Anything you want to add for the record, do not hesitate to do so. DR. DAVIS. I think I have covered the salient points. If The CHAIRMAN. I think you have presented the case very well. there is anything else that occurs to you, do not hesitate to add it. We certainly want to thank you very much for your statement. appreciate it deeply. Dr. DAVIS. Thank you, Senator. (A letter subsequently received from Dr. Davis follows:) We NATIONAL ASSOCIATION OF STATE MENTAL Hon. LISTER HILL, Chairman, Committee on Labor and Public Welfare, DEAR SENATOR HILL: It was an honor to be able to appear before your committee last Thursday to testify on behalf of our association in general support of the objectives of S. 3008, which amends the Public Health Service Act, providing for grants to the States for comprehensive health planning. You were gracious enough during my testimony to suggest that if we had further matter to add to our testimony your committee would be pleased to receive it. With your suggection in mind I have reviewed the proposed legislation with the board of directors of our association and it is their desire that I convey to you the following suggestion, which we think carries out the general intent of an exchange you and I had over the wide range of services to be covered in comprehensive planning and the impossibilities of any one individual having the professional competence to direct the entire program. It is our recommendation that S. 3008 be amended as follows: On page 3, line 9, after the word "agency" add a comma and add the following language "which may be an interagency commission." With this addition to the bill it would be clear to the States that the agency for health planning may be an interagency Health Planning Commission made up of those individuals in State government carrying direct operating responsibility for the several health, mental health, and mental retardation programs, each with coordinate status. Respectfully yours, V. TERRELL DAVIS, M.D., Director, Division of Mental Health, New Jersey. The CHAIRMAN. Our next witness will be Dr. Helen Taussig, president of the American Heart Association and professor emeritus of pediatrics at the Johns Hopkins Hospital. STATEMENT OF DR. HELEN TAUSSIG, PRESIDENT, AMERICAN HEART ASSOCIATION ACCOMPANIED BY DR. JAMES V. WARREN, PROFESSOR OF MEDICINE, OHIO STATE UNIVERSITY AND ROME A. BETTS, EXECUTIVE DIRECTOR, AMERICAN HEART ASSOCIATION. Dr. TAUSSIG. Mr. Chairman, I am Dr. Helen Taussig, president of the American Heart Association and professor emeritus of pediatrics at the Johns Hopkins Hospital. I am here to testify in behalf of the American Heart Association, on S. 3008, the Comprehensive Health Planning and Public Health Service Amendments of 1966. This bill is designed to enable the States to bring together the various State and voluntary health projects so that they may work_more effectively together and furthermore, the act urges the various States to develop their health programs in conjunction with the nongovernmental agencies to meet their local health needs. The American Heart Association is firmly convinced that the fight against heart disease requires the cooperation of the Federal Government, the State health departments, and the local voluntary agencies. In order to attain maximal effectiveness it is essential to have strong cooperation between the health departments and the medical societies, the medical schools and the voluntary health agencies; such as is planned for the regional medical programs. We believe that if the bill is well administered, it will increase the health and well-being of the community and it should also increase the effectiveness of the heart disease control program. We do, however, have a few specific suggestions. First, section 314(a)(1): Authorization gives the Surgeon General the power to make grants to States which have submitted plans. We recommend the establishment of a National Health Planning Council, similar to the National Advisory Council of the regional medical programs, and that said Council will review the programs and make recommendations to the Surgeon General, and that the Surgeon General must consult with, and may not act against the recommendation of said Council. The CHAIRMAN. You mean such as we have in the National Institutes of Health-each institute, as you know, has an advisory council. Dr. TAUSSIG. Yes. The CHAIRMAN. It meets three or four times a year. Dr. TAUSSIG. Yes. To repeat, we recommend the establishment of such a National Advisory Council. The said Council will review the programs and make recommendations to the Surgeon General, and the Surgeon General must consult with, and may not act against the recommendations of said Council. The Council should be composed of representatives of the various State and voluntary agencies concerned in the State planning, that is, the medical societies, the medical schools, the dental schools, and the principle voluntary agencies, such as the American Heart Association, the American Cancer Association, the National Society of Crippled Children and Adults, and Planned Parenthood. Next, in regard to section 314, section 2, the State plans a comprehensive State health planning, paragraph A reads "designated to provide for the establishment of a single State agency, as the sole agency for the administrating, supervising of the State health planning function under the plan." The bill should clearly state