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tion. The area where need for information and the presence of misinformation is most apparent is in the field of function—the activities of physicians in the delivery of medical care and the identification of their needs and motivation in relation to continuing education.

There is sore need for support within the nonuniversity setting for the measurement and evaluation of continuing education to assure its efficiency and pertinence. Additional need relates to the measurement and evaluation of the physician's performance, so that he can be helped to become more efficient and productive in the delivery of medical care. In short, we should be attempting now to identify what we should teach and what changes in behavior we are trying to bring about through continuing education.

ESTABLISH REGIONAL UNITS

It would seem of great importance that within each of the Regional Medical Programs there be one or more nonuniversity hospital granted funds to construct and staff units to measure and devaluate systemically patient care and its delivery, thus to assist in determing need, content, and motivation in continuing education. These units should be staffed by physicians, educational personnel, and sociologists. Because each region by definition is singular in quality, it is probable that each region will have sufficiently different needs to require difference in approach and measurement techniques. To establish just one or two national institutions or units involved in this type of research would be inefficient and insufficient. This investigative function cannot be carried on in the university setting, for we are studying a nonuniversity organism.

Once identification has been begun of need, content, and pertinence in relation to continuing education, it will be necessary to ensure that sufficient educationally oriented, able and motivated individuals are present within each community hospital (or available to it) to ensure productive usage of the information gleaned and facilities added. This assurance, in the form of trained personnel, might vary across a spectrum encompassing highly skilled, formally trained educators in the larger and more complex hospitals, to individual staff members who have had the opportunity to receive additional understanding in educational philosophy, skills, and techniques in smaller hospitals and communities. One might regard these individuals as the "marriage counselors" of our simile. They are vitally important to a marriage that has little solid foundation in previously existent love or mutual respect between its partners.

Only after the establishment and support of competent and productive continuing education programs should attention be turned to large-scale support of patient care facilities. While such devotion to competence in continuing education, orientation, and ability would somewhat delay the construction of actual physical facilities for more omplex and sophisticated patient care, the delay would serve to ensure that these faciilties would be properly utilized by physicians. Some programs could be coordinate and concurrent. Caring for patients is, after all, the primary purpose for the existence of our entire medical care system.

A PLEA FOR ACTION

In summary, this presentation is a plea for a cogent and logical progression of activity in relation to Regional Medical Programs, perhaps the most important portion of the socially oriented legislation that has arisen in recent years. By simile, it is a request for good, sound premarital discussion and orientation by the groom and the father-in-law to ensure that the bride of our “marriage" has the knowledge and the necessary appliances and counsel to keep house properly.

Community hospitals and their health professionals must be properly prepared to accept and use the knowledge that will pour from the perviously sclerotic communications pipeline. The medical care system must have initial funding support for identification of educational need and provision of educational space and personnel. Such funding will prepare it for the proper and productive utilization of the health care system and facilities to be established in the future as the result of coordinated regional and community planning for the delivery of medical care.

To paraphrase Winston Churchill, "We are not at the end, nor the beginning of the end, but perhaps we are at the end of the beginning." It is of vital importance that we be sure that this "beginning" represents a solid foundation for a productive and functional future.

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

THURSDAY, MARCH 28, 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 2123, Rayburn House Office Building, Hon. Paul G. Rogers presiding (Hon. John Jarman, chairman).

Mr. ROGERS. The subcommittee will come to order.

We are continuing our hearings on H.R. 15758, and our first witness this morning is Mr. Clinton M. Fair, who is the legislative representative of the AFL-CIO here in Washington, D.C.

Mr. Fair, we are pleased to see you this morning, and thank you for being present to give testimony. STATEMENT OF CLINTON M. FAIR, LEGISLATIVE REPRESENTA

TIVE, AFL-CIO; ACCOMPANIED BY RICHARD SHOEMAKER, ASSISTANT DIRECTOR, SOCIAL SECURITY DEPARTMENT

Mr. FAIR. Mr. Chairman, for the record, my name is Clinton Fair. I am with the legislative department of the AFL-CIO, and with me is Mr. Richard Shoemaker, who is the assistant director of our social security department, Mr. Chairman.

Mr. ROGERS. We are delighted to have you with us, too.

If you would like to, you can make your statement a part of the record, following your remarks, and you may sum up for us.

Mr. Fair. Thank you, Mr. Chairman.

Let me read in part from the statement, only because I can then add the emphasis that I would like to add.

Through the extension and improvement of the regional medical programs, this legislation strikes at the cause of death for seven out of 10 Americans.

