semiprivate, or others. The per diem figure is calculated based on total cost of all types of hospitalization.

Mrs. GRIFFITHS. Let me ask you again. What would it cost me to have a private room in the Springfield Baptist Hospital?

to

Dr. HALL. What would it cost you?

Mrs. GRIFFITHS. Yes. Are you going to base it on my income? Dr. HALL. No, I am going to base it on asking you whether you want go first class.

Mrs. GRIFFITHS. I want to go first class. What is the cost?

Dr. HALL. I would say up to $35 a day perhaps. But this would not be the per diem figure.

Mrs. GRIFFITHS. What would you say the cost for a private room is in St. Vincent's Hospital in Monett?

Dr. HALL. With the additional help that they get from the Sisters of Vincentia that run that and, of course, charge nothing for their fees, I would say their per diem is less than the cost of a private room, would probably be roughly the same, especially since they have built their new addition there in the last 2 years.

Mrs. GRIFFITHS. How many of the hospitals in your district received Hill-Burton funds?

Dr. HALL. I do not know the answer to that question. Some of our hospitals have refused Hill-Burton aid.

Mrs. GRIFFITHS. The Baptist Hospital refused Hill-Burton funds? Dr. HALL. That is right. On the other hand, if I may continue, there is the largest single grant hospital in the world of Hill-Burton aid in Springfield, Mo.

Mrs. GRIFFITHS. Was that how Brandon Hospital was built?

Dr. HALL. No, ma'am; it was given by Mr. Skaggs, of the Safeway Stores.

Mrs. GRIFFITHS. But there are other hospitals built with HillBurton funds?

Dr. HALL. Yes; but some of them have had additions.

Mrs. GRIFFITHS. This was not socialism?

Dr. HALL. I think so; in part, yes.

Mrs. GRIFFITHS. Now, I would like to ask you, if you know, do you have a standard fee per patient or do you check as to the income of the patient?

Dr. HALL. Are you talking about doctors' professional care?
Mrs. GRIFFITHS. The doctors in your district.

Dr. HALL. When I practiced medicine in my district, I subscribed to the Blue Shield of Missouri, which has a fee schedule and perform services roughly on that schedule.

I operated a 23-man clinic, all certified specialists in their own right, with some 78 employees, treating, of course, only outpatient employees in the organization and we had standard fees. We do not have a sliding scale based on income, as you indicated a while ago.

Mrs. GRIFFITHS. How many hospitals do you have in your district that perform that heart operation that removes part of the main artery running into the heart and replacing it with a plastic tube?

Dr. HALL. When I left there was only one, Mrs. Griffiths.

Mrs. GRIFFITHS. How many hospitals do you have in your district that have that nuclear device that you run over the throat and the thyroid?

Dr. HALL. I think all our major hospitals have that. In addition, my client, for example, was checked out through the Atomic Energy Commission. We had three different doctors on our staff that used the various isotopes from the Atomic Energy Commission. Hospitalization is not required for that.

Mrs. GRIFFITHS. What is the average load per doctor in your district; patient load?

Dr. HALL. I do not know. I had over 2,700 patients on my active list when I left, because I wrote every one a letter.

Mrs. GRIFFITHS. I would like to point out that my mother, as you are aware, died of a coronary 3 months after she had a major attack. She waited 4 hours in a doctor's office in your district for treatment. Dr. HALL. That is regrettable.

Mrs. GRIFFITHS. So that, the point I want to make to you is that, while maybe they do not come in your district to free hospitals, one of the answers is that they just die. That is one of the answers to it. Let me ask you another question that seems far afield.

When was it first known in this country that typhoid was carried by water?

Dr. HALL. I have forgotten the exact date. I believe it was in the late 1890's.

Mrs. GRIFFITHS. Are you aware in your district in the city of Kirksville, people were still dying like flies with typhoid in 1926?

Dr. HALL. I am aware, Mrs. Griffiths, that they died in 1936, the first year of my practice in Springfield, Mo., from a contaminated water supply.

Mrs. GRIFFITHS. So, in reality, there is not too much medical aid available to these people. They get ill and die.

Dr. HALL. I do not think I could accept that postulate at all because you just brought out that my own clinic and my own foundation established the first cardiac thoracic laboratory south of the Missouri River.

We have the only heart-lung bypass machine in which we can possibly do the very thing that might have saved your mother from that regrettable situation in which she found herself and for which I have full sympathy with you.

On the other hand, some people do not elect to go to a hospital even if it is next door to them.

