TESTIMONY OF CHIEF MEDICAL DIRECTOR, VETERANS' ADMINISTRATION, CONCERNING VETERANS' HOSPITALS, FACILITIES, AND PERSONNEL TUESDAY, JUNE 17, 1947 HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS AFFAIRS, Washington, D. C. The committee met at 10 a. m., Hon. Edith Nourse Rogers (chairman) presiding. The CHAIRMAN. The committee will please come to order. STATEMENT OF PAUL R. HAWLEY, CHIEF MEDICAL DIRECTOR, VETERANS' ADMINISTRATION Dr. HAWLEY. My name is Paul R. Hawley. I am Chief Medical Director, Veterans' Administration. The CHAIRMAN. We are delighted to have you, General Hawley, and the committee, I know, wants to find out your plans regarding hospitalization. Soneone has asked why you are closing some hospitals and building new hospitals and we would like to know the reasons. Dr. HAWLEY. Thank you. The chairman asked for a statement regarding the closing of hospitals. I should like to say first that the budget ceiling for purely medical personnel in the appropriation bill for next year, whether it was money limitations or actual ceilings imposed, is 59,636 full-time people. Mr. TEAGUE. Will you please repeat that, General? Dr. HAWLEY. 59,636; of which 2,933 are specifically earmarked to open three new tuberculosis hospitals, which was included in a supplemental request to the Bureau of the Budget and submitted to the Congress, so we feel committed to use those 2.933 for the specific purpose for which they were authorized. We have on duty today a purely medical personnel in our organization The CHAIRMAN. General, will you repeat that? Mr. RAMEY. General, 2,933; what was it? Dr. HAWLEY. They were specifically earmarked to open three new tuberculosis hospitals for care of tuberculosis patients. We had to go back to the Budget and show that the load in tuberculosis was increasing constantly, and that we had to open three new tuberculosis hospitals. We have on duty today in our hsopitals 61,521 full-time people. If you subtract from the 59,636 authorized for next year the 2,933 1 that are earmarked for new hospitals, that gives us only 56,703 fulltime people to operate hospitals next year, exclusive of those three new ones. Mr. ALLEN. General, could I interrupt right there? You spoke about the TB patients being on the increase. Now, did they contract that in the service, or did they get it after they got out of service? Dr. HAWLEY. Up until the present time, the vast majority of those cases are service connected, of course, because they have not been out of the service very long. The proportion of service-connected cases will decline. We do know that there were some 30,000 soldiers and sailors discharged from the services because of tuberculosis. Mr. ALLEN. Now, let me ask this: Is the percentage of tubercular patients among these ex-servicemen greater than it is among the population in general? Dr. HAWLEY. No, it is less. Mr. ALLEN. It is less? Dr. HAWLEY. It is less because of the screening on entrance to the service. There were 30,000 cases among the 10,000,000 or 11,000,000 or actually around 14,000,000, all told, of people who passed through the services, and that is a very small proportion but it is a considerable load in numbers. Mr. ALLEN. But it has no special bearing, since the general population has a greater percentage than this, and has no special bearing on the service? Dr. HAWLEY. That is right. I should like to qualify that statement. It is less than the general population for the age group concerned. It is probably not less than the general population because tuberculosis is essentially a disease of adolescence and young manhood. The CHAIRMAN. General Hawley, may I interrupt a moment? How much are you using the Board of Hospitalization in your selection of sites? Dr. HAWLEY. Every site goes before them for approval. We make the recommendation. The CHAIRMAN. But you really are the Board of Hospitalization? Dr. HAWLEY. No; I am only one member. The CHAIRMAN. But in effect, does not the Board always follow your recommendation? Dr. HAWLEY. No; I cannot say that. I have been voted down on at least two occasions by the Board, that I know of. I will say that on one of those occasions, the President overruled the Board, however. The CHAIRMAN. What were those cases? Dr. HAWLEY. One was on the tuberculosis hospital to be