Plans and specifications for security facility---- Total increases_-_ Decreases: Estimated cost of program statement for security facility__ Total decreases_ Total net change requested----- 450,000 1,688, 000 2, 138. 000 25,000 1,952, 000 1,977,000 +161,000 EXPLANATION OF CHANGES The net increase in appropriated funds is due to the lower estimated cost of facility improvements proposed for 1967, as offset by the higher cost of security facility plans and specifications over 1966 program statement funds for this project. NARRATIVE JUSTIFICATIONS This appropriation account covers the construction and facility improvement programs of St. Elizabeths Hospital. Projects for which funds are requested in fiscal year 1967 are set forth under the following activity headings: Miscellaneous improvements of existing facilities__. Fiscal year 1967 appropriation request_‒‒‒‒ MISCELLANEOUS IMPROVEMENTS OF EXISTING FACILITIES $1,688, 000 450,000 2, 138, 000 Funds requested under this activity heading are required for the following projects, all of which are part of a continuing program of restoration and modernization of existing hospital facilities: 1. Rewiring and extension of electrical facilities__ 2. Screening in patient buildings__. 3. Plumbing and heating modernization and improvement.... 4. Replace and increase capacity of hot water generating system. 5. Employees' locker room improvement program__ 6. Planning study of W. W. Eldridge Building (medical and surgical facility). 7. Increase fuel oil storage capacity- 8. Replacement of "R" Building elevator___ 9. Extend and improve electrical clock systems.. 10. Telephone cable extension___. $592, 000 50,000 602, 000 15,000 15,000 An amount of $592,000 is requested in 1967 for the hospital's continuing program of replacement, extension and modernization of basic electrical facilities. The circuitry and fixtures in several buildings fall far short of meeting the demands placed upon them by modern medical equipment. In certain of the patient buildings, surveys indicate that lighting is less than one-fifth of the amount required for the performance of normal household tasks. Conditions such as these have a direct and adverse effect upon the treatment, safety and morale of patients at the hospital. Funds authorized for the current year will provide for improvements to the primary underground distribution system which links the various transformer vaults with the hospital's main substation. Funds requested for fiscal year 1967 will complete the linkage in several areas by improving the lighting and circuitry in the buildings themselves. Screening in-patient buildings The replacement of wooden-frame, household-type screening in patient buildings with heavy duty, all metal screens, removable and operable from the inside, is a continuing program. An amount of $50,000 is requested for the fourth increment of this multiyear program in fiscal year 1967. In addition to reducing maintenance costs and providing greater resistance to patient abuse, installation of the new screening will provide greater security and more adequate insect protection. Plumbing and heating modernization and improvement Funds requested for this project represent the third increment of a continuing program of replacement, improvement and modernization of the plumbing and heating facilities of the hospital. Plumbing in many of the buildings of St. Elizabeths, particularly in the older facilities, is grossly inadequate and substandard. There exists, among other things, a need for improved and expanded toilet and bathing facilities, elimination of cross-connections and submerged inlets in existing systems, and correction of deficiencies in drain services. In addition, there exists a need for correction of heating system deficiencies in a number of buildings, involving principally the replacement and overhaul of steam service and return lines. In either case, spot repairs have proven inordinately costly and disruptive. Accordingly, the hospital has undertaken this program on a building-by-building basis. Based upon currently acceptable standards and probable future patient load projections, the total cost of the project is estimated at slightly over $3 million, of which $365,000 was provided in 1965, $485,000 in 1966, and the remaining $2,150,000 proposed to cover a 5-year period. The 1967 increment of this project is estimated at $602,000. Replace and increase capacity of hot water generating system An amount of $15,000 is included in the 1967 request for the third and final increment of improvement in the hot water generating facilities on the hospital grounds. Work under the 1967 phase of this program will improve service in nine patient buildings, the hospitals' laboratory, carpentry shop, Red Cross building and laundry-warehouse building. Interruptions of hot water service to vital areas and inefficient use of steam in the heating process are inevitable unless this project is carried through to early completion. Employees' locker room improvement program An amount of $15,000 is included in the budget for the second phase of a program of refurbishment and improvement in employee locker room areas. Locker facilities are required for over 3,000 employees who wear prescribed uniforms or whose duties make necessary the wearing of work clothes while on duty. Although some locker facilities exist, most are grossly inadequate in size and obsolete by any reasonable standards. The hospital has started action to correct the most deficient areas with funds appropriated in 1966 and proposes to extend the remedial work to two additional buildings in 1967. Planning study of W. W. Eldridge Building Funds in the amount of $225,000 are requested for the development of a program statement and the preparation of plans and specifications leading to a construction contract for the modernization and refurbishment of the hospital's medicine and surgery facility (W. W. Eldridge Building). Current and probable future patient load estimates indicate a continuing need for a medical and surgical installation of the approximate size and capacity of the present facility. The present building is structurally sound and has a substantial remaining useful life despite the fact that it is 35 years old. Considerable refurbishment and modernization are necessary, however, if the structure is to be made functionally adequate for the proper practice of modern-day medicine. The study and planning phases covered by the 1967 budget request will (1) determine the type and extent of improvements required, (2) determine the proper phasing and coordination of required improvements in order to insure completion in the most economical manner and with the least interruption of patient treatment activities, and (3) provide design and working drawings upon which cost estimates and requests for construction funds can be developed. The planning study will consider such items as air conditioning, replacement and relocation of the surgical suite, modernization of bed space and nursing units, and improvements in outpatient facilities, emergency rooms, intensive care units, recovery rooms, nurses stations, pharmacy, visiting