EAR. 11. Hearing, acoumeter, L. JR. .Fork 12. Bone conduction, 2. Low tones, R. 1. High tones, R.. 13. Give a summary of the case as you see it; peculiar conditions, etc.. Bond Cond. R.. L. ... Kindly use charts on back for illustrations when necessary. 19. HOSPITALS. [Extract from report of Massachusetts Industrial Board for 1913.] The next problem of importance was the relationship of the hospitals to the act. Many abuses in connection with hospital services under the act were discovered, and it was finally found necessary to take the same action in regard to hospitals as was taken with the medical profession. A meeting with the hospital administrators was held at the statehouse, at which James B. Carroll, chairman of the board, presided, and a general discussion of the hospital problem was participated in by the representatives of the 38 hospitals in attendance. A special committee, consisting of Dr. Halbert G. Stetson, chairman, Springfield; Dr. Walter R. Weiser, secretary, Springfield; Dr. Walter P. Bowers, Clinton; Dr. Fred A. Washburn, Boston; Dr. John H. McCullom, Boston; Dr. Francis R. Mahoney, Lowell; and Mr. Richard P. Borden, Fall River, was appointed to report on the hospital problem. The report submitted by this committee follows: The committee appointed by your honorable chairman to consider the subjects ofFirst. Hospital charges. Second. Additional surgical charges. Third. 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, 30003-S. Doc. 419, 63–2– -11 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: That the fee for hospital care in such cases should be $15 per week in addition to the following extras: Operating-room fee, $5. 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. Serums, special drugs, and special appliances shall be charged for at cost. Special nurses, when necessary, shall be paid for at the usual price for each hospital, the maximum charge not to exceed $4 per day and $4 per night. Ambulance, $3 for calls within a radius of 3 miles, and $1 for each additional mile, the charge to be made only in one direction. 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. 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 the 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. 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. 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. 5 A. MALINGERING. [Extract from Massachusetts Industrial Commission's Report, 1913.] The industrial accident board would not feel it had done its full duty to the legislature if it did not call attention to the conditions which have shown, especially in Europe, a tendency to sap the vital elements of character and check the growth of the qualities of the highest value in national development, because when all is said and done the material well-being of the wage earner depends as largely on his character as it does on the regulations which law imposes or assistance which legislatures can give. No innovation begun by a State can be stopped at anyone's pleasure or regulated according to the original intention. One of the logical, but most unexpected, developments of the workmen's compensation act was shown almost immediately in the throwing of aged and infirm employees out of industry to reduce the cost to certain employers of insurance premiums. One company in Massachusetts, after a physical examination, discharged 22 employees who were either aged or under par physically within a few weeks after the act went into effect. For instance, employees found with varicose veins, hardened arteries, and advanced in years, if injured, would not be likely to respond to treatment, and a trifling injury might result in payment for total disability under the act. Epileptics and others, who by reason of their infirmity would likely be injured in their occupations, when discovered, find employment more difficult and in some cases impossible. The State which has thrown these employees out of work will eventually be asked to make provisions for them, although the danger of acts providing for nonemployment insurance and superannuated insurance is so obvious that they need not be here discussed. However, because such legislation is dangerous and, if adopted, would necessarily result in a great burden to the State it should be studied and, if possible, by providing against the need of it, make such laws unnecessary, Workmen's compensation acts have been effective in some of the European States for 30 years or more. It is alleged, with substantial proof, that workmen's compensation acts have been followed by successful attempts at malingering, it being more difficult year by year to get injured workmen cured of their injuries. The growth of new forms of nervous diseases arising out of workmen's compensation acts had begun to attract attention in Germany as long as 20 years ago. European doctors are accused of using irregularly the workmen's compensation act as a form of revenue; some of the workmen are accused of exploiting their accidents—a process so human and easy to understand that it is quite a normal and psychical proceeding. It does not follow that all these cases of simulation are wholly fraudulent, because there is nearly always ground for making the original claim. German literature on this subject gives the case of a man who hoodwinked the insurance authorities in Berlin for the payment of 50 per cent of his average weekly wages for a disability arising out of industry and who was accidentally discovered to be following the occupation of an acrobat in Alsace. Another case has been quoted where a man drawing disability payment for an injured elbow at the same time under another name was earning a living as a pugilist.1 These cases are not manifesting themselves in great numbers in Massachusetts, but there are already indications that before long they will be of sufficient importance to constitute a problem. Such cases involve aliens of a certain type, temperamentally nervous, alcoholics, whose vital energy and stamina have become undermined; the subnormal, neurotics, and those suffering from various forms of nervous diseases. The lazy and incompetent-the failures in industry-may prefer, after injury, to receive one-half their average weekly wage for an indefinite period rather than trying to get work at their old or in any occupation. The object of the act is to return people to industry; one of the effects of