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per year, after the building was constructed, would it cost to operate the center properly for the benefit of the people?

Dr. PARRAN. To operate it, the maintenance and operation of the building and the service?

Mr. Brown. The building and the service. The building means nothing without the service.

Dr. PARRAN. We think there should be, approximately, $2 per capita spent for public health.

Mr. Brown. In a community of 20,000, that would be $40,000 a year?

Dr. PARRAN. Yes. The average now is somewhat under $1.

Mr. Brown. We have a county, a pretty good rural county, Doctor, in my home county of about 24,000 or 25,000, and I think our total county budget is only a little over $100,000

Dr. PARRAN. Mr. Brown, you are fortunate in coming from a community which, I believe, has a reasonable standard of income; you have no widespread endemic diseases, typhoid and malaria to deal with. People with adequate incomes can furnish for themselves many services which, in the poorer communities, they can not afford.

Mr. WINTER. Doctor, is that health center that is pictured there, is this the floor plan of it here?

Dr. SHAFFER. This is smaller. It is quite a bit smaller.

Mr. WINTER. That provides for 8 beds. This one here provides for 10.

Dr. PARRAN. What page is that? Mr. WINTER. It is on page 9. Dr. PARRAN. They are comparable. There may be variations. These are not standard plans. They are suggestive for adaptation by the local communities to fit their needs.

Mr. WINTER. These beds would be open to people being treated in some clinical service?

Dr. PARRAN. Partly that. They would certainly take care of emergency cases. In some instances, minor operations could be done. Conceivably, obstetrics in some communities, remote from the larger hospitals.

Mr. WINTER. Do you think that in a county of 20,000 to 30,000 people, that 8 beds are going to go very far in giving that kind of service?

Dr. PARRAN. By no means. That would be backed up by hospitals in that county, or we hope in an adjoining county, a larger hospital. Mr. WINTER. This is par of the integrated whole? Dr. PARRAN. That is the periphery of the whole. That is right.. Mr. HARRIS. Are there any further questions?

Dr. Parran, you will be available for any further questions in case the committee desires to have you come back?

Dr. PARRAN. I shall be, Mr. Chairman.

Mr. HARRIS. Thank you very much, Dr. Parran. We are glad to have your statement and testimony on this legislation. I would like for the record to show that we are glad to have Mr. Watson B. Miller, Administrator of the Federal Security Agency, with us this morning.

We are indeed happy to have you come to this committee. I know your interest in this program.

Would you like to make a statement to the committee?

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STATEMENT OF WATSON B. MILLER, ADMINISTRATOR, FEDERAL

SECURITY AGENCY Mr. MILLER. I would not like to gild the lily or embellish the rose, but perhaps the Chairman and members of the subcommittee would be interested in the proposition that for the first time since the formal shooting was over, and indeed, for the first time since the shooting started, during which time we have kept ourselves pretty close to the line in Washington, I felt I should go out and find out what is going on on the firing step.

I came down in your direction, Mr. Brown's State this time, and I also went to the west coast. There I conferred with a great number of physicians in the various cities, including the State Health officers and the State and county presidents of the branches of the American Medical Association. They are all very hopeful that the Congress will approve some such measure as this, because of the universal acknowledgement that there is so great a disparity in the distribution of physicians, and so great a paucity of health centers and what Dr. Parran called operating shops, for the extension of more American medicine to more American people.

I personally hope that in your wisdom, you will approve some such measure as this, because it would furnish a very desirable beginning for what we all hope for, better medicine for more people.

We are aware of the aspirations of the president in this field, and it would be perfectly futile to try to extend our good medicine further down than it commonly goes into certain segments of our population without the machinery for doing it.

Mr. Brown. You want this program put on a sound basis so that once it is established and the hospitals are constructed, we can maintain them and continue to operate them?

Mr. MILLER. This and all other programs that involve partnerships between the Federal government and the States, sometimes assimilable and palatable and effective.

Mr. HARRIS. We know you are very busy Mr. Miller and know you are interested in this program.

We are glad you took the time to come up here.
Mr. MILLER. I could not refrain from so doing, sir.

The Chairman will remember that I, for 20 years prior to coming into this new climate, recently I have been at least on the doorstep of medicine.

Mr. HARRIS. I would like for the record to show wire from our colleague, Hon. James M. Curley, favoring enactment of the provisions of Senate bill 191.

