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to be a person like Dr. Parran, I would not have to say what I am going to say now, but you are going to have human failings even in surgeons general. That is where the difficulty lies.

Mr. BROWN. That is what I am thinking about.
Mr. HARRIS. We all agree with that statement.

Reverend SCHWITALLA. I think there should be a check on the exercise of the Surgeon General's power, and if it cannot be done administratively, as apparently it cannot be done, then do it legally or through the courts.

Mr. HARRIS. May I then carry that one step further? Reverend SCHWITALLA. Then you are going to have this litigation. Mr. HARRIS. The State agency will disapprove an application. They will appeal it to the Surgeon General. Suppose then the Surgeon General overrides the decision of the State council. Then would the State council have the authority to appeal that decision to the courts?

Reverend SCHWITALLA. I would say "Yes.”. Of course, you heard what Dr. Smelzer said this morning.

Mr. HARRIS. I believe the language of the bill is such that if the Surgeon General disapproves an application, then you can ask for a court review.

Reverend SCHWITALLA. But not if he goes contrary to the recommendations. Dr. Parran said himself 5 years of legislation and a century of litigation. That might come out of the thing, but still with all of that, if the thing is right, it seems to me it ought to be put into this bill some place or another.

Mr. HARRIS. You would not suggest, however, that the Surgeon General might be right in overriding the State council ?

Reverend SchwITALLA. I do not think it will be done that crudely, do you?

Mr. HARRIS. But, nevertheless, we have got to anticipate some of these circumstances will arise or it would not be necessary to make that provision.

Reverend SCHWITALLA. Except this, let us keep the levels clear here, there should be appeal to the State level to someone in the State, should there not, first?

Mr. HARRIS. I think so, but the discussion-
Reverend SCHWITALLA. But that is not our business.
Mr. HARRIS. Appeal to the Surgeon General.

Reverend SCHWITALLA. That is going to be written by the Surgeon General into the regulations, the requirements on the State level. He is taking care of that himself. When all of this is exhausted, then you go to the Surgeon General.

We have things like this going on today. We do not always get into a major war. We are not going to get into a war with Russia just because we have disagreements with her. We do not have to go to the court right away. There is going to be give and take, but in the last analysis, there has got to be some way of handling these problems.

These are emergency analyses, these are crises regulations.

Mr. MARCANTONIO. Where the hospital is discriminated against particularly, in a case of flagrant discrimination—that hospital is going to be tied down by the final decision of the State council with no appeal to the Federal Government, where the Federal Government is supplying the funds.



Reverend SCHWITALLA. You said that a lot better than I could say it.

Mr. BROWN. Let us follow it one step further in an attempt to be helpful.

Of course, your whole argument is based on the fact that you may find, or the assumption that you may find, a State council which is intolerant of some minority group or organization.

Reverend SCHWITALLA. May I make one exception, Mr. Brown?

I was going to say this, the appeal may not; that is, the turn-down by the State council may not be on the basis of prejudice; may not be on this or that or the other thing, but the applicant may think so.

Secondly, it may not be on the basis of prejudice, but on the basis of a misconception of what that State needs from a purely medical viewpoint.

If you have the wrong kind of a State council-and we are going to have some State councils that are going to be only 99.9 pure, not 100 percent

pure—you will have that happen. Mr. Brown. You know, I think the world of Dr. Parran, but I do not think he will assay out any better than 99.9 percent pure, and I do not think we are going to get any other Surgeon General in the future that will have a better percentage of purity.

I am just wondering whether or not you are going to have the same situation, and, perhaps more danger of it when one individual passes

In other words, as a usual thing, whether you want to call it prejudice, or misunderstanding, or intolerance, or anything else you may want to designate it, you usually find that it exists more in the individual mind than it does in the collective mind of a group or a board.

Am I correct or not?
Reverend SCHWITALLA. Yes; I think you are very correct.

Mr. Brown. I am just wondering what position you are putting the Surgeon General in. You understand, an absolute monarchy is

. the greatest form of government in the world if you have the right kind of a monarch. It is the worst, too, with the wrong monarch. And that is the reason why I have brought out some of these points in this bill and have asked questions about them, for I do not believe in giving any one individual too much power.

Reverend SCHWITALLA. You cannot, apparently, give them power.

You can say to the Surgeon General, with the advice of the Federal council; apparently, there was opposition in some of the statements this morning about the concurrence of the Federal council with the Surgeon General. If you want to, I will say the Surgeon General with the concurrence of the Federal Hospital Council; that is fine, but the plea was made, as you know, and the background is that there is a lot of feeling that such a thing as an advisory committee, rather than a hospital committee, was the function of the hospital council.

Mr. Brown. I have been giving a lot of consideration, for some time, to introducing a bill to establish a national health council.

Reverend SCHWITALLA. Are you asking me to back it up or something like that?

Mr. BROWN. Just for the very reason that I do not think any one individual is infallible. I have all of the respect possible for Dr. Parran, but I do not believe any one individual has all the answers to the public health problem in the United States or can have them.

Reverend SCHWITALLA. If you are telling me that you will go along with this thinking, if the final word were left in the Surgeon General's hospital council, that is the last group we can think of, then I will go with you 100 percent.

Mr. Brown. I am inclined rather to go along with your philosophy, and your thought that there should be some appeal. That is what I am saying, but I am wondering, not because of Dr. Parran, for, as I said he is out of this picture, so far as personalities are concerned, in the long-range view of this business, whether you are not passing it up to one man instead of leaving it with a broader aspect. That is why we have a nine-man Supreme Court, for instance because we get a cross section and the best judgment of a number of minds.

