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The Federal Hospital Council provision of S. 191 is drawn in general terms, without particularization. However, the Senate record of S. 3230 should be taken into consideration by the appointive authority in making selections for council members.
It is noted that S. 191 provides that the Council may appoint professional and technical advisory committees. In our opinion there should be such committees, but they should be appointed by the Surgeon General, rather than the Council.
Now, if I may say a few words about the Priest bill, H. R. 5628. That bill requires that the Surgeon General shall prescribegeneral standards to assure that hospitals aided under this part are available to all practitioners in the community, who are licensed in the State, in accordance with provisions necessary to safeguard the quality of hospital services. We subscribe to that limitation, however, the last clause of the limitation, namelyin accordance with provisions necessary to safeguard the quality of hospital services, injects an ambiguity that may destroy the effectiveness of the provision. In lieu of that clause we suggest the following language: .and whose professional education has included training in a teaching hospital.
The public has a stake in every hospital, and access to the use of any hospital aided by this legislation should not be denied to any patient because of his choice of reputable licensed practitioner to treat him in that hospital, provided such practitioner has been trained in the use of hospital facilities.
During the hearings on S. 191 before the Senate Committee, the Medical Director of the Farm Security Administration pointed out that in areas there are hospitals which have so-called closed staffs, whereby only a few of the physicians in the area are admitted to the hospital. He stressed the evil of such a situation. Surely if the Government is to use the taxpayer's money to assist in providing hospital facilities for all the people, it should insist that any hospital receiving any benefits under this act shall make its, facilities available to the citizens of its locality and permit the patients the right to have any licensed practitioner attend them in the hospital without discrimination against practitioners of any school of medicine.
On December 28, 1938, at the invitation of the Government's Technicial Committee on Medical Care, the American Osteopathic Association made the following suggestions regarding hospital facilities:
Existing hospital facilities, including osteopathic hospital facilities, should be utilized to capacity before any new construction is sponsored in the areas served by existing hospitals. Any system of hospital care supported in any part from public funds should contain legal restrictions against discrimination due to the school of practice in managerial control of the hospital, or on account of the class of the hospital-namely, public, nonprofit, proprietary.
It is the aim of the American Osteopathic Association, the Associated Hospitals of Osteopathy, and the American College of Osteopathic Surgeons to promote the maintenance of high standards in osteopathic hospitals, just as it is the aim of similar organizations to promote high standards in medical hospitals.
There should be basic minimum standards for hospitals, the meeting of which would qualify a hospital for use by the hospital indigent, and for participation by the hospital in any system of general hospital care supported in whole or in part from public funds. The basic minimum standards so set should apply equally to osteopathic as to medical hospitals. We offer our cooperation for the definition of such a standard.
The osteopathic committee requests that Federal grants-in-aid for hospital construction and maintenance be made under certain conditions to be set out in the Federal law authorizing the grants, and that one of the conditions be that the applicant shall agree that patients shall have the right to be treated therein by regularly licensed practitioners of a school of practice of their own choosing.”
Mr. Gourley's testimony before you advocating that the Surgeon General have direct control of the allocation of funds for individual projects, without right of veto either by the Federal Council or a State Council, was not, of course, intended as an advocacy of Federal control of standards of maintenance and operation.
S. 191 provides for State control of standards of maintenance and operation with the exception that the Federally aided institutions shall be available to the people without discrimination. H. R. 5628 imposes another exception, that such institutions shall be open to all licensed practitioners in the community. We subscribe to the limitation and both exceptions.
Mr. Chairman, should this legislation be enacted into law, the American Osteopathic Association and the American Osteopathic Hospital Association can be depended upon for cooperation.
Mr. Priest. The second bell has run, which means the second roll call is now on, and it will be necessary for the committee to adjourn.
Before adjournment, without objection, a statement by Mrs. Thomasina W. Johnson for the National Non-Partisan Council on Public Affairs of the Alpha Kappa Alpha Sorority, statement on behalf of Citizens' Committee to Extend Medical Care, an additional statement on behalf of National Cooperatives, and statements by Members of the House of Representatives, may be inserted in the record at this point as though orally submitted.
