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APPENDIXES

APPENDIX A

MATERIAL SUBMITTED BY ASSOCIATION OF AMERICAN MEDICAL COLLEGES IMPACT OF FEDERAL ASSISTANCE IN MEDICAL EDUCATION FACILITIES CONSTRUCTION PROGRAM, UNIVERSITY OF MIAMI SCHOOL OF MEDICINE

To understand and appreciate the full implication of importance of possible Federal assistance in the construction of medical education facilities insofar as the University of Miami School of Medicine is concerned, it is necessary to consider briefly the unorthodox background of the school's beginning.

From 1886 until 1952, there were no facilities for undergraduate medical education in the State of Florida. Early in 1952, however, the University of Miami board of trustees reached the final decision to undertake the development of a medical school. Considering that the university was a comparatively young institution, being only in its 25th year of operation and having no financial support from tax sources, the decision was not lightly made. Several facets entered into the considerations.

As previously mentioned, there was no other medical school in Florida. Undergraduate students in medicine had to look outside the State for their education in medicine.

The university, dedicated to the philosophy of having an obligation to render service to the community and to the State, wished to include a school of medicine in its organizational framework to bring the overall stature closer to a complete university structure.

The greater Miami area presented a most logical site for the establishment and operation of a medical school. It was the most populous area of the State and had unsurpassed potential for providing well-rounded clinical opportunities for teaching and research.

Groups of forward-looking citizens encouraged the university to take this step which would benefit the community and State.

The State itself, recognizing the need to provide medical education opportunities, had offered a partial operations subsidy to the first medical school which would open in the State.

In consequence of needs and encouragements, the university opened its school of medicine in the fall of 1952, only 8 months after the decision to do so had been reached. Restricted financial resources of the institution necessitated improvisations. The State's offer of subsidy support carried no provisions for construction of physical facilities and, indeed, prohibited the use of any of the funds for building and operation of a hospital facility. At an outlay of less than $500,000 the university was able to remodel a former servants' quarters building on the Veterans' Administration reservation. This provided temporary and minimal space requirements for the preclinical teaching departments. An arrangement with the county of Dade to use the county-owned and tax-supported Jackson Memorial Hospital, located 7 miles away from the preclinical area, assured the development of clinical teaching facilities at the proper time.

The expense of this opening contrasts with the usual situation involving the outlay of four to six million dollars for the preclinical facilities and ten to twelve million dollars for the clinical teaching facility. The manner of the opening contrasts also in the time involved. Whereas, ordinarily, a year or two for planning and 2 years for building are required before a medical school can be opened for operation under the usual pattern, only 8 months were required for preparation prior to the actual opening of this school.

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Present status

In providing temporary housing for the preclinical departments, it was expected that permanent building could be undertaken before the demands of the school outgrew this temporary space. Failure of certain promises of financial assistance and the intervention of other critical aspects of the university have prevented construction of permanent quarters.

The building which houses the preclinical departments contains about 45,000 square feet of utilizable space. In this are the departments of anatomy, bacteriology, biochemistry, pathology, pharmacology, and physiology; the preclinical section of the medical library; administrative offices; students activities area; and one auditorium of small seating capacity. Student laboratories used in instruction, with one exception, were constructed to accommodate no more than 40 students at one time. Inasmuch as the classes have grown to twice this number at the present time, all laboratory teaching must be done by dividing the classes into two sections; this, of course, requires the faculty to devote double time to instruction.

The hospital used for clinical teaching was constructed as a service type institution. Although its facilities for handling the professional care of patients are unsurpassed, it was not designed to accommodate full-time faculty and personnel necessary to the school's operation, nor is adequate space available for classroom and conference type of instruction. Basic research areas are almost entirely lacking in the hospital proper.

To provide faculty offices, an abandoned area in the older part of the hospital was converted. As demands on this area outstripped its ability to accommodate more, odd rooms and corners have been stolen from the hospital's activities. The arrangement, of course, makes for wide separation of the faculty components and loss of intimate contact between departments.

