Dr. HESS. We don't want you to take the responsibility too much away from the local areas. Chairman HILL. Well, speaking of that, now, I wish you might have been here yesterday to hear the testimony of Mrs. Hobby, the Secretary of Health, Education, and Welfare, in which she brought out the point that where we have Federal aid in so many of these programs, instead of taking away the responsibility of the States and the local communities, the Federal aid has served as a stimulus and a challenge to get the States and local communities to do much more. For instance, she cited a case of one of the programs yesterday in which, instead of the States and local communities simply meeting the requirements of matching the Federal dollar, the States and local communities were putting up five or six dollars for every one Federal dollar. I really wish that the American Medical Association would set up a committee to study this thing of Federal aid, particularly in these programs that we are now talking about. From the information that I have, we find that instead of Federal aid being used to relieve the State of its responsibility or having the Federal Government imposed upon to meet the responsibility which the State and local community should be meeting, the Federal aid has served, as Mrs. Hobby's testimony showed yesterday, as a stimulus, as an encouragement and a challenge to the States and local communities to do even more. Senator Lehman, do you have any questions? Senator LEHMAN. Yes, I want to ask the doctor a question. The Federal Government has already recognized its responsibility with regard to vocational education in the bill that was passed a number of years ago, of course. It also recognized its responsibility for the rehabilitation of the physically handicapped. I think that the amount that is provided for the purpose of the two pieces of legislation has been entirely inadequate, particularly the rehabilitation of the physically handicapped, which you undoubtedly know much more about than I do. Now, a backlog of over 2 million physically handicapped exists in this country, and that backlog is being increased at the rate of 250,000 a year. We are not only not making any progress in wiping out the backlog, which could be wiped out under certain conditions, but we are allowing the number of the physically handicapped to increase year by year. I was very critical and have been very critical at what I consider the niggardly approaches made by the Congress, on recommendation of the administration, for the development of steps that will help to rehabilitate at least a reasonable number of our physically handicapped. When I made that criticism with regard to the rehabilitation of the physically handicapped and with regard to other medical matters, I always had to face, we have always been faced with the answer, "Well, there is no use having more money because we haven't got the trained personnel. We just can't proceed any quicker than we are given trained personnel or trained personnel is made available." That is always their excuse. I personally feel that, instead of taking care of 50,000 physically handicapped, we could take care of several times that number. 61995-55- -5 I also feel that much could be done in the mental hospitals for mental illness, which, as you know, house over 750,000 unfortunate people and, in my own State alone, I think there are 125,000 housed. Now, there again, when I was critical yesterday at the hearing with regard to the very small and inadequate amount that was going to be included on recommendation of the administration in the appropriation bill, I was again met with the answer, "Well, there is no use giving us substantially more money because we have not got the personnel sufficiently trained." Whether it be therapists, whether it be graduate nurses, whether it be research men, whether it be practical nurses or auxiliary staff, and all those things were discussed, that is always the excuse. "Give us trained personnel and we can proceed faster," and I believe we should proceed faster in matters of health than we have been doing today. Now, you talk about relieving the States of their responsibility, and Mrs. Hobby testified yesterday that when the Federal Government encouraged the States, it always increased the proportion of the funds provided by the State as compared to the Federal Government. She mentioned that for every dollar that the Federal Government provides, five or six dollars are raised by the States. She undoubtedly was dealing with average figures. I believe that in the State of New York, in the case of the mental treatment of the mentally ill, the State is spending 30 or 40 times as much as is provided by the Federal Government. I think I am probably reasonably conservative. I believe that in every field of medicine, the State of New York or the community is providing many, many, many times, not 5 or 6 times, but many times as much as is provided by the Federal Government. I just cannot understand why there should be an objection to the slight extension that is proposed in the bill as a principle that has been recognized as a Federal responsibility for a great many years. I wonder whether you would comment on that? Dr. NAFE. Well, I compliment New York for spending so much on State mental