gram. So there are modes of treatment that can be effective and, of course, we all ought to work to achieve the maximization of those modes of treatment and I really, very, very, seriously question the theory that you do not need some big places rather far removed from the home base of those who are the patients.

Mr. SYMINGTON. One other thing, we know some addicts are returning from Indochina. The estimates vary from 2 percent to maybe 15 percent, depending on the degree of addiction that people are willing to accept as equivalent to being hooked, and I suspect that this decision is based on an assumption that none of them really should return to a facility of this kind for any length of time. I think that is a rather interesting assumption.

Mr. ROGERS. As I understand you to say, your investigators had found three had been sent back to Alaska?

Mr. WRIGHT. Yes, sir; that is correct.

Mr. ROGERS. There are no facilities in Alaska to carry out this treatment.

Mr. WRIGHT. That is correct, sir. Mr. Lawrence and Mr. Willse checked with the Alaska patients. Is that correct?

Mr. LAWRENCE. There was outpatient care available in Anchorage at a psychiatric clinic. There was no inpatient facility anywhere in Alaska, we were told.

Mr. ROGERS. I believe in New Orleans-what did we find as far as the numbers of people returned to New Orleans?

Mr. WRIGHT. Mr. D'Amico and Mr. Nolen went to New Orleans. They can correct me if I am in error. Thirteen patients of the 94 were returned to New Orleans. There exists in New Orleans, at the Tulane Clinic an inpatient capacity of 15. Twelve of those beds were occupied, leaving only three unoccupied beds for inpatient treatment.

The investigators talked with some of those people who had been returned and developed the information that one, a former drug pusher was back out on the streets peddling drugs again.

Mr. ROGERS. Thank you very much. We appreciate your bringing this information to the committee because I think it does point up concern in the positive action taken by the House. In spite of the feeling of the House, this action should not be closed. This action was taken, as you pointed out, in complete disregard of the patients care. Also what concerns me is the fact that the authorities in HEW have assured us that these patients have been taken care of. This obviously has not been the case.

Thank you for letting us have this information.

Mr. WRIGHT. Thank you, Mr. Chairman. Thank you and each of my colleagues on the committee.

Mr. ROGERS. Our next witnesses are from the Department of Health, Education, and Welfare, Dr. John S. Zapp, Deputy Assistant Secretary for Legislation, Dr. Vernon Wilson, Administrator, Health Services and Mental Health Administration, and Dr. Bertram S. Brown, Director of National Institute of Mental Health.

The committee welcomes you.

STATEMENT OF DR. JOHN S. ZAPP, DEPUTY ASSISTANT SECRETARY FOR LEGISLATION (HEALTH), DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DR. VERNON E. WILSON, ADMINISTRATOR, HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION; DR. BERTRAM S. BROWN, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH; AND KARST J. BESTEMAN, DEPUTY DIRECTOR, DIVISION OF NARCOTIC ADDICTION AND DRUG ABUSE, NATIONAL INSTITUTE OF MENTAL HEALTH

Dr. ZAPP. We also have with us and I would like to have permission to have accompany us to the table, the Deputy Director, National Institute of Mental Health, Division of Narcotics Addiction and Drug Abuse, Mr. Besteman.

Mr. ROGERS. The committee welcomes you.

Dr. ZAPP. We appreciate very much, Mr. Chairman and members of the committee, the opportunity to appear before you this morning to discuss the administration of our drug abuse program, particularly the circumstances which made it possible for the Department of Justice to expand its treatment capability as we expanded and refocused

ours.

I would like to add here, I think it is appropriate for the controversy that has developed around the transfer of the Fort Worth facility that we have the opportunity to appear right after Mr. Wright, who is from the district and very concerned about this.

Because of the intense interest and concerns which this action has provoked within Congress, we would like to place our actions in the context of contacts and considerations raised by the Congress in passing similar resolutions in both the House and Senate that certain DHEW facilities remain under our direct administration.

These resolutions, while similar in general coverage and intent, had one area of significant difference, namely, the House version included the clinical research centers at Fort Worth, Tex. and Lexington, Ky. Originally the planning for the transfer of the facility at Fort Worth had August 1, 1971, as the date on which the Department of Justice would assume the responsibility for the facility. In the light of congressional concerns expressed, the Secretary of Health, Education, and Welfare voluntarily extended this date until October 1, 1971.

