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up that very question and in which they state that they would like very much the opportunity to deal directly with the Federal Government. I think, in other words, that perhaps there is a difference of opinion among these people and among the officials on it. It is not all on one side of the question, either way.

Mr. Brown. There must be, because your experience has been entirely different from mine.

Mr. PRIEST. I had one yesterday from a county court; that is, the judge of a county court, and

he indicated that they desired to build a county hospital in a west Tennessee county. He said, “We would prefer, so far as we are concerned, to deal directly with the Federal Government." They perhaps feared for some reason that they might not be included in the State plan.

Mr. BROWN. We have a Democratic governor in our State, but he is a good administrator. We do not have a bit of trouble on that score. We feel, in Ohio, we can still run our own business and do not have to have some paternalistic agency in Washington to tell us what to do, what to eat, what to sow, and what to reap. Let us get back to this one question, and then I am through, because I must leave.

This is your complete statement, as I understand it?
General FLEMING. I think so.

Mr. Brown. And you are very firmly in support of these amendments that have been proposed by the Public Health Service and supported by the President in his letter?

General FLEMING. I have not seen the Public Health Service amendments.

Mr. Brown. They fit right in, exactly, with your statement.

General FLEMING. I have studied the bill and I have studied the President's letter.

Mr. Brown. Those were the Murray provisions offered in the Senate which were defeated, or stricken out, by the Senate, but, as I understand, it is your position, that you favor these things here. That is the thing I wanted to know.

Mr. PRIEST. General, the amendments that my colleague, Mr. Brown, had reference to primarily were those dealing with the court's review and the administrative authority of the council set up in S. 191. I also have taken the position that both of those amendments, or rather, that the bill should be amended to strike out the court review, and also to leave the hospital council as an advisory council rather than an administrative council.

Those were the two, I believe, primarily, that you had reference to.
Mr. Brown. Yes, that is what his discussion is mostly about.
General FLEMING. That is right.
Mr. PRIEST. You may go ahead with your statement.

General FLEMING. The powers of the Surgeon General are actually subordinated to those of the State agency. Under the bill the Surgeon General is under a statutory mandate to approve a State application which meets the several requirements proposed. The State agency is under no such mandate. The expenditure of Federal funds should be administered by, and be under the control of, a Federal agency which can be held strictly accountable for the proper application of the moneys. The most direct way of assisting is also the best way, and that is by providing for the owner of the facility to treat directly with the Federal government.

grave doubts.

In any Nation-wide program in which the Federal Government participates it is extremely important that provision should be made for equality of treatment of participants in like circumstances. The bill makes no provision for this equality of treatment.

The method proposed is dependent upon the passage of additional legislation by each of the 48 States, the Territories, possessions, and for the District of Columbia. Whether citizens of the local communities will be willing for State legislatures, or some State authority, to control the expansion of local hospital facilities, particularly when the State makes no contribution in money for the purpose, is open to

The bill wisely relies upon the medical knowledge and experience of the United States Public Health Service. I can think of no more competent authority. But, with the greatest respect to the Public Health Service, I doubt if it is qualified to make judgments on municipal and private corporate law, finance, and construction. Heretofore in public works programs the Congress has entrusted such judgments to departments and agencies with experience and demonstrated skill in such fields. The location, the type, the size, and the equipment of a hospital are clearly matters for medical determination. Construction is not. I seriously question the propriety of setting up, as this bill would do, still another construction agency in the Federal Government to supervise the construction of hospitals.

I especially entertain this view because the Federal Works Agency, through its constituent organizations, is the foremost builder of hospitals in the world today, and I see no justification to embark upon the expensive duplication of the services it already is prepared and qualified to render, and which Federal Works was largely created to render.

The planning and construction of hospital facilities under a Federal-aid program are substantially similar to the planning and construction of other types of public works under previous Federal-aid programs administered by the Federal Works Agency. The necessary processes and techniques have been worked out and are available. They have been tested by long experience. The Federal Works Agency has the staff, as well as the experience, necessary for administering the construction aspects of a program of this scope. It is a going concern that has completed and is now completing programs not unlike that contemplated by S. 191.

