REPORT OF THE MEDICAL INSPECTOR To the State Hospital Commission: I beg to submit a report of my work as your medical inspector, covering a period from January 5, 1922, to the end of the fiscal year, June 30, 1922. For a part of the year the position of medical inspector was vacant. The work accumulated and as a result the visits to the institutions were prolonged and the usual number could not be made. Twenty visits were made to the civil State hospitals, six being visited once and seven twice. Three visits were made to the hospitals for the criminal insane, two to one and one to the other. Thirty-two visits were made to the private hospitals, six being visited twice and twenty once. The total number of official visits to all institutions was fifty-five. Five thousand two hundred and sixteen new admissions were interviewed in the civil State hospitals. One hundred fifty-eight of this number were voluntary admissions. Special attention was given to these cases. Every patient received as a voluntary commitment was expected to know the nature of such a commitment and the conditions under which he could be discharged. Any patient unable to tell this was recommended for discharge or regular commitment. Ten patients, accepted as voluntary patients, were recommended for regular commitment. Twelve patients, who showed no evidence of a psychosis, were recommended for discharge. Two hundred and twenty-four accidents were investigated and 64 special interviews were held. In the criminal hospitals 101 new admissions were interviewed; 5 accidents were investigated and 19 special interviews were held. In the private hospitals 400 new admissions were interviewed. Two hundred and twenty-one of these were voluntary admissions. Six of the voluntary patients were recommended for regular commitment. Five accidents were investigated and 11 special interviews were held. MEDICAL WORK IN STATE HOSPITALS The character of the work in the various hospitals under your jurisdiction is by no means uniform in character or excellence. It is reasonable to assume what is good treatment in one institution should be good treatment in all. It can hardly be said that the policy in any two hospitals is alike. Specific instances will illustrate. Syphilis.-There is no definite or uniform plan for the treatment of this disease. One or two of the hospitals are giving a vigorous course of treatment for this condition; some treat it in a more or less haphazard manner; some do not treat it at all. Wasserman Tests. In some of the hospitals this is a routine procedure on all new admissions; in some it is done only on suspected cases and in some it is only rarely done, Typhoid Inoculation.- Nearly all of the civil hospitals are inoculating against typhoid fever, some making it a routine procedure on admission. There are one or two who pay no attention to this form of prevention. Schick Test. This is being done in some of the hospitals on the entire population. On others nothing is done to inoculate against this disease although diphtheria develops at times. PSYCHIATRY Under present conditions it is impossible to give maximum service in treatment. In nearly every instance the physician in charge of a service has too many patients under his care to do satisfactory psychiatric work with any of them. The routine work of caring for the general health is about all that can be accomplished. I am convinced the recovery rate in our institutions could be increased if there was an adequate medical and nursing staff and proper housing facilities. Under present conditions it is fair to say that all that can be expected is being accomplished in the majority of the hospitals. Along psychiatric lines there is a difference in the hospitals under similar conditions. In some of the hospitals the records are well kept, anamneses are obtained in most of the cases and excellent clinical work is done up to the point of diagnosis. In others the work is somewhat perfunctory and insufficient effort is made to utilize all methods of approach. OCCUPATIONAL THERAPY Almost all the hospitals are attempting something in the way of occupational therapy, but no uniform program is in force in all the institutions. As I understand your Commission has definite plans relative to this subject, it will be unnecessary for me to comment further. PRIVATE HOSPITALS It would be expected that the very best methods of treatment would be the rule in private hospitals, but I regret to say this is not the case. In some of these institutions little is done along psychiatric lines, so far as I am able to discover. However, there are other private hospitals which maintain a very high standard of care and treatment. SPECIAL INVESTIGATIONS Special investigations were conducted in seven different cases where complaints had been received. Reports were made in each case at the time of the investigation. Two special investigations were made in private hospitals for the purpose of certifying for an increase in capacity. An investigation of a proposed observa tion ward was made. Three private hospitals, not under your jurisdiction, were investigated. In one of them five patients suffering with a psychosis were found and their removal ordered. I wish to express my appreciation for the support of your Commission. Respectfully submitted, Medical Inspector. REPORT OF COLLECTIONS BUREAU To the State Hospital Commission: Following the annual custom and rule of the Commission, I herewith submit my annual report of the work of the Collections Bureau for the fiscal year just ended. Upon assuming the direction of the work of the special agents of the Commission, September 1, 1921, my attention was called to a large number of cases which were awaiting final disposition. Your Commission directed me to proceed to the adjustment of these matters and to submit to it orally a report of the same, which I did. Pursuant to the further direction of the Commission, these cases