In extending the migrant health program, this legislation helps bring better health to some of the Nation's 1 million migrant farmworkers and their families and brings us closer to the day when we will have corrected what has been called America's shame.

The alcoholic rehabilitation amendments in this legislation will help provide proper treatment for the 5 million persons—more than twice wthe population of the entire Washington, D.C., area-who with their

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REGIONAL MEDICAL PROGRAMS; ALCOHOLICS AND

NARCOTICS ADDICTS FACILITIES; HEALTH SERVICES FOR DOMESTIC AGRICULTURAL MIGRATORY WORKERS

THURSDAY, MARCH 28, 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 2123, Rayburn House Office Building, Hon. Paul G. Rogers presiding (Hon. John Jarman, chairman).

Mr. ROGERS. The subcommittee will come to order.

We are continuing our hearings on H.R. 15758, and our first witness this morning is Mr. Clinton M. Fair, who is the legislative representative of the AFL-CIO here in Washington, D.C. Mr. Fair, we are pleased to see you this morning, and thank you

for being present to give testimony.

STATEMENT OF CLINTON M. FAIR, LEGISLATIVE REPRESENTA

TIVE, AFL-CIO; ACCOMPANIED BY RICHARD SHOEMAKER, ASSISTANT DIRECTOR, SOCIAL SECURITY DEPARTMENT

Mr. FAIR. Mr. Chairman, for the record, my name is Clinton Fair. I am with the legislative department of the AFL-CIO, and with me is Mr. Richard Shoemaker, who is the assistant director of our social security department, Mr. Chairman.

Mr. ROGERS. We are delighted to have you with us, too.

If you would like to, you can make your statement a part of the record, following your remarks, and you may sum up for us.

Mr. Fair. Thank you, Mr. Chairman.

Let me read in part from the statement, only because I can then add the emphasis that I would like to add.

Through the extension and improvement of the regional medical programs, this legislation strikes at the cause of death for seven out of 10 Americans.

In extending the migrant health program, this legislation helps bring better health to some of the Nation's 1 million migrant farmworkers and their families and brings us closer to the day when we will have corrected what has been called America's shame.

The alcoholic rehabilitation amendments in this legislation will help provide proper treatment for the 5 million persons—more than twice wthe population of the entire Washington, D.C., area---who with their

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families suffer the physical and emotional problems which result from alcohol addiction. The narcotic addict rehabilitation amendments in H.R. 15758 will aid in carrying on and expanding what must be an aggressive effort to stem the rising number of drug addicts, especially among the Nation's young people.

I would like to make one comment, turning to page 2, with regard to the regional medical programs.

The regional medical program has within the short time it has been in operation in our opinion made remarkable strides in developing cooperative arrangements with the medical profession, our medical colleges, and our health institutions. This program holds great promise in making available to patients the latest advances in diagnosis of heart disease, cancer, stroke, and related diseases.

This coordination of effort also holds great promise of avoiding the needless cost of duplication and wasteful proliferation of diagnostic and treatment centers in our hospitals.

We realize, of course, that the evaluation of the program is quite difficult at this time. The program is new, and the great bulk of expenditures to date has been for planning activities.

But we would point out further examples, which are in our testimony, Mr. Chairman, and which we think spell great promise for the program.

The second part of our testimony deals with the migrant health program. The migratory provisions of H.R. 15758 would extend this 6-year-old migrant health program for another 2 years.

The plight of the migrant farmworker in this country has been widely publicized in recent years, but the publicity in no way cushions the shock that must be felt by every thinking American upon being reminded that people living in this country today, working amidst plenty, must endure such squalor.

I would point out on page 6 of our statement are some of the statistics in this area.

Of more than 1 million migrants, 650,000 still live and work outside the area served by existing migrant health projects. By conservative estimates, this group includes over 6,500 persons with diabetes who are without adequate medical care, over 5,000 migrants with tuberculosis, and over 3,000 children under the age of 18 who have suffered cardic damage as a result of rheumatic fever.

Many children have untreated iron deficiency anemia, and over 250 infants will die in the first year of life as a result of congenital malformation or disease.

Over 16,000 expectant mothers will find it difficult to obtain prenatal care, and beetween 20,000 to 30,000 individuals have enteric or parasitic infestations, resulting in most cases from poor sanitation.

I would point out, as the testimony does, that as these people move from crop to crop, the necessity for the program is greater because they move from one area where a program is now in operation to an area in which it is now nonexistent. And if they are to get the kind of medical care we think they need, the program needs the expansion so as these people move from one area to another they have the facilities available to them.

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