built at Americus, Ga., which was rejected by the Board, and the Board directed that we use the existing hospital in Atlanta. That recommendation went to the President, and he disapproved the action of the Board and directed that the hospital at Americus be built. The other one, I am sorry, Madam Chairman, I cannot remember but vaguely the details. I remember the other case particularly. The CHAIRMAN. Thank you. Dr. HAWLEY. I have shown that to operate existing hospitals, that is, exclusive of the three new hospitals for tuberculosis next year, we have in this appropriation bill 56,703 full-time medical people and we have on duty today in those same hospitals 61,521 full-time medical people, which leaves us a deficit of 4,818. That is why we feel that we are forced to contract our operations at once, and this does not take into account some 6,000-plus beds in permanent construction which will be completed during the fiscal year 1948. The CHAIRMAN. It is my understanding that the Appropriations Committee granted you all the money that you asked for for the building of hospitals; is that correct? Dr. HAWLEY. For the building of hospitals? The CHAIRMAN. Yes. Dr. HAWLEY. That is out of my jurisdiction. I did not read that section in the appropriation bill. The CHAIRMAN. That is my understanding. Mr. TEAGUE. General, what is the trend of your patient load in the last few months? Dr. HAWLEY. The trend is level or only slightly upward, because every bed is being occupied; but the waiting list has been slowly whittled down. There are fewer on the waiting list than there were some months ago; not much fewer, but fewer. I think it has dropped from 25,000 to about 21,000. Mr. RANKIN. Madam Chairman, I suggest that the general be permitted to make his statement first. Mr. TEAGUE. It is my opinion that that question is very pertinent in there, the trend of the patient load. Mr. RANKIN. I think so, too. Mr. KEARNEY. In order to expedite the testimony of the general may I ask the committee as a whole to hold in abeyance any questions until he finishes? Mr. RANKIN. Thank you. Dr. HAWLEY. Mr. Chairman, I think I was asked the question about the closing of hospitals, and so far as I know, I have given you the personnel situation which is the only situation forcing the closing of certain hospitals. I might add that in the selection of those hospitals, up until this time, to be closed, we have selected two hospitals which have been terribly difficult to staff. We have been unable to get nurses to go there and unable to get enough other personnel. The other hospital was a small hospital-and all small hospitals are much more extravagant in their operation than the larger hospitals. The proportion of administrative overhead is greater, and we thought that, in this case, with only between 40 and 45 patients in this small hospital, those could be redistributed among the hospitals in that area without increasing the staff necessary to care for them. I think I have nothing further to offer. Mr. JOHNSON of Oklahoma. Let me ask this question, General Hawley. As I understand it, you have now roughly 61,000 and under the new bill you will have some 56,000, which you say will leave a deficit of 4,818? Dr. HAWLEY. Yes, sir. Mr. JOHNSON of Oklahoma. In other words, if I get the picture correctly, then you are going to have 4,818 less to operate with in the fiscal year 1948 than you asked for? Dr. HAWLEY. Considerably less than that. Of course, what the Bureau of the Budget submitted to the Congress does not represent our original request to the Bureau of the Budget. Mr. JOHNSON of Oklahoma. In other words, you have the two whittles, so to speak, the Bureau of the Budget and the Congress. Dr. HAWLEY. No; the Congress did not whittle. There was only one whittle, which the Congress did not take part in. Mr. JOHNSON of Oklahoma. The Bureau of the Budget was the one that cut that? Dr. HAWLEY. Yes, sir. Mr. Ross. Will the gentleman yield? Will you emphasize that point, General Hawley? Dr. HAWLEY. Yes, sir; by repeating it? Mr. Ross. Yes. Dr. HAWLEY. As far as I have read the appropriations bill, the Appropriations Committee did not cut any further but granted what the Bureau of the Budget recommended. Mr. Ross. In personnel requested for the hospitals? Dr. HAWLEY. Yes. Mr. Ross. Thank