PRESIDENT'S HEALTH RECOMMENDATIONS AND

RELATED MEASURES

WEDNESDAY, APRIL 7, 1954

UNITED STATES SENATE,

COMMITTEE ON LABOR AND PUBLIC WELFARE,

SUBCOMMITTEE ON HEALTH, Washington, D. C. The subcommittee met at 10 a. m., pursuant to recess, in room P-63 of the Capitol, Senator William A. Purtell (chairman of subcommittee) presiding.

Present: Senators Purtell and Lehman.

Also present: Senator Matthew M. Neely; Roy E. James, staff director; Melvin W. Sneed and William G. Reidy, professional staff members.

Senator PURTELL. The hearing of the subcommittee will come to order.

Our first witness will be Dr. Charles S. Wise, director, department of physical medicine and rehabilitation, George Washington University Hospital.

Do you have a prepared statement, and is it your intention to read the complete statement or do you wish to summarize it and have the complete statement made a part of the record?

STATEMENT OF DR. CHARLES S. WISE, PROFESSOR OF PHYSICAL MEDICINE AND REHABILITATION, GEORGE WASHINGTON

UNIVERSITY SCHOOL OF MEDICINE

Dr. WISE. I would like to extemporize, if I could.

Senator PURTELL. The complete statement will become a part of the record.

(The prepared statement of Dr. Wise is as follows:)

PREPARED STATEMENT FROM CHARLES S. WISE, M. D., PROFESSOR OF PHYSICAL MEDICINE AND REHABILITATION, THE GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

I should like to thank the committee for the privilege of testifying at the public hearings on the President's health recommendations on vocational rehabilitation contained in S. 2758, H. R. 8149, S. 2759, and other bills related to this subject. My own opinion can best be expressed from three different points of view. First, as a medical educator actively engaged in the teaching of physical medicine and rehabilitation to medical students and graduate physicians. Second, as a practicing physician, director of the department of physical medicine and rehabilitation at the George Washington University Hospital. Third, as a private citizen residing in the District of Columbia, acquainted with the relationships of the local office of Vocational Rehabilitation to our community needs.

The President's program as outlined in his address of January 14 deserves the most emphatic support. As a medical educator, it is apparent to me that one of the most important forces developing in our medical teaching in this country today is the increased emphasis placed on the techniques of treatment of our aging and chronically ill and severely disabled population. Certainly within the next 10 years the majority of practicing physicians will be more fully acquainted with the techniques and means by which disabled people can be returned to employment. Unfortunately, this was not the case during the first half of the century. Medical education during the past 25 years has concerned itself primarily with advances in preventive medicine and the treatment of acute diseases. Although we have a host of medical and surgical specialties in which an increasing percentage of men have become trained in highly skilled techniques, they have limited their work to smaller and smaller segments in the broad needs of medical care.

In this development of what might unjustly be critized as over sepcialization in medical techniques the overall needs of the individual patient sometimes have been overlooked. These needs have been clearly pointed out by such medical leaders as Dr. Howard Rusk of New York, and others. Our "New Look" in medical education is to stress the importance of utilizing cooperative medical specialists in a team approach to consider the needs of any single disabled individual. This is the cornerstone of rehabilitation. In most urban communities there no longer is the family physician who is completely skilled in all the newer medical techniques, as well as all of the social and vocational agencies available in his locality. No single physician can be expected to adequately fulfill the needs of a severely disabled or chronically ill patient. We therefore are employing new teaching techniques in which the team approach is emphasized. With this method a group of medical specialists, together with vocational counselors and representatives of community agencies-such as the Office of Vocational Rehabilitation--confer to survey the needs of a single patient. By utilizing this technique a much more effective solution of many of the disabled patient's problems is accomplished.

