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We have had the very dramatic illustration of the atomic bomb and the release of the atomic energy to demonstrate how vital it is that we work out some sort of relationship between laymen and experts.

It seems to me it has proved conclusively that laymen have contributions of value to make to experts, that it is not at all a one-sided proposition, that the scientist, however expert he may be in his field, needs the fertilization of contact with laymen and the people who are going to be affected by what he discovers, or the way in which he uses his knowledge.

I would certainly hope that, in this legislation, Congress would make a start towards setting a pattern of equal representation on all such boards.

In general, we believe that the amount of money provided in this bill is wholly inadequate to the problem. We are hopeful that it will be supplemented by later legislation, such as the prepayment plan that the President has proposed and which is embodied in a Senate bill which would help greatly to make up for the inadequacy of direct Federal' spending; in other words, there are ways in which can compensate without actually appropriating money.

We particularly like the new formula in H. R. 5628, because we believe it will help to channel money to those areas of greatest need, Perhaps the most important point I have to make regarding H. R. 5628 is in connection with the certification by the Surgeon General of funds to be made available to projects. Perhaps I have misread the intent of the bill, and I should like to find that out rather than simply testify on the bill.

It begins on page 16 of H. R. 5628. That clause (b) of section 625. The language in the first sentence reads as follows:

Upon approving an application under this section, the Surgeon General shall certify to the Secretary of the Treasury an amount equal to the Federal percentage of the estimated cost of construction of the project and designate the appropriation from which it is to be paid.

Well, now, that sentence has been interpreted to mean at least, by some people, that each project, that each hospital, individual hospital that is constructed, must be constructed with Federal funds that are exactly equal to the State's proportion. If that is true, then I think that is a serious barrier to the operation of the bill in rural areas; in other words, I should like to see some proviso in there that gives the State flexibility within its borders in allocating its share of the Federal funds to those areas most in need, so that the State is not bound to an exact determination of the Federal portion for hospital.

There is no need for my repetition of statistics on the greater need in rural areas. Everybody knows it. Everybody knows also that 60 percent of all of the children come from the rural areas. Therefore, as some of the lobar witnesses and others have pointed out when you try to deal with improving health in rural areas, you are not doing it just for farmers, because a large proportion of those children are going to cities later anyway. You are dealing with a national problem, and the only way you can reach that problem is by spending more money proportionately in rural areas than you do in cities. It simply cannot be met in any other way.

It is quite true that Congress would not be justified, in my opinion, in establishing an expensive system of rural hospitals based on farm

population and a production pattern that is going to change very rapidly in the next 10 years.

I think it would be very unwise to embark on that kind of a program, but I think, with the modification I have suggested here, that there is sufficient flexibility in the bill to permit the Surgeon General and the States to offer plans which will include such facilities for rural areas as scattered health centers, health mobiles, and other facilities of a type particularly adapted to those communities which could be contracted or expanded as the need appeared; in other words, you would not lose large sums of Federal money if you had a plan which called for the construction of large centrally located hospitals that were supplemented by other facilities and ambulance services to those hospitals.

I thank you, Mr. Chairman.

Mr. PRIEST. We appreciate your statement.

We will next hear from Mr. Gourley.


Mr. GOURLEY. I appreciate this opportunity of appearing before the committee. I am legal counsel for the Department of Public Relations of the American Osteopathic Association, and am pinch-hitting for Dr. Chester D. Swope, who is Chairman of that Department. Dr. Swope intended to appear and make a statement, but he is a practicing osteopathic surgeon here, so does not have control over his time, particularly at this time.

I do not have any prepared statement and would like to have Dr. Swope's statement incorporated in the record as though he had orally presented it, if that is permissible.

Mr. PRIEST. That will be entirely agreeable.

Mr. GOURLEY. Then I would like to comment on two or three items. There are about 11,000 osteopathic physicians, licensed and practicing in all of the States. There are more than 150 osteopathic hospitals. Those hospitals have been built by the patients and the doctors of osteopathy on their own, without any tax funds.

