language "each health care facility" on line 2, page 18 and substituting language along the following lines: "each health care facility or group of health care facilities under common control or coordinated direction." A similar amendment should also be made on page 3 at line 4. In conclusion we urge this committee and the Congress that even at best the advantages claimed for health facility planning are apt to be of trifling significance compared to the social, technological, and organizational changes and innovations realizable in the health care field in an atmosphere of freedom and flexibility; thus protection of innovation and development in the planning process is a major public responsibility. Respectfully submitted. SCOTT FLEMING. Vice President and Associate Manager. EXHIBIT A.—SUGGESTED AMENDMENTS TO H.R. 6418, PLANNING TO ENCOURAGE ORGANIZATIONS WHICH ASSUME RESPONSIBILITY FOR HEALTH CARE FOR AN ENROLLED POPULATION Insert at the end of section 2 of subsection (a)(2) (I) following line 5, page 3 of H.R. 6418, dated March 1, 1967, the following: "; and (iii) in developing criteria to guide the development of state plans, the Secretary shall give particular attention to provisions for the encouragement of innovation and proven or promising alternatives to prevailing patterns for the organization and delivery of health care services, including alternatives under which a qualified sponsor or sponsors may assume responsibility to provide or arrange reasonably comprehensive health care services on behalf of a population comprised of individuals and families choosing to obtain health care services primarily as provided or arrange by such sponsor or sponsors." Hon. HARLEY O. STAGGERS, [Telegram] ATLANTA, GA., May 2, 1967. Chairman, House Interstate and Foreign Commerce Committee, I heartily support extension authority for grants for comprehensive health planning and Public Health Service as contained in H.R. 6418. Also strongly support adequate appropriation ceilings to at least $500 million level by fiscal year 1971. Gov. LESTER MADDOX. Hon. HARLEY O. STAGGERS, [Telegram] BERKELEY, CALIF., April 29, 1967. Chairman, Interstate and Foreign Commerce Committee, Urge your support of principles involved in S. 1131 with particular reference to proposed section 353 regulating clinical laboratories in interstate commerce. Certain amendments for improvement of bill have been transmitted to Secretary Gardener. Copy being forwarded to you. If these changes are incorporated in bill we would find it entirely satisfactory. Urge your strong support. LESTER BRESLOW, M.D., California Director of Public Health. Hon. HARLEY STAGGERS, [Telegram] JEFFERSON CITY, Mo., May 4, 1967. Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.: With increased emphasis on licensing of clinical laboratories by each of the 50 States, it is apparent that licensing at the Federal level of clinical laboratories engaged in interstate commerce is desirable. The Missouri Division of Health is favorable to enactment of the "Clinical Laboratory Improvement Act of 1967” as contained in H.R. 6418. L. M. GARNER, M.D., Acting Director, Missouri Division of Health. By J. P. RUSSELL, M.D. [Telegram] TOPEKA, KANS., April 27, 1967. Hon. HARLEY STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, As director of health for State of Kansas may I urge your vigorous support for H.R. 6418? Regulatory action for control of medical laboratories involved in interstate commerce has been long overdue. Many of these laboratories are performing a volume business with little regard to quality of standard and frequently with little concern for consequences of responsible diagnostic testing results on medical patient. Accuracy of such laboratory diagnostic studies can often mean difference between life and death. Licensure and periodic inspection of such laboratories by a government agency is imperative if we are to insure a high quality of medical care to citizens of our State. HUGH DIERKER, M.D., Kansas State Health Officer. Hon. HARLEY STAGGERS, [Telegram] PIERRE, S. DAK., Apr. 25, 1967. Chairman, Interstate and Foreign Commerce Committee, Urge passage of H.R. 6418 regarding licensure of laboratories working in Congressman HARLEY STAGGERS, [Telegram] BISMARCK, N. DAK., April 27, 1967. Chairman, Interstate and Foreign Commerce Committee, JAMES R. AMOS, M.D.. [Telegram] BOISE, IDAHO, April 26, 1967. Hon. HARLEY O. STAGGERS, House of Representatives, Washington, D.C.: In 1967 Idaho Department of Health unsuccessfully attempted to enact State legislation on clinical laboratory licensure on the national level. We strongly support H.R. 6418. This is a definite public health need. A. W. CLOTZ, D.P.H., Director of Laboratory Division, Idaho Department of Health. [Telegram] BLACKFOOT, IDAHO, April 27, 1967. Representative HARLEY O. STAGGERS, House of Representatives, Washington, D.C.: The Idaho Health Association strongly supports and urges passage of the laboratory licensing bill H.R. 6418. Its passage is a definite health need. JACK JELKE, President. Hon. HARLEY O. STAGGERS, [Telegram] MAY 1, 1967. Chairman, Interstate and Foreign Commerce Committee, Federal licensing of clinical laboratories engaged in testing specimens shipped interstate is needed. Senate Bill 1131 relating to this activity is endorsed, in principle. Suggest correction of certain defects in printed bill as follows: 1. Section 353(b) should be modified not to cover laboratories sending only test reports interstate. Otherwise, a laboratory which occasionally sends a report to a physician across a state line may be subject to federal licensure, regardless whether the specimen was shipped interstate. 