In 1796 a group of benevolent doctors and laymen described their purpose as "that all the poor receive the benefits of a charity, the more refined as it is the more secret."

One hundred and forty-eight years later, a different medical policy was enunciated by President F. D. Roosevelt who declared among "basic human rights were adequate medical care and the opportunity to achieve and enjoy good health."

With this shift in concept, from charity to right, we need some practical new approaches and new techniques for defining and fulfilling these changes.

Let me give you a narrative case illustrated of what happened in Kansas City when public and private efforts were blended together at both operation and planning level. The history of our city hospital, Kansas City General Hospital, has paralleled with extraordinary fidelity the development of all other hospitals and, in fact, provides us with a panorama of what has happened in the field of medical care and particularly in the care of the indigent and medically indigent sick. The hospital had been operated in one form or another by the city for 100 years. It ran a pretty good show for its time; contributed to the medical education of many doctors, but soon medical science and advancements passed it by. As a result of failure of budget requests to be approved by the city, lack of maintenance to the buildings, unrealistic personnel policies, and mounting frustrations and discouragement among administrative and professional personnel alike, a number of hazards for the patient were created and several departments of the hospital were put in jeopardy for State and national approval.

The hospital was running the unfortunate downhill course which many such city hospitals have pursued. While there was an awareness of the financial difficulties with which the city was struggling, one could not approve the philosophy of operating at a substandard level a municipal service whose responsibility is the lives and health of thousands of its citizens. In addition to its financial woes, the complexities of operating a hospital, a very highly scientific program, as one of 16 departments was beyond the city's capacity.

Conditions had, in 1961, reached a catastrophic climax. A new and imaginative modus operandi had to be found. It came in the form of a suggestion made by one of our leading citizens. He proposed that a nonprofit, voluntary corporation be formed to operate the municipal hospital system under contract with the city. The general purposes to be served were first to find ways to stabilize the hospital operations; to assume qualitatively high quality of care to patients; to utilize clinical material available for training at all levels; and to assure maximum efficiency in the performance of these functions.

In 1962, following this concept, the general hospital and medical center was incorporated under the not-for-profit laws of the State of Missouri. On May 18, 1962, a contract was made and executed between this corporation and the city for the operation of the city's hospitals. Among other provisions was the freedom of this private corporation to enter into affiliate arrangements with various hospitals in the Greater Kansas City area for the purpose of extending resident and intern training in part to those hospitals which agreed to provide adequate supervision for postgraduate training. It is worthy to note

that the entire voluntary system of this area was in serious trouble for lack of an adequate supply of a house staff to assure proper levels of services to patients.

One of the first actions of the new corporation was to affiliate with the School of Medicine of the University of Missouri for postgraduate training in medicine.

Some money had to be found at once, apart from city revenues, to create the necessary arrangements with the University of Missouri and to develop as promptly as possible teaching and research pro

grams.

As evidence of public awareness and support for that concept, private funds were obtained for a full-time medical staff. As a direct result of this support, provision of adequate space, and an opportunity to innovate and a dream for a new medical future, the hospital has attracted many doctors from great institutions around the country.

Thus the groundwork was laid for a complete health center. Let me now present in chronological order the following developments: In 1962, the Kansas City urban renewal program approved the Hospital Hill development which includes approximately 135 acres. In 1963, Children's Mercy Hosital decided to locate its new building on Hospital Hill. Children's Mercy Hospital is joined to the medical center in a tripartite contract between Kansas City General Hospital and Medical Center Corp. and the board of curators of the University of Missouri.

In 1964 the dental school of the University of Missouri at Kansas City was planned on Hospital Hill and is now completed and occupied.

In 1966, the Western Missouri Mental Health Center opened on Hospital Hill. It and the psychiatric receiving center, now a part of the State program, provide major programs to help patients. In 1967, the voters of Jackson County approved bonds for a new teaching hospital on Hospital Hill by a 4 to 1 majority. Approximately $13 million are available for this project.

In March of 1968, the Brothers of Mercy joined the medical center complex and are presently building an extended care facility on the hill.

In June of 1969, the University of Missouri Board of Curators passed a resolution establishing a medical school in Kansas City.

In June of this year, 1970, the Missouri State Legislature provided construction funds for a State matching grant, and the Governor signed this bill in July.

In August of 1970, the Federal grant of $8.8 million was awarded for the medical school.

In the spring of 1970, the division of physician manpower notified the Jackson County Court that the application for Federal construction assistance to replace the existing general hospital was approved in the amount of $9.9 million. As of this date, a grant award has not been made.

The Kansas City Medical Center complex, as evident, represents a major resource of medical health care in Kansas City.

The potential exists now for the development of one of the finest health care, educational, and research centers in the Midwest.

I should note here that the General Hospital Corp. experiment suggests one workable way to blend the sort of viable mix which is indicated if we are to maximize personal health service programs within the limits of jurisdiction and tradition. Conceivably, the general hospital model has some transfer value for dealing with problems in other areas of the United States.

Senator, I might add that since you are going to New York you might be interested in knowing that in the city of New York they have adopted a modified version of our plan after having visited with us and asking our people to visit with them in New York.

Thank you.

Senator EAGLETON. Thank you, Mr. Stark.

I think we will hear the presentations of all the witnesses and then question the group, with anyone fielding the question who thinks he is the most informed in that area.

Mr. Wadsworth.

STATEMENT OF HOMER C. WADSWORTH, PRESIDENT, KANSAS CITY ASSOCIATION OF TRUSTEES AND FOUNDATIONS

Mr. WADSWORTH. Far be it from me in the presence of a good friend and distinguished Senator from St. Louis to suggest that everything is up to date here. You know better, Tom.

