SPECIAL ACTION OFFICE FOR DRUG ABUSE

PREVENTION

WEDNESDAY, OCTOBER 27, 1971

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D.C.

The subcommittee met at 10 a.m., pursuant to notice in room 2322, Rayburn House Office Building, Hon. Paul G. Rogers (chairman) presiding.

Mr. ROGERS. The subcommittee will come to order. We are continuing hearings on legislation to establish a Special Action Office for Drug Abuse Prevention, and we are also looking into the closing of the Fort Worth Clinical Center.

We have as our first witness today Dr. Jerome Jaffe, Special Consultant to the President for Narcotics and Dangerous Drugs.

We welcome you again to the committee, Dr. Jaffe.

As I understand it you are not going to make a statement but simply be available for questioning.

STATEMENT OF DR. JEROME H. JAFFE, SPECIAL CONSULTANT TO THE PRESIDENT FOR NARCOTICS AND DANGEROUS DRUGS, EXECUTIVE OFFICE OF THE PRESIDENT; ACCOMPANIED BY PAUL L. PERITO, GENERAL COUNSEL AND ASSISTANT DIRECTOR

Dr. JAFFE. I can make a brief comment.

As I understand it, Mr. Chairman, the primary focus of this hearing is to discuss the Fort Worth Clinical Center and the decision to transfer that to operate as a center under the Bureau of Prisons for the rehabilitation of individuals who are Federal prisoners who are also drug addicts.

That decision was made prior to my becoming a member of the Federal Government but I think, in all candor, I should tell you that I chaired a committee of nongovernmental experts who were familiar with the field of drug addiction sometime last November. One of the issues we took up was the role of Lexington and Fort Worth. It was the unanimous feeling of that committee that, given the progress made in the field of rehabilitation of drug addiction, the continued operation of a large center such as Fort Worth, where people were away from their communities for prolonged periods and then sent back with no linkage, was no longer justifiable but that kind of rehabilitation is best accomplished in the community for people who have not otherwise been convicted of crimes.

So, I can say, although I did not participate in the decision to transfer Forth Worth, had I been in the Federal Government, I would probably have participated heartily and endorsed it if not initiated it. Mr. ROGERS. Thank you.

According to the letter signed by the Attorney General and Secretary of HEW, you approved the closing of Fort Worth.

Dr. JAFFE. I never approved any closing. We approved a transfer of that facility which will continue to operate in the same physical plant, and which will have a major focus on working with prisoner addicts. If it is being closed, that is news to me. It is my understanding it continues to operate.

Mr. ROGERS. But closed to clinical research as had previously been done and to take care of the public, NARA people.

Dr. JAFFE. As I understood it, the demand for space for civil commitment had fallen off appreciably. There was sufficient capacity at Lexington and, furthermore, the facility had been closed to the public in terms of voluntary patients since 1966. It had been available only as a civil commitment facility and, with respect to clinical research, that was largely a euphemism. In fact, no research I know of has ever emanated from that facility.

One cannot conduct research on people who are civilly committed unless one spends years building up that kind of imminent staff to make the research worthwhile.

Mr. ROGERS. That is not the testimony we received at Forth Worth when we visited there. Have you ever visited the facility?

Dr. JAFFE. I have seen the facility. I have never been within it, per se. I am familiar with Lexington and the layout is similar.

Mr. ROGERS. But you have never been in the Fort Worth facility? Dr. JAFFE. That is correct.

Mr. ROGERS. Because the testimony was that they have done research there. Particularly the psychiatrist, I believe, who was from Forth Worth or Dallas went into that in some detail.

Dr. JAFFE. As I said, I have looked for the reports of their research and the literature. They have not appeared. I have not seen any evidence of that research.

Mr. ROGERS. What is the inpatient capacity presently of our facilities that are federally run for the NARA program?

