Commonwealth of Kentucky DEPARTMENT OF WELFARE _V f V LA v- • * Division of Hospitals and Mental Hvaiene RULES AND REGULATIONS FOR THE Mental Hospitals and the Feeble-Mincied institute Issued April 11th, 1939 Under Authority Section 4, Chandler-Wallis Act By J. G. Wilson, M.D. Director, Division of Hospitals and Mental Hygiene Approved April 11th, 1939 By Margaret Wo11 Commissioner of Welfare SUPERINTENDENT Clinical and Custodial Administrative, Agricultural 6 Industrial CLERICAL RECORDS BUSINESS MANAGER CONSULTANT CLINICAL DIRECTOR SENIOR PHYSICIAN book-keeper CLINICS LABRATORY DIETICIAN FARM MANAGER ALL ASSISTANT PHYSICIANS HTUJS TRIAL DIRECTOR X-RAY KITCHEN EMPLOYEES GENERAL REPAIRS ENGINEER RECEIVER COLD STORAGE DENTIST CHIEF NURSE DINING ROOM EMPLOYEES MEAT CUTTER VEGETABLES & TRUCK CROPS LAUNDRY BOILERS SOCIAL SERVICE ACCOUNTS WARDS & PATIENTS HOUSEKEEPING TRAY SERVICE EMPLOYEES SLAUGHTER HOUSE DAIRY BAKERY PLUMBING LIBRARY RECREATION & RE LEGION FIEID CROPS SHOE SHOP. ELECTRICAL CANNERY HYDRO-THERAPY hogs SEWING ROOM FIRE FIGHTING EQUIPMENT NORSES A ATTENDANTS SPECIAL THERAPY CRAFT SHOP FARE! SHOP POULTRY BROOM SHOP WATER SUPPLIES OCCUPATIONAL THERAPY MILK HOUSE PASTEURIZER fruit WOODWORKING SLOP SEY/IITG ROOM CARPENTRY BEAUTY SHOP OCCUPATIONAL THERAPY CENTER FARM FENCE & BUILDINGS WORK STOCK TAILOR SHOP OTHER REPAIRS BASKET SHOP WEAVING UNIT green house INDUSTRIAL GARAGE OTHER INDUSTRIES COMMONVYEALTH OF KENTUCKY DEPARTMENT OF WELFARE DIVISION OF HOSPITALS AND MENTAL HYGIENE RULES AND REGULATIONS for the Mental Hospitals and the Feeble-Minded Institute The duties of the Director of the Division of Hospitals and Mental Hygiene are clearly defined in the Chandler-Wall is Act to include issuing and promulgating rules and regulations for the administrative procedure of State institutions, and formulating rules, regulations and standards for the employ- ment of persons within the several State institutions. Regulation No. 1: The rules and regulations promulgated under authority of law will be called Regulations. Each regulation will bo numbered consecutively. From time to time changes in the present Regulations may be made by amendment in the form of a Division Circular Letter, New Regulations may be promulgated in the form of a Division Circular Letter. The Regulations arc to bo filed in the office of each State institution assigned to the Division of Hospitals and Mental Hygiene, Regulation No, 2: Hospital Districts. The following districts are assigned to the State Hospitals and patients will he committed to the hospital serving the district in which they reside. 2 EASTERN STATE HOSPITAL, Lexington, Kentucky, Counties of - Anderson Bath Bell Bourbon Boyd Boyle Bracken Breathitt Carter Clark Clay Elliott Estill Fayette Fleming Floyd Franklin Garrard Grant Greenup Harlan Harrison Jackson Jessamine Johnson Knott Knox Laurel Lawrence Lee Leslie Letcher Lewi s Lincoln McCreary Madison Magoffin Martin Mason Menifee Mercer Montgomery Morgan Nicholas Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Scott Wayne Whitley Wolfe Woodford CENTRAL STATE HOSPITAL, Lakeland, Kentucky, Counties of - Adair Boone Bullitt Campbell Casey Carroll Gallatin Green Henry Jefferson Kenton Marion Nelson Oldham Owen Russell Shelby Spencer Taylor Trimble Washington Wayne WESTERN STATE HOSPITAL, Hopkinsville, Kentucky, Counties of - Allen Bollard Barren Breckinridge Butler Caldwell Calloway Carlisle Christian Clinton Crittenden Cumberland Daviess Edmonson Fulton Grave s Hancock Grayson Hardin Hart Henderson Hickman Hopkins Larue Livingston Logan Lyon Marshall Meade Metcalfe Monroe Muhlenberg McCracken McLean Ohio Simpson Todd Trigg Union Warren Webster 3 Regulation No, 3: The director my authorize the admission of a legally committed patient to any State hospital when, in his opinion, the exigencies of the case warrant such an admission, or authorize his transfer from one institution to another when deemed advisable. Regulation No, 4; Duties of the Superintendent The superintendent of the institution shall be the chief executive officer of the institution, and in his absence or sickness the first assistant or clinical director or other physician designated by the superintendent shall perform the duties, exercise the powers and be subject to the responsibilities of the superintendent. Regulation No. 5: Subject to statutory powers and the regulations of the director, the superintendent shall have the supervision and management of the institution which includes all buildings, grounds and farms, together with furniture, fix- tures and stock, and the direction and control of all persons therein. Regulation No, 6: The superintendent shall personally maintain an effective supervision and inspection of all parts of the institution, and generally direct the care and treatment of the patients. Ho shall make or cause to be made a preliminary examination of each patient within thirty minutes after admission to the institution. The superin- tendent shall regularly visit all wards or apartments for patients at least once a week, and he shall prescribe rules for his officers and assistants to make daily inspections of the sections of the institution under their direction. 