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and even thousands of miles from Government facilities at which they might receive care. Transportation difficulties are very great indeed in Alaska. Thus, the fact of eligibility for treatment in a Government facility may be meaningless if help cannot be obtained in time of emergency.
Where private hospital facilities are available and Government facilities are not, it would be tragic to deny a veteran the medical care which could be made available under terms of the bill Senator Bartlett and I have introduced.
As the report of the Veterans' Administrator on this bill points out, very few veterans would require the care this bill proposes, and so this would be a very inexpensive piece of legislation. I am informed that during 1958 only eight veterans with non-service-connected disabilities would have required assistance from private facilities with which the Veterans' Administrator might contract.
The same reasons for the enactment of this legislation are applicable now as were evident before statehood. The great distances of Alaska and Hawaii from the other States have not been changed. The advent of statehood does not change basic facts of geography. The number of patients who would need such care has not increased. These were the original reasons for the special provisions for the territories. They still apply.
I urge speedy and favorable action on this legislation. It represents an inexpensive opportunity for the U.S. Government to provide humanitarian treatment for veterans of the armed services to whom its responsibilities have long been recognized.
I wish to insert in the record of this hearing a House Joint Memorial 44 of the Alaska State Legislature urging enactment of S. 2201.
As a conclusion to my remarks, I would like now to present for the record a letter from Dr. Ralph W. Carr, of Ketchikan, Alaska, supporting S. 2201 and describing a particularly tragic incident which illustrates the need for this legislation in Alaska, together with a memorial from our legislature on this subject. If it is agreeable, I will present these for the record.
Senator YARBOROUGH. Yes; they will be received, ordered filed, and made a part of the record.
(The letter referred to follows:)
KETCHIKAN, ALASKA, April 19, 1960.
Senator RALPH W. YARBOROUGH,
MY DEAR SENATOR YARBOROUGH: I am writing to express approval of S. 2201 which would have the practical effect of restoring to Alaska and Hawaii treatment of non-service-connected disabilities of Alaska and Hawaii veterans by contract between the Administrator and private hospitals.
A case history will illustrate why I feel so strongly about this. Just after Christmas in 1958 I was called from the office to make an emergency call to a third-class hotel to see a veteran who was having his first acute coronary attack. He had obviously had a rough life as a transient construction worker but was the brother-in-law of a prominent Seattle orthopedic surgeon and brother of an accountant in a responsible position in the same city. It was apparent that he was, under a rough exterior, a superior type. I urged that he go to the hospital immediately by ambulance, which was only a matter of two blocks. I told him that he was "the last of the Mohicans" because he was probably the
last veteran I could admit to the local hospital for a non-service-connected disability before curtailment of these benefits on the establishment of statehood for Alaska January 4, 1959. He demurred, in a nice way, and insisted on walking with a fellow construction worker. However, he fell dead on the sidewalk about 11⁄2 blocks from his hotel. His brother came to Ketchikan to investigate and thanked me for what I had tried to do. I also had a letter of thanks from the orthopedic surgeon brother-in-law in Seattle.
The point of the story is, of course, that this veteran didn't complete the trip to our own local hospital and certainly would not have been able to travel to Army or Public Health hospitals in Alaska or veterans' facilities in Washington or Oregon. Because of cases like this in non-service-connected disabilities of veterans, I urge your favorable consideration of S. 2201.
RALPH W. CARR, M.D., Chairman, Ketchikan Medical Society. Senator YARBOROUGH. Do you care to make an additional statement as well, Senator Gruening?
Senator GRUENING. I think my statement makes clear why both my colleague and I think this is desirable legislation: That it is just to rectify conditions which exist through no fault of anyone in particular, and which will do justice to our veterans as it is being done in the 48 older States.
Senator YARBOROUGH. Thank you very much.
STATEMENT OF HON. E. L. BARTLETT, A U.S. SENATOR FROM THE STATE OF ALASKA
Senator BARTLETT. Mr. Chairman and Senator Goldwater, first I should like your permission to submit for the record a copy of Alaska House Joint Memorial 44, urging passage of S. 2201.
Senator YARBOROUGH. It will be received, filed, and ordered printed in the record.
