It should also be specifically encouraged to expand its own program-that is, the State-so that its reliance upon the Federal share will steadily decrease; and it is my belief that the States will be encouraged to adopt this latter course provided they are not discouraged by a sudden and immediate curtailment of the basic Federal support, which we believe we foresee in this formula.

Thank you very much.

Senator PURTELL. Thank you very much, Congressman.

I can see your State has an outstanding record in this field, as it has in many other fields.

Mr. WARBURTON. We are very proud of it.

Senator PURTELL. And I can assure you the suggested formula will be very closely examined and reexamined.

Mr. WARBURTON. Thank you, sir.

Senator PURTELL. I want to thank you on behalf of the committee for appearing before us and helping us.

Senator Lehman.

Senator LEHMAN. I have no questions. I just want to thank the Congressman for his very good statement.

Mr. WARBURTON. Thank you, Senator.

Senator LEHMAN. I think the figures on page 3, giving the Federal grants in comparison to the State grants and the series of years and the projected result of the new formula, are most interesting. Senator PURTELL. Yes; they are.

Mr. WARBURTON. We attempted, sir, to use those as an illustration of the one danger we are concerned about. We are just concerned that a depreciation will immediately result that we, ourselves, are not able to pick up; and I might point out in that respect over the period of years since 1939, at which time we started with a Federal grant alone, plus private contributions, of $5,000-that is, $5,000 from the Federal Government at the beginning of the program-we have had a general steady average of the Federal amount depreciating while the State amount rose, you see, but we can't take over a tremendous sudden increase on the part of the State immediately and we don't know when we would be able to do so. It is a question of a gradual working up to that point.

Senator PURTELL. Your testimony shows you may be proud of the tremendous job you have done in this rehabilitation field.

Mr. WARBURTON. Thank you, sir.

Senator PURTELL. And certainly we don't intend to do anything to interfere with that work you are doing.

Mr. WARBURTON. I appreciate that, Mr. Chairman, and I appreciated it from the remark the chairman made to my distinguished friend, Mr. Potter of Michigan, a few minutes ago when he indicated that is not the intention of the committee, and we certainly appreciate it is not.

Senator PURTELL. Thank you for coming.

Mr. WARBURTON. Thank you, sir.

Senator PURTELL. Our next witness is Mr. Walter J. Mason, member of the national legislative committee of the American Federation of Labor.

We are very happy to have you with us this morning, Mr. Mason.

STATEMENT OF WALTER J. MASON, MEMBER OF THE NATIONAL LEGISLATIVE COMMITTEE OF THE AMERICAN FEDERATION OF LABOR, ACCOMPANIED BY DR. O. ANDERSON ENGH

Mr. MASON. Mr. Chairman, my name is Walter J. Mason, member of the national legislative committee of the American Federation of Labor.

Senator PURTELL. May I interrupt a moment?

Is it your intention to read a complete statement or do you wish that to be inserted in the record and summarized?

You may do whichever you wish to do.

Mr. MASON. I prefer to read the statement, Mr. Chairman, because we are very much interested in the subject.

Senator PURTELL. We are very happy to have you read the statement.

Mr. MASON. I have here with me, Mr. Chairman, Dr. Anderson Engh from the Anderson Rehabilitation Center in Arlington, Va. Because of Dr. Engh's wide experience in this field and the splendid work that he has done in rehabilitation, I thought he might be of help to the committee. However, we requested time for him and I understand you have a full schedule today. So I agreed to allot part of my time to him, if it is agreeable to the committee.

Senator PURTELL. Then you would like to have the doctor testify now?

Mr. MASON. He will only take a few minutes.

Senator PURTELL. We will be very happy to have him testify whenever you wish.

Mr. MASON. I think you could testify first, if you will.

Senator PURTELL. Doctor, we would like to have you testify.
Dr. ENGH. I thank you for the opportunity to testify.

I am an orthopedic surgeon, which means I do bone and joint work. I have been in this field for about 20 years.