Because alternate resources were available and in developing an orderly sequence to assure the proper care of patients, new admissions to the facility from the U.S. courts were suspended on August 1, 1971. Each U.S. court which referred patients to the Fort Worth Clinical Research Center was sent a letter notifying the court of this decision and designating an alternative resource.

When Congress reconvened after the Labor Day holiday the disparate resolutions were scheduled for discussion and negotiation by the House-Senate conference.

Because of the heavy schedule of important legislative issues the conferees with the agreement by the Secretary, DHEW, deferred consideration of the issue until early October.

On Tuesday, October 5 and Wednesday, October 6 the conference committee met. At that time all conferees received a joint letter fron

the Attorney General and the Secretary of Health, Educaion, and Welfare, describing our desire because of the need that the facility be aplaced with the Department of Justice as a resource to the Bureau of Prisons.

I might at this point state, when the letter was inserted in the record by Congressman Wright, he picked up an obvious typographical error which was corrected on the bottom of this page, when it discussed it as a 500-bed facility. The last paragraph on the page.

On October 6, 1971 the conferees deadlocked on this issue and tabled this matter after indicating no agreement could be reached. With the Congress no longer considering this matter, the Secretary of Health, Education, and Welfare, and Attorney General moved to accomplish the much delayed transfer.

The Narcotic Rehabilitation Act of 1966 authorized a civil commitment system that has basically three phases. The first is examination and evaluation not to exceed 30 days, which is followed by an inpatient phase not to exceed 6 months. Subsequently the patient is discharged to aftercare which consists of a community-based outpatient rehabilitation process not to exceed 3 years.

The patients at the Fort Worth Clinical Research Center, during October of 1971, were, with two exceptions, being treated in the inpatient phase and being prepared for aftercare treatment.

The arrangements to refer these patients were adequate and proper. Contact by the professional staff at Fort Worth with the various agencies outlined the patient's situation to the receiving agency. Because we had anticipated this activity approximately 1 week earlier, the transition to aftercare, while creating minor travel difficulties, did not present any difficulties beyond the usual concerns in referral of a patient to outpatient status.

It should be emphasized that the men involved were being returned to their home communities to family situations and agencies where there was previous contact and the capability to provide necessary care.

If we may we would like to summarize briefly the results of a single survey which was completed over the weekend. The subjects are the 89 patients discharged from the Fort Worth Clinical Research Center on October 8 and 9, 1971.

All 89 patients who were discharged on October 8 and 9, 1971, returned to their home communities for treatment and rehabilitation under the care and direction of personnel of agencies who are under contract to the National Institute of Mental Health.

Of the 89, 86 reported as scheduled to the aftercare agency: there were no special escorts for these men as a group and this is rarely, if ever, provided.

Of the 89, we have evidence that 29 abused a drug since returning to the community. Three have been arrested on various traffic charges. One of the three has spent a total of 11 days in jail as a result of a previous warrant issued prior to commitment to Fort Worth.

Of the 89, 31 already are gainfully employed, 86 continue on active status in the program. One of the 89 has been rehospitalized at a local community contract facility.

It is our opinion that this behavior does not vary greatly from any other 89 male patients who would be released back to the community from an isolated treatment center. Narcotic addiction is frequently a

chronic relapsing process. Evidence clearly points to the fact that the first 3 months in aftercare are critical ones. We believe that these men will, as they are treated and progress through the program, demonstrate the same pattern of improvement previously experienced by patients in this program.

Mr. Chairman, we appreciate the opportunity to appear before you today to clarify the situation with regard to the transfer of the Fort Worth Hospital from the Department of Health, Education, and Welfare to the Bureau of Prisons, Department of Justice. We would be pleased to answer any questions you or the other members of the committee may have.

Mr. ROGERS. Thank you very much, Dr. Zapp.

Mr. Nelsen?

Mr. NELSEN. Mr. Chairman, I missed some of the testimony so I would like to reserve a little time to see how things go. Frankly, I supported the transfer and my reason for so doing was that all of the evidence that I could see showed that this area was blessed with drug abuse and facilities, that there were more facilities for treatment in this area than any other area that I know of.

