see where they are trying to go in 10 years in their State and what are their needs and resources in order to accomplish their goals.

Mr. ROGERS. Do you anticipate that the Hill-Burton program will be carried as a separate program or in a comprehensive block program? Dr. STEWART. The Hill-Burton program will be carried separately. It is planning and developing new facilities in the State. This information would have to be related to planning of other kinds of health facilities in the State since there is a limit to the amount of capital that may be available within that State, for the construction of facilities over the next 10 years.

Mr. ROGERS. What about the medical schools? Suppose there is a medical school or maybe there may be four of them. They want to expand. Maybe they serve more than just one State.

How does the comprehensive State plan affect the future expansion, say, of a medical college?

Dr. STEWART. I would think that a State would take a look at where their doctors come from now? They would determine how many are coming from their own schools and how many from other State schools or other schools in other States, and then determine what the pattern has been? Then they look at all the developments that are being planned for the next 10 years in their State and find their needs are going to exceed the supply of physicians in that State even though those coming from other States may be doubled in their estimate. Therefore, they find they have an immediate need for a medical school in order to reach these 10-year program goals since a 10-year leadtime is needed in building a medical school. This means then that the capital to develop a medical school has to be put into that State to do it.

Mr. ROGERS. Suppose they have an oversupply for that particular State?

Dr. STEWART. If they have an oversupply of physicians as far as meeting the program goals that they are developing in that State, those goals being developed both privately and publicly, then they don't have to worry about developing a new medical school in their State.

Mr. ROGERS. Maybe the State is in New England. Maybe they serve a three-State area.

Dr. STEWART. If one of the objectives of that State is to be the producer of physicians not only for their State but for other areas, they would count this in their plan.

Mr. ROGERS. Here is what I think people are concerned with: Will the comprehensive State plan be the determining factor; is it going to be a regional plan or what? Then I think we need some assurance on these questions.

Dr. STEWART. The comprehensive State plan relates to that State and the resources of that State and whatever the program objectives are in that State. If that State is serving other States, as for instance in a case where a city is situated on a State boundary this will come into consideration. There will have to be come interrelation between these States.

While it will lay out these priorities and choices, there is nothing in the legislation that gives the comprehensive State health planning agency the authority to say, "This has to be," or "This has to be."

Mr. COHEN. There is no question, Mr. Rogers, that this national aspect has to be taken into consideration. The University of Michigan Medical School, with which I am very intimately familiar, obviously serves not only the State of Michigan, but being the largest, nearly the largest medical school in the Nation, it has great national significance and its research program and the people who come to it have an impact all over the country.

I think that you would have to, in the State planning, take account of that type of institution that performs out-of-State service. Mr. ROGERS. Out-of-State service?

Mr. COHEN. There is no question about that. I think that would have to be looked at as one of the considerations of the State plan. When you get to Minnesota and you deal with the Mayo Clinic, you certainly can't deal with the Mayo Clinic in terms of the type of medical services and the people who come there and all the other things in terms of Minnesota.

Mr. ROGERS. I would agree with you, but I think there has been some concern about this and this needs to be cleared up. Now, also about the community mental health facilities, here again would be a problem I would think.

Dr. STEWART. I think the best way I can illustrate it, Mr. Rogers, is that you have a whole series of programs being planned-community mental health, regional medical programs-but there is no way at the present to look across these and relate all of these plans to determine the possibilities of using existing and developing additional resources. It is a method of collecting the information and laying it down so that one can look at it. This is what the role of the comprehensive health planning agency is.

Mr. ROGERS. Do we have a comprehensive plan for the United States?

Dr. STEWART. No, we have not. We have, I think, cited some goals. The President cited four goals in the health message this year. We do have national objectives in certain areas, but not in the sense that we are talking about here.

Mr. ROGERS. Should we?

Dr. STEWART. I think eventually we will come to this point. I think it is probably better to build it up from the legal areas than it is to start now.

