topics like abortion rights into the debate can only further complicate the planning process. Once again, I urge the subcommittee to offer guidance to HEW to guard against permitting HSA involvement in social and moral issues.

Thank you again for the opportunity to appear here today, Mr. Chairman. I appreciate the subcommittee's consideration of my remarks.

I would also like to just briefly underscore what Congressman Stangeland pointed out. He had examples of local hospitals whose costs ran significantly below the national average. We had a community in our area where the hospital administrators could prove that the HSA was attempting to phase out a facility that was providing hospital care at a cost substantially below that at the facility to which the citizens would be diverted. It is not true that formal planning is correct in all cases. That is why I think flexibility should be made in all areas that it can be provided.

Mr. ROGERS. Thank you. Your suggestions are helpful to the committee and will be carefully examined.

Mr. PREYER. I share your views about the noninvolvement of HSA's in social and moral issues. I think that will handicap the planning process. I wonder what kind of guidance we can give on that without interfering with their local autonomy and perhaps constitutional freedom of speech issue?

Mr. MYERS. As I understand it, there are lobbying prohibitions currently in law that address the use of Federal funds. I think we should look at whatever way we can broaden that where the activities concern HSA's. I think the HSA board members have the right as individuals to take positions on social and moral issues. But as a body to pass a resolution which then may affect their decision to close one hospital which might have a service which perhaps might not be consistent with their moral values would, I think, cause a very difficult situation in the community and actually erode the confidence that health planning had been done on a basis absent of that particular bias.

I think the committee can in fact include strong language which would specifically point out the intent of Congress that we don't expect the bodies to embroil themselves in these social issues unless they are relevant to the mandate of planning that has been given to them and I think, within that mandate, there should be sufficient flexibility for them to express their personal opinions.

Mr. PREYER. Thank you, Mr. Chairman.

Mr. ROGERS. Mr. Carter.

Mr. CARTER. Thank you, Mr. Chairman.

I would like to congratulate the gentleman from Pennsylvania. You have a broad spectrum of citizens from every level of society in your HSA.

Mr. MYERS. I guess it would depend on who you ask. If you ask the HSA membership, they probably think they have a broad spectrum. If you ask the individual citizens affected by the HSA decisions, there is currently a feeling that there is not a representative level of communities and, quite frankly, I think the process by

which individuals are elected to HSA boards is so well hidden that the average participant in the community really does not know how to prepare himself to become a member. I am not speaking of immediately becoming a member, but to prepare himself in his plans to become a member sometime in the future.

I think there is not, from my observation, a cross-section, sufficient cross section represented in the agency.

Mr. CARTER. At the present time approximately 15 percent of the membership throughout the country is composed of elected officials, I believe. Do you think that is sufficient or should there be more, or less? Should they be classified as providers or consumers?

Mr. MYERS. That is a difficult question because I think there could be attempts by elected officials to utilize their membership on an HSA board to enhance their other political aspirations. I think that is a risk that should not be ignored.

I don't think that we can accept the theory that simply because somebody has been elected as a Member of Congress or a member of the legislature of a State or as a city councilman that he is best qualified to serve on a health planning board.

I am not sure that that is all that is necessary. I think whatever the board's makeup is, that certainly one of their responsibilities is to consider the opinions of people who have been elected in the communities. This can be done through the hearing process by permitting an adequate interface between the two bodies.

Mr. CARTER. I want to thank the distinguished gentleman for his excellent statement.

Mr. MYERS. Thank you, Dr. Carter. I appreciate your interest and the subcommittee's interest.

Mr. ROGERS. Thank you for your help.

Without objection, the Chair wishes to place in the record, as though read, the statements of Congressman Stewart B. McKinney of Connecticut and Hon. Baltasar Corrada, Resident Commissioner, Puerto Rico.

[Statements of Congressman Stewart B. McKinney and Hon. Baltasar Corrada, Resident Commissioner, Puerto Rico, follow:]

STATEMENT OF HON. STEWART B. MCKINNEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CONNECTICUT

Mr. MCKINNEY. Mr. Chairman and committee members: I value this opportunity to offer the committee some first-hand insight into the failure of HEW to properly administer the regional health systems program. I must also urge the committee to review and clarify certain existing provisions under Public Law 93-641 and Public Law 95-215, before further granting the regional HSA's the power to decertify certain medical facilities. I have personally witnessed, Mr. Chairman, the controversy, anger and harm that can result from misinterpretations of existing law. HEW has interpreted its power to grant an extension of temporary designation for a Health Systems Agency [HSA] one way, the public has interpreted its right to a meaningful public comment period in another way. Hence,

before the national program for the establishment of regional health plans proceeds much further, this committee must clarify the Agency's power, the public's right to involvement and HEW's responsibility to respond to public concern.

