerland Hospital withdrew from
membership, but is being urged to reconsider this action.
The Secretary wishes to record her cordial appreciation of the
courtesy and kindness shown her by the secretaries of the hospitals
throughout the province. Their prompt replies to questionnaires and
their willingness to respond to all the demands made upon them have
made her work a pleasure.
All of which is respectfully submitted.
ETHEL JOHNS,
Secretary.
The adoption of the secretary's report was moved by her and
seconded by Mr. E. S. Withers.
The report of the treasurer, Mrs. M. E. Johnson, Vancouver, followed. She introduced the report with a few explanatory remarks dealing
with the measures taken to ensure a credit balance. These included
careful collection of accounts payable, as well as economies in printing  An informal Conference of Women's Auxiliary groups followed.
Mrs. G. W. Swaisland described the organization and activities of the
Vancouver General Hospital Women's Auxiliary, mentioning the various divisions of its work and' outlining briefly the scope of each. She
laid special emphasis on the work of the Social Service Department
which is supported entirely by the efforts of the Auxiliary. Mrs. G.
Bell Brown spoke on behalf of the Auxiliary of the Nanaimo Hospital,
stating that this body has representation on the Board of Directors of
the hospital. She also mentioned that a substantial sum had been
raised with a view to assisting in the equipment of the projected new
hospital.
Mrs. R. M. Thompson presented an interesting report of the work
of the Auxiliary of the Chilliwack General Hospital, showing over one
hundred members on the roll and a total expenditure of $2440.64. Mr.
T. Mordy in the absence of Mrs. Jeffery, the official representative of
the Cumberland Hospital Auxiliary, spoke of the excellent work done by
this group.
Mrs. W. Stevens reported on behalf of the Auxiliary of St. Joseph's
General Hospital, Comox, showing that $1152.00 had been raised and
that an ambulance is to be purchased through their efforts.
The report of the nominating committee, prepared by Mr. T. Mordy
of Cumberland, was then read by him.
At the conclusion of the report of the nominating committee Dr.
H. C. Wrinch suggested that this committee continue to function until
the time of elections. Mr. Mordy stated his willingness to comply with
this request.
Convenors of Committees were appointed by the Chair as follows:
Resolutions, Dr. H. C. Wrinch; Press, Mr. E. S. Withers.
Mr. J. D. MacGregor of Victoria was requested to act as scrutineer
with the privilege of naming his own associates.
Miss J. F. Mackenzie, Victoria, spoke briefly on behalf of the Local
Committee on arrangements. Several members voiced their appreciation of the work done by Miss Mackenzie, especially in connection with
the exhibits.
The meeting adjourned at noon in order to attend the luncheon of
the Rotary Club. The delightful musical programme was greatly enjoyed. Mr. George Haddon spoke briefly on the aims and objects of
the Association and the Secretary outlined a few hospital problems
having a direct bearing upon community responsibility.
AFTERNOON SESSION, THURSDAY, AUGUST 28th.
The programme for the afternoon session was arranged by the
Committee on Business Affairs of which Mr. R. A. Bethune is convenor.
He was invited by the chairman to give a few introductory remarks
respecting the programme and at their close introduced Mr. E. W.
Carr-Hilton of Duncan, who spoke briefly on the special problem involved in the care of cases of tuberculosis and of infectious disease in
small hospitals.
Mr. W. H. Smith, of Vernon, called attention to the resolution
forwarded for endorsation to the hospitals of the province by the
Vernon Jubilee Hospital, the text of which follows:—
WHEREAS among the hospitals of the Province there are many
which serve large areas of unaorgaarized territory;
AND WHEREAS many of the residents of such areas are transient
laborers and those who are developing the land and are thus among
—10— those least able to pay for hospital service when such becomes necessary;
AND WHEREAS hospitals receiving Provincial aid have no option
but to treat and care for all who may require the services of such
institutions, whether they are able to pay for it or not;
AND WHEREAS any deficits which exist in the finances of such
institutions are almost invariably due to the large number of such
charges which it is impossible to collect;
THEREFORE BE IT RESOLVED that in the case of hospitals so
situated, and where the foregoing conditions exist, such hospitals be
granted special consideration by the Provincial Government, on a basis
which may be found adequate to counteract the losses from these
causes;
AND BE IT FURTHER RESOLVED that a competent official be
appointed whose privilege and duty it shall be to investigate all claims
which may be made for financial aid by hospitals, and whose duties
shall include inspection of financial matters, nursing and other operations. Such official to report and make recommendations to the department in charge of hospital affairs.
Several members took part in the discussion and it was moved by
Mr. Thompson of Chilliwack that action be postponed until after the
report of the Committee on Resolutions had been presented.
Mr.  R.
entitled :
L. Reid, K.C., of Vancouver, then delivered an address
HOSPITAL LAW IN BRITISH COLUMBIA
The word hospital comes to us from the old French "hospital",
modern "hopital" and in the olden days meant a place of shelter, a
lodging.    Edmond Spencer in his "Faerie Queen" (II-ix-10) says:
"Whereas they spied a goodly castle, placed
Forby a river in a pleasant dale;
Which chusing for that evening's hospital
They thither marched."
From this it came to mean a building for the reception, care and treatment of those persons who from any cause were unable to support or
provide for themselves, and were therefore more or less dependent on
the help of others. It is closely connected with the word "hospitality",
both implying benefits conferred on others and that, I think, is the aim
and object of all those engaged in the occupation to which you have
devoted yourselves, the service of your afflicted fellow man. In modern
times a hospital has been defined as "an institution for the reception
and care of sick, wounded, infirm and aged persons," and it is of
institutions dealing with' the first two classes and the law applicable
to them in British Columbia that I have been requested to speak to you
this afternoon.
In the first place, as you know, there are two kinds of law applicable to hospitals, as well as to all other institutions; the common law,
which we find in the decisions of the Courts, and which is the application to all transactions of certain rules of decision common to all those
jurisdictions in which English law has authority.
"The lawless science of our Law
That codeless myriad of precedent
That wilderness of single instances."
as Tennyson somewhat sarcastically says. This Common law is not
found in any written code, but is developed by the Courts as questions
arise from time to time to be decided. As opposed to this we have
Statute law which is the specific regulations laid down by the Legisla-
—11— tive Assembly from time to time to meet the peculiar circumstances
which have arisen in this particular Province owing to our municipal
organizations in settled districts, or the want of them in our great
empty spaces. As specific legislation is always followed where it
varies or alters the rules of the Common law it will be well to discuss
in the first place the Statute Law of British Columbia on the matter
of hospitals, and then to deal generally with the other.
The first general legislation of British Columbia on hospitals was
passed in the year 1902. It became evident that the monies received
from patients together with private donations were not sufficient to
carry on the benevolent work of caring for the sick,' both those able to
pay and those who were not, and that it was necessary to supplement
these sources of revenue by Government grants in aid. That this aid
-might be equitably allotted to the various institutions of this kind
in the Province, the "Hospital Act, 1902" was passed and came into
force on the first day of July in that year. In this Act a "Hospital" to
which the Act applied was defined as:
"An institution founded for the reception and treatment
of persons diseased in body, and in which they are treated
either at their own expense, or by charity, in whole or in part,
and which institution is in receipt of aid from public moneys
appropriated for that purpose."
You will see from this definition that the only hospitals included
were what may be called "Public Hospitals", viz., those which gave
treatment not only to the well-to-do but also to the sick who were
unable to pay for the services rendered to them and therefore were the
objects of charity, and (in order that a certain control might be
retained) only those which received aid from the Provincial Funds.
It did not cover those institutions which only admitted patients who
were financially able to pay the cost of their care and treatment and
which, therefore, did not need Governmental assistance, and which may
be styled "Private Hospitals."
The granting of aid was subject to the Hospital being approved
by the Lieut.-Governor in Council, which is a legal expression, really
meaning the Government in power in the Province for the time being.
When a Hospital was approved it was entitled to receive aid from the
Province according to the number of days treatment given by it to
patients during the year for bodily disease, but did not include the
care of anyone on account only of old age or merely' indigent circumstances, and who were not in need of medical attendance. This aid
ran from a minimum of $500 to Hospitals where the days treatment
per year ran from 365 to 500, on a gradually descending scale from one
dollar per day to thirty-live cents per day according to the number of
days treatment given per year. The greater the number of patients
treated, the less per capita was given. No aid was to be given to any
Hospital which refused to admit any one on account of his inability
to pay. Any Hospital within the Act was to be at all times subject
to Government inspection, and was compelled to have its regulations
approved by the Lieut-Governor in Council.
The framers of this Statute failed to remember that there were
isolated portions of the Province which could not comply with its provisions but from the very sparseness of the population in the vicinity
were peculiarly in need of help, so in 1908 the Government was given
power to make grants in such cases as might be deemed advisable. In
1910 the minimum allowance per day was increased to forty-five cents.
In 1913 only one Hospital in each municipality was eligible for aid
except another was established with the approval of the Government.
In the Statute this year we find the section which has probably caused
more friction between the Hospitals and the surrounding Municipalities
•     " any other part of the Act.    The Hospitals had found that even
—12—
than with this assistance from the Government they were not able to comply
with the demands made on their revenues owing to the number of
indigent patients which had to be treated and requested that provision
be made for a payment to them of one dollar per day afterwards increased to $2.50 in 1920, for each indigent patient by the Municipality
in which they had resided for the last thirty days before admission..
This liability was imposed; the Superintendent of the Hospital being
required to notify the Municipal Clerk immediately an indigent patient
entered the Hospital in order that he might be enabled to make enquiries in respect thereof and decide as to the Municipality's liability.
If any sums were so paid by it the patient was liable to repay, if at any
after time he was able to do so. In lieu of this, a fixed grant might
be agreed upon between the Municipality and the Hospital.
The difficulties which then arose were rather questions of fact
'than questions of law. Of course if the Municipality denied liability
and action was taken in the Courts, the burden of proof was on the
Hospital to show that the particular patient in question was indigent,
that is, so destitute of property or means that the claim of the Hospital
could not be enforced. It imposed a heavy burden on the staff of the
Hospital. In many cases the patient had left the hospital without
paying his account and could not be found; evidence of his financial
status was difficult and expensive to procure; the municipalities,
weighed down by incessant demands for local expenditure, were not
too anxious to help out the hospital authorities, and a great deal of
trouble was experienced on both sides. Claims had to be dropped or
compromised, but the drain on the funds of the hospital went on just
the same, for the sick and suffering had to be attended to whether
payment was received or not.
The hospital authorities went to the Government with their grievances and in 1916, the Municipalities were made liable for the treatment of all patients who had resided within their boundaries for thirty
days before admission, whether indigent or not, leaving them to recoup
themselves by collecting as much as they could thereof from the persons
who had been treated. It was now the turn of the Municipalities to
protest, and they did so vigorously. Patients were very slow in repaying the Municipalities its expenditure on their behalf, an epidemic of
"indigence" swept over the communities, and the large hospital bills
and the small collection per contra, appalled the local authorities.
Again the Government was deluged with complaints so that in the
last session of the Local House another attempt was made to remedy
the trouble. "Indigent person" was given a statutory interpretation.
It was defined as:
"A person who by reason of being poor and destitute is
unable  to  procure  suitable  surgical  or  medical  treatment."
How this helped matters I am unable to see.' Any dictionary would
have given the same information as did this new provision of the
Statute. The Municipalities are again only obliged to pay for
"indigent" patients and that on notice being given by the hospital to
the Municipal Clerk within seven days after admission, "or as soon as
practicable thereafter" (whatever that means) with "such particulars
as may be ascertainable to enable the Clerk to identify the patient."
The burden of ascertaining the worldly wealth of the patient, or rather
the lack of it, is again laid upon the hospital, and the vagueness of
the provisions as to what particulars the notice must contain makes
the position of the hospitals as bad or worse than it was prior to the
amendment of 1916.
There are also provisions in the Act of 1923 for the representation
of the Hospital Boards of representatives of the Municipality in which
it is situated and, if the Lieut-Governor in Council deems it advisable,
•of an adjoining Municipality.
—13— Notwithstanding the requirement that the hospital should give
.notice to the Clerk of the Municipality, there is no burden put upon
the Municipality to make any reply or return to the hospital. If the
Municipalities are only to pay for indigent patients, I should suggest
that they should be compelled, within a reasonable time after receipt of
notice from the hospital, to make enquiries as to the financial standing
of each patient concerning which they have received notice. They
have a Police force which could make the necessary enquiries and
obtain the requisite information speedily and at a much less cost and
with less trouble than the hospitals can. If the Municipality on making enquiries notified the hospital that they had agreed that the
patient was indigent, no further steps need be taken; but if they denied
this condition, the hospital would then be put upon enquiry itself while
the evidence was available. If the Municipality made no return
within a time to be fixed by the Statute, it should be taken as conclusive,
evidence that indigence was admitted.
So much for the Statutory Law relating to Public Hospitals. Now
let us consider the common law relating to the relations between these
institutions and their employees and between them and the physicians
whose duties call them to treat patients being cared for by them. In
doing so, I will treat first of the. hospital employees generally; then
of the nurses on the nursing staff, and of special nurses; and lastly of
the Hospitals' relations with medical men, including both those on the
staff of the hospital itself and with outside practitioners.
