How do we induce doctors to better utilize their time and talent by making use of the services of paramedical personnel to handle those procedures within the competence of subprofessionals that now consume so much of the doctor's time?

Health manpower-numbers, distribution, better utilization-that is our subject.

I repeat, this is a subject of national importance, the indispensable prerequisite to any health care program, private or public.

Without any further ado, I would like to call for such remarks and such presentation as he desires to make, the Honorable William Randall, Congressman, U.S. House of Representatives, from the Fourth Congressional District, Jackson County and adjacent counties thereto. Congressman Randall.

STATEMENT OF HON. WILLIAM RANDALL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MISSOURI

Congressman RANDALL. Thank you, Tom.

Let us make that 14 counties.

I appreciate the opportunity to make this very brief comment. We are going to try to pay our respects in a few minutes to a very distinguished citizen of this community, and I will ask to be excused after a few brief remarks.

I want to voice a thought that I know will be shared by all of you who are witnesses. There is a very distinguished list of witnesses, and I wish to express our appreciation and gratitude for the junior Senator of Missouri coming into the area and providing a forum for this kind of opportunity to present these facts.

I think before we proceed, also, there should be a special salute to two who will be witnesses, very distinguished witnesses, and I see them in the press section or just back of the press section, not only for what they have done and I refer to Nate Stark and to Homer Wadsworthbut for their plans which we know are in the offing so far as the new teaching hospital here, the new University of Missouri-Kansas City Hospital. I think, without reservation and without fear of being in error as time will go on, we will find that the new methods of this school, the innovations, will be, I say again without doubt, a trailblazer. It will set the pace nationwide for many new things. This is a very exciting point that we are here in terms of time for these hearings.

Tom, our side of the Congress, and we like to think there are two sides to the Congress, had quite considerable debate back in June and July while the other body was engaged in such things as some of our Supreme Court confrontations and sundry defense matters. In any event, there was quite a lengthy debate as to the need for medical manpower. I remember, those of you who have reason to want to corral these facts, you can find them in the debate on the House side, particularly in the Interstate and Foreign Commerce Committee.

Your purpose here, you are going to cover the Kansas City area and the Missouri area, and then you are going to New York, as you suggested.

I will point out for the information of all that the House has expended already for 3 years a total authorization of $370 million for the Allied Health Professions Training Act.

Also in July or in early August, the House passed the National Science Foundation Act, at another $537 million in new budget authority. Not all of that was the medical profession, but very likely, well, certainly 25 percent and probably as much as 35 percent was for health care.

At the end of June we were able to pass over the President's veto the $2.9 million Medical Facilities Construction and Modernization Act. That is Hill-Burton, in essence. I distinctly recall that when the time came for that vote, we got on what some of our colleagues call the horn-and talked with some who are interested in this program. We tried to reach Nate. We were able to reach Homer, and called our school over in the northeast part of town, Kansas City College of Osteopathy and Surgery. It is always a difficult decision when you come to the point of overriding a veto. There was no doubt but what it should have been overridden. We found at that time that Hill-Burton in its history has served almost 4,000 communities, and it has helped to a total of almost $12 billion, $11.6 billion in construction of hospital facilities over the years.

Also in early July, the House passed the HEW bill. We got by without a veto on that one, a $1.2 billion for general health services, mental health administration, and about $1.5 billion for other health, including NIH for the first time. Some of you may not have been knowledgeable, but we went into not only cancer, heart disease, stroke, dental problems, arthritic, and neurological, but the Institute at NIH was certainly an innovation for the first time.

Senator, and those who are on the distinguished list of witnesses, the really sorrowful and almost saddening aspect of overriding the veto, we had the votes to do it. The House has faced already this year four vetoes, the Senate faced up to at least two, have two in the offing, and have one left. After we were able to override the veto, we still did not have the votes as far as the Hill-Burton, that is, the medical facilities to fund the program, and that is what it is all about here this morning, whether we have the votes for the funding. All of us have a list of priorities, and I am sure that for those two Members of the Congress who are here this morning, health care is at the very top of that list.

