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(2) As to grants-in-aid, Congress is expected to prescribe the pattern, the execution of which would require administrative rather than medical ability.

In connection with grants-in-aid the House of Delegates of the American Medical Association on May 17, 1939, unanimously adopted a report which stated [reading:]

The bizarre thinking which evolved the system of Federal subsidies--sometimes called grants-in-aid—is used to induce States to carry on activities suggested frequently in the first instance by officers and employees of the Federal Government.

The use of Federal subsidies to accomplish such federally determined activities has invariably involved Federal control. (Pt. 2, p. 324, hearings before Senate Committee on Education and Labor, 76th Cong., on S. 1620).

We agree with that conclusion in substance, but so far as we are concerned, the placement of a doctor of medicine in the driver's seat of that Federal control would aggravate the evil involved. We have enough difficulty with lay administrators some of whom hide behind the sanctions of medical advisory committees on which we are denied voice. It took a law of Congress to compel a Federal administrator to permit the States to allow servicemen's wives to obtain obstetric services by duly licensed osteopathic physicians under the EMIC program. That is the Emergency Maternity and Infant Care program. Even today the Federal administrator of that program requires the mother to change to a doctor of medicine as soon as the child is 2 weeks old, otherwise participation in the infant care part of the program is denied.

It is interesting to observe that S. 545, creating a National Health Agency headed by a doctor of medicine, prescribes as the No. 1 responsibility of the Agency [reading]:

the administration of funds appropriated as grants to States for medical and hospital care, dental care, hospital facilities, and all other health activities.

Our second amendment is on page 6, section 5 (b), line 10. After the word "appointed," insert the following:

Provided, That the Secretary shall include among the members of any committee or committees so set up in the field of health, representatives of voluntary organizations of national scope operating in the fields of medicine, dentistry, osteopathy, nursing, hospitalization, and such related fields as the Secretary may determine.

This amendment is also offered to S. 712, page 2, after the word "effective."

Without such clear statement of congressional intent, experience has shown that the osteopathic profession and institutions will be denied a voice on these advisory committees. A current example will illustrate this contention.

When the Hospital Construction Act passed the Senate in 1940 it contained a provision for a national hospital advisory council to consist of eight members [reading]:

selected from leading medical, osteopathic, or scientific authorities who are outstanding in matters pertaining to hospitals and other services.

The Hospital Survey and Construction Act which passed Congress in 1946 dealt with the advisory council in general terms. Result, no osteopathic representative was appointed to the council. Furthermore, a 24-man advisory committee has been set-up to advise the council but there is no osteopathic representative on the committee.

This omission of representation on the council or the advisory committee is not a matter of injured vanity on our part. It has given rise to developments which, if I understand the Legislative Reorganization Act aright, is of peculiar interest to this Senate committee.

Senate Report 674, which accompanied the Hospital Survey and Construction Act as reported by the Senate Committee on Education and Labor in October 1945, stated [reading]:

Questions such as the place of osteopathy in general hospital servicę would be determined by State law.

The report also stated [reading]:

The bill as amended by the committee makes clear that the provision of minimum standards for the maintenance and operation of hospitals shall be a matter entirely for determination by the respective States.

The act as referred to by the committee was enacted into law, approved August 13, 1946, Public Law 725. Yet on February 4, 1947, the Federal agency approved and promulgated Federal regulations which require that base hospitals in order to be acceptable in a State plan must be approved by the American Medical Association. Thus, the Federal agency has imposed minimum standards of maintenance and operation of base hospitals in the States, and has denied the States the right to determine the place of osteopathy in base hospitals. This matter will be more fully dealt with in a separate communication directed to this committee at an early date. Reference is made to these facts at this time as illustrative of the need for express provision for osteopathic representation on advisory committees as proposed in our amendment.

Osteopathic physicians are licensed and practicing in all the States. There are some 200 osteopathic hospitals, most of which render general hospital service. There are 6 accredited schools of osteopathy and surgery, and more than 50 approved interne-training hospitals. Osteopathic physicians and surgeons serve as town, county, and city health officers and on State boards of health. They also serve as physicians to the poor, as school physicians, and as industrial-plant physicians. We submit that the scope of activities of the osteopathic profession and osteopathic institutions sufficiently affects the public interest to warrant assurance of osteopathic representation on advisory committees in the field of health, including health education and health security.