The osteopathic patients are taxpayers and they need assistance in this hospital program the same as others, so that if money is to be made available, then wherever it can be shown that assistance is needed, on the basis of relative need, they would expect to participate.

I may say that in their practice osteopathic physicians are licensed in most States to practice major operative surgery and engage in other practices that generally apply in the healing arts. And their education consists of 2 years premedical, 4 years professional, and many of them have at least a year's internship, most of them in recent years have such an internship. There are not enough osteopathic intern training hospitals at the present time to provide them all with extended internships.

The principal objective of the bill is provision of needed hospital facilities for patients and as necessary workshops for physicians.

Osteopathic physicians and hospitals are handling EMIC cases and are handling cases arising under the United States Employees' Com

pensation Act, as well as under the State workmen's compensation acts, in addition to serving the people generally. The additional hospital facilities to be provided under this bill would increase the efficiency of that service.

Mr. Chairman, a preceding witness stated that the Federal Advisory Council, as set up in the bill, would serve to protect the Surgeon General against pressure groups.

We suggest that there may be pressure groups inside the council as well as on the outside of the council.

When a similar bill was before the Senate a few years ago, S. 3230, there was a provision to provide that there should be medical, osteopathic, and scientific representation on the Federal Advisory Council.

The present bill is drawn is such general terms that there is no particularization. As a result there may or may not be osteopathic representation on this council, but whether there is or not, we think that the council should be stripped of all its administrative powers.

We do not think that it should be other than advisory. It is our experience that a number of these advisory groups are used as buffers, that it is a diffusion of responsibility, and we are unable to find out just who is responsible for what.

We think that that is a bad policy.

Another point is that since this is Federal money and not State. money, we think that the project applicant should be able, in the case of nonprofit organizations, particularly, to come directly to the Surgeon General with no need to go to State councils. The State government has no money involved in it whatsoever.

Mr. WINTER. They might have.

Mr. GOURLEY. There is no provision for it under this bill, as I see it. If a district in Kansas, a small town in Kansas decides that they want a hospital and they raise the money; that is, the people, patients and doctors, raise the quota, a sufficient amount of money, they submit their project to the State council and the council says, "Yes," or "No." The State does not put up any money.

If the State council says "Yes," then the Federal Government puts up the remainder within the State allotment.

There are no State funds involved, the way I understand the bill. The State is not putting up a dime in such a case.

If the State is not putting up a dime, why should a nonprofit organization have to clear through a State advisory council, just another hurdle, instead of coming directly to the Surgeon General. These are Federal funds that are being dispensed, exclusively. We do not think that the State council should control the allocation of the Federal funds.

We believe that we should be able to come direct to the Surgeon General.

We do not think that the Federal council should be other than advisory for another reason. When it comes to construction of hospitals, why, the Federal Works Agency has a splendid organization that has been dealing with community facilities, including hospitals, for years. They have an organization already set up and it is possible that they know more about hospital construction than a lot of the men that would be put on the council.

Why should we set up another Federal functionary and duplicate the resources that are already in existence? The Surgeon General should use the facilities of the Federal Works Agency.

Mr. WINTER. Who is going to make the surveys, then?

Mr. GOURLEY. The States may make the surveys; yes, the States should make the surveys, and the Surgeon General should be guided by those surveys, but should not be entirely controlled by them. He needs all of the assistance he can get. Most of the States are now engaged in making surveys. They are in the best position to do so immediately, but having made the surveys, we think the Surgeon General should have the final say, because these are Federal funds and he is a Federal administrative officer, and he should dispense the funds according to the merits and the need of the proposition.

Mr. WINTER. In other words, you would put it on practically the same basis as the Federal Works Agency operated; if a group wanted to start a project in a given town they would get their project ready and submit that to the Federal Government?

