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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.)

Nr. 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.


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

5 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.

Mr. Chairman, I will be glad to answer any questions you have.

Mr. Rogers. Thank you very much, Dr. DeBakey, for giving us your viewpoints on this program and its importance.

Could you give us an example of one region that you may be aware of, or maybe you would want to do this in your statement.

Dr. DE BAKEY. Well, rather than take your time about it, let my statement provide this information. I would like to discuss an area where they have not only accepted the total concept of the program but are utilizing the program in a most efficient way to provide the particular three elements that I think are essential: research, education, and patient care. These three elements must be combined at the level at which the physician meets the patient.

Mr. Rogers. This has been my concern with the program, and I realize it is still very young. But I am beginning to get feedbacks that the program is not reaching the practicing physician yet. It is not down to the hospital. It has stopped at a little higher level, at the dean's office.

Dr. DE BAKEY. This is understandable at the planning stage. Only at the operating stage will they begin to feel the program.

The most important thing to me is the fact that the program is becoming better understood by the practicing physician, and there is developing an enthusiasm for the program at the grassroots level that really is in striking contrast to some of the earlier experiences.

Mr. Rogers. That is right. I remember very vividly,

I think it might be helpful to point out some of these areas where you feel the program is being effective in getting to the community hospital, and where the people in the community are really beginning to receive the benefits. This would be helpful to the committee, and also to spread it

upon the record so that other areas can see what is being done in the most successful programs.

Dr. DE BAKEY. I will be very pleased to do this and include it in the statement I will file with you.

Mr. ROGERS. Thank you.
Mr. Kyros?
Mr. KYROS. We are happy to have you here, sir.

These programs of construction that you are talking about would still have to be initiated at the local level and passed on by the Advisory Council.

Dr. DE BAKEY. Yes; and they would also have to show justification as being within certain guidelines, as being essential to the efficacy of this program.

There are all kinds of construction needs, but we have various types of construction authorities, and I would think the important thing is that we limit the construction to the needs of this program; that is, where it can be demonstrated unequivocally that without the construction space the program couldn't be effective, couldn't be implemented.

Mr. Kyros. I duni't know how familiar you are, sir, with the money requirements of the program; but the figures yesterday were that it would be about $30 million carryover from the last fiscal year, and the bill this year carries $65 million.

Do you think $95 million will be enough for this kind of planning this coming year?

yate space.

Dr. DE BAKEY. Well, if I read the situation within the next year correctly, I would say we would come close to that, certainly; and I don't think it is going to jeopardize the program.

What I am concerned about is when we get into the operational phase within the next-well, say by 1971. I would say within this 2- to 3-year period we are going to see a real escalation in activity and, therefore, in funding needs.

Mr. Kyros. I understand, thank you very much.
Mr. ROGERS. Mr. Nelsen?
Mr. NELSEN. I have no questions.
Mr. ROGERS. Dr. Carter?

Mr. CARTER. It is an honor, Dr. De Bakey, to have you here. You are so well known to many of us as being absolutely dedicated to the service of humanity. We are honored to have you here.

I would like to ask about how the funds that you want--are they to be for something similar to intensive care units in different hospitals?

Dr. DE BAKEY. Yes. Well, some of them would be used in that way. For example, let us take the community hospital that is in a program. They need and can use, and in a sense can support, an intensive care unit; but the hospital is built in such a way that they can't even renoYou are familiar from your own experience, I am sure, in

your own area of Kentucky, where hospitals, even those built with Hill-Burton funds, are now so jammed that it would be denying the use of the space for some very essential purpose.

. So they need additional space. To build this, they have to have money. It may be a relatively small sum. It may amount to a hundred thousand dollars, but it is still money that is hard to find for this purpose.

An intensive care unit would be one wing. Another would be—I hope my colleague will point this out in his testimony to you--in terms of acute stroke units. There will be diagnostic facilities of certain specific character.

We point out in the Surgeon General's report, which the Council had the opportunity to review, the types of space needed. They will need classroom facilities. This is the kind of space that is essential to carrying out the program.

