We recognize fully the merit of thorough planning as a basis for the development of regional medical programs. Such plans, of course, must involve the facilities, personnel and services pertaining to the illnesses covered under the program. However, the Congress under P.L. 89-749 initiated comprehensive health planning thereby establishing planning mechanisms throughout the nation to be involved in over-all health care and to specifically include health facilities, services and personnel. It is obvious therefore, that rather complete duplication of planning now exists between the two programs and from reports which we receive we are just beginning to witness the confusion resulting from this conflict and overlapping. If health planning, which we strongly approve, is to be developed in an orderly manner, any overlapping and conflict must be resolved. At present the existing provisions go far towards encouraging competitive activities for domination of the field. We recommend, therefore, the Congress take action to eliminate the existing overlapping and confusion by requiring that the cooperative regional medical programs developed under P.L. 89–239, and the results of the planning developed under P.L. 89-749 be in conformity. H.R. 15758 proposes to increase the membership of the advisory council from twelve to sixteen members. In order to facilitate further the closest possible coordination between this program and the comprehensive health planning program, we would urge that additional representation of council members be required to include individuals directly engaged in area and state wide planning activities. We are pleased to note that the bill, as in the original Act, does not propose to authorize funds to be appropriated for construction purposes. The program is of such magnitude that we believe the funds should be expended for the operational phases of the bill. Further, we feel it would be unwise to duplicate the construction authority now provided for in other acts. The bill requests clarification so that grants may be made to agencies and institutions for services which will be useful to two or more regional medical programs. There are various services which can be developed most efficiently and effectively for larger areas than would be encompassed in a single region. We believe, therefore, that the authority to make grants as suggested here is desirable. MIGRATORY AGRICULTURAL WORKERS The bill proposes to extend the program of grants providing for health services to migratory agricultural workers for an additional two years. We strongly supported the original legislation and later urged an increase in the program so as to permit payment to hospitals for care provided migratory workers and their families. Our recommendations were made after a study of the problem of migratory workers in considerable depth. We found that hospitals in various parts of the country were providing care under emergency circumstances and with very sizable costs for services and for which no reimbursement was available. We were, therefore, very pleased that the Congress provided funds which could be paid to hospitals for inpatient care. The major portion of the funds which have been made available go for the provision of public health services and preventive medicine with a very modest amount being made available to pay for inpatient hospital care. We urge, therefore, that the funds to be provided under the bill be increased to at least $15,000,000, with $5,000,000 of this amount being allocated for reimbursement of hospitals providing inpatient care. Because of limited funds, the administrators of the program have necessarily restricted payments to hospitals under the program to areas which had an over-all public health program for migrants. Therefore, no provision has been made for assistance to migratory workers in transit or in areas of the country which had no over-all public health program for migrants. The increased authorization which we have recommended should enable the administrators of the program to provide inpatient hospital care to migrants wherever it is needed. Further, we recommend that the program be authorized for a period of four years instead of the two years called for in the bill. We have no comment at this time on other provisions of the bill. We would appreciate your making this statement a part of the record of these hearings. Sincerely, KENNETH WILLIAMSON, Hon. HARLEY O. STAGGERS, NATIONAL TUBERCULOSIS AND RESPIRATORY DISEASE ASSOCIATION, Chairman, Interstate and Foreign Commerce Committee, DEAR MR. STAGGERS: The National Tuberculosis and Respiratory Disease Association wishes to express its support for continuation of Regional Medical Programs as provided for in H.R. 15758. Although Programs have been largely developmental, reports of progress throughout the country indicate that the majority will shortly be initiating operational activities. Reports indicate an earnest desire on the part of persons concerned with this Federal program to fulfill the purposes of the legislation; namely, that the American public receive improved medical services through coordinated and more efficient delivery of medical and paramedical skills and talents. Authorization for funds must be adequate to meet the growing needs of the Programs in the next few years if they are to achieve their goal. The momentum of this Federal program, which involves relationships with many agencies and groups, is accelerating as operational activities are due to begin. Readiness to perform will be affected by the amount of Federal funds available. Therefore the Committee should consider whether or not the authorization of $65 million for fiscal 1969 is large enough to permit implementation of the extensive plans developed over the past few years. The NTRDA is particularly eager that Regional Medical Programs be successfully launched into operational activities because of the great need to improve services for chronic pulmonary disease patients. At time of appropriating funds for fiscal 1968, Congress specified that between one and two million dollars of the RMP appropriation for that year be devoted to chronic respiratory disease programs. The NTRDA had requested such action by Congress because of the critical situation in diagnosis and treatment of these diseases, particularly emphysema. Incidence of emphysema has so accelerated that it has become the second most frequent disease