Views of Readers Hebert Hospital Decision For one thing, the "facts" supporting When no federal agency came for The studies went on through the Office, the investigatory arm of Con- The Navy first publicly advertised Hospitals and institutions, not only in In the final analysis, the Navy received and considered four serious proposals. They included Jo Ellen Smith Hospital, and organizations from In the meantime, the local HSA had The HSA receives $650,000 in tax dol- official. thing, and the story, and your editorial, On Dec. 19, 1978, the Navy author- The lease was carefully negotiated Has this process really been too What's more important is that we ernment. ROBERT L. LIVINGSTON, Member of Congress. Mr. McCLORY. Thank you. Mr. LELAND. Just as a matter of consideration on your part I would like to ask you, when you say that you did not understand the intent of the legislation that created HSA to be concerned with the areas that you have raised as questionable in terms of dealing with information delivered or given by the HSA in your particular area, can you be more specific about that? Mr. McCLORY. Yes; just almost immediately after the establishment of the local HSA, which I say I helped established, and the personnel is made up of the largest number of people that I know, shortly after that there was an application on the part of the Good Shepherd Hospital to construct a new hospital, and there were extensive hearings which were held by the HSA and they considered all the health needs, the existing health care facilities that we had and where the hospital could be best placed to serve the maximum needs of the area and what the health needs were in the area that could be served by that hospital. It took up a lot of time. There was a lot of public interest, but they resolved the thing very ably, I thought, and entirely consistent with what I thought the HSA function should be. Then apparenty there were no further activities for them to carry out as far as whether we need more nurses or doctors or less or whatever, and so they got into this broad subject of what kind of advice should they give to everybody in the district, all the municipal bodies, the schools, the families, as to what advice they should give with regard to personal habits and personal conduct, with regard to all aspects of health needs, I suppose. They commented then with regard to healthy and unhealthy habits and practices and of course got into this very inflammatory subject of abortion and contraception and family planning advice to teenagers and in the schools. There was some discussion of utilization of motion pictures that had been developed by the private family planning agency, which was all right, but they were getting into this subject of whether or not these should be displayed in schools and public groups and be on public display and things like that. This stirred up all the prolifers and all the profamily planning, and it seems to me the whole subject of health care practically deteriorated into a discussion and a controversy about these very sensitive areas. They wrote all kinds of feature articles in the newspapers, "Church-State Collide on Sex Issues." These are feature stories, "Pro-lifers Try to Get Health Agency out of Family Planning." I just think we lost the respect and support for the HSA's for doing the job that I think we intended they should do. I do not think these non professionals are qualified in these areas, and I do not think we should cloth them with the authority to advise everybody in these areas. We have mandated that they should have consumers on there, that they should have nonprofessionals, which I think they should have, because if we are considering the health care needs of the area I think we should have the public represented and I think we should have consumers, people who have to pay the bills. But to charge those people then with a sophisticated advisory role with regard to family planning, with regard to ciga rette smoking, with regard to public water supplies, with regard to gun control, they can take over the whole subject of human conduct and we would be mandating it from Washington, D.C. Now that is the absurdity of this thing when we clothe people with some authority and then they exercise an excess of authority. So what I want you to do is cut this authority down to size. Let it fulfill the intent of providing what the health care needs are in the area with regard to what hospitals we need, what clinics we need, maybe diagnostic laboratories that we need, what nurses, what nursing homes, what nursing care, all kinds of health care facilities. But to have them taking over the President's physical fitness program, for instance, why should they? That is covered already. This is so absurdly duplicated. There must be dozens of agencies that are duplicated by these HSA's in their advice and in their reports. Mr. LELAND. I have no further questions. Are there any questions by my colleagues? Mr. MCCLORY. I might say, Mr. Madigan, my colleague from Illinois, was instrumental in helping get this particular HSA established so it would be locally controlled and administered, and it is. But for a while at least it took on a role which was beyond anything we ever contemplated. Mr. PREYER. I just wanted to thank Mr. McClory for his vigorous presentation. We will try to keep HSA's out of rural government. Mr. MADIGAN. Mr. Chairman, I was not here to hear all of Congressmen McClory's presentation, but I have often been impressed that he should be the man in charge of health planning for the whole country. We celebrated his 71st birthday several weeks ago, and as you can see he has more vigor than any of us. I do appreciate you coming by and helping us this morning. Mr. LELAND. On behalf of the committee, happy birthday. Our next witness is our colleague from the great State of Louisiana, my next-door neighbor, the Honorable Bob Livingston. STATEMENT OF HON. BOB LIVINGSTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF LOUISIANA Mr. LIVINGTON. Mr. Chairman, I would like to thank you and the members of the subcommittee for permitting me to testify before you today about certain provisions of the National Health Planning and Resources Development Act of 1974, and on proposed legislation to amend the act pending before the subcommittee. I might add that I may be submitting in a very short time some additional recommendations that I would certainly hope the subcommittee would consider in their endeavors. Mr. Chairman, it is not my purpose to appear before you as one who ignores the need for orderly, efficient and inexpensive delivery of health services to the people of this country. In fact, I understand and concede that there is great merit in the proposition