STATEMENT OF A. J. HENLEY, DIRECTOR, YEATMAN MEDICAL HEALTH CENTER

Mr. HENLEY. I would like to say, first of all, Mr. Chairman, thanks for inviting me.

Most of the rhetoric of health care being a right instead of a privilege is just rhetoric. At any rate, I think that certainly we agree more doctors, nurses, dentists, health aides, laboratories, and X-ray technicians are needed. I think that probably training is one of the biggest issues here, and I would like to say that I agree with the earlier statement that courses should be given to all health workers together for at least a year so that they could begin to learn to recognize the value of working with each other.

Certainly there needs to be more community facilities, such as the neighborhood health centers. I believe that medical centers need to emphasize preventive and outpatient care. I think this care needs to be provided in a setting with dignity, and that people do not look upon it as being charitable, because charitable care is generally recognized as being poor medical care.

This summer at Yeatman we did have a very pleasant experience in part, in that a group of medical students, all of whom were white except one, came into our community and began to help us in identifying what we believe to be a lead poisoning problem. These students worked with us, they located children in the area who had lead poisning, they provided and sought out hospitalization for these children, they developed resources to draw and analyze the blood, to educate the parents. I think these are the kind of things that medical school and medical students need to do so that they can become aware of the kind of problems that exist in ghetto areas. These students in turn learn about a preventable health problem. They helped children and the community to do something to begin to correct the problem. I'm sorry to say that some of the response from several of the hospitals was poor. The concern for payment superseded the concern for human life.

The effect of many Government programs designed to assist the education of health workers is, by and large, insufficient. It also suffers from the same kind of fragmentation that we have in other parts of the health care system. It's fragmented with different sections of the Government responsible for different aid programs, different eligibilities and rules.

What is needed is to pull together all health manpower assistance into one section so that plans for health and manpower development are coordinated. On the other hand, while the resources need to be centralized, the actual planning should be at a local level, so that all areas around the medical centers should be represented. A committee of health professionals and consumers, at the local level could best judge the merits of any plan.

As far as solving the problem of maldistribution, special plans to encourage physicians to return to low income areas or rural practice should be encouraged, be they black or white. Special financial arrangements should be given to schools and individuals who elect to become involved in the redistribution of health manpower.

I would suggest that as an alternative to services in the Armed Forces, services to a low income community or a rural area might be substituted for some military service.

As far as the need for training more black physicians, I think that one step in that direction would be to have a recruiter of black medical students in each medical school. Secondly, I think we need to start in high schools or earlier to let youngsters know that there is a real possibility of their getting into medical school. I'd also like to state that I think there is a vast untapped resource in our hospitals where qualified employees could become a tremendous manpower pool to an expanded medical educational facility.

Many blacks and other poor persons are working in hospitals at lower level jobs than their native ability demonstrates. In every hospital you can always hear statements in reference to nurses aides and technicians who, in the opinion of most professionals, would make good physicians, but this altogether, most of the time, goes as an unforgotten source.

I think one of the biggest problems in dealing with health manpower is that training is always designed to deal with the diseased body. People will always be in need of medical care unless we begin to structure our training so that we'll teach people to be healthy. We certainly need to train more black physicians and dentists. Certainly the medical schools of this State have a record that would probably even make Mississippi envious. Only a handful of graduates have been produced by all of these schools combined. The usual excuses of, "We can't find them, none have applied, they aren't qualified," have been used for

years.

I think the records will show to date that there have been six or seven black graduates from this medical school. As far as the records indicate, there has only been one from Washington University Medical School in the history of the school.

Some of the things that are stated as far as

Senator EAGLETON. Has St. Louis University ever graduated a black dentist?

Mr. HENLEY. Dentist, never. One black dentist was graduated from St. Louis University Dental School at the graduate level, and I would like to state that that black orthodontist is now the director of dentistry in our neighborhood health center and, incidentally, he's the only black orthodontist in the State of Missouri.

To date, Washington University School of Dentistry has not graduated a single black.

In 1950, the dentist population ratio was 1 dentist for every 1,700 persons. The ratio now is 1 dentist for every 2,000.

The black community is a separate entity. In St. Louis there are approximately 20 black dentists serving the inner city. The black population is approximately 300,000. The ratio is one dentist for every 15,000 black persons.

Senator EAGLETON. What is the national ratio?

Mr. HENLEY. One per 2,000. This kind of ratio is appalling and will require some deep concern and honest efforts in order to bring about a change.

I think the statement that the one black dentist who was graduated from the school of dentistry here in St. Louis University chose to devote a full-time effort to a black community and to a neighborhood health center possibly might point out why we have the kind of problems we have. Certainly most statistics show that graduates from dental school tend to stay in the same city or certainly in the same State in which they graduated from school. Certainly if none have graduated

Senator EAGLETON. Mr. Henley, that depends on the area of the country. I mean, those figures vary quite a bit between Harvard Medical School and others?

Mr. HENLEY. Right.

Senator EAGLETON. Some are much more transient than others? Mr. HENLEY. Certainly in this State it holds true that we only have one, and we have many.

Senator EAGLETON. In the black area at any rate.

Let me ask you a couple of questions about the Yeatman project. Other than the special summer project that you mentioned earlier, do any medical students during the regular routine year, that is from September to June, medical students here at St. Louis University have any on-going contact with Yeatman?

