Georgetown University or George Washington University or any of the other hospitals dealing in what we call general beds. I am sure you are aware there will be questions raised on this legislation in executive session and I am trying to clarify the facts. To the extent money is made available under the pending legislation, of course, there will be matching funds required, and I am trying to determine how much of these funds, if they were made available, would be used or could be used in the proposed construction set forth on this sheet. Mr. BUCHER. The answer to that is in the last three columns. The funds requested under this legislation are requested in addition to the Hill-Burton language, and the second column on your sheet is a total column. This means a total grant in aid. The first column is the over-all planned construction cost. Mr. SISK. The first column is $27,340,000. The next column is $6,260,000. $71,000 of Hill-Harris deducted from the $6,260,000 comes to $6,189,000. Are you saying that out of this $40 million they would receive a grant in this amount if this legislation was passed? Mr. BUCHER. Yes, sir. Mr. SISK. Now in line with the discussion earlier, that $6,189,000 will have to be used for extended care or for those types of facilities and not GM and S beds. Mr. BUCHER. Specifically it will be used for the purposes as set forth just to the left of that. It may be extended care facilities or diagnostic treatment, medical center instructional areas, and those which are diagnostic care facilities and the types of facilities and service programs which will keep the patient out of a general acute bed. That is the entire thrust of this. Mr. SISK. I think I have it clear. For the record I want to be sure of exactly what we are talking about. Does anyone else have a statement now? Mr. BUCHER. Dr. Ordman. Dr. ORDMAN. Thank you for the privilege of appearing. My statement was submitted earlier, Mr. Chairman. Mr. SISK. Thank you, Dr. Ordman. I believe we now have Mr. Werble, of the Children's Hospital. All of these statements, gentlemen, have been made part of the record. We have only a very few moments left because of quorum call. Is there anything you wish to add, Mr. Werble? CHILDREN'S HOSPITAL Mr. WERBLE. We have a slightly different problem from the others. I certainly support Dr. Grant's amendment, to make it clear that new beds can be built with this money. We currently have 225 beds we hope to relocate in the Washington Hospital Center. If in the doing of that it becomes wise and prudent and economic for the long term future to add some beds we would like not to be barred from doing that and just replacing 225. I would like to make this comment, too: I do not believe that anyone could win an argument with Mr. Whitener because it is a basic philosophical discussion. I can share some sympathy for the way he feels, however. As the volunteer president of a Volunteer Board we lose each year one and a half million dollars taking care of charity and welfare patients for whom we either get no pay at all or inadequate pay because we operate under an 1870 charter which requires us to give service to anyone who comes to our door without regard to race, creed, color, or ability to pay. We have seen this happen year in and year out. How do we do this? First we go to the community and we raise about $700,000 a year in voluntary contributions. The rest of it comes from unearmarked bequests that people give us. If a bequest is earmarked for some purpose our trusteeship will not spend that on operating expenses, but we are somewhat in the same position here. We have been spending money that should be going into capital funds. These bequests we get should have gone either into an endowment or building fund and we have been taking care of our charity loads. I would like to make one more comment. The idea of the Washington hospitals, all of them that are included, or virtually all of them included in this bill, work on what is known as the regional concept. It is the new concept in the delivery of medical care. The regional concept adds something to medical care. It also takes into account a standard of excellence, a striving for excellence. I am not saying that all hospitals do not give good care but some hospitals do give specialized care. I think Children's veers toward the life and death type case. If anyone troubles to read my seven-minute statement he will see it is pretty much a tear-jerker, but it is not out of bounds. In North Carolina you have two regional centers, one at DurhamDuke and one at Chapel Hill. These centers got funds outside of the Hill-Burton structure. The people in Mr. Whitner's district do go to those centers when they need open heart surgery and they will continue to go there even after their new hospital, I daresay, is built with this $10 million bond issue. Washington is an inusual situation. Every metropolitan center in the country faces the problem of regionalization. Here we face it doubly because of the unique District of Columbia boundary. You can no more run economic quality health care facilities in the Washington metropolitan area without a regional concept than you could run the airports and the seaport of the New York area without the New York Port Authority compact. This is what we are here for. Give me one minute more for the sick kids. We talk about $40 million. If this bill were passed we get $11 million in grants. If we