I
EMPLOYEES:
The liability of the hospital for its regular employees is exactly the
same as the liability of any other person or corporation. An employer,
be he the owner of a hospital or otherwise, is responsible fctr the
damages sustained by a third person for any acts by his servant, provided it be done in the ordinary course of his employment; and this
is so whether such acts are those of omission or commission, whether
they be negligent, fraudulent or deceitful, and even where they are done
in direct violation of the master's orders and are positive acts of misconduct, or even amounting to criminal deeds: (although in the latter
case, of course, the master is not liable criminally) and it makes no
difference whether such employer be a natural person or a corporation.
It will be noted, however, that this liability is confined to acts
done "in the course of his employment." If a servant goes out of his
way to do some act which he had no authority to do, and which is not
within the scope of the duties which he was employed to carry out,
the employer will not be liable, just'because the wrongdoer happened
at the time to be in his employment. Thus an orderly negligently
injuring a patient while carrying out his duties in the hospital as
such would render it liable for damages. But if an orderly went out
of his way to do an act which was in no way connected with or in
the course of his duties as such, the corporation would incur no
liability by reason thereof, but the injured person's remedy would be
solely against the wrongdoer himself.
It will be remembered that negligence is always a question of fact,
the law being that negligence is:
"The omission to do something which a reasonable man, guided
upon those considerations which ordinarily regulate the conduct of
human affairs, would do, or doing something which a prudent and
reasonable man would not do."
I think most people will look upon this as a very vague rule by
which to measure one's acts. Our ideas vary so much as to what that
ideal reasonable man will or will not do under a certain set of circumstances. But when we consider that no two sets of circumstances
ever are or will be exactly the same, and yet that negligence must be
avoided in them under penalty, in case of injury to another, of paying
—14— damages, we will see how impossible it is to frame a rule which will
cover all cases in anything else than the most general words. We can
only lay down a general principle and apply it as best we can under
the circumstances of each particular case.
A case in our own Courts (Brandeis v Weldon, 22 B.C.R. 405)'
where damages were claimed against a medical practitioner, who was
also the proprietor of a private hospital, for the death of the Plaintiff's
wife, illustrates this, and may be of interest to the members of this
association. A Mrs. Brandeis, a Bohemian lady, speaking no English,
was ill with pelvic inflammation, and on the defendant's advice was
removed to his hospital for treatment. When taken there, her temperature was 1011/5. The following evening her temperature had
gone down to 100 4/5 and she was apparently improving. At 10:00
p.m. a nurse attended her and she was apparently normal. At 11:00
p.m. the nurse visited her room and found she had disappeared. She
immediately told the matron, who telephoned the doctor. The Plaintiff's husband lived about a mile from the hospital. It was supposed
that she had gone home, so nothing more was done till the next
morning when her clothes were found on the bank of a river about
200 feet from the hospital, and her body about a mile down the river.
In the action two grounds of negligence were alleged: (a) that
the hospital was negligent in not preventing the patient from leaving the hospital, and (b) that her husband should have been notified
as soon as her absence was discovered without waiting till the next
day. The jury found the hospital negligent and gave a verdict for
damages. The Court of Appeal set aside the verdict and gave judgment
in favor of the defendant, holding that under the circumstances, the
condition of the woman, apparently normal at 10:00 p.m., and the
hourly attendance, that escape from the hospital was not owing to
lack of care, and that the best care had been given that could have
been given by the physician and nurses "in the .circumstances." Note
those last three words, for it is quite possible that under other circumstances a different conclusion might have been arrived at by the
Court. On the other ground, the lack of notice to the husband, the
finding was that as there was no evidence to show that the patient
was not already dead When the nurses discovered her absence, the
lack of notice was no evidence of negligence. In an English case
where a Plaintiff suffering from fits was put in the proper ward, and
in the absence of the nurse, broke a window, squeezed through the
bars, threw himself down and was killed, the hospital was held by the
Court of Appeal not to have been negligent.
NURSES:
The liability of a hospital for acts of the nurses which it is
instrumental in 6btaining for the treatment of its patients, is always
dependent on the question, whether the contract between the hospital
and the patient is one to supply nursing or is merely to supply nurses.
If it is to supply nursing, and the nurse in attendance is negligent, the
hospital is liable; if it is to supply nurses only, the hospital is only
liable where it has supplied nurses who are not properly qualified.
If the contract is to supply nursing, the selection of nurses, in
accordance with the usual practice, having the usual qualifications by
reason of training, etc., is not sufficient, but the hospital incurs liability
in case the nurse employed does not perform her duties properly and
the patient is thereby injured. The leading case on this point is
Lavere v Smith's Falls Public Hospital (35 O.L.R. 98-26 D.L.R. 346) a
case which was decided in the Court of Appeal in Ontario in 1915,
and which is worthy of being carefully studied by those in charge of
an institution of this kind, as the reasons for decision given by the
judges in that case discuss the relations between the hospital and its
nurses in a most thorough manner.
—15— The facts in this case were as follows: j The Plaintiff went to the
Smith's Falls hospital for an operation. This was successfully performed, after which, and while under the influence of the anaesthetic,
the patient was put to bed,and a hot brick placed against each foot.
One of the bricks must have been overheated, for when she recovered
consciousness, there was found to be a serious burn on the right foot.
The result of this burn was considerable pain and a certain amount
of disability which could only be removed, if at all, by an operation, the
result of which was considered by her physicians to be so uncertain
as to render it inadvisable.
An action was brought against the hospital which was dismissed
by the trial judge, but the Court of Appeal reversed his decision and
gave judgment for the Plaintiff for $900.00 damages and costs.
In this case the nurse in attendance was on the regular staff of
the hospital. She received her board and a certain money allowance.
She was under the control of the superintendent of the nurses, who
selected them, hired and discharged them, subject to the approval of
the Hospital Board. The superintendent of nurses alone selected the
nurse in question, the patient having nothing to say as to what nurse
should attend her. There were no direct instructions from the
physician in charge as to what the nurse should do. There was a
standing order as to warming the bed in such cases; the mode of
doing this was taught to the nurses during their training. It was the
duty of the attending nurse to see that this was properly done. Under
these circumstances the Court held that the contract was a contract
for nursing, not to supply a nurse, and that the negligence of the nurse
was the negligence of the hospital, for which it was liable.
But what if the physician in charge of the case orders such a
nurse to do a certain act, and the nurse in carrying it out according
to his instructions, injures the patient? In such a case the nurse
ceases, temporarily, to be the servant of the hospital and becomes, so
far as carrying out his directions are concerned, the servant of the
physician. Suppose, for instance, an operation is being performed, and
a nurse is present, acting on and subject to the directions and orders
of the operating surgeon. Under such conditions she is bound to act
precisely as the surgeon directs, and the hospital is under no liability
for her acts. In the Lavere case above mentioned, if the Doctor had
ordered a brick, heated to a precise and certain temperature, to be
placed at the patient's foot, and his instructions had been complied with
and thereby injury had been caused to the patient, the hospital would
not have been liable. But as the routine nursing was left to the hospital, to be carried out according to the usual practice, it was liable
for the nurse's negligence. On this point the Lord Chief Justice of
England says in another case, speaking of nurses at operations:
"Although they are such servants for general purposes, they are
not so for the purposes of operations and examinations by the
medical officers;—as soon as the door of the theatre or operating
room has closed on them for the purposes of an operation (in which
term I include examination by the surgeon) they cease to be under
the orders of the defendants  (i.e., the hospital authorities) the
nurses—assisting at an operation cease for the time being to be the
servants of the defendants, inasmuch as they take their orders during
that period from the operating surgeon alone."
But in order to protect herself and the hospital by which she is
employed, a nurse in taking orders from a physician, must be quite
sure that she understands them correctly, and as he intends them.
If she obeys his orders, she cannot be negligent; if there is any
negligence in such a case, it is his and not hers. But she must be
sure that she understands the orders given her and must not act
on what she should know to be a slip of the tongue. She holds herself
out, and the hospital holds her out, as being possessed of competent
—16— skill and undertakes that she will use reasonable care. If any command of the surgeon appears to be out of the usual practice or dangerous to the patient she should call his attention pointedly to the
order. If she does this and he makes it clear that she understands his
order as he understands it, and intends it to be carried out, she must
obey and it is not negligence for her to act on the belief that he has
greater competence and skill than she has. A physician should appreciate the necessity for and commend such action on the part of the
attending nurse.
A case which exemplifies the necessity for the nurse to take such
prcautions is that of Armstrong v Bruce, (1904) 4 O.W.R. 327. In
this case a doctor was being sued for malpractice in having had
applied to the person of a patient a "Kelly Pad" filled with "boiling"
water when it should have been filled with hot water. The nurse
gave evidence that the boiling water had been put in by the direct
orders of the defendant, the attending physician. This was denied
by the defendant and two other medical men present corroborated
his statements. The Court found for the defendant, and held that the
directions were not as stated by the nurse but that the usual directions,
to fill the Kelly pad with hot water, were those which had been
given, and that the negligence was that of the nurse, not that of the
doctor.
If the duty taken upon itself by the hospital is only to procure
nurses, as is the usual course when special nurses are retained, the
patient or his attending physician should, as a matter of precaution,
be consulted as to the nurse or nurses to be employed unless, for some
reason they cannot do so, or desire to leave such selection to the
hospital authorities. It should also be made a rule of the hospital,
so that all persons dealing with it, both patients and medical men,
may distinctly understand it, that as to special nurses the hospital
takes upon itself no other responsibility than that of engaging those
who are properly qualified, and that otherwise the matter of the nurses
and any liability for their acts is solely between the patient and the
attending nurse or nurses. I think this is the law, even without
such a specific rule, but it may avoid question if the limit of the
hospital's responsibility is clearly made known in that way to all
parties interested.
The rule, that there is no liability where the contract is to supply
nurses and not to furnish nursing, except for negligence in selection,
is illustrated by the case of Hull v Lees (1904) 2 K.B. 602. The
defendants were a voluntary association, in part supported by charitable
donations, to provide for the supply of duly qualified nurses to attend
the sick in a certain neighborhood. They appointed and paid salaries
to their nurses, for whose services they made charges to persons on
whose application the nurses were supplied if they were able to pay,
in other cases gratuitously. By the neglige.nce of one of the nurses
a hot water bottle, used to prevent collapse after an operation, came,
when very highly heated, in immediate contact with the plaintiff's
body, instead of being shielded, as it should have been, by the intervention of a blanket or other covering, whereby she was severely
burned. She sued the association for damages by reason of the negligence of the nurse. The jury found for the plaintiff and assessed the
damages at £300.
The Court of Appeal set aside the finding of the jury and entered
judgment for the defendants. One of the Judges thus distinguishes between the effect of a contract to supply nursing, and one to supply
nurses:
"The question is therefore raised, whether the Association who
supplied the nurse is responsible to the patient for the consequence
of her negligence. That question in the last resort is a simple one,
and depends, I think, upon the true effect of the contract between
—17— the association and the person to whom the nurse is supplied. If
the Association undertook to nurse the patient, then they are responsible for the failure of the person by whom they nursed her, to-
use due care. If on the other hand, they only undertook to supply
a competent nurse to the patient, then, if they exercised ordinary
care and skill in the selection of the nurse whom they supplied,
their responsibility is at an end, and they were not responsible for
her failure to exercise care and skill."
Under the circumstances they found that the contract made by the,
Association came within the latter class,  and therefore it was not
liable.
PHYSICIANS ON THE STAFF:
Whatever may be the liability of a hospital for the acts of Medical
practitioners, acting in the capacity of and merely as administrators
of the hospital, and this would seem to be on the same level as other
employees, in their capacity as professional men, although on the
hospital staff, the hospital is under no liability for their acts as such.
A servant is a person over whose acts the employer has control. The
master has a right to say what his servant shall do or shall refrain
from doing and the latter is bound to act as he is directed. This
cannot apply to a physician or surgeon in his professional capacity,
whose acts cannot be supervised or directed by the governing authorities of a hospital. Over the exercise of their professional skill and
ability the hospital has no control. The provincial authorities, under
the provisions of the "Medical Act," have provided for the examination and registration of trained specialists as duly qualified practitioners of medicine, surgery and midwifery in' British Columbia.
These authorities refuse to allow any person other than a registered
practitioner to be a house surgeon or house physician in any hospital..
Such duly registered practitioners are therefore considered to be
skilled persons over whose professional qualifications and conduct the
hospital authorities have no control or supervision and therefore they
are under no liability for their professional acts and such practitioners
are in no sense servants of the hospital, and this notwithstanding they
are on the staff of a hospital and are selected by its governing Board.
It does not treat its patients through the agency of its physicians but
only procures for them the physician's services. It is true that the
hospital may in the discretion of its governing authorities, dismiss
them, but it has this power not because they are its servants, but
because of its control over the institution where their services are
rendered. They would not, and in the nature of things, could not
under any circumstances recognize the right of the hospital, while
retaining them, to direct them in their treatment of patients.
The layman is presumably incapable of judging the right treatment to be adopted by medical men, and accordingly he is not required
to interfere with them or' is he in any sense warranted in doing so.
On the contrary the governing body, whoever it may be, would without
doubt be guilty of gross negligence if it attempted to do so, and if it
did, and injury resulted from such interference, it would be liable in
damages. The duty of the hospital, and its only duty in respect to its
medical staff, is to use due care and skill in selecting them, and this
duty is fully carried out when selection is made of those persons who
have been certified under the "Medical Act" to have the necessary
qualifications for practice within the Province, so long as it has no
knowledge of any specific unfitness owing to bad habits or conduct
on the part of the practitioner appointed, and has provided its staff
with reasonably fit and proper apparatus and appliances for proper
care and treatment of its patients.
The leading case on this point is Hillyer v The Governors of St.