I think it is our prerogative to die if we want to rather than to be invalided or prolong our situation in this free country.

Mrs. GRIFFITHS. One of the points I want to make quite clear is that one of the reasons, for instance, in this whole area of the country, that you do not have requests for hospitalization is because there is no diagnostician that is telling them to go to a hospital. They do not advise them in the proper way.

Now I would like to ask you, how many patients do you know of from any doctor in Springfield that have ever been referred to a doctor in St. Louis or Kansas City or the Mayo's who have better equipment and better training and are better able to handle a case?

Dr. HALL. I have referred thousands of them.

Mrs. GRIFFITHS. You have?

Dr. HALL. Yes. I am sure that most of the doctors in those up and coming and dynamic medical societies down there do exactly the same thing, but I have no way of knowing the number of references.

We all use the great Barnes Hospital and the Washington University Clinics, St. Louis University Clinics, now the new University of Missouri Hospital and Clinics and consulting service, Mayo Clinics, Kansas City Medical Center. This is commonly accepted and good practice.

So far as the other comment is concerned, I think the Congresswoman is exactly correct that it is probably one of the few Elizabethan areas of the United States that remains. Much of the country from which she and I both come is remote. It is just remote enough that some of the people down there would resent a dietitian telling them. how to mix their corn wheat cakes and blackstrap molasses even if she were available at all times for this purpose.

Mrs. GRIFFITHS. I want to point out that one of my ancestors who was buried in that area has a nameplate on his grave indicating he was born in 1790. Those people had been there a long time.

One of the real problems in the whole area is that it does not have proper diagnoses, there are not enough medical doctors, there are not enough qualified people, there are not enough hospital beds, there are not enough nursing homes.

They all lived a long time and some of them, I am sure, will have to be shot on Judgment Day. I look forward to the fact that I am going to be chairman of this committee one day because I will outlive all these people who precede me. I still would like to say, however, that one of the main problems in that area with respect to hospitalization is that the people are simply not aware; nobody has ever told them.

There is a vast difference in various areas of the United States in the kind of care you are going to get.

Now, my grandmother was one of those people who were referred to Barnes. She is the only person who ever went. The kind of care that you are going to get in a big city hospital when a patient is finally referred there is going to be very costly. The average income in that community will not support it.

One of the reasons that referral is feasible at all is because many of those homes in which the people are living came to them immediately after the Revolutionary War.

So, although they did not know how to keep from dying from typhoid, they did keep the house in the family, but they will have to give that up when they go to Barnes or Mills.

Dr. HALL. May I insert there that perhaps they developed an immunity that made them such long livers.

Mrs. GRIFFITHS. They did not have the tension that the rest of the people have.

But I think it is a real error to assume that in this country everybody is getting the same kind of medical and hospital care and that it is generally available and that many of the people who never seek a hospital do not seek it because they are not sick. They are sick but they do not have the money, and you know and I know those people are proud. They are not about to take charity. You have a rough time pushing it off on them. They can remember generations back. So that, in reality, if this bill were paid ahead of time, a lot of those people would be saved.

Frankly, I think they are pretty fine people.

Dr. HALL. I think it would be difficult to legislate it for them if you cannot inform them and make them take it. Certainly in this modern day of regimentation and mobilization for three wars in the last decade and communication devices and our fine new highways and byways that we have all through there, it would be mighty pitiful if someone did not know, did not want to take advantage of modern care because it is more quickly available for them now than it used to be when our ancestors, of whom we are mutually proud, could hitch up the wagon and go a very short distance to the next town to get the care they needed. There is no question about this.

Mrs. GRIFFITHS. I agree, it would be available if they knew to go and if they could get in the doctor's office to be diagnosed when they got there.

I would be really interested in knowing exactly how many medical doctors there are in your district and how many osteopaths as well as how many hospital beds there are available and how much nursing home care.

Dr. HALL. Those figures should be easily available.

Mrs. GRIFFITHS. Thank you very much.

(The information referred to follows:)

I. Total nursing homes in Missouri, 437.

(a) Two hundred and ninety-six of these nursing homes were licensed as of December 1, 1963.

(b) Sixty-nine of the total were from 30 to 120 days overdue for a license. (c) Seventy-two of the total are out of compliance involving major deficits.

II. Ratio of registered nurses to number of patients:

(a) Domiciliary homes: No registered nurse is required.

