Dr. STEWART. No, I have not.

Mr. FOGARTY. I did go through it last fall. I was quite impressed with this program. They are giving regular medical examinations to their people. I think they had some 22 stations and 40-plus tests that would be made in these 22 stations. Then everything is fed into a computer at the end of the line. If something bad shows up it is picked up right away by the computer.

Mr. FLOOD. What is that setup, Mr. Chairman? What is it all about?

Mr. FOGARTY. When Kaiser first started building these huge dams out in the wilderness they had no medical manpower in those areas, and accident rates were quite high.

DR. GARFIELD'S CONTRIBUTION TO THE PROGRAM

In about the middle thirties a doctor got the idea-and he is still with the staff out there, though his name slips me right now

Dr. STEWART. Garfield?

Mr. FOGARTY. Dr. Garfield.

He was unpopular at that time because he tried to practice group medicine to take care of these people.

Now it has grown to where they have over a million members. In this particular project they examine about 50,000 people a year. It takes about 2 hours for a male to go through these 22 stations and about 3 hours for a female. By belonging to their organization it does not cost the individual anything, but it costs the organization about $22 or $23, whereas if you went to specialists in regular practice for these tests it would cost in the neighborhood of $200 to $300. Mr. FLOOD. What is the source of their revenue? How do they operate this?

Mr. FOGARTY. These are all members of the organization.

Mr. FLOOD. Annual fees?

Mr. FOGARTY. Yes. And they built their own hospitals out there with no Federal funds. I was quite impressed with it.

Mr. FLOOD. Any mental examination, psychiatric, et cetera?

Mr. FOGARTY. No. No dentist either. That is one fault I had to find with it. I thought it was a program that might be looked into as far as the Public Service is concerned.

Dr. STEWART. Mr. Fogarty, I am well acquainted with that operation out there.

Mr. FLOOD. Is there a prenatal clinic?

Dr. STEWART. Yes, there is. This is a prepaid program which covers ambulatory care as well as hospital care, and prenatal care is part of the package. They pay a premium. I think this automated screening program they developed out there has great promise.

Mr. FLOOD. How will it be affected by medicare on July 1?

Dr. STEWART. If their hospitals participate in the medicare program those who are eligible under medicare will be paid for through the medicare program as any other hospital. They happen to serve a defined population group, the members. But the membership is open to the community. I think it has great possibilities. The annual physical examination for, say, the population over 40 years of age in the country

would be literally impossible both from a cost standpoint and from the use of physicians. This obviously uses physicians very efficiently and has cut the cost down considerably.

Mr. FOGARTY. They are in on excellent position to follow this group for years. They keep all this data and are finding things now that will likely be of value to medicine generally. I remember one thing they told me, cancer of the breast in women over the age of 50 was just double that of under 50. This is one thing they picked up. They gave me several examples like that. I asked them to write to me, but I have not had a chance to read it yet. I was very much impressed with it and thought that something might be done in the Public Health Service along this line. Its value just for data gathering is something like the Framingham project on heart disease; that is, following a group of people over the years.

Dr. STEWART. Some of the base data which has gone into certain of the screening tests that occur in this complex of screening tests were developed in the Public Health Service. The diabetes screening is one, for example. The development of future screening tests which can then be incorporated into this automated system, I think is quite a field.

Mr. FLOOD. Is the diabetic treatment now almost entirely oral?

Dr. STEWART. No, it is not entirely oral. I do not know what the percentage distribution is between those who are oral insulin or injected insulin, but both are used.

POSSIBILITY OF SIMILAR PROGRAM IN CAPITOL

Mr. FOGARTY. I was thinking after I saw this, as long as the west front of the Capitol is going to be rebuilt, why wouldn't it be a good idea to have a screening process like this that would provide these services for Members of Congress and all the legislative employees. They would be given this examination once a year or twice a year. It could be used as an experimental project right here in the Capitol, and perhaps should be expanded to the whole government.