for which benefits are granted to workers who are retired for disability prior to age 65, at an annual cost of about $90,000,000. Other diseases of pulmonary insufficiency, such as chronic bronchitis, are widespread and responsible for much illness and restricted activity. Deaths from emphysema have been doubling approximately every five years in the recent past and along with asthma and chronic bronchitis now represent the tenth cause of death in the United States. The seriousness of the chronic respiratory disease situation impelled the Public Health Service and the National Tuberculosis and Respiratory Disease Association to convene a Task Force in the Fall of 1966 to discuss how the control of these diseases could be improved. The critical needs in medical services for patients became a focus for much of the discussion and led to one of the Task Force's major recommendations; namely, that provision be made for pulmonary function laboratories, respiratory-care units, home-care, and rehabilitation programs. Data indicate that the lack of such resources is widespread. Many community hospitals are even without the necessary apparatus to take care of seriously ill respiratory disease patients. Organized home-care programs exist in only a small percentage of our general hospitals, while outpatient clinics which can play a full role in rehabilitation and counseling of respiratory disease patients are virtually non-existent. The community practitioner is particularly at a loss to help patients with chronic respiratory disease except for recommending hospitalization when the illness becomes critical. The average general practitioner is the victim of inadequate education because of the recency in the rise of these diseases. Thus, the type of supervision needed to protect patients from acute infections and to maintain their physical condition at as optimal a level as possible cannot be provided in most communities under existing conditions. It is obvious that direction and supervision of high quality chronic respiratory disease programs must be provided by medical schools and medical centers. Demonstrations of patient diagnosis and treatment must be brought to the community practitioner through continuing education courses offered by these institutions and facilities. The Regional Medical Programs offer the most expeditious way to achieve this goal. Interest in improving programs for chronic respiratory disease patients exist in many areas and it is our belief that this interest will generate development of such programs. TB-RD associations will help stimulate interest in such programs, utilizing their background of experience in promoting better patient services. In the past, many associations have supported medical education in pulmonary disease, and have demonstrated the need for screening surveys and diagnostic and treatment services. TB-RD associations were influential forces in communities for many years in promoting more adequate services for tuberculosis patients. In the same way, associations have been in a position to witness the dearth of help for emphysema and chronic bronchitis patients today and because of this, they will be good community partners to the RMP in seeing that the urgent needs of respiratory disease patients are met. The American Thoracic Society, the medical section of the National Tuberculosis and Respiratory Disease Association, has provided leadership in medical standards and research in tuberculosis and other respiratory diseases. Staff of our organization will continue to work closely with the Division of Regional Medical Programs to promote high standards of diagnosis and care for chronic respiratory disease. The NTRDA is pleased with the proposal in H.R. 15758 to expand the number of Advisory Council members from twelve to sixteen. At the time Congress specified that attention be paid in Regional Medical Programs to chronic respiratory disease, it also requested that one of the members of the National Advisory Council have competence in this particular medical field. Expansion of Council membership will provide more scope for ensuring representation of the various areas of medicine which are of necessity involved in the many activities of Regional Medical Programs. We question if evaluation of Programs, as provided in Section 102 of the bill, should be performed solely by the Secretary. It would seem more satisfactory for both the Department of HEW and the public, to require that such evaluation be done by outside groups. We are certainly in support of extension of grants for health services for migratory workers and our only reservation is that these seem very minimal amounts considering the high rate of disease in this segment of our population. Tuberculosis rates are high in these people because of their low economic status and because their living conditions favor spread of the disease. We support provision of funds for construction of special facilities for inpatient and outpatient treatment of alcoholism. Alcoholics have a high rate of tuberculosis, and extensive difficulties have arisen in recent years in hospitalizing many of these persons in community hospitals, including tuberculosis hospitals. Some of these difficulties would seem to be obviated by the provisions suggested. However, recognition of the high rate of tuberculosis in alcoholics is essential in planning adequately for treatment facilities. It gives us great pleasure to record our support for extension of Regional Medical Programs. Sincerely yours, JAMES E. PERKINS, M.D., Hon. JOHN JARMAN, AMERICAN DENTAL ASSOCIATION, Chairman, Subcommittee on Public Health and Welfare, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C. DEAR MR. JARMAN: Pursuant to the announcement of March 18, 1968, the American Dental Association wishes to submit its views on H.R. 15758, the Health Services Act of 1968. The Association's brief comments will be limited to those provisions of the bill which would extend and improve the Heart Disease, Cancer and Stroke Amendments of 1965 and the Migrant Health Act of 1962, as amended. As part of its commitment to improving the total health of our people, the American Dental Association is sympathetic to the goals of H.R. 15758. The dental profession has particular and long-standing concern with respect to oral cancer and some forms of heart disease. Additional research into the pre vention and treatment of these disease manifestations