construction, [$709,000] $600,000, to remain available until June 30, 1957: Provided, That any part of this amount may be transferred to the General Services Administration.

EXPLANATION OF LANGUAGE CHANGE

The following additional phrase has been incorporated into the appropriation language covering miscellaneous construction, alterations, repairs and equipment, on the grounds of the Hospital, including preparation of plans and specifications, advertising, and supervision of construction: "To remain available until June 30, 1957".

The purpose of the change is to make the funds appropriated under this account available for obligating purposes during the budget year appropriated and one year thereafter. Certain projects can be completed within one year. However, for the larger projects, one year is not sufficient time for the development of specifications and drawings, bid solicitation and analysis, making of awards, and supervision of contract execution. The proposed additional language will enable the Hospital to carry out major repair projects in as efficient a manner as possible by precluding waste which might arise from attempting to complete projects in a twelve-month period when a longer time is required by reasonable standards.

Amounts available for obligation

(Balances for June 30, 1954, are as certified under sec. 1311, Public Law 663)

APPROPRIATION ESTIMATE

Construction, maximum security building: For expenses necessary for the preparation of [tentative drawings] plans and specifications for a maximum security building at Saint Elizabeths Hospital, [$110,000: Provided, That with respect to construction of new facilities hereafter authorized, and expenditures for major repairs of buildings and grounds, the per diem rate calculated for the District of Columbia pursuant to section 2 of the Act of August 4, 1947 (24 U. S. C. 168a), shall include a proportionate share of repairs and of the annual increment of the depreciated total cost of such construction, such depreciation to be based on the estimated life thereof, not exceeding forty years, beginning with the fiscal year following completion of construction, and such proportionate share shall be deposited in the Treasury to the credit of miscellaneous receipts] $269,000, to remain available until expended.

EXPLANATION OF LANGUAGE CHANGE

The following proviso appearing in the 1955 Appropriation Act has been deleted from the language for "Construction, maximum security building, as proposed for fiscal year 1956:

Provided, That with respect to construction of new facilities hereafter authorized, and expenditures for major repairs of buildings and grounds, the per diem rate calculated for the District of Columbia pursuant to section 2 of the Act of August 4, 1947 (24 U. S. C. 168a), shall include a proportionate share of repairs and of the annual increment of the depreciated total cost of such construction, such depreciation to be based on the estimated life thereof, not exceeding forty years, beginning with the fiscal year following completion of construction, and such proportionate share shall be deposited in the Treasury to the credit of miscellaneous receipts."

This proviso is permanent legislation and therefore does not need to appear in subsequent appropriation acts.

GENERAL STATEMENT

Senator HILL. Dr. Overholser, I want you to take whatever time is necessary. You have a big institution out there, and we are very proud of it. Dr. OVERHOLSER. I think 10 minutes will cover it, Senator. I will do my best.

Senator HILL. We want you to take your time. You have a great institution, one that I am very proud of, and I am sure Senator Thye is, too. Suppose you proceed in your own way, then, Doctor. Do you have a prepared statement?

Dr. OVERHOLSER. Would it conserve time if I read it, or do you wish me to summarize it?

Senator HILL. We will put it in the record in full, and have you summarize it, if that is agreeable.

(The statement referred to follows:)

STATEMENT BY WINFRED OVERHOLSER, M. D., SUPERINTENDENT, ST. ELIZABETHS HOSPITAL, ON SALARIES AND EXPENSES, ST. ELIZABETHS HOSPITAL

Mr. Chairman and members of the committee, the 1956 budget as submitted to you provides for an increase of $82,000 in the direct appropriation and an increase of $510,597 in reimbursements. These amounts result in a 14-cent per day increase in the per patient-day cost (from $4.97 to $5.11) and are based on an anticipated patient load of 7,255, an increase of 81 patients over 1955.

The increase, principally for personal services, provides for the opening and operation of the new admission-treatment building and for some relief of other seriously understaffed areas. With respect to the additional staffing requested, it would seem pertinent at this point to review briefly the personnel problems which have confronted the hospital in recent years.

St. Elizabeths Hospital has had a continuing personnel shortage since the conversion to the 5-day 40-hour workweek in 1946. Subsequent adjustments in personal service allowances have been generally inadequate to overcome the burden placed on the hospital by the shortened workweek and by the subsequent steady increase in patient population. The cumulative effect of the conversion to the shortened workweek and the increases in patient population was demonstrated in 1948 by a ward-by-ward survey made for the purpose of determining the minimum number of employees required to provide essential ward coverage and to furnish suitable care and treatment for patients. The staff shortages as revealed by that study amounted to 367 positions. An analysis of industrial and maintenance activities made at the same time indicated a substantial shortage in personnel available for this essential work.

These studies were completed in August 1948, at which time the hospital had 2,393 employees and a patient load of 6,227 patients. The patient-to-employee ratio was 2.60 to 1. Subsequent budget submissions cited the shortages disclosed by the surveys and requested relief. However, personnel increases granted the hospital since 1948 have been inadequate as to relief of this understaffing and indeed have failed to keep pace with the steadily increasing patient load. result, the patient-to-employee ratio estimated for the current fiscal year (1955) is 2.82 to 1 based on an average employment of 2,536 and a patient load of 7,174. The problem has been further aggravated by the following conditions:

1. The increasing average age of patients and the resulting necessity for providing more on-the-ward care for this group of patients has placed an ever-increasing strain on available personnel resources.

2. The efficiency of ward personnel is lowered by serious overcrowding of wards. The necessity for maintaining patients in halls, dayrooms, and other unsuitable areas results in inadequate surveillance and in general patient discontent and restlessness. Under these conditions, some normally well-behaved and cooperative patients have become disturbed and even assaultive.