4 Regulation No, 7: The superintendent shall appoint officers and employees in such numbers and at such salaries as are proscribed by lav; and regulation for the designated position. He shall also prescribe the duties of each officer and employee, or assign such prescription of duties to the heads of department of the institution. Regulation No, 8: The superintendent may, subject to the provisions of the Chandler-Wallis Act, remove any officer or employee. Upon any such removal he shall make a record thereof, with the reasons therefor, in a permanent record of the institu- tion, He shall also state these reasons on all copies of official advice of "change in status of employees". Form PE-4, which he is required to forward to the Division of Personnel Efficiency and to the Director of the Division of Hos- pitals and Mental Hygiene, He shall not discharge any employee who has contin- uously served in his position for six months, until such discharge has been ap- proved by the Director of the Division of Hospitals and Mental Hygiene, He may, however, suspend him from duty, pending the receipt of approval for discharge. Ho shall also report all serious illness or accidents or deaths among employees to the Director of the Division of Hospitals and Mental Hygiene, and keep a book in which these are recorded. Regulation No, 9: The superintendent is authorized to give such orders and instructions as ho may deem best calculated to insure good conduct, fidelity and economy in every department. Salutary discipline must be maintained among all employees of the institution, and rules and instructions of the superintendent must be uniformly obeyed. 5 Regulation No, 10; The superintendent shall cause full and fair accounts and records of the entire business and operations of the institution to be kept regularly from day to day in books and records provided for the purpose. Regulation No, 11; The reports of the activities of the institution shall be made for each month by the fifth day of the following month to the director on forms and in such manner as may be requested by the director. The annual report of all activities shall bo made to the director by the tenth day following the close of the fiscal year. Regulation No, 12; The superintendent shall cause to bo kept a record in which is entered at the time of reception of a patient, his name, residence, occupation, by whom brought and by what authority, on whose petition committed or received, and an abstract of all official certificates or papers accompanying such persons. Regulation No. 13; The superintendent is authorized to utilize such municipal or state laboratory services that may be received without expense to the institution other than for transportation or of supplies. Regulation No, 14; "When the director is satisfied that the state hospital is prepared for the purpose, ho shall issue instructions for a mental hygiene clinic or clinics to bo held, by members of the staff of the state hospital concerned, at places designated by the director. Regulation No, 15; The superintendent is authorized with power of investigation, or to 6 delegate such power to one detailed by him, into the care and treatment of any patient, the conduct or neglect of any officer or employee. Regulation No, 16; Organization of the Hospital Under the Superintendent The clinical director shall serve under the general direction of the superintendent, as coordinator and director of all special care and treatment of the patients of the institution. He shall have his office in the administration center. He shall assign all new patients to the physicians for psychiatric examination and treatment. Ho shall conduct staff meetings at least twice a week for the present- ation of patients for diagnosis, treatment, parole or discharge. In the absence of the clinical director, the superintendent shall assign one of the staff physicians to act as clinical director. No patient may bo transferred from one ward to another ward without the approval of the clinical director, or such other employees as the clinical director may designate to approve such transfers. The clinical director will assign selected cases to the field liaison wo rke r. The clinical director shall have supervision of the activities of the clinical laboratory. X-ray, pharmacy, surgery, hydrotherapy, occupational therapy. The clinical director shall cooperate with the Supervisor of Nurses in her assignment of nurses and attendants to duty where and when required. The special diets must be checked at intervals by the clinical director to see that special diets are obtained and that too many are not being so served. The clinical director will post instructions in the receiving ward for care of new patients. He will conduct, from time to time, special classes of instruction to new attendants. 