Awaiting hospital admissions, May 31, 1947-Continued

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Mr. KEARNEY. Mr. Lusk.

Mr. Lusk. Mr. Chairman, in view of the discussion that has taken. place this morning, I believe and I would like to recommend, that the committee look into this matter. I think we would be neglecting our duty if we do not investigate the situations described by Mr. Johnson of Oklahoma and Mr. Mitchell, just to find out from the other angle, from the servicemen of their veterans' organizations, the information that they can give us on this situation.

I am sure that General Hawley is doing a fine job, but I do know, too, that there are discrepancies in these reports, and I know from my own situation at home a little bit about it, and if we can get the information I am sure that General Hawley would not object to our doing that, so that we can correct any situation if it is necessary to be done.

Then I would like to go further and present this information to the Bureau of the Budget or the President or whoever should have it and try to get some recognition of the real needs here, and work on it from that angle. I think they need help in the Veterans' Administration to get proper funds, and perhaps if we could be of assistance along that line, we should do it.

Mr. KEARNEY. Before I call on the gentleman from New York, I will say that the Chair has had similar experiences along the lines described by the gentleman from Indiana and the gentleman from Oklahoma.

I brought these matters to the personal attention of General Hawley in one instance and Colonel Cook in the other two, that I am thinking of now. Those three cases were taken care of.

But, General, I think that what the gentleman from Indiana and the gentleman from Oklahoma have in their minds is the same thing that I have and that is this:

As a layman, I know nothing about the practice of medicine but I do know that if a veteran is denied admission to a hospital and he dies within 24 hours or within 10 days after the manager of a particular hospital says, "No, this is not a case that demands immediate hospitalization," I say there is something wrong with the particular manager of that particular hospital. In other words, it is my thought that we should err in favor of the veteran and not in favor of the convenience of the manager.

Now, I have one case that I recollect as though it happened yesterday. That was a case in southern New York. The doctors who were attending this veteran recommended immediate hospitalization. The doctors at the hospital said it was not an emergency case. Well, it turned out to be an emergency case.

Now, why do the managers of hospitals or the doctors in charge of the hospitals, do those things?

They could not claim there were no beds available because in this particular instance there were plenty of beds available.

That, I think, is what both of these gentlemen have in mind. Why should when the doctors attending a case certify that it is an emergency case, in my opinion, and I think that is the opinion of every member of the committee-why should not that veteran be admitted immediately for available treatment?

Dr. HAWLEY. I agree with that thoroughly, and I would say that we are admitting 40,000 veterans a month in hospitals and while I

deplore these errors of medical judgment I am afraid it is too much to hope that there will never be bad judgment employed except in only a small proportion of cases. We do our best to try to prevent that. But I would like also to say that there is a wide difference of opinion sometimes between service officers and between competent medical people as to whether or not a case is a hospital case and if every veteran were to be admitted to a hospital on his own application and on his own determination for the need of hospitalization, we would have to have, perhaps, twice as many beds as we have now.

Mr. KEARNEY. These cases that I refer to are cases where, as I stated, competent medical authorities have indicated that this is an emergency case, and the result was that they were not admitted. Dr. HAWLEY. Yes; I understand that.

Mr. MITCHELL. No one here has claimed that the service officer is sending these boys to the hospital without advice from their medical officer; is not that so, Mr. Chairman?

Mr. KEARNEY. That is right.

Mr. Ross.

Mr. Ross. Mr. Chairman, I am not familiar with the situation in Oklahoma or the situation in Indiana but based on my conversations with veterans, veteran groups, and from reports that I have received from them, at the risk of being criticized for throwing bouquets, I want to say that I think the general has done an admirable job. I think his has been a record of real accomplishment, regardless of red tape.

Of course, there is room for improvement and in that respect, if I may suggest to the general, if he feels that additional personnel is needed, then I offer the suggestion that he make known his needs to the subcommittee of the Committee on Hospitals and if in their determination they find that these needs are justified, let us go before the Congress and get the additional appropriation for this personnel. Mr. KEARNEY. Mr. Donohue.

Mr. DONOHUE. Mr. Chairman, I would like to inquire, from what source do you select your managers, General?

Dr. HAWLEY. The managers, of course, are selected by the Administrator, usually on our recommendation, and they come from doctors who have shown administrative ability and from laymen who have shown administrative ability.

Mr. DONOHUE. Are most of them former Army and Navy officers? Dr. HAWLEY. Only in this respect, that a large proportion of the doctors in the Veterans' Administration service during the war were inducted into the Army and kept in their positions. They are not mostly from the regular service or from active service during this war in other fields.

Mr. DONOHUE. How many of your managers are retired Army and Navy officers?

Dr. HAWLEY. A very small number. I would have to furnish that to you. I can only think of about five or six at the moment. (The requested information follows:)

At the present time six retired Army and Navy officers of the Regular Establishment are serving as managers at Veterans' Administration hospitals.

Mr. DONOHUE. And are most of your managers doctors that have been schooled in hospital administration?

Dr. HAWLEY. The large percentage are doctors. There are a few exceptions.

Mr. DONOHUE. Are these doctors that have been schooled in hospital administration?

Dr. HAWLEY. No. So far as I know, we have none who is a graduate of a formal course in hospital administration.

Mr. DONOHUE. In your opinion, Doctor, do you not think you should have medical men that have had specialized training?

Dr. HAWLEY. I do, very much, and were it not for the limitation of 90 days' instruction a year in a civil institution, I should like to send some of our hospital managers to formal courses in hospital administration.

Mr. DONOHUE. Are not there several universities that have courses, training hospital administrators?

Dr. HAWLEY. There probably are. I know only of one university that has a complete 9-month course in it, which is Northwestern, in Chicago.

Mr. DONOHUE. And are not there men available from that school that could be employed?

Dr. HAWLEY. There have been none that I know of applying.
Dr. PRESS. It is the difference in salary.

Dr. HAWLEY. Yes; as Dr. Press points out, graduates of that school can command up to twice the salary in other than Government institutions than we can pay.

Mr. DONOHUE. What is the salary that one of these hospital managers gets?

Dr. HAWLEY. The average salary is less than $10,000 in the Veterans' Administration.

Mr. DONOHUE. And you say the hospital administrators coming out of Northwestern are commanding twice that?

Dr. HAWLEY. I say the larger civilian institutions pay a great deal more than that. In fact, the salary ranges up to $25,000 or more per year.

There has been no one coming out of that school that has ever applied for a position that I know of and has been rejected. Mr. DONOHUE. Have you ever sought them?

Dr. HAWLEY. Yes. We have placed one man, I think. We have been in correspondence with them. We have not gone to the school. I think I had better answer that categorically, no. We are tremendously interested in getting them.

Mr. DONOHUE. I can suggest to you on personal knowledge that men coming out of there as hospital administrators get far less than $10,000 a year.

Mr. CROW. Will the gentleman yield for one question?

Mr. DONOHUE. I yield.

Mr. CROW. Doctor, do not the hospital administrators have to take the civil-service examination?

Dr. HAWLEY. Not the doctors. Lay managers do.

Mr. CROW. I saw a notice the other day that the Veterans' Administration salary for hospital manager was a $7,000 to $9,000 salary. Dr. HAWLEY. Yes; that is a lay administrator, not doctors, Mr. Crow.

Mr. CROW. I am sorry.

Dr. HAWLEY. The doctors are under Public Law 293.