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I was very glad to hear the chairman of this committee say that it was your intention either to refer to or include in this hearing that part of the testimony on title I of S. 1606.

Senator PEPPER. Yes. We will let the record show that Senator Donnell and Senator Pepper, the acting chairman of this hearing, have been conferring about the best way to bring together the testimony under S. 1606 relative to this subject embodied in S. 1318 in one hearing, and we are going to let the clerk of the committee make inquiry as to what is the most feasible way of doing that; whether we will have to do it by reference to given volumes of the testimony under S. 1606, or whether we will actually, physically, reincorporate that testimony in this record we will work out.

Owing to the fact that it is not possible to reprint the testimony on maternal and child health in the record of the hearings on S. 1606, it has been decided to publish the names of those who have testified on that bill from April 2 through June 21, 1916. All testimony on maternal and child health in the S. 1606 hearings shall be considered part of the record on S. 1318.

WITNESSES TESTIFYING ON TITLE I OF S. 1606, APRIL 2 THROUGH JUNE 21, 1946

April 2: Hon. Claude Pepper, United States Senator from Florida.
April 3:

Watson B. Miller, Federal Security Administrator.

Dr. J. W. Mountin, Medical Director, United States Public Health Service. April 4: Arthur J. Altmeyer, Chairman, Social Security Board. April 9:

Caroline F. Ware, American Association of University Women.

Dr. Clark Foreman president, Southern Conference for Human Welfare. April 11:

Rev. Jack R. McMichael, executive secretary, Methodist Federation for

Social Service. Dr. Allan M. Butler, associate professor of pediatrics, Harvard Medical

School. April 16:

William Green, president, American Federation of Labor, accompanied by

Nelson Cruikshank, director, social-insurance activities. American Fed

eration of Labor.
Edward H. Weyler, Kentucky State Federatian of Labor.
Mrs. Herman H. Lowe, American Federation of Women's Auxiliaries of Labor.
Dr. W. Montague Cobb, national medical committee of the National Associ-

ation for the Advancement of Colored People.
The American Association of Medical Social Workers.
The American Public Health Association.
American Society for Research in Psychosomatic Problems.
Connecticut Independent Citizen's Committee.
Bowling Green Local 22 of the Farmers' Union.
Girls' Friendly Society, United States of America.

Medical Society of the State of Pennsylvania.
April 17:

Dr. R. L. Sensenich, chairman of the board of trustees, American Medical

Association. Dr. Franz Goldman, Yale University School of Medicine. Dr. George Carrington, Medical Society of North Carolina Committee. Dr. R. C. Kash, Martha Gaston Hospital, Lebanon, Tenn.

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April 18:

Dr. Ernst P. Boas, chairman of the Physicians Forum.
Louisiana State Medical Society.
Dr. Harold T. Low, president, Association of American Physicians and

Surgeons.
Dr. E. I. Robinson, president, National Medical Association, accompanied

by Dr. Paul B. Connelly. April 19: Dr. Edward H. Cary, chairman of the board of trustees, National

Physicians Committee. April 22:

Dr. Vlado A. Getting, secretary, Association of the State and Territorial

Health Officers, and Commissioner of Public Health, Boston, Mass.

Dr. Alice Hamilton, National Consumers League. April 23:

Dr. John P. Peters, secretary, Committee of Physicians for Improvement

of Medical Care. Dr. Carl 0. Flagstad, chairman, legislative committee, American Dental

Association, accompanied by Dr. Alan 0. Gruebbel, secretary of the council on dental health, American Dental Association ; Dr. Harold Hillenbrand, editor of the Journal of the American Dental Association; and George H. Fox, general council of the American Dental Association, and Secretary of the committee on legislation of the American Dental Associ

ation. Dr. Maurice Kaufman, accompanied by Dr. Seymour J. Schoenfeld, secre

tary, dentists committee for the passage of the Wagner-Murray-Dingell

bill. April 24: Beatrice F. Jacobs, chairman of the health and education committee,

the League of Women Shoppers. April 25 :

Hon. Clinton P. Anderson, Secretary of Agriculture.
Charles F. Brannon, Assistant Secretary of Agriculture,
James Patton, president, National Farmers' Union.

Mrs. Jerome Evanson, director of education, North Dakota Farmers Union. April 26:

George . Hecht, president, Parents Institute, Inc.
Dr. T. Duckett ones, American Council on Rheiunatic Fever of the American

Heart Association.
Hazel Corbin, registered nurse, general director, Maternity Center Associa-

tion.