Bartholomew's Hospital [(1909) 2 K.B. 820]. The Plaintiff in this
case was himself a medical man who had entered the hospital for the
—18— purpose of being medically examined under an anaesthetic. The
examination was conducted by a consulting surgeon on the staff of
the hospital. During the examination the Plaintjff was placed on the
operating table in such a position that his arms were allowed to hang
over its sides, and thus his left arm came in contact with a hot water
tin projecting from beneath the table, which caused a serious burn on
his left arm. During the examination his right arm was also bruised
by the operator or some other person pressing against it, with the
result that traumatic neuritis and paralysis of both arms followed,
rendering him unable thereafter to exercise his profession. The Court
of Appeal held that there was ns liability on the hospital. One of
the judges said:
"A public body is liable for the negligence of its servants in the
same way as private individuals would be liable under similar circumstances, notwithstanding that it is acting in the performance of
public duties, like a local Board of Health;  or of elemosynary and
charitable functions,  like a public hospital. The  first  question
then is, were any of the persons present at the examination servants
of the defendants? It is, in my opinion, impossible to contend that
Mr. Lockwood, the surgeon, or the acting assistant surgeon, or the
acting house surgeon, or the administrator of anaesthetics, or any of
them, were servants in the proper sense of the word; they were all
professional men, employed by the defendants to exercise their profession to the best of their abilities according to their own discretion; but in exercising it they were in no way under the orders or
bound to obey the directions of the defendants."
And again:
"No surgeon would undertake the responsibility of operations if
his orders and directions were subject to the control of or interference
by the governing body."
This case was followed in our own Courts in the well known case
of Thompson v Columbia Coast Mission, 20 B.C.R. 115. Here the
Plaintiff paid $1.00 per month to the defendant Mission for hospital
treatment in case of illness. Following an accident he had trouble
with his shoulder and went to the defendant Mission's hospital where
he was treated by the doctor in charge, who diagnosed his complaint
as rheumatism and treated it accordingly. Not improving in health,
he went to the Vancouver General Hospital where it was found that
he was suffering from a dislocated shoulder, but owing to his advanced age and the length of time since the accident, it was not
considered advisable to remedy the trouble by an operation and he
consequently remained seriously injured. The jury which heard the
case found against the Mission, but on Appeal the case was dismissed
as against it, the Court holding that the doctor in charge of the hospital was not, in his professional capacity, the servant of the hospital.
The Chief Justice puts the question of the liability of the hospital very clearly.   He says:
"A professional man cannot in the performance of a professional
service be the servant—of anyone, certainly not of a corporation or
of a non-professional employer, because, in the exercise of his professional skill and care, he could not properly be subject to the control
of a master, and hence, when a patient enters a hospital, whether as
a paying patient or not, the hospital must not be negligent in those
matters which they control, but as to their professional employees,
they must be deemed to have performed their duty to the patient
when they have taken care to select and provide a competent medical
man to treat him, and that the ordinary rules of law as to the liability
of a master for the negligence of a servant do not extend to pro->
fessional employees exercising professional skill and care.'.'
As to what* is a "competent medical man" in B. C, Mr. Justice
—19— McPhillips says:
"All those whose names are on the British Columbia Medical
Register must be deemed to be persons of professional competence.
Possibly cases might arise where there would be responsibility if it
were known that the practitioner employed in a hospital were, owing
to habits or conduct, unfit to properly discharge the duties entrusted
to him."
But this rule would not apply to any other than fully competent
medical men. In the Thompson case, the Chief Justice refers to a
case in the American Courts where damage was occasioned by the
unskilful act of a surgical interne or house pupil, who himself treated
the patient instead of calling in a surgeon, as it was his duty to do.
Here he was negligent in his ministerial duty to call in a surgeon,
and the hospital was held liable for such act.
An interesting case arose in Quebec, (Boilard v Montreal, 18 D.L.R.
366), where a child who had been vaccinated, was shortly after found
suffering from infantile paralysis. There were a number of theories
brought out in the course of the trial as to the cause of this; whether
the vaccine was infected, or whether the vaccination had anything at
all to do with the matter. We are not here concerned with either of
these theories, but in the course of the Appeal the Court'held that as
the City bought the vaccine from the Institute of Vaccination at Montreal, who had prepared it subject to the examination of the Provincial Board of Health, and received it in hermetically sealed bottles,
it was not responsible for any defect in its quality; and also that it
was not responsible for any negligence on the part of the physicians
administering it, unless it were proven that it had been guilty of
negligence in the choice of such physicians.
There are many other cases in the Reports bearing on the same
question, but the ones quoted are sufficient to show the line following
by the Courts in dealing with the liability of a hospital for its medical
stafl-
PHYSICIANS NOT ON THE STAFF.
If this is correct as to the liability of the hospital for the acts of
medical men who are on its staff, a fortiori it follows that there is no
liability on the part of the hospital for negligence of physicians not on
the staff, who are attending patients there. The patient can only look
to the doctor himself, and his acts, or any acts of the nurses in obedience to his directions or demands, are entirely a matter between himself and his patient, with which the hospital has no concern whatever,
and the fact that some of the acts so authorized are carried out by
persons who, in other respects, and when not so engaged, are in the
direct employ of the hospital and are truly its servants in every sense
of the word, whether as nurses, orderlies or otherwise, makes no
difference.
Another question which I was requested to discuss was as to
whether a Public Hospital has the right to refuse to admit or to continue to keep a patient. I can find no decided cases on this point.
A patient could not be excluded from a public hospital, merely because
he was unable to pay for his treatment, because if this was done, the
hospital would be excluded from receiving Government aid, the Statute specifically providing that:
 to any hospital which refuses to
"No aid shall be given-
admit any patient on account of his or her indigent circumstances."
There may be cases when the hospital is full and has no accommodation for other patients in which it might be justified in refusing to
accept any more whether indigent or not. It is bound to provide for
the isolation of those suffering from infectious diseases if it accepts
them, and the provision for the isolation.of smallpox patients is com-
—20— pulsory under the Act. Not being a medical man, I cannot say whether
or not there are any other classes which should not be admitted, but
If there are, proper bylaws should be passed in respect thereof, giving
the hospital such powers as may be necessary and these should be
approved by the Lieut.-Governor in Council as provided by the Act.
Generally speaking, however, I should say that if the hospital has the
necessary accommodation it should not, unless under the most exceptional circumstances, refuse the admission of any person requiring its
services.
If a patient continues to need treatment the same rule would
apply, but the hospital is not obliged to keep patients after they have
ceased to require its services. This is a question for the attending
physician or, if there is none, the medical staff, and if the hospital
acts on their advice, it will be protected.
Such are some of the points which will commonly arise in ordinary
practice and as were suggested to me by Dr. Bell. I do not suggest
that it covers all the cases which may come up from time to time;
that would be impossible for me to do in such an address as this.
Neither am I, or any other person able to foresee what may, at one
time or another, be the combination of circumstances which will confront you. The greatest difficulties which you will meet, will be
questions of fact, not questions of law, and those can only be met and
solved when and as they arise. I have endeavored in a general way to
outline the general principles of the law relating to hospitals, exemplifying them by some of the decided cases, but you may not find it
always easy to foresee how the courts may apply them under many
varying circumstances for which there may be no precedent among
cases which have been decided up to this time. The knowledge of
these principles may, however, assist you to some extent, perhaps, to
avoid trouble to the institutions which may be under your direction.
There is always, however, this thought to encourage you. Troubles
only arise because you are actually doing something. And it is your
ctuty as I have no doubt it is your pleasure, to be of some good to the
world, by actually being of service to it. In doing so, many questions
must necessarily be continually arising which will be unpleasant.
Shall we, therefore, do nothing, because we foresee that by acting
difficulties will arise? I think not, for inaction would be the greatest
mistake of all; not merely a mistake, but worse than that, a moral
crime, when the needs of our poor humanity are so great and the
demands on your skill and attention are so enormous. May I wish you
all Godspeed and success in your task.
Mr. Reid's masterly address was received with prolonged applause
and the discussion which followed was animated. Numerous complicated legal questions were brought forward for his consideration by
Messrs. T. Mordy, R. W. Thompson, G. R. Binger and Drs. Bell, Darby
and Wrinch.
The discussion of the hospital care of infectious diseases was
resumed. Dr. A. D. Buchanan, of New Westminster, speaking of himself as a "Municipal Man," pleaded for a better understanding between
the municipalities and the hospitals regarding this and other problems. It was useless to expect a satisfactory solution unless all parties got together and showed a spirit of mutual sympathy and understanding.
Mr. T. Mordy spoke of conditions in Cumberland, and Mr. A.
Tyrell, of Kamloops, gave an interesting description of the efforts of
the railway men's organizations to outline a sound plan of caring for
cases of infectious disease. Mr. W. W. Cory, representing the Canadian
National Railways Employees' Association, further explained this
project. ■
—21— Mr. R. L. McCulloch, of Abbotsford, deprecated the tendency shown
to "pass the buck" to the government. He urged educating the municipalities to recognize their responsibilities.
Dr. F. C. Bell outlined the plan being worked out by the Vancouver General Hospital that the government be requested to re-insert the
word "indigent" in the hospital act so as to force municipalities to
acknowledge the just claims of the hospitals for the payment of
accounts incurred by this type of patient. As an outcome of this
discussion it was moved by Mr. E. S. Withers, of New Westminster,
and seconded by Mr. E. M. Cook, of Chemainus, that a joint committee
with representatives from the Hospitals Association, The Union of B. C.
Municipalities and the Provincial Government enquire, during the
coming year, into the various points at issue mentioned during the
afternoon session   The motion carried.
The meeting then adjourned.
FRIDAY,  AUGUST 29th, MORNING SESSION.
As soon as the meeting was called to order, the Chairman
announced the death of Dr. R. H. Mullin, which' had occurred at
5 a.m. at St. Joseph's Hospital. The assembly arose and remained
standing for one minute in silence as a token of sorrow and respect.
Dr. F. C. Bell was then requested' to take charge of the meeting
which dealt with medical service in hospitals.
The first speaker was Dr. "V. B. Burnett of Vancouver, his subject being "What we can du to improve obstetrical practice in
hospitals." Dr. Burnett outlined the requirements of a modern
obstetrical department with respect to equipment and facilities, emphasizing especially the necessity for the segregation of infectious
cases and for adequate provision for nurseries.
He deplored what he felt to be the attitude of the modern
nurse toward this important and interesting branch of nursing
practice. That they no longer displayed the interest they should
was due, he thought, to certain defects in thei present system of
training in large hospitals which did not permit the nurse to follow
through her cases in a sufficiently thorough manner to ensure her
acquiring • skill and judgment in obstetrical nursing. The students
in small hospitals had all round experience and on the whole
tended to develop better. Dr. Burnett advocated the special training of graduate nurses in the more advanced phases of obstetrical
nursing, such as abdominal palpation, rectal examinations and pelvic
measurements and even the administration of anaesthetics. He
deprecated the tendency toward a set routine in the care of maternity
patients and urged a more personal and sympathetic attitude on the
part of the nurse. He spoke of the. problem's associated with the
question of visiting and strongly urged the exclusion of all children
from maternity wards, and emphasized the importance of careful
case records.
In conclusion he again urged reform in the present method
training student nurses and appealed to graduate nurses to aid
supplying a highly efficient personnel for this important branch
nursing. ,
Dr. G«orge Darby of Bella Bella, in discussing Dr. Burnett's pa
thanked him very cordially for the compliment paid the small train
schools. He endorsed Dr. Burnett's plea for nurses trained in
advanced phases. It was frequently necessary for the nurse in
hospital to give anaesthetics and it would be very helpful if t
also could be trained to do simple examinations. Occasionally
was necessary for thlem to  deliver patients themselves  in the
of
in
of
per
ing
the
his
hey
it
ib- sence of both physicians. Mr. T. Mordy discussed the question from
the director's point of view. Hie stated that in small hospitals it was
practically impossible to command the services of highly trained
specialists and urged that the preparation of the ordinary graduate
nurse should be as thorough as possible.
Mr. George' Binger of Kelowna stated that to his opinion the
ordinary nurse learned to adapt herself to local conditions fairly
quickly. Dr. H. C. Wrinch also thanked Dr. Burnett for his compliment to the small hospitals and suggested such an interchange of
pupils between the large and small schools as would permit the
former to gain the practical experience afforded in the small
hospitals.
,   A paper was then read by Dr. Ridewood of Victoria, entitled:
WHAT THE SURGEON EXPECTS FROM THE HOSPITAL
He expects a great deal.
The surgeon sees the patient at his office or at the patient's
house where he examines, and makes his notes of the patient.
He decides the patient should go to the hospital for diagnosis
or treatment, or operation. He is apt to be met by the patient's
prejudice against hospitals in general or some tale about neglect at
the hospital in question, or some complaint about the food received
whtn the patient was last in the hospital. There should be no
justification of any such complaint and the food should not only be
the best, but should be put up in the most appetising way before the
delicate palates of the sick. The question of expense is also apt
to trouble the patiest. He wants to know how much it is going
to cost him. The hospital must be economically run, no excessively
expensive buildings or fittings, and the rate per bed or room should
include all the usually necessary examinations and treatments so that
as far as possible there are no extra charges except in the case of
special nurses. With the increasing cost of sickness some form
of state health insurance alone will equalize this burden—for the
indigent this does not compensate the patient for the time he is
out of work.