7 Regulation No, 17: The Case History The history of each now patient in a state hospital will be prepared in the following manner on the prescribed forms: The case history will be kept in a special folder which has the proper identifying data. The history will be recorded under the following headings: Family history Personal history Personality Physical examination Neurological examination Monta1 Examinat ion: Attitude and general behavior Stream of mental activity Emotional reactions Mental trend; content of thought Sensorium, mental grasp and capacity . Summary: The outline of Cheney*s "Handbook of Mental Examination" will be followed as much in detail as is practicable. Regulation No, 18; Routine Clinical Examination 1, Urinalysis 2, Blood'Wassermann or Kahn a. Spinal fluid Wassermann and Colloidal Gold tost when indicated 3, Stool examination 4, Dental examination 8 Other Special Examinationss (when indicated) (Bio-chemical analyses (X-ray of chest or other portion of body Such as (Blood counts, sputum examination (Ophthalmoscopic examination of eye grounds A consultant should be called when necessary for certain special examinations. Regulation No. 19: Special Therapy Hydrotherapy with wet pack or continuous tub will be given only on written order of the physician, Metrazol and insulin therapy will be given to a patient only after written consent has been obtained from the responsible relative or guardian. Fever therapy does not require the written consent of a relative or guardian* Regulation Ho, 20; The Senior Physician shall assist the superintendent and clinical director as directed by the superintendent. All other physicians shall serve as directed by the clinical director, or as the superintendent may request through the clinical director* Regulation No. 21: The Supervisor of Nurses in each state hospital shall bo a registered nurse, with previous experience in a supervisory capacity. She shall have super- vising authority over all other nurses, supervisors and attendants, and all nurses, supervisors and attendants shall serve on such duty as is assigned to then by the supervisor of nurses* Nurses and ward attendants are required to take their regular turn on night duty. The supervisor shall keep a daily record of assignments to duty through the 24-hour period. 9 At the Feeble-Minded Institute a registered nurse shall have charge of the hospital for the acutely ill, and be assisted by a registered nurse. Regulation No. 22; Inoculations All employees are subject to the orders of the superintendent for such immunization inoculations or health tests as nay bo prescribed by the director. Regulation No, 23; Uniforms of Nurses and Attendants All nurses and female attendants and male attendants shall wear the uniform prescribed by the superintendent through the Chief Supervisor of Nurses and Attendants. The superintendent shall prescribe the amount of laundry to which each employee may be entitled, but in no case may ho allow an employee to include any other than his or her own personal laundry. An employee who lives outside the institution, but who is required to wear a washable uniform, shall be entitled to the laundering of the uniforms in the institution laundry. Regulation No, 24; Fire Regulations The superintendent shall formulate the necessary rules and regulations for the efficiency of personnel in fire protection, Tho chief engineer shall be held responsible for testing and keeping in working condition all station equip- ment against fire. The chief engineer will also act as fire chief and direct all personnel assigned to special duties to fight fire. Regulation No. 25; Fire drills shall be held at least once a week, and patients will receive special attention during these drills so that the patients will automatically re- spond to tho call and take their places in marching to the fire exits cr to the doors of the fire escapes. One of these weekly fire drills shall be held at night at least once in every three months. 10 Regulation No. 26: The dietitian shall possess the qualifications already set forth by the Division of Personnel Efficiency, The dietitian shall have charge of the prepar- ation of food in all kitchens,and the service of food in all dining rooms and wards. All employees in the main kitchen, congregate dining rooms and. bakery will servo under the direction of the dietitian. The dietitian shall plan menus for patients and personnel, and write these one week in advance and submit them to the super- intendent for his approval. There shall be cooperative arrangements with the dietitian and the receiver or business manager and head farmer, but the dietitian shall be responsible only to the superintendent’s orders. The dietitian shall prepare monthly reports which show the character of the food served, and the per capita cost of the daily ration. Regulation ho. 27: Business Manager (or receiver or senior storekeeper when no business manager is employed) The business manager shall have charge, under the direction of the super- intendent, of the requisitions, receiving, storage and distribution of the supplies. Ho shall keep all such records as prescribed by the fiscal department of the State government. He shall assist the superintendent in all administrative work assign- ed to him by the superintendent. Regulation No* 28: Property The care of State property requires the cooperative interest of all officers and employees of the institution. A system of property exchange shall he followed in each state hospital and in the Institution for the Feeble-Minded. The property will be defined into expendable and non-expendable property. All non-expendable property will be ac- counted for by the employee in charge of any division or section of the institu- tion, as directed by the superintendent. Worn out property will be exchanged for usable property, and all worn out or useless property so exchanged shall be kept in a special store room, for the inspector of hospitals to see and condemn 11 for sale, destruction or other disposition. The exchange system shall bo insti- tuted by order of the superintendent of the institution when he feels that his