average minimum fee for similar services in the locality in which said services are rendered.

These recommendations were approved by the Board, and steps have been taken towards the appointment of district medical referees, etc., as suggested. Conferences have been held with the insurance companies and the medical advisory board, and in the main the medical problem, although it has not yet been settled, seems to be in a fair way of being ultimately satisfactorily worked out.

THE HOSPITALS AND THE ACT.

The next problem of importance was the relationship of hospitals to the act. Many abuses in connection with hospital services were discovered, and it was finally decided to request the hospitals of the State to send representatives to attend a conference for the purpose of considering the matter of reasonable hospital fees within the meaning of section 5, Part II. of the Workmen's Compensation Act, and such other matters as concern hospitals in the administration of the law. This conference was held in Room 439, State House, Wednesday morning, Dec. 10, 1913, at 10.30 o'clock, and was attended by all the members of the Board and representatives from 38 hospitals. Mr. James B. Carroll, chairman of the Board, addressed the representatives, inviting a general discussion of the various problems which arose in connection with the administration of the statute, and as a result of the conference it was decided to appoint a special committee to consider the subjects of hospital charges, additional surgical charges and recommendations as to the improvement of the law with reference to hospital attendance.

The special committee, consisting of Dr. Halbert G. Stetson, chairman, of Greenfield; Dr. Walter R. Weiser, secretary, of Springfield; Dr. Walter P. Bowers of Clinton; Dr. Frederic A. Washburn of Boston; Dr. John H. McCullom of Boston; Dr. Francis R. Mahoney of Lowell and Mr. Richard P. Borden of Fall River, was appointed.

This committee held several meetings and finally reported as follows:

The committee, appointed by your honorable chairman to consider the subjects of (1) hospital charges; (2) additional surgical charges; and (3) recommendations as to how the act might be improved, beg to herewith submit their report.

In considering these questions the committee has secured data from 54 hospitals in the State, and their conclusions are based upon such data, together with the experience of the members of the committee.

In arriving at a fair charge for hospital care, we asked for the per capita cost of each institution. The average is found to be $16.66 per

week. The usual operating-room charge is $5, but some charge $10 in unusual cases.

The X-ray charges vary because of various ways of making the charge. In the opinion of the committee the radiographer should be paid for the examination regardless of the number of plates made. It is to his ability to interpret plates and to his advice that the surgeon owes much of his success in obtaining good results.

Serums, notably that of tetanus, must be used in certain cases, and the expense is apt to be very great. This item, together with special appliances and special drugs, should be paid for at cost.

In cases of delirium tremens following accidents, and a few other conditions, special nursing is a necessity, and this should be paid for at the usual nursing rates.

We inquired into the ability of the hospital managements to collect bills from those who remained in the hospital more than two weeks. The feeling is almost unanimous that although persistent effort is made to collect from the patient or friends the loss is enormous, ranging from 50 to 99 per cent.

Many hospitals claim that the admission of industrial accident cases is a detriment to the hospital, because of this inability to collect from long fracture and septic cases, and the losses incident to such cases. Nevertheless, the hospital must be regarded as being the most desirable place for the treatment of all serious cases.

The following conclusions are respectfully submitted as the suggestions of this committee for working basis in the solution of these problems:

1. That the fee for hospital care in such cases should be $15 per week in addition to the following extras:

2. Operating room fee, $5.

3. X-ray, $5 for each examination, without regard to the number of plates made, except for examinations of the head, trunk or hip, when a charge of $10 may be made.

4. Serums, special drugs and special appliances shall be charged for

at cost.

5. Special nurses when necessary shall be paid for at the usual rate for each hospital, the maximum charge not to exceed $4 per day and $4 per night.

6. Ambulance, $3 for calls within a radius of three miles and $1 for each additional mile, the charge to be made only in one direction.

7. Out-patients shall be charged a maximum fee of $2 for the first attendance, plus the operating-room fee if used. For subsequent calls the charge shall not exceed $1 for each visit.

8. When a surgeon is employed to care for an injured person and such person is admitted to the hospital, or when the custom or rule of a hospital provides that a patient shall pay the surgeon's fee, the surgeon

should, under the Compensation Act, be entitled to his proper fees in addition to the hospital charges.

9. That the period of time for which hospital services shall be paid by the association should be extended to such time as is necessary or expedient for the injured person to remain in the institution.

10. That the Industrial Accident Board should be given power to decide upon the payment of bills for medical, surgical and hospital attendance, beyond the first two weeks after injury, in cases in which their judgment dictates such extended attendance.

The Industrial Accident Board approves the following fees by hospitals:

1. The fee for hospital care in all cases shall not be more than $15 a week, in addition to the following extras.

2. Operating room fee, $5.

3. X-ray, $5 for each examination, without regard to the number of plates made, except for examinations of the head, trunk or hip, when a charge not to exceed $10 may be made.

4. Serums, special drugs and special appliances may be charged for at cost.

5. When it becomes necessary to engage a special nurse for more than three days, the insurer should be notified and have the right to bring the matter to the attention of the Industrial Accident Board for investigation as to the necessity for the engagement of the nurse and the extent of nursing required. The maximum charge per day for such special nursing shall not exceed $4.

6. The Board will approve a charge, not to exceed $3, for ambulance calls within a radius of 3 miles, and $1 for each additional mile, the charge to be made only in one direction. 7. The fee for out-patient attendance shall not exceed $1 for each visit.

8. When a surgeon is employed to care for an injured person and such person is admitted to the hospital, or when the custom or rule of a hospital provides that a patient shall pay the surgeon's fee, the Board will approve of the payment of a reasonable fee to the surgeon, in addition to the hospital charges.

Recommendations Nos. 9 and 10 have already been provided for in the report of the Board recommending amendments to the law.

"SERIOUS AND WILLFUL MISCONDUCT.”

If the injury is due to the "serious and willful misconduct on the part of the employer, or anybody exercising the right of superintendence, "the injured employee is entitled to double compensation. On the other hand, if injury is due on the part of the workman to his "serious and willful misconduct " he is not entitled to any compensation.

The words "serious" and "willful" in the law make it most difficult to enforce. As the law now stands it is not efficient, and seems to bear most heavily on injured employees, because there have been more cases before the Board in which the injury is held to be due to the employee's "serious and willful misconduct" than where such "serious and willful misconduct" is charged against the employer.

This part of the law needs to be cleared up.

In Iowa (section 2) no compensation is allowed for an injury caused by the employee's self-intention to injure himself or to willfully injure another; nor shall compensation be paid to an injured employee if the injury is sustained where intoxication of the employee was the proximate cause of the injury.

In West Virginia (section 28) the act provides that no employee or dependent of any employee shall be entitled to receive any sum from the workmen's compensation fund on account of any injury to or death of an employee caused by a self-inflicted injury, the willful misconduct or the intoxication of such employee. If the injury or death results to an employee from the deliberate intention of his employer to produce such injury or death, the employee, the widow, widower, child or dependent of the employee shall have the privilege to take under this act, and also have cause of action against the employer as if this act had not been enacted, for any excess of damages over the amount received or receivable under this act.

The Michigan act (section 2) provides that if the employee is injured by reason of his willful and intentioned misconduct, he shall not receive compensation under the provisions of the act. The New Jersey act (section 3, General Provisions, paragraph 1) provides that for the purposes of this act, "willful