PRESIDENT'S HEALTH RECOMMENDATIONS AND RELATED MEASURES THURSDAY, MARCH 18, 1954 UNITED STATES SENATE, COMMITTEE ON LABOR AND PUBLIC WELFARE, SUBCOMMITTEE ON HEALTH, The subcommittee met at 10:08 a. m., pursuant to recess, in room P-63 of the Capitol, Senator William A. Purtell (chairman of the subcommittee) presiding. Present Senators Purtell (chairman of the subcommittee), Goldwater and Hill. Also present: Roy E. James, staff director; Melvin W. Sneed and William G. Reidy, professional staff members. Senator PURTELL. The subcommittee meeting will come to order. Our first witness this morning is Mr. George Bugbee, executive director of the American Hospital Association. Mr. Bugbee, we are very happy to have you here to help us with this matter under consideration. I would like the record to show that Senator Cooper is at the meeting of the Armed Services Committee and, therefore, couldn't be here. Senator HILL. I think Senator Lehman will be here shortly. He is trying to get here. Senator PURTELL. And Senator Goldwater we expect here shortly. We would like to have you start, Mr. Bugbee, if you would. STATEMENT OF GEORGE BUGBEE, EXECUTIVE DIRECTOR, AMERICAN HOSPITAL ASSOCIATION Mr. BUGBEE. Senator Purtell, I have a rather extensive statement. I will read as rapidly as I can. I have tried to keep it as brief as possible and still cover the points. As a representative of the American Hospital Association, I wish first to express our appreciation for an opportunity to discuss with you the amendments to the Hospital Survey and Construction Act. The American Hospital Association and the 5,500 member hospitals it represents are interested in the health of the American people. They have joined together to make the highest possible quality of care available to all the people. care It became obvious to us many years ago that the kind of health ca available to any segment of the population was directly related to the availability of hospital services. The hospital is fundamental to the modern practice of medicine and is the means by which the advancements of medical science can be brought to the people. Further, the establishment of standards and controls by the medical profession which are essential to the welfare of the people are best attainable within hospitals. Thus, the exist ence of good hospitals makes for better medical care and the absence of hospitals may result in very limited or no medical care. The lack of hospital facilities in many areas of the country is a serious deterrent to meeting the health needs of the people residing there. It was with this background of thought that the American Hospital Association adopted the position that Federal funds were necessary to assist in providing hospital facilities in needy areas. A mechanism of providing Federal funds on a matching basis to the States was visualized. Therefore the active support of the Hospital Survey and Construction Act by this association was a natural consequence. Senator HILL. Mr. Bugbee, may I interrupt you there? Mr. BUGBEE. Yes. Senator HILL. You speak of your support of that act. I think you are very modest. You and I know the inspiration which you gave, the thought you gave, to bringing that act into being, and, of course, you recall how you sat in day after day and week after week with Senator Taft and myself and other members of the subcommittee as we wrote that legislation. You, along with the representatives of the Public Health Service, sat right in our executive session when we were trying to write that act, and get the best act we could. Mr. BUGBEE. I appreciate, Senator Hill, that recognition of the fact that we have followed it very closely, and it gives me an opportunity to express our appreciation of the time and effort that you have given to the act, too, through the years to make it an effective program. In general, we are highly pleased that past operations of the hospital survey and construction program have so warranted public support through accomplishments under the act that additional expansion is recommended. We believe the proposals embodied in S. 2758 are constructive in character. We are appearing before the committee to raise certain questions which occur to us and to suggest technical changes which we think might more satisfactorily accomplish the objectives of the sponsors of S. 2758. Representatives of the American Hospital Association have regularly had opportunity to appear before this committee in regard to hospital construction grants, this being the 13th time we have been privileged to present testimony on the subject before a congressional committee. The Hospital Survey and Construction Act was studied at length and substantially revised by a special subcommittee of the Senate Committee on Labor and Public Welfare. It was passed almost unanimously by the Senate on December 11, 1945. We would like to quote very briefly from testimony in March 1946 on the Senate bill before the House Interstate and Foreign Commerce Committee. What was said then is equally true today. The American Hospital Association is concerned with this act because it will vitally affect our own field of humanitarian endeavor. We were one of the first organizations to offer our support to this legislation, and we have followed its legislative progress closely, because we are keenly aware of the need for the additional hospital facilities that may be provided under it, while on the other hand we are apprehensive of the dangers involved if this program is not wisely and carefully carried out. The Hospital Survey and Construction Act proposes Federal grants-in-aid to assist the States to build hospitals and health centers in communities and areas where they are most needed. The nationwide program is to be under the general supervision of the Surgeon General of the United States Public Health Service, who will consult with a Federal hospital council of experienced hospital authorities in establishing overall standards and regulations, and in approving State construction programs. The administration of the program in each State will be carried out by authorized State governmental agencies. The program has two purposes-first, to inventory existing hospitals and survey the need for additional hospitals and develop programs for the construction of such public and other nonprofit hospitals as will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate hospital, clinic, and similar services to all of the people, and, second, to construct public and other nonprofit hospitals in accordance with such programs. In other words, the design of this legislation is to develop an integrated system of hospitals and health centers that will make these facilities more readily available to an increased number of people, especially to serve rural or needy areas. The program is thus directly related to the health and welfare of the Nation. * The success of this Federal program is a direct result of the care with which the original legislation was drafted to insure certain principles were followed. Intimately concerned with the revision of the legislation in the Senate committee were Senator Lister Hill of Alabama, a sponsor of the legislation, and the late Senator Robert A. Taft of Ohio. Senator Taft's particular contribution to this legislation, much of which he personally rewrote, related to the specific delineation in the act of the intent of the legislation with a minimum