In the law enforcement, for example, here in the District of Columbia, most of the crimes on the streets are committed by drug addicts that have been arrested and then released. Ninety percent of the inmates in the Women's Detention Center are users of narcotics. If there is any area where the public suffers the most, it is from the release of addicts by penal institutions. This has provided a greater problem to the public than any other area that I know of.

I did not support a transfer of any of the Public Health Service hospitals until a good alternative use was provided and in my judg ment this area was an area that needs attention. Therefore, in the conference I supported the view that the Senate took. I think it can honestly be said that in this area there has been a tinge of politics. In conference, the Senate stood fairly firm on the transfer and some of us on the Republican side supported the Senate's view. I will be asking for more time later.

Mr. ROGERS. Mr. Preyer?

Mr. PREYER. Thank you, Mr. Chairman.

Perhaps this has been covered earlier when I was not here, but is there some explanation of the discrepancy between the 94 patients and 89 patients in your testimony?

Dr. ZAPP. I will refer that question to Mr. Besteman.

Mr. BESTEMAN. I can account for the discrepancy up to 92 but I cannot account for 92 to 94. We are talking about 89 patients who were in the NARA program and going to aftercare. There were three other patients in the facility who were not in that status. So then I get a total of 92. I cannot account for the 94, sir.

Mr. PREYER. Which status were the other three in?

Mr. BESTEMAN. There was, in fact, still one prisoner there who would remain on site. There was one person there awaiting escort because of status to be returned to a U.S. marshal and there was one other patient there who was not scheduled to go to aftercare.

Mr. PREYER. The standard treatment at Fort Worth, I gather, involved a 30-day period of examination and then a period of up to 6 months of treatment. Did most of your patients stay the entire 6 months as a part of your usual treatment?

Dr. BROWN. The patients ranged in their inpatient phase 2, after the initial 30-day evaluation, anywhere from 1 month to 6 months with perhaps an average of 42 to 5 months as a whole.

Mr. PREYER. So the average was closer to the 6 months period?

Dr. BROWN. Yes, sir.

Mr. PREYER. These patients which have been discharged on an average-how long had they been in phase 2?

Dr. BROWN. Approximately a month less. Approximately 31⁄2 to 4 months.

Mr. PREYER. What would be the extremes?

Dr. BROWN. I think the shortest would have been at least 22 months.

Mr. BESTEMAN. As was indicated in the testimony, we asked the courts to cease sending patients on August 1 and, since discharge occurred on this is commitment to inpatient treatment-since discharge occurred on October 8 or 9, this would be the least amount of time available to any one person.

Mr. PREYER. So there were discharges earlier than there would have been ordinarily under the standard treatment?

Dr. BROWN. As an average I would say that is so. No individual, however, was discharged before it was felt it was proper.

Mr. PREYER. You contend that they were all returned to care that was under the direction of personnel from agencies under contract to the National Institute of Mental Health? Is that true, in the Alaska situation, for example?

Dr. BROWN. Yes, sir; when Congressman Wright asked his investigators about being sent back to Alaska with no care, supplementary information was provided that it was for an outpatient phychiatric clinic, so that the three people in Alaska were returned to one of our contract aftercare agencies at a psychiatric clinic in Anchorage.

It is true there is no inpatient facilities. We have to clarify this very basic point-I think it is an important one-that some of the patients were, indeed, returned to aftercare outpatient clinics in communities that did not yet have inpatient facilities. This is accurate. None were returned to places that had no treatment. All were returned specifically to an aftercare person, agency, clinic, or professional. Mr. PREYER. How many were in Anchorage-all three of them? Dr. BROWN. I think so. I cannot say that specifically. Whether it was Anchorage per se. I can only say it was Alaska.

Mr. ROGERS. If the gentleman would permit. That is fairly important. Anchorage is almost the same distance as Fort Worth from town to town, to get there-I would think that would be fairly important to know.

Dr. BROWN. We will track that down specifically.

Mr. ROGERS. Don't we have where they came from, their homes? Mr. BESTEMAN. Yes, but here I only have where they were discharged to. Three went to Anchorage. I know from personal experience that that has been the source in Alaska which is the reason for choosing that one aftercare agency.

I would be almost certain it would be but we will get their exact home addresses to you.

Mr. ROGERS. I think that would be interesting to have before we conclude the hearing. Could we get that? Is there any way?