(b) Practical nursing home: In the event a licensed practical nurse is in charge of patient care and on the 7 a.m. to 3 p.m. shift, a registered professional nurse is required, on a part-time basis. Minimum of 4 hours weekly. This nurse is responsible for an inservice training program and the quality of patient care. In some instances, a registered professional nurse replaces the licensed practical nurse on the 7 a.m. to 3 p.m. shift. Staff ratio in a practical nursing home is as follows: 7 a.m. to 3 p.m.: licensed practical nurse or registered nurse; 3 p.m. to 11 p.m.: qualified aid; 11 p.m. to 7 a.m. : qualified aid.

Personnel requirements are: 1 for 10: 7 a.m. to 3 p.m.; 1 for 15:3 p.m. to 11 p.m.; 1 for 15: 11 p.m. to 7 a.m.

On the 7 a.m. to 3 p.m. shift, one registered nurse or licensed practical nurse is required, all others can be qualified aids.

(c) Professional nursing home: A registered professional nurse in charge of patient care on the 7 a.m. to 3 p.m. and on call 24 hours daily-3 p.m. to 11 p.m. a registered inurse or licensed practical nurse in charge of patient care 11 p.m. to 7 p.m. a registered nurse or licensed practical nurse in charge of patient care.

Personnel requirements in a professional nursing home: 1 for 10: one registered nurse, 7 a.m. to 3 p.m.; 1 for 15: one registered nurse or one licensed practical nurse, 3 p.m. to 11 p.m.; 1 for 20: one registered nurse or one licensed practical nurse, 11 p.m. to 7 a.m.

III. There are no requirements for a registered dietitian in the nursing homes. A dietary consultant is available from the Division of Health.

IV. There are 39 approved nursing homes in the Seventh Congressional District.
V. There are 2,053 hospital beds in the Seventh Congressional District.
VI. There are 21 hospitals in the Seventh Congressional District.

VII. Eleven hospitals in the Seventh Congressional District have received Hill-Burton funds.

VIII. The average patient-load-per-doctor in the Seventh Congressional District is 1,015 patients.

IX. There are 307 doctors of medicine and 123 doctors of osteopathy-a total of 430 in the Seventh Congressional District.

The CHAIRMAN. Mr. Derounian?

Mr. DEROUNIAN. Dr. Hall, your testimony has been a wonderful revelation to us on the inside workings of patients in your district. Since Mrs. Griffiths has asked you quite thoroughly about nurses and doctors and nursing homes, in your opinion if H.R. 3920 were to be passed, would it correct the deficiencies that Mrs. Griffiths charges is in your district medical care?

Dr. HALL. First of all, let me point out, as I wanted to, to Congresswoman Griffiths, that I was testifying for the entire State of Missouri and not for just our association of which I am proud.

The answer to your question is "No, I do not feel it would handle the question. It took us a long time before we would let revenuers come in those hills."

Mr. DEROUNIAN. Dr. Hall, I am looking at all these bills for the medical care to the aged and medical care to anyone else from the standpoint of what kind of care it would give to the patient. I am not quite so concerned about whether it will make the doctor rich or poor.

In your opinion, would H.R. 3920 provide better medical care to the individual citizen?

Dr. HALL. Congressman Derounian, this was the subject of my testimony about a year ago. I purposely did not repeat this in this year's statement because the chief counsel of the committee asked us not to go over that which we had done before.

In summary, let me answer your question

Mr. DEROUNIAN. The reason I ask that is because H.R. 3920 would supply approximately 30 percent of the average medical bill of an individual whereas H.R. 422, the previous King-Anderson bill, supplied 25 percent.

Dr. HALL. The answer to your question is that in my opinion it would not as I stated in my opening paragraph.

Mr. DEROUNIAN. Thank you very much.

The CHAIRMAN. Mr. Curtis?

Mr. CURTIS. Mr. Chairman, in the light of the questioning of Mrs. Griffiths, I think I would like to ask the doctor this. I thought this point had been well established by the Secretary of Health, Education, and Welfare when he said in his prepared statement, "In our country we have the best health care of any society."

In order to get this into context, do you feel that way, Doctor?
Dr. HALL. I certainly do. It is beyond peradventure of doubt

around the world.

Mr. CURTIS. So the point that Mrs. Griffiths is pointing to is to make it even better?

Dr. HALL. That is correct.

Mr. CURTIS. We are all seeking to do that but in seeking to do that, if we were to damage the system, we might end up not as well off as we were before; is that not correct?

Dr. HALL. Let us make it crystal clear that we are all for improving all people's health care situations.

Mr. CURTIS. We are trying to discuss what system or how we can improve the system we now have or whether it does need assistance. We are all after the ultimate goal.