Nurses Association has for many years appeared on the floor of the house of delegates in the American Nurses Association in opposition to ANA platform and in opposition to certain resolutions which have been introduced. And the Georgia State Nurses Association last year, at the biennial, moved that the American Nurses Association go on record as being opposed to the enactment of the type of legislation similar to the Forand bill or the inclusion of medical benefits under the Social Security Act.

And, Mr. Curtis, it is rather unique that you would ask me that question. You are mentioned in the proceedings of the house of delegates.

Mr. CURTIS. I hope favorably.

Miss HUDSON. We thought so.

This is a person speaking on the question.

And I quote: "I do not feel that this delegation is prepared to vote on something of this type at this time. I would quote from a speech from the Honorable Thomas B. Curtis from Missouri, who has been in the House of Representatives, in which he says: "* *** and the Committee on Ways and Means has been studying this for some time, and I have been on the Social Security Subcommittee since 1953 and I am presently the ranking Republican on the Social Security Subcommittee. There are many, many complex problems involved in this matter that need a great deal of thought as we proceed, and whether these nurses are fully aware of all of this and all this that it involves I sincerely question.""

And then she goes on and she makes a further statement, and she says: "I was present at part of the conference yesterday morning on legislation, and I was not thoroughly convinced that all of the answers to these questions were brought out clearly."

Mr. CURTIS. In other words, you do not feel that your association, the American Nurses Association, had a full study of this matter? Is that your view?

Miss HUDSON. That is my view, Mr. Curtis, and Mr. Chairman.

As chairman of the committee on legislation for Georgia, the State Nurses Association, I have received and read all the literature sent out by ANA to the State nurses associations, and it is my opinion that ANA has not clearly presented an analysis of the King bill. I fail to find where ANA has advised its members that H.R. 4222 discriminates against the private duty nurse. Also, there is only a general reference to the fact that H.R. 4222 covers only recipients of social security. In Georgia, 47 percent of our people, of 65 and over, are not covered by social security. And it is this group in which we find the need. Also, only a general reference is made by ANA that the patient must pay $10 per day for his hospital service for the first 9 days. This, in effect, in my opinion, is a $90 deductible benefit. For this reason, I believe that in testifying against H.R. 4222, I am in accord with the resolution passed by the house of delegates of ANA, and I quote from the resolution:

Whereas necessary health services should be available to all people in this country without regard to their ability to purchase, and

Whereas prepayment through insurance has become a major and an effective method of financing health services, and

Whereas certain groups in our population, particularly the disabled, retired, and aged, are neither eligible nor able to avail themselves of voluntary health insurance: Be it therefore

76123-61-pt. 2--43

Resolved, That the American Nurses Association support the extension and improvement of the contributary social insurance to include health insurance for beneficiaries of old-age, survivors, and disability insurance.

It seems to me that the "resolve" is in conflict with the first "whereas" because all senior citizens are not covered by social security. Mr. CURTIS. I do not know whether you have a collection of the literature that the ANA has sent to your group and the members on this subject in the past year, but if you do have, I would personally appreciate it if you would send me a list of it. I have seen the kind of material that certain groups have sent out. I am not saying this about this, because I have not seen it at all. But I would infer that it is propaganda rather than information, and I am just curious. If you do have any of that, to read it myself, so that I can evaluate it. I have read considerable literature that is sent out by various groups on both sides of this question.

Do you have such there?

Miss HUDSON. I do have about four pieces here, which I will submit to you at this time.

Mr. CURTIS. I will appreciate that.

Just remain seated, because I will get those.

Now, Miss Thompson, when she testified, speaking for the ANA, stated that the American Medical Association had been putting undue pressure on nurses to induce them to vote the other way on H.R. 4222. I am just wondering whether you had pressure put on you in any

way.

Miss HUDSON. We have not had any pressure whatsoever put on the nurses in Georgia about this matter, at this time or any other time.

Mr. CURTIS. Have you heard, among other nurses attending these meetings, of anything that is identifiable in this area?

Miss HUDSON. No, I have not.

Mr. CURTIS. I am going to ask that this be put into the record: A headline story in the St. Louis Post-Dispatch, of July 28, 1961, on page 3-A. The bold headline: "Efforts To Turn Nurses Against Health Plan for Aged Reported-Pressures To Oppose Social Security Method Said To Come From Doctors, Hospital Executives."

This is an article from Thomas W. Óttenad, whom I know and have good respect for; but this is not a news item. It will appear in the record for anyone to judge. It talks about vague reports, with no identification. It says, with regard to Miss Thompson's testimony, "She made no reference to reports of pressure in her prepared testimony."