Mr. BROWN. Will the gentleman yield?

Mr. ROGERS. Yes.

Mr. BROWN. It seems to me that this is really what we are talking about. There has been some implied criticism, not of the community of Rochester specifically, but of other communities, for their failure to take into account what the other guy may be doing in the interest of economics, efficiency, and so forth.

Dr. STEWART. That is correct.

Mr. BROWN. If you don't take into account what is being done in the medical schools in Cincinnati and the hospitals of Cincinnati, how are you going to have a comprehensive plan for the State of Kentucky, much of which is served by the medical facilities in Cincinnati?

Dr. STEWART. You are quite right, Mr. Brown. The development of a comprehensive State health plan in Ohio would certainly have to

take into account the relationship of the health personnel in Ohio and Kentucky.

Mr. BROWN. And it can't do this without a comprehensive plan for the United States.

Dr. STEWART. I was taking this in a different connotation. There is some comprehensive planning in the United States. We have some idea of what the economic development will be in the United States and what proportion of the dollar, the health dollar, might be 10 years from now and how that might be distributed between capital and expenditures.

Mr. ROGERS. If the gentleman will permit, I think we would be concerned about manpower here, is there enough national effort in the individual States to have enough schools to provide the proper manpower.

Dr. STEWART. No, I think we have recognized there is not enough effort.

Mr. ROGERS. Should we start devoting more effort to this area? In other words, I think we kind of need an across-the-whole-spectrum as well as vertical view.

Mr. BROWN. I don't want to appear to sandbag you in cooperation with my colleague in the chair.

Mr. ROGERS. The Chair, I might say, is not trying to.

Mr. BROWN. We have had some discussion in the State of Ohio as to whether or not we should have another medical school. I think this patently is a question which involves more than just the State of Ohio because if every State is going to have another medical school, then perhaps we have too many medical schools in the United States. Again it seems to me that in determining the criteria that are mentioned on page 2 of the legislation that there is implicit some kind of an overall plan for the entire United States in order to get an adequate plan for the individual States, and if that is not the case, then the criticism which is made of the local community in defense of the State plan is invalid.

Dr. STEWART. What I am saying, Mr. Brown, is in your decisionmaking as to whether you should or should not have another medical school in Ohio, besides taking into consideration the manpower needs, I think you would also need to know what kind of capital is going to be needed in your State for hospital construction in the next 10 years, for community mental health centers, and for all the other health needs in relation to what you think the capital resources will be in the next 5 years. This helps you make your choice.

Mr. ROGERS. I agree with the Surgeon General, and I am sure Mr. Brown does, too, that we need to know this information and a comprehensive plan is a good idea and the Congress adopted it. This committee did.

I think the point we are trying to develop is that perhaps we also need some thought of a group within the Department presenting an overall picture for the United States and relating it for the committee.

Mr. COHEN. Very definitely we would conceive of our responsibility more and more to develop the totality of the information necessary for the whole health resources in the country, and it is not simply because of the factors that you mentioned of the medical school, but the point is that the Federal Government is going to be putting so

much money into both medicare and medicaid in the payment of actual services that the Federal Government has a real dollar interest as well as quality of care in being sure that (a) the services and facilities are available and (b) that they are not overbuilt because we are going to be helping to pay for them.

On the national point don't forget that under the legislation for the construction of medical schools and under the Nurse Training Act there still is a Federal responsibility and a congressional responsibility for determining the kind of priorities and emphases because what do you do with regard to the Medical School Construction and Educational Assistance Acts and the Nurse Training Act determines national priorities with regard to those manpower as well as construction aspects so that there is still that aspect remaining.

Mr. ROGERS. Let me ask a couple of questions on section 11(a) where it broadens the definitions of students eligible for loans. Does this put them in the category of no payment, or what is the purpose of this?

