STATEMENT OF DR. JOHN J. BOURKE, EXECUTIVE DIRECTOR, NEW YORK STATE JOINT HOSPITAL SURVEY AND PLANNING COMMISSION Dr. BOURKE. Mr. Chairman, Senator Hill, members of the committee: I have submitted a statement. Senator PURTELL. Is it your desire to present in brief form the statement, or do you wish to read the statement? Dr. BOURKE. I will read the statement, with your permission. Senator HILL. Why the word "Joint"-New York State Joint Hospital Survey and Planning Commission? What does that word "Joint" mean? Dr. BOURKE, That is because it represents the three departments having major responsibilities for hospital care Senator HILL. I understand. Dr. BOURKE. The Welfare Department, the Health Department, and the Department of Mental Hygiene. Senator HILL. Oh, I understand. Dr. BOURKE. In other words, it carries out the aims Senator HILL. Those are the three separate departments under your State government, and this commission represents the whole? Dr. BOURKE. That is right. Senator HILL. Fine, Doctor. I just wanted to get this clear in my mind, and for the record. Dr. BOURKE. Mr. Chairman, I should like to add a short statement to my prepared statement, if I may. Senator PURTELL. We will be very happy to have it. Dr. BOURKE. My testimony is limited to the medical and technical aspects of Senate bill 2758 and the related Hill-Burton program, in which I believe I am competent, namely, the provisions of the bill designed to secure community medical services and facilities for the patient and for the practicing physician. I do not believe that I am competent nor authorized to speak favorably or unfavorably with regard to the Federal-State fiscal relationships, those aspects of the bill, under discussion. There are other groups studying those items. Public Law 725, the Hill-Burton bill, as amended in 1949, has, in my opinion, contributed greatly to the health and improved quality of medical-care services in New York State. The program, administered by the New York State Joint Hospital Survey and Planning Commission, has been universally well received and has enjoyed the full cooperation and support of the medical and nursing professions. For example, after an inspection trip in 1951 to a number of the smaller Hill-Burton projects in rural areas, the president of the State Medical Society noted in a published statement that: "The provision of these hospitals, by meeting the needs of the physicians in the community, should enable them to render broader and better services to the people in their communities." In New York the program has mobilized the full participation and assistance of representatives of medicine, hospitals, agriculture, labor, industry, and other groups concerned with hospital care, at both the local and State levels. To date, 83 hospital projects are receiving Federal aid in New York under the Hill-Burton Act. Of these, 65 are in operation, 10 are under construction, and 8 are still in the design stage. Their total construction cost amounts to $93 million, of which $26 million is being met with Federal funds. Moreover, it is significant that 85 percent of the Federal funds have been assigned to projects under voluntary nonprofit and church auspices. Exhibit 1 illustrates that. Senator PURTELL. Without objection, that exhibit will be received and made a part of the record. (The exhibit referred to is as follows:) EXHIBIT No. 1. NEW YORK STATE JOINT HOSPITAL SURVEY AND PLANNING COMMISSION Construction status of projects approved to receive Federal aid, New York State, Jan. 31, 1954 1 At 65 different hospital facilities, 6 of which are sponsors for more than 1 project. Senator HILL. In other words, those figures show you haven't just sought to use these funds to particularly help out your State; isn't that right? I mean you haven't sought to just channel these funds into what you might call State or county institutions? Dr. BOURKE. That is right. Senator HILL. Is that right? Dr. BOURKE. There have been no funds allocated to State projects. I will refer to that briefly. Senator HILL. All right. Dr. BOURKE. I believe that the aims of the Congress in passing Public Law 725 have been realized, as evidenced by the number of small communities in the rural areas of our State which now, for the first time, have modern, well-equipped hospitals and more competent medical staffs augmented by younger physicians attracted by the new facilities. These communities probably would not have achieved this goal without the encouragement and assistance of the Federal program and many would still be operating their hospitals in hazardous, converted, frame dwellings and without proper equipment for effecting proper diagnosis and treatment. The requests from hospitals for Federal grants for the construction of new and expansion and improvement of existing hospitals have at all times exceeded the funds available to the State. In February, 1954, there were 119 potential hospital projects in the State with estimated construction costs of $343,218,139. These were on the basis of surveys made as to the individual hospitals. Approximately one-third of this cost was for projects envisaged under voluntary nonprofit and church auspices; one-fifth for Stateoperated mental and tuberculosis hospitals; and one-half for improving the municipal hospital system in New York City. And I have supplied an exhibit in that connection. Senator PURTELL. Without objection, that exhibit will be made a part of the record. (The exhibit referred to is as follows:) EXHIBIT NO. 2. NEW YORK STATE JOINT HOSPITAL SURVEY AND PLANNING Review of hospital projects in construction, architectural planning or discussion stage in New York State which are eligible for consideration of Federal aid for construction and equipment under the Federal Hospital Survey and Construction Act without reference to the availability of Federal funds, February 26, 1954. Summary of: I. General and chronic hospital projects approved on split-project basis with partial financing in fiscal year 1954-55. II. General and pediatric hospital projects programed, on basis of anticipated Federal funds for inclusion in fiscal year 1954–55. III. General and chronic hospital projects expected to be ready for consideration for Federal grant, fiscal year 1954-55, if sufficient funds were to be available. IV. General and chronic hospital projects expected to be ready for consideration for Federal grant, beginning fiscal year 1955-56, if sufficient funds were to be available. V. State mental and tuberculosis hospital projects. II. General and pediatric hospital projects programed, III. General and chronic hospital projects expected to V. State mental and tuberculosis hospital projects 3. 