Dr. JAFFE. If you ask for the NARA program, I cannot give you a specific figure. It is continously changing as people write new contracts. I can say that we do not know, in all honesty, the total Federal capacity for inpatients in the entire United States, let alone NARA. Our first step, when we were created, was to modify a contract which was designed to conduct a survey of the 6,000 known treatment programs in the United States so that it would at least give us some estimate of the capacity for inpatients, for residential care and for outpatients. This had not been part of the original contract. That contract was finally signed several weeks ago in its modified form and, hopefully, within several months we can report to you on what our inpatient capacity in this country is.

Mr. ROGERS. HEW testified yesterday that they had 100 slots where they could treat people. In other words, they could treat 1,000 people with inpatient care.

Dr. JAFFE. 1,000 slots?

Mr. ROGERS. 1,000; not beds but that they could take care of that many people during the year.

Dr. JAFFE. That sounds a little bit on the low side.

Mr. Chairman, I have no specific figures but in my travels I am aware that our residential capacity in this country is really that of many thousands of available slots. How many people you can treat in a year is a function of how long you elect to keep them in residential status. If you keep them 1 month you can turn over 12 times and treat 12,000 people. If you elect to keep them 6 months you can treat 2,000. These are somewhat arbitrary figures.

Mr. ROGERS. This is what they provided for, as I understand it, 1,000. Take New Orleans, we want to be specific. They have 15 beds for inpatient treatment. They have an addict population estimated to be 6,000. Now, is that a sufficient inpatient treatment?

Dr. JAFFE. Are you referring specifically to civilly committed people or voluntary patients?

Mr. ROGERS. Both.

Dr. JAFFE. It is important to make a distinction.

Mr. ROGERS. Why? Don't they both have to have inpatient treatment?

Dr. JAFFE. No; not necessarily. I do not know where the 15 figure comes from.

Mr. ROGERS. It comes from the Tulane Hospital facility.

Dr. JAFFE. This is the same for both voluntary and civil commitment?

Mr. ROGERS. It is the only inpatient treatment center.

Dr. JAFFE. If we had had those figures, we would have suggested to the various funding agencies that residential capacity be expanded in that area.

I think, as you know, we have been working on a reasonable formula. Speaking with people around the country we have tried to determine what ratio of residential beds one needs to handle a particular subgroup of patients. In general, it is between 10 and 18 percent residential capacity at any given time, which would mean if they had several thousand people in treatment at a given time, they may need more than 100 or 200 beds.

Mr. ROGERS. This is my concern.

Dr. JAFFE. It is my concern, too, sir.

Mr. ROGERS. That you close Fort Worth when there are no beds available in New Orleans.

Dr. JAFFE. There is no waiting list for Forth Worth. The waiting list is in New Orleans.

Mr. ROGERS. Do you know why there is no waiting list in Fort Worth?

Dr. JAFFE. Because it is obliged to take people only under civil commitment.

Mr. ROGERS. More than that. Do you know why?

This is a letter written by HEW telling the judges not to send people to Fort Worth. Surely you are aware of that?

Dr. JAFFE. That was not the case in 1967 and 1968.

Mr. ROGERS. They did it in 1967, too, when they were trying to close it out. Now they sent them out again. They released those who were civilly committed at Fort Worth on the 8th of October and they sent

a letter to the district attorney in New Orleans that day and he gets the letter on the 12th without any opportunity for him to make any judgment or decision.

All of them were released on the 8th. I presume you did not necessarily approve that procedure?

Dr. JAFFE. No, sir; I was not aware of the decision or the details or how they had planned to make the transfer from HEW to the Bureau of Prisons.

Mr. ROGERS. That was pretty amazing that all of a sudden they decided they can all be released at once.

Dr. JAFFE. Not amazing but

Mr. ROGERS. Unusual.

Did your office do any checking as to those people as to their

Dr. JAFFE. My office does not have sufficient authority to check on anything. As you know, we have no legislative authority and it is extremely difficult for us to recruit the staff we originally projected. Now we can participate in making policy. We have no way of finding out if that policy is being adhered to or even whether the details are followed up. We have to rely on whatever information comes back to

us.

