Mr. ROSEN. Madam Chairman and members of the committee, in the first chart which has been prepared, the history of the hospital patient load of the Veterans' Administration is traced from a time shortly after Public Law 90 was passed on October 6, 1917, which first authorized Federal hospital care for veterans with serviceconnected disabilities. From that time until 1921 hospitalization of veterans was primarily provided in facilities operated by the United States Public Health Service, and in hospitals of local communities and States, such hospitalization being provided under contract with the Veterans' Administration. In 1922 Public Law 194, approved April 20, 1922, was passed, which for the first time established a Federal policy for the hospitalization of certain veterans for the care of disabilities which were not of themselves directly related to service. That law provided for hospitalization of veterans of the Spanish-American War, Philippine Insurrection, and Boxer Rebellion for non-service-connected neuropsychiatric or tubercular ailments. This provision was restated in Public Law 542 in 1923, plus authority for transportation. The CHAIRMAN. Will you give the date of that law? Mr. ROSEN. March 4, 1923, Public Law 542. On June 7, 1924, Public Law 242, known as the World War Veterans' Act, was passed. It provided hospitalization to veterans of all wars, occupations, and expeditions since 1897, regardless of disability or service connection. At that time there was an increase in the patient load, which prior to the passage of the law was approximately 25,000 patients, to slightly over 30,000. In 1930 the Veterans' Administration as currently organized was first set up by Public Law 536 of July 3, 1930. That act incorporated in the Veterans' Administration the National Homes for disabled veterans, and the increase in patient load following the passage of that act is attributable to the patient load in hospitals associated with these homes. Public Law 2, the so-called Economy Act, of March 20, 1933, restricted hospitalization to veterans with service-connected disabilities or with TB, NP, and permanent disabilities when they had no adequate means of support. The patient load declined, primarily in nonVA hospitals, as the result of this law. In Public Law 141 of March 28, 1934, the same Congress restored the status of eligibles which Public Law 2 had eliminated, and from that time the trend of the patient load was upward until World War II. During the course of World War II there was some decline in the patient load associated with limited possibilities of staffing hospitals, and other factors. Following World War II there was a rapid increase in the patient load, as shown here. During the month of January last, the average patient load in VA hospitals was in excess of 98,000. It is possible also to trace the patient load in terms of the diagnostic composition of the patient load. You may see a line here indicating that the volume of care provided for patients with mental illnesses has definitely increased from the beginning of the hospital program, and that such patients are the largest single component of patients in VA and non-VA hospitals, those with tubercular ailments being the smallest.. 30158-53- -2 Another program of the Veterans' Administration, that of the provision of domiciliary care, is indicated here [chart 2], but for a shorter period, only since 1945. At the present time the total authorized capacity of beds in domiciliaries is 18,147, with less than 17,000 beneficiaries occupying beds in 17 different domiciliaries. Mr. FRELINGHUYSEN. These charts you gave us, are any of them the same as those you are talking about? Mr. ROSEN. Only the first chart I described is not included in the copies you have. Admiral BOONE. Can you indicate them by numbers? Mr. ROSEN. Not by numbers. This chart is an attempt to describe rather briefly one of the other medical care programs of the Veterans' Administration [chart 3]. It is the outpatient dental care program set up under authority of Public Law 2 in 1933. Today, and for sometime past following the tremendous rate of applications immediately after World War II, the Veterans' Administration has been receiving from 50,000 to 60,000 or 64,000 applications every month from veterans requesting dental treatment. During January the number was 60,000, and since the end of the calendar year is usually associated with a low point in the receipt of dental treatment applications, it is expected that the number per month will increase for the remainder of the year. This chart indicates the recent experience of the Department of Medicine and Surgery in the outpatient medical care program [chart 4]. The bottom line, labeled "Fee," is that part usually described as the hometown medical care program. It represents that part of the outpatient medical care provided for service-connected disabilities which is obtained by veterans from physicians in local home communities. An additional description of the hospital program of the Veterans' Administration would be incomplete without some attention being paid to the number of eligible veteran applicants for hospitalization who have not yet been scheduled for admission [chart 5]. As has been done with other charts, this covers the period only since the end of World War II, and I think it is of some interest to note that since that time the so-called waiting list for mental patients has gone from about 2,500 to a point today where it comes slightly over 13,000 out of a total of 21,496. The CHAIRMAN. Service-connected cases? Mr. ROSEN. No; the total. Contrarywise, the number of G. M. and S. patients has declined from a high of about 27,000 to a point where in January it was of the order of 6,000. Mr. TEAGUE. Is that the total of all veterans who applied? Mr. TEAGUE. They are on a waiting list? Mr. ROSEN. Yes. Mr. TEAGUE. You have 15,000 waiting for admission? Mr. ROSEN. No, 21,000 plus. Mr. TEAGUE. Including service-connected and non-service-connected both? Admiral BOONE. May I interject there? Just a week or two ago we had only 70 service-connected cases of all categories waiting for admission. We make it a point to take care of all service-connected cases immediately. The reason for the 70 is, that when an applicant is told he can be admitted, he does not elect to go in immediately. Mr. TEAGUE. If you have two cases, one you would call an emergency not service connected, and one not determined to be an emergency but service connected, which would go in first? Admiral BOONE. The emergency case. We must always have beds for service connected, because it it is the primary requirement of law. Mr. TEAGUE. But the truth is, non-service-connected can go in ahead of service connected if it is an emergency? Admiral BOONE. That is humane. Mr. TEAGUE. I do not know how humane it is, but some reports I get Admiral BOONE. Suppose there is an accident in the streets in front of Mount Alto and a veteran is picked up from a motorcycle. Service connected or non-service-connected, he would be taken in. Mr. TEAGUE. That is the extreme, but how about borderline cases? Admiral BOONE. Precedence would be given to the service connected. Mr. TEAGUE. Is not that the reason why we keep getting reports that service-connected veterans cannot get into hospitals, due to the determination of what is an emergency? Admiral BOONE. Well it is up to the hospital admission officer to determine what is an emergency. Mr. TEAGUE. That is why service-connected cases cannot get into the hospitals. Take Dallas, Tex.; a city that size is always having emergencies. Admiral BOONE. I think when you consider only 70 service-connected cases throughout the Nation are waiting for admission, with a patient load of approximately 98,000, it is negligible, and it is only for short periods, hours or a day or two. We make every effort to take service-connected immediately. Mr. PROUTY. Madam Chairman. The CHAIRMAN. Mr. Prouty. Mr. PROUTY. You say there are only 70 service-connected throughout the country waiting for hospitalization? Admiral BoONE. Yes. Mr. PROUTY. How many nonservice connected? Admiral BOONE. The last figure was 21,000 plus. Mr. PROUTY. And actually in hospitals at the present time, what percentage are nonservice connected, and what percentage are service connected? Admiral BOONE. In VA and non-VA hospitals, 35.6 percent are service connected, and 64.4 percent nonservice connected. To break that down into three categories: TB: 40.9 percent are service connected and 59.1 percent nonservice connected. NP: 48 percent are service connected and 52 percent nonservice connected. G. M. and S.: 11.6 percent are service connected and 88.4 are nonservice connected. The CHAIRMAN. Is it not true that many cases of service connected waiting for hospitalization are cases that must be worked out? For example, many mental cases have not wanted to admit they were not quite right. |