institutions and I believe Indiana in its new program is trying to do the same. Of course, we feel, in Indiana, the tax dollar is the same way that it comes to the Federal Government in Indiana, and I believe we are trying and do take care of our mental groups there and that is the way we feel about this. We feel that Indiana is solving very well this question of the practical nurse and ancillary services or auxiliary services. In fact, recently in my hometown of Indianapolis, instead of going to the Federal or county government to build hospitals, went out and raised $12,500,000 to build hospitals. I believe the community is proud of that. I think it did the community good. It got everybody together. They owned the hospital, and I think that is somewhat the principle. We agree entirely these things be done, but we believe, in Indiana, I am talking about now, that the community should assume some responsibility here and not put the thing, run to Washington for all this money. I think you know something about our State legislature and some of our actions of our chambers of commerce, and others, that we would like to stimulate our people to do this job. That is my personal opinion, and we think that, for instance, as I said before, that much of this must be done at home. And I think that is our feeling in this regard. Senator LEHMAN. Doctor, I certainly do not wish to relieve communities of their responsibility, their initial responsibility, but nobody has suggested that the Federal Government go in and run the hospitals or run the laboratories or run the research departments. I think we have so many bills that I am not entirely certain that I have all the details at my disposal but I believe S. 929 authorizes $5 million for the entire Nation, and that is not an appropriation. There is a lot of difference between an authorization and an appropriation. Now, $5 million spent all over the country is certainly not going to make very much of a dent in solving the problem, or is not going to relieve communities of their responsibilities. But it is at least a further recognition that the Federal Government is interested in these problems and wishes to stimulate the communities. I know that Indiana has been very generous, just as New York State has been very generous, but I have no hesitation in saying, and I speak from experience of having been the chief executive of the State for 10 years, that neither Indiana nor New York is doing their duty to the people. And what we are trying to do is to stimulate locally interest in local initiative. Chairman HILL. Well, gentlemen, we may not agree, but we do deeply appreciate your coming here. I was bold and presumptuous enough to say that I had hoped you would have a committee to study this whole question of Federal aid. I hope you will study it from two standpoints: First, from the standpoint of what a small amount of Federal aid does to stimulate the people back home to do more, to do a much greater and a larger part. The other thing that I think we have to consider today in a way that perhaps we did not in the old days, is the Federal Government's responsibility. When we go to war, we have a selective service. The Federal Government has no citizenship separate and apart from the citizenship back in the different States upon which it can call. You know the story of the many rejections, because of physical disabilities and because of educational disabilities by the Selective Service during World War II and, for that matter, during the Korean war. The Federal Government recognized its responsibility even in the early days and, insofar as education is concerned, before we became a Federal Union, back in 1785 and 1787, we passed the monumental land grant acts, giving great donations of public lands for educational purposes. In fact, if one of you gentlemen happen to be from New Hampshire, I would quote Daniel Webster who said, the act of 1787 was the greatest law of any lawgiver, ancient or modern. I hope you gentlemen will consider this matter a little further, will you? Dr. Hess. I certainly will. Chairman HILL. I tell you, my father was a doctor, my uncle was a doctor, my brothers-in-law were doctors, and I have five first cousins who are doctors. And I want to say this frankly, the doctors in the Second Alabama Congressional District were primarily the ones who elected me to the House of Representatives when I first came to Washington. So I am partial to doctors. Dr. HESS. And they did a good job. Chairman HILL. And I want to find myself in agreement. I think if we could join hands with the doctors, there are many fine things we could accomplish. So I hope you gentlemen will consider this a little further, will you, Doctor? You are going to be the new president of AMA and I heartily congratulate you. Dr. Hess. I would want to make this one comment, if I might, and that is we are constantly studying these problems. We are a very conservative organization, sir. We have to be, and we are very much interested in the very problem that you are interested in; it is just the ways and the means of doing it, and doing it in the best manner. I don't think we are too uncooperative, sir. We disagree, sometimes, on method only, because of our conservatism. Chairman HILL. I did not mean by that, Doctor, to even