General, assume that there should be a redistribution of the personnel at the level for the services rendered to the individual veteran, would there then be sufficient personnel to render reasonably adequate service under this?

Dr. HAWLEY. In the same number of beds, Mr. Phillips?

Mr. PHILLIPS. Yes.

Dr. HAWLEY. I do not think so. I would not like to give the impression for 1 minute that every hospital is manned most efficiently, but those which we have spot checked from the central office show more instances of undermanning than of overmanning and while there could be adjustments between hospitals or among hospitals, I do not believe that it would alter the general picture very much.

Mr. KEARNEY. General, to follow up this thought of mine, what I am getting at is this:

With the cut, how can we let us say "we"-build new hospitals, if you are denied the authority to staff those hospitals? What good are they?

Mr. ALLEN. That is a point.

Dr. HAWLEY. We assume, Mr. Chairman, that as the new hospitals approach completion that the personnel ceilings will be adjusted upward accordingly.

Mr. KEARNEY. You are just shooting in the dark there.

Mr. TEAGUE. General, you close temporary hospitals as you complete permanent ones?

Dr. HAWLEY. Yes. I should say that we also in many instances close temporary hospitals to move into the permanent structures.

Mr. JOHNSON of Oklahoma. General Hawley, when you appeared before the Appropriations Committee, you. just stated a minute ago that the only way you could get into the record your actual needs would be if someone on the Appropriations Committee asked you; but you could not volunteer under this directive.

At that hearing, did anyone on the Appropriations Committee ask you what your actual needs were?

In other words, did you have a chance to tell the Subcommittee on Appropriations what you did need, or did they just let the Budget Bureau figure ride through?

Did you actually get a chance to get into the record what you actually needed?

In other words, we will say that the Bureau of the Budget cut you 4,818. Did anyone on the Appropriations Committee ask you what you actually needed to operate your beds?

Dr. HAWLEY. The hearings of that committee have been published, and if I may have the opportunity of correcting any misstatement I make here after consulting that printed hearing, I would say at this time that I was not asked any direct questions on that.

Mr. JOHNSON of Oklahoma. In other words, here is the way I look at that.

The Appropriations Committee should be as conversant with this situation as the Veterans' Affairs Committee. Certainly if it is apparent to us here today with the cursory examination we have made so far, they could have asked and brought out the same thing that we are bringing out now.

Mr. KEARNEY. Did they deny the general the opportunity to testify what his needs were?

Mr. JOHNSON of Oklahoma. Here is what happens.

Under this directive that is issued by the executive branch of the Government, he is only allowed, General Hawley, before the Appropriations Committee he cannot volunteer what he needs, unless some member of that committee asked him what he needs, so what I am trying to bring out is that no one there asked him what he needed. Mr. KEARNEY. I will say to the gentleman from Oklahoma that that is not my understanding. My understanding is that General Hawley or any other agent of the Government who testified before the Appropriations Committee, they testify generally as to what their needs are.

Is not that So, General?

Understand, I am not trying to put you on the spot.

Dr. HAWLEY. I understand.

Mr. KEARNEY. We want to know whether you are being denied necessary. personnel or the funds properly to run your set-up.

Dr. HAWLEY. We do not have enough funds to run the present scope of our set-up.

Mr. KEARNEY. How much more do you need?

Dr. HAWLEY. $100,000,000 and 30,000 people.

Mr. KEARNEY. $100,000,000 and 30,000 more people?

Dr. HAWLEY. Yes; including those necessary to man the additions that will come in during 1948.

Mr. RANKIN. Let me say that while these representatives of the Government are limited in their demands by the Bureau of the Budget, as the general has stated, they can answer any question that is asked them.

Now, the Congress is not limited by the Budget recommendations. You can raise the Budget recommendation just as easily as you can cut those Budget recommendations when it is necessary to do so.

This responsibility rests with the Congress of the United States. Mr. KEARNEY. Will the gentleman yield?

Mr. RANKIN. I yield.

