THE HERMAN KIEFER HOSPITAL OF DETROIT
A study made at the request of the Commissioner of Health
Detroit Bureau of Governmental Research, Inc.
April, 1931, Report No. 122.
The Herman Kiefer Hospital of Detroit
During, the period of April 28, 1930 to May 21, 1930, local tabloid newspaper ran a series of articles attack the operation of the Herman Kiefer Hospital and the administration of the Health Department under Dr. Vaughan. Dr. Vaughan verbally requested the Detroit Bureau of Governmental Research to make a thoro investigation of these charges so as to determine their accuracy.
A study was made extending not only over the period of the newspaper accounts, but also over a period of six months following. Each statement which was possible of verification, or which noted a condition which still existed, was thoroly investigated. The results of this study are given herewith
Description of Hospital
The Herman Kiefer Hospital, located in Detroit on Hamilton Ave., between Taylor and Pingree Avenues, is a specia1 hospital devoted to treatment of communicable diseases, tuberculosis and indigent maternity cases’. The communicable disease unit of about 525 beds comprises five buildings, of which two are built to conform to the modern conceptions of medical asepsis. These modern buildings can handle all types of disease at one time, but the other buildings must classify the diseases treated. The maternity unit is a single building of 65 beds and 65 bassinets, usually completely occupied. The tuberculosis unit of 675 beds is a new building, modern in every respect, in which tuberculosis patients are hospitalized pending other disposition – the most serious cases remaining at the hospital. Besides these definite services, a portion of the power house is set aside for the hospitalization of prostitutes, this service being directly under Dr. Dixon, and not a part of the Herman Kiefer administration.
Operation of a Contagious Disease Hospital
The operation of a communicable disease hospital differs greatly from that of a general hospital due to the ease with which the diseases treated can be communicated. In view of this, a brief summary of the routine may help to make this report more clear to the lay reader.
At all times, nurses, attendants, and doctors must guard against infection from the disease treating are treating. It is not possible to permit relatives and friends of the patient to visit the hospital, only cases of critical illness can be seen and then only by the nearest relatives. This adds greatly to the misunderstanding of the operation of such a Hospital. Rules leave been set up, called ‘technics’ designed protect the nurses, doctors, and others so that they can attend the patients with perfect immunity.
These technics are based upon the known principles of transmitting infectious diseases; by contact or by droplet infection (coughing, sneezing, etc.). Protection against contact infection is secured by wearing a sterile muslin gown which completely covers the outer clothing or uniform, and by scrubbing the hands and arms before and after handling a patient. Droplet infection is prevented by prescribed methods of handling a patient. The technics, while simple, are so effective that only in rare cases do attendants become infected, and such visitors as are allowed are entirely free from danger.
The most effective of such known technics is that where the patient is treated as a unit, but this requires specially constructed hospital buildings, only two of such existing in the Herman Kiefer unit. In the other older buildings the disease is made the unit, the attendants treating several patients with the same disease without change of technic.
The various portions of the hospita1 are known as clean or unclean area, depending upon its freedom from infection. The clean results from washing all furniture, walls, similar articles, and sterilizing the bedding after use by a patient. Uniforms used by the nurses in attending patients are never worn outside the hospital buildings.
An index of the efficiency of the technics is the rote of cross infections among the patients; that is, the number of patients suffering from one disease, who are infected with another contagious disease while in the hospital. In some cases, however, a patient is admitted to a ward with one disease but at the same time incubating another, which later develops symptoms permitting a diagnosis, altho by this time other patients in the some ward have been exposed and may contract the disease. This can only be prevented by a hospita1 where provision is made for each patient to be kept separate from all others – either by cubicles, or in a building constructed according to modern standards. A fertile source of such cross infections is measles the most highly infectious of a11 the communicable diseases.
On page 38 of this report, the influence of measles on cross infection is shown.
The source of each case of cross infection is investigated by a rather elaborate routine, and if found to be due to carelessness by any employee, results in censure or dismissal.
Tuberculosis, however, is a disease with, a very slow infection so that it is not necessary to observe the strict technics required for contagious diseases. Visiting is permitted at such times as do not interfere with the proper rest and comfort of the patient. The technics for tuberculosis patients are mostly concerned with the proper disposa1 of sputum cups, dressings, and like means of infection.
Outline of the Charges
In order to give o brief outline of the ground covered by the charges, the following summary is a grouping which is convenient, but subject to qualifications as the newspaper did not present an orderly development of the criticism of the hospital.
I – Charges made against Dr. Vaughan, Health Commissioner.
a. Improperly trained for his position.
b. Gross favoritism in appointing department heads.
c. Improperly used city employees in his private home.
d. Permitted favoritism in awarding X-ray contracts in the Herman Kiefer Hospital.
II – Charges made against Mr. Phillips, Superintendent of Herman Kiefer Hospital.
a. Improperly trained for his position,
b. Improperly used hospital employees in his private home.
c. Nepotism – his wife and daughter on City payroll.
d. Used hospital employees and supplies in construction of his private home.
e. Undue partiality for chef in contagious disease kitchen.
III – Charges made against administration of the hospital.
a. The male employees improperly housed.
b. Contaminated linen improperly handled.
c. Employees carried on payroll under wrong titles.
d. Public prevented from learning conditions at hospital.
e. The hospital was cleaned only after newspaper attack.
f. The superintendent openly permitted gambling.
g. There is no food handlers’ examination for kitchen help.
h. Hospital capacity only increased after newspaper story.
i. Salary deductions for time off not returned to the City Treasurer.
IV – Charges made against food and food-handling.
a. Food and trays are infested with vermin.
b. The best food goes to Dr. Phillips and the chef.
c. The chef’s home is filled with hospital supplies.
V – Charges made against the nursing service.
a. Nurses are indifferent -to crying children.
b. Nurses are permitted to make spinal punctures.
c. Improper technics followed permitting nurses to become infected.
d. Filthy bedding and dressing permitted due to insufficient nurses.
VI – Charges made against the medical service.
a. Cross infections are common occurrence.
b. Nurses and doctors are discourteous.
c. Private doctors refused permission to attend patients.
d. Improper medical service, and wrong diagnosis, frequently occur.