Research activities of the faculty have been developed in whatever accommodations which were at hand or could be salvaged. These areas include a converted barracks building on a former Navy blimp base located about 15 miles from the preclinical section of the school and 22 miles from the teaching hospital; various areas in the temporary preclinical building which already is inadequate; a renovated ballroom in a former country club structure; and a remodeled mortuary adjacent to the teaching hospital.

Despite obstacles, the faculty's efforts have brought the status of the school to that of full approval by the American Medical Association and the Association of American Medical Colleges. In its present status, it is a new institution with minimal and temporary physical facilities. It has already made its initial contribution to the Nation's health resources through graduating two classes of new physicians, and through the conduct of research programs which total more than $1 million per year. Its immediate influence and its potential capabilities have resulted in several developments constituting the nucleus of an outstanding medical center for service, research, and teaching. The school will stand as the hub of this center in its ultimate development.

The need

Any new medical school has three basic needs in physical facilities. These are its basic instructional facilities in the preclinical areas, hospital facilities for its clinical instructional need, and adequate research quarters in which it can make its contributions to the advancement of medical knowledge and skills. The University of Miami School of Medicine has or soon will have two of these; namely, its clinical facility and its research building.

Excellent clinical facilities are provided in Jackson Memorial Hospital by the county of Dade. In the last 10 years, almost $14 million has been expended by the freeholders of Dade County to improve and expand the hospital. This institution is a component part of the school's resources.

Recently, and through provisions of Public Law 835 (Health Research Facilities Construction Act), a $2 million research building has been assured the school. Construction on this building is just ready to begin. Funds for its construction came in part from the Public Health Services and in part from university funds.

There remains, then, only the permanent building for educational programs to round out the school's permanent operations. A summary of the dollar need to provide such structure is presented.

Land for construction site. Already leased to the university on a 9-year lease by the county of Dade.

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If Federal funds can be provided for construction of facilities, the University of Miami School of Medicine will be benefited as follows.

Permanent facilities will be provided thus obviating such wasteful effort of faculty. Their attention can be turned to greater research effort which will reflect in contributions to the stockpile of medical knowledge and skill. Whereas at the present time, the school is privileged to admit up to 10 percent of each class from among nonresident applicants, but has never done so because of the paucity of physical facilities, an expansion of the classes by 10 percent could be accomplished.

In addition to regular medical students, the school will be able to accommodate a number of nonmedical students working in the basic medical sciences toward the Ph. D. degree.

By having adequate and modern quarters for its activities, the school can expand its programs to offer postgraduate educational opportunities to practicing physicians of this and other geographic areas. These programs will involve special attention to the Latin American countries which are so needful of the help of the United States in their medical advancement. Such programs are, we believe, a firm manner of cementing good relations with peoples who now are on the brink of communism and whose hemispheric assistance can easily be lost to our country.

WARD DARLEY, M. D.,

UNIVERSITY OF CALIFORNIA MEDICAL CENTER,
Los Angeles, Calif., March 20, 1958.

Executive Director, Association of American Medical Colleges,

Evanston, IN.

DEAR DR. DARLEY: In reply to your recent memorandum regarding Federal construction funds for medical and dental schools, I am listing the UCLA Medical Center building program items. These are student-expansion programs which would expand our basic and clinical science facilities to accommodate medicalstudent classes of 100 each. Our class size now is 50 students. This is divided into several units in order to phase in both the financing and construction stages. The basic sciences unit emphasizes the expansion of all the preclinical departments of the medical school, the animal facilities, the biomedical library, and administrative areas. The estimated cost for the project is $10,892,000. At the present time programs are being submitted by the clinical departments and hospital divisions for the expanded program which will include bringing the inpatient facilities from 312 up to 1,020 beds, and outpatient facilities for approximately 550 patients per day.