The patient deciding to go into the hospital, on telephoning the
hospital, the surgeon should be able to be' immediately told if there
is a room or bed vacant—should be able to give orders for the
patient—and if an operative case, should be able to find what time
he can list the operation. In a small hospital, one telephones the
matron who can arrange everything and give all information straightway. In a larger hospital, it sometimes means telephoning to the
hospital three times. First to arrange a bed—then to arrange the
operation—'then orders for the patient; each time a certain amount
of delay. This should not be. An admitting office and admitting
officer should do this.
When the patient is admitted there is the question of the notes
of his case. The surgeon has his own notes. In the record department there should be a stenographer, specially trained for the purpose of knowing medical terms, who can take the dictated notes in
shorthand and transfer these to typewriting at leisure.
We will take an operative case next. Operations, except
emergencies, are generally done in the morning. This sometimes leads
to congestion. There should be a sufficient number of operating
theatres—a sufficient theatre staff to cope with the congestion in
the larger hospitals. The surgeon should be punctual, but cannot
always be so.    An operation may prove to be a much  longer one,
 gs	 as regards time, than was anticipated, and this may throw the
theatre list out of gear. After an operation it takes some time to
clean things up in the theatre and get ready for the next—if however,
a spare theatre is available, things can be got ready there, while
the last operation is in progress. The surgeon should have to wait
no unreasonable time for the patient to be brought from the ward
or for an anaesthetist—it generally takes some time for the patient
to be anaesthetized and unless things are well run there is a good
deal of time consumed that is not actually operating time. The
theatre nurse is a very important person. So important to the
surgeon that the surgical staff should be consulted in her selection.
She must be able to train the nurses in aseptic technique, in the
names and care of all the instruments and appliances. A nurse cannot be trained in this way in a day, consequently the nurses in training, in the operating theatres, should only be changed one at a time
at regular intervals so that there is always a large proportion of
partly trained and not a bevy of helpless, raw hands. In the larger
hospitals there should be more than one fully trained operating
nurse, since one cannot properly supervize more than one major
operation, to say nothing of the minors.
The surgeon expects the hospital to provide a satisfactory supply
of surgical instruments with which all ordinary operations can be
performed. A satisfactory supply of sterile towels, sheets, gloves,
gowns, aprons and masks. That the cutting instruments be kept
sharp, and other instruments intact and in working order. Also
satisfactory anaesthetic apparatus so that the anaesthetist can give
either warmed ether vapour or gas and oxygen  if needed.
All pathological material removed should be examined in the
laboratory without any extra charge except the extra charge for the
use of operating room. If the material is not so examined, cases of
cancer, etc., will be overlooked or mistakes will go incorrected since
the surgeon is tempted to spare the patient extra expense and the
hospital loses its right to be called Class A in hospital standardization.
For fracture cases the surgeon expects a satisfactory series of
splints, for all purposes, to be readily accessible.
He expects the apparatus for saline infusion—tracheotomy—and
other emergencies to be always ready for use, and accessible and
these days also the apparatus for blood transfusion and a list of
properly selected donors.
In the after case of operative cases in the wards, he expects
the ward supervisors to be specially trained in the care of surgical
cases—so that he shall be informed of any serious changes in his
patient's condition.
He expects instruments for dressing, drainage tubes, dressings,
syringes—lotions to be always ready so that he can do all his dressings properly without unnecessary delay. Also a .steriliser always
boiling so that any special instrument etc., can be boiled without
delay. Also sterile rubber gloves, readily accessible, in the wards
for occasions when they are required.
He also expects that the charts of the patients be kept conveniently arranged so as to be readily accessible on his rounds—
together with history forms, prescription blanks, X ray forms, pathological forms, etc.
He also expects a well trained male nurse to look after male
cases after spinal operations and a well equipped and efficient X ray
and laboratory service.
In concluding his-remarks, Dr. Ridewood spoke of the desirability
—24— of larger hospitals loaning expensive apparatus, not constantly in
use, to smaller institutions and spoke appreciatively of courtesies
extended by the Vancouver General Hospital.
Permission was requested at the close of this address by Dr.
A. D. Buchanan, to introduce Reeve Lockley of Esquimalt, President
of the Union of Municipalities. This was granted by the Chair and
Reeve Lockley delivered a brief address. He referred humorously
to the fact that he might not be safe in a hospital gathering when
it was known that he was the President of the Union with whom
such sharp issue had been taken, but he described himself as having
as one of his principal aims: "to get the hospitals, the school
trustees and the Union together" so that some amicable conclusion
could be arrived at and some constructive policy formulated. He
emphasized the necessity for co-operation and a united front, if
governmental action is desired, and urged the appointment of a
joint committee to consider the problem from all angles. His remarks were very cordially received by the members present.
The morning's program was concluded by the following paper
prepared by Dr. F. C. Bell, General Superintendent of the Vancouver
General Hospital
THE PERSONAL FACTOR IN HOSPITAL
ADMINISTRATION.
By Dr. F. C. Bell.
The greatly increased interest which individuals and communities
now display in matters of public health has led, by comparison with
conditions of twenty years ago, to a corresponding demand for
institutional facilities for the treatment of disease. Such demand has
in part arisen from the activities of institutions themselves, the
result of a consciousness on the part of the hospitals of the problems
they must face. The physical side of the hospital—its construction,
equipment, service, finance and administration make a multitude
of pressing everyday difficulties which develop that need for consultation, and search for advice which are tangibly expressed by the
fact of gathering together as we do now.
In surveying the whole hospital field it is often one of our
perplexities that the benefit of service given so many individuals
fails of recognition by the community as a whole, and that there so
often appears to be a lack of sympathetic public support of our
institutions. I want to suggest to you that this condition of affairs
is contributed to by the oft repeated failure on the part of hospitals
themselves to appreciate the human problem of the patient. Too
often we are slow to recognize the fact that it is through the
patient that we establish most of our contact with the community,
and that patients leave our institution with a resultant dissemination
of their hospital experience among their friends.
"Treat not only the disease, treat also the man." These words
of Virchow, the great pathologist, seem to me to set the standard
for the highest form of hospital service. The hundreds of patients
who are daily in the hospitals of British Columbia, present the
hospitals not only with a variety of bodily ills, but with problems
of personality and environment which are as varied as human nature,
and which influence vitally the ultimate success of the hospital's
mission to maintain, as well as to restore health.
Virchow's words appear to set, not only a standard, but express
a warning, for one of the hospitals' great dangers is over specialization—concentration on pathology and the overlooking of personality.
—25— There is a similar problem to be grappled with in the fiehi of
medical education where the production of the coldly scientific and
wholly selfish type of practitioner is causing not a little concern to
his elders. Sir William Osier was one of the first to draw attention
to danger of over emphasizing the scientific side of medicine to the
exclusion of an education of sympathy and humaneness.
Those who are accustomed to the hospital atmosphere too often
fail to recognize how new and strange an experience, to the average
patient, is the first contact with a hospital. The admission procedure,
the unfamiliar antiseptic odors, the sight of many sick people, the
preoccupied business-like efficiency of hurrying nurses and doctors,
and their chance words of comment dropped in conversation, fill
many a patient with vague and uncertain ideas of what may be
going on behind the many closed doors, and what may soon be
happening to himself. Courage and self reliance seem easily lost
in the strange institutional atmosphere. The educated man who is
familiar with hospitals, having previously been a visitor or a patient,
and who is self confident and at ease even during sickness, is in
quite a different position from those who have rarely required
medical or hospital attention; or the timid woman, the sensitive
child, or the man harrassed by family cares.
It does not seem to be that hospitals or their personnel lack
kindness in the treatment of patients. It is surely their stated business to be helpful and they generally are, but it is rather helpfulness
in a professional and technical way not always to the exclusion of
that helpfulness which contributes to the ease of mind of the patient
and makes for explanation of the intent of the treatment given.
While the patient is generally full of worrying questions he would like
to have answered, or forebodings which it would be desirable to
dispel, and of states of mind which depress him he does not know
to whom to turn for explanations of questions which are rarely
anticipated as natural ones, and which remain unanswered if unexpressed. Such forebodings and states of mind require not merely
a general attitude of kindness but sympathetic insight, facility of
analysis, and definite action, to dispel. Apparently we have a new
task confronting us, that of adjusting the Hospital regime to a treatment of physical, racial or temperamental needs which are additional
to the conditions now so scientifically considered. In those hospitals
where there is evidence of some appreciation of these facts, and a
sympathetic attitude of convincing the patient of its friendly interest,
its ability in diagnosis, its skill in treatment and its intelligent
appreciation of the relation of personal problems to disease; there
is also evidence that the Hospital's work is worth while. The
patient leaves such an institution in a grateful frame of mind and
the experience has probably been of "permanent educational value
to him in the matter of personal and public health, and in the growth
of a sense of participation in a modern social and economic movement."
The result is different when the hospital has no specific machinery
for getting at the back! of what is in the patients' mind and making
the somewhat inflexible and mysterious hospital routine less of
a puzzle to him. If the patient has any skepticism as to whether
hospitals are good places for him such is apt to develop into a
large doubt. This is further enlarged by his friends who have
trouble in being understood at the enquiry desk, or in asking their
way to a ward, obscurely situated; who may be unable to talk with
the doctor or to get a diagnosis. If the cases are medical ones the
patients worry through a retarded convalesence and go home glad
to be free—but Wondering., Once outside, their impressions of
hospital matters are translated into definite complaints which shake
the confidence of those who hear them.    If the  cases are  surgical
—26— there is sometimes the climax of protest against the vast unknown
of perfected hospital machinery in a refusal to permit operation,
or at least a violation of rules framed for the treatment of cases.
These patients frequently leave against advice, grateful for a somewhat peremptory discharge from hospitals, which in turn feels
affronted by its lack of ability to deal with an unresponsive or
unreasoning attitude of mind.
One important relation of the hospital to the Community is the
furnishing of information about the condition of patients. Patients
themselves not only wish to know how they are getting on, but also
that their friends and relatives may have information. Hospital
Staffs and administrators must of course use their discretion in
what they tell the patients or relatives, just as private physicians
do, yet the hospitals often fail to give elementary and necessary
information or to give it cheerfully in a way which will be helpful
or even useful.
Interpretation of the hospital's work, rules, and results to the
public is part of the hospital's function. That public includes
patients, their relatives, and friends, and also the broader circle
of the Hospital's supporters, or any one in the community, in fact,
who has a reason to be interested in the hospital's activities. The
interpretation is made partly in the hospital's formal report, and
partly through its daily relations with its patients and those interested in them. Too little attention has been given to the spreading
of correct information about hospitals through the channels of its
routine contact.
We may also note that the degree of the patient's lack of understanding of the hospital is comparable to the hospitals' lack of
understanding the patient. The patient can be greatly helped and
better understood if there is right procedure at the time of admission.
There should be tact in obtaining what data are then required, but
seem senseless, or irrevelant to the patient, especially if similar
particulars are again required from him on the wards. There is an
irritating sense of being indexed and classified as if the subject were
an inanimate one rather than human and animate. Hospitals do not
always meet the evident responsibilities resting on them /either
completely or wisely because of failures to assign sufficiently trained
or responsible persons to the task of sympathetically receiving the
individual patient.
The critical moment, for the patient, from the standpoint of
disease, is after the time of admission to hospital but the critical
time for the patient from his standpoint, as a person is usually at,
or a little before the discharge. Having become adjusted to his
hospital environment (sometimes unfortunately over hospitalized)
the patient often views with some dismay the necessity for recommencing his particular battle of life. Ofttimes he may still be
iu need of some definite form of medical care, either at home, in
attendance at an Out Patient Department, or a convalescence which
the hospital is neither equipped for nor established to give. In these
cases it seems to be. the responsibility of the hospital to reefer the
patient to some existing organization which is prepared to meet the
difficulty, and it is just here that the Social Serviqe department
nurse can best come in and assist the hospital Staff by securing the
essential facts regarding the patient's personality, the family housing,
home conditions and finances. If this information is then taken in
conjunction with the facts known concerning the patient's condition
it should enable the responsible member of the staff to formulate a
programme for the after care. Not all hospitals can however find
themselves in a position to carry on extensive work of this nature,
but if they are unable to do so they should still recognize responsi-
—27— bility for providing the patient or friends with an explanation of
the case, and know into what channels to direct the patient to further
assistance. Co-operation with charitable agencies in behalf of their
patients is a particularly significant responsibility for all hospitals
since no inconsiderable proportion of ward patients are likely to be
adversely affected by lack of it.
In the long run, the degree of support accorded the hospitals
of this Province will depend upon the degree to which their work
s appreciated by the community. The elaborate facilities, equipment,
staff and organization needed for the thorough study and treatment
of disease require a commensurate high degree of appreciation on
the part of the community of just what hospital work is, what it
requires, and what it costs. The foundation of appreciation in these
matters is understanding. Anyone grasps the beneficent service of
a hospital to the emergency accident patient, but understanding of
the less obvious, and more typical cases, which constitute the
majority of the whole, is not so easy. The patients lack of understanding of the hospital at the time of discharge is a misfortune
to the patient as well. Only on the basis of mutual understanding
can adequate public support for the best hospital work be built up
and  maintained.
The meeting adjourned for luncheon which took place at the
Provincial Royal Jubilee Hospital under the auspices of the Woman's
Auxiliary of the hospital, the President, Mrs. C. W. Rhodes having
charge of the arrangements. Out of respect to Dr. Mullin, the social
features of the luncheon were abandoned and a question box was
conducted. Below will be found some of the many questions submitted, which may prove of some interest.
(1)    Can hospitals protect themselves with respect to liabilities
arising out of accidents or injuries to patients?