I haven't prepared any definite statement. I made a few notes today. After listening to my two predecessors here, I feel it would be unnecessary for me to state some of the things that I had planned to say.

In orthopedic surgery, we deal with bone and joint disturbances. We also handle the polios and the spastics and those people injured at work, people injured in automobile, airplane accidents, and take care of congenital deformities.

So, you see, we are dealing with a great group of individuals which require rehabilitation. However, my interest is a little greater than

that.

About 14 years ago I bought 4 acres of ground across the river over in South Arlington. I bought it because I felt that I wanted to do a little rehabilitation. My interest in that has grown. About 3 years ago the people in our area, with free labor and materials, built a hospital.

Yesterday we had ground-breaking ceremonies for a large addition, which will be called the rehabilitation addition. That addition will be probably twice as large as our present hospital and it will be five stories in height and will be in the shape of a Y.

That also is being done with free labor and materials. The labor is going to be given to us through the Trade Council of the American

Federation of Labor, and we are very happy of their interest and the support people give.

I am also interested because I am the orthopedic consultant for United States Public Health in this area, and we get many patients who are compensation cases, and they in many instances require rehabilitation.

I am particularly interested because we are doing a pilot plan study for the Bureau of Employees' Compensation, which deals with civilservice employees. That is being done at this present time.

We are learning a great deal from this pilot plan study.

We felt that a pilot plan study in a demonstration area was necessary in order for us to come to some real conclusions concerning the value of rehabilitation.

I wish to state that rehabilitation in our experience in this pilot plan study is proving of real value.

We feel that money should be expended for rehabilitation.

We can see some faults in it, but the advantages of it are very great. There is no question about the economic advantages.

I want to pose some problems that come up to us, and I am sure will come to the legislators, concerning these bills.

When I speak of the orthopedic disabilities, which are tremendous in number, I am not even taking into consideration many other disabilities. For instance, the cardiacs make up a large number of patients. The arthritics are probably twice as many as the cardiacs, and I would say they go into many thousands, probably millions.

If you want to put your psychosomatic cases in that group, you are going to have many, many more.

So, if you see you are going to do rehabilitation completely, you have something which is very expensive, and it is unlimited. It will require constant expansion in the future, so that it means you must use good judgment in any appropriations that are made.

I feel there must be an increase in appropriations, however. Now, when we attacked this problem over at the Anderson Orthopedic Hospital or the Anderson Orthopedic Rehabilitation Center, we felt we should draw up some plans for the future as to what would constitute the best type of rehabilitation program, and I made these

notes:

That a rehabilitation center should be nonprofit.

It should be a chartered and incorporated institution in the State or the District of Columbia.

It should be a combination of outpatient hospital, domiciliary, and vocational or trade-school components.

By outpatient, I mean patients who are coming in that can be rehabilitated. They naturally won't cost as much as the patients who have to be hospitalized.

Hospitalization is very expensive. You can't rehabilitate many patients who have to be hospitalized. Only those who are most seriously involved should be hospitalized.

Therefore, I recommend a domiciliary type of care and there is no reason in the world why many of these patients can't receive domiciliary care, which is much cheaper. That can be done on a cooperative basis. Many of those patients can help themselves. Many of them could go to the cafeteria. Many of them can help the patients who are receiving hospitalization.

In

I also included in here the vocational section or trade school. our plan at the Anderson Rehabilitation Center one wing of that Y will be used as a trade school. Now, you probably wonder why you should have a trade school linked with a hospital in doing rehabilitation. Well, it is from the standpoint of economy. In the trade school you ought to have normal individuals—in fact, the preponderance of normal individuals-so that your handicapped patient can get the benefit of it. If you don't do it that way, the cost of taking care of those handicapped patients is going to be tremendous, because you will need a large number of instructors; you will need a large amount of equipment.

I would say that to run the program properly you would probably need 200 to 300 outpatients; you would need about a hundred inpatients requiring domiciliary care or hospitalization, and you ought to have a trade school in which you have 300 or 400 people.