organization is prepared to follow it. Regulation No. 29: General Rales Relative to Employees The hours of duty will be sot by the superintendent through the heads cf the different departments of the institution. Vacations and absence from duty mil be recorded and arranged for by heads of the departments of the institution, as designated by the superintendent. Only those employees as prescribed by lav/ will receive food and supplies from the institution. Members of families of employees will not be entitled to food or supplies unless specifically prescribed in the laws governing the State institutions. The superintendent shall keep or assign those persons necessary to keep a service record of each employee. When an employee resigns or is discharged, a report will be made to the director stating reasons for the resignation or discharge. Duplicate copies of these reports will be furnished for the Division of Personnel Efficiency, Transfer of Employees: Written consent of the superintendents concerned shall be required for the transfer of an employee who requests a transfer from one State institution to another. Such transfer must also be approved by the Director of the Division of Hospitals and Mental Hygiene and the Division of Personnel Efficiency before they are made effective. The law authorizes the director to transfer any officer or employee for special purposes. Employment; Before final appointment of any employee, the superintendent shall cause a physical and mental examination to be made either by himself or one of his pro- 12 fessional staff, and, even though otherwise qualified, the applicant shall be re. jected if he is found to have any of the following disabilities or conditions: 1* Mental deficiency of such a degree that the applicant is unable to carry on his routine tasks vd.th.out con- stant oversight or supervision, 2, Physical defects or diseases which prevent him from performing any or all the duties to which he may be assigned, 3, Marked emotional unstability, 4, Evidences of alcoholism or drug addiction, 5, Slouchy, dirty, or otherwise markedly disagreeable personal appearance or habits. Reemployment: The reemployment of an employee who has been discharged from a State institution may not be done without the written approval of the superintendent who disc ha rge d h im. Number cf Officers and Employees; The number of officers and employees for each institution will be sot by the Director of the Division of Hospitals and Mental Hygiene, Regulation No, 30: Correspondence All official correspondence with the Division of Hospitals and Mental Hygiene or with the Department of Welfare or with any other department of the State government shall be mailed by the superintendent to the Director of the Division of Hospitals and Mental Hygiene, The envelope shall be addressed to the director. Employees nay write to tho director, but any such letter must bo trans- mitted through tho superintendent who shall forward the letter with his remarks. Regulation No, 31: Correspondence with Relatives of Patients The superintendent has the authority to make such arrangements as he deems most feasible for the correspondence with relatives of patients concerning 13 the welfare of the patients. Regulation Ho, 32: Reports to be Submitted to the Department The director will inform the superintendent of all necessary reports to bo made to the department and what forms shall be used. Regulation Ho, 33; Care of Patients The institution was established for the primary purpose of care and treatment of the patients. It is the duty of every officer and employee to remember this, and conduct himself accordingly. Regulation He, 34; Admission Routine Each new patient shall be received in a special section of the hospital known as the receiving ward. There shall be a special ward for men and a special ward for women intended for the solo purpose of receiving and treating new patients. The requirements of the State admission or commitment laws must bo com- plied with in each admission. The physician assigned to the receiving wards shall personally receive each new patient, and they shall be assisted by the nurse in charge of the re- ceiving ward. The "Officer of the Day" shall receive new patients committed at night or any other tine when the physicians in charge of the receiving wards are not on duty. The clinical director will issue printed detailed instructions to nurses and attendants in each receiving ward for routine measures to be followed with each new admission. Every effort will bo made to give the patient a feeling of personal interest in his welfare. Regulation No, 35; The care of the patients’ clothing and personal effects shall bo pre- scribed by the superintendent in written instructions. 