No one present knew of any company wihich would offer to
insure against such risks.
Should   women   be   allowed   to   be   members   of   hospital
directorates?
The opinion was almost unanimously in favor of their so
doing.
Should Women's Auxiliary Associations have representation
on  the  Hospital  Board.
The majority felt that they should.
How long should case records be preserved?
The answer given was "Several years at least if they are to
be of any use to the patient or to the hospital."
Has the association considered the feasibility of establishing
a central purchasing bureau?
The reply was in the affirmative, but that many hospitals
felt they could not utilize such a bureau since they were
obliged to make all purchases locally.
What vacations should be granted annually (a) to graduate
staff nurses,  (b) to pupil nurses.
To graduates, one month;  pupils, three weeks.
Should not the doctor be penalized rather than the hospital
"n cases of the Workmen's  Compensation Board  cases remaining in the hospital too long?
No definite answer was forthcoming to this question, but
the opinion was expressed that the responsibility of the
doctor to the hospital in this connection should be brought
forcibly to hi» attention.
Has the hospital  any redress when the Workmen's  Compensation Board repudiates charges for hospital service to-
—28— patients authorized by 'local medical men?
The consensus of opinion was that at present the hospital
has no option but to submit to the decision of the Board.
Space does not permit of all questions being recorded here. The
last and most hotly debated was: "W|ha>> stand does this convention
take on bobbed hair?" Discussion became so animated that the
chairman hurriedly brought the proceedings to a close after a very
cordial vote of thanks had been passed and tendered to Mrs. Rhodes'
and her associates and to Miss J. F. Mackenzie for the , delightful
luncheon.
FRIDAY, AUGUST 29th, AFTERNOON SESSION.
The afternoon session was devoted to Nursing affairs and was
held at the Provincial Royal Jubilee Hospital. Miss K. W. Ellis,
Director of Nursing in the Vancouver General Hospital, took charge
of the meeting and presented the following report on Nursing Progress.
REPORT ON NURSING'PROGRESS
I beg to submit the following report on nursing affairs and in
it to bring to your notice what the past year has seen accomplished
by the three sections of the Graduate Nurses' Association of B. C.
viz: Private Duty, Public Health and Nursing Education. The convenors of these sections now attend all executive meetings and report
fully on the work done by their committees. The steadily increasing
membership, the co-operation of the various sections, together with
interest shown in topics brought up  for discussion is  encouraging.
Private Duty Section Meetings possibly have not been attended
as well as those of other sections, owing to the fact, no doubt, that
frequently calls of the private duty nurse do not permit of the
regular attendance. Last summer a Refresher Course was held at
the University of B. C. under the direction of Miss Ethel Johns.
This course was well attended, thirty-three nurses having enrolled
and those who were able to take advantage of the lectures and conferences expressed their appreciation of the benefit derived therefrom.
Public Health Section—An institute extending over a period of
three days for members of this section was held at the University of
B. C. in April, 1924, also under the direction of Miss Johns. A
generous invitation to attend many of the lectures was extended by
the University authorities to members of the Nursing Association,
other than those belonging to the Public Health Section. It was
gratifying to note that the Government acknowledged the value of
such a course by recalling public health nurses in this province to
attend. Further recognition has also been made of the value of
special instruction in this branch of the work by the fact that a
resolution was passed by members of the nursing association requesting that in making appointments to public health positions p'rior
consideration be given to those who have taken a special course or
have obtained the equivalent in practical experience.
Nursing Education Section—Regular meetings have been held by
this section and have been well attended. The revision of the
standard curriculum dealt with at some length in last year's report
has been completed and may now be obtained in printed form, a
copy having been sent to the various hospitals throughout the
Province.
It is to be hoped that this may be of some assistance in establishing a more uniform standard in the Training Schools, both as regards
—29— the  requirements for students  entering and also  the  course  of instruction given.
To aid in this objective, it has been felt by members of this
section that standard lesson plans might prove of value and the
consideration of standard records, including application forms, for
general use in hospitals throughout the Province has also been suggested.
Several matter of common interest have been discussed at various
meetings during the year:—
Health insurance. A committee being appointed to keep in
touch with the further development of this scheme.
The desirability of a travelling dietetian to visit the smaller
hospitals at regular intervals and give a course of instruction in dietetics. Possibly Miss Randal will give us some
information as to the response this suggestion has met with.
Affiliation—how may the present system be improved upon.
A demonstration of practical nursing procedure followed, arranged by Miss Gregory-Allen of the Jubilee Hospital. Miss C. Veysey,
a student in the second year, showed the method of applying hot
compresses to the eye, and Miss Phinney, a first year student,
demonstrated the application of a mustard plaster.
Miss A. Shafer, Dietitian of the Jubilee Hospital, then read the
following paper:—
THE DIET DEPARTMENT IN THE HOSPITAL
Upon the diet department rests the responsibility of feeding
the entire hospital personnel including the patients, staff and help;
and the manner in which this is done has a lot to do with the
popularity of the hospital as far as publicity from ex-patients is
■concerned and also has a great deal to do with the contentedness of
the staff and help. The success of diet therapeutics depends almost
entirely upon the manner in which these diets are administered and
in the educating of the patient concerning his special dietary needs.
Financially, the commissary department presents the largest item
of expense. Dietetics has a place in the nursing profession and the
subject has been placed on the curriculum in training schools. From
this you will see that the diet department is no small part of any
hospital, regardless of size.
No one doubts the importance of good food in a hospital but
very few have any conception of the difficulties to be overcome in
serving food in the best possible manner. Most people are in the
habit of eating three meals a day every day of their lives, unless
something seriously is the matter, and I believe it is because food
enters so commonly in our every day lives that we do not attach
to it the importance Which it deserves. I do not wish to be understood that people do not appreciate' good food, they do—but they
accept it as a matter of course, and as far as applying the principles
of good nutrition and facilities for preparing and serving food
efficiently we are just a bit behind.
Several weeks ago I was told that the food service was the
weak spot in most hospitals. The patient and staff all present a
more or less critical attitude toward the food. There is more dissatisfaction about the food than from all other sources put together. This
is rather a big pill to swallow, but unfortunately the criticism is
true in varying degrees in most hospitals.
The two chief points  in  the criticism  toward  hospital  food  is
—30— that the variety is limited and the food is too often served cold
and unattractive. The conditions which make for unsatisfactory
food service must be overcome and the principles are applicable in
you want  good   service  you
all institutions regardless  of  size.    If
must make conditions for it possible.
The suggestions to be made which tend toward better food
service will be covered under five heads, namely:
1. Good supplies necessary.
2. The kitchen staff.
3. The location and  equipment of the  kitchen.
4. The serving of the food after it is cooked.
5. Co-operation  with  other  departments.
At this point you will probably be wondering what it is going
to cost you and you will likely say that you cannot afford the
necessary changes. The money part is very important and cannot
be ignored but you must give at least as much thought to the
service as you do to the financial end, instead of putting expenses
down to the very lowest figure and considering the results of
secondary importance.
Now, in the first place it is necessary to have good supplies.
This will depend somewhat on the markets and merchants in your
locality. Have the merchants enough interest in your institution
to give you good service or do they treat your hospital as a sort
of a safety valve with which to get rid of surplus or undesirable
goods? Are the supplies checked on delivery to see that you get
the goods you pay for? Does the financial position of the hospital
enable you to buy good supplies or must you accept an inferior
article because of price? Proper storage facilities are necessary,
particularly for perishable goods as meat, milk, butter, eggs, fruits
and vegetables.
Even more important than the. buying of good supplies is the
preparation of food and this will depend oh the kitchen staff and
their workshop. Good materials to begin with, are of no avail if
they are spoiled in the cooking. A good kitchen staff and proper
equipment is necessary. The chef is a skilled man and will demand
the pay of a skilled person. There is no economy in employing an
inexperienced cook at a low salary as he wastes more in the month
than wiould pay the difference in his and a better man's salary.
The chef's job is no small one. He works in front of a hot stove, the
three meals must go out like clock work day after day, he must
have a good appreciation of cleanliness, and economy must be
exercised by all people in the department to prevent unnecessary
waste. There is a tendency for people handling things not their
own to be more or less careless and wasteful. The kitchen is a
place where small leaks amount to goodly proportions by the end
of a month. A hospital cook is not so much required to make
fancy dishes as to cook plain foods.well. He must be an expert
in cooking meats, be able to cook potatoes and other vegetables
properly, to make a custard without holes, etc. Last minute failures
on the part of a cook are an avoidable waste and are usually due
to inexperience or carelessness.
The kitchen must be planned and equipped so that the work
can be done efficiently. Instead of the kitchen being planned as a
part of the hospital, it is so often only an after-thought and placed
in the part least suitable for anything else. Perhaps the ventilation
or the light is poor. Or perhaps it is so placed that the noise and
odors cannot help but escape and permeate through the rest of the
building. The equipment must be such as to allow the work to be
accomplished most efficiently.
—31— The serving of the food is also very important and this is where
many fail in their efforts for good service. Food is so often cold
or dried up and unappetizing when it reaches the patient. There
is too great a gap between the time the food is cooked and the
time it is served, and during this time it is being kept hot with
the result that flavors are lost, food overcooked or dried out. Meats
particularly, dry and toughen when kept hot for a time after being
carved and potatoes become soggy. There are two systems commonly
used in serving trays in hospitals and they have their advantages
and disadvantages largely in the location of the kitchen to the rest of
the building or in the efficiency by wihich the system is carried out in
that particular place. The oldest and most common method is to send
the food all ready to be served from the main kitchen to the ward
pantries where it is dished upon the patients' trays under the supervision of the head nurse who knows all her patients and what they require. Serving should begin the minute the food arrive from the
kitchen but how often is the food just set aside until the nurses have
time to dish up. Perhaps even one of the doctors is holding up the
works while he has come to visit a patient or to do a dressing at
mealtime. The central service system requires that the kitchen be
so placed as to be accessible to all the floors by food elevators.
Here each tray is prepared directly from' the stove, thus preventing
lost flavors by reheating.
There must be the closest co-operation between the diet department and other departments in regard to the ordering and serving
of foods. There may be a rigid system of regulating the requisition
for supplies in other parts of the house but the general impression
in hospitals is that the kitchen is managed on the short order
restaurant plan and that anything desired should be obtained at
any time. We must recognize that the commissary department is
an organized part of the whole scheme with which every other
department is more or less intimately connected.
The department should have at its head a person who is directly
responsible for the entire food service including the making of
all menus, special diets, control over the supplies and the supervision of the preparation and the serving of all the food. It is
necessary that this person have a knowledge of nutrition and experience in handling foods. If the hospital is not large enough to
justify the employment of a dietitian, the work may be combined
with that of another member of the staff, but it is necessary that
she have special training in diet Work. The head of the department
must have enough imagination to introduce variety in the meals,
athough the number of employees in the kitchen, their competency
and the equipment modify the menu very much. The head of the
department must also be open minded enough to receive and profit
by criticisms.
I hope that I have not given you the impression that good
food service must necessarily be a costly one but that to make it
function efficiently it must be given other consideration besides cost.
The following paper, prepared by Dr. Walker, was read by Dr.
E. M. Pearse, Medical Superintendent of the Jubilee Hospital;
Mr. President, Ladies and Gentlemen:—
I am not responsible for the title of the paper affixed to my
name on the programme, and I am as unprepared to take up the
subject of Insulin from a theoretical or research point of view as
most of you would be to listen to such a discussion.
In any laboratory engaged in routine work, research problems
form the substance of one's dreams, for sustained research is not
—32— possible at the end  of a telephone  which  anchors  one  to  earthly
matters of fact.
I therefore propose to discuss briefly the larger problem of the
treatment of Diabetes, and lay special stress on the use and limitations  of Insulin in this  field.
As you all know, Insulin is a product of those cell inclusions
known as the Islands of Langerhans, which are found imbedded between the digestive cells of the pancreas. If one analyses the
records of post mortem findings in cases of clinical diabetes, one
is struck by the fact that fibrosis of these cells is not a constant
finding, and therefore one could scarcely expect that Insulin would
be of equal value in all such cases as a remedial agent.
In other words, diabetes is not invariably due to changes in the
pancreas, and therefore Insulin cannot be regarded as a specific
remedy. It is of enormous value, however, in most cases occurring
in early life and especially in those giving a history of diabetes
following Mumps; and appears to be of some use in all cases. This
lessened value might be expected if we assume that those cases not
due to pancreatic disease are due in part to disease of other ductless
glands, whose functions may be carried on to some extent by the
combined efforts of members of the group.
Now let me sketch the treatment of a typical case, and comment
on matters as they arise. We will suppose that a patient is admitted
to hospital with characteristic history and symptoms, and is found
on admission to have a blood sugar content of 400 mgms per 100 ccs.
Our practice is to place such a patient on a diet which will
provide basal calories, maintain nitrogenous equilibrium and prevent
any increase of acidosis. For this purpose age, weight, height, and
sex are obtained, and the diet calculated in terms of Proteid, Fat
and Carbohydrate so that 0.66 gms of Proteid per kilo body weight
are given and 100 per cent, basal calories yielded, and the total
glucose bears a ratio to the fatty acid of 1 to 1.5.
Such a diet might consist of Proteid 42 gms, Fat 129 gms,
Carbohydrate 53 gms.
This prescription is sent to the diet kitchen and worked out in
terms of actual foodstuffs, which are provided and served on special
trays by diet kitchen for rooms and wards. The patient is consulted
in likes and dislikes by the dietitian so that meals will be pleasing.