(The statements referred to are as follows:)
STATEMENT BY MRS. THOMASINA W. JOHNSON, LEGISLATIVE
REPRESENTATIVE ON BEHALF OF THE NATIONAL NONPARTISAN COUNCIL ON PUBLIC AFFAIRS OF ALPHA KAPPA ALPHA SORORITY
Mrs. JOHNSON. Mr. Chairman and members of the committee, our organization, composed of 165 chapters, with a total membership of some 6,000, in 46 States, is vitally concerned about the status of the health of America and inadequate health facilities for meeting our tremendous health needs. We have attempted to do a demonstration job through our Mississippi health project, which has been described by Dr. Thomas J. Parran, as one of the best jobs of volunteer publichealth work he has ever seen.
The Alpha Kappa Alpha Sorority has long been interested in health as the basic need of all people and particularly as the greatest need of Negroes.
We urge the passage of this bill, with certain amendments that we believe will be strengthening. As facts and figures have proved, cer
. tainly the provisions of this bill will not meet the total health needs of this country, but it will be a step in the right direction.
We are satisfied that the principal health problems and the evident need for hospitals and health facilities have been well established in this and in previous committee hearings. There is a phase of the hospital need, however, which we believe has not been adequately emphasized. The problem of providing adequate hospital and medical care for Negroes, who constitute the largest minority group, is cer tainly a problem that must be equally emphasized if we are to provide adequately for the total health needs of the country. The Negro in America is cut off from many health benefits by reason of his location or residence in areas of America where there are no health services; or in areas where he is not admitted to such services; or in areas where his low-income status prohibits the purchase of these services. Because of these long-standing barriers the Negro in this country faces these handicaps:
(a) Negroes has a shorter life expectancy than their white neighbors by 12 years.
(b) Negroes have a 30- to 40-percent higher death rate than do whites.
(c) Negroes have a higher illness rate than do whites.
(d) The tuberculosis mortality rate among Negroes in the United States is reported to be three times as high as for whites and even higher in certain cities and certain age groups.
(6) Indications are that venereal disease is more acute among Negroes than among whites.
(f) The maternal and infant mortality rates show a disproportionate rate of about 2 to 1 for the Negro mother and child.
The health problem of the Negro, therefore, is a complex of poor medical care, lack of hospital facilities, restricted admission to existing facilities, poor hygiene and housing, low income, and lack of health education. For these very evident reasons his health needs are infinitely greater. Unless medical facilities are made available to the Negro patient, to the Negro physician, the quality of whose service to the patient will depend upon the type of facilities at hand and to the community as center for all health services—the total health need of the community will not be met, and will, indeed, be jeopardized because of the health status of its Negro population.
It is significant that the major health problems among Negroes are among those illnesses which could be best benefited under hospital care. For example, tuberculosis as the first major health problem requires hospitalization to assure inactivity, sputum examination, X-ray, nursing care, and, as far as the community is concerned, safety through isolation of the patient.
Heart disease as the second major health problem requires hospital care and rest enforcement not possible in the home.
Venereal disease, especially in the light of the new treatment, should have hospitalization to secure proper treatment and to prevent the spread of the disease by isolating the patient, thereby protecting the community.
Pneumonia, as the fourth major health problem, needs hospitalization to secure immediate typing of sputum, clinical and laboratory facilities, constant nursing care, and oxygenation.
Infant mortality and maternal mortality are health problems of major import. Both of these could be greatly reduced as has been proved through the maternal and health services of the Children's Bureau. Where health facilities are available and prenatal care, delivery, postnatal care, and baby clinics are available, this has been greatly reduced.
Even though the mortality rates for Negro mothers and babies are higher by 2 to 1 than for whites--in spite of these formidable factshospital accommodations for Negro mothers are unbelievably small. In southeastern United States, embracing 18 Southern States and the District of Columbia, there is either strict segregation under conditions unsuited to the care of the sick, or there is a complete exclusion.. Provisions for the care of Negro mothers and babies have been attempted on a small scale by developing the Negro hospital. In Mississippi there are two such hospitals with an aggregate capacity of 75 beds to serve 50 percent of the population with a tubercular rate three times higher than among whites.
