tie into this nucleus of the new plan from our State planning agency. So from that standpoint we have it in being.

As far as the actual implementation of details into the health area, the committee is just now picking up from the task force's work and we anticipate that we should have the preliminary guidelines and goals set out within the next 4 or 5 months, just about the time it would be funded.

Mr. ROGERS. So you would be ready to move?

Governor SMITH. We expect to be ready as soon as HEW is ready to fund us and Dr. Slavin, who is heading this and who is a special assistant to me, was in Charlottesville yesterday working with the regional office of HEW. It is a matter of close liaison in the establishment of the guidelines so that we don't spin our wheels by getting and doing something that is not going to be useful.

Mr. ROGERS. As I understand from your testimony, you have set up an agency within the Governor's office to do the planning?

Governor SMITH. That is right.

Mr. ROGERS. But you have used an advisory council and you have them use an advisory council from your various regions.

Governor SMITH. That is right. It is a statewide advisory council and regions are represented on it. We hope to be able to pull together the best thinking of the medical professions, the lay people, the road people, everybody that has a stake in this comprehensive planning for health because what affects health affects the whole gamut of State agencies and every State agency has an input into it as well as every county health agency.

Mr. ROGERS. In your estimation, how much of the Appalachian program is devoted to health in your State? What moneys would be devoted to health?

*

Governor SMITH. I think the total authorization for the health demonstration units for Appalachia is somewhere around $89 million for the 13 States-and that is $89 million out of $1.1 billion of the total authorization.

It appears that in West Virginia we will be allocated somewhere around $18 million for construction and the operation over a 5-year period with a matching basis after the second year with this ninecounty unit once we get the demonstration unit established. It is strictly a demonstration program. It runs for so long and quits.

Mr. ROGERS. Under that program can you also build hospitals? Governor SMITH. This demonstration provides that you can do it, but basically we are talking about the use of people rather than buildings in our program. Hospital construction in West Virginia is primarily Hill-Burton, aided through the Economic Development Administration (EDA). We have been able to get some loans and some grants to help some of the Hill-Burton money along. But basically the demonstration in this nine-county unit is primarily to show how we can effectively use the facilities we now have, find out what is lacking, and try to create those facilities we find are needed which would probably call for some construction. But as we have been using Hill-Burton funds for matching for county and regional medical units, some of this demand is met as we go along.

Mr. ROGERS. Governor Smith, is the expenditure of OEO funds which you get in the Appalachian program for health coordinated through HEW?

Governor SMITH. OEO doesn't have very much in the health field. The Appalachian health money of course has to be coordinated through HEW if it is going to touch the public health field, but most times also it has the input of a Hill-Burton grant or something has to go into it, so you get an interrelationship between all these programs. Of course, this is one other advantage of trying to put the creative effort through the Governor's office because then you can find out where these inputs are and if something is going wrong you have an opportunity to stop it; if going right you find it necessary to move ahead.

Mr. ROGERS. Thank you very much. Thank you, Mr. Chairman.
The CHAIRMAN. Mr. Nelsen?

Mr. NELSEN. Thank you, Mr. Chairman. I wish to thank the Governor for his very good statement. I may mention that in my office one of the girls is from West Virginia.

Governor SMITH. Very good. I'm glad to hear that.

Mr. NELSEN. Very accomplished, and as has been mentioned, we frequently hear about the great wonderful State of West Virginia from the gentleman to my right.

I wonder, Governor, have you been able to use the funds that have gone to your State? Have you been able to match in all instances the funds that have been available to you through these various programs? Do you find it difficult?

Governor SMITH. We have been able to meet the needs as they occur. We are anticipating some problem as the road program develops under Appalachia. The cost of building roads is going up and what we had anticipated 3 or 4 years ago would take care of the need is not going to be enough.

I think Congress finds that out too.

We have that problem of matching, but we have a rather unusual device in West Virginia to help meet such situations. In my first budget, I requested a million and a half dollars to be appropriated to the Governor's office for the purpose of matching and aiding Federal

programs.

