(B) To provide a higher priority in the construction of certain types of facilities, even though they may be under present provisions of the act. Considering S. 2758 in relationship to these purposes, the following comments are offered: 1. Chronic hospitals are clearly eligible for a construction grant under Public Law 725. 2. Nursing homes may be eligible under the act and could be brought under it by regulation even though that has not been true up to the present time. 3. All hospitals often care for patients who are chronically ill and certainly all facilities for the long-term care of patients should be planned in an integrated system as all classifications very much interweave and are interrelated and may wisely all be provided for in some communities in one unit. 4. The categorization of appropriations for chronic hospitals and nursing homes while admittedly giving a priority may lead to separate construction or may prevent the construction of other facilities which will generally contribute to the care of chronic patients. 5. No type of diagnostic or treatment facility for ambulatory patients seems to warrant a priority or need for Federal construction money which would justify a separate definition of facility and the priority given by a separate appropriation. 6. Categorization of facilities in 5 types which are but variations of hospitals will tend toward the construction of separate types of facilities where 1 facility might much better serve multiple purposes. 7. Separate appropriations for each of the types of facilities authorized in section 651 of S. 2758 will result in a very small allocation of money to each State and may well not be applied for in every State by any eligible applicant during the period for which it is available. 8. Two separate State plans for facilities which can often not be wisely separated seems cumbersome, and would better be handled in one survey. As we have tried to visualize the problems involved in carrying out the intent of S. 2758, we are concerned with the difficulties involved in establishing priority for the various facilities to be constructed. The funds as stipulated must be maintained separately and it will not be possible to shift funds from one category to another in the event it seems desirable to do so. If it is found through experience that there is little or no demand for funds in a State, for one or more types of facilities suggested in the proposed amendments, it would be well to allow the expenditure of these funds for other needed facilities. This would avoid the accumulation of especially allocated funds and major criticism of the overall program. All of the facilities envisioned under the present act and S. 2758 are believed to contribute to better health care in each State. With all the reservations as to the wisdom of the technical approach to accomplish the stated objectives in S. 2758, and with a definite impression that without correction wise administration will be difficult, it is suggested that at a minimum the following amendment would be helpful in correcting certain of the difficulties though it is realized that such an amendment would reduce the planned priority under S. 2758: Page 5, beginning with the word "Sums" in line 13, strike out through line 17 and insert in lieu thereof the following: "Sums allotted to a State for a fiscal year and remaining unobligated at the end of such year shall remain available to such State for the same purpose for the first 6 months of the next fiscal year (and for such 6 months only) in addition to the sums allotted to such State for such next fiscal year, and thereafter shall be available to such State for obligation during the next 6 months for construction of any projects eligible under part C of this title." We believe that a more effective accomplishment of the objectives of S. 2758 might be attained by the following amendments to Public Law 725, the Hospital Survey and Construction Act: 1. Define and include nursing homes. 2. Define and include rehabilitation facilities. 3. Assign priority to all facilities for the care of long-term patients with the exception of those for the care of mental illness or tuber culosis. 4. Require a reinventory and resurvey providing additional funds for Federal matching on a 50 percent basis with a minimum allotment to each State of $25,000. President Eisenhower, in his health message to Congress, recognized the need for additional hospital facilities and the major problem of the care of the chronically ill, and the ever-growing number of aged in the population. He has suggested that the Hill-Burton grants-in-aid program be utilized as a basis for working out solutions to these problems. The American Hospital Association is fully in accord with the President, both as to the seriousness of the problems and the need for a solution, as well as the wisdom of considering the Hill-Burton Act as a means of assisting in finding the answers. We are, however, greatly concerned that no amendment weaken a highly successful and workable