Under titles II and IV of the Lanham Act the Agency since 1941 has built 872 hospitals throughout the country. The Public Works Administration, a former constituent of FWA, built 880 hospitals, and WPA, another former constituent, 226. And all this work was done through direct cooperation of the Federal Government and the participating communities. The total number of hospitals built under these programs was 1,878 at a cost in excess of half a billion dollars. In addition, 2,168 existing hospitals were remodeled or improved and additions were made to 156 others under the WPA program.

At the present moment the Federal Works Agency is assisting with advances of $3,422,200 in the planning of 169 hospital projects by local communities to cost $95 million, under the authority of title V of the War Mobilization and Reconversion Act of 1944.

The Public Buildings Administration, another FWA constituent, has a much longer history in hospital construction, having over many

years built for the Public Health Service 19 Veterans' Hospitals at a cost of $24,384,144 and 32 marine hospitals at a total cost in excess of $43,400,000.

I would, therefore, suggest that the committee give consideration to such amendments of the bill as would remove the objections raised by the President and which would entrust to public health authorities the medical determinations involved in the program, and to construction authorities the construction problems involved.

I trust nothing I may have said will interfere with the accomplishment of much needed assistance in the hospital field, but on the contrary that it may be helpful to the committee in arriving at a judgment that will make certain that such assistance will go forward without confusion and with due consideration of the time-honored proprieties of Federal-State relationships.

Mr. PRIEST. Are there any questions, Mr. Winter?

Mr. WINTER. General, you say in your statement that since 1941, under titles II and IV of the Lanham Act, you built 872 hospitals?

General FLEMING. Yes, sir. I might say that some of those, particularly those built in the middle stages of the war, were wooden, temporary construction, because no other materials were available at that time.

Mr. WINTER. Those were built entirely by Federal funds, were they not?

General FLEMING. They were built not entirely by Federal funds. In some cases they were 100 percent Federal funds, and in some cases they were grants of a partial amount of Federal funds.

Mr. WINTER. The funds contributed by other agencies, that was a very small percentage of it, was it not?

General FLEMING. No, in some cases--
Mr. WINTER. I mean, in the overall picture.

General FLEMING. I think in the overall picture, probably, pretty close to 50 percent was put by other agencies.

Mr. WINTER. And you built 872 hospitals under that program? General FLEMING. Yes, sir.

Mr. WINTER. And the Public Works Administration built 880 hospitals?

General FLEMING. Yes, sir. And in the earlier stages of Public Works, the Federal participation was 30 percent, and later on 45 percent.

Mr. WINTER. And the WPA built 226 ?

GENERAL FLEMING. That is correct. In that case, the overall contribution by the local authority was 25 percent.

Mr. WINTER. When did this program begin, is that right down to date?

General FLEMING. Yes, sir.
Mr. WINTER. In other words, since 1941 to the present time
General FLEMING. No, 1933, the beginning of PWA.

Mr. WINTER. From 1933 down to the present time you have constructed 1878 hospitals?

General FLEMING. That is correct, sir. I say we are the greatest hospital builders in the world,

Mr. WINTER. And have those hospitals been built, constructed, under any such program as contemplated in S. 191?

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General FLEMING. No, sir. Of course, the PWA and the WPA programs were programs to provide employment in useful public works. The Lanham Act program was to meet war needs in communities that had an influx of population and did not have the funds to meet these needs.

Mr. WINTER. And these hospitals, however, the local communities had something to do about getting the projects started, did they not?

General FLEMING. We did not build any unless the local community came to us and asked for it.

Mr. WINTER. And did you require any showing to support that, that they could support that institution after it was built?

General FLEMING. We did, in the PWA and WPA programs, but in the Lanham Act program we could not require that because they might lose all of their population when the war was over.

We required them to do this, they had to be able to carry them on during the war period. And now we are in the process, in cases where we built the thing entirely with Federal funds, of 'trying to sell it back to the community and get what money we can out of it.