Senator FERGUSON. Then what you really desire is representation rather than to just place laymen in the field? Is that true?

Mr. GOURLEY. Well, our first consideration is representation. We should have a voice, regardless of whether the Administrator is a layman or physician.

Senator MCCLELLAN. How many osteopaths did you say there are in the Nation?

Mr. GOURLEY. Approximately 11,000.

Senator FERGUSON. And about 160,000 M. D.'s, I believe we heard for the record the other day.

Mr. GOURLEY. I think that is right, in active practice. The 1940 figures included active and inactive.

Senator MCCLELLAN. This is in the nature of a controversy between the professions, is it not? You feel that if a medical doctor were appointed as Under Secretary, your branch of the medical field would

be pretty much ignored and would have no voice and no opportunity for expression and helping to formulate policies? Is that what it really amounts to?

Mr. GOURLEY. It requires express provision insuring advisory representation of our profession and the public it serves, regardless of whether the Under Secretary be a layman or any type of physician.

Senator MCCLELLAN. The first thing you want to do is to have the opportunity of making your influence felt in the general set-up is it not?

Mr. GOURLEY. Representation, yes. When a Government body makes regulations which affect the welfare of our patients, both in our private offices and in our hospitals, we ought at least to be consulted; but instead we will wake up some morning and there it is.

Senator FERGUSON. Then you fear the regulation of this agency? Mr. GOURLEY. We have been burned several times.

Senator FERGUSON. That is what you fear? You fear the regulation, and when you say "burned" I suppose you mean that your profession has been interfered with, patients have been taken away from you?

Mr. GOURLEY. That is too true, denying the patients choice of physicians.

Senator FERGUSON. But isn't there a bigger question involved? Isn't it a question of the public health, the welfare of the Nation?

Mr. GOURLEY. We think you can protect the public health without taking prejudicial action against osteopathic patients. We don't think the welfare of the osteopathic patients transcends the welfare of the patients of the other physicians, but we think they are on a par, on an equality. They deserve the same protection and the same consideration.

Senator FERGUSON. But if this medical set-up is to be successful it has to take some stand as to what is advisable in a community. Isn't that true? We will all have to admit that.

Mr. GOURLEY. From the Federal standpoint?

Senator FERGUSON. From either State or Federal.

Mr. GOURLEY. When you get into the States, that raises other questions.

Senator FERGUSON. Well, come back to the Federal. What is the purpose of, let us say, a Cabinet officer for health? What would be the purpose of it? What would he do, in your opinion, and why should we have one?

Mr. GOURLEY. I don't know that you should have one.

Senator FERGUSON. Why should we have a Federal Health Department?

Mr. GOURLEY. Well, you have a Surgeon General in the Public Health Service, now. He has to do with promoting the public health by way of sanitary measures and the protection of streams from pollution.

Senator FERGUSON. He will have to take a stand that "this is unsanitary. This is against the health of the Nation," and by so doing he is going to hurt somebody, isn't he? Take the matter of pollution of streams. Here is some man polluting a stream. Along comes Health and says he can't do that.

Mr. GOURLEY. That is an interstate matter and the Federal Government has the right to do it, but the practice of osteopathy in a doctor's

office is not interstate commerce. And in the EMIC pediatric program, when the Federal Government here says an osteopathic physician is capable of taking care of a serviceman's child for the first 2 weeks under EMIC but is not capable of taking care of the child the next day thereafter, we don't see anything in interstate commerce or any other justification for that. It is regulations such as that that we are talking about.

Senator FERGUSON. That is the regulation today?

Mr. GOURLEY. Yes.

Senator FERGUSON. But that is in the Veterans' Administration. Mr. GOURLEY. No, that is in the Children's Bureau, which would be, as I understand it, under this Department of Health.

Senator FERGUSON. Well, there is such a regulation now?
Mr. GOURLEY. Yes, there is.

Senator FERGUSON. What is the reason assigned for it?
Mr. GOURLEY. That is a long story, Senator.

Senator FERGUSON. It should not be a long story.