Mr. HENEY. We are, through the department of community medicine, establishing programs for medical students at the health center. We have had this summer, two or three students on preceptorship type programs, working with the physicians and patients in the health center. We have also had two students on assignment to us from the University of Missouri Medical School.

We intend to enlarge this kind of program as we go along.

Senator EAGLETON. How is the Yeatman project funded, basically? Mr. HENLEY. Well, 314E money; HEW.

Senator EAGLETON. Is that 100 percent Federal?

Mr. HENLEY. Yes; 100 percent.

Senator EAGLETON. Is your connection with St. Louis University one of just accommodation; that is, it's the one that was willing to undertake it, or how did that come into being?

Mr. HENLEY. First of all, we did not really approach Washington University. Their record was so appalling until we felt that it would be a waste. We did come here because we knew that there were individuals at this school that were interested. I cannot speak in total for the school. I can speak for certain individuals at this school.

Laboratory assistants, social service aides, medical record assistants have been trained for us at this university by various departments, and they have proven to be as well trained as any I have ever seen. I think these kind of programs have demonstrated what we can do in the areas of paraprofessional training. I personally would like to see a training program whereby inner-city residents could complete courses that would be set up by medical schools, hospitals, and the junior colleges which would include in the design, career-ladder-type programs in order to train paraprofessionals. These things have been done in other States, but to date they have not occurred in this city.

Senator EAGLETON. What kind of manpower do you have at the Yeatman Center, other than M.D.'s?

Mr. HENLEY. We have at the Yeatman Center a complete complement of physicians, covering all specialties. We have health educators, nutritionists, social workers, the complete gauntlet of health services, really. Senator EAGLETON. Do you have some M.D.'s, one or more who are there full time, you know, 8 a.m. to 6 p.m.?

Mr. HENLEY. Presently we have 14 physicians, nine of them are full time.

Senator EAGLETON. Nine are full time?

Mr. HENLEY. Right.

Senator EAGLETON. On the staff, as it were, with no other private practice?

Mr. HENLEY. Some of them have other practices in that they work in the offices of other physicians after they leave us. We have made no attempt to control what the physician does after we get what we pay for.

Senator EAGLETON. And the other five or so are part time?

Mr. HENLEY. Part time.

Senator EAGLETON. Of the nine full time, how many are black and how many are white?

Mr. HENLEY. Our ratio is about 50 percent.

Senator EAGLETON. And your part time?

Mr. HENLEY. In dentistry it's predominantly white.

Senator EAGLETON. That was nine full-time M.D.'s and five part-time M.D.'s. How many dentists do you have?

Mr. HENLEY. We have presently six dentists.

Senator EAGLETON. How many full time and how many part time? Mr. HENLEY. We have two full time, the other four are part time. Senator EAGLETON. Is that basically, is the Yeatman Center basically a diagnostic service with some medical services, of course, but are a good number of your patients referred on for more sophisticated medicine to a hospital or somewhere else?

Mr. HENLEY. If something is needed requiring hospitalization or sophisticated testing, we do send patients to hospitals. We are quite capable of handling most medical problems in that we cover internal medicine, obstetrics, gynecology, minor surgery, radiology, pediatrics, psychiatry, the whole gauntlet of medical specialties.

Senator EAGLETON. How long has it been in operation?

Mr. HENLEY. We have been in operation for 13 months. In that 13 months we have had approximately 34,000 patient visits, this representing approximately 14,000 individual patients.

Senator EAGLETON. Have you done any studies on this point: Suppose patient comes in the first time with whatever his or her complaints are, a proper analysis or diagnosis is made, and that patient is urged to come back in a week, 2 weeks, or a month. Do you have any statistics or analysis of how many patients you lose in the sense they come the first time and that's the last you see them versus those who do return as suggested and urged?

Mr. HENLEY. We have been running a 17.2-percent missed-appointment rate. However, any patient who does not show up for an appointment will find one of our outreach workers at his home the next day to either encourage or find out why he missed his appointment and to encourage him to come down.

Senator EAGLETON. And of the 17.2 who missed the first assigned appointment, how many do you redeem by this outreach?

Mr. HENLEY. I cannot give you an accurate statistical figure as to that amount.

Senator EAGLETON. I assume it must be a significant proportion of them, otherwise you wouldn't have the outreach program?

Mr. HENLEY. We do have I must say this 17-percent level remains rather constant. Certainly missed-appointment rates in some areas are high. For instance, we have a higher missed-appointment rate in dentistry because most of the people in our area are accustomed to crisisoriented dental care, in that they come when they have a toothache, and they will miss an appointment if it's just for filling or something of that nature.

Senator EAGLETON. Do you turn anybody away? Do you have any geographical boundaries beyond which you just don't

Mr. HENLEY. We serve a geographic boundary, yes.

Senator EAGLETON. And if so-and-so is a resident beyond that boundary you say, "Tough luck"?

Mr. HENLEY. Right; unless it's an emergency. We turn away no emergencies, whether they are residents or not, but I'll grant specific limits as to a geographic area.

Senator EAGLETON. Thank you, Mr. Henley. Your total statement will appear in the record.

(The prepared statement of Mr. Henley follows:)