the act is that people refuse to go to work while they are in pain. Before the act went into effect the uninsured workman with a broken leg, whose muscles became contracted 1 "National Insurance and National Character." Edinburgh Review, July, 1913. and partially atrophied, because of the fracture, was forced by necessity to go to work, and did go to work. Every day he found that the pain was less and less, and it soon disappeared. The injured employee receiving half or more of his average weekly wage under a compensation act, and who for any reason is not ambitious, may, and sometimes does, refuse to go to work while there is any pain in the injured part. The longer such injured employees stay away from work the harder it is for them ever to go to work; and unless prompt and stringent means are taken to force them back into employment it is not long until the atrophy becomes permanent, and the injured employee becomes a charge on the law up to full period of total disability, and subsequently on private or public charity. This is not to be wondered at. The ordinary person after a fortnight's vacation in the summer time finds it difficult on his return to start to work, and if the incentive to remain away at vacation on half pay could be supplied it is probable that summer vacations would be extended longer than they are to-day. Some workmen who are victims of bad advice or afraid of pain refuse to accept the medical or surgical services offered by the insurance companies, which is necessary to put them back on a working basis. To remedy this defect in the Massachusetts law it is suggested that section 19, paragraph D, of the Illinois law should be added as an amendment to the act, which says: "If any employee shall persist in insanitary or injurious practices which tend to either imperil or retard his recovery, or shall refuse to submit to such medical or surgical treatment as is reasonably essential to promote his recovery, the board may, in its discretion, reduce or suspend the compensation of any such injured employee. The principal danger of malingering, which up to now has not been very great in Massachusetts, is not in the cost of insurance to employers, or its effect on the profits of the insurance companies; but the great danger of the spread of these practices is to the workingman himself, because nothing more quickly undermines energy and self-respect than this practice, the consequences of which are permanent and hit him when he is down. In the opinion of the board the way to prevent the growth of practices which have made similar acts odious in Europe is: First. The establishment of a definite medical policy regarding injuries, so that as far as possible and human all injuries shall be judged on a uniform basis. Every time the board is outwitted by a malingerer the precedent is important. The board needs a medical adviser whose duty it will be to pass on the medical problems which rise out of industrial injuries. A competent medical adviser will assist the board in fairly and uniformly administering the law, and while benefiting the employee whose injury is genuine and disability honest, will prevent the malingerer from getting benefits which are not deserved; and Second. To give the industrial accident board authority to hire or establish one or more wards in hospitals, located to serve the industrial centers of the Commonwealth, where doubtful cases of disability may be sent at the discretion of the board for observation and study, the cost to be assessed pro rata on the insurance companies. NO. 6. ACCEPTANCES AND REJECTIONS OF ELECTIVE ACTS BY EMPLOYERS. The reasons given for accepting the acts in various States vary, but they do not in any case necessarily show that the employer is entirely satisfied with the particular compensation act under which he is working. They do show either that he is satisfied with the principle of compensation or believes that the particular act has more merit than demerit from the point of view of his needs. The reasons given by employers for rejecting the act are valuable mainly from the standpoint of legislation, as they frequently suggest some defect in the law which caused the employer to reject it. While many employers have accepted the law because they believe in the principle of compensation and regard the system as intended to be fair and just to both employer and employee, others have acted from a merely practical motive, as, for example, by advice of their insurance agent, or for the reason that the act tends to avert litigation or leads to prompt settlements and fixes definitely the amount of liability. Many, in replying, have frankly stated that their reason or accepting the law was the fact that their defenses under the iability act were removed by the statute. CALIFORNIA. Reasons for accepting the act.—California, in the reports of employers who have accepted the act, reflects a variety of motives for favorable action. A company employing 450 persons in manufacturing electric heating appliances went in under the act "because the principle is good. A department store with 500 employees said, "Under the compensation a portion of our insurance premiums is likely to reach injured employees. Under ordinary liability, no part, or a very small part, of the amount paid out by us in premiums may reach injured employees." A telephone company regards it as "fair to both sides.” A firm with 30 employees preparing "upper leather" assigns as its motive "equity." A firm of building contractors says that they are "wholly in sympathy with its purpose." A metalweld company with 12 on the pay roll "accepted for reasons both humane and financial; cost in case of accidents limited to reasonable amount." A manufacturer of pumps, gas engines, and general jobbing, 20 employees: "More satisfactory than carrying insurance, and we think it a just act; employees should be projected." Purely financial considerations are avowed in many cases: "Figured it put us on a definite basis for settlements, and we know where we are at. "Seemed more economical than insurance and more practical of adjustment with more fairness to both parties." "Insurance company advised and issued policy only on condition that we did." Ordinary protection becomes decided and less opportunity for contested claims; as good for one as the other." "The company's lawyers advised that it would be the most economical under the |