Mr. HARRIS. Who would be asked to submit plans?

Dr. SMELZER. The group that wants the hospital in that community; somebody. You can call it the nucleus of the board of trustees or whoever is responsible for the germination of the original idea that there should be a hospital there Then they would submit that to the State' agency. If the State agency felt that they were all right, they would pass it on to the Federal level for that approval before the money could be allotted or the share of the money would be allotted. If the Surgeon General, with the Federal Advisory Committee saw that it was all right, then they would approve it.

Mr. HARRIS. Would this locality or community have to provide the funds and so forth, for the survey and the plans and so on that they would submit to the State agency?

Dr. SMELZER. That is part of the $5,000,000. Not the providing of the plans after the survey is made.

Mr. HARRIS. I assume, then, before they even apply for or investigate the probability of getting the hospital, the State survey will have been made?

Dr. SMELZER. That is right.

Mr. HARRIS. And they will know whether or not they have been included in that State survey; is that right?

Dr. SMELZER. Yes, sir.

Mr. HARRIS. And then it will be passed on by the Surgeon General? Dr. SMELZER. It goes to the State level and the Federal level and back to where it starts from.

Mr. HARRIS. In other words, the Surgeon General can not do anything about it until the State agency has passed on it?

Dr. SMELZER. Yes, sir.

Mr. HARRIS. All of this must be channeled through the State agency? Dr. SMELZER. That is right. That is the intent.

Mr. HARRIS. I assume that the State agencies are organized by the various legislatures?

Dr. SMELZER. I think it was the intent that the Governor, or legislature, might appoint or name a State agency; it might in some instances be the department of health or a special commission as the Governor of Michigan did. He set up a little commission or created a new agency.

Mr. HARRIS. In case they did not have a State agency, what would they do then?

Dr. SMELZER. If the Governor refuses to do it?

Mr. HARRIS. This does not provide for the setting up of such?

Dr. SMELZER. If the State legislature, or the State authorities do not agree on an agency, they cannot participate. It says that.

Mr. BROWN. Then the legislature has to do that?

Dr. SMELZER. I said create. If they do not create or designate, or designate or create, perhaps I should put it that way. If there is no State agency set up, they cannot participate.

Mr. HARRIS. Are there any further questions?

Mr. WINTER. When this original survey is made, is that proposed to determine the hospital needs of the entire country?

Dr. SMELZER. No; the entire State.

Mr. WINTER. They all participate in it?

Dr. SMELZER. They do not have to. Some may not. That is right.

Mr. WINTER. That is proposed to determine what that State's requirements are?

Dr. SMELZER. That is right.

Mr. WINTER. After that survey is made, is any community precluded from coming back and asking for hospital service under the provisions of this bill?

Dr. SMELZER. You mean if the survey does not show the need? I think that lets them out, does it not? That stops there.

If there is no need, then that stops the log rolling or what not. Mr. WINTER. The situation Mr. Harris is inquiring about then could not happen under this bill, could it?

Dr. SMELZER. Yes.

Mr. WINTER. How could it?

Dr. SMELZER. Well, he said that something in the community wants a hospital. All right. I said there must have been a State survey. Mr. Harris agreed that there was a State survey. All right. If the State survey presumably is made, it knows the need.

If their survey showed there was a need, then the plans were asked for, accepted, passed on to the Federal level.

If there is no State survey, there can be no money go to any hospital in that State.

Mr. WINTER. After the survey is made, though, is what I am getting at.

Is that final, so far as that State is concerned?

Dr. SMELZER. For the time being.

Mr. BUGBEE. The State plans can, from time to time, be revised, but it is true that if an applicant wished to build a hospital which was not provided for in the State plan, that in all likelihood he could not build it under this program.

I think that may seem somewhat arbitrary to the committee, but it is true in regard to hospitals, that you can have three hospitals all too small to give you satisfactory service, whereas by making a plan and having the one hospital properly located, you can have enough in the way of diagnostic and therapeutic treatment to give decent service in that one hospital.

