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HAYWARD, CALIF. Dr. ROSNER. Thank you for affording me the opportunity of appearing before you. I would not wish you to be anxious about the pile of reference material that I carry with me. I don't mean to use it at all, as reference material, but if you should wish documentary facts, I am prepared to present them.

Mr. O'HARA. I might say at this point that you did frighten me a little bit.

We are already late for another appointment, but I don't want to prevent you from offering your testimony, Dr. ROSNER. I am Ben Rosner,

M.D. I am a physician and surgeon, in private practice in Hayward, Calif., and among other things, I am chairman of the Subcommittee on Medical Issues of the Joint Congressional District Council, Democratic Clubs, and also I am in the same capacity with the 13th Assembly District Council of Democratic Clubs in California.

I have before me the letter I received from Mr. Ted Ellsworth dated the 27th of March 1962. In this letter he states:

The subcommittee is especially anxious to find out if there is a need and desire on the local level to coordinate all of the various programs-State, Federal, and private that exist for our elderly population. One aspect of this whole problem is certainly that of medical care and the benefit in interrelating other programs for the aged with the medical care program. If a shortage of doctors or if discrimination against some doctors by hospitals adversely affect existing or future medical care programs, then I am sure that the subcommittee would like information concerning this.

And so I am here.

Mr. O'HARA. We are very happy you are, and if I am correct, the Ninth Congressional District is represented by Representative George Miller.

Dr. ROSNER. May I add that you are correct only in part? Due to the recent reapportionment in the State of California, Mr. Miller's district has been reapportioned and the 13th Assembly District, which is somewhat rearranged, took from the previous boundaries, but still comprises most of southern Alameda County where we are meeting, the 13th Assembly District, together with the 25th Assembly District, from northern and eastern Santa Clara County, now comprising the new Ninth Congressional District. Mr. George Miller still represents the 13th Assembly District. However, the new Ninth Congressional District is a new congressional district, and the position is being rather, shall we say, warmly, to put it mildly, contested by, so far, I believe three Democratic aspirants and two or three Republicans.

Mr. O'HARA. I thank you for that information. I shall not tell you who I think should win, because I don't know. I hope, for the sake of residents of this new district, that you succeed in obtaining as able and conscientious a Representative as Mr. Miller.

Dr. ROSNER. I think he is a very able and conscientious man, and I wish you would convey my regards to him. However, I think it best I get back to the point at issue, since the hour is late.

I heard representation here today from several people with whom I wish to concur. The gentleman who is the dean, I believe, of the school of optometry, whose name for the moment escapes me, here at the university, who comments about the need for both preventive and therapeutic care by ancillary health personnel—they are not physicians and surgeons—but the point I am speaking to is basically there is a great shortage not only of physicians and surgeons, but other ancillary health personnel, and it needs remedy.

Also, I will address a comment or two relative to the presentation by the representative for the rest home and nursing home associations. There is also here in the audience Mr. Mark J. Barrett, who is the owner and manager of a rest home in Hayward, where I see a good number of senior citizens. And certainly the problems of not just medical care for the aged, but putting the still productive capacities of our senior citizens to productive uses is a most important one.

Our greatest natural resource is our people, and unfortunately, we have been wasting a great deal of our greatest national resource because many of these senior citizens are highly skilled, highly competent, highly able, and highly experienced individuals who are just stagnating, and they should not be stagnating:

And so it is not just to the issue of the productivity of the senior citizens that I speak, but also to the maintenance of their productivity and to their retraining and rehabilitation.

The specific issue which I am about to reach is the very unfortunate shortage of both real and artificial, of physicians and surgeons, in the ancillary personnel, but I wish here only for the moment to speak of the shortage of physicians and surgeons. Certainly the present dentist program is very seriously taken into consideration as to this shortage, and I have before me a copy of the Medical Tribune for March 5, 1962. It is a publication put out by, oh, I don't know, perhaps a conglomeration of drug houses; and there is an exclusive Ribicoff medical issue, and here Mr. Ribicoff outlines the problems of health facing the United States, after his first year in office, and I allude very briefly to one aspect here. Specifically, we need to take steps to enlarge our supply of medical manpower. We need better arrangements to make health services available to people who are less fortunate and have a need for those services and lack the funds to pay for them, the old men and women of America. Taking these in order, we will need much more medical manpower in years just ahead than we are now able to train. Numerically, there has been a steady increase in the supply of physicians and dentists in recent years, but in proportion to population, supply of both physicians and dentists has been declining.

