What guarantee does VA have that the funds for these salaries throughout the year will not be transferred away from VA into your office? Dr. JAFFE. I suppose only the assurance that if they perform well and they are getting results in treating servicemen in a way that meets the same kind of performance standards that we set for every other civilian agency, they will continue to have that budget and continue to have the opportunity to serve. Mr. SATTERFIELD. And continue to have the funds furnished by your office? Dr. JAFFE. That is correct. Mr. SATTERFIELD. So, then, salary, really, for all intents and purposes, are under control of your office, not VA? Dr. JAFFE. The budget, but not salaries, and how they staff. Mr. SATTERFIELD. Salary is money. The money that pays the salary is what I am talking about. Mr. WEBER. That is correct, sir; but I think this is consistent with the notion that we want a single point of responsibility with respect to efficacy of such programs. But I think it should be kept in mind, Congressman, that the President's proposal provides for the duration of the agency for 3 years, with the option of extension for two. So, it is not as if the President is contemplating a continued duplicative and competing function but, rather, responsive to the emergency need which has been identified by this committee and supported by the President. Mr. SATTERFIELD. We don't know at this point whether this will be an ongoing program or not, and I think it would be safe to conclude that it will be and hope that it won't. Mr. WEBER. There is that confusion on it; yes, sir. Mr. SATTERFIELD. Who would make the determination of the nature and scope of treatment in VA hospital drug treatment centers, and who makes the determination whether or not there will be rehabilitation there and, if so, to what degree? Would that be VA or your office? Dr. JAFFE. After consultation with VA, this office would perform its mandate of setting policy-determining standards and setting performance standards, including what we would expect out of treatment provided by the VA. Mr. SATTERFIELD. So the historic treatment, then, or historic way of running our VA hospitals system, is not going to continue insofar as drug programs are concerned? Dr. JAFFE. That is correct. We are even making precedents with respect to the statutory exclusion of people with bad-conduct discharges, so we are making precedents with respect to servicemen with this particular problem in a number of areas, sir. Mr. SATTERFIELD. Who would determine the procedures that would be used in these drug treatment centers? Would you determine them, or would the director of the hospital determine that? Dr. JAFFE. I suppose the regular hospital would. I think commonsense will primarily determine the procedures. Medicine has somebody of knowledge that permits them to organize without detailed direction. Mr. SATTERFIELD. After reading H.R. 9264 and particularly referring to section 5 and section 6, it seems to me that, and I am not talking about individuals because we don't know who will continue in an office over a period of time, but it would seem to me when you read those two sections, that all of the determinations we have talked about right in this series of questions would rest with your office and nowhere else. Dr. JAFFE. The final responsibility for a concerted movement to solve this problem is lodged in this office, and what I think the bill tries to do is to make the authority commensurate with that responsibility. No more and no less. Mr. SATTERFIELD. It seems to me it is pretty unlimited. Dr. JAFFE. I think the responsibility has virtually no limits. Mr. SATTERFIELD. You talk about authority. I don't see any limitations on it. Section 6 in terms of the questions I have just asked would give to your office absolute final say-so as to each determination I have suggested; and the question of what we think might happen and what might be best means nothing really; if the authority is there to exercise it, it can be exercised; and this is what worries me as a legislator, whether we should build limitations into it. Mr. WEBER. I think, Congressman, it might be useful to note that the actual mechanism that will be used will be in effect an interagency working agreement and the interagency working agreement is a vehicle, an instrument that is widely used in Government. For example, just with respect to the sky marshal program, where planning, funding, budgeting authority is all lodged in the Secretary of the Department of Transportation, yet they call upon in the same sense the resources of Justice, resources of Treasury, and use of the Customs and to the extent that they are all committed to the same objective, to the extent they are all interested in evaluated procedures and mehods of treatment which are more effective, to that extent we do not see this as a recipe or framework for adversary proceedings, but, rather, a device to insure that the optimum amount of resources will be marshaled for this program and put tó effective use and the responsible official would be identifiable and held responsible for his actions and, in fact, that is the Director of this Office. Mr. SATTERFIELD. I don't disagree with that objective. But when you talk about mutual agreements, I don't know how you can have a mutual unilateral agreement. Mutuality really grows out of free give and take on both sides. If you take away every part of the power and authority the VA Administrator has in this area and then try to reach agreement with him, he will have to take what you give him and that is not mutuality. Mr. WEBER. Speaking from my own experience, and I have been on both the receiving and giving end, that is, formerly as Assistant Secretary of Labor where we had to deal with OEO and now from the vantage point in OMB, and I think it is clear there is the formal authority and certainly it has to be exercised, but within the framework of interagency relationships. As