398,951 1 Based on intensive survey December 1952, revised on the basis of information currently available to the Commission. Estimated cost of this project fluctuating. # $1,870,459 allocated from available apportionments to New York State. Dr. BOURKE. Further evidence of hospital needs in New York is that the legislature has just passed a bill authorizing a public referendum on a $350 million bond issue for the construction of additional State mental-hospital facilities. Physical facilities, though necessary and desirable, represent only one aspect requisite for adequate hospital care. Therefore, it is most heart warming to report that in New York the Hill-Burton Act has stimulated communities to thinking about the relationship of their hospitals to other community professional and health services; that it has created an interest in the quality of care provided; and that it has encouraged architects, engineers, and the building trades to show ingenuity in hospital planning and in the use of structural materials developed during World War II. Moreover, the fact that the Hill-Burton Act required the development of a statewide plan for hospital construction has given growth to discussion among various interests in the health field addressed to providing more effective facilities, freeing many rural and small urban hospitals from isolation, and fostering an interchange of specialized medical skills between the medical teaching centers and the smaller hospitals. In brief, the interest created is resulting in a better understanding of the role of the hospital in serving its community more adequately. For example, in the course of planning, many of the smaller communities realized that it was neither feasible nor economical for them to provide the full range of hospital facilities and medical skills. Their answer was to develop working relationships with larger neighboring hospitals to insure good care for their people. To this end, they have made arrangements for the part-time services of radiologists, pathologists, specialized surgeons, and internists from the larger hospitals and teaching centers. This concept foreshadows the development of new administrative techniques and methods for the more adequate care of patients-for those in the hospitals, for those attending hospital clinics, and for those under care at home-if we are to avoid overbuilding and unnecessary costly capital construction. It brings into focus the need for nonbed facilities devoted to the prevention of illness and rehabilitation, wherever possible. Therefore, I respectfully recommend the passage of Senate bill 2758, which will assist communities to construct and equip muchneeded diagnostic and treatment centers, rehabilitation facilities, hospitals for the chronically ill, and nursing homes. Many authorities in the field of hospital planning recognize the expanding role for the general hospital into a focal point for the integration of the health services of a community. Such a hospital should provide preventive services as well as cure disease. Its facilities and staff should be devoted to the maximum rehabilitation of patients and concerned with the care of long-term illness and convalescence. These recommendations are consistent with the findings of the National Commission on Hospital Care, established by the American Hospital Association in 1945, which included representatives of the medical profession, medical schools, hospital trustees and administrators, industry, labor, and agriculture. Diagnostic and rehabilitation facilities: If the general hospital is to be of assistance to the local practicing physician and exert influence in decreasing the demands for bed care, its facilities should be made available to ambulatory as well as hospitalized patients. Medical successes in the communicable-disease field during the last 50 years have largely been due to the preventive programs of immunization, sanitary control of the environment, early case finding and, more recently, the effects of some of the newer drugs. Yet, this success is tending to change the character of the illnesses necessitating hospitalization, for many of the diseases and disabilities now becoming more important tend to be of a chronic nature. Here early diagnosis is essential, if the condition is to be arrested, and rehabilitation procedures are of prime importance if the patient is to return to a productive life. There Modern medical science provides diagnostic and treatment techniques, but many require elaborate and expensive equipment which the average practicing physician cannot afford personally. fore, if he is to have access to them, it is important that they be available at a center for his use if he is to detect disease early and achieve adequate, correct diagnoses. Similarly, rehabilitation centers could do much toward stimulating hospitals and physicians to return patients to normal activity, or at least to self-sufficiency. If located in the proper setting, they should be a vital force in improving educational programs for nurses, physicians, and rehabilitation technicians, and in lessening the burden of public support for many handicapped. Their efficacy and importance to our economy has been demonstrated by those sponsored by private interests and the success of the National Vocational Rehabilitation program. Therefore, the services of rehabilitation centers should be available to all and rehabilitation not limited solely to those for whom job opportunities are waiting. Rehabilitation is a concept and an attitude rather than a medical specialty. It should permeate all stages of medical care. Hence, the success of any rehabilitation program will depend largely upon the advice, assistance, and understanding which the medical profession brings to State and community planning. With regard to nursing homes, there are 8,000 beds in nursing homes in upstate New York generally housed in unsafe, overcrowded, converted dwellings. Most are operating under proprietary auspices. Half their patients are supported by public funds. Although these homes are rendering a greatly needed service, the question arises as to whether the quality of care could not be improved, rehabilitation be made more effective and quarters be made safer in better and larger facilities which could operate more economically. Preferably, these facilities should comprise units of suitable, wellequipped general hospitals which are capable of providing medical and nursing care of high quality. With regard to chronic hospitals, it is essential to distinguish between hospital and nursing home care of the chronically ill. The former is requisite for the patient needing active, clock-around medical and professional nursing care and observation which can be secured only through use of the range of services and equipment available in 46293-54-pt. 1-10 |