This is my only copy. I could give you references how to get additional copies, I will be glad to submit it.

Mr. O'HARA. We can obtain it.

Dr. ROSNER. I will simply identify it. This is Medical Tribune, volume 3, No. 10, Monday, March 10, 1962, and it is published each Monday by Medical Tribune, Inc., 624 Madison Avenue, New York 22, N.Y. Mr. O'HARA. Thank you.

Dr. ROSNER. Now, I want now to reach not so much what the problem is to be in the future here and hereafter in supplying the need of physicians and surgeons, but I would wish to speak more specifically to better utilizing what physicians and surgeons we already have.

I have before me, in fact, I have three copies of it if you wish to see them now, a copy of Look magazine of January 17, 1961, and the caption is “Why Hospitals Lock Out Doctors.” This is a lockout in terms that perhaps laymen use the term as the most descriptive, it is a lockout and the lead capition is “Nearly Half the Physicians in the United States Are Unable To Treat Their Patients in a Hospital.”

This is not just speculation; this is based on real facts. And, however, I will state perhaps some of the real facts.

I wish to invite the committee's attention to a suit that was recently filed in the Federal courts, and I read from the Oakland Tribune of California of Tuesday, February 13, 1962, page 8:


GREENSBORO, N.C. (UP).-A Federal court suit was filed here yesterday by a Negro group which said the action could open up federally supported segregated hospitals throughout the country to Negro patients and doctors.

The suit challenges the constitutionality of using Federal funds for construction of segregated hospital facilities.

The suit was filed in this southern city which spawned the Negro lunchcounter sit-in movement by six Negro doctors, three Negro dentists, and two Negro patients.

The suit challenges the constitutionality of a provision of the Hill-Burton Act under which Federal funds are provided for hospital construction.

Specifically challenged is the section which provides that Federal money can be used for segregated hospitals:

If the plan makes equitable provision on the basis of need for facilities and services of like quality for each (racial) group * * *."

Dr. ROSNER. Gentlemen, I submit that this condition is not due to a lack of competence of these physicians who are locked out, but just as the Negro physicians, the basic issue here is economic discrimination, that unfortunately the majority of your hospitals, and incidentally our medical societies, and I speak of county and State and AMA medical societies, the majority of these are controlled by what I might term medical politicians, perhaps many of them practitioners who gain control of the hospital staffing of our hospitals and thus unfortunately the rank and file physician all too often has great difficulty getting hospital appointments, for the reason that it is an economic advantage for the physician or hierarchy of medical physicians and prohospital staffs to control those staffs and to either keep doctors out in the economy of scarcity and also if the doctors are allowed on the staff, then they often are not granted the privileges which their training, skill and competence would warrant.

This is a matter purely of economics, and it is going to take considerable planning for us to overcome these problems, so that our physician resources might be made adequate, might be more adequately used to furnish the greatly increased needed care, both preventive and curative, of our aging population. This is a serious problem and organized medicine unfortunately seems most reluctant to police itself.

Last June, there was a great deal of publicity about the American Medical Association taking original jurisdiction in circumstances where local, county, and State medical societies would not police themselves. There was a great deal of publicity and the matter was referred to the next clinical meeting of the AMA in November 1961, and there was no publicity about that, but that amendment to the constitution and the bylaws of the American Medical Association was referred back to the committee, and the article in the medical publication that reported on this minimized the importance of it.

I submit to you that there will be a great need for planning on the Federal level, the assistance of local agencies to correct these problems, and for this purpose this committee has already on file, I am informed by Mr. Ellsworth, a resolution which I submitted to it, and if I may, may I read it? Mr. O'HARA. You may.

Dr. ROSNER. Actually, the whole sheet is written thusly for our local problem here in California, but the problem is national, and may I state this, it is national in this connection. The law has been well established not in just our State, but first let me quote the law. In an action entitled "The United States Government v. The Medical Society of the District of Columbia and The American Medical Society," a case involving a group of health insurance people in Washington, D.C., in the Supreme Court of the United States, in 1943, the American Medical Association was found in criminal violation of the Federal Sherman-Clayton antitrust laws relative to its exclusion of physicians who were willing to render prepaid medical care to this group, prepaid group, excluding these physicians from hospital staffs, and the American Medical Association, American Medical Society of the District of Columbia, were found in criminal violation of the Federal laws relative to hospital staffing policies and access of physicians to hospital staffs and patients who would choose a prepaid

plan, and these physicians for their care. In the State of California it has already been decided in the case of Tatkin, Sylvan 0. Tatkin, M.D. v. The Los Angeles Medical Association and the A.M.A., it has been decided that the practice of physician access to hospitals does come under the antitrust laws of the State of California, specifically the Cartwright Act, and if this were not so, common law principles would apply.