long as there is a commitment to get the job done well and a willingness to continually treat the issues on their merits and resolve them in a way that is going to assure that VA does the job in a positive and effective way, certainly in the process of negotiation any positive input that they have, I am sure, will be afforded considerable weight by Dr. Jaffe or the Director, whoever he might be. Mr. SATTERFIELD. I am not convinced that the VA with the setup it has today and staff and 166 hospitals in a very comprehensive hospital system isn't capable of continuing to run its own house best, including drug treatment. And that is what disturbs me about this. Thank you. Mr. ROGERS. Dr. Jaffe, let me ask you this, please. What is the treatment goal? We talk about setting up treatment. What is the treatment goal here? Dr. JAFFE. There are a series of goals, sir. Mr. ROGERS. Yes; I think this should be spread out on the record. Dr. JAFFE. We can talk about an ideal Mr. ROGERS. No; what you are planning to institute and what the President is proposing. What is the treatment goal? Dr. JAFFE. There isn't a single goal. There is a set of goals. The set of goals, including helping and offering the kind of treatment that would permit every drug user to become a law-abiding productive nondrug using emotionally stable member of the community. That is an ideal set. We don't really thing that we will, for every drug user will be able to achieve all of those goals. Some may never become fully independent. They will require continued treatment over prolonged periods of time. Some will become more law abiding but may not really be returned to the work force that may be dependent largely on the state of the economy and their skills. Others may become law abiding and get jobs, they may continue to use drugs from time to time. I don't think we can pretend that we will achieve perfection in every situation, but at least they are the parameters against which we will measure the performance of every treatment agency, to what extent each individual is moved to some degree toward each of those skills. Clearly what I have presented is arbitrary hierarchy. We really are concerned if somebody intends to use drugs, this has a self-destructive element, it takes them away from productivity, it is a burden on families, but we would like to make it that they are not destructive to the community around them. We do expect treatment programs to provide the kind of treatment that will minimize illegal activity on the part of those people treated. Mr. ROGERS. This is what I wanted to get at. What has first priority? What are the goals? Getting them off heroin, with a substitute of methadone, to try to cure the crime problem here? Is it to get them into a rehabilitative program? What is the second priority? To get them where they can work? I want some specifics as to how this will be accomplished, what facilities will be used, what personnel are available now to do this? This is generally what I think you should set forth for the committee. Dr. JAFFE. We can give you our general views based on the information we have available. Clearly, methadone or substitute drugs similar to that will be used wherever that seems to be the best means to permit people to become law-abiding and productive citizens. That doesn mean it will be used exclusively. Mr. ROGERS. Where will these programs be established? Dr. JAFFE. We already have established and federally supported a number of community-based programs. Mr. ROGERS. How many? Do you know? Dr. JAFFE. If we knew in great detail, we might not need such an agency. HEW is funding 45 programs. OEO has programs, but I don't know how many. Mr. ROGERS. Let's get more specific here. How many programs is NIMH funding, drug-abuse programs? Mr. LAWRENCE. By the end of this fiscal year, we would have awarded 45 grants for specialized narcotics addiction treatment. Mr. ROGERS. How many do you presently fund? Mr. LAWRENCE. These are the waning days of this year. I believe it is 45. Mr. ROGERS. Now? Mr. LAWRENCE. Yes; carrying the ones that were just approved by the National Advisory Mental Health Council. Mr. ROGERS. They haven't actually been funded yet? Mr. LAWRENCE. Awards are just going out this week. Mr. ROGERS. Let's don't get into semantics here. I want to know what our present effort really is. I have it here somewhere, but I would like for you to confirm it for me. Mr. LAWRENCE. Most of these are very recently awarded and very few of them are operational at the present time, Mr. Chairman. Mr. ROGERS. How many now? Not what you are awarding. Mr. LAWRENCE. Twenty-three are operational at the present time: Mr. ROGERS. Could you list those for us? Mr. LAWRENCE. Yes, sir; I have them with me, but I could submit them for the record. Mr. ROGERS. What is the funding on each of them and how long have they been operational? Can you tell me the shortest length of time one has been operational? Mr. LAWRENCE. No; I don't have that level of detail with me, sir. Mr. LAWRENCE. No: I am afraid not. Mr. ROGERS. I have figures that said that four had actually been funded with eight approved. Does that ring a bell with you at all? Dr. JAFFE. Six have been operational since 1968, sir, funded by NIMH. NIMH under the original act. The following year there were 11 that I knew of that were functioning. They represent 18 and there are more coming on the line all of the time. As we speak, I would guess some agencies are beginning to function. Mr. WEBER. According to the information we have, 18 are fully operational and five are starting operations at this time, and we will verify that. Mr. ROGERS. Five more are funded? Mr. WEBER. And are beginning operation. They are in a startup operation. Mr. ROGERS. Would you let us have for the record listings of those and how many they can take care of and the range of services if you have that? Mr. WEBER. By all means. (The following information was received for the record:) |