2. Section 353 (d) (1) (B) should be clarified to stipulate basis on which Secretary will establish standards to determine whether laboratory is operating satisfactorily to carry out purposes of Section 353. 3. Section 353 (i) should be clarified so that naturopaths and chiropractors are not exempted on the basis that they may be considered "licensed physicians." 4. Section 353 (k) should be clarified to permit States having freedom of enacting higher standards than those proposed under federal regulations. Your consideration of these suggestions appreciated. NATHAN J. SCHNEIDER, Ph. D., President, Association of State and Territorial Public Health Laboratory Directors. [Telegram] NEW YORK, N.Y., May 2, 1967. Hon. HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, The National Council on Alcoholism urges that your committee approve H.R. 6418 and its authorization to extend and expand the provision of Public Law 89-749. It is our hope that alcoholism and its victims may indeed receive the necessary recognition and services that the farsighted concepts of sound health planning embodied in H.R. 6418 can bring about. THOMAS P. CARPENTER, President, National Council on Alcoholism. Hon. HARLEY O. STAGGERS, HOUSE OF REPRESENTATIVES, Washington, D.C., May 26, 1967. Chairman, House Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: I am aware that your Committee is in the process of scheduling hearings on your bill H.R. 6418, the "Partnership for Health Amendments of 1967." This is a fine bill, which if enacted, will have significantly beneficial effects on the programs of health planning and services of the Commonwealth of Puerto Rico, however, in studying your bill I have noted a problem which I think should specifically call to your attention. Section 5 of the bill would add a new Section 353 to Part F of Title III of the "Public Health Service Act" (42 U.S.C. 263) to provide for definitions and requirements in the licensing of biological products and clinical laboratories. To this effect, the term "interstate commerce" is so defined as to include and regulate all commercial activities which would be performed wholly within the Commonwealth of Puerto Rico for the purpose of the proposed amendments. It is apparent, as you know, that the Administration drafters of this proposed obsolete definition were temporarily unaware of our present Commonwealth status and overlooked the solution to the problem presented in the definitions of the "Public Health Service Act." Section 2(f) of such Act defines the term "State" as meaning Puerto Rico. and Section 2(g) of this same Act defines the term "possession" as including Puerto Rico. Consequently the drafters of the definition of the term "interstate commerce", proposed in H.R. 6418 as an amendment to the Act, included commerce specifically "within" the Commonwealth of Puerto Rico on the apparent theory that such imposition upon the internal commerce of the Commonwealth was authorized by the inclusion of Pureto Rico within the term "possession" given in Section 2(g) of the Act. This problem, of course, could have been ideally resolved by striking out "Puerto Rico" from the term "possession" in Section 2(g) of the "Public Health Service Act", but since H.R. 6418 does not appear to be the instrument for such amendment I must postpone it for the future and, counting with your kind cooperation, avail myself of a practical solution. As you know, the "Public Health Service Act" was enacted as Public Law 78-410, on July 1, 1944, almost 8 years before the advent of the Commonwealth of Pureto Rico. In this connection it would seem pertinent not to overlook the present relationship between the United States and the Commonwealth of Puerto Rico, as established by Public Law 81-600. Implicit in the creation of the Commonwealth in 1952, by the mutual agreement of the people of Puerto Rico and the United States Congress, was the understanding that the Commonwealth of Puerto Rico was to be accorded autonomy in the regulations of its internal affairs. As a matter of fact, in 1953, this compact enabled the United States to request and obtain from the United Nations that the Commonwealth of Puerto Rico be removed from their rolls of the non-self governing territories and possessions. To this effect, on November 27, 1953, the United Nations recognized that the people of the Commonwealth of Puerto Rico, exercising effectively the right of self-determination in a free and democratic way, had achieved a new constitutional status and that, in view of this new status, it was appropriate that the United States should cease the transmission of information with regard to Puerto Rico under Article 73 (e) of the Charter U.N. Gen. Ass. Res. 748 (VIII) (1953). Because of the significance of this constitutional