It was a beautiful spring day in May 1921 when Mary Frances Skiff Memorial Hospital was dedicated. The hospital had already been hailed in a national health-care journal as “one of the finest and most modern in the country.” In keeping with this reputation, the hospital board made additional investments in the facility, including the purchase of an X-ray machine in early 1925, making Skiff one of the first small hospitals in Iowa to have this technology. All seemed well at the time, but a problem was brewing just beneath the surface.
The total cost to open the hospital had been $170,000 and Vernon Skiff had pledged $100,000 of this amount, with the remainder supported by pledges from local citizens. The city of Newton provided the land and agreed to support ongoing facility maintenance expenses via tax collections. While Mr. Skiff had immediately made good on his pledge, and some local residents had paid as well, a $40,000 debt remained unpaid due to the lack of follow-through by many others, likely due to the impacts of the Great Depression. Incredibly, the board members of the Newton Hospital Association carried responsibility for this debt personally while waiting for community members to honor their pledges. The future of the hospital hung in the balance for several years as creditors demanded repayment of the principal. In late 1926, F.L. Maytag came to the rescue and pledged $250,000 to build a YMCA in Newton in exchange for community members raising sufficient funds to pay off the remaining hospital debt.
The Chamber of Commerce recognized this as a prime opportunity to improve the community and kicked off a fund drive which collected more than $54,000 in just one week. The debt of the hospital was quickly repaid and the headline of the Newton Daily News on April 17, 1928 declared “Skiff Hospital is Out of Debt!” The debts of the Newton Hospital Association were retired and all assets of the hospital were transferred to the city hospital Board of Trustees in 1928. At this point the public-private partnership ended and the hospital became a solely municipal hospital supported by revenues gained from medical services provided to patients, ongoing gifts from individuals (including a $50,000 endowment from the Skiff family), and taxes collected by the city for the support of building maintenance (12 percent of the annual budget in 1928).
As a side note, Skiff hospital was fortunate to be located in a supportive community with benefactors capable of providing significant financial support. Other hospitals were not as fortunate, with nearly 800 closing across America between 1928 and 1938.
With the financial difficulties resolved, the hospital was able to again focus on the still quickly changing face of medicine in America. Perhaps the biggest change was related to how physicians worked in the hospital environment. During the late 1800s, the American Medical Association (AMA) had worked to establish guidelines for the practice of medicine, resulting in physician licensing requirements in many states, including Iowa in 1886. During the early 1900s, the AMA turned its attention to medical education, establishing guidelines for the training of physicians including their work in hospitals. The intent was to ensure only the most competent and well-trained individuals were recognized as medical doctors.
These changes worked their way into the formal organization structures of hospitals in the early 1900s with the development of an official “medical staff” for each hospital. At Skiff, this standardization of medical practice began in 1929 when the hospital board accepted the following recommendations from the Jasper County Medical Society regarding physician practice in the hospital:
Doctors must apply to be a member of the medical staff of the hospital Membership on the medical staff was to be restricted to doctors who 1) graduated from a medical school, 2) were competent in their specialty, and 3) were worthy in character and ethics The medical staff would develop rules and regulation governing their work in the hospital including requirements for regular meetings and regular review of each others’ work by looking at the written medical records That all doctors, in conjunction with hospital staff, were required to write accurate and complete medical records on the care they provided to each patient That the doctors needed the laboratory and X-ray departments of the hospital to support their diagnostic and therapeutic treatment of patients admitted in the hospital
Interestingly, these essential components remain in place, relatively unchanged, 84 years later.
While the hospital and physicians were in agreement on most issues, such as developing the formal medical staff, it was not so with all issues. For example, in 1933, the medical staff requested that the hospital pay for the rubber gloves and the suture they used when treating patients in the hospital. The board agreed to purchase gloves but insisted that the physicians continue to bring their own suture! Present-day hospitals would not even allow a physician to bring their own suture, let alone require them to do so. In another example of how times have changed, the first superintendent (administrator) of the hospital, Miss Stoddard, resigned from her duties in May 1933 when the hospital board learned that “she had been married for some time and intended to join her husband.” In those early days, nurses were not allowed to be married and were required to live in the hospital or in the nurses’ dorm next to the hospital. When the board learned that she had been married, her continued employment was no longer acceptable.
Though social advancements in medicine may have been slow, technology was rapidly changing during this time. By the 1930s, vaccines had been developed for tetanus and typhoid, insulin had been discovered as a treatment for diabetes, blood transfusions were becoming commonplace, and penicillin was widely used in the treatment of infections. X-ray machines were installed in most hospitals, electrocardiographs (EKG) were beginning to be used, blood pressure meters had been developed, and clinical laboratories were providing ever deeper insights into the chemistry and anatomy of the body.
These advancements, along with increasingly skilled physicians and well-equipped hospitals, transformed the face of medicine in America, leading to ever-increasing use of medical services and, not surprisingly, increased costs. As individuals found it increasingly difficult to afford medical care, the concept of health insurance began to arise. Can you guess the role that Newton and Skiff Medical Center played in the development of health insurance? Look for the answer in the next story in a few short weeks.