were reinvestigated with the result that many of them proved to be able to reimburse the State. In one or two instances our investigation disclosed long dormant accounts of patients with hitherto unknown estates, a part of which it was possible to use for the payment of the accounts for maintenance. These estates were in the hands of the Public Administrator of New York City. These special investigations brought to the State treasury, through the Commission, a total of more than forty thousand dollars. As a result of the submission of copies of the annual inventories and accounts of the committees of incompetent persons to the Commission, the rate of reimbursement in a great many cases was raised to a figure commensurate with the financial and domestic circumstances of the patient, taking into consideration the fact that rates in private institutions were much higher than the rate charged by the State. The total sum collected on maintenance accounts for the fiscal year was $1,296,836.34, as compared with $1,013,252 for the preceding year, which represents an increase of $283,584 or 28 per cent. There are no available figures showing the number of cases which were investigated during the fiscal year ended June 30, 1921, but a careful check on those made during the year just ended. shows that 13,950 cases were investigated including reinvestigations but not including more than one visit on each case. The cost of maintenance of the bureau including salaries of employees and traveling expenses was $27,740. Two employees of the bureau whose salaries are included in this amount spent some of their time in working in other bureaus of the Commission. A calculation based upon the above figures shows that the total cost of investigation was close to 2 per cent of the amount collected, in other words, for each dollar expended the State received $46.74. The cost per case was less than $2. It appears that during the year there were in the State hospitals an average of one thousand ex-service patients for approximately half of whom the Federal government reimbursed the State at the rate of $2 per day. The diligence of the special agents of the Commission in the very careful conscientious execution of the orders of the Commission is to be commended. The Commission has not knowingly permitted the financially responsible to escape payment nor has it knowingly imposed an unreasonable or unjust burden upon those not so fortunately situated. It has at all times endeavored to protect the patient from the impositions of unscrupulous persons and taken all available means for the preservation of the legal and moral rights of the individual. Taking all things into consideration the agents have fairly, justly and equitably discharged the very difficult duty assigned to them. In reviewing the accomplishments of the past year, it is reasonable to assume that barring unforeseen or unavoidable circumstance, the present fiscal year will be even more fruitful than the past, not so much in financial returns, though substantial gain is expected, but in the general good accomplished and a more intimate knowledge of each case and the more satisfactory result of efficient team work and real esprit de corps. In conclusion I desire to thank the Commission for its thoughtful consideration, advice and support as well as for its sympathetic appreciation of the efforts of the bureau. Respectfully submitted, JOHN F. O'BRIEN, Counsel. REPORT OF THE INSPECTOR OF BUILDINGS AND ENGINEERING To the State Hospital Commission: Your inspector of buildings and engineering respectfully submits herewith his report for the year ending June 30, 1922. At the close of the year the buildings under construction at Marcy, Kings Park, Middletown and Central Islip were nearly completed. As all of these will be occupied during the next year they will add materially to the capacity of the hospitals and consequently will increase the radiation system and the corresponding requirements of the power plant. The operation of the power plants has been improved throughout the entire hospital system. The amount of work which the power plants do is much in excess of that required six years ago and is being done with less fuel than was consumed at that time. Many of the State hospital power plants now need new equipment. At the St. Lawrence and Buffalo Hospitals new boilers are needed to help out those now in use. At Kings Park and Hudson River new boiler plants should be erected as the old buildings are not suitable for the installation of large boiler units. Gowanda should have an entirely new cold water system and Hudson River should have its cold water supply equipment completed according to plans already made. Binghamton should have the mechanical layout of steam mains and return lines changed so as to utilize all exhaust steam and thus eliminate waste and the non-return of part of the condensate to the boiler house. More attention should be given to the matter of waste of steam, and changes that will eliminate such waste should be made. A comparative table showing the amount of coal consumed at the several hospitals is given herewith. The high per capita coal consumption in some cases is due to the low grade of fuel used. others it is due to inefficient power plants and conduits. Respectfully submitted, CHARLES B. Dix, Inspector of Buildings and Engineering. Coal consumed in State hospital heating plants, 1920, 1921 and 1922 In REPORT OF INSPECTOR OF DAIRY PRODUCTS To the State Hospital Commission: I herewith respectfully submit my report as inspector of dairy products for the fiscal year ending June 30, 1922. June and July in the butter business usually comprise the heaviest speculative period for storage butter. The lateness of the season delayed putting butter in storage and in the middle of June, according to the government reports, the holdings at all storage centers were 8,709,000 pounds short of the previous year. |