I recently became involved in a matter regarding the proposed health systems plan [HSP] for Fairfield County, Conn. As a result of the overwhelming public concern in Fairfield County regarding the future possibility of decertifying certain hospital units, the lack of available information regarding the HSP's regional, economic impact, and the insufficient opportunity for full public comment, I solicited the assistance of both the HEW regional office in Boston and Secretary Joseph Califano. In both instances I requested that the fast-approaching deadline for submission of the Southwestern Connecticut Health Systems Agency's application for permanent designation be delayed for just 90 days in order to allow the public's overwhelming concern every opportunity to be fully expressed. It was not until I received the Secretary's official response to my request for extension, that I realized how harmful HEW's misinterpretation of existing law could be to the future of all H.S.A. programs in the country. It was also as a result of this response that I realized the importance of this committee's task in clarifying existing provisions to correct H.E.W.'s misinterpretation, and thereby mollify the public's legitimate concern that future plans will be arbitrarily forced upon them. Let me explain in more detail.

As a result of the controversy and inordinate public interest by Fairfield County resident's concerning the content of the proposed HSP. I sent Secretary Califano a letter outlining those concerns. [insert No. 1, see p. 913].

Unfortunately, Mr. Chairman, the Secretary's response not only lacked cognizance of the dilemma facing Fairfield County (as outlined in my letter), it also demonstrated an insensitivity to the public concern and an astonishing lack of knowledge of the language of the enabling legislation. Insert No. 2 [see p. 916] is the response bearing the secretary's signature.

Clearly the Secretary's response was inaccurate. The exact wording of Pub. L. 92-215 states:

The Secretary may upon application of a conditionally designated entity, extend for an additional period of not to exceed 12 months the period of such entity's conditional designation if the Secretary determines that (A) unusual circumstances exist. . .

The conference report accompanying Pub. L. 95-215 (House Report 95-828), to which the Secretary refers in his letter, states:

Such circumstances which might cause the Secretary to make such a determination include but are by no means limited to (emphasis added) the following: -Agencies serving areas that in whole or in large part have had to devote a greater portion of their effort and resources in the first 2 years to organizational development, community involvement . . .

There is a clear contradiction between the Secretary's interpretation of the criterian needed to extend a programs' conditional designation and the conference reports interpretations of those same criteria. The Secretary's letter refers to a "rather specific list" of

unusual circumstances under which an extension would be granted. However, the conference report states that those unusual circumstances, including "community involvement", are by no means limited to that which the report lists. Furthermore, the Secretary's perfunctory reference to the need for public involvement does not do justice to the importance of public involvement in the ultimate success of a regional plan. Nor does his letter demonstrate a legitimate effort on the part of H.E.W. to become familiar with the situation in Fairfield County. Will this misinterpretation of the legislative intent of the law also prevail when citizens are faced with the more serious questions such as decertifying local medical facilities. H.E.W. has requested this committee to grant H.S.A.'s the power to decertify and I think the committee should take a long look at the quality of the administration of existing statutes before granting further powers under Pub. L. 93-641.

Lest any of the committee members incorrectly believe that the public concern in Fairfield County, to which I refer, is merely the uninformed protestations of some local politician, let me recount for the record the following facts.

The HSP for Fairfield County was first released to the public on Dec. 19, 1977 with the vote for final approval scheduled for February 7. At each of the four public hearings held to consider the plan— Jan. 25, 26, 27, and Feb. 2, 1978-well over 200 people attended. In fact, as mentioned in my letter to Mr. Califano, one meeting was closed because the number of attendees exceeded the legal capacity of the meeting hall. The groups in attendance represented diverse interests within the community, however, there was no question as to the commonality of their goal-an extension of time for meaningful public involvement in the plan. In addition to those attending the meetings, several groups in Fairfield County presented their criticism in well-documented written statements, which were submitted to the Southwestern Connecticut H.S.A. By way of example, a critique was submitted to the H.S.A. by the Stamford Area Commerce and Industry Association [see insert No. 3, p. 917].

Furthermore, Mr. Chairman, in response to the community's concerns, the governing board of the region's H.S.A. stated their willingness to participate in workshops in an effort to resolve any differences that might exist concerning the programs goals. Both the sponsors of the program and its critics were in contact with my office and the H.E.W. regional office in Boston. Clearly, a 90-day extension for public comment-which would have been obtained by a better understanding by H.E.W. of the criterian for that extension-would have insured a successful mandate for the regional health plan in Fairfield County. As it stands right now, Mr. Chairman, the public has been frustrated in their attempts to contribute and shape the program to their particular needs. They are concerned that H.E.W.'s apparent misinterpretation of the law as it pertains to extensions, may be an indication of future uncertainties that could result in the decertification of local medical facilities. They now view this well intended program as one more example of arbitrary, government intervention in their lives.

It is indeed an unfortunate situation. Hopefully it is one that this committee can rectify. I would urge the committee to review the provisions dealing not only with the laws regarding extensions of conditional designation, but with any provisions which might allow the public more meaningful participation in the development of their regional health plan. Furthermore, Mr. Chairman, I would urge the committee to scrutinize the potential for misinterpretation in any additional provisions to the law, especially those concerning decertification. Any further mandate to Pub. L. 93-641 must include clear and unmistakable guidelines for the implementation of its goals.

[Testimony resumes on p. 926.]

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