It is usual to give such diet and estimate the carbohydrate
tolerance of the individual before calculating the dose of insulin that
may be required, but if this be done considerable time will be lost,
and greater expense to the patient incurred. Knowing that the
blood contains an excessive amount of sugar it seems a much more
rational procedure to administer insulin immediately such fact be
known, and reduce the figure to normal range at the earliest possible
moment. Moreover the carbohydrate tolerance will invariably be
found somewhat higher if the blood sugar is first reduced to
somewhere near normal level. Consequently it has been our practice
for some time to administer insulin as soon after admission as
possible to a patient in the condition sketched, while waiting for the
diet to be worked out. The response made to this preliminary dosage,
checked of course by blood sugar estimations, enables one to estimate
roughly the value of insulin, per gm. of sugar for the individual.
In many cases it will be found that no further insulin is required
at all. Patients who were apparently severe diabetics on admission
are found able to hold their blood sugar to normal range on calculated
diets, even though wide choice of foodstuffs is allowed.
There is no doubt whatever, that education of patients in dietetics is infinitely more important than all else combined. While in
hospital they are taught how to choose their food so that they can
work out the prescription given them in terms of Proteid, Fat and
Carbohydrate, varying their meals each day. They are supplied
with charts of food values, and given notes on calculating diets, as
soon as they make response to treatment. If they need Insulin they
are taught to administer it themselves As soon as they are up
they are placed on increased calories varying with the activities
of the individuals. Before they leave hospitals they are taught how
to test the urine for presence of sugar, and are provided with
Benedicts solution and test tube for this purpose. Each patient is
advised to purchase a balance for weighing food before leaving
hospital and the balance we have found most suitable for this
purpose is that made by the Eastman Kodak Company for weighing
photographic chemicals. It is graduated on a beam for weights
below 5 gms, and has a set of weights in gms up to 100 gms. It
is compact and is sold at a price about one-third of any other balance
we know  .
There are two case records that I should like to show. One indicates the extreme ease of dealing with a highly educated patient with
a mathematical mind, and the other brings out some points on the
relative inertia of Insulin. The first patient had been under treatment for a few months before I saw him. At the time of his first
visit to me his blood sugar was 400 mgms per 100 ccs. He came into
hospital for two days, receiving 40 units of Insulin and basal calorie
diet. He was discharged with a blood sugar of 133 mgms and during
his stay had been educated so well that his blood sugar has remained normal ever since. During the past three months he has
had this test made seven times. I should think that not more than
ten hours work have been devoted to this patient.
The second patient I saw in September last year, when he
arrived in Victoria from the Vancouver General Hospital where he
had been treated for two or three weeks. Those in whose care he had
been sent me a letter concerning himt, advising me of the great
gravity of the case. The boy's mother had been given a hopeless
prognosis, and I took the same view of his condition. He went
steadily down hill till Christmas as an out patient, and then I got
him to come into hospital as his blood sugar was up to 500 mgms.
In bed on basal calorie diet Insulin was pushed to the limit of usefulness without reducing the blood sugar below 283 mgms. I gave
him 1 grain of parathyroid by mouth at 11 a.m. on 21/12/23. His
blood sugar fell within four hours to 103 mgms, and on less Insulin
than before and an increased diet, with the addition of 1-10 gn. of
parathyroid daily he remained wjell for three months. Then he
went down hill again and returned to hospital in coma on 31/3/24.
Both Insulin and parathyroid were pushed without lasting effect, but
he carried on in poor shape until May. At this time he was given
5 grs. of Didymin daily, in addition to 60 units of Insulin and the
effect of extract of orchitic substance has been just as marked as
the parathyroid. Since May he has been quite a different being,
and always expresses himself as feeling fine. I was moved to try
the effect of Didymin in this case in consequence of the success I
had with Ovarian substance in a diabetic whose illness followed
X ray treatment of a fibroid uterus, where the history pointed to
diabetic symptoms being due to the effect of rays on the  ovaries.
In conclusion I would emphasise the necessity of education of
patients in dietetics and insist on the need for accurately weighed
diets for the dose of Insulin, if this be required, is only to be
measured against the difference between the amount of sugar taken
as food and the amount the patient can burn up unaided. Since
sugar is formed on digestion by all food stuffs—Proteid yields 58%,
—34— Fat 10% and Carbohydrates 100%—it is qiuite impossible to treat
diabetes intelligently by recommending some article of food as
permissible and barring others.
The following paper was then read by Mr. George R. 'Binger:
THE LADY SUPERINTENDENT AND HER PROBLEMS
Mr. President, Ladies and Gentlemen:—j
When I received Miss Ellis' letter saying that the Nursing
Section of this Association wanted me to read a paper on the
Problems of a Lady Superintendent and asking me to place myself
in the position of one of them, I remembered my school days and that
a very argumentative gentleman by the name of Euclid after making
all sorts of wild and silly statements ended up with "Which is
absurd." This I always thought was the most sensible remark his
■books contained.
It is not altogether that I do not wish to be a lady superintendent,
but how could I or any other mere man ever hope to possess the
qualifications necessary to fill one of the most trying positions a
human being could ever voluntarily occupy. I have often asked
myself "Why do they do it?" and the only answer I can make is
"just because they are women."
I thought when I began this paper that it would not be a
difficult matter to mention several problems which face a lady
superintendent which would open the way to discussion, but when
I began to think the matter over I found it beyond me to pick out
matters which are of outstanding importance and could be solved
by this Convention. I then tried to pick the brains of some of the
lady superintendents of the nearby hospitals but found /that they
seem to be in the same predicament.
There are so many small things cropping up all the time which
in themselves are not very much like the mosquito, are not very big
but their continuous buzz and occasional nip get on the nerves and
it must require more than ordinary self control on the part of a
lady superintendent not to let her temper get the upper hand and
say something which would cause trouble.
I am afraid therefore that I shall simply have to generalize and
endeavour to give you a short sketch of what a lady superintendent
of a small hospital is up against.
In my opinion, of course I may be wrong and am open to
correction, her sister in the same position in one of the large hospitals,
where there are heads of different departments who are responsible to
the Board for the proper management of those departments, has an
easier task than she who has sole charge and has to oversee everything from seeing that the institution is efficiently run to the
ordering of two-pennyworth of soap. It would take up too much of
your time were I to try to enumerate all she has to think of and do
from the time she gets up in the morning till she is asleep at night.
Her duties are never ended for even when she has her hours off
she is always on call if wanted.
A lady superintendent of a small hospital is in the unenviable
and almost hopeless position of having to try to please everybody
and at the same time do her duty and carry out the rules of her
hospital, for if these rules are not carried out she runs the chance
of being jumped on by her directors. She has to consider the
efficient running of her hospital and do her utmost to have it
equipped in an up-to-date manner, this is no easy task in the present
impecunious state of most of the hospitals of the province, where the
—35— unfortunate directors are turning grey in their endeavour to keep
down expenses and find enough money to pay the actual running
expenses.
There are the little differences between members of the staff
to be settled, oil to be poured on the troubled waters so that the
waves of discord may be calmed and everything once more be made
to travel over a smooth sea. This she must do without showing
the least favoritism, for it is fatal to discipline where ones likes
and dislikes are allowed to weigh in any decision that has to be
made, and the fair sex are very quick in seeing any signs of
favoritism being shown and naturally resent it.
Normally the patient is just the ordinary type of human being
but when sickness overtakes him is like a chameleon and in the
changing of his skin takes on many different characteristics
Some are patient under suffering, appreciative of the care and
attention they receive and do everything in their power to make
things easier for themselves and those looking after them. They
make one of the bright spots in nursing. Others are a real trial •
and tribulation. They become restless and impatient. Nothing is
right, their bell is continually ringing and they think they are the
only pebble on the beach and should receive the attention of the
whole staff, though they are probably not nearly as bad as others.
This is where the lady superintendent having previously looked in
the glass to see that she is not showing any signs of annoyance and
having put on her sweetest smile, walks in and does all in her
power to smooth things over whereas she would no doubt much
prefer to administer a dose which would forever quiet their grumbles.
I think one of the real thorns in the flesh is the Public with a
very large capital "P." I do not know if other secretaries have noticed
the fact that the word hospital in the opinion of the ordinary man
on the street should never have had a place in the English language.
If not I envy him from the bottom of my heart. It is an extraordinary thing how ready people are to pick holes in the management
and believe rumors which are absolutely without foundation and
on the face of them are absurd. Probably they like to believe these
things as giving them' as an excuse for not supporting the hospital.
The lady superintendent comes in for criticism from people who
know nothing about the running of a hospital and evidently do not
wish to learn. These unfounded rumors generally come to the ears,
through some misguided friend who thinks she is doing her a good
turn in letting her know what is going on and though she knows
there is no truth in them it must be very annoying to one who is
doing her utmost for the comfort of her patients and the good of
her hospital.
Where there is a Training School in connection with the hospital
her trials are greatly increased, as she has ten or twelve young girls
to handle who have to be taught what proper discipline means besides the hundred and one other subjects which go for making the
finished article a good capable graduate who will be a credit to her
Training School.
It is quite an education to watch a young girl from the time she
first arrives in hospital. The way she walks down a corridor, enters
a ward, handles her tray, are absolutely different after she has been
training for a short time and aid these small details a lady superintendent has to watch and correct besides looking after the welfare
and proper behavior of the pupils giving lectures, correcting papers,
and in fact doing all that a head mistress of a boarding school has
to do and this on top of her professional duties.
She is of course, responsible to  the Board  who are as  a rule
—36— a hard headed lot of business men and look at things from a business
man's point of view. Here I would like to give as my opinion that
a great many of her difficulties would be made easier by closer
co-operation between herself and her directors. She should be able
to understand their difficulties and they should be able to look at
things from her point of view and the only way that this can be
accomplished is by frequent personal discussions of points which
arise from time to time.
The Secretary is generally the go-between and is asked to put
the lady superintendent's wishes before the directors and the
directors instruct the secretary to give certain instructions to the
lady superintendent. This sounds easy and in many cases is all
right but there are occasions where the secretary knowing both sides
of the question and, if he is any sort of a man, being able to look
at things from both viewpoints feels that a much better understanding
could be arrived at if the matter were discussed personally. You
all know, I am sure, how difficult it is in every day life to explain
things satisfactorily between two people. Wjith every good intention
on your part, you cannot give that personal touch to what you say
and probably one or other gets the impression that you are trying
to favor the other fellow, which does not tend to a proper understanding. So it is in the case of a lady superintendent and her
directors.
In conclusion I would like to say that every graduate, however
good a nurse she may be, is not fitted to fill the position of a lady
superintendent of a hospital whether large or small, as it takes a
woman of outstanding ability to be equal to the task.
This is my idea of the qualifications of a lady superintendent:
She should have executive ability, be a good disciplinarian, but able
to lead those under her rather than drive. Her disposition should
be cheerful and sympathetic, always ready with a smile and a kind
word. Be tactful, for want of tact often causes many troubles. She
should have the patience of Job. In fact, that much tried- individual
would have lost out had he been up against some of the trials and
worries our lady superintendents are asked to face and come through
smiling. She should be a good judge of character, be able to see
through a brick wall without showing she is trying to do so, be
just in all her decisions, especially so where she is in charge of a
School and last, but by no means least, have her work thoroughly
at heart, for, unless she has, her life is one long drudgery and
she is bound to go under.
This look rather like a perfect woman doesn't it, But thank
heaven there are still such women in the world.
An animated discussion took place concerning the requirements
laid down by the British Columbia Association of Graduate Nurses
with respect to educational requirements for admission to Schools of
Nursing in British Columbia. This provision calls for the successful
completion of two years high school or its equivalent. Correspondence was submitted from Mr. A. P. Glen, writing on behalf of the
Ladysmith General Hospital, stating that this requirement was unjust
to the smaller schools, since it prevented women without the necessary
educational requirement, but otherwise suitable, from entering.
Several delegates endorsed this view. Miss Helen Randal defended
the entrance requirements, pointing out the necessity of maintaining
nursing standards at least as high as those which obtain in other
provinces in Canada, if the nurses of British Columbia are to compete with them on equal terms. Miss Johns pointed out that a certain
elasticity of interpretation could be made in the word "equivalent"
and that often applicants lacking the necessary standing,  could  at
—37— least approximate the standard by undertaking special studies. It
was finally decided that the matter would be brought to the attention
of the Graduate Nurses' Association with a view to mutual adjustment.
The rival merits of Prince Rupert, Nanaimo and Vernon, as the
next place of meeting were placed before the Association most
eloquently by their respective representatives, but as the hour was
late final decision was  postponed till  the  following day.
SATURDAY, AUGUST 30th, MORNING SESSION.
The final session of the Convention was called to order at
10 a.m. Mr. George McGregor announced that he had requested Miss
M. E. Johnson and Mr. R. A. Bethune to serve with him as scrutineers.
The election of officers then took place. This is the first occasion
upon which elections have been held since the revision of the constitution providing for regional representation and the preparation of
a formal slate by a nominating committee. It has therefore been
thought wise to publish in full the following statement prepared by
the nominating committee under the very able convenership of Mr.
T. Mordy. This material should be of assistance in conducting
nominations and elections on future occasions.
To The President, Officers and Members of The B. C. Hospitals Assn.
We beg to present for your consideration the following as the
report of the Nominating Committee for the Election of Officers
at the Convention held in Victoria on August 28, 29 and 30, 1924.
On May 29th, a circular letter was sent out to all the hospitals
in B. C. stating the date of the Convention, the various offices open
for nomination, term of tenure of office of the same, qualifications
necessary, etc., and inviting nominations to be sent in at as early
a date as possible.