So there are dangers to having many small hospitals. And it may be necessary under this State plan, to make that determination and then to tell a number of applicants that they are not included in the plan and are not eligible for Federal funds.

Mr. WINTER. That is what I am getting at. Supposing it developed that after this plan was in effect and the survey had been made and the funds allocated that some hospitals were built, and they proved to be inadequate.

Mr. BUGBEE. The plan can be revised at any time on the basis of new facts or the population may, as in some States, have a larger number of hospitals, use them more.

It has been found that usage goes up. So that the plan is not a final thing.

This act provides for periodic revision of the plan and amendment by the State.

Mr. WINTER. That is, periodic revision of the entire plan, the integrated plan?

Dr. SMELZER. That is right.

Mr. WINTER. Down to the local center?

Dr. SMELZER. That is right.

Mr. WINTER. The Health Center?

Dr. SMELZER. That is right.

Mr. WINTER. And the same survey is provided for the public health center with regard to these rural areas?

Dr. SMELZER. Yes, sir.

Mr. HARRIS. We appreciate your coming in and giving us your testimony.

It has been very helpful.

I would like to ask Reverend Schwitalla to come forward now.

STATEMENT OF THE REV. ALPHONSE M. SCHWITALLA, S. J., PRESIDENT, CATHOLIC HOSPITAL ASSOCIATION OF THE UNITED STATES AND CANADA, AND DEAN, ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE

Reverend SCHWITALLA. I would like to submit to the members of the subcommittee, copies of this, but if I did, you would have a terrible time. It would have to be an exact copy and my copy is so scribbled you would not be able to decipher the scribbling on it, and it would not mean a thing to you.

Mr. HARRIS. We will listen to you.

Reverend SCHWITALLA. If you will listen to me and give me the privilege of filing a revised copy by not later than Monday morning, when I will promise to have it in the hands of the clerk, I shall do so.

Secondly, would you allow me to have the moral and the intellectual support and the support of the emotions for that matter of Mr. Kneifle, and secondly, Mr. George Reed of the legal department of the National Catholic Welfare Conference at my side.

Mr. HARRIS. Will you identify yourself?

Reverend SCHWITALLA. My name is Alphonse M. Schwitalla, and I am president of the Catholic Hospital Association of the United States and Canada, and Dean of St. Louis University School of Medicine.

After the magnificent talk this morning that I heard from Dr. Parran, I am sure there is a lot of what I have to say that could very well be omitted, perhaps, and it ought to be kept in here by way of emphasis; and then you just heard Dr. Smelzer's talk. And I am sure that about the only thing that is left for me to do here is to pick out a few things that the Catholic Hospital Association is particularly interested in.

These two other gentlemen began by talking about the privilege that was theirs of appearing before you and I want to begin by saying that it is my privilege, too.

It is my serious responsibility to appear before this subcommittee to represent the views of approximately 20,000 Catholic sisters and other professional personnel of the approximately 1,000 Catholic hospitals and health agencies in the United States. On behalf of these institutions, which have voted representative power through the administrative board of the Catholic Hospital Association to the president of the association, I wish to endorse the purposes of the Hospital Survey S. 191 as passed by the Senate.

The Catholic Hospital Association is an organization of the Catholic hospitals of this country. Organized in 1915, it embraces in its membership 95 percent of the health-caring agencies conducted under the auspices of the religious orders of the Catholic Church and under the authority of the bishops of the church.

The Catholic Hospital Association operates as one of the affiliated agencies of the social action department of the National Catholic Welfare Conference, an organization well known throughout the country especially in Washington by Catholics and non-Catholics alike for its broad and forward-looking outlook on public questions particularly upon social problems.

The Catholic Hospital Association has worked intimately with the National Catholic Welfare Conference in the development of its viewpoints on national interests in the health fields. What I have the honor and responsibility of presenting before this subcommittee has been pondered, discussed and most carefully formulated on many

occasions.