PREVENTIVE MEDICAL CARE PROGRAM IN DEPARTMENT OF HEW

Mr. CARDWELL. Our Department has a preventive medical care program for certain employees over age 40. This has also been extended to other departments. Is that not right?

Dr. STEWART. Yes, but it has not been automated and computerized such as this.

Mr. FOGARTY. They have the latest equipment out there.

Mr. FLOOD. That seems to be of great value, that is, this computerization. This seems to be the chief value. Otherwise it is just another place where physical examinations are given.

Dr. STEWART. That is right, it is only in the last few years that we have learned how to use computerized reading of an electrocardio

gram.

Mr. FLOOD. They have you on that card, Mister, and there you are. Mr. FOGARTY. They have detected many diseases in the early stages that would have been fatal if they had not gone through this battery of tests.

Mr. FLOOD. It sounds great to me.

Mr. FOGARTY. I hope you are able to see it sometime.
Mr. FLOOD. Is this a private nonprofit corporation?
Dr. STEWART. It is a private nonprofit corporation, yes.

COMMENTARY OF HARVARD GROUP ON REGIONAL CENTERS

Mr. FOGARTY. Now, on heart, cancer, and stroke, you hear some criticisms every once in a while on the regional centers. I have one brought to my attention:

"Researchers Criticize Regional Plan." Harvard group challenges primary purpose of national network of health centers. A Harvard research group recommends abandoning the plan for the nationwide network of research and patient centers proposed by the President's Commission on Heart, Cancer, and Stroke. In opposing the plan the researchers share a position taken by many groups of private physicians-if for different reasons.

Dr. STEWART. Yes, sir; I am familiar with that article.
Mr. FLOOD. What do they propose in its place?

Mr. FOGARTY (reading):

Rather than launching an effort against heart disease, cancer, and stroke the Harvard investigators urge an attack on infant mortality and deaths among young adults.

Dr. STEWART. Mr. Fogarty, my impression is that article was written based on the Commission report and not on the legislation. As you know, the legislation really was implementing 3 or 32 pieces of the some 30 recommendations of the Commission report.

Mr. FOGARTY. That is probably so.

Dr. STEWART. The legislation implements regional medical programs and not as they infer in their article a series of centers here and there which you visualize as a series of buildings here and there.

REGIONAL HEART, STROKE, AND CANCER CENTERS

Mr. FLOOD. I have always felt about this piece of legislation, that it sailed through Congress under false colors. I was for it then and I am for it now, but I am convinced that the average Member of Congress thought, as I did, that this was supposed to be what the President said in his message it was going to be, and all the speeches said it was going to be. But then when the time came to appear before the Appropriations Committee to get the money, it was something else altogether. We thought that there was to be a decentralized authentic regional heart, stroke, and cancer operation out in the provinces and heartland of America, where the people were. It did not turn out to be that at all. This is merely an implementation of existing large medical centers and you go out and bring the peasants in.

Dr. STEWART. No, sir.

Mr. FLOOD. Yes, sir.

Dr. STEWART. That is not correct.

Mr. FLOOD. If they are to be treated they still have to go to the bother and trouble and expense of going to the big medical centers that now exist and are going to be expanded. All that will happen out in the provinces, is to try to stir up the initiative to examine the people and encourage examination to discover these defects in time.

Dr. STEWART. I do not think that is quite correct.

Mr. FLOOD. Tell me what is correct. I have heard this story five or six times now.

LOCATION OF REGIONAL CENTERS

Dr. STEWART. The initiative is with the local region.
Mr. FLOOD. What is the local region?

Dr. STEWART. It is an area which contains enough people to use the highly specialized diagnostic and treatment techniques that have been developed in the university medical centers in the last few years.

Mr. FLOOD. And that almost is self-definitive. That means the great metropolitan areas and a few large cities which are not metropolitan, but out in the provinces they cannot meet the conditions you proposed. Dr. STEWART. The University of Vermont is proposing one which covers the New England area above Vermont into New Hampshire and Maine. The University of Virginia is planning all of Virginia except the southwest section of Virginia, which will be covered by North Carolina, which is where the people get their care at the mo

ment.