Thie trend can be illustrated by our recent experience in teaching medical rehabilitation at the George Washington University School of Medicine. Through the National Foundation for Infantile Paralysis we have received a 5-year grant for a pilot study in the techniques of integrating medical specialties in the rehabilitation of the chronically ill and severely disabled patient. Similar programs are being carried out in 7 or 8 other leading universities. Although the projects have only recently been inaugurated they show promise of establishing a teaching pattern which will have a far-reaching effect.

I point out this detail simply to emphasize the instruction which is currently being planned and will be received by physicians in the future. When our present students complete their training and enter the field of practice they will expect and desire the cooperation of Federal governmental agencies, particularly the vocational rehabilitation agencies, in assisting them with the problems of thier patients. This was not the case 10 years ago. At that time, for example, only 3 percent of the patients coming to the District of Columbia Office of Vocational Rehabilitation were referred by physicians. Today, every student graduating from the George Washington University School of Medicine, as well as from most medical schools, will be more fully acquainted with the resources available in his community. This will place new demands upon the Office of Vocational Rehabilitation, which only can be met by an expanded program as outlined in the bills under study.

Not only is the medical practitioner becoming better acquainted with these needs and the resources available for help, but through radio, television, magazines, and newspapers the general public is becoming better informed. The public's increasing awareness of the newer possibilities is restoration of the severely disabled will result in more demands upon the physician to make available these services. I can say with assurance that every dollar spent on vocational rehabilitation in the proposed legislation not only is necessary, but falls short of our present needs.

As a practicing physician with awareness of many patients who require rehabilitation facilities, it has been my privilege to work closely with the Office of Vocational Rehabilitation and with many related private agencies. This committee undoubtedly has been supplied with the number of potentially rehabilitative individuals requiring these services throughout the 48 States. There is little doubt that we do not now, nor will we in the immediate future, have sufficient funds, facilities or personnel to meet this problem.

As chairman of the Medical Advisory Committee of the local Office of Vocational Rehabilitation in the District of Columbia, I am aware that there are approximately 1,000 clients waiting for services for whom sufficient funds are not available. There are an estimated 7,000 people at present living in the District of Columbia who could be restored to gainful employment. In the past few years about 400 patients annually have been completely rehabilitated in the District of Columbia. It does not require a financial expert to point out what this means in savings, both in public assistance and in releasing other members of a patient's family for employment.

About 2 years ago it was my privilege to be a member of the task force for the Office of Defense Mobilization concerned with the utilization of the handicapped in our manpower problem. During the several months I served on this committee evidence was presented demonstrating the need for various offices of vocational rehabilitation throughout the country to care for the tremendous backlog of disabled patients.

I would have liked to present to this committee a severely disabled patient from the local Office of Vocational Rehabilitation as an outstanding example of what can be accomplished for even the most extreme cases. The patient I have in mind is a 27-year-old Negro man who was born without either arms below the elbow or legs below the knees. All his life he had been unable to walk, and moved around by hopping about on the floor. Despite this seemingly overwhelming disability, he was fitted with two artificial limbs of special design for his legs, and supplied with crutches which he can use with the stumps of his arms. With a brief period of training he was able to be employed, incredible as it seems, as a telephone operator in a local hotel. The young man is now working at the Good Will Industries in some type of gainful employment. Many similarly dramatic stories can be told. These of course are not the runof-the-mill cases. They are the outstanding examples. Innumerable older patients with cardiac disease, arrested tuberculosis, mental and emotional problems, and degenerative diseases, although less dramatic in their effect on the laity, are the bulk of important rehabilitation cases. Our failure to restore these undramatic cases represents one of our greatest losses in human resources. From the viewpoint of the private citizen I should like to point out that the Office of Vocational Rehabilitation is perhaps the sole governmental agency dealing exclusively with the multiple problems of severely disabled and handicapped persons.