Mary Oxholm, chairman, Spokesmen For Children, Inc.
May 1:

Hon. Lewis B. Schwellenbach, Secretary of Labor.
Dr. Martha M. Eliot, Associate Chief of the Children's Bureau of the

United States Department of Labor.
May 2:
James B. Carey, secretary-treasurer, Congress of Industrial Organizations,

accompanied by Robert K. Lamb, legislative representative of the United

States Steel Workers of America.

Edward F. Poss, grand worthy president, Fraternal Order of Eagles.
May 3:

Gen. Omar N. Bradley, Administrator, Veterans' Affairs.
Fred Bailey, legislative counsel, the National Grange, accompanied by

Lloyd C. Halverson.
May 6:

John H. Hayes, president-elect of the American Hospital Association, ac

companied by George Bugbee, executive director of the American Hospital

Association.
Rev. Alphonse H. Schwitalla, S. J., president of the Catholic Hospital Associ-

ation, accompanied by M. R. Kneifl, executive secretary, Catholic Hospital

Association. May 7:

Rt. Rev. Msgr. John O'Grady, secretary, National Conference of Catholic

Charities.
Hon. Arthur Lewis Miller, a Representative in Congress from the State of

Nebraska.

May 7-Continued

Leonard W. Mayo, chairman, National Commission on Children and Youth,

accompanied by Henry F. Helmsholz, M. D., section on pediatrics, Mayo

Clinic. May 23:

Dr. Ira D. McCoy, Bad Axe, Mich.

George F. Addes, secretary-treasurer, United Automobile Workers, CIO. May 24: Dr. George Baehr, president, New York Academy of Medicine, accom

panied by Dr. lago Galdston, secretary of the committee on medicine and the

changing order, New York Academy of Medicine. May 28:

Dr. Robert L. Benson, Oregon physicians' service, Oregon State Medical

Society.

Dr. A. R. Foss, Montana State Medical Society.
May 29: Dr. George A. Unfug, president, Colorado State Medical Society.
June 18:

Alfred Baker Lewis, president, Union Casualty Co.
Dr. Albert W. Bailey, chairman, committee on health insurance, American

Osteopathic Association.
June 23: Dr. Russel A. Dixon, chairman, committee on education, extension of

the National Dental Association, Mr. GOURLEY. That refers to the subject matter of this legislation.

Dr. A. W. Bailey, osteopathic witness, of Schnectady gave a rather full statement on title I, of S. 1606, on June 18. We subscribe to that testimony as ap art of the record on this bill.

We submit that the basis of the programs under this bill, S. 1318, is that the States are not financially able to carry the full burden, and that the objective is to furnish sufficient funds to enable the States to furnish the services involved. We see nothing in that which indicates a conclusion on the part of Congress or an admission on the part of the States that the States are less concerned over the welfare of mothers and children in their boundaries than is the Children's Bureau, or that the States are less able than the Children's Bureau to qualify the professional and instiutional services involved.

While section 103 (a.) (6), relating to maternal and child health services and section 203(a) (6), relating to services for crippled children, purport to allow the States to determine what doctors and hospitals may participate, and how mothers and children may have choice of doctors or hospitals from among those participating, actually each of these sections contains a joker which vests those powers in the Children's Bureau.

These sections require that all State plans shall “provide such methods of administration as are necessary for the

proper and efficient

operation of the plan."

Who is to determine what is proper and efficient”?

Similar language used in title V of the Social Security Act has been construed by the Children's Bureau as giving the Bureau sole authority to judge what is "proper and efficient" in State plans.

With that understanding of the language employed in this bill, no State would be permitted to prescribe any standard for participation of professional personnel or hospitals, or any method of exercising choice of doctor or hospital by the patient-beneficiary, which does not satisfy the wish of the Children's Bureau as to what constitutes “proper and efficient administration” of the State plan.

Now, in connection with a similar proposition, when the House Committee on Appropriations had under consideration the EMIC pro

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gram, they rendered a report, House Report 450, Department of Labor appropriation bill, fiscal year 1944, and said this:

The States have established standards for licensing health practitioners and the Federal Government has never attempted to establish such standards. In the judgment of the committee, the Children's Bureau has not the power under law either to establish such standards or to question the standards established by the States. It is not the desire of the committee, of course, to permit the use of Federal funds to break down safeguards against the practice of healing arts by improperly and inadequately trained persons, but the committee does believe that the State laws and standards constitute the necessary protection for the public. Therefore, the committee has included in the bill a provision denying the use of the appropriation to promulgate or carry out any order, instruction, or regulation which has for its purpose the discrimination between persons licensed under State law to practice obstetrics.