program or fail to achieve the successful results which S. 2758 is planned to accomplish. The Hospital Survey and Construction Act was a nonpartisan proposal. The American Hospital Association is a nonpartisan organization. We believe that the health goals for the American people enunciated by President Eisenhower and by the sponsors of S. 2758 are universally acceptable, but that their successful achievement is more likely through modification by changes to the basic act which we are prepared to submit to the committee. The supplementary appropriation will, of course, be necessary as the President has recommended to further the objectives of S. 2758. We wish to reiterate our strong desire to cooperate with this committee and with the administration in the development of legislation to further meet the health needs of the American people along sound lines. Senator PURTELL. Thank you very much, Mr. Bugbee. Senator Hill, have you some questions? Senator HILL. Mr. Bugbee, how long have you been director of the American Hospital Association? Mr. BUGBEE. For 11 years, Senator Hill. Senator HILL. What was your work before then? Mr. BUGBEE. I was administrator of City Hospital in Cleveland for 5 years. Senator HILL. How large a hospital is that? Mr. BUGBEE. Fifteen hundreds beds. Senator HILL. Fifteen hundred beds. You were the administrator of the City Hospital in Cleveland when the present Justice of the Supreme Court and former Senator, Harold H. Burton, was mayor of the city of Cleveland; is that right? Mr. BUGBEE. I was. Senator HILL. At the time you went to the 1,500-bed hospital in Cleveland, that was considered a very large hospital, having 1,500 beds? Mr. BUGBEE. That is correct. Senator HILL. Before you went to that hospital where were you? Mr. BUGBEE. I was at the University Hospital in Ann Arbor in various administrative capacities. Senator HILL. How large a hospital was that? Mr. BUGBEE. Twelve hundred beds. Senator HILL. Twelve hundred beds. The reason I ask these questions is so that the committee may know of your experience and the basis upon which you give this testimony here today; and you not only represent the American Hospital Association, speaking their views, but views which have been arrived at, as you have brought out in this testimony, by different conferences and meetings that you have had throughout the country. You spoke of this particular conference you had about a year ago. In fact, if I may be frank with you, when some of us were seeking to get the Hospital Survey and Construction Act extended, we were not altogether happy that you had a lot of conferences over the country, but the fact is that those conferences made out a very fine and compelling case for the extension. Mr. BUGBEE. They did. Senator HILL. Is that right? Mr. BUGBEE. They did. Senator HILL. In other words, you not only sat in and helped all you could in writing this act, but you and your association through the years have kept in touch with its operation and have kept what we might call a continuing study; is that right? Mr. BUGBEE. We have tried to do so. Senator HILL. Of the act and its operations and results and effects? Mr. BUGBEE. That is correct. Senator HILL. Is that correct, sir? Mr. BUGEEE. That is correct, and it is very complicated legislation aimed at meeting an important need; and, to the degree we could, we have tried to be helpful. Senator HILL. These conferences which you had about a year ago took in every section of the country, did they not? Mr. BUGBEE. That is correct. There were representatives, I believe, from the State agencies and from hospital associations in practically every State in the country at the four conferences. Senator HILL. When you speak about these State hospital associations, of course, they are composed of representatives not only of your governmental hospitals, that is, hospitals run by government, whether it be a State institution or county institution or city institution, but also representatives of nonprofit hospitals and also, as well, representatives of private proprietary hospitals; is that right? Mr. BUGBEE. That is right, Senator. Senator HILL. So, you have a representation there and a cross section of the whole hospital field, whether the hospital is operating for profit or hospitals, private hospitals, operated for nonprofit, without profit, or whether they are governmental institutions; is that right? Mr. BUGBEE. I believe the association is very representative of the hospital field. Senator HILL. Let me ask you this question: The testimony that we had yesterday, I think, was pretty clear that if this bill passes it is going to take some little time, as we would expect, to get it really in operation. I mean as far as any construction is concerned. As I recall, and you can confirm this, it took some little time after we passed the original act before the States were able to raise their share of the money and match the Federal funds and make the surveys and then make the plans and then have those plans submitted by the State agencies