Expansion of the clinical sciences facilities to the level of a 100-medical-student class will require careful consideration of all parts of the hospital service areas, including dietary, housekeeping, clinical laboratories, surgeries, etc., as well as the expansion of the inpatient and outpatient facilities mentioned above. The estimated cost for this project is $15,143,000.

We are proposing that the first 2 years of a dental-school curriculum become a part of our basic sciences unit expansion, naming 1 division for dental education in each of the 6 existing basic science departments, and using medicalschool laboratories and other facilities jointly. The additional space required for this would approximate 12,000 square feet at an estimated cost of $540,000 if it it built simultaneously with the basic sciences unit mentioned above.

The cost of the last 2 years of the dental curriculum, including the clinic, has not been compiled at this time but probably will cost approximately $3 million. 28728-58-13

We still plan facilities for a school of nursing, $3 million, and a school of public health, $3,700,000, and sundry other items for parking, dormitories, etc., which add up to a tremendous sum. However, we would be able to expand our student body from 700 to approximately 2,500 students in the medical professions. Any Federal matching funds available would speed up the completion of these programs and lift a heavy burden from the State's financing problems. We have a special problem in California, particularly in the southern part, due to the immigration of a high population since the war. Even today our metropolitan area of Los Angeles is gaining approximately 500 new inhabitants a day-a rate which has remained constant since the war. Thus, our overall educational facilities are overtaxed and the medical professions need more educational facilities very acutely.

Cordially,

STAFFORD L. WARREN, M. D., Dean.

STATEMENT IN SUPPORT OF FEDERAL LEGISLATION FOR RESEARCH AND TEACHING FACILITIES CONSTRUCTION FOR SCHOOLS OF MEDICINE, DENTISTRY, AND ALLIED PROFESSIONS

In my capacity as dean of the University of Colorado School of Medicine, I am writing in support of proposed legislation to aid in the construction of research and teaching facilities for the medical schools of the country. At this time, such support is essential to the University of Colorado School of Medicine if it is to fulfill its educational and service objectives and contribute most effectively to our State and our Nation. The following brief summary describes our present situation.

The University of Colorado School of Medicine was founded in 1883 at Boulder, Colo., the site then and now of the University of Colorado. It has carried on in the field of medical education continuously since that date, either in Boulder or in Denver; since 1924, all 4 years of the medical program have been offered at the present University of Colorado Medical Center in Denver. The center proper consists of the school of medicine, the school of nursing, the Colorado General Hospital, and the Colorado Psychopathic Hospital. Construction of the center in Denver in 1924 was made possible to a large degree through the generosity of the general education board of the Rockefeller Foundation and by significant contributions from citizens of this area. Indeed, of the current valuation of $4,621,379 of our buildings and grounds, as set forth in the most recent auditor's report of June 30, 1956, 60 percent has come from sources other than the State of Colorado.

The facilities for the school of medicine were designed to accommodate 4 classes of 50 students each. When the present plant was constructed, the faculty numbered approximately 25 full-time members (all in the preclinical departments) and about 75 volunteer members. The Colorado General Hospital had 150 beds. Over the years, in response to the needs of our country for more doctors, our entering medical-school class has been expanded so that it now numbers 85, including up to 20 students from those Western States and the Territory of Alaska which themselves do not have medical schools. The full-time faculty has been expanded to almost 100, and the volunteer faculty to almost 700. This increase of over 60 percent in student body has not been accompanied by a comparable increase in teaching facilities, preclinical or clinical. Although the Colorado General Hospital has, by the addition of 1 wing, been increased to approximately 275 beds and the Colorado Psychopathic Hospital, built in 1924, adds 78 beds for the mentally ill, the teaching bed total is far short of that needed, and makes necessary a number of extramural affiliations which, though valuable, limit the efficiency of our educational efforts.