(The article referred to follows:)

[From the St. Louis Post-Dispatch, July 28, 1961]

EFFORTS TO TURN NURSES AGAINST HEALTH PLAN FOR AGED REPORTED PRESSURE TO OPPOSE SOCIAL SECURITY METHOD SAID TO COME FROM DOCTORS, HOSPITAL EXECUTIVES

(By Thomas W. Ottenad, a Washington correspondent of the Post-Dispatch) WASHINGTON, July 28.-Pressure is being put on registered nurses to persuade them to oppose plans for providing health care for the aged through the social security system, the Post-Dispatch was told today.

Representatives of the American Nurses Association said the pressure is being exerted by some physicians, representatives of State and local medical societies, and hospital administrators.

Reports received by the association in Washington tell of offers to pay expenses of nurses willing to testify against pending health care legislation backed by the Kennedy administration; threats against nurses belonging to the association; and threats by some physicians to "run our hospitals without nurses."

There have been reports also of physicians appearing at local meetings of the nurses association demanding to be heard in opposition to the social security approach. One State medical society, warning its physician members that it was of the utmost importance to obtain letters from nurses opposed to the social security approach, urged them to "encourage your nurse to write her Congressman."

AGAINST AMA STAND

The American Nurses Association, which strongly supports the social security method of providing health care for the elderly, finds itself in direct opposition to the American Medical Association, which opposes this approach. The nurses organization reports it has a membership of more than 171,000 registered

nurses.

Miss Julia C. Thompson, representative in Washington of the nurses organization, said: "The pressure being put on our members is rather subtle in nature. "There are almost no reports of nurses being threatened with loss of their jobs, but many physicians have sought vigorously to persuade nurses to oppose the social security method of financing health care for the aged.

"And because nurses traditionally have been accustomed to taking orders from doctors, this has intimidated some of them."

Miss Thompson was scheduled to testify today before the House Ways and Means Committee in support of the Kennedy administration's pending health care legislation. She made no reference to reports of pressure in her prepared testimony.

PRESSURES INCREASING

However, in an attached statement reviewing the position the nurses association has taken previously in regard to social security legislation, she said pressures on nurses have been increasing since last year when the organization reaffirmed its endorsement of the social security method of financing health care for the elderly. The association first supported this method at its biennial convention in 1958.

Among reports of pressure received by the organization in Washington was one from the third (St. Louis) district of the Missouri State Nurses' Association. It said, "Some nurses have reported individual pressures to repudiate ANA's stand." It added that no approaches have been made to representatives of the local association.

The Illinois Nurses' Association reported that an official of the State medical society requested an appointment to discuss the pending legislation. He accepted the nurses' position in a very gentlemanly way, it was reported.

In Arkansas, it was reported, the women's auxiliary of the State medical society offered to pay all costs if the nurses organization would send its members a letter prepared by the auxiliary. The offer was rejected. It was reported later that the woman who made the request was on the payroll of the American Medical Association.

In Ohio, doctors "hit the ceiling" when they learned that a delegation of nurses had conferred with a Member of Congress concerning health care legislation, it was reported. The physicians demanded to address a district meeting of the nurses association, the report said, and "they talked up a storm about socialized medicine * The first day of the uprising three or four doctors threatened to run their hospitals without nurses."

In her prepared testimony, Miss Thompson cited the low pay received by many nurses as evidence that they themselves need a social security-financed system of health care for the elderly. She pointed out that staff nurses employed in hospitals have an average annual income of $3,800.

The salaries of nurses employed in physicians' and dentists' offices were even less, averaging $300 monthly, she said. The average pay of nurses on private duty is $336, she said.

Mr. CURTIS. I have before me the transcript of questions asked by Mr. King, where she identifies vaguely reports of pressures. It does not sound like pressures as much as trying to influence and persuade, in the State of Washington.

76123-61-pt. 244

It seems to me the main thing in here is that the doctors want to have an opportunity of presenting their point of view to the nursing groups. And if that is what is meant by "pressures," heavens, I think we all could use a lot more of that kind of pressure, simply exchange of views.

This article insinuates something different, though.

I am going to write to Miss Thompson, because whenever I hear of this type of pressure, on whatever type committee I happen to be on, I want to examine into it, because when witnesses come here and indicate, as others have, that undue pressures have been put on, I want to either identify it or want to stop this kind of smear attack, because this news article without substantiation is nothing more than smear. I have had some experience with this kind of thing before. The testimony, to a large degree, before this committee, on the part of the proponents, has been of the smear nature; with primarily the AMA as the goat; without any intimation of details of any improper action.

If there has been any improper action, for heaven's sake let us get it on the record, but if there has not, and the people who charge it do not want to specify, let them forbear and cease smearing the institution and the names of reputable people in our community.