14 Regulation No, 36; Correspondence of Patients Every patient shall ho permitted to write to some relative or friend at least once in every two weeks, in the superintendent’s discretion. If the patient is unable to write but desires to send a letter, such letter should be prepared by a proper person at suitable intervals. If the patient has a guardian, the nail matter should bo disposed of ac- cording to written directions of the guardian or committee. Letters which are obscene, profane or otherwise objectionable, should be forwarded to the director, the guardian of the person, or disposed of according to instructions of the guardian or the clinical director. Regulation No, 37; Reports of Accidents, Injuries, Escapes and Suicides The superintendent or his delegate shall immediately investigate and re- port to the director all serious injuries or accidents, and all accidents or in- juries in which an employee may be culpable, all escapes wherein the patient is not returned within twenty-four hours, and all suicidal attempts through which the patient sustains an injury. In case of escape, vigorous search shall be made and the correspondent relative or friend be notified. One certain person employed in the institution shall be charged with the responsibility of carrying out all reports concerning the escaped patient. The local police need not be notified in the discretion of the super- intendent. Regulation No, 38; Records of Paroled Patients A record of parole shall be kept in each institution. Parole cards (Form No, H-16) shall be filled out in duplicate - one for the office file and one for the patient. 15 Regulation No* 39; No patient shall be permitted to leave the hospital on parole until he has a definite place to go, where he nay be expected to receive reasonable care. It nay be necessary to take a patient to the county judge for arrange- ment for care. Regulation No, 40; Burial of Deceased Patients Religious burial services shall be required when a deceased patient is buried in the institutions cemetery. Regulation No, 41; Immunization of Patients New patients will be immunized against small pox and typhoid fever as soon as practicable after entry, and when the physical condition warrants it. Regulation No, 42; Inspection of Hospitals Systematic weekly inspections of all sections of the institution shall be made by the superintendent or his staff. A record shall be kept in the form provided for this purpose by the superintendent. Regulation No, 45: Reports of communicable disease shall be made in conformity with the regulations of the State Department of Health, Regulation No, 44; Special Form to be Used to Report Injuries and Accidents, Report in Duplicate a. State vdiether accidental, etc, b. Whether rdtnessed by employees or patients, giving names, c. State disciplinary measures taken if employee was at fault, d. Names of those notified. 16 Regulation Ho, 45; Mechanical Restraint and Seclusion Me c hani c a1 Re st ra int: Mechanical restraint or seclusion may be employed only when it is necess- ary for surgical or medical reasons, or to prevent a patient from injuring himself or others. The signed order of the physician is necessary for the use of mechanical restraint, and the attendants shall be instructed in the proper application of mechanical restraint, A full report of restraint or seclusion shall be kept from day to day. Definition; Mechanical restraint consists of any apparatus that interferes with the free movement of the patient, and which he is unable to remove. Only the camisole and restraining sheet may be used. Ho patient may be continuously kept in restraint more than three hours0 If restraint is necessary for a longer time, the patient must be released for an interval and the restraint then be reapplied. This does not apply to the Feeble- Minded Institute, where the Superintendent nay use other special forms of restraint when approved by the Director of the Division of Hospitals and Mental Hygiene* Seclusion; A patient is in seclusion when at any time in the day or night he is confined in a room alone with the door closed so that the patient can not open the door from the inside. Seclusion may be used only on order of the physician. Dry packs shall not be used in the treatment of patients. Wet packs shall be used only as a therapeutic measure, on order of the physician. Records shall be kept of all restraint and seclusion. 17 Regulation No. 46: Visiting Days Visiting clays shall be designated by the superintendents, but Sunday shall be one of tho designated days. The hours of visiting shall be arranged by the superintendent between 10 A.H, and 4 P.H., as suits the work of the institu- tion, Attendants must not be permitted to discuss the patients’ condition with visitors, who should be referred to the physician in charge for all information, or, in his absence, to the "Officer of the Day", Visitors shall bo treated with courtesy. In turn the visitors shall be required to obey the rules of the institution. The superintendent is authorized to close the institution grounds against tho entry of curious, careless and noisy drivers of automobiles. Regulation No, 47: Employment of Patients Outside tho Institution No patient residing in a state hospital shall bo employed outside the institution for private purpose. Regulation No, 48; Patients Who Are Seriously 111 The correspondent relative of any patient who is seriously ill must be notified of such illness. The superintendent, the clinical director, and the chief nurse shall have a daily list of all patients who are listed as seriously ill, Tho religious requirements of tho seriously ill must receive the needed attention. Regulation No. 49; Statistical Data on Patients The monthly report on movement of patients shall be made to tho director within six days after the close of each month. In preparing statistical data, the State institutions shall follow the detailed directions of the following manuals: 18 Institutions for the Mentally 111; The Statistical Manual of the American psychiatric