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STATEMENT OF HON. HULETT C. SMITH, GOVERNOR OF THE STATE OF WEST VIRGINIA, PRESENTED BY LOUIS S. SOUTHWORTH, ASSISTANT SUPERVISOR, DIVISION OF ALCOHOLISM, WEST VIRGINIA DEPARTMENT OF MENTAL HEALTH

Mr. SOUTHWORTH. Thank you, Congressman Staggers, Mr. Chairman and Dr. Carter.

I would like to make a few remarks prior to presenting the Governor's statement.

It is a pleasure, a privilege and an honor to come before you today in support of title III, part A of H.R. 15758, and I appreciate this opportunity to speak in favor of sound alcoholism legislation such as you are considering today.

We support the testimony given by Mr. George Dimas, president of the North American Association of Alcoholism Programs. The interest in West Virginia in this kind of program is longstanding. Governor Hulett Smith of West Virginia and our Secretary of State, the Honorable Robert D. Bailey, Jr., previously submitted statements for the record before the full Committee on Interstate and Foreign Commerce, at the hearing in September 1965. Their statements reflect the sentiments of the entire State government of West Virginia in support of this sound legislation.

Governor Smith asked me to tell you that he deeply regretted that he could not appear here today in support of this bill. He did, however request that I read to you the following statement voicing his complete approval of this important measure.

"As throughout the Nation, alcoholism is a serious public health problem in West Virginia. During the past 4 years, our State has taken positive action. With State moneys and a small Federal grant, we have established the base for a comprehensive alcoholism program. We now have eight alcoholism information centers and three treatment facilities. Even though West Virginia has had national recognition for what it has done, the facilities we now have cannot begin to meet the need for services demanded. Each of the treatment facilities has a long waiting list and our local alcoholism information centers have a caseload far beyond their capacity to provide adequate services *** and the caseload continues to mount.

"We are one of the States under the jurisdiction of the U.S. Fourth Circuit Court of Appeals. The decision by this court that 'we can no longer treat the alcoholic as a criminal *** but as a medical problem,' has resulted in a very noticeable impact on the need and demand for alcoholism services. The current case now before the Supreme Court, Powell v. Texas, will no doubt have a still greater impact and create a still greater demand on our limited resources. This problem of alcoholism that we now face in West Virginia and the Nation is so great that State and local resources cannot cope with the problem. Federal action is essential. Money for staff and facilities is a must, and time is of the essence.

"This bill on alcoholism that we are considering here today was introduced by our own Congress, Harley O. Staggers. The State of West Virginia is proud that our Congressman had the courage and foresight to take the leadership for legislation on this most serious public health problem.

"As Governor of West Virginia, I personally urge this committee to take favorable action on title III, part A of H.R. 15758, 'The Alcoholic Rehabilitation Act of 1968.''

Mr. ROGERS. Without objection, the statements of Dr. MitchellBateman and Mr. Dancy, referred to earlier by Mr. Staggers, will be made a part of the record at this point.

(The statements referred to follow :)

STATEMENT OF M. MITCHELL-BATEMAN, M.D., DIRECTOR, WEST VIRGINIA DEPARTMENT OF MENTAL HEALTH

During the past four years, the Department of Mental Health has endeavored to establish the base for a comprehensive alcoholism program as part of our state mental health plan. As we have progressed, our Division of Alcoholism has made every attempt possible to provide a complete range of services needed. We have used existing facilities in our state hospitals and local mental health clinics and worked with other agencies, trying to meet the ever increasing demand for alcoholism services requested by our citizenry.

We are proud of what we have accomplished but, in essence, the work we have done is just the beginning of what must be done in the future. The problem of alcoholism and the many related problems of the families of the alcoholic must not only be recognized as a joint responsibility of the federal, state and local governments, but must be cooperatively funded if we ever hope to treat alcoholism as a serious medical and public health problem.

The Alcoholic Rehabilitation Act of 1968, as introduced by Congressman Staggers, can be the breakthrough for developing comprehensive programs and services as an integral part of our Comprehensive Mental Health Centers Act. Favorable action on this alcoholism bill by the Sub-Committee on Public Health and Welfare, can lead to the eventual passage of the bill with adequate federal funding to make the "Great Breakthrough." I urge favorable committee action. on this bill.

STATEMENT OF DONALD R. DANCY, M.P.H., SUPERVISOR, DIVISION OF ALCOHOLISM, WEST VIRGINIA DEPARTMENT OF MENTAL HEALTH

The passage of the proposed "Alcoholic Rehabilitation Act of 1968" is essential, Title III, Part A of H.R. 15758 can be the beginning of a real federal, state, and local cooperative effort to meet the ever increasing demand for alcoholism facilities and service in West Virginia and the Nation.