and approved here in Washington; is that true? Mr. BUGBEE. That is correct, Senator, and S. 2758 does provide survey funds which would be matched by the States. I don't know how readily State moneys would be available. It conceivably might take some little time to have them appropriated. On the other hand, I think the State agencies are familiar with the State survey method and, to that degree, it perhaps ought to go more rapidly than it did before. Senator HILL. Even if they have the money ready and available today and ready to go forward, it takes some time; you can't make these surveys overnight, can you? Mr. BUGBEE. No, sir. Senator HILL. Then that leads me to this question: We have a declaration in the budget as to the $62 million, which would be authorized under this bill but, of course, that is not a budget estimate as yet, and it couldn't be a budget estimate until the legislation was passed, but we have a budget estimate for the next fiscal year of only $50 million. Now, isn't this true: That most of the things this bill would provide in the way of construction can be done under the original act? Mr. BUGBEE. Yes. Senator HILL. Is that correct? Mr. BUGBEE. I would think most of the types of facilities could be, Senator, though I believe there may be merit to making very clear that they are included. Senator HILL. I understand, but most of them could. For instance, a chronic hospital Mr. BUGBEE. There is no question Senator HILL. Chronic hospital is written out, and even the word "clinic" appears here, and outpatient departments for ambulatory patients, and those sorts of things. Now, what I am thinking of is: If we are only able to use $5 million, have only $50 million for next year, or most of next year, what will that do to the program if we have been carrying on now since about 1947, or thereabouts? Mr. BUGBEE. Well, I think the $50 million alone would be less than could be spent wisely-it is, of course, the smallest appropriation that has been made under the basic act. On the other hand, as we have suggested in our testimony, we are hoping that the suggested supplemental appropriation will be made for the broad purposes of the act, with whatever additional priority need be given the types of facilities described in 2758. Senator HILL. You would hope, then, that more than $50 million would be available this coming fiscal year? Mr. BUGBEE. Our association would certainly hope so on the basis of the need for the construction of facilities. Senator HILL. Did your surveys, the conferences you had here a year ago, and other surveys that you made show there is still a very great need for general hospitals, mental hospitals, and tuberculosis hospitals, as well as chronic hospitals? Mr. BUGBEE. The Public Health Service, of course, has the summary of the figures developed by the State plans, as to the degree of need for beds, but the 4 conferences held countrywide approached that same problem and there was much discussion as to the backlog of applications which could not be met out of the appropriations up to that period, and without exception the States reported that they had multiple applications for hospitals in areas where they were needed. Senator HILL. According to the testimony we had yesterday from the Public Health Service, there is a need if we continue through the Hospital Survey and Construction Act to meet those needs, the needs we have since the act was passed, or certainly since about 1947, for almost 600,000 additional general, mental and tubercular beds and some 240,000 chronic-disease beds. Mr. BUGBEE. Senator, it is a very substantial number. I would not be prepared to confirm those figures are necessarily exactly right, but we are far enough away from having needed beds so that it has not been a question of worrying about national overconstruction. Senator HILL. I sit as a member of the Appropriations Committee and I have heard a good deal of testimony. I know surely there is a crying need not only for general hospital beds, but for beds for mental patients; isn't that true? Mr. BUGBEE. That is correct, sir. Senator HILL. Isn't it true that so many of our mental hospitals and institutions for the mentally ill are terribly crowded and inadequate today? Mr. BUGBEE. Certainly the figures would prove that, and from what knowledge I have that is certainly true. Senator HILL. Do you have that article, Mr. Chairman, we read from yesterday, the article which appeared in "Hospitals," the journal of the American Hospital Association? Senator PURTELL. Having to do with the surburban areas? Senator PURTELL. Yes; we have it. Senator HILL. I don't know who is the author of that article. Senator PURTELL. I will be able to tell you in a minute. The writer is not identified, but there is the article. Senator HILL. Oh, yes. Thank you. Senator PURTELL. Page 69 of the "Hospitals." Senator HILL. Which is the journal of the American Hospital Association? Mr. BUGBEE. Correct. Senator HILL. This is the January 1954 issue. The article was captioned "The Road Ahead." |