What I think can be suggested is that what is going on here has lively prospects, as we will attempt to indicate, and may have implications far beyond the particular circumstances in the Kansas City region today.

It will be quite apparent as we proceed that a determined effort is being made here in Kansas City by a great many people, and in all sorts of related ways, to create a new and improved system for providing medical care. It is the purpose of my remarks to suggest the main purposes that together we seek to serve, the kind of problems that we have encountered to this date, and the major obstacles that we have yet to master as we move forward with this program.

Our fundamental aim is to develop the means by which to provide comprehensive medical services to all of our people on the most efficient, humane, and economical basis possible. We include in the range of such services those activities designed to prevent and control disease and disability. What we seek for is the capability of delivering the right amount of service at the right place and at the most appropriate

time.

A plan of medical service must proceed from some sort of base of operations. This is why the Kansas City General Hospital and the recently authorized new medical school of the University of MissouriKansas City are the keystones of our plan and program.

I might indicate that when I refer here, for purposes of shorthand, to General, I am talking about the complex of facilities that are here located and the people involved, the dental school, the substantial complex of psychiatric facilities, with which you are very familiar, that are on this hill, the Brothers of Mercy facility, the medical school in general itself, and Children's Mercy Hospital, which is one of the leading children's institutions in the country today.

Good medical care is now rendered by excellent practitioners at many hospitals and clinics and private offices in the Kansas City area. We wish to use the available physical plant of the community and the distinguished array of trained manpower now serving our local institutions. Thus we have created a plan for medical education that is based on the full use of our major facilities in Kansas City and the medical and dental and nursing manpower associated with these agencies. We wish to keep those in practice abreast of the constantly expanding body of knowledge and technique in science and medicine.

Thus the plan and program contemplated for the academy of the health professions. The development of the base hospital and the related teaching and research activities requires land acquisition and planning for proper development, and the marshaling of significant funding to make it all possible. Thus the health resources institute, an agency that will function as well in providing the kinds of technical assistance necessary to work out good cooperative endeavors between the hospital hill complex and the many other service agencies in this community.

I believe that you will find common threads that bind together the effort that is being made here. What is suggested that is new is built upon that which now exists here and takes advantage of the wealth of talent and experience that has made possible a good medical community. The principle of cooperation has been given a practical twist in that the people and agencies joined together in common purpose have discovered that each have something important to give to the others involved. The emergence of the concept of a community system for training residents in various medical specialties, as distinguished from the prevailing pattern of institutional competition for people in short supply, may be viewed as a conspicuous example of this.

Since we do not have a large pool of money from which to draw subsidy for that which we need to do, we have learned to make do with bits and pieces of money drawn from various sources and with enormous contributions of time by doctors and other professional people interested in this program. It is of more than passing interest that almost all of the expense involved in putting together the team of people responsible for planning the effort has been underwritten by private persons and agencies and the medical staff fund of General Hospital. Never has so much been done by so many, using so few dollars.

Each of the matters that I have touched lightly involve extensive thought and action, and the interrelated work of many people. The leadership mobilized to carry these tasks are here today, for the most part, and will give you sufficient detail on their activities to afford a deep as well as broad picture of this development. All that I can add is that any presentation is a bit like taking a photo of a horserace, The parties are moving with all dispatch, and the picture of events changes now almost daily.

Special significance attaches to the determined efforts being made to extend the best of medical services and training activities related thereto into the poor sections of our community, and on a basis that welcomes in the doing full involvement of the people to be served. The same can be said for our current levels of thought regarding the

training of doctors and others in related fields. We are aware of our responsibility to open up fresh opportunities for young men and women from minority groups, so much so, that we hope to attract something like 10 percent to 20 percent of each medical school class from these groups.

The experience of the past 8 years or so in building this program suggests some observations that may be of value to the Congress at this time. Our local and State agencies of Government, including our educational institutions, are desperately strapped for money to maintain the level of their current efforts. The city is spending about $1 million less at General Hospital than it would like to spend and that is needed to provide minimal services of good quality. The city simply doesn't have the money, and it has many other demands for the few dollars it does have.

The University of Missouri has not provided any operating budget for this program to date, not because it is opposed to doing so, but simply because its total resources are far below current requirements. The simple fact is that something new and important at local and regional levels cannot be mounted here or elsewhere with any assurance that existing tax sources will supply the funds required for good levels of operation.

It is of importance, in my judgment, to point out that the Federal effort in medical care and medical education and research is a many faceted and fragmented one, fully useable only as local people have the wit and patience to shape it to our special needs. Clearly, the gaps are enormous, just as the time and effort required to make existing programs work is considerable. The evidence that we have seen to date suggests the merit of large-scale experimentation in major efforts of this kind, perhaps on a basis that gives to a local party capable of welding into cooperative activity the many and varied kinds of agencies involved. It is my opinion that experimental models are needed in many places to explore various ways of improving medical care delivery and training additional medical manpower in the process, of which the Kansas City effort may be regarded as simply one of importance and of promise.

We have no question about the future course of our program here. The momentum necessary has been created. The quality of leadership is exceptional. The level of enthusiasm, the give-and-take of the parties involved is very high. The generative force of the new ideas at work-in educational matters as well as in the articulation of the parts of the service programs-is plainly evident. The resources needed to work with are in good prospect if not in hand, although something of an act of faith is needed to reach such a conclusion at this time. It is full steam ahead for the Kansas City program, as I see it, and a great tribute to Dr. Dimond, Dr. Noback, and Dr. Smull, and others of their many colleagues who have been associated with them in this development.

Thank you.

Senator EAGLETON. Thank you, Mr. Wadsworth.
Dr. Smull.