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FROM THE STATE OF MISSISSIPPI Mr. COLMER. Mr. Chairman and members of the committee, I am very grateful for the opportunity to appear before your committee in behalf of S. 191. I am in accord with the objectives of this bill. The Senate has already in its wisdom seen fit to pass the bill, and I am very much in hopes that this subcommittee will see fit to make an early endorsement of the bill to the full committee and that that committee will in turn report the bill favorably. In that connection I assure you that as a member of the Rules Committee when you apply for a rule for the consideration of this measure you will find a sympathetic reception awaits you.

There is nothing more important in the life of our citizens than the necessity for adequate medical care. In fact, life itself is dependent upon the benefits of such care. The United States has long been the leader in the world not only in political advancement but for advancement in the standards of living and medical care.

However, during the war it must be realized that the health of our civilian population has of necessity been neglected. So many of our doctors were called into the service to minister to those who fought the country's battles abroad, as well as those who were preparing in camps for that objective, that our civilian population did not always have the proper medical attention.

It is obvious also that during the past 5 years our efforts have been largely to win that war. The result has been that hospitals, both public and private, for the reception of our unfortunate ill have not been constructed as during the peacetime period. In other words, new hospitals, except for military personnel, were with rare exceptions constructed during the war period. The result has been that our hospital facilities have not been expanded along with our normal population increase; construction materials, labor, and other necessities for construction have been unavailable during that period. As a result our hospital facilities have lagged behind the rest of our program. Moreover, there is an ever-increasing demand, which goes hand in hand with our advancement in civilization, for new hospital facilities.

In addition thereto, heretofore communities, counties, and States have had to depend upon their own resources for the construction of public hospital facilities. This bill offers an opportunity to these various subdivisions of government to have their own funds locally raised augmented by Federal funds on the theory that the public health is in the interest of the public welfare.

In my own section of the country this will prove a great boon. For, unfortunately, in many agricultural sections of the South the revenue secured by the various governmental subdivisions is not sufficient to bring about the desired facilities for hospitalization. In my own congressional district there are many communities which would like to take advantage of the provisions of this bill. For instance, in Jones County, Miss., the enlightened and progressive people of that county have long been striving to provide adequate hospital facilities for that community. The largest city in that county is Laurel, with a population of some 30,000. In the several counties surrounding that county there is only one county with hospital facilities. The hospital at Laurel has a capacity of only approximately 50 beds, and yet the people of the surrounding counties with no hospital facilities and numbering some 100,000 are dependent upon this small hospital for their medical treatment. If this bill is enacted into law the people of that county will go forward with their plans to erect a modern construction which will prove a boon to 100,000 people in that vicinity.

I sincerely hope, Mr. Chairman and members of the committee, that you will see fit to report this bill.

Mr. Clark Foreman was scheduled to appear as a witness this morning for the Southern Conference for Human Welfare. He is unable to be present and asks consent that he may file a statement.

Without objection, we will permit him to file a statement.
(The statement referred to is as follows:)


Washington, D. C., March 14, 1946. Congressman PERCY PRIEST, Chairman, Subcommittee on Health, House Interstate and Foreign Commerce Committee,

Senate Office Building, Washington, D. C. Dear Congressman PRIEST: On behalf of the Southern Conference for Human Welfare, I should like to express our appreciation for the opportunity of filing this statement in the record of the committee's proceedings. I should like also to express our very special appreciation to you, Mr. Priest, for the deep interest that you have in the health problems under consideration, as well as our support of the position you are taking on the particular legislation before your subcommittee.

The southern conference, representing a good cross-section of the southern States, has a vital concern in the hospital construction program, just as it has with the total health program outlined in President Truman's message to Congress on November 19, 1945.

Our hospital needs, those of some 40,000,000 people, are indeed pressing. Our total health needs are in no measure small. By comparison with the country as a whole, the health indices demonstrate that we have suffered from many lacks-not only from those things that keep people well, but from the insufficiencies of personnel and facilities necessary to care for the sick. Doctors are all too few in many of our communities, and as previous witnesses—particularly those representing the American Medical Association-have so ably pointed out, the key attractions to doctors in any community are proper facilities for diagnosis and good workshops or hospitals in which they can care for their patients.

The absence of modern hospitals in so many areas of the South, as in typical rural communities throughout the Nation, is in large part a reflection of the income of these areas. Such areas do not have the corporate and individual wealth that provide tax funds with which to build hospitals, nor do they have the sources of generous endowments. In many communities the purchasing power to meet the fees and charges necessary to support medical and hospital facilities is also lacking. As a result, the 13 Southern States had in 1940 only 2.2 general hospital beds per 1,000 people as contrasted with 3.9 general hospital beds per 1,000 people in nonsouthern States at that time.

The integration of public health facilities in the hospital construction program, as outlined by the United States Public Health Service, is also of particular interest to us. We have made tremendous strides in the provision of public health departments in the last decade, of which we are proud. Nevertheless, as Surgeon General Parran indicated, too many health departments are still housed in our courthouse basements.