were lucky enough to get the loan authority it would be $22 million. If we sold our current property we would have five. 22 and 5 are 27. There is $13 million shy. Here is a lay board of just interested citizens who are in effect willing to undertake to try to raise, in spite of all that we are told you cannot raise it in the District of Columbia, $13 million. We hope to get it nationally because of this regional concept. We will talk about treating patients, yes, from as far south as North Carolina. By taking a regional approach to the fund-raising we hope we will be able to raise the rest of the money necessary to do a job for the community of Washington. Thank you, Mr. Chairman. Mr. SISK. Thank you, Mr. Werble. (Subsequently, Dr. Werble submitted the following additional information: CHILDREN'S HOSPITAL OF THE DISTRICT OF COLUMBIA, Washington, D.C., June 27, 1968. The Honorable, B. F. SISK, Chairman, Subcommittee No. 5, House District Committee, U.S. House of Representatives, Washington, D.C. DEAR CONGRESSMAN SISK: I hope this supplementary statement can be made a part of the record of your hearing, held June 17, by your subcommittee on HR 6526 dealing with government grants and loans for the construction of hospital facilities in the District of Columbia. As you may recall, I filed a brief general statement, as president of Children's Hospital, and added several moments of oral comment at the tag end of your hearing. Primary purpose of this statement is to furnish additional information on the tabulation of funding requirements, placed in the record by Mr. William M. Bucher, as spokesman for the Hospital Council of the National Capital Area. This tabulation lists the estimated cost of a new Children's Hospital at $22 million. It is based on a figure supplied by our institution to the Hospital Council many months ago when work on this legislation was first initiated. This figure represents our earliest estimate, calculated before we had moved very far into the planning process. According to the latest estimates from the hospital planning consultants we have retained, the figure will be in the range of $30 million to $40 million, probably closer to the latter. This is important because the point was raised during the subcommittee hearings on the willingness of residents of the Metropolitan Washington Area to undertake voluntary action to match government aid in developing and maintaining the kind of hospital and medical facilities that are required for the Nation's Capital and the area that surrounds it. Assuming a cost figure of $35 million for rebuilding Children's Hospital on the Washington Hospital Center grounds, the funds authorized by HR 6526 would provide a federal grant in the order of only $11 million, based on the Hospital Council's tabulation that was made part of the Senate committee report on the companion bill which has been passed. If the House bill is amended to include loan authority, proposed by the Hospital Council and supported by a number of institutions-including Children's, we might become eligible to borrow another $11 million for 50 years at a low rate of interest. This would give us a base of $22 million. To this, we can add an anticipated yield from the sale of our present property-perhaps several mililon. But the difference between this and the $35 million to $40 million anticipated total cost would have to be raised by a vigorous voluntary fund campaign, undertaken in the Metropolitan Area and, hopefully, on a national basis. The raising of $10 million to $15 million is a massive undertaking for the citizens of the community who serve as volunteer members of the Children's Hospital Board. An effort to explain the motivation for this effort was made in my brief prepared statement, already a part of the record. Children's also would like to go on record as favoring the proposed amendment permitting the use of funds for the construction of new beds, as well as the replacement of existing ones. We now have a 225-bed hospital. Our consultants tell us that this number does not permit the most economical operation of a regional medical facility that seeks to achieve excellence in the kind of situations which might mean the difference between life and death. We are advised that a 350-bed hospital may be required for efficient and effective operations. We appreciate the time and thoughtful consideration given by you and the members of your subcommittee to the problem of maintaining adequate medical facilities in the Nation's Capital to serve the surrounding area and region. Sincerely yours, Mr. SISK. Now we have Dr. Burke. WALLACE WERBLE, President. STATEMENT OF DR. F. G. BURKE, MEDICAL DIRECTOR, HOSPITAL FOR SICK CHILDREN (FORMERLY CHILDREN'S CONVALESCENT HOSPITAL) Dr. BURKE. Mr. Chairman, I am Dr. Frederic Gerard Burke, Medical Director of the Hospital for Sick Children, formerly the Children's Convalescent Hospital in Washington, D.C. I appreciate the privilege of appearing before this committee to support your favorable consideration of the proposed legislation (HR 6526) to provide supplemental aid for modernization of hospitals in the District of Columbia. We are particularly in support of those parts of the proposed legislation that identify the needs for extended hospital care facilities. The Hospital for Sick Children, formerly the Children's Convalescent Hospital in Washington, D.C., is the only intermediate stay pediatric facility