status of the Commonwealth of Puerto Rico President Kennedy issued his memorandum of July 25, 1961 (which has not been superseded) in which he states that: "... it is essential that the executive departments and agencies be completely aware of the unique position of the Commonwealth, and that policies, actions. reports on legislation, and other activities affecting the Commonwealth should be consistent with the structure and basic principles of the Commonwealth and, 66 . . . The Commonwealth structure, and its relationship to the United States which is in the nature of a compact, provide for self-government in respect to internal affairs and administration, subject only to the applicable provisions of the Federal Constitution, the Puerto Rican Federal Relations Act, and the Acts of Congress authorizing and approving the constitution." Up to the present moment, as you know. Congress has consistently recognized this principle by not extending federal regulations to the internal commerce of Puerto Rico, and all the laws enacted applying in Puerto Rico make specific reference to the "Commonwealth of Puerto Rico" and to this effect they equate the Commonwealth with the States of the Union by including it within the meaning of the definition of the term "State." Among the many actions taken by the Congress to support this policy, I might take the liberty of mentioning the case of the bill H.R. 13881 approved by Congress last year for the purpose of regulating in interstate commerce the transportation, sale and handling of dog and cats used in research. During the consideration of the bill by the Senate, Chairman Magnuson stated that the inclusion of the internal commerce of the Commonwealth of Puerto Rico in the bill did not originate in the House-passed version, that such inclusion made by the Senate Commerce Committee violated the compact and that it should be deleted from the bill. The Magnuson amendment was agreed to and the House ratified the amendment. I sincerely hope that this situation may be kept present for the purpose of amending the definition of the term "interstate commerce" proposed in Section of H.R. 6418 as follows: "On page 10, at the end of line 10, after the term the District of Columbia, strike out "the Commonwealth." "On page 10, beginning on line 11, strike out "of Puerto Rico." To preclude any possible misinterpretation, it would seem prudent to clarify the legislative history of the bill by adding in the report that the term "possession" including Puerto Rico in Section 2(g) of the "Public Health Service Act" of July 1, 1944 (Public Law 78-410) has become inapplicable to the Commonwealth of Puerto Rico because of the reasons, supra. Since this is an Administration bill, I have discussed the matter with Mr. Ralph Huit, Assistant Secretary for Legislation, of the Department of Health Education and Welfare, and with Mr. Sidney Saperstein, Deputy Chief of the Legislative Division, in the Office of the General Counsel, in this Department, and I have been informed by them that their Department has no objection to my recommendations. I would appreciate very much your good office in the sponsoring of this necessary amendment. Respectfully yours, SANTIAGO POLANCO-ABREU, Resident Commissioner of the Commonwealth of Puerto Rico. HOUSE OF REPRESENTATIVES, Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: I enclose for your consideration a copy of a letter from The Honorable John A. Burns, Governor of Hawaii, emphasizing the importance underscore the Governor's comof passage of H.R. 6418 to my State. May ments in requesting the earliest possible favorable action on this legislation. The Hawaii Department of Health has completed planning for community health programs authorized by Public Law 89-749 and is anxiously awaiting extension of the Act so that its early progress in qualifying for these important Federal-State health programs will not be disrupted. May I respectfully request that every consideration be given to Governor Burns' letter and that it be made an official part of the hearings on H.R. 6418 when they are resumed. Your kind attention to this inquiry will be most appreciated. Hon. PATSY T. MINK, PATSY T. MINK, Member of Congress. EXECUTIVE CHAMBERS, Honolulu, Hawaii, May 1, 1967. House of Representatives, Longworth Building, Washington, D.C. DEAR REPRESENTATIVE MINK: We have been informed in a special letter from the Association of State and Territorial Health Officers that hearings on H.R. 6418 (the bill to extend Public Law 89-749) are to be held on May 2, 3 and 4, 1967 by the House Committee on Interstate and Foreign Commerce. As you no doubt know, the threefold intent of this bill is to increase the ceiling for State Health Planning grants, to increase the ceiling for formula grants, and to increase the ceiling for project grants under the Comprehensive Health Planning and Public Health Services Amendments of 1966. These increases represent a substantial amount and could means a considerable expansion of services available to the citizens of Hawaii when our State Comprehensive Health Plan is finally promulgated. In addition to this, it is the intent of this bill to extend the life of Public Law 89-749 up to a total of five years. |