And presumably, at least, you get a better seasoned and a better reasoned decision when you get through.

Reverend SCHWITALLA. I think you are very wise, Mr. Brown. If we can change that to the hospital council in place of the Surgeon General, I would go along with it fully, provided we safeguard that principle of appeal.

There should not be any place in the picture where there is an area where there is no appeal possible.

Mr. BROWN. I agree very fully with the statement you read from Senator Taft. I read it in the Senate Report and was impressed with it before you read it in your statement.

This is a departure. And yet this service that the charitable hospitals have rendered, that is, the Catholic hospitals, the Protestant hospitals, et cetera, has been so outstanding and so necessary that I think they are certainly entitled to, and should be given, aid under this law just the same as other hospitals. And yet I do not want to see anything wrong.

i know communities where the population is predominantly Catholic, where the prejudice might be the other way.

Reverend SCHWITALLA. I think where the population is predominantly Catholic, you ought to put in a Methodist hospital, and where it is mostly Methodist, put in a Catholic hospital.

Mr. Brown. It is my desire to see this thing worked out so that we can get away from this picture or thought of even a suspicion that somebody in the hospital field is not being treated fairly, somebody is getting unfair advantage, or somebody else is not getting fair treatment. I do not know how it will be done, myself, but I still think that perhaps we are not curing it much when we step from one board up to a single individual. Yet I think Dr. Parran would lean backwards to be fair. I am not worried about him, but I think, perhaps, some countries and some nations have had Surgeons General in their history, or men in similar positions, who certainly have been prejudiced.

It can happen here.
Mr. HARRIS. I believe you had your last paragraph to read.

. Reverend SCHWITALLA. We should provide appeal possibilities all along the line, various contacts of the State with the Federal authorities. I am particularly happy to see that terminus of the appeal to be the council rather than the Surgeon General.

I thought of the Surgeon General first because in so many places in the other parts of the bill the Surgeon General was the person men. tioned to appeal to.

Mr. HARRIS. But you do think if that right should be given, that the State should have the right to appeal that decision, if they thought their position was justified?

Reverend SCHWITALLA. I want to give it to all parties in interest if at all possible.

My last comment on S. 191 is that the constitution, the size and personnel of the Federal Hospital Council should be safeguarded by all means as it is devised in S. 191. It is all important that these highly technical questions which are involved in the location of a hospital be submitted to the competency and professional wisdom of persons who are disinterested, objected and fully qualified to advise upon technical matters. The Federal Hospital Council should reach its decisions not on the basis of a majority vote, but on the basis of professional authority of the individuals composing it. This councis, therefore, must be viewed less as a parliamentary agency than as a professional agency, It should not, of course, disregard the needs of the people but it would seem that adequate provision is made for bringing to the Federal Hospital Council the needs of the people through the three members of the council who represent consumer groups.

You cannot decide on a majority vote basis whether a patient has appendicitis or not.

It is recommended that a requirement for participation by a State in the funds available through the eventual law based on S. 191 should be the constitution of a State hospital council similar if not identical with the Federal Hospital Council. Mr. HARRIS. Are there any further questions?

. Thank you very kindly, Father. We are indeed glad to have you come before this committee and give use your views on this important subject.

It is now 25 minutes to 5 o'clock.

In view of the fact that the members of the committee perhaps have other work to do, we will adjourn until 10 o'clock in the morning.

(Thereupon, at 4:35 p. m., Thursday, March 7, 1946, the committee recessed until Friday, March 8, 1946, at 10 a. m.)

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FRIDAY, MARCH 18, 1946


Washington, D.O. The subcommittee convened at 10 a. m. Hon. J. Percy Priest, chairman, presiding.

Mr. PRIEST. The committee will come to order.

We will take up further consideration at this time of S. 191. I would like for the record to show at this point that during the past several months, bills dealing with Federal aid for hospital construction have been introduced in the House by the following members, H. R. 2498 by Congressman Neely of West Virginia; H. R. 2755 by Congressman Patrick of Alabama; H. R. 3845, a bill dealing with the same subject in somewhat different manner, introduced by the late J. Buell Snyder of Pennsylvania, who passed away very recently. He was interested in the subject and had introduced a bill; and then I suppose the record already shows that I introduced a bíll under the number of 5628, also dealing with this subject.

We would like to hear at this time, Mr. E. I. Erickson, president of the American Protestant Hospital Association.



Mr. ERICKSON. Mr. Chairman and members of the committee: For the record, my name is Ernest I. Erickson, president of the American Protestant Hospital Association and superintendent of Augustana Hospital, Chicago, Ill.

The American Protestant Hospital Association is pleased to appear before you to express our keen interest and active support of the Hospital Survey and Construction Act, S. 191. We feel that this is a vital preliminary step toward making adequate hospital care available to every citizen of this Nation.

It will help you to understand our position if you know that our membership is composed of hospitals founded, operated, and supported by such churches as the Baptist, Episcopalian, Presbyterian, Lutheran, Methodist, Evangelical, and other Protestant denominations. Although most of our member hospitals and hospital administrators are also members of the American Hospital Association, many of our problems in these Christian hospitals are such as to require concerted attention to them through an organization such as our association.

We have also cooperated and consulted with the Catholic Hospital Association on such problems as have been of special concern and interest to church and other voluntary hospitals.

Over a period of many years, our various Protestant church denominations have from time to time recognized the need for more




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