Senator, on our side, and not representing the inner city but the suburbs and the counties that go as far south nearly to Joplin, and out east to Sedalia and Marshall, a total of 14 counties in west central Missouri, as long as we happen to be a Member, we will continue to cast our vote for more money for the very important area that you are talking about here, because with all the brick and mortar and with all the other talks about insurance and the Kennedy bill, and on our side the Martha Griffith concept, it is going to be meaningless unless we have the manpower to fill the vacuum.

The startling thing about it all, and I am sure it will be developed, will be the almost unbelievable statistics that can be shown of the needs for medical manpower by the year 2000.

Thank you very much.

Senator EAGLETON. Thank you, Congressman Randall. We appreciate it. We know you are on a tight schedule. We are pleased you had the opportunity to be with us.

Congressman RANDALL. Thank you, Tom.

Senator EAGLETON. I might add a footnote to the Congressman's statement. He mentioned in his previous statement the allied health professions bill which is now in conference. Interestingly enough, one of the major items, if not the major item, of disagreement between the Senate version of that bill and the House version of the bill-a conference committee is one that tries to unravel the differences between the two bodies-is a point that was put in on the Senate side of $100 million in special emergency funding for teaching hospitals. The House, or at least the conferees for the House, have been reluctant to accept that provision. It is interesting that the very focal point of today's meeting, in terms of medical manpower, and with the advent of a new teaching hospital and new medical school here in Kansas City, that that would be the one item on which the conference is apparently being hung up.

We thought it was an emergency, we still think it is an emergency insofar as medical manpower is concerned.

I would like now to call forward a group of three witnesses to make their presentation collectively, as it were.

Mr. Nathan J. Stark, immediate past chairman of the board of trustees, Kansas City General Hospital;

Mr. Homer C. Wadsworth, president, Kansas City Association of Trusts and Foundations: and

Mr. Herman J. Sutherland, chairman, Mid-American Comprehensive Health Planning Agency.

I am informed that Mr. Sutherland is out of town, but that Ned W. Smull, president, Health Resources Institute, and director and chairman of pediatrics, Children's Mercy Hospital, will pinch hit for Mr. Sutherland.

Mr. Stark.

STATEMENT OF NATHAN J. STARK, IMMEDIATE PAST CHAIRMAN OF THE BOARD OF TRUSTEES, KANSAS CITY GENERAL HOSPITAL; GROUP VICE PRESIDENT, OPERATIONS, HALLMARK CARDS, INC.

Mr. STARK. Senator, I would like to start out by correcting a misconception on the part of some people who met yesterday, and that is Mr. Wadsworth claiming that the title given to me at Hallmark, G.R.P.V.P. in charge of operations, had something to do with get well cards. [Laughter].

I would like at least to bring you greetings, and I hope, before we are through, not sympathy.

Rather than answer specifically the questions that you posed in your letter, I would propose that I give you a very brief background of a report on a Kansas City concept which, I think, is quite germane to all of the questions, and then having done this, I would suggest that I turn to Mr. Wadsworth who can give us some of the implications of this concept.

Twenty-five years ago the circle of interested people in medical and health needs was hardly more than a handful. Today the issues of medical care are before Congress, in debating forums, in the news, in popular magazines, and on the radio and TV, enlisting the interest of millions, the serious attention of thousands.

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In 1796 a group of benevolent doctors and laymen described their purpose as "that all the poor receive the benefits of a charity, the more refined as it is the more secret."

One hundred and forty-eight years later, a different medical policy was enunciated by President F. D. Roosevelt who declared among "basic human rights were adequate medical care and the opportunity to achieve and enjoy good health.”

With this shift in concept, from charity to right, we need some practical new approaches and new techniques for defining and fulfilling these changes.

