Memo to C M Dunham, Subject: Hopital Plan (Encl: Medical Department - the Major Premise)

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Ofice Menzormdzcm UNITED STATES GOVERNMENT I, Lo Van Horn, Area Manager, Brookhaven Area, & Attached is the hospital plan which you requested, on your recent visit to Brookhaven.

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According to files in the medical department, it was recognized as Tar back as April of 1947 t h a t top f1igh.t medical care must be srovided for the employees of the Laboratory, for individuals connected with t h e Laboratory through the operat3on of subcoatre,ctors and f o r dependent farailies of Brookhaven The following pages will attempt t o shov progress which has been made ill the prc j ect of providing this medical coverage, and will offer f o r consideration certain basic operating policies which seem pertinent to the existing situation.

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The physicians and surgeons who will practice i n the hospital will be organized i n the hospital and compris:tng the BKG practice i n the surrounding comunities, consultants i n special fieLds of medicine who practice within a radius of 40 miles of t h e Laboratory, and senior consultants, those specialists who practice in New York or in the medical schools of Associated The word "staff" i s here defined as a group of doctors practicing emTloyed physicians, attending physicians who A president of' the medical staff w i l l be appoijlted and will be supported by standing comalittees as follows : 1. Executive Committee, consisting of the heads of the various clinical divi - sions t o coordinate the activities and policies of the variow departments, . 2.Wali fi cations Committee t o review the qualifications of attendj.ng physicians (non-BIU, employed) applyfng for membership on the medical staff .. 3.. I4edical Records Cornittee t o supervise and appraise the medical records i n order t o see that thcy are maintaimd at the required standard. The membership of t h e medical. staff will be restrj.cted t o physicians and surgeons who are graduates of approved medical schools and legally licensed t o practice i n New York State. A fixeC and delii_iite plan fir making apFoiiitments t o the medical staff w i l l be physicians who wish to practice at Brookhavcn i s attached, k copy of the application for appointment t o be filled out by all The medical staff will initiate and ado2t rules, regulations and policies governthe pr des s ional work of the hospital. Thuse rules will specifically provide that medical staff rneetir4s will be held atleast once a month; (b)that the medical staff rcview aad analyze b tre pilar intervals their cl in l cal experiences i n the various departments of the hospital and that t'ne medical records of patients will be the basis f o r such review and analysis. Accurate minutes of a l l staff conferences will be Iuaintained. Accurate and complete medical records will be written for all patients, a complete medical record being one which includes identifying data, complete personal and family history, history of present illness, physical examination, special examinations such as consultations, clinical laboratory, x-ray, and other examinations, provisional o r working diagnosis, medical or surgical treatment, pathological findings, progress notes, final diagnosis, condition on discharge, follow-up, and in the case of death, zutopsy findings. A com2etei;t medical records librarian has been employed who will establish the medical records system by and with the advice of a consultant on medical who f o r for 11 years, has been medical records libra rj an of the Doctor '6 Hsspital i n &NewYork City. The medical records system will be so s e t up as t:, completely conform t o t h e standards acceptable t o the American College of Surgeons.

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Vader conpctent rfiedical sxpervisioii there has been e stab li shed a complete clini - c a l laboratory providins chemical, bacteriologj-cal, serological and pathological services as detailed i n Appendix A. ervise all technical activities of the clinical laboratory and reports directly to the physicim i n chmge of Giboratory activities. also fully ‘trained in clinical laboratory technic tothe extent that each of them could carry ox th2 duties of the laboratory ih tho ab8ence:of tho cKef laboratory The chief tcxhnician is fully qualified t o SupThe supporting technicians arc A fully equiyped x-ray laboratory has been act i via ted, It i s under the supcras a consultku; physi.cian tothe nedical department, who is also a registered nurse has been enployed. Westinghousc install et ion ttnd offers a scope of x-ray service far beyond that ordi.- narify found i n a hgspital of less than one hundred beds. operator and. patient is assured. coapetc:;it medical radiologist serving as one of the 3NL coneultlints and A fully trained x-ray technician The equipment i o a most modern Proper protection f o r the Kedical service for ambulatory patients is organized as a def j nj te out patient physlcians ’ pi-ivatu examin-irig rooms aad a branch of the clint cal Laboratory. Physical exaninations 2z-e given in this depaytmcnt, which isat present treating an average of iForty-patients per duy m d ‘exaiiiing ton. A fully equipTed treatment room has berm activated and i s supported by fcur k Physical therzpjr miit has beer1 actjvated with modern diathermy, uitra--?iole?;, No traincd physical therayy tcchiiician has bccninfra-red and whirlpool ap:parstus, employed, but the chicf nurse and o m of the BNL staff physicians are specifically A fully stoclred pharmacy under thc ixiiediate supcrvision of a registergd phamacist and under the gciicral supervision of a staff physician has been opened. phamzcist has i mediate supervision over (a) the preparation of injectable medication and sterilization of aL1 preparations hc hiaself prepares; (b)the routine manufacture tions; (d) the fill tii g and labellag of all drug containers issued the nursing units fron which m2dication isto bc abin l ste red ; (e) the periodical inspection of all pharmaceutFca1 sup2lies of’ a l l nursing units; ( f ) t h e maintenance of an approved stock of antidotes ?or emcrgcncy use; ( g ) tile dispensing of a l l narcotic dmip-and a perpetual invellCory of them; (h) specif is it ions for purchase of all drugs, chemicals and phamaccuticel preparat,ionp us;:d inthe treatment of patiento. petext suporvision and direction Tor the efficient administration and rsnderim Of