In West Virginia, a small state of 1.8 million people, we have at least 75,000 persons with alcohol problems, plus three more persons per case (family members) indirectly involved. This makes a total of 300,000 persons adversely affected by alcoholism problems.

From sample surveys made in urban and rural areas, we found the following: 1. Between 1962 to 1966, records of one urban police department showed 52 percent of all arrests were for drunkenness; 74.4 percent of the cases appearing before Justices of the Peace were for offenses involving drunkenness, and 66.2 percent of misdemeanors appearing in the county court involved drunkenness. 2. In a current study (not yet complete) the indications are rather conclusive that at least 40 to 50 percent of all arrests in rural areas are for public drunkenness. Drunkenness arrests plus other charges that involved drunkenness show a range of 60 to 70 percent of all arrests involve a drunkenness offense.

West Virginia State Police arrest records for 1966 show 53.7 per cent of all misdemeanor arrests were for drunkenness. Arrests for moving violation showed 4.5 per cent were for drunken driving. Of all arrests made by the West Virginia State Highway Patrol, 12.63 per cent involved either drunkenness or a drinking driver.

A survey of State Mental Hospitals from January 1 through June 30, 1967, showed 35.29 per cent of admissions reported that, "excessive use of alcohol was a major factor contributing to their illness." This 35.29 per cent plus voluntary admissions to our alcoholic intensive treatment units (3.4 per cent) makes a total of 38.69 per cent of all admissions to our State Mental Hospitals who have serious. problems with excessive use of alcohol.

From information and data available on prisoners in our state institutions, between 75 and 80 per cent of all prisoners are alcoholic or have a related alcohol use problem.

A survey of alcoholic patients receiving intensive treatment in one of our more advanced alcoholic treatment units shows that 66.4 per cent have responded very favorably to treatment. Of these, 38.8 per cent have refrained from drinking and made improvement in other areas of adjustment to life, and another 27.6 per cent have had less than one 24-hour drinking episode per six months during the last year and improved in other areas of social and personal adjustment.

In one study of public drunkenness offenders, the records of 140 such offenders showed an average of 23.3 arrests per each individual. From 116 of these cases referred to a local alcoholism information center for counseling, guidance and treatment, only 21 have reappeared in court over a period of one year. Although the study is not complete, these current findings definitely indicate that the old system of prosecution is outdated, outmoded and inadequate, and that proper referral, education, counseling, and treatment is effective and an economically sound investment.

A recent study by the West Virginia Division of Vocational Rehabilitation shows the average cost of service for rehabilitating an alcoholic is considerably less than any other disability category. The average cost per alcoholic was $103. Comparatively, the next lowest disability category cost was $217 and the highest category was $876.

The problem of alcoholism in West Virginia is beyond our financial and human resources. We need more facilities for treatment and staff to expand the treatment facilities we have. We need more local alcoholism information centers and the staff to operate them. In short, we are only providing a token of what is needed.

I respectfully request that the Sub-Committee on Public Health and Welfare favorably consider the proposed, "Alcoholic Rehabilitation Act of 1968.”

Mr. SOUTHWORTH. Mr. Chairman, West Virginia recognizes the size and extent of the problem and we take pride in the positive steps we have made in creating a division of alcoholism in the Department of Mental Health and in allocating State moneys to start our program. We have tried to make maximum use of our moneys and other existing resources. We have worked cooperatively and established interagency programs with the West Virginia Association of County Officials, the division of vocational rehabilitation and other related agencies. This has enhanced our progress. Still, without substantial assistance from the Federal Government, we have reached a point where further progress will be extremely limited. West Virginia is in desperate need of the kind of Federal assistance proposed by Congressman Staggers in the Alcoholic Rehabilitation Act of 1968.

Mr. ROGERS. Thank you, Mr. Southworth, for being here and for presenting these statements. They will be most helpful in the consideration of this matter by the subcommittee.

While you are still sitting there, I want to recognize the presence of one of our distinguished colleagues from West Virginia, who has come into the hearing room, the Honorable Ken Hechler. If you have anything to say, Mr. Hechler, the committee would be glad to hear you.

STATEMENT OF HON. KEN HECHLER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WEST VIRGINIA

Mr. HECHLER. Thank you.

I would like to echo the statement on the need for this legislation in the State of West Virginia that Congressman Staggers is sponsoring.

The statistics that have been presented to the committee, I think, show conclusively the need for this legislation. The fact that over

one-third of the occupants, inmates, of our mental institutions are affected by alcoholism problems I think is a point which the committee should consider. The fact, also, that such a large percentage of the inmates of our prison institutions in the State of West Virginia are affected with problems associated with alcoholism I think is also something that should be considered by this committee in favorably reporting this legislation, which I think is necessary for the Nation.