Mr. KEARNEY. I would like to ask General Hawley if he stated to the Appropriations Committee that he needed $100,000,000 more and 30,000 more employees?

Dr. HAWLEY. I would like to change that figure to 28,000 from 30,000.

Mr. PHILLIPS. General, assume that some of the high bracket $5,000 or $6,000 men were relieved of their duties, a great number of them, and about three attendants hired for these high-priced executives and distributed at the level where they are needed and assume that some of these social workers were relieved of their duties; would that make any difference in the service that could be rendered to the veterans in the hospitals?

Dr. HAWLEY. The answer to that is-I presume you mean in the Department of Medicine and Survey.

The total doctor cost, in general hospitals, is currently about $1.50 a day.

In tuberculosis hospitals, it is about 90 cents a day, and in neuropsychiatric hospitals, is 35 cents a patient-day and I do not believe that you could effect any great economy on those low figures.

A certain amount of supervision of hospitals is absolutely essential to keeping them up to a proper standard.

One great difficulty that the Veterans' Administration had in the years passed was that there was a number of hospitals which were never visited by anyone from outside within 5 years, and we do not think that you can maintain a proper standard of medical care without some supervision.

Now, as to social workers, it is my conviction that the social worker is one of the most important people that we have in a hospital, certainly where psychiatric cases are concerned.

Another example is this: One of our general hospitals had some 60 or 70 frozen bed cases, patients who had been there for months and years, with no expectation of ever leaving a hospital until they died. Within 3 months after the Social Service Department of only two case workers was organized and functioning, 30 of those patients left the hospital and returned to their homes.

I think that the social worker pays for herself many times over. Mr. CROW. Do you have any break-down of the cost of the social workers in the different hospitals?

Dr. HAWLEY. No, but I will provide it. (The requested information follows:)

Summary of annual cost of social service workers

Prepared by Department of Medicine and Surgery, Budget and Planning Division, June 17, 1947

Mr. RAMEY. May I ask a question, Mr. Chairman? General Hawley, at the time that Mr. Rankin was chairman, in visiting hospitals, I went to several hospitals near industrial districts, such as Dearborn, close to Detroit, and the Dayton hospital. At that time labor was paid approximately $100 a week. It was impossible for those superintendents of hospitals, like the gentlemen at Dearborn and Dayton-at Dayton there was Mr. Angell, a very good man, who had been sent there from Indianapolis, but their trouble was that they could not hire good attendants. After all, it is the attendants who are there with the man. Has that situation worked out so that you can get competent attendants as yet? Dr. HAWLEY. It is not fully corrected in industrial areas, sir. It is not as acute as it was during the period of peak wartime industrial production.

I have been to both of those hospitals you mentioned within the past 3 weeks. I was at Dearborn 3 or 4 days ago, and while their personnel turn-over is entirely too great, they do not have much difficulty in filling the actual positions. The quality leaves a great deal to be desired and increases their turn-over.

Mr. RAMEY. You cannot get people that will stay as attendants. Dr. HAWLEY. That is right.

Mr. RAMEY. It would be a good thing if that attendant was made a career position.

Dr. HAWLEY. We have been able to have attendants up-graded in the civil service, not to start with, but to offer them a career as they improve, and more and more approach a male nurse in training. Their grade and pay goes up proportionately and we are quite sure that that not only will give us better patient care but will be an economy. Labor turn-over is an expensive thing.

Mr. RAMEY. Thank you very much.

Mr. Ross. Mr. Chairman.

Mr. KEARNEY. Mr. Ross.

Mr. Ross. General, the initial question, I think, was why are some of the hospitals being closed.

Dr. HAWLEY. Yes, sir.

Mr. Ross. In that connection, may I ask a couple of questions? Is the personnel problem with respect to the adequate servicing of the present number of beds as serious as it has been intimated here that it is?

The reason I ask that question is this:

If my memory serves me correctly, the General testified here several weeks ago that in the program of expansion which has taken place that there was a possibility that many of the hsopitals had become overstaffed and in the program of readjustment which would take place, in all probability this condition would be corrected.