First of all, we were able to sell quite a number of them and realized about 46 percent of what we put in, but those were the best cases and we are now not getting that much. We have just one customer to deal with in each case.

Mr. WINTER. In other words, what I am getting at is that the program that you would like to see continued and made a part of whatever legislation we may recommend in this committee, and the manner in which these hospitals shall be constructed

General FLEMING. I think the construction phase of it should be entrusted to a construction agency, that is all. Let the Public Health with advisory committees, or however the Congress wants it, decide where hospitals are needed, the type of hospitals, the size, how they are to be equipped; that is for medical determination, but when it comes to construction, I think it should be put in the hands of a going construction agency that has experience in hospitals. You have to know how to build them.

I think, with our experience, we have learned a great deal and know how to save costs in future operations by putting in features which we know should be there.

Mr. WINTER. In other words, whenever a particular site is selected for a hospital, you want your agency to construct that hospital?

General FLEMING. Either construct it, or, just as we did in PWA, not construct it ourselves, but supervise the construction of it and handle that phase, handle the funds connected with construction.

I do not say that we should go in and build it ourselves.

Mr. WINTER. I do not mean that you do the actual work, but you want to control construction, the size of the hospital?

General FLEMING. Not the size; that is a matter for medical determination.

Mr. WINTER. The plans and the over-all planning of the hospital? General FLEMING. Whether it is going to be 100 beds or 400 beds, when that is decided, then we step in the picture knowing what should be there for that type of hospital.

Mr. WINTER. You think that same thing is true in regard to the health centers?


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General FLEMING. Yes. We built health centers, too, many of them.

Mr. WINTER. You do not think the local citizens should have any responsibility other than selecting the site and the type of hospitals that they want?

General FLEMING. They have the responsibility, certainly.
Mr. WINTER. I mean in the construction of the hospital.

General FLEMING. The funds are turned over to them. They will be the contractors for it. But we will supervise that construction.

Mr. WINTER. What I am getting at is this, we have had testimony here about how the American Medical Association works their program of keeping certain classes and types of doctors out of certain hospitals, this same thing might work if put into one agency on the construction of these hospitals, that there would be no Federal funds available unless you did thus and so as set out by your organization.

General FLEMING. I cannot concieve of that kind of interference, because we have gone through that experience with all of these hospitals we built in the past with local communities participating, and Î think you will find every one of them thinks that the procedure is entirely satisfactory.

Mr. WINTER. Well, I happen to have been a city commissioner back in the very days you are talking about, and we expended some of our funds, together with Federal funds, and it did not make a whole lot of difference what we wanted to do. When the program was set up, there were half a dozen Federal inspectors coming around and saying, “You cannot do this," and "You cannot do that,” “You have got to put so much of this in and so much of that," and our program did not make any difference, the way we had it set up.

In order to get the Federal funds, we had to comply with whatever regulations were set down by the Federal organization that was handling that program.

General FLEMING. The only regulations are those in the law.

For instance, under the Lanham Act, I recall only one instance where we withdrew Federal funds. The Lanham Act required that opportunity for work on the project should be without regard to race, creed, or color, and we had a recreation building in the South where the mayor of the city refused to employ any Negroes, although there were skilled Negro workmen in that locality. He just said he would not do it. So the law was there. I said if he would not do it, we could not give him our funds. “If you will employ them, we will give you the grant, and if not we will build it.”

Mr. WINTER. That was not exactly what I am trying to get at here. What I had in mind was this: We set up this program as you have outlined; that is if we do, and a given area out in Kansas wants to build a hospital, instead of coming in under the program as set out in S. 191, you want that community to have to come direct to the Federal Government, when they set up a hospital area, and you want to determine whether or not you are going to build that hospital out there for us.

General FLEMING. I do not go as far as that. I have not formulated any type of amendment to the bill, but I think, for instance, in the allocation of funds for planning hospitals for which we have under title V of the George bill, the law requires that if somebody in Kansas,

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