As far as recommendations for changes in the present proposed legislation are concerned, I have very few suggestions to offer. Under the new proposed formula for Federal grants to the States it appears that the high income per capita States, which includes the District of Columbia, will receive a proportionately lesser grant than previously had been given. I presume that with an increased overall appropriation this discrepancy would not cut down on the activities of the vocational-rehabilitation agencies in the higher income per capita States. In this regard it is important to note that in these Statessuch as New York, Connecticut, the District of Columbia, California, and others at the top of the income per capita list-are the ones which have the largest number of medical teaching institutions and universities. It is in these schools that the new approaches and studies in the field of rehabilitation, as well as the training of personnel, are being carried out. Diminished grants in these areas would be most unfortunate. Its overall effect would be to stunt the growth of this new and important field at its source.

I should like to place before the committee a suggestion in regard to the section concerning the administration of Federal grants. Under section 5 of S. 2759 it is stated that

"(a) To be approvable under this act, a State plan for vocational-rehabilitation services shall:

"(1) Designate the State agency administering or supervising the administration of vocational education in the State, or a State rehabilitation agency (primarily concerned with vocational rehabilitation), as the sole State agency to administer or supervise the administration of the plan, except that where under the State's law, the State blind commission, etc."

It has been my experience that vocational rehabilitation includes many aspects of education, employment, medical services, combining a multiude of disciplines. A single agency should be responsible for the integration of this multitude of services and the Federal Office of Vocational Rehabilitation raised to a bureau status. Vocational rehabilitation has now come of age.

Giving the Federal Office of Vocational Rehabilitation bureau status would integrate and clarify its services, rather than dividing their supervision between educational agencies, labor, employment, et cetera. The disabled individual would be better served by a single agency with a uniform pattern. If the Federal Office of Vocational Rehabilitation could be raised to bureau status, perhaps State planning could likewise raise the status of their local agencies to become solely responsible for the integration of these services. Under the present administrative plan there is the possibility that one agency or another might allow the responsibility for vocational rehabilitation to become divided among several agencies. This division of responsibility would result in the dispersal and inefficient administration of services to the handicapped individual. Planning for the future an integration of these services under a single Federal office with bureau status and State agencies devoted exclusively to the rehabilitation of the disabled is a necessary and forward step. Dispersal of services through various agencies weakens the entire structure and appreciably lessens the effectiveness of providing rehabilitation services badly needed by many citizens.

In

Other witnesses will appear before you with their recommendations. closing I should like again to express my emphatic support of the legislation under consideration. I cannot stress too strongly that the problem of rehabilitation of our disabled citizens is not to be decided by whether or not it is economically feasible. On the contrary, it is certain that we cannot afford the luxury of wasting our human resources.

From the viewpoint of a private citizen, I should like to point out that the Office of Vocational Rehabilitation is in my mind perhaps the sole governmental agency which deals exclusively with the multiple problems of severely disabled and handicapped persons. In these trying times, when democracy must demonstrate its most important values to the rest of the world, there is no other governmental function which can so dramatically emphasize the respect with which our Government regards the inherent dignity of the individual.

Dr. WISE. Thank you, Mr. Chairman. First, I would like to express my appreciation for being able to appear here before the subcommittee in expressing a few views I have had regarding this legislation under consideration.

First, I want to give my overall emphatic support of the legislation and the program as outlined by the President in his address of January 14, 1954.

I would like to discuss this problem from perhaps three points of view. I am not only a medical teacher and educator but I devote my professional career to the education of physicians and graduate physicians in the field of physical medicine and rehabilitation at the George Washington University Hospital. I am also a practicing physician dealing with the needs of disabled people in this area.

Thirdly, I am also a private citizen of the District of Columbia and I work as a member of the advisory committee of several agencies dealing with the handicapped in this area and, in particular, the local Office of Vocational Rehabilitation.

So, I would like to express my viewpoint from those three phases of my previous experience. I don't know all the information developed so far before the committee, but I think one point that I might just emphasize is the fact that medical education is changing.

For the first quarter of the center or so, the first half of this century, we have developed tremendous new skills and experience in techniques and there have also developed a host of specialties. We have sometimes been accused of being overly specialized. However, this training is necessary because of the techniques involved.

Senator PURTELL. You are speaking of the medical profession as a whole now?