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REGIONAL MEDICAL PROGRAMS; ALCOHOLICS AND NARCOTICS ADDICTS FACILITIES; HEALTH SERVICES FOR DOMESTIC AGRICULTURAL MIGRATORY WORKERS

WEDNESDAY, MARCH 27, 1968

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND WELFARE,
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,
Washington, D.C.

The subcommittee met at 10 a.m., pursuant to notice, in room 2322, Rayburn House Office Building, Hon. Paul G. Rogers presiding (Hon. John Jarman, chairman).

Mr. ROGERS. The committee will be in order, please.

We will continue hearings on H.R. 15758, introduced by the chairman, Congressman Staggers of West Virginia, and our first witness today is the Honorable Richard Daley, mayor of Chicago, who cannot be with us, but whose statement will be read by Miss Phyllis Snyder, who is the executive director of Chicago's Alcoholic Treatment Center. We are delighted to have you with us Miss Snyder, and we will be pleased to have you read the mayor's statement.

STATEMENT OF HON. RICHARD J. DALEY, MAYOR, CHICAGO, ILL., PRESENTED BY PHYLLIS K. SNYDER, EXECUTIVE DIRECTOR, MAYOR'S COMMISSION FOR THE REHABILITATION OF PERSONS AND CHICAGO'S ALCOHOLIC TREATMENT CENTER

Miss SNYDER. "Mr. Chairman, members of the committee, I welcome this opportunity to add my support, on behalf of the city of Chicago, for passage of title III, part A, of H.R. 15758, known as the Alcoholic Rehabilitation Act of 1968.

"We in Chicago have long recognized the need for an adequate program of alcoholism care and control. We are very proud of the fine work being done at Chicago's Alcoholic Treatment Center, a municipally supported facility providing inpatent care for 72 males and outpatient services to men and women. This facility has been operating since 1957.

"My commission on rehabilitation, comprised of 22 very able, dedicated, and knowledgeable citizens, has been studying the city's alcoholic problems and the needs to combat these problems since 1955. Our treatment center is a direct result of their recommendations.

"The studies of this commission have confirmed that it is not within our fiscal power to implement the kind of comprehensive program which is so necessary. Inasmuch as Chicago and Cook County have an estimated 250,000 alcoholics, more than one-half of the total alcoholics

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in the State of Illinois, passage of title III, part A, of H.R. 15758 will be of significant help to us in Chicago.

"Enactment of legislation in this area is long overdue. The disease of alcoholism ranks among the foremost health problems of our society. Under present conditions, the primary burden of dealing with the more severe stages of alcoholism on the community level lies with law enforcement, rather than public health authorities.

"This situation is as unrealistic as it is ineffective. Law-enforcement authorities, already burdened with increased responsibility in the area of crime control, are no better equipped to handle incidents of alcoholism than medical doctors to handle crime problems in the community. Several Federal, State, and local courts have already transferred responsibility for handling chronic alcoholic repeaters from law enforcement to public health agencies.

"The President's National and District of Columbia Crime Commission both recommended such a transfer in communities throughout the Nation, not only for sound humanitarian reasons, but to relieve lawenforcement authorities of an onerous, unproductive responsibilitya responsibility, I might add, which drains law-enforcement resources away from the real fight against crime and criminals taking place in the country today.

"The legislation being considered by the committee would therefore be extremely helpful to U.S. communities, especially major urban centers, which need assistance in the development and improvement of alcoholism care and treatment facilities and services.

"This is particularly true in light of the possible court decisions which would prohibit the criminal detention of chronic alcoholics on charges of public drunkenness. Action must be taken, and soon, to prepare communities for the task of effecting an orderly transfer of community responsibility for chronic alcoholism from law enforcement to public health hands.

"The Alcoholic Rehabilitation Act of 1968 is therefore a vitally needed step toward alleviating one of the most serious urban health problems of our time. It will help the communities to help themselves in developing local programs to curb the incidence and prevalence of alcoholism in our society. And let us not forget that in addition to the humanitarian and administrative aspects of this legislation, it will also be a step toward reducing the economic impact of a disease costing American industry an estimated $2 billion annually in lost man-hours and work efficiency.

"In conclusion, then, our country urgently needs a comprehensive national program to deal with the health problem of chronic alcoholism. The Alcoholic Rehabilitation Act of 1968 represents the beginning of such a program. The administration is to be commended for proposing it, and Chairman Staggers for sponsoring it.

"On behalf of the city of Chicago, I sincerely hope that your committee will approve, the 90th Congress will pass, and the President will sign to law, this bill that will aid our States and communities in providing services for the care and control of a disease afflicting millions of American citizens.

"I thank you."