rooms, lounges, elevators and utilities. Increase fuel oil storage capacity Funds in the amount of $59,000 are requested for expansion of the fuel oil storage capacity at the hospital's powerplant. Approximately 1,400,000 gallons of fuel oil are used each year for operation of the recently renovated oil-fired boilers. At present, storage capacity is limited to 40,000 gallons, an amount sufficient for only a 2-day reserve at winter usage rates. Inclement weather or other unforeseen events could disrupt the already tight delivery schedule and result in the shutdown of a substantially large portion of the hospital's steam producing capacity during cold weather, with serious consequences for heat and hot water services. The hospital proposes to augment its present complement of two 20,000-gallon oil tanks with a third tank of 100,000-gallon capacity. thereby increasing the total reserve to 140,000 gallons, or a 7-day supply at winter usage rates. The funds requested will also provide for necessary pumping equipment, connection with the present fuel system, and fire protection. Replacement of "R" Building elevator The hospital requests $67,000 for replacement of the elevator in "R" Building, a structure which houses psychiatric patients who have chronic or long-term ailments. The present elevator is over 40 years old, barely marginal in safety and costly to repair, due to the fact that replacement parts must be custom made at considerable cost. Regular maintenance at least once a month is imperative and recently this installation has averaged at least two shutdowns a week for repairs. The cost of renovation would approach that of a complete replacement and still not provide the advantages of a new elevator. Continued use of such an unreliable installation in a patient building is undesirable. The proposed new unit will have the same capacity and dimensions as the old elevator, and will utilize the existing shaft and door openings. Extend and improve electric clock systems The sum of $18,000 is requested in 1967 for the purpose of replacing and adding to the existing centrally controlled and regulated clock systems in three hospital buildings. One of the existing systems is obsolescent, difficult to maintain and costly to repair due to the unavailability of necessary parts. The two remaining systems fail to provide for clocks in many areas for which experience has proven a need. The hospital has found that centrally controlled units are more efficient and generally more economical to maintain, particularly in view of the fact that many clocks which would normally require setting are located in locked wards. The extended and improved clock systems would be capable of correcting themselves automatically for periods up to 1 hour, and could be centrally controlled for greater periods of time. Telephone cable extension An amount of $45,000 is requested for the provision of approximately 2.500 cable feet of additional internal telephone system trunklines. The additional cable will make possible the expansion of the hospital's internal telephone system which has proven an invaluable asset in terms of economy, efficiency, security and added safety, particularly in the reporting of fires. The fire alarm feature makes it possible to summon help immediately by the dialing of 2 digits from any of 2,000 extensions. The amount requested provides only for installation and connection of the cable itself. Telephone instruments would be obtained either from existing inventory, or purchased as needed from equipment funds under the "Salaries and expenses" appropriation. SECURITY FACILITY An amount of $25,000 was appropriated in 1966 for the development of a program statement leading to the construction of patient treatment facilities having appropriate security features. The hospital in 1967 requests, as the second phase of this project, the sum of $450.000 for the development of plans and specifications for the proposed new facility which will (1) serve as a replacement for two antiquated patient treatment buildings constructed in 1879 and 1899 and (2) provide adequate housing for prisoners and other patients requiring treatment and care under security conditions. The number of patients in St. Elizabeths Hospital requiring treatment under security conditions is well in excess of the number that can be accommodated in the 396 beds of the John Howard Pavilion, the present (and only) maximum security building. As a consequence, there are a substantial number of "prisoners" as well as disturbed and potentially assaultive civil patients housed in quarters in several areas which lack the security and other facilities necessary for proper treatment. During the past year or so, the problem of "prisoner" patient escapes has been a matter of grave concern to the hospital, the public, and to the Congress. Considerable effort has been made to determine the causes of such escapes. Although a variety of factors contribute to the situation, the lack of proper facilities has been found to be an important cause. Deficiencies in the physical plant tend to increase patient elopments in two ways. First, there are the obvious problems when "prisoners" and other disturbed patients must be housed in areas lacking proper security facilities. Such areas offer far easier prospects of escape. A second and most important way in which poor facilities aggravate the elopment problem is the psychological effect of forced relocations, that is, the need for transferring patients to other ward areas to accommodate new admissions. Under present conditions, it is necessary to move patients out of John Howard Pavilion into less secure wards as soon as medical judgment indicates that they are no longer maximum security risks. This practice, dictated by space shortages rather than therapeutic considerations, interrupts the patient's treatment just as he begins to respond satisfactorily, and forces him to adjust to new staff and surroundings. On occasion, the impact of such a change can cause a regression into the patient's former disturbed state. The ultimate cost and size of the project will be affected by the findings of the program statement, which will define more sharply the exact role of the security facility in its relationship to existing hospital structures and programs. The hospital believes, however, that the total cost of the project (including the program statement and planning funds) will be approximately $9,125,000. Authorization of the $450,000 requested in fiscal year 1967 will enable the hospital to move forward without delay with the planning of a facility which will provide greater safety for its patients and the public, replace obsolete treatment buildings, and provide the best in curative treatment for an area of mental illness that constitutes a major social problem of the time. WEDNESDAY, MARCH 9, 1966. SOCIAL SECURITY ADMINISTRATION WITNESSES MR. ROBERT M. BALL, COMMISSIONER MR. JACK S. FUTTERMAN, ASSISTANT COMMISSIONER, OFFICE OF ADMINISTRATION MR. HENRY A. CROOKS, DIRECTOR, DIVISION OF FINANCIAL MANAGEMENT MRS. MILDRED L. TYSSOWSKI, BUDGET OFFICER MR. JAMES B. CARDWELL, DEPARTMENT DEPUTY COMPTROLLER |