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service isa qualified adninistrator who a8 a major i n the Army Nur ~ eCorps served a s chief nurse intwo large gcneral hospitals i n the E,T.O. been selected with grcat care over a pcriod of seven months and i s extremely flexible. .- The nursing staff has A graduate dietitian,a member of the American Dietetic Association, has been the ward kitchens which hats been adequately equipped f o r the feeding of fourteen manent dietary which will be ready for operation before the first of the year. dietitian is fully qualified to render the efficient administration of the general food service and direct'thfe scientific diet of the patients. During thc earl;y days of the hospital she will operate from the larger of She is assisting the Architectural Planning group i n designing the perAmple facilities have been provided t o house a completc library of medical texts, periodicals, and refcrcnce works. cent t o the library stack room. department, fully qualified to efficiently carry on her duties. is i n charge of the rnedica.1 library and serves a s the medl.cal department representThe medical library as a branch of the BNL Research Library is developing. Two study o r work rooms are being furnished adjaThc medical librarian is a3 empfoyec of the medical The medical department at present comprises an out patient ward or clinic, three i 3hospital wards of fourteen beds cach, an x-ray laboratory and a clinical laboratory. I n addition t o the above, coiistruction on an eleven-bed ward for communicable diseases i s approxinatcly 75 pcrcent complcte and the construction of two rooms of surgery with ccntral supp:ly and a sterilizing room plcte. Both surgery and -the isola%i.on.ward w i l l be completed by December 1. ward building has bccn set aside for the dietary depai-tmor?t but this project i s still i n the dmiting board stage. establishcd i n the ward kirtchens. Tcmporary but adequate dietary facilities have beea The Acting Chairman, Medical Department Matrons and Janitor:; (3) A s an interesting analysis of the services which the 3NL hospital i s preparcd to of for in relztion t o 1;liose offered by 50 bed and 250 bed hospitals averaged throughout the country, the i'ollowing table is submitted, on a survey m d e by the U. S, Public Eealth Service i n 1947,

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< Central Supply Room Medical Records Dept. Mental Hygiene Clinic Oc cupat ioml Thcrqy Out Patient Clinic Social Service Dept .X-Ray Diagnosis It will be noted t h a t the special services which tho BNL hospital plans and is prepar"ed t o offer go far beyond the national average for hospitals of 50 beds o r less, and in fact compare favorably with the national average of hospitals having i n excess of 250 beds.' In addition, BNL will offer an isolation mr a service for communicable diseases, which i s entirely contrcyy t o standard practice in small hospitals. PROPOSED HOSPITAL POLICIES: The follow-ing individuals o r groups of'individuals will k eligible for admiss--ion t o the hd pital : Employees of the l o c a l AM: staff and dependent families domiciled with them '\ Ehergcncy cases from the surrounding community Specifically excluded are fanlilies of subcontractors' employees The hospital sh:3ll reserve the right to refuse ahmission when it i s obvious that adequate facilities for the treatment of the injury o r disease hergency maternity care will be provided eligible patients while on the, BNL and local AEC employees may receive without charge simple iagnostic exam- 7 ination i n the out patient clinic. nected, treatment cither i n the clinic or in the hospital will be handled as a comsubsequexrb t o diagnosis will bc 'provided a t p&lishod rates. empl~yees,TJhether.treatcdi n the cLj.nic o r in the hospital, will be .charged f o r services rendered, both diagnostic and the2apcuti.c. If the injury or illness is occupational conIf thc injury or illness i s non-occupational connectdd, t'reatmznt Patients othcr than Charges for hospitalization will be made on the ."inclusive" rate plan, as