that the single State agency should in most instances be the State agency concerned with the public health of the community and if such is not the case, that such State agency should have strong representation on the planning council, as the program is concerned with State and community health. Section B calls for the establishment of a Health Planning Council. We believe that it would be wise to state definitely that the Planning Council includes representatives in the State and local agencies, such as the department of the state health commission primarily concerned with the health of the people, the heart disease control program, and the nongovernmental organizations which should have representation from the regional medical advisory council or councils, and the leading medical schools and dental schools, the medical societies, and the various health agencies such as the Heart and Cancer Association, Planned Parenthood, agencies concerned with vocational training and rehabilitation, and others deeply concerned with the health of the community. Furthermore, we believe that the hospitals that are concerned with the health of the community should have some representation on the Health Planning Council. Finally, in section B, it should be stated that the single State agency, although it need not always accept the recommendations of the Health Planning Council, cannot undertake the programs which are not approved by the Health Planning Council. Were such a provision not inserted, the Health Planning Council might be nothing but a "token" board, with no responsibility, as the health agency would not have to accept any of its recommendations and could act entirely independently from the board. Finally, in this connection on page 5, section H, which concerns the annual review of the program by the State agency, the review should be done in conjunction with the State planning advisory board. This also applies to page 11, line 3. Our next suggestion is that in order to be certain that these funds are used to supplement and not replace other funds, we recommend that on page 4, paragraph E, the wording be amended so that the funds could not replace either State or private funds. This might be done merely by adding to line 13 "available either from State or private sources." Our next recommendation concerns the project grants at the bottom of page 13. These project grants for areawide health service developments should be so planned that they are not at cross purposes with the regional medical program or programs, or with the medical practices and services already existing with the States. The American Heart Association has repeatedly testified concerning the shortage of manpower and the importance of training; therefore, we are in accord with the project grants for training, studies, and demonstration, but we urge that such grants should not only be available to public or private agencies, but also to persons in nonprofit private organizations and/or agencies. (This recommendation applies to page 8 (c), and (d), and also page 26, section 5, line 8.) The American Heart Association is even more deeply concerned about authorization of grants. In section 9, page 25, lines 18-20, enable the Surgeon General to "make grants under such terms and conditions as may be prescribed by the regulations for provision to public and nonprivate schools of public health, accredited by a body or bodies, recognized by the Surgeon General." We feel very strongly that this should be broadened to not only include schools of public health, but departments of public health within the medical schools, even in schools in which there are no specific departments of public health within the medical schools, the departments within the medical schools which are concerned with the health problems of the community should be permitted to apply and receive grants. Furthermore, in such States that do not have either schools or public health or medical schools, that the community hospitals concerned with the public health of the community should be able to receive grants to improve the health of their community. We believe this change is essential because of the extremely limited number of schools of public health in this country. I believe there are only 12 such schools in the entire United States of America. Those States which do not have schools of public health should be permitted to receive help through their medical schools, and where there are no medical schools, the States need help through the leading community hospitals. This recommendation also applies to page 26, line 2. Gentlemen, this concludes our prepared testimony. If there are further questions which I can answer, I shall be glad to do so. Thank you for permitting us to testify. of you. The CHAIRMAN. Well, Doctor, as you know, we are all very proud You and Dr. Blalock have been great pioneers in the field of cardiac and heart surgery. You were pioneers of the blue baby operation as we know it today. I notice you are professor emeritus at Johns Hopkins. Are you doing any teaching now? Dr. TAUSSIG. I am doing some teaching. This year I am working mostly with the American Heart Association. That takes most of my time. The CHAIRMAN. In other words, you are carrying the message to the people throughout the country, rather than concentrating on just a few classes at Johns Hopkins; is that right? Dr. TAUSSIG. Yes, sir. We The CHAIRMAN. Well, I think your