Also a communication from Dr. Stegeman, of Santa Rosa, Calif.; also one from Mr. A. L. Jones, secretary of the Armstrong Machine Works, Three Rivers, Mich. (The communications referred to are as follows:)

BOSTON, Mass., March 5, 1946. CHAIRMAN, INTERSTATE AND FOREIGN COMMERCE COMMITTEE,

House of Representatives, House Office Bldg., Washington, D. C.: Favor enactment of measure for drawing plans and building hospitals under provisions of Senate bill 191.

Hon. JAMES M. CURLEY, M. C.

WILSON STEGEMAN, M. D., F. A. C. S.,
534 B STREET, SANTA Rosa, CALIF.,

February 16, 1946. Hon. CLARENCE F. LEA,

House of Representatives, Washington, D. C. MY DEAR MR. LEA: We have just heard that you have been placed in charge of the committee which will control the dispensing of funds for increased hospitalization, as authorized under the companion bill to S. 191. I am very anxious to acquaint you with the local very logical hospital project on which we are working, and which I mentioned briefly in the post script to my letter to you regarding postwar drafting of 18-year-old students.

The Santa Rosa . Medical Association, composed of 25 doctors practicing in Santa Rosa, whose patients account for 95 percent of the patient-hospital-days in the Santa Rosa area, are working very hard on the formation of hospital district to include the present third supervisorial district (the area around Santa Rosa, as well as the city) with the very logical end in view of building a fine private hospital on ground adjacent to the present county hospital. This ground would be deeded to the district by the Board of Supervisors. The private patients would have the use of the already-existing scientific equipment, facilities, and personnel on a per-patient, per-day basis. Escellent equipment, personnel and facilities already exist in the present county hospital, and the use of them for private patients seems only a logical thing inasmuch as taxpayers have already paid for the election of this fine hospital and its contents. It seems only logical that they should also be enabled to have the use of them for their own families, as well as for the county's indigents.

The plan seems to us extremely logical and is being accepted wherever we present it, which we are beginning to do. We will thus be creating a medical center for this area which the surrounding communities could also use without additional cost to themselves. Inasmuch as they would not receive as much benefit from the use of it, and probably only their complicated or special cases would come here (their simpler cases being taken care of at home in their own private smaller hospitals), it seems logical not to tax them for the erection of the hospital.

There would thus be no duplication of expensive equipment and expensive personnel, both of which are required in any hospital, no matter how small. Naturally the initial cost would be less, inasmuch as the building would not have to be equipped beyond less expensive furnishings of the patient rooms, the X-ray and laboratory and surgical facilities and so on all being available simply by wheeling the patient into the present county hospital, and then back out to his room in the private hospital.

We are having a little trouble convincing a stubborn mayor who seems set on erecting a small (necessarily so, with only $175,000 voted at a recent bond election) municipal hospital over which he would have political control. (Under the local hospital law introduced by our own Senator Slater into the California Senate in 1945, the hospital district business is done by 5 elected hospital directors who serve for 4-year terms without salary, thus opening the way for publicspirited interested people to be elected to the posts of control.)

If any funds are going to be available for our use in bringing about this worthwhile project, I am sure you will keep us in mind. We expect to hit the headlines very soon. Yours very truly,

WILBON STEGEMAN, M. D.

ARMSTRONG MACHINE WORKS,

Three Rive Mich., February 25, 1946. Public Health Subcommittee of the Committee on Interstate and Foreign Commerce,

House Office Building, Washington, D. C. Attention : Mr. Clarence F. Lea, chairman; Mr. Elton J. Layton, Clerk. GENTLEMEN: We respectfully request your favorable consideration on bill, S. 191, an act to amend the Public Health Service Act to authorize grants to the States for surveying their hospitals and public health centers and for planning construction of additional facilities, and to authorize grants to assist in such construction.

Our hospital is a city-owned hospital servicing a community of approximately 20,000 people with two-thirds of them living outside of the City of 7,000 population. This hospital was built and the annual deficit paid by an annual city tax. During the past 23 years the city has raised by taxation for hospital purposes $233,000 and with additional donations made of $50,000 total $283,000. There is now about 130 percent occupancy and it is impossible to care for all the patients who wish admittance.

The Government wish us to admit Second World War veterans but we cannot do so.

In view of our city raising by taxation and donations $283,000 and an addition being now required costing $268,680 to take care of patients outside our city, we feel our city should not be expected to entirely finance the full amount of the present proposed addition which on the basis of percent occupancy can be considered entirely for the benefit of the rural community and small towns outside our city.