is needed and can and should be included in the regional medical programs authorized in H.R. 15758. When the Heart Disease, Cancer and Stroke legislation was under consideration in 1965, the Association submitted to this Committee details regarding the incidence of oral cancer and the low survival rate of victims of the disease. At that time, attention was directed to the need for more research into the specific causes of oral cancer and the methods of treatment and rehabilitation of patients who suffer from it. The Association is pleased to note that considerable progress is being made in this field and that members of the dental profession and several dental schools are participating in the programs that are being developed. The Association also is pleased with and supports fully the amendment included in H.R. 15758 which makes it clear that a practicing dentist as well as a physician may refer a patient to a facility engaged in research, training or demonstration activities which are supported by regional medical progam funds. With respect to the provisions of the bill extending the migrant health program, the American Dental Association recognizes the need for increasing the availability of dental care for migrant workers and their children. The Association supports the extension of the program but agrees that as soon as feasible, this activity should be included in the regular public health programs of states and communities. The American Dental Association appreciates the opportunity to present its views on this legislation and respectfully requests that this letter be included in the record of hearings. Sincerely yours, JOHN B. WILSON, D.D.S., Chairman, Council on Legislation. Re H.R. 15758. Hon. HARLEY O. STAGGERS, Interstate and Foreign Commerce Committee, UNIVERSITY OF HAWAII, SCHOOL OF MEDICINE, Honolulu, Hawaii, March 13, 1968. DEAR REPRESENTATIVE STAGGERS: House Resolution 15758 includes a paragraph on "inclusion of territories" which would bring Guam, American Samoa, and the Trust Territory of the Pacific Islands within the scope of the Regional Medical Program. The Medical School of the University of Hawaii is involved in medical research and teaching in many areas of the Pacific. We have been asked by the health administrators in American Samoa to develop an affiliation between the new Lyndon B. Johnson Tropical Medicine Center and the University of Hawaii School of Medicine. The same applies, but at a somewhat more preliminary stage, with the health administrators of the Trust Territories, with special regard to the hospital that will be built on Ponape. These programs will be mutually advantageous as we will provide continuation education for the medical and nursing staffs, and they will provide facilities for research and certain aspects of education for our faculty and students. I would urge your support of the paragraph in question because this would facilitate the cooperative ventures described. Sincerely yours, WINDSOR C. CUTTING, M.D., Dean. THE CHRISTOPHER D. SMITHERS FOUNDATION, INC., Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, DEAR CONGRESSMAN STAGGERS: I am pleased to learn that you have scheduled hearings on HR-15758. If it is appropriate, I request that this letter be made a part of the record for those hearings. As you know, this Foundation participates primarily in activity associated with alcoholism. We support the activities of all the major organizations at work in this field. I have read with much interest the provisions of Title III, Part A of HR15758, to be known as the Alcoholic Rehabilitation Act of 1968. In my judgment, it is an excellent piece of legislation which, when passed and adequately funded, will provide much needed Federal assistance to the states and communities. Because of the humane and progressive decisions of the courts in recent years to the effect that late stage alcoholics should be treated as sick people and not as criminals, the states and municipalities must now prepare to meet the needs in treating large numbers of persons found by the courts to be suffering from alcoholism. The size of this problem and the urgency for new facilities and trained personnel make it impossible for the states and cities to meet their needs adequately without significant Federal assistance. The enactment of Title III, Part A of HR-15758 will provide the kind of Federal assistance necessary in a most commendable way. Sincerely yours, R. BRINKLEY SMITHERS, President. ALCOHOLISM COUNCIL OF PALM BEACH COUNTY, Congressman PAUL G. ROGERS, Harvey Building, West Palm Beach, Fla. DEAR CONGRESSMAN ROGERS: Your endorsement of Bill U.S. H.R. #15758, Title 3, Part A would be greatly appreciated. It is our feeling that this legislation would be extremely helpful in rehabilitating the 12,000 alcoholics in Palm Beach County. Sincerely, RICHARD A. CONLIN, Chairman. TAMPA, FLA., March 20, 1968. Congressman PAUL G. ROGERS, Washington, D.C. DEAR CONGRESSMAN ROGERS: We have just started our Florida Regional Medical Program and not too many physicians are yet aware of its great potential for improving the quality and efficiency of medical care through improvements in communications and in continuing medical education. The Regional Medical Programs must develop into ongoing operational projects and therefore the administrations bill to extend and slightly modify Regional Medical Programs is highly desirable. This is the type of congressional legislation the physician in practice and in education will favor. Cordially yours, H. PHILLIP HAMPTON, M.D. The CHAIRMAN, GATEWAY COUNCIL ON ALCOHOLISM, Subcommittee on Public Health and Welfare, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.O. DEAR SIR: I have recently received a publication from the North American Association of Alocholism Program outlining the hearings of March 26-28 on HR-15758. I was not present to represent the Ketchikan Gateway Council on Alcoholism during those hearings, but would nevertheless wish to voice our opinion of that bill; especially the section Title III Part A, known as the "Alcoholic Rehabilitation Act of 1968". Under the Alcoholic Rehabilitation Act of 1968 we understand that alcoholic facilities and programs will be tied directly with the existing mental health centers of each state. And that provisions for receiving aid for construction, staffing, and specialized facilities will be requisited by this direct tie with the mental health centers. |