Miss HUDSON. Mr. Chairman, I would urge that an investigation be made of that. And in submitting these documents, I think you will see

The CHAIRMAN. Just a minute, now. You said "of that." Identify the "that," will you?

Miss HUDSON. An investigation of the charges which have been brought against the medical profession. And included in these documents, I think you will discern some pressure from other sources.

The CHAIRMAN. From both sources?

Miss HUDSON. No; from other sources. This is material sent out from ANA, which will speak for itself.

The CHAIRMAN. Do you want that in the record?

Miss HUDSON. I would like to have it in the record.

The CHAIRMAN. All right. Without objection it will be inserted in the record at this point.

(The resolution referred to follows:)

To: presidents and executive secretaries of State nurses associations and presidents and executive secretaries of district nurses associations.

From: Helen V. Connors, associate executive secretary; Julia C. Thompson, Washington representative.

Re: Health insurance under social security-Anderson-King bills.

Beginning July 24, 1961, the Committee on Ways and Means of the U.S. House of Representatives will hold hearings on H.R. 4222. This bill, introduced by Representative Cecil King, Democrat of California, and, S. 909, introduced by Senator Clinton Anderson, Democrat of New Mexico, would provide the following health insurance benefits for recipients of old-age, survivors, and disability insurance, or those under the railroad retirement system:

(1) Inpatient hospital services for up to 90 days. Hospital services would include all those customarily furnished by a hospital for its patients, and would be subject to a deductible amount (paid by the patient) of $10 a day for up to 9 days, with a minimum of $20;

(2) Skilled nursing home services, after the patient is transferred from a hospital, for up to 180 days;

(3) Outpatient hospital diagnostic services, as required, subject to a $20 deductible amount for each diagnostic study;

(4) Home health services for up to 240 visits during a calendar year. These services would include intermittent nursing care, therapy, and part-time homemaker services.

Services by physicians and surgeons are not included in this bill except as they are provided by a staff of a hospital.

EXHIBIT I

The American Nurses' Association will offer testimony during the hearings in accordance with the following resolution adopted by the ANA House of Delegates in June 1958:

"Whereas necessary health services should be available to all people in this country without regard to their ability to purchase, and

"Whereas prepayment through insurance has become a major and an effective method of financing health services, and

"Whereas certain groups in our population, particularly the disabled, retired and aged, are neither eligible nor able to avail themselves of voluntary health insurance: Be it therefore

"Resolved, That the American Nurses' Association support the extension and improvement of the contributory social insurance to include health insurance for beneficiaries of old-age, survivors and disability insurance; and be it further "Resolved, That nursing service, including nursing care in the home, be included as a benefit of any prepaid health insurance program."

This position was reaffirmed by the ANA House of Delegates in May 1960. Therefore, a statement in support of the major provisions of H.R. 4222 (King, Democrat of California) will be presented on behalf of the ANA. Carrying out the directive of the house of delegates, the statement will present the stand taken by ANA in favor of the extension of OASDI to include health insurance for its beneficiaries.

As you know, the American Medical Association is actively working to convince State and district associations to repudiate the stand of the ANA. The latest incident reported to us was a recent telegram to State medical societies requesting them to approach SNA's asking them to go on record in opposition to the legislation introduced by Senator Anderson and Representative King. In one instance reported to us a representative of a State medical society attempted to recruit a representative of an SNA to testify in Washington, D.C., in opposition to the legislation which ANA supports in prinicple.

So that we may be well prepared to speak for nurses before the House Committee on Ways and Means, we need to know the extent of the pressure from physicians against the position of ANA, and what is known of the effect of this pressure as it may be reflected in the activities of individual nurses at the time of the hearings.

Please complete and return the attached questionnaire before July 21, 1961. (Returned July 13, 1961; stated no approach by representatives of the State or local medical society.)

Mr. KING. Not of Miss Hudson, but I would like Mr. Curtis to clear up a statement I hope I misunderstood.

The smearing seemed to be predominantly on the pro side?

Mr. CURTIS. Yes. And let us specify it right here and now. This news article in the St. Louis Post-Dispatch.

Wait a second. That demonstrates it. And I have read this testimony here, which gives rise to it-the insinuation that there has been undue pressure placed on the nurses by the AMA and the doctors to get them to change their testimony.

But

Now, all I am saying is: If that can be authenticated, I will join you and anyone else in criticizing it and bringing it out. if that cannot be substantiated, I think it has no place in testimony before this committee, or, indeed, in the public press.

Mr. KING. The only place where I touched on pressure on nurses, Mr. Curtis, was in Seattle, Wash., and I included the circular that was sent out by the AMA with respect to altering or changing the