1. Opening of full-pay pavilion, including reinstatement 2. Within-grade promotions on classified personnel and 3. Within-grade promotions and corresponding FICA Subtotal, "built-in"_ B. Program increases: 1. Improved staffing for nursing service: 5, 768,000 3, 909,000 2,420,000 6, 329, 000 +561, 000 283,000 20, 851 6, 972 1,188 312, 011 $142,357 154, 350 5. To maintain inventory levels in accordance with 31, 683 Decreases: Subtotal, program increases. A. Reduction in 1963 wage board pay increases funded in 1962 B. Reduced equipment purchases and related transportation costs-- 295, 232 607, 243 11,000 Subtotal, decreases Net increases_. EXPLANATION OF CHANGES 35, 243 46, 243 561, 000 Opening of full-pay pavilion. The increase of $283,000 in appropriations will provide for the opening of this area in 1963 rather than 1962 as originally planned because of delays in renovating and equipping this unit and thus ask for reinstatement of 104 positions originally authorized in fiscal year 1962. Addi tional reimbursements of $385,000 are budgeted at a rate of $38 per patient-day with a 90-percent collections experience; no reimbursements related to this unit will be earned in 1962. To improve nurse anesthetist staffing.-An increase of $18,400 is requested to provide three nurse anesthetists positions (GS-8), on reimbursable detail, to improve coverage in the operating rooms. To improve staffing in nursing service.-Since fiscal year 1961 a concentrated effort has been made to improve staffing in the nursing service of the general hospital. The 35 positions, 12 staff nurses (GS-6) and 23 nursing assistants (GS-3) is a continuation of this program. An increase of $154,350 is requested to provide these additional positions. Expansion of training programs.-The increase of $84,274 will provide for expansion of training programs to enable the hospital to make greater use of its resources to train in the scarce skills related to medicine. Among the items provided for are: (1) Expanded enrollment of student nurses, (2) new programs in the field of medical technology and nurse anesthesia, and (3) the initiation of a program to train as many medical residents as the capacity of the institution will permit. Maintenance of inventory levels. The average cost per issue for supplies and materials used in the care of patients has increased during the past fiscal year. The increase of $31,683 will permit the hospital to purchase supplies at the same level of consumption and eliminate the cutting into of critically low inventory levels. New positions requested, fiscal year 1963 Senator HILL. Dr. Burbridge, we are glad to have you back, and we will be glad to have you proceed in your own way. Dr. BURBRIDGE. Thank you, Mr. Chairman. I have a very complete statement that I would like to have appear in the record, but I would like to present my summary statement. Senator HILL. You may proceed as you wish, Doctor. (The statement referred to follows:) STATEMENT BY SUPERINTENDENT OF FREEDMEN'S HOSPITAL ON "SALARIES AND EXPENSES, FREEDMEN'S HOSPITAL" INTRODUCTION Mr. Chairman and members of the committee, Freedmen's Hospital, since its inception in 1865 as one of the original 13 installations of the Bureau for the Relief of Freedmen and Refugees, has been a federally operated installation. During this period, 97 years, it has been under the supervision of the War Department, the Department of Interior, District of Columbia, Federal Security Agency, and the Department of Health, Education, and Welfare. The immediate supervision of the hospital's activities has been delegated by the Secretary of Health, Education, and Welfare to the U.S. Public Health Service. Freedmen's has developed, in its near century of existence, into a hospital rendering service to a representative portion of the population of the District of Columbia and the surrounding counties of Maryland and Virginia. In addition to its patient services, research, and public health functions, Freedmen's Hospital also serves as the teaching hospital for the Howard University College of Medicine. In the 1st session of the 87th Congress, legislation was passed authorizing the transfer of Freedmen's Hospital from the Department of Health, Education, and Welfare to Howard University and approving construction of a new general hospital to replace the presently old and outmoded facility. Though the actual transfer of Freedmen's Hospital to Howard University has not been effected, much closer liaison has already been established with the university pending the effective date of the transition. It is anticipated that under university control and ownership the hospital will develop into an institution that the Federal Government and the university will be proud to display as a symbol of advanced thinking in the care of patients, research, and a training center for medical and paramedical personnel. SOURCE OF FINANCING The financing of the programs at Freedman's Hospital is made possible by funds received from the following sources: 1. Federal Government, through direct appropriation. 2. District of Columbia government and other legal jurisdictions for the care of their indigent patients. 3. Individuals, through direct payment or through third-party plans. PROGRAM FOR 1963 The 1963 estimates propose an increase of $561,000 in total available funds for obligation of which $176,000 is in direct appropriation and $385,000 from reimbursements from non-Federal sources. These additional funds will be used in the following manner: MANDATORY INCREASES In fiscal year 1963 there are four mandatory or built-in increases totaling $312,011 for which the hospital is requesting obligational authority. Specifically (a) the opening of the full-pay pavilion to patients, $283,000; (b) within-grade promotions for classified personnel, $20,851; (c) within-grade promotions for employees on reimbursable detail from Howard University, $6,972; and (d) the annualization of certain wage board increases which have occurred during fiscal year 1962, $1,188. It should be noted at this time that all of these mandatory increases are more than offset by increased reimbursements from non-Federal sources by virtue of anticipated income in the amount of $385,000 to be earned from patients hospitalized in the full-pay pavilion. 