Mr. ROGERS. Thank you very much, Miss Snyder, for this statement from Mayor Daley. We appreciate his testimony, and I think it might

be helpful for the committee if you could submit for the record a rundown on your alcoholic treatment center. I would be very interested to see the staffing, the number of people, and the types of treatment that are given.

(The information requested was not available at time of printing.) Mr. ROGERS. I notice you have in-patient as well as out-patient care, Miss Snyder.

Miss SNYDER. Yes, we do.

Mr. ROGERS. Thank you.

Our next witness is an old friend of this committee, Dr. Michael De Bakey, chairman of the Department of Surgery, Baylor University College of Medicine, Houston, Tex.

I might say that Dr. De Bakey was on the President's Commission for Heart, Cancer, and Stroke, which was really the guiding force for the formation of the regional medical program.

It is a pleasure to have you with us, and we are pleased to receive your testimony at this time.

STATEMENT OF DR. MICHAEL De BAKEY, CHAIRMAN, DEPARTMENT OF SURGERY, BAYLOR UNIVERSITY COLLEGE OF MEDICINE, HOUSTON, TEX.

Dr. DE BAKEY. Thank you. I am grateful for the opportunity to again appear before this committee, as I did on July 7, 1965, in support of the regional medical programs and to report on their progress. I would like to tender my thanks for what this subcommittee and the entire Committee on Interstate and Foreign Commerce have done to develop this program, a program which is already setting a pattern for enhanced medical care within the Nation.

I come before you in strong support of title I of H.R. 15758, introduced by the chairman of your full committee, Mr. Staggers.

I have been a member of the National Advisory Council on Regional Medical Programs since its creation, and I, therefore, have had the opportunity to see this program in its planning phases, and see it develop throughout the country as we hoped it would.

There have been times when I have been guilty of impatience, but the fact is that this program has developed, I think, at a normal pace and in a very sound way.

Now we are at a point where I think we will begin to see the first fruits of this program in terms of its original objective, which was to provide the best possible care for the patient at all levels of our society, and to extend this kind of care to every citizen. This was a need we have recognized but were not able fully to achieve in the past.

I believe this program will achieve its main objectives; certainly in the fields of heart disease, cancer, and stroke, and hopefully in all the related areas.

At this time there are certain aspects of the legislation I would like to discuss in more specific terms. You will recall, Mr. Chairman, in the original testimony, and in the original bill, there was much discussion of construction authority.

I think the committee was wise in pointing out that without this type of authorization for new construction-there was authorization

for renovation that the program would not be jeopardized in the planning phase.

Now, however, we are in the area of actual operation, and already there are 11 programs functioning. I would say by the next several months, perhaps 40 or 50 percent of the programs will be in some phase of operation. So we are moving, you see, quite rapidly.

As we move into this area, construction needs will become increasingly more apparent, and already we have evidence of this need.

This construction is fairly specific in nature and fairly limited in scope. It is not on the same scale as already existing construction needs within the medical centers-construction for which the centers already have the authorization if not the money.

Now, the construction authority we need for the regional medical programs applies primarily to the community hospitals and to the more peripheral units, where the past construction has not anticipated this type of program.

In the Surgeon General's report there is documentation and outlining of the various types of construction needed.

What I should like to do, Mr. Chairman, rather than take your time now, is to submit a formal statement for the record within the next few days. I had hoped to have this ready for you today, but I got involved in a series of emergencies over the weekend.

Mr. ROGERS. We understand, and without objection, your formal statement will be made a part of the record, following your testimony. Dr. DEBAKEY. This is the limited but well-defined need for new construction. I leave to the committee's judgment as to how this best should be met.

Allow me to point out that it is essential for the future of the program to find means of meeting these needs of the community hospitals. These needs include construction space for classrooms; particular types of diagnostic facilities, laboratory space of special types; and treatment units relating to heart disease, cancer, and stroke. The outlying hospitals simply do not have this type of space available, and frequently have no means of finding the funds to provide this kind of construction.

Finally, Mr. Chairman, I would emphasize that we have reached the stage in this program where we must look to the funding levels over the next 3 to 5 years. As we move more and more into operation, I think the cost of these programs will reach the figures we visualized in our original concepts and the original proposals in the President's Commission's report.

You will recall that we expect this to reach authorization levels of well over $450 million by the end of 5 years. Now we are beyond that point in our thinking, and we now have better evidence of what the needs are going to be. I would say they will approximate $5 or $10 million in each region within the next 5 years. Therefore, I would hope the committee will contemplate authorization levels of some $500 million within the 5-year period.

This level will not be reached soon, of course. However, I would think by 1971 we would be close to the $300 million level.

I would hope by that time the opportunities to provide funding at this level would be more readily available than at this moment.

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