Dr. STEWART. What this does is correct an oversight, Mr. Rogers. The intent of the Nurse Training Act was to provide a grant to the school for the federally sponsored student. In that act the definition of federally sponsored student covered the contributing loan fund. The Allied Health Professions Act added the revolving loan fund, and since the language did not take into account that those students are not covered in the grants to schools, this is corrective.

Mr. ROGERS. In section 11 (c) why is it that you need another higher education representative to the National Advisory Council on Education for the Health Professions?

Dr. STEWART. Mr. Rogers, I don't know the answer to that question. Mr. ROGERS. Will you let us know and supply it?

Dr. STEWART. We will supply it for the record; yes, sir. (The information requested follows:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT ON SECTION 11(c) OF H.R. 6418-MEMBERSHIP OF THE NATIONAL ADVISORY COUNCIL ON EDUCATION FOR THE HEALTH PROFESSIONS

The Veterinary Medical Education Act of 1966 amended Sec. 725 of the Public Health Service Act to add one member of the Advisory Council on Education for the Health Professions. The former membership of the Council was divided between four members from the general public and 12 members from among leading authorities in the fields of higher education. No change was made in this division at the time an additional member was added to the Council. The proposed amendment-Sec. 11 (c)-would change the language of the second sentence of Sec. 725 (a) so that the division of the Council would be between four members of the general public and 13 members from among leading authorities in the fields of higher education, the effect being that the additional member who was to represent the veterinary profession would come from among leading authorities in the fields of higher education instead of the general public.

Mr. ROGERS. I think that is all.

Thank you very much for your testimony and for your patience. You have been most helpful to the chairman.

Mr. COHEN. Thank you, Mr. Chairman.

Mr. ROGERS. The committee will stand adjourned until 10 o'clock in the morning.

(Whereupon, at 1:05 p.m., the committee adjourned, to reconvene at 10 a.m., Wednesday, May 3, 1967.)

PARTNERSHIP FOR HEALTH AMENDMENTS OF 1967

WEDNESDAY, MAY 3, 1967

HOUSE OF REPRESENTATIVES,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C.

The committee met at 10 a.m., pursuant to notice, in room 2123, Rayburn House Office Building, Hon. Harley O. Staggers (chairman) presiding.

The CHAIRMAN. The committee will please come to order.

This morning we continue the hearings on H.R. 6418, a bill to amend the Public Health Service Act to extend and expand the authorizations for grants for comprehensive health planning and services.

Our first witness this morning will be John H. Venable, M.D., president of the Association of State and Territorial Health Officers. Dr. Venable, will you take the chair, please, and identify yourself and the gentlemen that are accompanying you. You may proceed in any way you see fit.

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STATEMENT OF JOHN H. VENABLE, M.D., PRESIDENT; RUSSELL E. TEAGUE, M.D., PRESIDENT-ELECT; AND ALBERT HEUSTIS, M.D., SECRETARY-TREASURER, THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS

Dr. VENABLE. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, I appear before you today as president of the Association of State and Territorial Health Officers, with Dr. Albert Heustis, of Michigan, our secretarytreasurer, on my right, and Dr. Russell Teague, our president-elect, on my left. This indicates the importance which we give to this legislation. We want to present our association's views on H.R. 6418, the bill to extend the authority of Public Law 89-749, to require the licensing of clinical laboratories which do business in interstate commerce, and sundry additional proposals. The burden of my statement to you today will deal with the extension of Public Law 89-749.

On October 11, 1966, it was my privilege to represent our association and the State of Georgia before this committee when hearings were conducted which resulted in Public Law 89-749. That brief hearing, the committee will recall, was necessitated by the need for immediate congressional action to extend the authority of the old section 314 (c) of the Public Health Service Act, the basis for Federal support of public health programs throughout the States. At this point, I wish to express our appreciation to the chairman of the committee, Mr. Staggers, for scheduling these hearings on H.R. 6418. You gave us your assurance last October, Mr. Chairman, that you would take this action

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