you. Mr. JOHNSON of Oklahoma. May I ask one further question? Dr. HAWLEY. Yes, sir. Mr. JOHNSON of Oklahoma. All right. Now, when you appear before them in making your request, are you allowed to state, or were you allowed to state, or did you state, the figure that you needed, or did you discuss solely the amount set by the Bureau of the Budget? What I am trying to get at is this: Did the Appropriations Committee have a chance to know what your actual needs were, or were you bound by this figure as recommended by the Bureau of the Budget? Dr. HAWLEY. I think the gentleman knows of the instructions which were given. Mr. JOHNSON of Oklahoma. Yes, I do. Dr. HAWLEY. And, of course, unless the direct question were asked, we could not volunteer information. Mr. ALLEN. General Hawley, let me ask right there: Now, I want to get this perfectly clear. As I understand it, the Bureau of the Budget has suggested a personnel ceiling on you of 59,636 for the next fiscal year? Dr. HAWLEY. That is right; of which 2,933 are for three new hospitals to be opened. Mr. ALLEN. All right. Now, how many people do you have in your department now? Mr. ALLEN. All right. You told this committee, or a subcommittee of this committee, that you now have approximately 10,400 beds, or will have, rather, 10,400 beds, empty, after July 1, even if last year's ceiling were continued; is that right? Dr. HAWLEY. No, we have 5,700 beds closed at this time with the 61,521 people. Now, in addition, there will be some 6,000 new beds completed during the year, which will give us between 10,000 and 12,000 beds that we see no opportunity of opening without closing some other beds or temporary hospitals. Mr. ALLEN. In other words, you are now operating a total of what? About 100,000 beds? Dr. HAWLEY. 102,000, yes, sir. Mr. ALLEN. 102,000 beds. And that is with a ceiling of 61,000 personnel, in round numbers? Dr. HAWLEY. Yes. Mr. ALLEN. Now, then, under the new ceiling of 59,636, you will be able to operate only how many beds? Dr. HAWLEY. About 98,000. Mr. ALLEN. You may not comment unless you want to but where are we going when we are having more veterans needing hospitalization, more hospitals opened up, building more hospitals and yet the ceiling-it does not matter who places the ceiling-if the ceiling is going to be placed upon you so that you are going to have absolutely to close still more beds that seems to me, Mr. Chairman, to be a very serious matter, and I think a matter which ought to have some affirmative action on the part of the Congress. Mr. KEARNEY. I want to get this very clear in my mind, General, if the gentleman will yield. Mr. ALLEN. Certainly. Mr. KEARNEY. I understand now that this is not the work of the Appropriations Committee. Dr. HAWLEY. That is true. Mr. KEARNEY. It is the work of the Bureau of the Budget. In other words, if you are denied the necessary personnel to operate completely these hospitals, it is the fault of the Bureau of the Budget and not the fault of the Congress. Dr. HAWLEY. It is the action of the Bureau of the Budget, Mr. Chairman. Mr. KEARNEY. You use the word "action" and I use the word "fault." Mr. ALLEN. Now, Mr. Chairman, may I say this: It might have been the result of the action of the Bureau of the Budget in the first instance but the Bureau of the Budget is not controlling upon the elected representatives of the people and I take the position that regardless of what the Bureau of the Budget does or does not do, if the Members of Congress see that he is going to need a ceiling of even more than 61,000 in order to operate hospital beds than he actually has, then it is the business of the Congress to see that that money is appropriated regardless of what the Bureau of the Budget says. Mr. KEARNEY. There is not any question about it but what I wanted to get firmly in my own mind is that first of all it was the Budget's initial step that reduced in their own language these 4,000 employees. Mr. ALLEN. I am not trying to shield the Bureau of the Budget but I do not want to shield the Congress, either. Mr. KEARNEY. I do not want to shield anybody. If we need the personnel, I think it is up to the Congress to give it to them. Mr. ALLEN. We agree 100 percent. Mr. PHILLIPS. Mr. Chairman, may I ask this? 64872-47- -2 |