(The resolution referred to follows:)
IN THE HOUSE
(By Mrs. Fischer and Mr. Hansen)
HOUSE JOINT MEMORIAL No. 44
IN THE LEGISLATURE OF THE STATE OF ALASKA
FIRST LEGISLATURE-SECOND SESSION
To the Honorable Sumner G. Whittier, Administrator of Veterans' Affairs; the Honorable Lister Hill, chairman, Senate Committee on Labor and Public Welfare; the Honorable Olin E. Teague, chairman, House Committee on Veterans' Affairs; the Honorable E. L. Bartlett and the Honorable Ernest Gruening, Senators from Alaska; and the Honorable Ralph J. Rivers, Representative from Alaska:
Your memoralist, the Legislature of the State of Alaska in first legislature, second session assembled, respectfully submits that:
Whereas bills have been introduced in both Houses of Congress (S. 2201 and H.R. 7910) to restore to veterans in Alaska and Hawaii necessary treatment for non-service-connected disabilities; and
Whereas the intent of these bills is to make such treatment available to veterans in Alaska and Hawaii as it is in the other States; and
Whereas while it is true that hospitalization is available for many veterans, it is not available to those who require emergency care and cannot be transported to the location of the hospital-sometimes hundreds of miles distant and accessible only by air; and
Whereas the cost of maintaining the program provided for in the proposed bills would be infinitesimal, there being only a few veterans who would not be treated in Government installations; and
Whereas because there are so few veterans which the proposed bills will affect, and yet their needs are great, it is impossible to understand the opposition of the Veterans' Administration;
Now, therefore, your memorialist urges the passage of S. 2201 and H.R. 7910 in order that the Nation will fulfill its obligation to veterans on the basis of their need and not on the basis of their accessibility to a veterans hospital. Passed by the House February 16, 1960.
Chief Clerk of the House.
Passed by the Senate February 25, 1960.
KATHERINE T. ALEXANDER,
Secretary of the Senate. Certified true, full, and correct.
WARREN A. TAYLOR,
WILLIAM E. BELTZ,
Chief Clerk of the House. Senator BARTLETT. Alaska House Joint Memorial 44 has been adopted by the first legislature of the State of Alaska, S. 2201, in my judgment, meets three cardinal tests of public policy: the test of logic, the test of humanitarianism, the test of budgetary soundness.
When Alaska and Hawaii were Territories, the Veterans' Administrator had authority to make contracts with private hospitals for the treatment of veterans in Alaska suffering from non-serviceconnected disabilities. Congress gave the Veterans' Administrator this authority for several reasons, according to the Veterans' Administration:
** the exception to permit hospital care in private facilities for war veterans with non-service-connected conditions in a Territory or possession was based upon special considerations. These apparently included the factors of great distances from the mainland, difficulty in transferring patients to the States, and the relatively small volume of patient demands in the Territories and possessions (letter of Administrator Whittier to Senator Lister Hill, August 13, 1959).
Mr. Chairman, I have mentioned the test of logic. In this connection, it is clear that the factors which caused Congress to give the Veterans' Administrator authority to make contracts with private hospitals in Alaska and Hawaii for treatment of non-service-connected disabilities are equally pertinent today. The political status of Alaska and Hawaii has changed, but the geographical, transportation, and population factors are just as they were prior to statehood. Alaska remains 586,000 square miles in size. Air transportation provides the sole link between some of our major cities. Air transportation can be hazardous for veterans suffering from certain disabilities and may be uncertain under some weather conditions. Air transportion has always tended to be rather costly.
Statehood has not introduced to Alaska or Hawaii any Veteran's Administration hospital. No such hospital is contemplated by the Veterans' Administration, as far as I know. As Gov. William A.
Egan of Alaska observed in his letter of April 14, 1960, to Chairman Yarborough:
There is no Veteran's Administration hospital in Alaska. In comparable areas in the first 48 States, there is an average of 34.4 such facilities.
Mr. Chairman, I have referred here to the test of logic. In view of the fact that the absence of a Veterans' Administration hospital, great distances from the contiguous States, transportation difficulties within Alaska, and relatively small volume of patient demands were the factors which caused Congress to authorize private hospital care in Alaska for veterans with non-service-connected disabilities; and since each of these factors remains pertinent today, should not Congress restore to the Veterans' Administrator the authority to make contracts with Alaska private hospitals for the treatment of nonservice-connected disabilities?
The argument most frequently heard against the restoration of the authority to make contracts with private hospitals is that no similar authority exists in the other States. The argument implies that passage of S. 2201 would provide benefits to Alaska and Hawaii which other States do not enjoy. Truthfully, Mr. Chairman, S. 2201 would place the care of Alaska and Hawaii patients on a basis more fairly comparable to the care of patients in the other States, who need not travel great distances by air far from their homes for hospitalization.