Mr. CARTER. Certainly we have seen that many of our hospitals in the smaller areas, and I am sure it is true in cities, that in the past few years building has taken place, but still it is inadequate.

Dr. DE BAKEY. Completely inadequate, and also it doesn't take into consideration these kinds of needs. They didn't even visualize these needs in the early plans. Their concern was with immediate needs that they had to meet.

Mr. CARTER. I see the need of these things.

Dr. DE BAKEY. May I say to you, Dr. Carter, that it was part of your understanding that helped produce this program, and I want to thank you again for your insight into this whole program.

Mr. CARTER. Thank you, sir.
Dr. DE BAKEY. It was a tremendous help to us.
Mr. ROGERS. Mr. Skubitz ?
Mr. SKUBITZ. Thank you, Mr. Chairman.


I have no questions, Dr. De Bakey, but I want to join my colleagues in welcoming you here today. I am looking forward to receiving your recommendations.

Dr. DE BAKEY. I want to express my appreciation to the committee for the wisdom and kindness and generosity they have shown, and it is good to know there are public servants like yourselves. Mr. ROGERS. Thank you. (Dr. De Bakey's prepared statement follows:)



Mr. Chairman and members of the subcommittee, I am Michael E. De Bakey, Professor and Chairman of the Department of Surgery, Baylor University College of Medicine, in Houston, Texas. I had the honor of being named by President Johnson as the Chairman of the Commission on Heart Disease, Cancer, and Stroke, whose report led to the initial recommendation of the Regional Medical Programs legislation which this committee developed and passed in 1965. Since its creation, I have been a member of the National Advisory Council on Regional Medical Programs and am also a member of the Regional Advisory Group of the Texas Regional Medical Program.

I testify today in strong support of Title I of H.R. 15758 introduced by the distinguished Chairman of your full committee, Mr. Staggers. If enacted, Title I would extend the authorizing legislation for Regional Medical Programs for an additional five years as well as clarify certain technical aspects of P.L. 89_239.

I would like briefly to reiterate the basic concept of the Regional Medical Programs, the future of which this subcommittee is presently considering.

The Regional Medical Programs comprise a group of units added—wherever possible—to already existing medical centers in regions throughout the country. The units are part of the overall research, teaching, and medical care going on within the medical centers in regard to heart disease, cancer, and stroke.

These units together make up a national network for research, for teaching new developments to doctors and nurses, and for care of patients under investigation. Thus each physician served by this network has, readily accessible to him for his patients, the full range of up-to-date knowledge and skills developed through nation-wide research. At the same time the doctor contributes to research, for his observations add to the total knowledge.

Each of these units we are discussing has its own facilities and staff, though they function as part of the existing medical work force, to pull together and strengthen the medical resources now in existence.

The Regional Medical Programs as initially authorized, placed principal emphasis on regional voluntarism, as the means by which their goal might be achieved. Today I can report that your confidence in this approach has been well placed. Within the last three years 54 Regional Medical Programs have been brought into being. By this summer approximately one-half of these will have entered the operational phase. The remaining regional programs will shortly thereafter begin operation.

With its emphasis on voluntary cooperation the Regional Medical Program mechanism has managed to harness the creative energies of practicing physicians, hospitals, medical schools, voluntary, state and local health agencies. All too frequently in the past these creative energies have been isolated from one another or, even worse, in competition. Regional Medical Programs make it possible for all providers of health services to combine their strengths to improve the care of patients with heart disease, cancer, or stroke. Thus our aspirations of 1965 today are working entities.

One of the most important developments is the large and increasing involvement of the medical profession. In a recent speech the President-elect of the American Medical Association said, “As a whole, the medical profession at the beginning of the year 1968 is probably more deeply involved in the planning process to determine the nature of the Regional Medical Programs than it has been in the planning of any previous Federal program."

Now in considering the future of these Programs, Mr. Chairman, I would like to discuss the legislation before your committee. I was disappointed to

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