I say, that is if my memory serves me correctly.

That was inferred, anyway.

Dr. HAWLEY. Yes, sir.

Mr. Ross. Now, in addition to that, is the personnel problem the only factor in the closing of these hospitals?

Does obsolescence enter into it?

Dr. HAWLEY. No; only the personnel.

In fact, of those recommended to be closed, there is one more hospital which has been a great problem to staff and keep patients in for at least the past 15 or 20 years, and one in which we would have to spend some $3,000,000 to rehabilitate the plant and when we had spent that, we would still be faced with the same staffing problem. Mr. Ross. Then plant does enter into it?

Dr. HAWLEY. That is in one case. But the Administrator has not made any recommendation concerning that operation.

Mr. Ross. How many have been closed recently?

Dr. HAWLEY. There have been three that have been ordered closed by the Administrator.

Mr. Ross. And in one-third of those that were closed, the plant issue did enter into it?

Dr. HAWLEY. No; this one has not been directed to be closed yet. It was on a list of six, so in one case out of six, plant was the entire thing.

Mr. WHEELER. Will the gentleman yield?
Mr. Ross. Yes.

Mr. WHEELER. Numerous inquiries have been directed at me, General Hawley, as to why the Finney Hospital at Thomasville, Ga., has been ordered closed, while at the same time there is a new one being built at Tallahassee, Fla., only about 60 or 70 miles from there and a new one at Americus, which has been mentioned, only 90 miles from there?

Numerous inquiries, as I say, have been directed to me, asking why that situation existed?

Dr. HAWLEY. We have never been able to get enough nurses to go to Finney. We had hoped to operate 500 beds there and have never been able to get a staff for that many, and the hospital, which is a huge plant of 1,000 or 1,500 beds, at the last report had about 250 patients in it.

It is a very extravagant operation.

The patient-day cost is running anywhere from $14 to $27 a day, according to the number of patients hospitalized during the month. This number fluctuates considerably.

Mr. WHEELER. Is there any particular reason why the personnel refuse to go to Finney?

Dr. HAWLEY. Yes; but this is not confined to Finney. We have that difficulty in other hospitals located in the smaller communities.

There is a great shortage of nurses in this country. They can choose and pick and do not like to go to smaller places where they do not have recreational facilities for their off-duty time, and it is just impossible to employ them at such places.

Mr. WHEELER. Now, there is not very much difference in the size of the town of Thomasville, for instance, and the size of the town Americus. If you cannot get them to go to Thomasville, why do you feel that you can get them to go to Americus, where you are building a new hospital within 90 miles of Finney?

Dr. HAWLEY. I would say that that was a program which we fell heir to and which specified a hospital in southwest Georgia. Is not Americus in southwest Georgia?

Mr. WHEELER. Yes. Not in my district but I am familiar with that.

Dr. HAWLEY. Our limits of action in that case were to locate that hospital, which had already been approved, within the area of southwest Georgia, and there were several towns in southwest Georgia considered.

Mr. WHEELER. You mentioned a nurse shortage. There is another question that has risen in my mind.

Dr. HAWLEY. Furthermore, that is only a 200-bed hospital, which is different from trying to staff a 500- or a 1,000-bed hospital.

Mr. WHEELER. You mean, the one at Americus will be only 200 beds?

Dr. HAWLEY. Yes, 200 or 250.

Mr. WHEELER. As regards the nurse shortage, in my district, I recently had from my district the application of two nurses who had just finished the cadet training. They wanted to get jobs with the Veterans Administration. I contacted your division who handles that sort of thing and they said, "We have a long waiting list. We do not know when we could place these nurses.'

Dr. HAWLEY. I would like to check that for you, if you would just give me the details that you have.

Mr. WHEELER. And I would just like to know that. Either one of these girls, or both, would have been glad to go to Thomasville. In fact, they would rather have gone to Thomasville than some other place.

Dr. HAWLEY. Did you take that up with my office?

Mr. WHEELER. Yes.