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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.

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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,

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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 whom we hope to educate to want adequate medical care, but there may be just as many medically deprived people totally unrelated to economic circumstances. Included in this group are many of our most talented and capable citizens who simply do not seek medical care that could be classified as adequate.

Finally, Mr. Chairman, we believe that the key to the success of the regional medical program in Georgia is the involvement of community hospitals. This, no doubt, is true in every region in the country to a greater or lesser extent. Very early in the development of plans for the Georgia program, the regional advisory group recognized that the vast majority of physicians, nurses and others involved in the regional program relate themselves to one or more hospitals. Therefore, each hospital in the region has a vital role in the program and in the future of medicine. This includes the large hospital, the small hospital, and the hospital in the medical center, and the hospital remote to the medical center. At the present time there are about 19,500 hospital beds in Georgia distributed among 178 general and limited services hospitals of all

sizes. Over 3,000 physicians serve on the staffs of these hospitals. To emphasize the role of hospitals in the program, it is planned that each hospital will become a central focal point through which the objectives of the regional medical program will be carried out. Every hospital will become a teaching hospital. This does not imply that medical students and house staff need to be present; but, it does imply that physicians, nurses, dentists, pharmacists, administrators, members of the public, and all of the allied health professionals shall organize themselves into an educational program. Each hospital has been asked to submit the names of a group of persons to serve as a local advisory group to the regional medical program. It was suggested that a physician (as chairman), a hospital administrator, a nurse, and a member of the public be the minimum number to comprise each designated group.

This local advisory group may be as large as the local hospital or community desires, but it must be named by and through acceptable administrative mechanisms.

These groups of local hospital representatives are functioning well. Of Georgia's 178 hospitals, 121 have appointed local advisory groups. This represents approximately 90 percent of the general hospital beds in the region. It is pertinent to this presentation that the chairman of the local advisory groups met in Atlanta on Sunday, March 24, 1968, for a day of planning and discussion. According to the registration, 87 hospital representatives were present. Similar meetings, as approved in the program plans for Georgia region, will be held at least twice during each calendar year. This

method of affiliating local direction at the grassroots with the overall program of health planning is, in our opinion, a sound and effective approach.

Although health planning has been going on in our region for many years, this is the first time that representatives from all interested groups have deliberated together in an attempt to coordinate their health care planning into a unified plan for progress. Both interest and participation of the practicing physicians, local hospitals, and medical schools have been excellent. Close communication with other agencies, organizations, institutions, and Government programs is

assuring complete coordination of all activities in the area of health in the Georgia region, and the purposes of Public Law 89-239 are being achieved.

Thank you again, Mr. Chairman, for this opportunity.
Mr. ROGERS. Thank you for an excellent statement.

I notice that you say 87 hospital representatives were present at your last meeting out of what? Some 178?

Dr. CHAMBERS. Potentially 178. Of that number 121 have already set up the local advisory groups. The ones who have not are primarily the extremely small hospitals, Mr. Chairman, maybe as few as 15 to 20 beds.

Mr. ROGERS. But you feel the major hospitals in the State have?
Dr. CHAMBERS. We have 90 percent of the beds covered.

Mr. ROGERS. Even though they don't attend the meeting, they have signed up for this?

Dr. CHAMBERS. Yes. These same ones are not the ones who were at previous meetings, necessarily, but this percentage is a pretty good attendance, for a region our size.

Mr. ROGERS. Is the region too large?

Dr. CHAMBERS. No, we do not think so. We are beginning to get subregionalization now. This is what we hope to accomplish.

Mr. ROGERS. How long have you actually had the region formed ?

Dr. CHAMBERS. Our program, Mr. Chairman, actually began January 1, 1967, so we are only about 15 months old.

Mr. Rogers. You present a very encouraging picture.
Dr. CHAMBERS. We feel we have accomplished a lot in 15 months, sir.

If the committee would be interested, sir, I would be glad to leave a copy of the operating rules and regulations of our programs.

Mr. Rogers. I would like very much to have that for the committee files.

Thank you very much, Dr. Chambers.

Our next witness will be Thomas Carpenter, president of the National Council of Alcoholism, Inc., New York.



Mr. CARPENTER. I have with me Mr. William Moore. He comes to us after a distinguished executive career with the Heart Association.

I know the previous testimony has covered many aspects of the problem. We have a brief statement identifying ourselves and our particular interests.

Mr. Rogers. You may proceed.

Mr. CARPENTER. The National Council on Alcoholism is the voluntary health agency concerned with alcoholism. It has 82 affiliates serving the major cities, plus 11 group members in smaller communities throughout the United States. Each affiliate has a volunteer board of directors and a citizen constituency. These boards, like the national board of directors, are representatives of the legal, medical, educational, civic, religious, business, and industrial interests which are concerned with the disease of alcoholism.


The National Council on Alcoholism directly speaks for nearly 11,000 U.S. citizens who are involved in its programs and vitally concerned about the prevention and control of alcoholism. The council represents a unique citizen response to this problem, and has been leading the attack against this disease for 23 years.

This national voluntary health organization, concerned as it is with the third largest public health problem of modern times, also seeks to change community attitudes toward alcoholism and the alcoholic. Long regarded as a personal and moral problem, alcoholism has only in recent times been recognized as a major medical and social problem affecting a broad spectrum of health, welfare and social areas of con

The National Council on Alcoholism, through its programs of public and professional education, attempts to bring a message of hope and help to the community regarding alcoholism. The basic points of this message are: alcoholism is a disease; it can be treated successfully; it is a public health problem and a public responsibility.

The affiliates of the National Council on Alcoholism have ongoing programs of public education which are reaching increasing numbers of citizens where they live. Affiliates also sponsor professional seminars for physicians, nurses, social workers, and other professional persons to enable them to deal more effectively with alcoholics whom they see in the course of their regular work. These activities comprise the portion of the National Council on Alcoholism's program which is intended to transform public and professional attitudes toward alcoholism, thus making it easier for the alcoholic to seek and accept treatment.

In addition, each affiliate of the National Council on Alcoholism maintains an alcoholism information center which serves as neutral ground for alcoholics and their families to obtain information concerning alcoholism, and which makes referral to treatment resources and facilities. Because our local voluntary councils on alcoholism have of necessity, in some places, had to fill the vacuum created by a lack of community facilities for the treatment and rehabilitation of alcoholics, we are particularly concerned that this legislation be approved by the Congress.

The establishment of specialized facilities for alcoholics as provided in title III, part A, H.R. 15758 is a major contribution toward creation of a comprehensive community attack on the problem of alcoholism.

As president of the National Council on Alcoholism, I commend the members of this subcommittee and the leaders of the House of Representatives for their concern for the health and social welfare of their constituents who suffer from, and are threatened by, alcoholism. I am happy to testify in favor of title III, part A, H.R. 15758, which, if passed, will insure that specialized facilities for alcoholics will be included in the Community Mental Health Centers Act. By this wise and humane gesture, facilities will be provided which will help advance the control of alcoholism in the United States of America.

I pledge to you anything that the National Council on Alcoholism can do in the way of support or the furnishing of any additional information which may be helpful to you.

Thank you very much.

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