The committee recommendation was enacted into law and discrimination, so far as obstetrics is concerned generally has been eliminated.

But the spirit of the congressional committee's recommendation has not been carried into the other parts of the program. Discrimination is being practiced in the parts of the program other than obstetrics.

Now, inasmuch as this program is essentially an extension of title V of the Social Security Act and EMIC, it is assumed that the same problems will arise which would call for anti-discriminatory safeguards in this bill, expressly applicable to the entire program. In order to avoid application of the joker provision to which I have referred in sections 103 (a) (6) and 203 (a) (6), with respect to the setting of standards for participating professional personnel and methods of obtaining choice of practitioner or hospital on the part of the beneficiaries, we ask specific prohibitions to the effect that the Chief of the Children's Bureau shall exercise no authority with respect to the establishment of such standards for professional personnel or standards for hospitals, or other participating institutions.

Osteopathic physicians are licensed and practicing in all the States

Senator PEPPER. Are they authorized to engage in obstetrical work in the States?

Mr. GOURLEY. Yes; they are. Some 40-odd States.
Senator PEPPER. Under this bill it is left entirely up to the States.

If they are authorized to do that kind of practice in the States, it is, or is it not?

Mr. GOURLEY. It is not, as I have just indicated, sir.
Senator FEPPER. Very well.

Mr. GOURLEY. They are licensed in all of the States—in most States their license includes obstetrics, pediatrics, and major operative surgery—and they are rendering maternal and child-health service and services for crippled children.

Yet the States may not now use osteopathic physicians and surgeons to render services for crippled children under the Social Security Act, title V, part 2, nor pediatric services under EMIC, because the Children's Bureau will not permit the State officers to do so.

This bill employs the terms “medical,” “physicians," "general practitioner,” “hospital.” In order that mothers and children cared for by licensed osteopathic physicians may not be excluded from the benefits of this act, we ask that wherever these terms are used in the bill they be expressly defined to include osteopathy and licensed osteopathic practitioners and hospitals, within the scope of their practice as

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defined by State law, and that osteopathic representation on the National Advisory Committee under titles I and II be provided for.

Precedent for such specific inclusion is furnished by Public Law 558, Seventy-fifth Congress, relating to treatment and hospitalization of Federal civil employees for occupational injury and illness. That law reads, I quote, as follows:

The term “physician" includes surgeons and osteopathic practictioners within the scope of their practice as defined by State law.

The term “medical, surgical, and hospital services and supplies" includes servives and supplies by osteopathic practitioners and hospitals within the scope of their practice as defined by State law.

Thank you for your attention.
Senator PEPPER. Any questions?
Senator DOXNELL. No questions.

Senator PEPPER. Thank you, Mr. Gourley. We appreciate your giv- . ing us the benefit of the your testimony.

Dr. Eliot. May I submit one more statement?
Senator PEPPER. Surely.

Dr. Elio. Apropos of the last statement that has just been made, I would like to make a statement of the position of the Children's Bureau on acceptance of graduates of schools of osteopathy under our program.

In accordance with its authority under the Social Security Act, title V, parts 1 and 2, and on the advice of its advisory committees on maternal and child health and crippled children's services, the Children's Bureau has not approved State maternal and child health or crippled children's plans that have set a standard for physicians giving care to children lower than graduation from medical schools approved by the Council on Medical Education and Hospitals of the American Medical Association.

By adding provisos to the Department of Lalor Appropriation Acts for the fiscal year 1944 and thereafter, the Congress has restrained the Children's Bureau from setting such a standard of obstetric care and requires that standards for obstetric care be left to the determination of States under State laws.

Some States have continued to set standards limiting the expenditure of State and Federal funds to physicians who are graduates of approved medical schools.

At no time has the Congress taken steps to restrain the Children's Bureau from continuing to maintain its present standards for the medical and surgical care of children, including crippled children.

Senators and Members of the House of Representatives are undoubtedly aware that the best skills the medical profession has should be utilized when Government funds are made available for the care of children with such conditions as infantile paralysis, tuberculosis of the spine or hip, and other serious bone conditions, or for such medical conditions as heart disease, pneumonia enteritis in infants, or for diagnostic and other health measures.

Much has been said about the maintenance of a high quality of care under a Government program.

The Children's Bureau advisory committees have repeatedly given this matter consideration and have recommended that the Bureau hold to its present standard until there is adequate evidence through impartial investigation that graduates of schools of osteopathy or graduates

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