Of course, Alaska and Hawaii are the only States in which no Veterans' Administration hospital facilities exist a fact which counters the objection that S. 2201 is "special treatment" for the noncontiguous States. In reality, S. 2201 is designed to alleviate the existing "special treatment" under which the 49th and 50th States have no VA hospital facilities within their borders, and the geographical, special factors which are largely beyond the control of man.
Mr. Chairman, I have referred to the test of humanitarianism S. 2201 would avoid unnecessary hardships upon sick veterans in Alaska. The first aspect of these hardships is physical. And as Senator Gruening has already told you, Dr. Ralph W. Carr, chairman of the Ketchikan, Alaska, Medical Society, advised the subcommittee in his letter of April 19, some disabilities may preclude safe transportation of a patient by air. Dr. Carr gave the example of a veteran suffering from an acute coronary condition.
The second aspect of these unnecessary hardships is economic. It may be true that under section 605 of Public Law 85-857 a veteran with a non-service-connected disability can certify his inability to "defray the cost of transportation" to a hospital facility of the Federal Government, and receive his transportation at the expense of the Veterans' Administration. But there are many veterans who would hesitate to certify such inability, or who could pay transportation costs to the nearest available facility, but only under severe financial hardship. For example, a veteran living at Valdez and seeking treatment at Elemndorf Air Force Base, near Anchorage, would spend in excess of $30 in traveling to and from the Elemndorf hospital.
A veteran in Nome seeking hospitalization at Ladd Air Force Base near Fairbanks-the closest available Department of Defense hospital to him-would spend over $100 in airline tickets alone. A veteran in Ketchikan seeking hospitalization at the closest Department of Defense hospital near Anchorage would be required to spend more
than $130 in airline tickets, round trip. If the Ketchikan veteran were accepted for hospitalization at the Public Health Service hospital at Mount Edgecumbe near Sitka, he would pay over $60 in airline fares. In addition, in each of these cases the veteran would be hospitalized far from his family and friends, assuming that the veteran's condition permitted him to make the long journey to the nearest available Government hospital bed at all.
This brings me to the final test, Mr. Chairman. I refer to the test of sound budgeting. According to my information, the cost of the contract care system in Alaska was in the $150,000 to $200,000 area. The new system involves expensive transportation costs borne in some cases by the United States and in some cases by the patient. The contract care system provides better assurance that the taxpayers' dollars are spent on the costs of hospitalization rather than on the costs of transporting the sick. The contract care system worked well before statehood, and I am sure it will work well again. It will work much better, I suggest, than the other system now in effect. I urge the adoption of S. 2201.
Mr. Chairman, I have noted that the interest in S. 2201 is very great in my part of the country. Some excellent discussions of the bill have been made available to me, which I ask be inserted in the record. These materials include a letter to me, dated April 21, 1960, from Mr. James Fennel, department of Alaska service officer, Veterans of Foreign Wars; a joint statement, dated April 15, 1960, by Mr. Fennel and the American Legion department service officer in Alaska, Mr. Joseph M. Briones; a resolution adopted by Ketchikan Post No. 3 of the American Legion and dated December 15, 1958; House Joint Memorial No. 44, to which I have referred; letter to me, dated December 11, 1959, from Mr. James J. Brunette, director of veterans affairs for the State of Alaska; resolution adopted by Ragnar Myking Post 4352, Veterans of Foreign Wars, Ketchikan, Alaska, dated December 11, 1958.
Senator YARBOROUGH. They will be received and filed as part of the record.
(The material referred to above follows:)
Senator E. L. BARTLETT,
DEPARTMENT OF ALASKA,
DEAR SENATOR BARTLETT: I received your letter dated April 14, 1960, and having just returned from an extensive field trip to northern and westward Alaska, I can truthfully say that the Veterans of Foreign Wars of the United States, Department of Alaska, supports your Senate bill 2201 and H.R. 7910.
In my many visits to the outlying areas I can speak with some knowledge as to the hardships suffered by the veterans in Alaska with non-service-connected disabilities. As an example, a veteran becomes in need of emergency hospitalization for non-service-connected disabilities, he has to pay his own transportation to the nearest Government or military hospital. If he could afford this amount he could afford to go to a private doctor, so the end result is, the veteran either has to pay out of his own pocket or suffer with his disability. This is only one case and there are more, too numreous to mention.
If this office can be of assistance to your legislation, please do not hesitate to call on me.
JAMES FENNEL, Service Officer.