providing multidisciplinary hospital care for chlidren suffering from a variety of illnesses in the Washington Metropolitan area. The patients admitted to this thirty to ninety day, with extensions, hospital are largely referred from the several acute short stay hospitals in the area. The medical needs and programs for children afflicted with longterm sicknesses are considerably different from those provided in acute short stay hospital units and are the basic therapeutic thrust of our hospital staff. These deal with the important psychologic and sociobehavioral needs besides the medical and surgical ones. The Hospital for Sick Children is now in its 85th year of operation and recently changed its name from the Children's Convalescent Hospital in order to comply with the semantics suggested by the Blue Cross Association in order to obtain a hospital contract with that prepay organization. The word "convalescence" has become associated with nursing homes in current times and ours is a licensed intermediate stay and rehabilitation hospital. Under the Hill-Burton program we are just completing an eighty bed addition to the hospital which will help us meet the extended hospital care needs of this community's small children. Because of shortage of Hill-Burton funds when this building program finally got underway, the modernization and renovations of the older structures and other sharp curtailments of our building plans had to occur. Specifically, the lack of sufficient funds to modernize and replace the old and decrepit beds and facilities resulted in elimination of beds for thirty to forty adolescent children. In addition, the proposed ambulatory and rehabilitation facilities for outpatients suffering from chronic illness was eliminated. It is estimated that approximatley three million dollars will be required to modernize the existing hospital to accomplish this building program. In addition to meeting the specific medical needs of these sick children, with chronic heart, lung, bone and neurologic diseases to name a few, the reduced medical costs and opportunities for training of medical and paramedical personnel must be stressed in a pediatric extended care facility. The costs are generally one-third those of acute short-stay hospitals, a not inconsiderable savings. Pre and post doctoral training programs are conducted for physicians, and nursery, and other hospital aids are trained to help meet the medical manpower shortages in many areas. These training plans will be greatly expanded in our new facilities. The proposed legislation (HR 6526) and (S 1228) would significantly encourage the construction of much needed, low operating cost extended hospital care program for children in this area and I heartily endorse your favorable consideration. Mr. SISK. I am sure there are questions we could ask of you gentle men. Mr. Gude, do you have a question? Mr. GUDE. No, sir. Mr. SISK. I am sorry we had to rush this portion, but I am anxious to get these hearings completed. Your complete statements are in the record, and the Committee can take a look at them. I have great sympathy for the problems you have, and I am hopeful that from all this we can develop something that will be of benefit to the community. I appreciate all of you gentlemen joining together and giving us the expression of your views. I know of the concern Children's Hospital has and I am inclined to be sympathetic to giving you some flexibility. Thank you, gentlemen. The record will be kept open for one week that we may include various material requested, and any other matters received for the record. Also, there will be included in the record at this point certain correspondence sent to Chairman McMillan in support of this proposed legislation. (The matters referred to follow :) HEALTH FACILITIES PLANNING COUNCIL, Hon. JOHN MCMILLAN, Chairman, District of Columbia Committee, DEAR MR. CHAIRMAN: The Health Facilities Planning Council for Metropolitan Washington wishes to make known to your committee its great interest in H.R. 6526, a bill "To authorize project grants for construction and modernization of hospitals and other medical facilities in the District of Columbia.” This proposal is identical in substance with H.R. 15070 in the 89th Congress. The Senate District Committee held hearings last year on the companion bill, S. 2622. By letter of January 8, 1966 and again in an oral statement at the hearings, the Planning Council strongly supported this urgently needed measure. As did its predecessor, H.R. 6526 embodies the Administration proposals for supplemental aid for modernization of hospitals, and for modernization and construction of other types of health facilities in the District of Columbia. To qualify for such supplemental aid, projects would have to be approvable under construction aid programs the Hill-Burton program, or the Mental Retardation Facilities of the Mental Health Centers Construction programs. Supplemental aid would be conditioned upon such approval or the denial of approval upon the sole ground of insufficient funds under the District's allotments under those programs. The proposed legislation grew out of growing concern for the pattern of special aids for individual hospital construction projects in the District-under the Washington Hospital Center Act of 1946 and later extensions and amendments of that Act. This pattern arose because the ability of District sponsors to raise |