Mr. GOURLEY. That is right. If there is need and Federal funds are to be used, then it should be the Federal Government that passes on that application.

Mr. WINTER. Would you tie that in with the survey that you would have the State make; that is, the necessity of the hospital would have to be within that area in which the survey was made?

Mr. GOURLEY. We would not tie the Surgeon General exclusively to any certification of need by any State functionary; no, we would not. We would have the Surgeon General have the benefit of the State survey.

Mr. WINTER. In other words, the survey would just be more or less of an informative process?

Mr. GOURLEY. That is exactly so.

Mr. WINTER. And he could accept it or disregard it as he chose?

Mr. GOURLEY. We do not think that he would be disposed to disregard the survey, but it is my understanding that when the States submit their plans they will say where the hospitals are to be built and under what priorities they are to be built, and if there are hospitals already there, they will say which hospitals are to be included.

Mr. WINTER. Are we not going to have to draw that line somewhere. Do you want to give all of that authority to the Surgeon General?

Mr. GOURLEY. That is right. I want him to have the benefit of the surveys that are conducted by the States in the States. He would take all of that information into account.

Mr. WINTER. You would be giving him quite a job, would you not? Mr. GOURLEY. We are not so concerned about how much of a job an administrator has.

We think that it is his job to administer the program that Congress gives to him.

Mr. WINTER. What is wrong with this State set-up under S. 191? Mr. GOURLEY. What is wrong with it?

Mr. WINTER. Yes.

Mr. GOURLEY. Well, we think, as I have tried to point out, so far as the surveys are concerned, well and good, except that the Surgeon General should not be entirely bound by them.

If a group in Kansas wanted to build a hospital, felt that they needed it, they would have to submit their application to the State council. If the State council said "no," they would be stopped. They have no appeal, either in a court of law or otherwise.

They cannot come to the Federal Government. They are absolutely stopped. We do not think that is right. We do not think that a State Advisory Council should have control of the dispensation of Federal funds when they are entirely Federal funds.

Mr. WINTER. You want it to be State-wide and let any group that wants to make application for a hospital, that wants it regardless of what the State authority might say, to do so?

Mr. GOURLEY. That is right.

Mr. PRIEST. We appreciate your statement.


Dr. SwOPE. Mr. Chairman, it is a privilege to express to you the viewpoints of the American Osteopathic Association and the American Osteopathic Hospital Association regarding this bill, S. 191. During the course of my remarks, I intend also to advert to H. R. 5628 which has been recently introduced by the distinguished chairman of this subcommittee, Mr. Priest.

Inasmuch as my remarks on S. 191 when it was being considered by the Senate Committee on Educaton and Labor are available to this committee, I shall make my statement the briefest possible.

The osteopathic profession serves the people in all the States. There are approximately 160 hospitals registered by the American Osteopathic Association as meeting prescribed minimum standards. Many more are needed, especially in the rural sections where approximately 25 percent of the osteopathic profession is located. Osteopathic graduates are trained in the use of hospital facilities, and in many instances there is no available hospital to serve their patients. Many of the smaller communities have found it impossible to raise the money necessary to build and equip a modern hospital. They need help, either from the State or the Federal Government. S. 191 offers a vehicle for Federal assistance.

In doing so, the bill sets up a Federal Hospital Council, and invests that council with veto powers over the Surgeon General, both with respect to regulations and the approval of projects. We suggest that any Federal Hospital Council should be advisory only. We do not believe that such a council should control the disbursement of Federal funds.

A Federal council of an advisory character should contain a representative of the osteopathic profession and osteopathic hospital institutions. That such an inclusion is indicated is evidenced by the the fact that the Senate on May 30, 1940, passed a National Hospital bill, S. 3230, similar in many respects to S. 191, but providing for a purely advisory National Hospital Council of eight members, as follows:

The eight appointed members shall be selected from leading medical, osteopathic, or scientific authorities who are outstanding in matters pertaining to hospitals and other services.

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