In view of the proposed addition being due to the patients outside our city, I urge and suggest that your committee report favorably on S. 191 so a grant will be made to assist us in the construction of our addition.

We have on hand $28,000 cash which has been donated to pay part of our city share of the cost of the addition.

In order to make available more adequate hospital facilities in our county, I earnestly recommend that S. 191 be approved in order that such services will be more closely available and at a price the average person can afford to pay.

Hoping your committee can and will approve this bill and serve our country by seeing that it is made a law and that you will include this letter at your hearing, we are, Yours respectfully,

THREE RIVERS HOSPITAL BOARD,

A. L. JONES, Secretary. Mr. HARRIS. It is now five minutes to twelve. We are expecting a call any minute. It has been suggested that we could have a special hearing this afternoon after we have completed the roll call.

We will adjourn then, tentatively, until 2:30 o'clock this afternoon.

(Thereupon, the committee recessed until 2:30 o'clock p. m. this same day.)

AFTERNOON SESSION

(The subcommittee reconvened at 2:30 o'clock, p. m., pursuant to the taking of the recess. Whereupon the following occurred :)

Mr. HARRIS. The committee will come to order. We will be glad to hear Dr. Smelzer at this time.

STATEMENT OF DONALD C. SMELZER, M. D., IMMEDIATE PAST

PRESIDENT OF THE AMERICAN HOSPITAL ASSOCIATION

Dr. SMELZER. I have with me Mr. George Bugbee, our executive director, whom I would like to have as my technical adviser.

Mr. HARRIS. Very well.
Dr. SMELZER. Mr. Chairman and members of the committee.

It is a privilege to appeare before you on behalf of the American Hospital Association, representing the majority of the hospitals of the country. We strongly urge enactment of the Hospital Survey and Construction Act in the exact form in which it was passed by the Senate on December 11, 1945, as Senate bill, S. 191. This legislation was substantially revised by a special subcommittee of the Senate Committee on Education and Labor, and although it embodies certain compromises on issues that are of profound concern to the hospital

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field, we believe that, on the whole, it has been measurably strengthened by that revision.

The American Hospital Association is concerned with this act because it will vitally affect our own field of humanitarian endeavor. We were one of the first organizations to offer our support to this legislation, and we have followed its legislative progress closely, because we are keenly aware of the need for the additional hospital facilities that may be provided under it, while on the other hand we are apprehensive of the dangers involved if this program is not wisely and carefully carried out. Since the practically unanimous Senate action last December, hospital people have had opportunity to study and discuss this act. We are in opposition to the amendments which have been suggested as embodied in H. R. 5628, recently introduced, and our support is given to the measure in the form in which it passed the Senate.

THE AMERICAN HOSPITAL ASSOCIATION AND S. 191

We wish to make clear the interest of the American Hospital Association in this legislation. The association was founded in 1898 when several hospital superintendents met to discuss better methods of hospital administration. It has grown steadily until more than 3,400 hospitals are now members. We estimate that over 85 percent of the civilian general hospital bed capacity of the Nation is represented in the American Hospital Association including many governmental hospitals. In the 45 years of our existence we have had one primary aim: Better hospital care of the people we serve. In the past two generations there has been vast improvement in the quality of hospital services, and the American Hospital Association, by study, research and exchange of information has played no small part in that development. We are proud that this improvement has been one of the motivating factors in the demand for increased availability of hospitals. People expect and receive a broader range of services from hospitals than ever before, and there have been developed in this country the highest standards of hospital care in the world today. Our natural concern for health and welfare leads us to be anxious that this be made available to meet the full needs of the Nation, but in such fashion that its high standards and basic values are preserved.

The American Hospital Association through its member hospitals represents the trustees who compose the governing boards of those hospitals. A roster of the boards of trustee of the nonprofit hospitals, and of the religious who administer and guide the policies of the hospitals operated by our various churches, would indeed be a “Who's Who” of the public-spirited citizens who are outstanding in the community because of their demonstrated civic usefulness and genuine social interest; they are the representatives of the general public organized to supervise the policies of the hospital and to see that the institution gives to the community its fullest possible measure of service.

The Hospital Survey and Construction Act proposes Federal grantsin-aid to assist the States to build hospitals and health centers in communities and areas where they are most needed. The Nation-wide program is to be under the general supervision of the Surgeon General of the United States Public Health Service, who will consult with a Federal hospital council of experienced hospital authorities in establishing overall standards and regulations, and in approving State con

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