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2 97.50. Each day over 10 4.30 Physicians other than BTSL employees who practice in the surrounding community m8.y refer to and treat * %lig i bl epatients inthe hospital, as follows: Courmunity physicians practising i n t h e hospital shall be divided into two catespecialists called i n by BNL staff phjsicians, 2nd a t - Apglicants for appointment t o the hospital stdff as attending physicians will submit their qualifications a s pi-saq3le form attached and wiU be passed‘upon as to eli gibi lit physicians will be under -the general supervision of the senior clinician and shall conform t o the rules and :regulations as established by the mcdical staff. consultants will be paid by BIZ. appointed BNL consultants will bill the patient, direct Tor services rendered. Attending physicians and consultants other than The facilities of thl3 hospital vi11 be Iilaae available t o the community when it i s determined that an actual cmergencg exists. The word “emergency“ may apply t o an individual case, such as 8 seriol;s automobilt: accident near the site,to local comunity disaster, or t o individwl cases urgently reqtiiring hospitalization when beds are no% available i n thc comauniiiy llospitsls. tinable under New Pork State law) from the community, other than cli gi ble patients, will not be accepted. Final decision i n individual cases shall rest with the chairman of the medical department or hi6 delegate. Individuals who arc eligible for out patient and hospital care may have prescriptions filled in the pharmacy. This will apply t o prcscriptions of physicians employed by the Laboratory a d also to prescriptions of outside physicians for use by eligible patients. ication and drugs as part, of the inclusive rate plan, OL-L patient prescriptions will be billed to the patient on the basis of cost plus a 50 psrcent mark-up. Dugs, medication or proprietarlcs will be dispensed by the pharmacist only on thc prescription 02 a physician,, The pharmacy will not be obligated t o fill prescriptions of attending physicians which reqEire ingrcdients that are not i n stock. Patients who are hospitalized w i l l receivo rcquired medThe H. K. Ferguson Company resident j?hp.ician may be apyointed t o thc xtiedical staff and will be i n dirk-ct supcrvlsion ol” hospitalized Fcrguson employms. However, it i s specifically emphasizcd that the Forguson physician will be bound by the regulations of the medical s%aff and under the immcdiate direction of the

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The ocrviccs of the clinical laboratory will be available to local physicians in their diagnosis, examinzition and trca.t;Tncnt of cligrble patients. service when rcndcrcd on an out patieilt basis shall be made i n accordance with the published schedule of rates. ized patients as part o f the inclusive rate plan. Charges for this Clinical laboratory services will bc afforded fiospitalRoutine physical examination x-rays w i l l be provided without charge. services t o hospitalized patients will be provided in the inclusive rate plan. other x-ray scrvices, except those connectcd with occupational connected injury or il hess, if on an out patient basis will be charged for in accordance with publlshod

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Associated Universities, Inc. General and Research Hospital Place and date of bi~~,,.........,...~..~~~.....*.*...~.~. Citizenship............. Medical education: Medical schoo~................................................... Licensure: State oy Province................ ...............Date.................... Graduate training following internship: Membership on other hos,pital staffs (past and present) .........................................................................................................................................................................Fellowship i n American College of Date.................... Fellowship in American College of Physicians.....;...... ... Date... ................. (Give on a separate sheet a list of scientific papers o r essays, and of national scientific meetings attended awing the previous three years .) DOE ARmNES

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Application for Appointment t o the Medical Staff -- Contiriued The undersigned applies for uembersh'ip on the medical staff of BROOKHAVEN NATIONAL LABORATCRY GElEML AND RESEZAFICH HOSPITAL and for privileGes of practice a s indicated minor surgery, first a i d in emergencies) . Major or minor work desired ( A s anesthesia pathology, radiology) In making ap-plicaLion for appointment t o the medical staff of the BROOKHAVEN NATIOIW, LABORATORY GENERAL AND RFSEARCH HOSPITAL I agree t o abide by the by-:Latrs of the medical staff and by such rules and regulations a s may be from time t o time enacted. Lloreover, I hereby declare that Is hall not engage i n the practice of the diviaion of fees under any guise whatsoever. I understand that1 am not t o collect fees for others referring patients t o me, nor permit others t o collect fees for me, nor t o make joint fees with 2hysicians or surgeons referring patients t o me for operation o r consultation, nor p(emt%any agent …