Our legislature only meets for 60 days in one year and 30 days in the other, so in this interim period when it is not in session and we have a program that needs matching I have the funds right in my office to do that.

So we have never had any problem until the next legislature got back.

Mr. NELSEN. I notice you mentioned the need of moving slowly and of avoiding the waste funds. It seems to me that often this use-it-orlose-it type of thing in many programs, in elementary schools and others, has caused a situation where we are often in haste without even fully justifying the programs, fearing that if you don't use it you lose it.

many

In aid programs we used to make loans and times a loan was put under stop order because all of the funds were not immediately needed, but never lost to the one that we were dealing with. It seems to me that in some of these Federal programs there might be some merit to providing that if a State is moving carefully it would be complimented and protected in so doing. This might be an area where

some thought could be given on our part in the way of handling these programs.

Of course you have fiscal years and budgets and all that to do with, but it would seem to me there might be some merit to that. Would you have any ideas or suggestions about that?

Governor SMITH. I don't know how it would be done. I am not that familiar with the Federal fiscal program. It appears to me the more careful planning to begin with, the less we are going to have wasted as it goes down the line.

I think the old theory, "haste makes waste," is sometimes applicable, but the arrangements that we have in some of these programs, the ability to do exactly what you are talking about, is in this program.

One of the great things that could be done I don't think it ever will be done would be a consistency of how these programs are administered. If we had them all on the same type basis it would be a great help, but I suspect that that is wishful thinking.

Mr. NELSEN. I am sure you would agree to breaking down these new departmentalized block grants and moving toward the flexible approaches and improvement as to the Federal Government's handling of these things.

Governor SMITH. I think it really brings about the fact that the States want to do these things and you give them a chance and I think they will do it.

Mr. NELSEN. Thank you very much for your very good statement. Thank you.

Mr. VAN DEERLIN (presiding). Mr. Murphy.

Mr. MURPHY. Governor, I would like to add my voice to Chairman Staggers' and other committee members who congratulated you on your statement.

Does your State legislature meet every year?

Governor SMITH. It meets for 60 days in the odd years and 30 days in the even years.

Mr. MURPHY. And of course the appropriations for the State go through your

Governor SMITH. Are appropriated annually.

Mr. MURPHY. Have you had any difficulty in your State legislature getting funds to match the Federal funds?

Governor SMITH. None at all. As long as they are effective and we are doing the job we have no problem. We have questions asked as usual, which I think would be true in any legislature, but, as I said earlier, we have been able to meet the demands of the matching, based upon our own needs and our own estimates.

In some programs we haven't brought everything in them because we haven't felt it was necessarily applicable to West Virginia, but those in which we have, we have had no problems at all.

Mr. MURPHY. Have you had an increase in the last 5 years State health department staffing?

in your

Governor SMITH. The State health department has continued to grow constantly. Of course, our biggest problem in staffing the State health department has been the inability to attract to government those who are really qualified for the salaries we offer.

We are, in general, trying to boost the salaries so we can maintain and retain the doctors and skilled personnel that are required in the State health department.

Mr. MURPHY. That seems to be a problem on a national basis. Have you expanded the State medical schools to train more doctors and more medical personnel?

Governor SMITH. West Virginia only has had a State medical school in the State since 1952. It graduated its first doctors in 1960. It hasn't been expanded because it was really just getting up to its ability to graduate the 66 or 76 that it is set up for as medical doctors, and to be producing 75 dentists and 200 nurses that are scheduled for that program.

It has not been expanded since its original start. It has just grown to where it was supposed to be.

Mr. MURPHY. The State has had to rely on outside medical schools? Governor SMITH. Up until 1952 students were getting 2 years of medical instruction at West Virginia University and then completed their courses at the Medical College of Virginia under a contract arrangement with the medical college.

Mr. MURPHY. Many Governors have stated that they have a gravitation from the rural areas of their doctors into the urban areas and thereby creating a vacuum of qualified medical people in the rural

areas.

