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Special Articles

MIDWIFERY FEES

IN the Medical Practitioners (Fees) Regulations, 1948,the Minister of Health has set out the following revisedscale of fees payable to medical practitioners calledin by midwives. These revised fees, which have beenunder negotiation now for some months, came into

operation on April 18. The fees suggested are approxi-mately 50% higher than those at present in force.

Special provision is now also made for the reimbursementof the doctor should he have to use for mother or childcertain specified expensive drugs.

1. Fee for all attendances from the commencement oflabour until the child is born, whether or not operativeassistance is involved, including subsequent visits to motherand/or child during the first fourteen days inclusive of theday of birth, and including also a postnatal examination ator about the sixth week after the birth, except where owingto circumstances beyond his control the practitioner cannotundertake such examination, 4 14s. 6d.

2. Fee for all or any of the following-version in labour,removal of adherent or retained placenta, exploration of theuterus, treatment of postpartum haemorrhage, or any operativeemergency arising directly from parturition, including sub-sequent visits during the first fourteen days inclusive ofthe day of birth, and including also a postnatal examinationat or about the sixth week after the birth, except whereowing to circumstances beyond his control the practitionercannot undertake such examination- £ 4 14s. 6d. A fee shallnot be payable under this paragraph when a fee underparagraph 1 is payable.

3. Fee for a single attendance only, either during the periodfrom the commencement of labour until the child is born(whether or not operative assistance is involved) or for any

of the purposes mentioned in paragraph 2, :5;:2 12s. 6d. A feeshall not be payable under this paragraph when a fee underparagraph 1 or 2 is payable.

4. Fee for either (a) suturing the perineum or (b) resuscita-tion of baby, jE3 3s. provided that where ’only one attendanceis made a fee of JE2 12s. 6d. shall be payable in lieu of the feeof f 3 3s. A fee shall not be payable under this paragraphwhen a fee under paragraphs 1 to 3 is payable.

5. Fee for induction of labour, whether or not more thanone visit is involved, :E2 12s. 6d. A fee shall not be payableunder this paragraph when a fee under paragraphs 1 to 4is payable. ’

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6. Fee for attendance at, or in connexion with, an abortion,miscarriage, or threatened abortion or antepartum hoemor-rhage after the 28th week of pregnancy, including all visitsin respect of such attendance during the fourteen days fromand including the first visit, 4 4s. : provided that where onlyone attendance is made a fee of JE2 12s. 6d. shall be paid inlieu of the fee of E4 4s.

7. Fee for attendance of a second medical practitioner togive an anaesthetic, whether on the occurrence of abortionor miscarriage, at parturition, or subsequently, El 15s.

8. Fee for visits to mother and/or child not includedunder paragraphs 1 to 6: day (9 A.M. to 8 P.M.), first visit12s. 6d., subsequent visit 10s. 6d. ; night (8 P.M. to 9 A.M.),1 Is.

9. The usual mileage fee of the district to be paid for allattendances under paragraphs 1 to 8 : provided that onemileage fee only shall be paid in respect of one journey,whether such journey shall have been made for visiting one,or more than one, patient.

10. Fee for attendance on mother or child at the medical

practitioner’s residence or surgery, 5s.11. The appropriate fee as prescribed above shall be

increased by the amount of any reasonable expensesnecessarily incurred by the practitioner in supplying anyof the following drugs or preparations, where such a drug orpreparation is essential for the proper treatment of the motheror her child : carbon dioxide, ergometrine, lobeline, liverextract and injections of liver, methylamphetamine, oxygen,penicillin- preparations, pethidine, sex hormones, sulphon-amide preparations, vasopressin, vitamin Bl complex,vitamin K.

HEALTH SERVICE IN NORTHERN IRELAND

THE Health Services Bill (Northern Ireland), whichwas introduced towards the end of last year,l has nowbeen enacted ; and last week the General HealthServices Board and the Hospitals Authority, whichhas been set up under the Act, met for the first time.These two bodies have the following medical members :

General Health Services Board.-Mr. S. T. Irwin (vice-chairman), Dr. J. H. P. Giff, Dr. R. E. Hadden, Dr. Cecil

Kidd, Dr. M. F. Leslie, Dr. J. A. McVicker, Dr. P. V.Pritchard, Dr. J. C. Smyth, and Dr. R. J. Spence.

Hospitals Authority.-Dr. F. P. Montgomery (chairman),Dr. F. M. B. Allen, Prof. J. H. Biggart, Dr. W. F. Bryson,Mr. A. M. Calder, Dr. Muriel J. L. Frazer, Dr. N. B. Graham,Dr. T. A. Kean, Mr. H. I. McClure, Prof. W. W. D. Thomson,Mr. J. R. Wheeler, and Mr. C. J. A. Woodside.The duties of the General Health Services Board corre-spond with those of the local executive councils underthe English and Scottish Acts, while the HospitalsAuthority has functions similar to those of the variousregional boards in England and Scotland. Speaking ata luncheon given last week by Mr. William Grant,minister of health and local government, Dr. Montgomerypointed out that there could be no immediate or drasticchange in the provision of hospital accommodation ;the further 4000-5000 hospital beds needed in NorthernIreland would have to be slowly built up.

Medicine and the Law

An Unexplained DeathIMPORTANT issues are raised by a letter we have

received from a doctor whose child died in hospital. Hereare some of the facts as he gives them.

His wife, having been delivered of a child in theprivate maternity ward of a voluntary hospital, is dueto return home with her baby when at 6 A.M. she is toldby the house-surgeon that the baby has been founddead ; it is suggested that the baby vomited duringsleep and choked. Ten minutes later she goes towardthe nursery to see the child but is persuaded by thehouse-surgeon (who has been consulted by the nursingstaff) that it would be better not to proceed as the childis "all blue." The day sister, after expressing theopinion that the babies were possibly " kept too warm,"assures the mother that her child is the only baby founddead. The father of the child (our correspondent) isinformed, three hours after the mother’s urgent request;the news comes not from the house-surgeon or the hospitalbut from the private rooms of the honorary surgeon.At the hospital the father is told that the cause of deathis unknown and cannot be known. The parents are, attheir most pressing request, shown the dead child : theface alone is visible ; it is unmarked. Two days later.the father is notified by the coroner’s officer that aninquest will be held next day on the death of the childand of the other child who died with her. At the inquestthe theory of a painless death due to heat-stroke is putforward. This theory, according to our correspondent’sletter, was not supported by the pathologist’s evidence.The parents asked the hospital for an inquiry, withevidence on oath, the finding to be published in themedical press if they so desired, and all their commonrights to be reserved, whatever the finding. The hospitaloffered instead an inquiry before its own nominee,evidence not to be on oath, the finding not to be publishedin the medical press, and the parents’ legal rights to besurrendered. An appeal to the Ministry of Healthreceived a sympathetic reply but all power to bringpressure to bear upon a voluntary hospital was dis-claimed. It was still possible to bring an action fornegligence in the civil’ courts. The defendants, however,paid into court, with a denial of liability, a sum of moneysufficient to satisfy such amount of damages as was

likely, in view of decisions of the House of Lords, to beawarded for the loss of expectation of life in the case ofa dead infant. The parents, whose quarrel was with a

1. See Lancet, 1947, ii, 630.