suggestion is a good one. must consider the fact that we have only 12 schools of public health and recognize that a lot of education and training in public health is going on within our medical schools-our general medical schools, so to speak; is that correct? Dr. TAUSSIG. Yes. The CHAIRMAN. And we should seek to encourage and help that training as well as the training in public health schools; is that right? Dr. TAUSSIG. Yes. The CHAIRMAN. Well, I want you to know we are very much honored to have you here today. You are a lady and an American of whom I have been very proud for many years. We are grateful for the tremendous, wonderful work that you have done. We certainly appreciate very much your presence here and the statement which you brought to us. We are honored to have you. Is there anything you gentlemen would like to add? Dr. WARREN. I might just comment about two things briefly. Since I come from a medical school which does not have a school of public health, Ohio State University, our medical schools of our type are very active in the public health field, and I think it would be highly restrictive to exclude such schools from the benefits of this bill. So I strongly concur with what is said about that. The CHAIRMAN. Do you have a public health school in the State of Ohio? Dr. WARREN. No. The CHAIRMAN. Pittsburgh would be about the nearest school to you. Dr. WARREN. It depends on the original pattern. The University of Cincinnati has very strong interests. I am not sure I do not believe that it is organized as a separate school. It is a matter of the university organizational pattern. It is a department and a very strong and large one-not technically a separate school. The Heart Association has been interested for some period of time in the program of the heart disease control branch of the Public Health Service. We felt that there have been some reasons why this might be more logically transferred to the National Institute of Health. That is an intra Public Health Service decision. We do feel that this unit is doing an excellent job and would not want to see activities of this bill disrupt that, but rather supplement the activities. They are undertaking a very fine program and we would like to note that. Finally, with the increased activity almost day by day in the development of regional medical programs under the bill passed last year, those activities should certainly be coordinated with the activities of this bill, and there has been some expression of apprehension that the Council, the group set up in the regions under this bill, and under that bill, might possibly be in conflict. I think steps should be taken so that they would work in cooperation. The CHAIRMAN. Work together? Dr. WARREN. Yes. That is all I have to say. The CHAIRMAN. Anything you would like to add, sir? Mr. BETTS. Just one item, Senator. In one of my other capacities, voluntary, this year, I am serving as chairman of a committee on continuing education of the National Health Council. Along with you, we are very much concerned with this matter of manpower and training of existing personnel. So that we would strongly endorse the proposal in this bill for providing for training-but underscore what Dr. Taussig has already said-we should very much like to see this broadened to make it possible for employees or personnel, rather, of voluntary organizations and private organizations to receive the benefits of the training programs as they come into being through this kind of planning. This, I think, is referred to in one or two points in the specific suggestions we have made and in an accompanying memorandum, of which Mr. Barclay has a copy. The CHAIRMAN. We will have that memorandum appear in full in the record at this point. (The memorandum referred to follows:) Memorandum TO ACCOMPANY SUGGESTED ALTERATIONS to S. 3008, Submitted BY MR. BETTS, AMERICAN HEART ASSOCIATION The American Heart Association believes that any measure intended to improve health services and to administer more economically the funds that are made available by the Federal Government, is worthwhile legislation. The objective of far greater cooperation among all organizations and agencies concerned with the health of the people is most desirable. We assume that this may well be one of the principal results of the work that has been done by the National Commission on Community Health Services. Certainly, it is to be hoped that the bill now before the Senate will help to achieve this all-important purpose. We should at this point, however, like to mention that a year ago the Congress had before it another major piece of health legislation in the form of the regional medical programs bill, which was later enacted into law. We should like to stress the necessity for having the kind of joint or cooperative planning called for in the present bill coordinated at all points with the regional medical programs, in order to make certain to prevent overlapping of function or conflict of interest. Additionally, and a point which we should like to emphasize strongly, it would be our hope that as a result of this legislation the administrators of the Heart Disease Control Branch will finally gain the authority, which they have not had in the past, to plan and develop project grants. We do not presume to indicate where in the present bill such provision be made, but we do regard it as very important that this authority be conferred. |