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"We'll just wipe it out and leave a drain in it. That's best," replied the senior surgeon who performed most of the operations at the state hospital.

The young doctor -- McMasters by name -- showed his amazement even through his operating mask. He knew that for at least twenty years it had been standard procedure to remove inflamed gallbladders. He knew that removal was the only thing to do in this case. But he also knew that his suggestions held no weight against the clumsy confidence of Dr. Spellman, the senior surgeon.

Still, he could not hold his tongue when he saw that Dr. Spellman was going to close the incision with just one row of wire sutures -- it needed to have at least three different closures if it was to heal. "The peritoneum is ready for closing," Dr. McMasters suggested.

But Dr. Spellman disregarded the suggestion and quickly dosed all of the layers of the abdominal wall with the single row of stitches. "Finished," he announced.

That night, the inevitable happened. A few stitches broke through the tissue, and the wound reopened. At three a. m., the night nurse found the patient with his intestines spilled out of the abdominal wall and the wound wide open. Knowing that such a catastrophe required immediate re-stitching, she called Dr. Spellman at his apartment on the grounds, and reported what had happened. Dr. Spelhnan gave directions that a heavy dressing be drawn tight with adhesive tape to hold the intestines in. "I'll stop in to see the patient in the morning at eight-thirty," he concluded, and hung up.

When Dr. Spellman "stopped in" at eight-thirty, the patient was dead.

Dr. McMasters and Dr. Spellman met again over the patient's open abdomen at the autopsy. Signs of negligence were plainly evident.

"Well, after all, what could you expect?" Dr. Spellman commented. "He was just a poor dope."

Dr. McMasters turned on his heel and left the room. He had heard it said before, but now he believed it. Some doctors, instead of being in the Hippocratic tradition, were most certainly in the 'hypocritic' tradition.

(Based on report 772)

Marian was transferred to Ward 11 on a stretcher late one afternoon and put right to bed. The next morning, in spite of her complaints, she was gotten up into a wheel chair. It was a standing rule on Ward 11 that no patients were allowed to stay in bed except by doctor's order. Marian spent all her days in a wheelchair and was put back to bed at night.

Five weeks later, the attendants were informed that Marian had been transferred to Ward 11 with a broken hip.

Alberta was more fortunate. Her fractured leg was put in a heavy cast before she was placed on Ward 11. It hurt her a great deal, however, and she kept asking to see the doctor.

Four days later the doctor came to check on Alberta and found that the circulation had been cut off in the leg at that time. The doctor doesn't think he will have to amputate.

(Based on reports 766 and 769)

Patient Dubinsky, who usually walked up and down the ward from morning until night, lay on a bench in the toilet, moaning and groaning. His mental condition was such that he never spoke, so he could not describe the pains that assailed him. But Oliver, the attendant, investigated and found that Dubinsky had a continuous rectal discharge of blood and other matter. Obviously, Dubinsky was seriously ill.

Oliver took the patient to the infirmary that afternoon and was lucky to arrive just when Dr. Best was making his daily "rounds." Oliver explained the case. Dr. Best looked at the patient from across the hall and said, "Nurse, give that patient a rectal suppository when you get a chance." That afternoon, Dubinsky was returned to the ward, where he lay on a bench in the toilet, moaning, groaning and discharging.

The following day, Oliver reported the condition to the building supervisor. He suggested that the discharge had such a terrible odor and was so abnormal that he wondered if it might not be the lining of the intestines. The supervisor didn't look at the patient at all, merely ordered: "Give him some mineral oil, and we'll put him on the list for a colonic irrigation later in the week."

On the third day, Oliver decided he would try once more to get something done. He took Dubinsky to the infirmary again. Again nothing positive was done, and the patient was sent back to the ward. That night, the night attendant supported Oliver's hand by writing in the report: "Patient Dubinsky breathing heavily and passing blood through bowels."

On the fourth day of Dubinsky's illness, Oliver finally got results -- at least, he got permission to transfer Dubinsky to the infirmary for observation and treatment. It may be presumed that Dr. Best read the nurse's notes on Dubinsky each day thereafter. It is certain that the doctor never examined Dubinsky personally and never gave any orders for his treatment.

The nurse (who thought Dubinsky might have cancer or tuberculosis of the intestines) was not surprised. She had become accustomed to Dr. Best's methods of examination and prescription by guess -- at a distance of ten feet. She had never seen him make a rectal examination, touch a festering sore, open the lids of a running eye, or even dress a wound.