that proper planning of the health service industry will provide exactly those benefits, and that the 1974 act has gone far to provide such planning. But the act, as it currently stands, is not without its problems, some of which require immediate attention. It is my personal belief that this subcommittee can do much to ease those problems. For one thing, the legislation before you is very complicated, so much so that a colleague of ours here in the House and a member of your general committee frankly stated, during the House debate on the original authorization bill last September 18, that he "did not completely understand the bill and was not sure that many of his colleagues understood it." I believe that that would extend to the entire bill itself. He is not alone. In many instances, the bill is incomprehensible, particularly in its reference to composition of board members. But more importantly, the very conceptual basis of the act requires careful analysis, particularly now that we, the American people, have had an an opportunity to test the bill through practical application in the real world. I cannot speak for any other district, but I can speak for my experiences with the New Orleans Area/Bayou River Health Systems Agency. Funded last year with approximately $650,000 of U.S. taxpayers' dollars, the agency is an autonomous nonprofit corporation structured for the benefit of health consumers and hence, the citizens of the metropolitan New Orleans area. The planning area takes in 11 parishes, encompassing as broadly diversified geographical interests as exist in this country. There is the great urban center of New Orleans on the one hand, and rural farm land and small southern towns on the other. There are cattle farms, sugar growers, fishermen, suburbanites, urban businessmen, rich and poor, black and white. So the HSA attempts to plan health care for everyone, and it is a tall order-perhaps too tall. I would like to submit for the record an account of my experience with the local HSA-over the disposition of the F. Edward Hebert Hospital. I will not go into detail now, but I would like to touch on a few of the major problems that I undertook and faced during that time. By virtue of its autonomous corporate structure, the HSA answers to no one, and therein lies the rub. The staff of the local HSA has treated its statutory responsibility with dictatorial authority-without reason or common sense, and most importantly, without fear of being held accountable for the use or misuse-of the federal funds appropriated to it. Mr. Chairman, I would like to state for the record, even though my written statement does not reflect it that in most instances, except where I refer otherwise, that I am basically talking about the staff of the HSA rather than the board members who are serving as public officials in their functions and are serving to the best of their ability. Irresponsible statements have emanated from staff officials, which have self-servingly justified HSA positions, but which have flown in the face of well-considered decisions of the General Accounting Office, the House Armed Services Committee, the U.S. Navy, the entire Louisiana congressional delegation-Senators and House Members alike-and all concerned State elected officials including the Governor of Louisiana. The HSA failed to comment when the GAO and U.S. Navy were studying alternative uses of Hebert Hospital. Later the staff insisted on spending $27,000 of taxpayers' funds for a similar study, which was then not used in developing a staff position. The staff presentation was made, not with the intent of presenting both sides of a question fairly and impartially, but with blatant bias and preconceived direction which guided many unwary board members, not to a position of truth, but toward the position sought by the staff director. National guidelines were imposed by the HSA on isolated geographical areas with equal intensity as those imposed upon highly dense urban areas. The general rule of 4 beds per 1,000 in an urban area was said to apply to the entire metropolitan area of New Orleans, ignoring the real problems of one section, separated by the Mississippi River, which has only 2 beds per 1,000. Simple inquiries about expenditures of Federal funds were left unanswered until I pushed for those answers. Then when I inquired as to the facts behind staff actions, I was accused of threatening and intimidating staff participants and consultants. Inquiries with HEW about staff actions were met with a proverbial shrug of the shoulders, with responsible HEW officials admitting they had no line of authority over, and no responsibility for, HSA officials. High inflammatory statements were given by HSA officials to the press, but copies were denied to my congressional staff. This from an agency supported by Federal funds. Open meetings were held under carefully orchestrated restrictions, allowing great amounts of time for presentation of staff positions, and very little for opposing views. I might add that as the U.S. Congressman for the district in question I was told that I had only 3 minutes to summarize my own position, and, indeed, was told to sit down and be quiet by one of the board members. You can imagine, Mr. Chairman, I did not like that. A public meeting was held on one occasion, yet the vote was not taken in public, but by secret ballot. Mr. Chairman, I bring these matters to your attention, together with a file from a concerned constituent [see p. 413], who has dealt with the same HSA on an entirely unrelated matter. I would like to file that in the record with your permission, Mr. Chairman. It expresses my own sentiment that the current law allows a local HSA far too much latitude for independence, to such extent, that if such power and control over massive Federal funds falls into the wrong hands, health planning for an area may not only be frustrated, but in fact may severely and adversely impact a given health service area. My recommendation, Mr. Chairman, is that immediate steps be taken to eliminate the autonomous structure of the nonprofit corporation; to replace it with a public body, with the majority of its board members, say 30 percent, made directly responsible to, and appointed by, the Governor of the particular State. An additional 25 percent should be appointed by the head of each local governing body, and the balance of the board should be equally divided between consumer and medical community interests. I would add that the size of the board should be restricted to no more than 30, since any board larger than that becomes totally unwieldy; and that the board be given strict supervisory powers over all members of the staff, including the right to hire, pay, 46-585 - 79 - 27 |