Is that true in West Virginia?

Governor SMITH. I think that is true in West Virginia. We have several counties in which we do not have a qualified medical doctor, and that is one of the problems that has been involved in this regional approach in southern West Virginia. Instead of getting the doctor to the patient, we are going to try to bring the patient to the doctor.

Mr. MURPHY. We have tried in some Federal programs to gear them to having doctors stay in rural areas under some Federal training programs.

Would you advocate an increase or a greater assertion on this type of program?

Governor SMITH. The thing that I always imagine and visualize and what we are going to have to do in the rural areas, is to establish, well, if you are going to use the Navy's vernacular, a corpsman, out in the area with a small staff of a nurse or a small unit where they could probably diagnose the case and then have the ability to get the patient to the area where the facilities are for the doctor to give the proper health care.

You can't build a hospital every place. Costs of hospitals and medical services, the skills, the training, and the equipment that are needed. are such that you have to go to a regionalized approach, so I would advocate that the Congress, if it wishes to get into this, create these satellite training or satellite examining units in the rural areas, and then beef up the strength of the medical center so that the person who is brought there can get the finest of care.

Mr. MURPHY. But it is your opinion that it is essential for the Federal Government to participate in these medical health programs right with the States and try to resolve some of the health problems particularly in rural areas.

Governor SMITH. The rural States are usually States that have financial problems and unless you have this assistance the muscle and financial strength of the Federal Government-it would be impossible to do the task.

Mr. MURPHY. Governor, in New York we have a very controversial action called Medicaid under title XVIII or the Medicare Act that was passed.

Has your State legislature enacted any legislation similar to the New York notion?

Governor SMITH. No, sir. The only thing that we have done to implement title XVIII is to extend the program that we had originally. We were in the original Kerr-Mills act. We were one of the States that were in that, so we have kept that going. We have just added to it some of the provisions to pick up the dependent children up to age 21. We have not gone any further into that, into the Medicaid end of it. Mr. MURPHY. You haven't established an income level for people to be eligible for that particular title?

Governor SMITH. No, sir.

Mr. MURPHY. Thank you very much.

The CHAIRMAN. Dr. Carter. I might say this is a medical doctor we have on the committee.

Governor SMITH. I understand he is from our neighbor State of Kentucky, too.

Mr. CARTER. Governor, I certainly want to compliment you on your excellent presentation and on your keen insight into medical problems in rural areas particularly.

Certainly I should hope that you would be able to get more organizations into those rural areas, but in case that is impossible under a plan such as yours, and it is to be hoped, as I see it, I think your idea of getting patients to the doctor is extremely good because it will certainly increase the amount of work more doctors can do and also provide aid for those in distant areas. Thank you, sir.

The CHAIRMAN. Thank you, Dr. Carter. Mr. Ottinger.

Mr. OTTINGER. I am glad to have you with us, Governor. This program in one of its major components calls for long-term planning for hospital facilities. We have in many States, however, critical shortages of hospital facilities at the present time.

Can you give us any idea of what the situation is with respect to your own State?

Governor SMITH. I couldn't make a guess, but it seems to me the task force on health reported that we would have a shortage of some 5,000 hospital beds by 1980. That is the figure that runs through my mind. I refer to the type that would be suitable for medical care at that particular stage in our history.

We have been running a shortage in the field of-there are three different classes of care. I am just trying to think of the one it applies to. It is not the intensive care that would come in the hospital, the critical case, but the "convalescent" care. Maybe that is the term I am thinking about.

The Hill-Burton funds that we are using now are primarily diverted to the building of those units that meet that particular need. I would be glad to give the committee a complete breakdown on the report of the Task Force on Health and a complete breakdown on this situation on what exists and what we anticipate it will be in 1970, 1980, 1985, through the years.

Mr. OTTINGER. Are there hospitals to your knowledge in West Virginia that are really in a critical condition where they get emergency cases and they actually have to put them in the corridors, where people

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