The hospital's failure to obtain sufficient personnel to keep abreast of its increased responsibilities has necessarily resulted in some reduction in the standard of care and treatment furnished patients and in the curtailment of many preventive maintenance measures. Lack of the small additional staff to keep stock-control

records has made it most difficult to keep a well-balanced inventory and to reduce stocks to a minimum.

Provision is made in the 1956 budget request for additional staffing to provide for some relief of the most critically understaffed areas and for the opening and operation of the new admission-treatment building which was authorized by the Congress on condition that two deteriorated buildings which are over 65 years old be razed. Construction of this building is scheduled for completion by the end of the current fiscal year. The building, planned and erected in accordance with the most modern concepts of psychiatric treatment, will provide facilities for the prompt and intensive treatment of newly admitted patients. This program is fully expected to shorten the average stay in hospital of new patients, and thus economize on patient days. It is encouraging in this connection to note that recently two new drugs have become available which appear to offer much in shortening the course of certain types of psychosis, and which should be useful aids in the program of intensive treatment.

The additional personnel provided in this request would increase the estimated average employment in 1956 to 2,690. Since the anticipated patient load is expected to increase to 7,255, this would result in a patient-to-employee ratio of 2.70 to 1-a ratio which still compares unfavorably with that of 1948.

ADDENDUM TO STATEMENT

The House, in appropriating funds for salaries and expenses for St. Elizabeths Hospital for fiscal year 1956, has approved the recommendation of its Committee on Appropriations that funds requested for this purpose be reduced $17,000. The reduction translated into total funds available (i. e., direct appropriation and reimbursements) amounts to approximately $91,000.

A decrease of this amount would deny the hospital approximately 30 of the 41 additional positions requested for areas or activities other than direct-patient care in the new building and would reduce the net increase in permanent positions from 152 to 122. The decrease would result in the following:

(a) No additional maintenance positions could be added (13 were requested) in spite of the greatly increased load caused by the new admission building and the increasing backlog of essential preventive maintenance and repair work. The present maintenance and industrial staff has for several years been unable to keep abreast of the constantly increasing demands on its time and has been forced to curtail many preventive maintenance activities in order to service emergency needs. Work has to a large extent been on a priority basis. Continued curtailment of preventive maintenance activities will undoubtedly result in excessive deterioration of hospital property and equipment.

The opening and operation of the new admission building with numerous new facilities and the servicing and operation of expensive and complicated equipment (ventilation, heating, refrigeration, elevators, etc.) would greatly increase the burden on the already undermanned maintenance staff. In fact, there is serious doubt as to the advisability of opening a building with extensive facilities such as are in the new admission building, unless adequate maintenance services are provided in advance. An adequate and uninterrupted supply of such service is necessary for the basic care and treatment of the patients.

(b) The House Appropriations Committee report, in denying 6 additional positions for property control, indicates that in the opinion of the committee these additional positions were requested by the hospital for the purpose of performing substantially the same work now done by 2 employees. The fact is that the additional employees would perform the following essential property control functions not now being performed and which cannot be performed with existing staff:

1. Maintain control records on nonexpendable property valued at more than $3 million. No records are now kept for more than 95 percent of this property. 2. Maintain stock control records on about 750 different expendable supply items not now properly recorded or controlled.

3. Operate a continuous hospitalwide physical inventory program for nonexpendable equipment in order to provide basic data for accurate records, and to protect the Government against possible losses resulting from lack of periodic inspections.

4. Operate a continuous inspection program covering numerous expendable property substorerooms. Inspections of the sort to be carried out by the additional staff constitute the only effective way to prevent undue inventory buildups and excessive consumption.

5. Maintain current repair records on major equipment items in order to develop replacement standards and provide a basis on which to make replacements on a planned basis. No such records are now maintained.

The hospital cannot, without additional personnel, meet the requirements of the Federal Froperty and Administrative Services Act of 1949 and the Budget and Accounting Procedures Act of 1950. Surveys made of the property control program at the hospital (by representatives of the General Accounting Office, General Services Administration, and Department of Health, Education, and Welfare) have all agreed that the present program is inadequate and that additional staff is essential to effective property management.

(c) The House Appropriations Committee report states that "It is not the intention of the committee that any reduction apply against positions budgeted for direct care and treatment of patients." Funds approved by the House, however, would permit an increase of only 11 of the 22 additional medical positions requested for very seriously understaffed ward areas. This will mean a continuation

of the nearly intolerable personnel shortages on the wards affected.

The loss of the 30 positions covered above will seriously hamper the hospital in its efforts to provide adequate care and treatment to patients, essential maintenance and industrial services, and effective property control. Restoration of the positions is therefore requested.

ANALYSIS OF REDUCTION IN NEW POSITIONS

House allowances would require the deletion of the following new positions:

MAJOR REPAIRS AND PRESERVATION OF BUILDINGS AND GRounds,
ST. ELIZABETHS HOSPITAL

Mr. Chairman and members of the committee, funds requested for major repairs and preservation of buildings and grounds at St. Elizabeths Hospital for 1956 total $600,000, a decrease of $109,000 under the amount appropriated in 1955. This amount will permit the hospital to continue a conservative repair program designed to prevent undue deterioration which is ultimately much more costly than an adequate maintenance program. Only the most urgent projects are included. An estimated amount of $417,700 will be collected from the District of Columbia and deposited into the Treasury to the credit of miscellaneous receipts as the District's share of the cost of major repairs at St. Elizabeths Hospital for 1956. This is in accordance with the provisions of Public Law 472, 83d Congress.