Association, Published by the national Committee for Mental Hygiene; Institution for the Feeble-Minded: The Statistical Manual for the Use of Institutions for Mental Defectives, published by the National Committee for Mental Hygiene* Regulation No* 50; Legal Protection of Patients The superintendent shall prevent the service of legal process on patients, or the signature of patients on checks, or the drawing of wills by patients, etc,, except upon order of a judge of a Kentucky court of record* A patient in a state hospital may endorse checks without reference to this order, if the money is deposited in the institution’s office to bo made available for the patient’s use, but not to exceed Fifty Dollars in one sum. An order against serving legal process should be posted in the front hall of each institution* Regulation No, 51; Transfer of Patients to Other Institutions of the State Written orders of the Director shall be necessary for the transfer of a patient from one State institution to another State institution. Regulation No* 52: Parole and Discharge of Patients No patient is to be paroled if in the judgment of the staff he is homicidal, suicidal, destructive or dangerous to himself or others. Information about the parolee shall be placed in the patient’s history* Escape shall be entered into the patient’s record* A patient absent one year shall be discharged* A patient held on a criminal order or a warrant by the U, S. Government, who has escaped and is discharged from the books, may be re-admitted on the orig- inal court order* The State shall not be liable to any expense incurred by a patient who is on parole* 19 The parole period shall extend to one year, or the patient nay be dis- charged in less tine, if the superintendent deems it advisable. Parole may also bo extended beyond one year, in the discretion of the superintendent. Regulation No. 53: Each attendant now on duty, and each now attendant, will be required to purchase a prescribed book on the care of mentally ill patients. All attendants shall be given at least twelve hours of instruction by the medical staff and the registered nurses. These classes should be held at least three times a year for new attendants. Regulation Ho. 54: The superintendent is authorized to assign office space to each assist- ant physician in that part of the institution where the physician may best serve the patients assigned to him. An office in the physician’s most important ward is considered the place for his best service. Regu1ation No. 55: All patients with active tuberculosis shall be segregated from all other patients and given special treatment for the care and cure of tuberculosis. A special section shall be provided for each sex. Regulation No. 56; Yi/henever notified by the proper authorities or responsible relatives that a patient has boon legally committed to the State mental hospital, the super- intendent thereof shall send one or more experienced attendants to call for the patient and accompany him to the hospital. In case of a female patient, there shall always be at least one female attendant assigned to accompany the patient to the hospital. 20 Regulation No, 57: Care of Narcotic Drugs The registered pharmacist, if one is employed, shall be held responsible for the care of the narcotic drugs. If no registered pharmacist is employed, then the Clinical Director must assume charge of the care of the bulk of narcotic drugs, A special locked container shall be provided for this purpose. A small number of tablets of the drugs in daily use may bo placed in a locked cabinet in the pharmacy. Each physician would have a key to this cabinet, and any one who takes a drug from the cabinet should record the date, the drug and its amount, and the name of the physician, in a book kept in the cabinet, A daily check can then be made within a few minutes. Regulation No, 58s Money Lending No employee in a State institution shall be permitted to engage in the money-lending business with employees as his clients, and no employee shall accept money as a gratuitous fee from any patient in the institution, neither shall he borrow money from any patient, nor barter with them. Regulation No, 59: An ’’Officer of the Day” (referred to in Regulation No, 34) shall be designated by the Superintendent in every institution except the Feeble-Minded Institute, All physicians on the staff shall bo required to take their turn at this duty except the Superintendent himself, and the Clinical Director, The term of duty shall be twenty-four hours, during which time the "Officer of the Day" may not leave the institution except by express permission of the Superintendent, who will designate someone else to take his place. The duties of the "Officer of the Day" shall be prescribed by the super- intendents along the same general lines as those required of such officers in hos- pitals operated by the United States Veterans Facility and the United States Public Health Service, but such duties must always include keeping a "journal of the Officer of the Day", making routine rounds of all wards after 10 Pel.!,, and being easily available and subject to call for every emergency. Regulation Ho, 60: The Superintendent shall keep an efficiency rating of every employee on blank forms provided by the Director of the Division of Hospitals and Hental Hygiene for that purpose. Frankfort, Kentucky, April 11th, 1939.