suggest that. I just hope that, because you are such fine people, we can all be together. I might have added one other step, speaking about so many doctors. I even have the great honor of bearing the name of the great Joseph Lister. Dr. HESS. I understand that. Chairman HILL. I remember that history records when he first began his teachings of antisepsis, they were not too well received by many other doctors and many others outside of the medical profession. So I hope we can sit down together and give this further study and thought together. Dr. HESS. We shall always be glad to sit down with you and talk with you. Chairman HILL. Thank you, gentlemen, and I appreciate you gentlemen coming here. And on behalf of the committee, we express to you our deep appreciation. Dr. HESS. Thank you for your courtesy. Chairman HILL. Thank you. C. L. Greiber, American Vocational Association. Mr. GREIBER. Mr. Chairman and members of the committee, thank you for this opportunity. Chairman HILL. I believe you are the State director of the State board of vocational and adult education, Madison, Wis., as well as representing the American Vocational Association. STATEMENT OF C. L. GREIBER, REPRESENTING THE AMERICAN VOCATIONAL ASSOCIATION AND THE NATIONAL ASSOCIATION OF STATE DIRECTORS OF VOCATIONAL EDUCATION Mr. GREIBER. I am representing the National Association of State Directors of Vocational Education, as well as the American Vocational Association. Chairman HILL. Fine. You may proceed in your own way, please. Mr. GREIBER. Thank you, sir. Practical nurse training is fundamentally a vocational training program. It is a type of apprenticeship through which students in approximately 1 year become trained workers by a combination of full-time school training followed by training on the job supplemented each week by related training in school. The State of California in recognition of the fact that it is primarily vocational training entitles the program "Vocational Nurse Training." The first school for practical nurse training to be financed from public funds was organized in 1919. By the end of 1943 such training was offered on a preparatory basis by the public schools in only 14 cities located in 6 states, 8 in Michigan, 2 in New Jersey and 1 each in Connecticut, New York, Washington, and Minnesota. However, since the United States Office of Education has taken an active interest in the program there has been great development. In August 1954, there were 248 programs under the supervision of the vocational schools, junior colleges, or publicly supported universities. Only three States offered no training in the field-Maine, New Hampshire, and Wyoming. In Wisconsin we have five programs conducted by vocational schools, in Milwaukee, Madison, Superior, Kenosha, and NeenahMenasha. These cities are located in different geographic areas of our State and the programs were established in these centers in order to give the largest spread of training service. The schools, in addition to providing training to residents of the cities in which they are established, attract many students from neighboring communities and rural areas. We have 5 programs, and those 5 programs train approximately 175 practical nurses a year. I have attached hereto a letter from the director of the State board of nursing in Wisconsin, in which she states that a modest estimate of today's need for licensed trained practical nurses is 7,500. There are presently 1,420 licensed trained practical nurses in our State, and, as I said before, our 5 centers train approximately 175 a year, so you can see the need for the expansion of the program to additional organi zations. All of these programs were initiated after community organizations in each instance petitioned for their establishment in order to alleviate shortages of nurses. In one city, Superior, the program was established because hopsitals in the area did not have a sufficient number of trained nursing personnel to meet minimum standards set by the State. Attached are several tables which were prepared by the State department of nurses making a comparison of the need for nurses based on occupancy in hospitals and the numbers who were available for employment at this time. On the basis of that need, which was definitely demonstrated, we established the program in Superior. The chairman of the committee on nursing education of the State medical society, Dr. J. S. Devitt, of Milwaukee, stated his appraisal of the committee's opinion of practical nurse training as follows. He said: 1. The problem is most acute in areas which are poor economically and where there is less industry, as for example, the rural areas. 2. Where shortages exist, these areas should receive assistance to obtain and retain essential personnel and subsidization of faculties for training practical nurses. Practical nurse training is important to the national security and welfare in that it makes available personnel who may assist in times of emergency and disaster. Our national security and welfare are dependent upon a healthy citizenry. Manpower losses which are occasioned by work absences due to illness adversely affect our national economy. Improved health measures which would include more trained nurses would strengthen us in our fight to maintain our freedom. |