We noted with enthusiastic support that Surgeon General Parran proposed to your subcommittee that there be some provision of office space for physicians, particularly as a part of the rural health centers. Again, with reference to Surgeon General Parran's testimony, he indicated that the total needs for all of the facilities related to hospital care are greater than can possibly be provided through the appropriations authorized in S. 191 as passed by the Senate. We urgently request that your committee give favorable consideration to increasing the authorized annual appropriation under the Hospital Construction Act and to extending the program beyond the 5-year period stipulated in S. 191.

Above all, the southern conference urges that the subcommittee vote for the passage of the hospital construction program as embodied in your bill, Mr. Priest, H. R. 5628. That measure, as you suggest, is in accordance with the objectives of the Senate bill, S. 191, and provides for the same general program. It does, however, propose six specific improvements over S. 191 to which we subscribe.

With all due respect for the outstanding contributions made by the hospital associations and other voluntary professional organizations of this country, we have sufficient confidence in the Surgeon General of the United States Public Health Service, the Administrator of the Federal Security Administration, and the Congress, to question the need for turning administrative controls over to a part-time nongovernmental body such as the Federal hospital council set up in S. 191. For the same reason, we question the necessity for court review of administrative decisions. We do feel that there is merit and need for an advisory body to which the Federal and local agencies can turn for consultative services.

But on this matter we strongly insist that lay or consumer advice is equally as important as professional advice. We are inclined to say, too, that without the requirement that States provide for standards of maintenance and operation of hospital and health center facilities in accordance with general national standards, many of our facilities and many of our people would feel the consequences. The quality of services would in general, we feel, be best safeguarded by the provisions of H. R. 5628. For these reasons, Mr. Chairman, the Southern Conference for Human Welfare urgently requests your subcommittee to vote for the enactment of a national hospital construction program and that the Congress enact the specific measure before your subcommittee which we feel would best meet the total needs—namely, H. R. 5628. Respectfully yours,

CLARK FOREMAN, President, Southern Conference for Human Welfare. Mr. PRIEST. I have some other requests to file statements, and without objection, permission will be granted to Mr. Albert S. Goss, National Master, the National Grange, to file a statement for printing in the record.

Similar permission will be granted to Dr. Clarence Poe, representing the North Carolina Hospital and Medical Care Commission to file such a statement. (The statements referred to are as follows :)

WASHINGTON 6, D. C., March 18, 1946. Hon. CLARENCE F. LEA, Chairman,

House Interstate and Foreign Commerce Committee. DEAR CONGRESSMAN LEA: I am enclosing herewith a statement of the position of the National Grange on S. 191, which I should appreciate having included in the record by the Committee on Interstate and Foreign Commerce. Sincerely,

FRED BAILEY, Legislative Counsel, the National Grange.



We find in S. 191, the bill providing for hospital survey and construction, recognition of one of the most serious problems confronting the Nation. A large percentage of our population has neither the means nor the technical knowledge to meet health problems without Federal assistance.

The National Grange addresses itself particularly to the provisions which are aimed at meeting one of our most distressing national health problems—that of the more than 50,000,000 people who live on farms and in small towns not now adequately served by modern hospitals.

Rural health is not alone a farm problem: it is a national problem. In many areas it is more: it is a national disgrace. Lack of proper hospital and medical facilities has been, and continues to be, the principal reason rural health is far below the average of the Nation.

For too long we have accepted at face value the glib saying that ‘farm life is a healthy life.” The facts contradict that saying. The inadequate and sometimes nonexistent medical facilities available to rural areas is not alone a rural problem. Physical defects and preventable diseases originating in rural areas become city problems when rural people move to town. Many of them become charity patients.

The death rate among infants and small children is higher in rural areas and small towns than in cities. In 1942 the infant mortality rate was more than one-fourth higher in rural than in urban areas. Maternity mortality in 1941 was almost one-third higher in rural than in urban communities.

Selective Service records show that 43 out of every 100 men examined for military service were rejected, principally for reason of physical defects. That was the national average. But among those coming from farms, 53 out of every 100 were rejected. That is an appalling indictment of a Nation whose medical science leads all the world.

Grange members throughout the National are keenly aware of the urgent need for better hospital facilities. They are deeply concerned about the appalling condition of rural health. That concern already is being reflected by leadership in promoting Blue Cross and other medical-aid measures. Yet, we are at present almost helpless to cope with the fundamental difficulty-lack of trained medical assistance and the equipment to make that assistance most effective.

The two—lack of doctors and hospitals—bear a direct connection. Young doctors today hesitate to start their practice in rural areas. There are two reasons for that: First, is the almost complete lack of adequate laboratory and hospital equipment which they have been trained to use and, second, the economic inability of many rural areas to finance the heavy outlay necessary to provide adequate medical personnel and facilities.

The existence of poor health conditions in low-income areas is not a coincidence. There is a direct connection between the two. Poor health greatly impairs the ability of many areas to improve their economic status. The annual economic waste of productive efficiency is many times greater than the amount proposed to be spent under this bill.

A large part of the reason for the appalling health situation of our rural people is the fact that hospital facilities in many rural areas are either entirely lacking or inadequate. It has been found that over 1,250 of the 3,070 counties in our Nation are without a single satisfactory general hospital, and that 700 or more of these counties have populations exceeding 10,000. While it is held that there should be about 4.5 general hospital beds for every 1,000 persons in a State, most rural areas do not have 2 beds per 1,000.