Mr. GOURLEY. Congress passed a law saying that there could be no discrimination in the EMIC obstetric program, which the Children's Bureau says includes the maternity period and until the child is 2 weeks old.

Senator FERGUSON. That is not a very long story.

Mr. GOURLEY. No; but that is not all the story. The Children's Bureau takes the position that inasmuch as Congress prohibited discrimination in the obstetric program and did not say anything about the pediatric program, therefore it is all right to discriminate against osteopathic patients in that, and the Bureau instructs and requires the State to do so. It was not such a long story after all.

Senator FERGUSON. No; it turned out to be, even for a lawyer, a short story.

Do you have anything more, Mr. Gourley?

Mr. GOURLEY. No, Senator; that is all.

Senator FERGUSON. Is Dr. Steinkamp here? (No response.)

Has Dr. Skinner arrived yet? (No response.) It will be understood that if Dr. Skinner or Dr. Steinkamp sends a statement it will go into the record.

Our next witness is Miss Smart, representing the Woman's Christian Temperance Union.

STATEMENT OF MISS ELIZABETH A. SMART, REPRESENTING THE NATIONAL WOMEN'S CHRISTIAN TEMPERANCE UNION, WASHINGTON, D. C.

Miss SMART. Mr. Chairman and gentleman, I am Miss Elizabeth A. Smart. My address is 100 Maryland Avenue NE. I represent the National Woman's Christian Temperance Union.

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The National Woman's Christian Temperance Union is one of the oldest organizations dealing with the interests of women and children. We are concerned with the problems of public health, of food and drug administration, education, and the problems of children.

We are glad that these problems are receiving sufficient recognition to be regarded as having Cabinet status.

We feel, however, that in setting up this new executive department.

98634-47-pt. 2-10

there will be found, as a matter of practical application, to be a great many adjustments to be made. We doubt if Congress can in advance and at the present time foresee all of these necessary adjustments.

We think it unwise therefore to make the law setting up the new department too rigid and inflexible.

For this reason, we prefer the Aiken bill, S. 712, to the FulbrightTaft bill, S. 140.

We would also like to point out to an economy-minded Congress that the Aiken bill is less expensive. On the face of the bill it asks for $47,000 as opposed to $51,000. With the implied ramifications of those three Under Secretaries in the Fulbright-Taft bill, we feel the saving will be a great deal larger in the ultimate working out of the plan than merely appears on the face.

Some of the services to be performed are interlocking and economies could be effected by coordinating them without making it necessary to duplicate them in rigidly defined separate compartments.

So we would strongly recommend to your committee the adoption of the Aiken bill, S. 712.

Senator FERGUSON. Is there anything further that you wish to add, Miss Smart?

Miss SMART. There is only one thing, which perhaps is not revelant to this hearing. I did not suppose that S. 545 was under consideration at the hearing. My organization would be opposed to S. 545, for the reason that it would completely absorb the Children's Bureau and the Department of Public Health, which we feel would be a great mistake. We feel that the subordination of children's interests to adult interests is always bad.

Senator FERGUSON. You wish, then, that the Children's Bureau remain with Welfare?

Miss SMART. Well, it would be in these bills included as part of this new Department.

Senator FERGUSON. Where should the Children's Bureau be, in Welfare or in Health?

Miss SMART. I think Welfare would be better. It, of course, deals with both functions, but our main concern is to keep it separate and integrated as a whole, and not absorbed into these adult services, which we feel would militate against the best interest of the children. Senator FERGUSON. Will you just explain the part that you think should be kept in Welfare and what should be under Health?

Miss SMART. Our feeling is that they should not be separated. That is the thing we are opposed to in this new bill.

Senator FERGUSON. If you can't separate it, then, in your opinion, should it be under Health or under Welfare?

Miss SMART. My opinion would be that perhaps Welfare would be the better place to put it, because it covers welfare services as well as health services.

Senator FERGUSON. But don't welfare services cover adults, also, to a great extent?

Miss SMART. Well, our desire is to keep the Children's Bureau as an integrated function, separated from these other services. Now, you ask under which of those services should we then place it? Of course, we realize it would probably have to be attached to one or the other department, and we just have a feeling that perhaps it could

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