Only three institutions made any attempt to nominate a complete slate, and nominations were made on the floor of the convention up to the very last minute.
The election of officers resulted as follows:—
Honorary President The Hon. The Provincial Secretary
President Chas. Graham, Cumberland
First Vice-President -Dr. G. B. Brown, Nanaimo
Second Vice-President E. S. Withers, New Westminster
Secretary .-. Miss E. Johns, Vancouver
Treasurer Geo.  Haddon,  Vancouver
CONVENERS  OF  COMMITTEES
Medical Affairs Dr. F. C. Bell, Vancouver
Nursing Affairs Miss P. Rose, Nanaimo
Business Affairs, and Accounting R. A. Bethune, Kamloops
Constitution and By-laws J. H. McVety, Vancouver
DISTRICT  REPRESENTATIVES
Vancouver Island George McGregor, Victoria
Vancouver J. J. Banfield
Coast Mainland Dr. George Darby, Bella Bella
Fraser Valley Dr.  A.  D. Buchanan, New Westminster
Yale-Cariboo M. L. Grimmett, Merritt
Okanagan George Binger, Kelowna
Kootenay East Mother Nazareth, Cranbrook
Kootenay West— George Johnstone, Nelson
Grand Trunk Pacific Harry Birch, Prince Rupert
—38— The tendency to postpone nominations to the very last minute
militates against the posting by the committee of a complete list
of nominations in time to receive due consideration by the delegates
before voting. Also it was not clearly understood by the delegates
that they must vote as institutions, not as individuals, hence it was
not feasible for any institute to nominate more than one candidate
for each office vacant, as their vote could not be split. Many district
representatives were nominated by members or institutes not in
that particular district; in many cases wrong districts being named,
causing a certain amount of confusion, which was aggravated by
some of the  districts  not having  their boundaries  clearly defined.
We therefore respectfully recommend:
(1) That no nominations be permitted on the floor of the convention later than the session immediately preceding that
of the election of officers:
(2) That representatives of districts should be nominated from
these districts respectively, and for that purpose we suggest
a meeting of the hospitals in each district prior to the
meeting of the convention.
(3) That the question of the proper demarcation of boundaries
of districts be referred to the Committee on Constitution
and By-laws.
In conclusion the Committee wish to express their extreme
gratitude to the very able secretary of the Association, Miss E. I.
Johns, for the great amount of trouble she took to guide our faltering
footsteps in an entirely new departure, and to the delegates assembled
in Convention for their very kind and courteous consideration.
Respectfully submitted,
T.   Mordy,   (Convener)
R. L. McCulloch
H.   R.   Storrs,   M.D
Nominating Committee
Mr. R. A. Bethune of Kamloops gave notice of motion as follows:
"That the Committee on Constitution and Bylaws be requested to
suggest such amendments to "Article 4; Officers" as may in their
judgment be deemed advisable, the same to be submitted at the
convention for discussion."
Mr. T. Mordy of Cumberland gave notice of motion as follows:
"That a fifth standing committee be formed to be named the committee on Municipal Affairs."
On motion of Mr. T. Mordy, seconded by Mr. H. Birch of Prince
Rupert, it was decided that the convener of the committee on
Municipal Affairs to be appointed at this meeting shall, for this
year be a member of the Executive Committee.
Informal discussion took place concerning the best method of
outlining hospital districts in such a way as to ensure representation
of all parts of the province on the Executive Committee. It was
finally decided to refer this question to the Committee on Constitution and Bylaws.
The report of the Committee on Resolutions of which Dr. H. C.
Wrinch, M.L.A. of Hazelton was convener was then considered. A
most affecting resolution of condolence with Mrs. R. H. Mullin was
first submitted and passed by a standing vote. Dr. Wrinch reported
that the original resolutions submitted by the Board of Directors of
the Vernon General Hospital had been used as the basis for the
Mowing report which was adopted in motion of Mr. W. H. Smith
of Vernon, seconded by Mr. J. R. Brennan of Penticton.
—39— REPORT OF COMMITTEE ON RESOLUTIONS
The Resolutions Committ.ee recommends that in view of the
expressed desire of the Union of B. C. Municipalities to co-operate
with the British Columbia Hospitals Association in matters requiring
legislation affecting hospital support, that in the event of the following resolutions receiving the endorsation of this Convention that the
same he submitted by a Committee of this Association to the Union
of B. C. Municipalities at their Convention at Penticton for their
consideration.
AND FURTHER, that in the event of the endorsation of said
Resolutions by the Union of B. C. Municipalities, that the Executive
Committee of the B. C. Hospitals Association be instructed to arrange
for their presentation to the Provincial Government by a joint
deputation of the two aforesaid organizations.
BUT, in the event of failure of the Union of B. C. Municipalities
to endorse said resolutions, the Executive Committee of the British
Columbia Hospitals Association be empowered to deal with the
matter in such manner as it may deem advisable.
WHEREAS, the Government of the Province of British Columbia
enacted legislation to provide that Municipalities shall be responsible
for the care and treatment in hospitals of patients residing in such
municipalities.
AND WHEREAS, this legislation has been amended from time
to time upon representations made by the Union of B. C. Municipalities.
AND WHEREAS, certain of such amendments have not been in
the best interests of the hospitals of this Province.
AND WHEREAS, unless legislation is enacted to provide that
Municipalities shall be responsible for the payment of the accounts
for the care of their sick, whether indigent or otherwise, the hospitals
of this Province must of necessity approach the Provincial Government with a view to changing the present system of financing
hospitals within this Province.
BE IT RESOLVED, that the B. C. Hospital Association be requested to give this matter earnest consideration with a view to
approaching the Provincial Government towards having the present
Act amended in such a manner as to protect the hospitals for the
payment of their just debts against the municipalities.
WHEREAS, the maintenance and operation of an Isolation
Hospital is in the interest of Public Health of the whole community.
AND WHEREAS, it is considered unfair that the fees for attendance and medical treatment should be a charge on the individual,
THEREFORE BE IT RESOLVED, that the Provincial Government be requested to assume the whole cost of Isolation Hospitals,
and that a copy of this resolution be forwarded to the Honorable, the
Provincial Secretary, and to all municipalities, and to the Union
of B. C. Municipalities for their endorsation and support.
WHEREAS, among the hospitals of this Province there are many
which serve- large areas of unorganized territory,
AND WHEREAS, many of the residents of such areas are transient laborers and those who are developing the land and are thus
among those least able to pay for hospital service when such becomes necessary,
AND WHEREAS, hospitals receiving Provincial aid have no
option but to • treat and care for aill who may require the  services
—40— of such institution, whether they are able to pay for it or not,
AND WHEREAS, any deficits which exist in the finances of such
institutions are almost invariably due to the large number of such
charges which it is impossible to collect,
THEREFORE BE IT RESOLVED, that in the case of hospitals
so situated and where the foregoing conditions exist, such hospitals
be granted special consideration by the Provincial Government on a
basis which may be found adequate to counteract the losses from
these causes.
WHEREAS, the financial support of the Hospitals of the Province
of British Columbia has proven to be a subject of much controversy
between .Municipal Governments and the governing boards of the
hospitals, with respect to legislation which has been enacted from
time to time by the Government of the Province of British Columbia.
AND WHJEREAS, this British Columbia Hospitals Association
earnestly desires the establishment of a permanent policy for the
financial care of hospitals to the exclusion of legislation which may
prove to be of a contentious nature and subject to fluctuation from
time to time,
AND WHEREAS, it is the opinion of the British Columbia
Hospitals Association that an equitable adjustment of the problem
cannot be arrived at without a unity of effort between the parties
interested in legislation controlling the same,
THEREFORE BE IT RESOLVED, that the British Columbia
Hospitals Association in Convention assembled, is in favor of and
earnestly advocates the appointment of a committee of enquiry, whose
duties it shall be to accummulate evidence of legislation at present
in force where similar conditions obtain, together with opinions as
to the success and equity of such legislation. And from the date
thereby secured to compile recommendations for the good financial
government of the hospitals of this province.
AND BE IT FURTHER RESOLVED that the aforesaid committee
should comprise representatives of:—The Government of the Province
of British Columbia; the Union of the British Columbia Municipalities;
and the British Columbia Hospitals Association,
AND BE IT FURTHER RESOLVED that copies of this resolution be forwarded to the Honorable The Provincial Secretary and
to the Secretary of the Union of British Columbia Municipalities.
WHEREAS, Section 10 of the Hospital Act makes provision for
the inspection of hospitals by a person appointed by the Lieut.
Governor in Council for the purpose, such inspection to include the
accounts and books thereof, buildings, medical appliances and drugs
and any other thing in or about the hospital.
AND WHEREAS, it is that such inspection if made, would continually provide the Provincial Secretary with first hand information
as to the difficulties, financial and otherwise which hospitals may
experience.
AND WHEREAS public monies have been and are provided under
the above mentioned act, and are actually disbursed on the basis
of a return of hospital days without any check as to the adequacy
of the arrangements made by hospitals for treatment.
BE IT RESOLVED that this Association considers an inspection
as provided for, is necessary and now requests the Provincial
Secretary to make an appointment for the purpose of giving effect
to Section 10 of the Hospital Act.
RESOLVED that a hearty expression of appreciation be extended
—41— to the following whose contributions to the work of this Convention
and the entertainment of its delegates has made this Convention the
success that it has been:
1. Local Committee on arrangements.    Miss J.  F.  Mackenzie,
Dr. E. M. Pearse and Mr. Geo. McGregor.
2. Reeve Lockley, President of the Union of B. C. Municipalities
for his address assuring the co-operation of that body.
3. Mayor Hayward, for his kindly words of welcome.
4. Rotary Club for luncheon and transportation.
5. The Provincial Royal Jubilee Hospital for luncheon, etc.
6. St. Joseph's Hospital for Luncheon, etc.
7. To the Exhibitors, both voluntary and commercial.
8. To Mr. R. L. Reid, K.C., Dr. W. B. Burnett, Dr. Ridewood and
Dr. Walker for their interesting and instructive papers.
9. To  Mr.  and  Mrs.  Butchart for  their  entertainment  of  the
delegates.
10. The management of the Empress Hotel for their accommodation and courtesies.
11. To the Press for their attention and co-operation.
12. To the Victoria Graduate Nurses Association for their kind
assistance at the Registration Desk.
13. To the Retiring  Officers.
Dr. Henry Esson Young, Provincial Officer of Health was invited
to the platform by the Chairman and gave- a short address in which
he made reference to the irreparable loss sustained by the Province
in the death of Dr. R. H. Mu'llin. HJe referred in general terms to
problems of hospital finance and described briefly the efforts being
made by the Provincial Government toward the conservation of
health.
A report regarding the observance of Hospital Day was submitted
by Dr. Hi C. Wrinch but was not read. Dr. Wrinch had sent a
questionnaire to the various hospitals in the province and had received replies from twenty-five.    A summary follows:
Seventeen hospitals observed the occasion on May 12th.
Five found another date more convenient.
All hospitals reported an unqualified success.
Four  made  use  of  the   Sunday  following  to   present  their
cause in the churches.
All held a reception, in nearly all cases well attended.
Fifteen of the Institutions served refreshments.   Two charged
a small fee, two accepted voluntary contributions in the other
cases no charge was made.
One   hospital   chose   this   occasion   to   hold    its    graduating
exercises.
Four conducted baby shows, in one case this was the principal
feature of the day.
Four held a public meeting in the evening.
The question was asked whether a parade was held. One answer
was: "Heaven Forbid"—On the other hand one hospital held a
Callithumpian Parade which was a huge success.
In this connection it is apparent that the American idea of this
feature has not reached our constituency. It has been carried out
there in certain cases by a parade of a series of floats, representing
some phases of hospital work.
—42— In compiling this report there may be noted a distinct line of
progress from striking and spectacular features to the quieter and
less obtrusive methods in the nature o£ receptions, made interesting
and instructive by means of music, demonstrations and addresses;
all of which may be held where convenient in conjunction with
graduation exercises, or opening of new buildings or new departments.
Without doubt, the amusing and attractive events put on in the
name of the hospital have a fair place in creating or arousing in
the community a recognition of the existence of a hospital in their
midst and its claim upon them for their intelligent interest and a
fair measure of support. When this interest is aroused it can and
is further developed and more intelligently broadened by means of
less amusing or striking and more  educative  features  and  events.
The development of this idea is aptly expressed in one of the
returns of our questionnaire which we quote herewith:
"According to our situation, our program for celebration of
the day appeared adequate, and we feel disinclined to attempt
programs which have been followed in other places and appear
to us of novel description but not suitable to the public year
after year."
After a spirited contest Nanaimo was chosen as the place of
the next meeting.
At the close of the session the meeting adjourned to meet at
luncheon at St. Joseph's Hospital where the members were entertained by the Sisters of St. Anne and by the Women's Auxiliary of-"
the Hospital. The Right Reverend J. O'Donnell, Bishop of Victoria,
presided and at the close of, the luncheon, delivered the following
address:
ADDRESS BY BISHOP O'DONNELL
I wish to express my sincere pleasure to find myself associated
with the B. C. Hospital Convention and under the roof of this ancient
St. Joseph's Hospital. I am here because I wish to testify that
the Association deserves every encouragement and every assistance
possible not only from the Church, but also from the state. This is
true because the object of your association is one that must meet with
the approval of every good citizen and tend to the well-being of all.