Mr. ROGERS. How large an office do you anticipate having if the legislation is passed?

Dr. JAFFE. Sixty professionals and 60 support people.

Mr. ROGERS. 120 people.

Dr. JAFFE. That was the original projection.

Mr. ROGERS. You presently have what?

Dr. JAFFE. Somewhere around 60 but many of those are detailees who, in fact, are not fully trained. They are there to help us answer inquiries and letters. The professionals we have that can be considered sufficiently trained and experienced to participate in these policy decisions in a meaningful way number only about 30 people. So we really cannot accept responsibility for appropriate implementation of any rational policy that we have been able to make.

Mr. ROGERS. Even though you are the Special Assistant to the President?

Dr. JAFFE. A Special Assistant to the President can only participate in policymaking.

Mr. ROGERS. You can give some pretty strong directives, can't you? Dr. JAFFE. In general. I don't think one should give a directive that you cannot back up or follow up.

Mr. ROGERS. You are speaking for the President. Are you saying now you would not have sufficient authority, being in the White House? Dr. JAFFE. I think policymaking is always something that is a gray area between policy and operations. We have preferred in some instances to wait to see the intent of Congress, to see where they wil draw the lines between policy and operations and what that authority

is.

Mr. ROGERS. What did the President give you as your charge when he made you Special Assistant? It was an office it was not necessary to have legislation for.

Dr. JAFFE. He specifically gave us the responsibility of formulating and developing policy which, as I understand, is as far as we can go. Mr. ROGERS. I presume that policy once made is enforced by the Office of Management and Budget; isn't it?

Dr. JAFFE. I was not aware that the Office of Management and Budget was an enforcement agency.

Mr. ROGERS. Then you have a lot to learn. I would say it is the most effective enforcement agency the President has.

Dr. JAFFE. It can do certain things.

Mr. ROGERS. You even have to clear statements with the Office of Management and Budget before you come to Congress.

Dr. JAFFE. That is one of the policies.

Mr. ROGERS. That is the way they enforce it. Surely you know that.

Dr. JAFFE. I was aware of that, sir.

The fact is there is not sufficient staff to monitor the details of the transfer of a facility from one agency to another. Those operational kinds of activities and that particular operation proceeded between HEW and the Bureau of Prisons. Many of the things that you are telling me perhaps would have found their way to me in due course, but are now being brought to my attention for the first time.

Mr. ROGERS. Well, I realize that and hope you can check into this. For instance, we had information that these people that have been released just automatically on that night, when the Senate and House did not agree, they went ahead with the transfer, not taking proper steps to let people know in the communities. Coming back, New Orleans is a good example. As a result these people were just thrown out. The evidence is that about one-third have already turned back to drugs immediately and one guy is even pushing in New Orleans.

Dr. JAFFE. I would like to comment on that in general. This kind of general behavior indicates the difficulty in bridging the gap between a man's home community and a hospital that may be several hundred miles away. It has been a problem which has been recognized by people in the field for many years. Even if an individual received letters, phone calls, personal visits, it does not necessarily guarantee that you can take him from Fort Worth and have him feel part of another organization back in his hometown.

This was part of the consideration that caused them to say this model could not work with efficacy. These relapses can be expected under optimal conditions. There is the tendency of people with this particular problem, when they return to the community, not to seek help, not to feel part of it.

We can use the military analogy in the sense that at one time Fort Worth and Lexington were the battleships of our attack on this problem but, like battleships in general, they have served their time. There are better approaches, more effective, more modern, perhaps with more impact, and I do not think that it is any more reasonable to expect HEW to keep operating a battleship than to ask the Navy. There are perhaps some that would like to continue operating battleships. Most people feel they in fact belong in mothballs. I think in this particular situation, most people who worked in the field felt this large hospital based on civil commitment, hundreds of miles from most people's homes with no real linkage does not tend to produce the kinds of results that we could expect from facilities in the community where people have a feeling, where they have already a job, hopefully, that they have been helped to get by the people working with them while they are still in residential care.

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