Lack of hospital facilities is also reflected in a scarcity of doctors. Just before the war there were so few doctors in the 1,000 most rural and isolated counties that each one had to serve 1,700 people. In the big cities there was a doctor for each 650 people. In addition, country doctors tend to be older, have greater distance to cover, and have been unable to keep up with advances in medical science. Rural communities also do not have enough nurses.

Rural folks would like to solve their own problems, and they are doing what they can to do so. But due to the vicissitudes of economic change, many farmers realize that their incomes will not permit them to finance the hospital and medical facilities that they need. Cities have men of great wealth whose philanthrophy has built marvelous hospitals. Few rural communities have been so fortunate. Cities have clinics and free hospital care for those who cannot afford the expense. Many rural areas offer little more than the country church cemetery.

The farms of the Nation have contributed heavily to its wealth. They have supplied a large number of the medical students as well as students and leaders in the other sciences. The Nation as a whole too long has slighted or ignored rural health problems.

The National Grange, through the more than 78 years of its existence, has never ceased to battle for impreved rural health facilities. The history of that battle would fill volumes. We quote only resolutions adopted at the two most recent annual sessions of the National Grange.

In 1944, at Winston Salem, N. C., the Grange demanded that "consideration be given to support of expanding Federal and State aid for the erection of hospitals, supplying of medical equipment and training personnel for medical care so that the cost of these may be reduced as well as making more of them available."

In 1945, at Kansas City, the Grange adopted, after long and careful study, a resolution, which reads as follows:

(1) That farm people and doctors should have access to modern diagnostic facilities and a hospital of good standing;

(2) That since many rural areas cannot provide these facilities and service through their own efforts alone, State and Federal funds be made available for the construction of new hospitals and the improvement of some existing hospitals serving rural areas, but with the management of these institutions remaining in the hands of the local people; and

"(3) That adequate diagnostic and hospital facilities and stabilization of paying power through insurance are not only important for enabling rural people to secure modern medical services but they are also prerequisites for attracting and holding physicians, dentists, nurses, and other health personnel in rural areas.”

These resolutions contribute a clear-cut and emphatic endorsement of the basic principle of the Hospital Survey and Construction Act, S. 191.

The National Grange approves highly of the idea of a Federal hospital council, at least in an advisory capacity. If it is to be vested with administrative powers, it must not be dominated by those primarily concerned with large urban hospitals. If this is a real danger, it would be better to leave the final administrative decisions in the hands of the Surgeon General, who has shown an appreciation of the rural problems. Because matters of public interest will quite probably be equally as important as technical matters, the council could well consist of four representatives of the consumers and four representatives of the technical authorities. The State advisory councils should also be similarly constituted.

Though it may be that rural consumers would get adequate representation on the State advisory councils and the Federal hospital council, we would like to see this written more specifically into the law. Thus, in section 612, subsection (a), paragraph (2), we would prefer this language "including representatives of both urban and rural consumers.” This suggestion also applies to section 623 (a) (2). Similarly, in regard to the Federal hospital council, the language should so read that not only must rural consumers be represented by a person familiar with the need for hospital services in rural areas but by a representative of the rural consumers. The rural representative need not be a rural consumer, but should represent the rural views.

Because of the relative sparseness of the farm population, many rural communities will not be able to have hospitals. For this reason, we are anxious that any hospital construction bill provides for enough health centers to permit a number of the smaller rural communities to have them. Unless this is done, many of the smaller rural towns of 2,500 and less will be without doctors. For the most sparsely populated areas, possibly mobile clinics should be provided to serve the small remote rural communities.

We believe health centers should be defined broadly enough to permit a few beds for emergency and maternity cases. If there is danger that major operations will be performed in them unnecessarily rather than in regular hospitals, regulations against such abuse could be provided for. However, if proper hospital facilities are available, there is little danger of such abuse.

Another matter than may need further consideration regards the provision in section 625 (e). It appears that after 20 years a hospital that has been built in part with Federal funds can cease operating as a nonprofit institution or can be sold to a profit-making concern without need for any repayment to the Federal Government or compliance with other provisions of the act. Twenty years is a rather short time in the life of a hospital.

It may be that there is no way in which States could rightfully be required to furnish State aid to their rural areas, but this is a serious problem. Some of our wealthy predominantly urban States have rural areas that are very poor. In these States the Federal percentage will be low, though the rural community in such States may need outside aid as much as the rural areas in some of our poorer rural States. It is also conceivable that in the States where the Federal percentage is high, the rural communities will still be unable to construct hospitals unless State aid is provided.

We recommend passage of S. 191. We believe that if the suggestions we have made are incorporated into the bill, it will come closer to giving rural people what they want and need.

Mr. PRIEST. The Chair has also two or three letters that have been written by Members of Congress and others, including one from the Honorable Homer Ferguson, United States Senator from the State of Michigan, and one from the Baltimore City Hospital, all of whom ask permission to file letters or statements in the record, and, with

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