Let me give you a narrative case illustrated of what happened in Kansas City when public and private efforts were blended together at both operation and planning level. The history of our city hospital, Kansas City General Hospital, has paralleled with extraordinary fidelity the development of all other hospitals and, in fact, provides us with a panorama of what has happened in the field of medical care and particularly in the care of the indigent and medically indigent sick. The hospital had been operated in one form or another by the city for 100 years. It ran a pretty good show for its time; contributed to the medical education of many doctors, but soon medical science and advancements passed it by. As a result of failure of budget requests to be approved by the city, lack of maintenance to the buildings, unrealistic personnel policies, and mounting frustrations and discouragement among administrative and professional personnel alike, a number of hazards for the patient were created and several departments of the hospital were put in jeopardy for State and national approval.

The hospital was running the unfortunate downhill course which many such city hospitals have pursued. While there was an awareness of the financial difficulties with which the city was struggling, one could not approve the philosophy of operating at a substandard level a municipal service whose responsibility is the lives and health of thousands of its citizens. In addition to its financial woes, the complexities of operating a hospital, a very highly scientific program, as one of 16 departments was beyond the city's capacity.

Conditions had, in 1961, reached a catastrophic climax. A new and imaginative modus operandi had to be found. It came in the form of a suggestion made by one of our leading citizens. He proposed that a nonprofit, voluntary corporation be formed to operate the municipal hospital system under contract with the city. The general purposes to be served were first to find ways to stabilize the hospital operations; to assume qualitatively high quality of care to patients; to utilize clinical material available for training at all levels; and to assure maximum efficiency in the performance of these functions.

In 1962, following this concept, the general hospital and medical center was incorporated under the not-for-profit laws of the State of Missouri. On May 18, 1962, a contract was made and executed between this corporation and the city for the operation of the city's hospitals. Among other provisions was the freedom of this private corporation to enter into affiliate arrangements with various hospitals in the Greater Kansas City area for the purpose of extending resident and intern training in part to those hospitals which agreed to provide adequate supervision for postgraduate training. It is worthy to note

that the entire voluntary system of this area was in serious trouble for lack of an adequate supply of a house staff to assure proper levels of services to patients.

One of the first actions of the new corporation was to affiliate with the School of Medicine of the University of Missouri for postgraduate training in medicine.

Some money had to be found at once, apart from city revenues, to create the necessary arrangements with the University of Missouri and to develop as promptly as possible teaching and research programs.

As evidence of public awareness and support for that concept, private funds were obtained for a full-time medical staff. As a direct result of this support, provision of adequate space, and an opportunity to innovate and a dream for a new medical future, the hospital has attracted many doctors from great institutions around the country.

Thus the groundwork was laid for a complete health center. Let me now present in chronological order the following developments: In 1962, the Kansas City urban renewal program approved the Hospital Hill development which includes approximately 135 acres. In 1963, Children's Mercy Hosital decided to locate its new building on Hospital Hill. Children's Mercy Hospital is joined to the medical center in a tripartite contract between Kansas City General Hospital and Medical Center Corp. and the board of curators of the University of Missouri.

In 1964 the dental school of the University of Missouri at Kansas City was planned on Hospital Hill and is now completed and occupied.

In 1966, the Western Missouri Mental Health Center opened on Hospital Hill. It and the psychiatric receiving center, now a part of the State program, provide major programs to help patients. In 1967, the voters of Jackson County approved bonds for a new teaching hospital on Hospital Hill by a 4 to 1 majority. Approximately $13 million are available for this project.

In March of 1968, the Brothers of Mercy joined the medical center complex and are presently building an extended care facility on the hill.

In June of 1969, the University of Missouri Board of Curators passed a resolution establishing a medical school in Kansas City. In June of this year, 1970, the Missouri State Legislature provided construction funds for a State matching grant, and the Governor signed this bill in July.

In August of 1970, the Federal grant of $8.8 million was awarded for the medical school.

In the spring of 1970, the division of physician manpower notified the Jackson County Court that the application for Federal construction assistance to replace the existing general hospital was approved in the amount of $9.9 million. As of this date, a grant award has not been made.

The Kansas City Medical Center complex, as evident, represents a major resource of medical health care in Kansas City.

The potential exists now for the development of one of the finest health care, educational, and research centers in the Midwest.