Your work is holy. In the highest and most noble sense of the
word, the work of your association is charity—the work of your
hospitals is charity. Do not misunderstand me, I pray you, I do
not mean that your endeavor is the mere giving of alms to the
needy. No. Alms-giving and such like are only a small expression
of God's most beautiful virtue. The charity of which I speak and
associate with your deeds for the perfection of hospitals, for the
alleviation of miseries to which nature is heir to is something more
glorious, it is that love you have for afflicted human beings, based
upon the love we all owe to God, our Creator, our Redeemer and
our Sanctifier.
1. Nothing is more striking in the history of human society at
the coming of Christ as the absolute disregard of man's life, as man.
Not that the citizen had not a certain political value as he has
to-day, or that wealth was deprived of its natural influence. But
I speak of the value attached to the life of a man as a human being.
In this light he was become the vilest of all animals. 'There was no
belief in future retribution and the extinction of this belief was the
main cause of this disregard. The gladitorial games, the condition
of slaves of both sexes, were a striMng exhibition of it.    For ex-
—43— ample, in the slave war, Crassus crucified 10,000 slaves in cold
blood. No one blamed Crassus, but the general of to-day, as we know,
who should dare to put to death a single unarmed captive would
not only deserve but meet with the world's execration. How was
the change brought about? It was brought about by those who shed
their blood like water for the sake of their divine belief. They
gained by death admission for truth into the hearts of men; they
gained for the life so sacrificed a value which it did not before
possess. For 280 years, from Christ up to Constantine's decree of
toleration, thousands upon thousands of all sexes and conditions
and ages, sacrificed themselves for the love of God and truth.
Suffering and horrors were born unshrinkingly, riches and beauty
and culture were put aside, fame was scorned for One whose
lacerated limbs were stretched upon a cross for hours in the sight
of a gazing multitude. It is strict truth to - say that man learned
not to make man suffer because the Son of God had suffered. Man
learned to believe the sufferings of his fellowman because he saw
in the suffering body the image of his brother—yea more, a brother in
Christ Jesus Our Lord. Regard for human life rests upon no other
basis than belief in man's future destiny and would not survive the
extinction of that belief. Heathenism or a denial of God, and, that
man is only a super-animal, even in our own day produce the same
effects as they did in the civilized and highly cultured peoples of
ages gone. The intense abhorence of pain and necessary suffering,
the fear of responsibility, birth control, infanticide are all bitter
fruits of neglect of God, the loss of charity, the absence of love
of our neighbor because of God.
2. The noblest works for the good of others in which man can
be engaged fall under the following three classes: Propagation of the
truth of God, Religion; that of forming human character by education;
that of administering to human infirmities by acts of mercy. The
Catholic Church has held in practice that virginal life adapts itself
more readily to the above mentioned works than any other class
of humans because of the sacrifices involved in the pursuit of these
three vocations. The dedication and sacrifice which lie at the root
of virginal life communicate themselves to these works as conducted
by it, and will give to them a high and superhuman character, a
power of attraction which comes from Christ the Divine Original of
sacrifice, whose signet is the virginal life. In this case, no human
remuneration will be the spring of these works; neither praise nor
power nor wealth will call them forth or reward them. Rather,
they will flourish amid poverty, self-denial and humility in those
who exercise them, and be the fruit not of political economy, but
of charity, love of God, and love of our neighbor. I may advance
before you as a brilliant example of this, the work of the Sisters
of St. Ann in St. Joseph's Hospital during hallf a century in this
City of Victoria. The same may be said of the religious communities,
the directors of hospitals from the dawn of free Christianity. In
Canada and United States, 130 Religious Communities are in charge
of hospitals. This means over 20,000 nuns, and at least as many
nurses under their care and instruction.
3. We are not surprised then to find from the period in the
third century when the Church came forth from the catacombs, the
commencement of scientific treatment of human misery in established
hospitals and the nursing of the sick and afflicted by women specially
dedicated to God for that purpose. Tertullian informs us that it
was customary in the third century on a certain day of the month,
each one contributes small offerings. There is no compulsion, but
each one makes his offering willingly for the relief of the sick."
This looks as if the hospital auxiliary was an ancient and honorable
institution.    Eusebius  states  that  during  the  plague  A.D.   264,  the
—44—
IN Christians organized for the relief of the stricken. This was in
contrast with the indifference of the pagans who left the sick
unaided to die likja dogs'. Julian the apostate who hated the
Christians with a diabolical hate, called on the pagans to establish
hospitals like the Christians had done and thus overcome their
increasing influence. He promised that the State would second
their efforts.
These are only a few examples from the first centuries of ihe
Church to show the antiquity of sick relief. Christians then, as
to-day, had to undertake this work of mercy, because the law of
God, charity, the charter of Christianity, demanded it.
In Canada and the United States there are seven hundred
Catholic Hospitals, comprising more than fifty per cent of the
total of available hospital beds.
We have all heard of the Hotel Dieu of Paris, 7th century,
and of the Hotel Dieu, Lyons, 6th century. We know that Rome in
the 9th century had 24 hospitals. Canterbury, a hospital founded
1070, by Archbishop Lanfranc. St. Bartholomew's, London, 1546. Bethlehem, 1547, St. Thomas', 1553, etc. All this and more may be read in
the justly fanfpus "Hospitals and Asylums" by Sir Henry Burdett.
In conclusion let me urge you to bear always in mind the sacred
Christian character of your hospitals and your duties therein. The
remembrance of this shall destroy the germ of commercialism which
is liable to grow and flourish in any holy work in this world. It
shall help you to infuse into those under your care and instruction,
the Christian view—the only view to be taken of the sick and
afflicted, the image of Christ suffering. The Christian outlook
also shall develop co-operation between all Christian hospitals and
shall destroy all tendencies to pettiness and meanness, in necessary
conventions and mutual undertakings for the progress of hospital
work. The Christian view shall compel you to see in Christ the
Chief Physician, under whose loving direction you labour for the
welfare of humanity.   I thank you.
At the conclusion of the luncheon, the convention was declared
formally closed to meet next year in Nanaimo.
-45- Constitution and By-Laws
Article  1—Name.
The name of this Association shall be "The British Columbia
Hospitals Association."
Article 2—Purpose.
To serve as a means of intercommunication and co-operation
for the hospitals of this Province.
To increase the efficiency of all hospitals in the Province
by establishing and maintaining the best possible standards
of hospital service.
To stimulate and to guide intensive and extensive hospital
development.
To develop on the part of hospitals a sense of responsibility to the community with respect to education in health
matters with special emphasis on the training of nurses.
To keep the people of this province informed concerning
hospital problems and to serve as a means of communication between hospitals and those in authority in provincial
and municipal affairs.
To frame from time to time suggestions for, additions to, or
changes in legislation  affecting hospitals.
Article 3.—Membership.
Members shall be all persons connected directly or indirectly
with hospitals paying the membership fees hereinafter mentioned,
and such members shall be classified as follows:
(a) Honorary
(b) Individual
(c) Institutional
(d) Auxiliary
Honorary members shall be those persons who are held by the
Association to have rendered conspicuous service in the hospital
field.
Institutional membership may be held by any hospital, public
or private, carrying on work within the province. Institutional
membership shall include all members of Trustee Boards or Boards
of Directors and all persons holding executive positions in hospitals
having membership in the Association.
Individual membership shall be all persons connected directly
or indirectly with hospital work who are not members of Trustee
Boards or Boards of Directors, or who do not hold executive positions
in hospitals.
Auxiliary membership. The senior Auxiliary or Women's Organization duly recognized as such by the Board of Directors of the
institution it serves may be admitted to corporate membership, provided the hospital with which it is associated is a member of the
B. C. Hospitals Association.
—46— Article 4—Officers.
The officers of the Association shall be:
Honorary President.-
President.
First Vice-President.
Second Vice-President.
Secretary.
Treasurer.
The Executive Committee shall be composed of twenty members,
as follows:
(a) The Officers of the Association.
(b) The representatives of the districts hereinafter mentioned.
(c) The conveners of the Standing Committees.
The following districts must be represented on the Executive
Committee viz., Vancouver Island, Vancouver, Coast Mainland, Fraser
Valley, Yale-Cariboo, Okanagan, Kootenay East, Kootenay West,
Grand Trunk Pacific.
Article  5—Fees.
Membership fees shall be due and payable on the first day of
July in each year, as follows:
Honorary Members (no fee).
Institutional Membership shall be' payable according to the
following scale.
(a) Hospitals of ten beds or under, per annum $ 5.00
(b) Hospitals of eleven to twenty beds, per annum _.,. 10.00
(c) Hospitals of twenty-one to fifty beds, per annum  15.00
(d) Hospitals of fifty-one to one hundred beds, per annum.. 20.00
(e) Hospitals of one hundred and one beds and over, per
annum   25.00
Individual members shall pay a fee of five dollars per annum.
Auxiliary membership fees shall be one-half of that paid by the
Institution with which it is associated.
Article 6—Election of Officers
Election of Officers shall take place at the Annual Meeting
each year, and shall be by ballot. All officers shall be elected for
a term of one year. Institutional members only shall be eligible
for office.
A Committee on Nominations consisting of three members shall
be appointed annually. Two of these members shall be designated
by the Executive Committee, and the third, who shall act as convener,
shall be appointed by the President. No member of the Executive
committee shall be eligible to serve upon the Nominating Committee.
It shall be the duty of the Nominating Committee to request and to
receive -from the members of the Association the names of persons
suitable to hold office in the Association. Two weeks prior to the
Annual Meeting the Committee shall prepare a list of all persons so
nominated for the information of the'members attending the Annual
Meeting. Nominations shall be permitted from the floor at the
Annual Meeting.
Article 7—Committees,   Executive  and  Standing
(a) The Executive Committee shall transact the business of
the Association during the year and shall report to the Association
at the Annual Meeting, or to Special Meetings when necessary.    It
—47— shall act in, the capacity of a Membership Committee and shall pass
upon all applications for membership in the Association. The Executive Committee shall also act as a Legislative Committee for
the purpose of considering legislation affecting hospitals.
(b) Medical Affairs. The Standing Committee on Medical
Affairs shall consist of five members, the Convener of which shall be
elected by the Association at the Annual Meeting. Its duties shall
be to investigate and report upon all matters relating to medical
service in hospitals.
(c) Nursing Affairs. The Standing Committee on Nursing
Affairs shall consist of five members, the Convener of which shall
be elected by the Association at its Annual Meeting. Its duties
shall be to investigate and report upon all matters relating to
nursing service in hospitals.
(d) Business Affairs and Accounting. The Standing Committee
on Business Affairs and Accounting shall consist of five members,
the Convener of which shall be elected by the Association at the
Annual Meeting. Its duties shall be to investigate and report upon
all matters relating to business administration and accounting in
hospitals.
(e) Constitution and By-Laws. The Standing Committee on
Constitution and By-Laws shall consist of five members, the Convener
of which shall be elected by the Association at its annual meeting.
Its duties shall be to receive, consider and report upon all proposed
amendments of, additions to, and deletions from the Constitution
and By-Laws of the Association.
(f) The remaining members of the Standing Committees shall
be appointed by the Executive Committee at the meeting immediately
following the Annual Meeting.
Article 8—Meetings:   Time and   Place
The time and place at which the Annual Meeting and Convention
shall be held may be decided at the regular meeting of the year
preceding or may be left in the hands of the Executive Committee
with full power to act. Special Meetings may be called from time
to time by resolution of the Executive Committee. Fourteen days
notice in advance of the holding of said meetings shall be sent to
each member of the Association.
The Executive Committee shall meet at least once a year. It
shall meet when called upon to do so by the president of the Association or at the request of any five members of the Association.
Article 9—Quorum
Ten per cent, of the institutional membership shall constitute
a quorum of the Association at its Annual Meeting or at a special
meeting. Five members shall constitute a quorum of the Executive
Committee.
Article 10—Amendments to Constitution and By-Laws
The Constitution and By-Laws may be amended at any regular
meeting of the Association by a two-thirds vote of members present,
providing that notice of motion has been given prior to the meeting
to the Committee on Constitution and By-Laws.
Article  11—Resolutions
No resolution affecting the general policy of hospitals holding
membership in this Association shall be presented at any regular
or special meeting of this Association unless  the  same  shall have
—48— first been presented to the Executive Committee in writing. No
action affecting the general policy of said hospitals shall be taken
until the question has been referred to all institutional members,
unless the question at issue shall have been unanimously agreed
upon by the delegates present at said- meeting.
Article   12—Voting,
In any matter of business or policy requiring action by vote of
the Association, voting of institutional members shall be in proportion of one vote for each five dollars ($5.00) of membership flee:
thus an institution paying five dollars in membership fee shall be
entitled to one vote, and so forth. One delegate shall be entitled
to record the entire vote of the hospital represented by such delegate.
The combined delegation of any institution or auxiliary body
shall agree among themselves as to how that institution or auxiliary
body shall vote. No institutional or auxiliary vote shall be divided
on any question. If time for deliberation is required by a delegation
of an institution or an auxiliary body before casting a vote, the
chair shall postpone the taking of a vote for a reasonable time.
After postponement for such a purpose there shall be no further
discussion of the  question before taking a vote upon  it.
Honorary Members are not entitled to vote.
Individual members shall not be entitled to. vote at the Annual
Meeting or at any subsequent meeting of the Association unless the
membership fee shall have been paid at least thirty (30) days prior
to the holding of the Annual Meeting.
Auxiliary bodies are entitled to half the number of votes cast
by the institution with which it is associated .
Votes by proxy will not be allowed.
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—52—

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