First: Briefly, I am preparing before you to endorse and to support on behalf of the Catholic Hospital Association, the intents and purposes of the legislation which is here being reviewed by calling attention to certain features of the Hospital Survey and Construction Act upon which the Catholic Hospital Association feels itself particularly competent to talk. The comments which I shall make have been discussed with the members of both the American and of the American Protestant Hospital Associations and I believe that these amendments would meet the public support of both of these associations.

Let me present the views of the Catholic Hospital Association with reference to the endorsement and support of the present legislation. In 1943 as well as in conventions previous to that year, the Catholic Hospital Association attempted to clarify its views with reference to national legislation in the health field by the formulation of resolutions. A chain of these resolutions, the elements of which were formulated not only during the annual conventions but also in meetings of the executive and administrative boards of this association, make it clear that the Catholic Hospital Association has stood for: (a) The extension of hospital facilities into areas of economic and social need;

(b) The emphasis upon construction of new facilities without disregarding, however, the other factors which are essential to supplying health care in these areas;

(c) The project of a national hospital survey for the study and investigation of national resources, facilities and needs;

(d) The maintenance of a broadly conceived mutually respectful cooperative relationship, which we had thought of as a partnership, between the voluntary hospitals and the governmental agencies devoted to health care;

(e) The importance to the sisterhoods of the social changes, as affected by the needs for health care to permit the sisterhoods to maintain their traditional position in the health caring fields through which spiritual viewpoints and the religious motivation have been preserved in health care.

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OTHER ELEMENTS IN A NATIONAL HEALTH PROGRAM

I am happy to say that these principles in a national health program have been sufficiently well integrated into the planning and formulation of S. 191 to permit the Catholic Hospital Association to endorse the Senate bill in the hearings held on February 26, 1945, in the Catholic Hospital's Association's presentation before the Committee on Education and Labor of the Senate of the United States.

Even more specifically than my endorsement of these two congressional bills, is my endorsement on behalf of the Catholic Hospital Association of the statement which you have just heard from Dr. Donald C. Smelzer, the past president of the American Hospital Association. This statement must be regarded as a scholarly, penetrating and exact formulation, illuminating as it does, so many of the problems pertaining to hospital surveys and hospital construction, merits most careful study by any one interested in these problems and must be regarded as a summary of almost encyclopedic knowledge of a highly specialized field.

In this presentation, I wish to underline, if I may, some of the points which Dr. Smelzer has made. I wish to supplement his remarks by emphasizing the utilization of Federal funds in a national program. With even greater emphasis than that of the American Hospital Association, the Catholic Hospital Association "does not lightly recommend Federal grants-in-aid for hospital construction or any other purpose." The Catholic Hospital Association has conformed to the traditional attitude of caution on the part not only of the Catholic groups but also of the other church groups in its attitude towards the acceptance of financial subsidies from Federal sources. The compelling reason why at present we are endorsing the acceptance of such funds arises from the fact that the demonstrated need of the country for health facilities under the new social strains is such as to transcend the funds available from sources which have traditionally built, established and maintained the voluntary hospitals and especially the church hospitals. When we turn to the Federal Government, therefore, to ask for Federal funds, this group I represent is not doing so impelled as it were by the common "fund seeker's front" making an attack upon the Federal Treasury to secure from that seemingly inexhaustible pool of resources, our pittance or share for the building of hospitals. We are rather impelled by the thought that the greater the Federal Government expands the areas over which it achieves suzerainty or dominion, the greater is the need for health care over the very people for whom the Government has assumed patronage

Of course, the Catholic group, like other groups, as already mentioned by Dr. Smelzer, is fearful lest "the use of Federal funds to expand the distribution of health facilities may deteriorate into a medium of control," but here again, we are becoming increasingly hopeful that if with the acceptance and with utilization of Federal funds we can intensify the partnership between governmental and voluntary agencies, the fear of unwarranted control can be minimized. Perhaps we are thinking that utopia has come.

It is hoped that the Congress will write into the Hospital Survey and Construction Act not a system of checks and counterchecks but rather motives for and principles of mutual respect of Government for the people and of people for the Government so that the partner