1. Increased staffing PROGRAM INCREASES The hospital is requesting the sum of $154,350 for 35 additional nursing service positions. In fiscal year 1961 a program was begun to bring the nursing service staffing in the general hospital up to a level recommended by the Public Health Service. A total of 55 positions has already been approved under this program and estimates for 1963 include 35 additional positions under the program. In order to improve the fiscal activities of the hospital, request is being made for an increase of $6,525 in order to strengthen the staffing in this area. It is the opinion of the Public Health Service that before any revision of the hospital's present fiscal activities may be accomplished, qualified personnel must be obtained in order to administer and to direct this program. 2. Improvement of nurse anesthetist staffing An increase of three nurse anesthetist positions, at a cost of $18,400, is being requested as reimbursable appointments from Howard University. The approval of these positions will provide improved coverage in the various areas requiring the services of nurse anesthetists and will eliminate the present problem of canceled operations due to lack of personnel. 3. Expansion of training programs The hospital is requesting an additional $84,274 for the expansion of existing training programs and the beginning of two new programs for the training of nurse anesthetists and medical technicians. A review of the hospital's medical resident programs to determine the full potential for training physicians in the various specialities indicated that 36 additional physicians could be accommodated. Recognizing the national need for trained medical personnel, the hospital is requesting that this expanded program be approved and funds be provided, over a 3-year period, to implement the total recruitment of 36 medical residents. The hospital is also requesting funds to appoint 3 nurse anesthetists and 12 laboratory technician trainees. The hospital feels that a real contribution will be made toward providing trained personnel in these fields in view of the present problems hospitals throughout the country are experiencing in the recruitment of these types of hospital workers. 4. Maintenance of inventory levels The hospital is requesting an additional $31,683 for the purchase of supplies and materials. This amount will not increase present inventory levels but will permit the purchase of supplies at the same rate at which it is estimated they will be consumed. CONCLUSION In developing the estimates for Freedmen's Hospital for 1963, the future transfer of Freedmen's Hospital to Howard University was an important consideration. The programs contained in the budget before you will in no way conflict with the future role of Freedmen's Hospital as a university owned and controlled installation. I wish to again take this opportunity of thanking this committee, Mr. Chairman, for the continuing interest it has shown in the development of Freedmen's Hospital. GENERAL STATEMENT Dr. BURBRIDGE. Freedmen's Hospital during its 97 years of existence has carried out its functions under governmental control. In the first session of the 87th Congress legislation was passed authorizing the transfer of the hospital from Federal ownership to Howard University. Though the actual transfer to Howard University has not as yet taken place, it is anticipated that the hospital under the university's direction will continue to develop, providing improved patient services through modern facilities and expanded training programs for medical and paramedical personnel. The 1963 estimates propose an increase of $561,000 in the total available funds for obligation of which $176,000 is in direct appropriation. This increase will provide for the following built-in items: (1) Opening of the full-pay pavilion for patient care; (2) withingrade promotions for classified and employees on reimbursable detail; and (3) annualization of wage board increases which have occurred in 1962. In fiscal year 1962 Congress approved 104 positions, 99 classified and 5 on reimbursable detail, and made available $193,000 in direct appropriations for the opening of this unit. Due to more detailed planning and increased costs, the original estimate of $127,000 for renovations and equipment had to be revised to $190,000. Because of unavoidable delays, the completion of renovations and the acquisition of equipment could not be accomplished by January 1, 1962, as originally planned, and this area will not be ready to receive patients until September 1, 1962. Request is being made in 1963 for the reinstatement of the 104 positions approved for 1962 and for $88,000 in appropriated funds in order that this area can be opened to receive patients on September 1, 1962. The program changes to be financed from this increase are: (1) 35 additional nursing service positions; (2) 1 additional administrative position; (3) improved staffing of nurse anesthetists; (4) expansion of training programs; and (5) increased supply funds to permit the purchase of materials at the same rate at which they are to be used. Mr. Chairman, this concludes my statement. I wish to take this opportunity of thanking the committee for the continuing interest that it has shown in Freedmen's Hospital. If you have any questions, we will be happy to answer them. BUDGET BUREAU ACTION Senator HILL. Doctor, did you get all the funds that you asked of the budget? Dr. BURBRIDGE. No; we did not. Do you mean our original estimate to the Bureau of the Budget? Senator HILL. Well, you had some reductions by the Department, itself, did you not? Dr. BURBRIDGE. We had some reductions by the Department and some reductions by the Bureau of the Budget. Senator HILL. What did the Budget reduce you? Dr. BURBRIDGE. The Budget Bureau reduced us $116,000. Dr. BURBRIDGE. This was for four items. First was a reduction in equipment and miscellaneous items, $10,000; 14 positions in the nursing service, $64,000; a decrease of 9 positions to improve staffing in other departments in the amount of $41,000, and miscellaneous changes for $1,000, for the total of $116,000. Senator HILL. You speak about your nursing service. Was that to employ more nurses? Dr. BURBRIDGE. That is right, nurses and nursing assistants. HOSPITAL STAFFING Dr. BURBRIDGE. Well, naturally, staffing is one of the most important factors in operating a hospital. We have always felt that we have not been quite up to the staffing needs of our patients. As a matter of fact, the hospital runs approximately 2.28 personnel per occupied bed and if these funds are approved we will run 2.4 whereas |