In this case, Dr. Tatkin had been excluded from membership in the Los Angeles Medical Association and thus in effect the membership on the hospital staffs in the area in which he practices, in Cuca

monga, Calif.

Now, to read my resolution, all this resolution is addressed to the Honorable Stanley Mosk, attorney general of the State of California, to investigate the criminal violations, mind you, of the existing laws, and if such violations are found, to prosecute so that these violations might be removed. The resolution reads:

Please write to the Honorable Stanley Mosk, attorney general of the State of California, Library & Courts Building, Sacramento 14, Calif., urging him to investigate and prosecute violations of the antitrust laws of the State of California by medical societies and hospital staff cliques, against the public's free choice of physician in hospitals.


Whereas the King-Anderson bill provides payment for hospital services for the aged under the social security principles; and

Whereas President Kennedy's plan for the elderly will be seriously handicapped, or even unworkable, unless there is an adequate number of doctors available to render the increased medical care that would be required; and

Whereas "Nearly half the physicians in the United States are unable to treat their patients in a hospital," (Look magazine, Jan. 17, 1961, "Why Hospitals Lock Out Doctors”), and thus, in effect, the public does not have free choice of physician because many licensed and competent physicians and surgeons are arbitrarily excluded from access to hospitals for racial, religious, political and/or economic reasons alone; and

Whereas such discriminatory exclusion of physicians and their patients from access to hospitals of their choice is in criminal violation of the antitrust laws of the State of California and of the United States; and

Whereas in 1961, the California Democratic Council went on record to the effect that, “Doctors should not be denied access to use of hospitals for reasons other than medical competency and professional character": Therefore, be it

Resolved, That the California attorney general be urged to investigate and prosecute California hospitals, and county and State medical societies for criminal violations of the antitrust laws relative to exclusion of licensed physicians from hospital staffs. Respectfully submitted.

BEN ROSNER, M.D., Chairman, Subcommittee on Medical Issues, 13th Assembly District Coun

cil of Democratic Clubs; Chairman, Subcommittee on Medical Issues,

9th Congressional District Council of Democratic Clubs. There is no doubt that we have a great shortage of physicians. I have before me a little item from the Daily Review of Hayward dated March 12, 1962, “Human Factors”—this is on page 1—“More Cancer Cases Could Be Considered." Then listed here is a statement: “The shortage of medical manpower to perform the immense task of examining well people to detect cancer in its early stages is one of the human factors in this problem of cancer. I could quote many other problems. I think it is important. I have statistics on medical school application decline while population grows.

Mr. O'HARA. Might I interject for just a moment here?
Dr. ROSNER. Yes.

Mr. O'HARA. We also recognize that the time is short. If you think you could set forth more completely and more convincingly the points that you have made by reference to these matters, and if you want to submit a background statement or background material, we shall grant you permission to do so and have it printed in the record following your statement.

Dr. ROSNER. Thank you. I would appreciate that opportunity and thus will not further state any more matters right now; if

you gentlemen have any questions of me, I would be glad to answer them.

Mr. O'HARA. I want to thank you and all the others who have testified for taking the time to attend these hearings.

I might add that I am aware, and I am sure other members of the subcommittee are, too, of the problems that have been created in certain places from time to time by practices associated with the admitting of physicians to hospital staffs. Since one of the problems confronting any program to aid the aging is a general lack of trained personnel in medical and other fields, this is certainly one of the questions that would be examined by any commission, agency, or office that might be established by Congress following the recommendations of this committee.

I assure you that if this committee reports any bill, it will call attention to the problem of the shortage of personnel in the field. I think you may rest assured that the problem to which you have referred would be a part of that investigation.

Mr. Giaimo, do you have any questions?

Mr. O'HARA. We wish to thank you again, Dr. Rosner, for appearing. We are hopeful that the problems you have raised and those raised by other witnesses will receive some attention in the months ahead.

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