These facts are emphasized with the hope that earnest consideration will be given to the distribution of the proposed hospitals and health facilities and to provisions for the care of the Negro patient through hospitalization, Clinical treatment, and the utilization by the Negro physician. Certainly the general public health can be no higher than the sum total health of every individual in the community nor the safety of all no more secure than the safety of each of us.
Our organization asked for certain antidiscriminatory amendments to the Senate bill which were essentially included. In the Senate version of S. 191, page 24, lines 17 through 24, ending with the word “group," there is a provision on discrimination because of race, creed, or color. The designated purpose for this provision was that this statute would prohibit inequitable distribution of separate facilities because of race, creed, or color. However, we believe that the orginal intent of this section is not quite clear where the word "provided” is used in line 21. We should like to change the word "provided” to "required by State law.” We should also like to change the word "shall” in line 20 of that section to "may.” Even though in a grantin-aid program which is to be administered and financed partly by a State, State law would obtain, hence, separate hospital facilities would be mandatory and the word "shall” would probably be correct. However, we prefer the word “may,” which is discretionary rather than mandatory. We should like to point out, however, that we are unalterably opposed to segregation in any form before of race, creed, or color. We are also usually uncompromising on the issue of segregation because or race, color, or creed. However, in the matters of health and education, where the need among the minority groups is so great, we face a reality and recognize the State laws, where the States are participating in these two fields, provided there is equitable and proportionate distribution of services, funds, and facilities on the basis of need. This attitude is to be in nowise interpreted as condoning, approving, or compromising on our basic principle on segregation because of race, creed, or color.
We should also like to amend section 633, page 38, subsection (b), line 24, after the word "activities," adding the following: "one of whom shall be a member of a minority group." We believe that it is important to have members of a minority group on policy-making levels and particularly is this important for Negroes, inasmuch as they are legally segregated from the rest of the population, in some form or other, in 17 States.
From time to time when seeking representation for Negroes on policy-making administrative levels, and other positions, we have been confronted with the argument that there should not be special
representation for Negroes since it is impracticable to have all other national groups so represented. The query sometimes posed is: Shall we have Irish, Italian, Polish, and German representation paralleling Negro representation? The query ought not be very puzzling, for the answer undoubtedly is that when Negroes are integrated into American society as are the Irish, Italian, Polish, and Germans, there will be no need for their having special representation. Negroes will then find their places in the natural course of events even as other racial and national groups do.
The fact is, however, that the Negro is, of all Americans, singled out for separateness in a very definite and peculiar way. The representatives of the general public usually do not represent adequately this separate group of people. It so happens that in much of the current general planning for communities, in the absence of unmistakable reminders when policies are being made, the Negro is simply forgotten. So long, therefore, as he is not integrated into the American social order as are other groups in 17 States, there is ample ground for asking for representation, because more often than not he certainly is not represented by the run-of-mine representation. If then the Negro seems to be seeking special consideration, that seeking grows naturally out of special separateness to which he is subjected, contrary to his wishes.
Many times the needs of Negroes are not met in planning groups because he is simply forgotten in planning bodies. This will insure that he be part of the planning group which is his democratic right as a citizen.
We should like to repeat our point of view on the payment of a certain percentage of the cost of construction, administration, and maintenance. We believe that in States and particularly certain areas of certain States where the need for health facilities might be greatest, the ability to pay would be lowest. We believe that the Congress should take this fact into considertation and attempt to meet this situation. In areas where these facilities
be most needed the State will not be able to pay even a small percentage and the United States citizens suffer and the United States pays the cost in loss of manpower in both war and in peace. How many potentially great people we have in America whose potentialities never reach fruition because of illness no one knows. Not only do we think it will benefit America as a whole to provide a floor on hospital and health facilities but we believe that the cost of maintenance should be borne completely by the Federal Government for at least a period of 3 years and that the cost of maintenance through a subsidized total budget on a progressively diminishing scale for a period of the next 7 successive years should be borne by the Government.
America has thought nothing of subsidizing States for roads and dams; for railroads; set up bird sanctuaries; and so forth—how much more important is the health of our citizens. We do not believe any citizen of these United States should be deprived of certain fundamental and basic human needs such as health, education, housing, and seo forth, because he lives in a poorer section of America.
We have gone a long way in America toward technological advancement; we have done a good job in conservation and use of our natural resources; our industrial progress is unbelievable; yet the point where