In addition to the very marked increase in the number of medical students being educated each year by this school, there are also approximately 225 interns and residents receiving graduate training in the various specialities of medicine and approximately 25 candidates for the doctor of philosophy degree. The school of nursing numbers over 500 students (undergraduate and graduate), and there are 75 students in the paramedical areas, such as medical technology, X-ray, physical therapy, etc. Each year almost 3,000 physicians come to the medical school for postgraduate courses. From these figures it can be readily seen that the educational mission of the University of Colorado School of Medicine and its associated programs has grown remarkably during the past 35 years,

and plays a very significant role in the training of physicians, nurses, and technologists, at the same time rendering a very large amount of medical service to the 8,200 admitted inpatients, and the large ambulatory load comprising 140,000 outpatient clinic visits each year at the medical center.

Those who have been trained at the University of Colorado Medical Center over the years have gone forth to serve not only the residents of Colorado but citizens of the United States as a whole. Indeed, our medical graduates are to be found in all but 2 of the 48 States, and significant numbers have settled both in Alaska and the Territory of Hawaii. At present there are over 2,400 living graduates of the school of medicine.

At this critical time in our Nation's history, when the demands for physicians and other trained health personnel are increasing because of our expanded population, we have just completed an exhaustive survey on our own situation, particularly in respect to our needs for the next 25 to 50 years. Participating in this study have been members of the faculty as well as many other especially qualified persons. On the basis of our findings we have projected an overall program, designed to make up for our deficits and to provide us with the proper facilities for the years ahead. This "master plan" has been approved by the board of regents of the university, and includes necessary physical expansion of the schools of medicine and nursing and their affiliated programs, a new hospital of 405 beds to replace the obsolete Colorado General Hospital, and a new school of dentistry to accommodate 50 students per class. The medical school entering class will be increased to 96 students, and additional increase in numbers of graduate students in the basic sciences (a group sorely needed as teachers and investigators) will also be possible. Finally, improved medical care for a larger segment of our population will result. The plan envisions adequate teaching and research space as well as modern patient care facilities, to be built as economically as is consistent with effective operation. The new structure will be built so as to permit future expansion when needed.

Several years ago the Legislature of the State of Colorado appropriated something over $6 million from a 10-year special mill levy toward the revitalization of the medical center. The proposed building program, as approved by our board of regents, will cost approximately $18 million. In short, unless an additional $12 million can be obtained, implementation of this program cannot take place. It is the unanimous view of all those concerned that the medical center has too long carried on its activities in an inadequate facility, and all are agreed that anything short of the proper plan would be unfair to the faculty, the student body, and the very large number of patients cared for in the center. The completion of this project is essential to the continuation of the high standards of education and service developed at the University of Colorado over the years. The faculty and staff have performed in a dedicated manner over the years, despite inadequate salaries and facilities, because they have felt the great potential of this center, 1 of 2 university medical centers in the entire Rocky Mountain West, and this potential can now be achieved with proper financial help. All of us who have worked so long in the development of this program, however, recognize the need for Federal support if we are to achieve our goal. At its most recent session, the Colorado Legislature approved a general fund of $61,932,659. The State universities and colleges, as well as other institutions, are supported from this fund. The demands of all of the institutions of higher education within the State and those of the other State agencies are so great that there can be no doubt but that financial aid from other than State sources must be obtained if we are to meet the needs of the University of Colorado Medical Center. In order to raise the additional $12 million required, we will actively seek support from private donors and from the State of Colorado, but Federal help is essential.

There can be no doubt but what the University of Colorado Medical Center, if it achieves its present goal, will be in a position to offer far greater and more effective educational and health services not only to the State but to the country as a whole.

With a building program approved, availability of the necessary funds will enable us to move immediately into the new construction. Within a period of 4 to 5 years the entire project could be completed and the University of Colorado Medical Center would be in a position to fulfill in proper fashion its mission. It is therefore our real hope that the Congress will provide legislative support which will make available matching funds for the construction of research and teaching facilities for schools of medicine, dentistry, and the allied professions.

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