Mr. FLOOD. You still travel 300 miles.

Dr. STEWART. There is a problem here, Mr. Flood.

What we are talking about is the kind of diagnostic and treatment techniques developed recently. They have certain unique characteristics about them.

Mr. FLOOD. As far as treating the actual patient once the condition is discovered. I admit the initiative and momentum of increasing examination, to diagnose, to educate and get them in and have these facilities in smaller areas so that this will be identified at the earliest possible moment with a better chance of cure, this is good. But where got thrown off and where I think the average Member of Congress was thrown off, we thought something was going to be done about making this medical care more readily available to everyone, but we find out no. You have to go 300 miles and stay there for 6 months just like you do today.

Dr. STEWART. No, sir; Mr. Flood, this is not correct.

Mr. FLOOD. No? What is correct?

EXAMPLE OF HEART, STROKE, AND CANCER CENTER FUNCTION

Dr. STEWART. Let me give you an example.

Mr. FLOOD. Go ahead.

Dr. STEWART. At the present time let us take coronary heart disease, the intensive care of the acute attack. This takes a team of highly skilled people with monitoring devices and with ability to intervene with electrical devices in order to save your life for the first couple of days.

Mr. FLOOD. I understand you cannot have the hardware and skills and people in a town of 5,000 people with a hospital of 25 beds like you can have at the University of Pennsylvania. Even I know that. Dr. STEWART. You do not have to have it only in the University of Pennsylvania.

Mr. FOGARTY. Let him give the example.

Dr. STEWART. At the present time there is one in the Washington area which we put out as a demonstration in Holy Cross Hospital in Silver Spring. This is one other than those that are located at Georgetown and George Washington. There is no reason why we cannot have more of these out in the large community hospitals out in the area. You do not want to put one in every hospital because you have to have a skilled team and if they are only used once a month they lose their skills.

OPERATION OF THE REGIONAL CENTER PROGRAM IN WILKES-BARRE

Mr. FLOOD. I have 100,000 people in Wilkes-Barre, I have 5 hospitals, what happens?

Mr. FOGARTY. One hospital ought to have one of these units.

Dr. STEWART. One of those larger hospitals should get a connection with a university so they can get the trained and skilled people.

Mr. FLOOD. The University of Pennsylvania is only 21/2 or 3 hours away from me.

Dr. STEWART. The whole idea of the regional medical program is to get a way that the university can reach out to the community with these skills so that doctors in that community can get that service for that patient. On top of that you can build a continuing education program, a research program, for the doctors in that community.

Mr. FLOOD. Do you think the county medical associations throughout the country know this? Do you think what you are telling me is known? I did not understand it and I have been trying to figure it out for 2 years.

Dr. STEWART. Mr. Flood, it takes a while for this to get out.

Mr. FLOOD. Every guy sitting in that chair gave me a different story for the last 2 years.

Mr. FOGARTY. Not on this. This is something new. I saw it in Boston.

Mr. FLOOD. You are talking about this heart business.

Mr. FOGARTY. Dr. Farber, who has been before this committee 10 or 12 years now had a heart attack recently and this is what saved his life.

Mr. FLOOD. I am talking about the heart, cancer, and stroke bill, not just heart. You are talking about heart because you have exhibit A sitting here.

Dr. STEWART. No, sir; I will give you an example in cancer if you wish. The treatment of childhood leukemia.

Mr. FLOOD. Let us talk about the law on this heart, cancer, and stroke program.

Dr. STEWART. I am talking about the law. The idea is there have been new diagnostic and treatment techniques in heart, cancer, and stroke in the last 10 years which are in the university medical centers. If your doctor happens to know about them and you happen to live long enough to get there, you can use them.

USES TO WHICH FUNDS MAY BE APPLIED

Mr. FLOOD. Where is this $19 million of construction going on? Dr. STEWART. That is not construction.

Mr. FLOOD. I am talking about bricks and mortar.