Mr. ROGERS. Thank you very much for being here and giving us the benefit of your statement.

Mr. HECHLER. Thank you.

Mr. ROGERS. Our next witness is Dr. Chambers, Medical Association of Georgia, Atlanta, Ga.

It is a pleasure to have you here, and we know of you through your good friend, Congressman Jack Flint of Georgia.

Dr. CHAMBERS. I would like to submit a copy of this journal for the record.

Mr. ROGERS. Without objection, we will accept the journal for the files.

(The publication referred to, "Journal of the Medical Association of Georgia," April 1967, was placed in the committee files.) Mr. ROGERS. You may proceed, Dr. Chambers.

STATEMENT OF DR. J. W. CHAMBERS, REPRESENTING THE MEDICAL ASSOCIATION OF GEORGIA

Dr. CHAMBERS. Mr. Chairman and members of the committee, I am in private practice of medicine in La Grange, Ga., associated with a fee for service group practice. La Grange, Ga., is a small city of 25.000 population in a county of 50,000 population. There is one hospital in our community; it has approximately 220 beds and is an accredited hospital.

I appreciate the courtesy of this committee in hearing a voice from the "grassroots support" of H.R. 15758. It is my belief that the health professionals in our region consider the original legislation, Public Law 89-239, as important as any that has been passed by the Congress in many years, and we feel that it deserves continued support. Our interest in this program, however, began before Public Law 89-239 was passed. This was evidenced by discussion among representatives of the Medical Association of Georgia, Emory University School of Medicine in Atlanta, the Medical College of Georgia in Augusta, the Georgia Heart Association, and the Georgia Division of the American Cancer Society. These discussions were expanded during 1966 to include the representation from the Georgia Hospital Association, Georgia Department of Public Health, Georgia Medical Association, Georgia Dental Association, Georgia Pharmaceutical Association, Georgia Division of Vocational Rehabilitation, Georgia State Nurses Association, Georgia State League for Nursing, Georgia Department of Family and Children Services, Community Council of Atlanta Area, Inc., and the Planning Council of Metropolitan Savannah.

In addition, the Georgia Nursing Home Association and knowledgeable and interested laymen were included. From such discussions,

involving these diverse groups, a plan was developed for the organization of a regional advisory group composed of approximately 125 knowledgeable and interested persons broadly representative of our region.

Evidence of the interest of the physicians of Georgia in the regional medical program has been shown by the fact that the entire April 1967 issue of the journal of the Medical Association of Georgia was devoted to the Georgia regional medical program.

This is the journal I asked to be put in the record.

Although the program had only officially begun on January 1, 1967, the responsibility for leadership by physicians was already keenly felt. In fact, the Medical Association of Georgia was unanimously elected by the regional advisory group to serve as applicant for the Georgia region.

May I quote briefly from an editorial entitled "A Unique Opportunity for Leadership," which appeared in the April journal.

The regional medical program for Georgia provides the membership of the Medical Association of Georgia a unique opportunity for leadership in "promoting the science and art of medicine and the betterment of the public health." However, the role of leadership can only be effectively assumed as physicians understand the program.

The legislation which established this program was the result of the report of the President's Commission on Heart Disease, Cancer, and Stroke, commonly called the DeBakey report. However, Congress gave thoughtful consideration to many medical leaders and organizations before passing Public Law 89-239 in October 1965. As a result, this law provides for local medical programs which can and will be developed by people in the areas involved for the people in the areas to be served. This is inherent in the legislation through the language of "cooperative arrangements," and "without interfering with the patterns, or the methods of financing, of patient care of professional practices, or administration of hospitals."

The regional medical program for Georgia has been planned carefully by Georgia people in a truly cooperative atmosphere during the past 15 months. This can best be judged by the membership of the program's Georgia advisory group. The program is practical and will provide the tools for every practitioner to improve not only his own medical capabilities but also to improve the quality of medical care provided for each and every one of his patients.

This is a challenge for each member of the Medical Association of Georgia and may well be our greatest opportunity in our time for exhibiting responsible leadership.

Another factor which we feel recommends the extension of the regional medical program is the already demonstrated marked improvement in communication and dialog, not only among teachers, medical schools, and practitioners, but also among all of the health professions in the region. In short, we have begun what we believe to be successful treatment of the "town gown" syndrome in our region. The long-range effect of this will be improved care of patients. The original program plan for the Georgia region takes into account that new knowledge from the medical centers must flow to every area of the region and equally important, the knowledge and needs of the practitioner and others in the small towns must flow to the medical centers.

Still another recommendation for the extension of this program, we believe, has been the demonstrated mechanism for developing a program of public education to stimulate lay people to want and to seek good medical care. There are many economically disadvantaged people

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