This trade-school idea arose at the Woodrow Wilson Hospital in Staunton, Va. I think it is a good one. We feel it would be better placed in a metropolitan area because many of the patients don't care to travel 160 miles away. I don't mean to criticize Woodrow Wilson Rehabilitation Center because I think it is an excellent center of its particular type, but I believe a rehabilitation center is better located in a metropolitan area because that is where you can have a trade school. You have ease with which your outpatients can get to it. You get the satisfaction of the families of the individuals. It is hard to get people to go 150 to 200 miles away from their home. So, I feel that combination of outpatient hospital, domiciliary care, and trade school is essential for doing it at a reasonable rate. I feel that volunteeer functions are important.

Now, in what we have over there at the Anderson Orthopedic Rehabilitation Center we have the entire community interested. I am sure you can appreciate that because we would have never had the hospital built with free labor and materials unless we had the wholehearted cooperation of the community. They provide transportation. They help in the rehabilitation center. In fact, our women's auxiliary, the Gray Ladies, the Red Cross, and others offer help in rehabilitation which cuts the cost down tremendously.

I feel that the hospital should be approved by a board of accreditation.

Now, our hospital is approved by such a board. It isn't wise to try to run any rehabilitation project unless you have accreditation by accepted groups, such as the American Medical Association and others.

I feel the rehabilitation center should be designed to rehabilitate all types of patients.

At the present time we are rehabilitating orthopedic patients. I feel that is very uneconomical. For that reason, we are going to take all types of patients into our center.

Now, I frequently mention our own center. From what I have described, it probably would appear to you that we are very well satisfied the way things have been going. We are satisfied, except for this problem: There are many patients who require rehabilitation, for which there is no money for their room and board.

Now, we are willing to do free work for patients who can't afford it. We feel, however, that the doctors who do that type of work can't do all free work and there must be some agencies that should pay the doctor for work which is not given to indigent patients.

Specifically, we need some money to be able to pay the room and board of patients who come in... We would like to be able to do more than we are doing right now.

For the Bureau of Employees' Compensation we are taking in 4 patients at the present time. The Bureau of Employees' Compensation couldn't afford to send in more patients.

There has to be an appropriation somewhere to do this job right. I would like to request that the committee give some consideration to using the Anderson Orthopedic Center as a pilot-plan study. I think we are deserving of it because we have not asked the Government for any money in the past. We have proved we can do the job in an economical manner.

We feel you need a pilot-plan study so you can proceed with some of the needs in rehabilitation in the future. There is a great deal to be learned from a pilot-plan study.

Senator PURTELL. May I interrupt a moment, Doctor?

Unfortunately, official business requires my presence elsewhere, so I must leave; but I assure you all the testimony will be very carefully read and digested by all members of the committee. Others members of the committee are at other meetings, I am sure, this morning.

So I am going to turn the meeting over to my colleague, Senator Goldwater, from Arizona.

Senator Goldwater.

Dr. ENGH. I would like to suggest the use of the Anderson Rehabilitation Center as a demonstration center or pilot-plan center for other reasons. In this area we have the Federal Office of Vocational Rehabilitation. They can keep their eye on what is being done. They can advise us.

In this area we have the Federal offices of the American Federation of Labor and, as I said before, the American Federation of Labor is intensely interested in what is being done. They can also help us and advise us in our problem.

In this area also we have United States Public Health and I feel that United States Public Health has an interest in what is being done.

The fact that we are located only 15 minutes away from the Capitol will make it possible for all these agencies to give reasonable consideration to the value of a pilot-plan study.

Now, as I have said before, this may appear selfish on my part in asking it, but I feel I am justified that by virtue of what we have done in the past and anything that we do over there is essentially for the purpose of making rehabilitation work better.

I thank you.

Senator GOLDWATER (presiding). Do you have any questions, Senator Lehman?

Senator LEHMAN. May I express my regret that I have to leave to attend another meeting. I would like to hear the other witnesses, but I simply have to get to this meeting.

I assure you I will read your testimony with a great deal of interest.