granting of latitude to the Federal administrative agency for the interpretation of congressional intent. Second, he was insistent that within the carefully spelled out purposes of the act that the States be given maximum administrative authority. Further, the requirements that the States were to comply with in order to be granted funds by the Federal Government were clearly stated and the act unequivocally orders the Federal administrative agency to grant funds where the States comply with these requirements. Senator HILL. Excuse me, Mr. Bugbee. Mr. BUGBEE. Yes, sir. Senator HILL. That was one of the most important things, and that was writing into this act the fact it was to be administered and operated at the State level and not from Washington. Mr. BUGBEE. Yes, sir. Senator HILL. Isn't that true? Mr. BUGBEE. It is true, and it was fundamental to the association's support of the legislation. Senator HILL. The association insisted on that and met with a ready response from both Senator Taft and myself; isn't that true? Mr. BUGBEE. That is correct, sir. There are other broad philosophical concepts in the act which are not there by chance. The act requires local participation as an earnest of assumption of local responsibility for the successful operation of the facility. The act requires that each State shall inventory all facilities and develop a State plan to delineate those hospital facilities which should be constructed to bring present facilities up to a proper level. Further, the State plan must order proposed construction projects by priority before granting funds which insures that local applications in each State will receive attention on the basis of priority of need rather than on the basis of political pressures. The act insures that the Federal administrator will not act in an arbitrary manner, as it requires regulations and other administrative actions be approved by the Federal hospital council. Backing of the Federal council also permits the Federal administrator to administer the act in an objective manner. The requirement for surveys is one of the most important features of the act. For the first time, the act provided for an actual inventory of all of the hospital resources within a State, whether governmental, nonprofit, or privately owned even though funds for construction go only to governmental or nonprofit agencies. These studies and the ideal plan for hospitals which each State must prepare provided a guide for all construction, whether federally aided or not. The plan avoids duplication and insures adequate facilities for all of the people within a State. Much more could be said of the consistent and thoughtful study given to the preparation of this legislation. The association participated in this study and has contributed to the very best of its ability not only in the preparation of the initial legislation, and later amendments, but in its administration. We believe this is a proper function of our association. We are, of course, proud of the accomplishments under the act in bettering hospital care for the people of this country. We are sure this committee knows that this act has been described as a model of local, State, and Federal partnership in meeting an important national need. We have endeavored, not only at the Federal level, but in States and localities to stimulate and insure continuing participation in the suc cessful accomplishment of these important objectives. Shortly after the enactment of this legislation in the spring of 1948, the association with the approval of the Public Health Service held working conferences countrywide with representatives from official State agencies and hospital administrators representing State and local hospital associations. These conferences had as their objectives: 1. To accomplish an exchange of information on the hospital-construction program between representatives of hospitals and State planning agencies; 2. To identify required activities and possible developments under Public Law 725; 3. To establish suggested priorities of action to accomplish a constructive State hospital planning program: 4. To define responsibilities of hospitals and State agencies for the various necessary and desirable activities under Public Law 725; 5. To suggest basic principles which should underlie the future hospital-expansion program: 6. To outline ways in which full public understanding and support of the hospital program might be accomplished: 7. To stimulate interest in the conduct of similar conferences within each State. The working conferences referred to were not inconsequential in promoting the successful operation of the program. We have a copy of the report of these conferences should the committee wish to examine it. Senator HILL. Excuse me. How lengthy is that report, Mr. Bugbee? Mr. BUGBEE. It is about a hundred pages, Senator Hill. Senator HILL. Certainly I hope you will file a copy here. In fact, you might file enough copies so that each member of this subcommittee may have a copy. Do you have sufficient numbers for each man on this subcommittee? Mr. BUGBEE. It is some time back, and I do not. I have one copy. Senator HILL. Will you file that one copy? Mr. BUGBEE. I shall do it. Annually, the American Hospital Association has cooperated with the association of directors of the State agencies administering this act in providing opportunity for them to meet and discuss not only the day-to-day problems of operation under the Hospital Survey and Construction Act, but all aspects of hospital care which might affect administration of this program to insure adequate hospital facilities. countrywide. In the past 2 years, in spite of very limited association personnel, 2 members of the staff made visits to every newly operating hospital in 4 States which had received Federal aid under this act to study the success with which these hospitals were providing community service. These studies involved inquiry as to the demand for hospital service, the number of new physicians attracted to the community, the adequacy of the supply of technical personnel such as nurses, laboratory technicians, and so forth, the effect on occupancy of nearby hospitals, and the success which each hospital was enjoying in balancing its budget. Reports from these studies are briefed in an article in the March 1953 issue of Hospitals, the journal of the American Hospital Association. A third member of the staff recently surveyed a number of health centers being constructed in the Southern States. The history of the services rendered by these important units, over 400 of which have been built countrywide, is described in an article appearing in the November 1953 issue of our journal. Last year, with legislation proposed in the Congress for an extension in the expiration date for the Hospital Survey and Construction Act, the association determined again to secure grassroots opinion about the act. Conferences were organized nationwide to which were invited representatives of State administrative agencies and State hospital associations. These 4 regional groups each met for 2 days. As an agenda, they first listed all possible criticisms of the act, both favorable and unfavorable. Then they, by actual vote, gave their opinion as to the validity of both favorable and unfavorable criticisms. We have here for the committee copies of the report of these workshops. Senator PURTELL. Have you a sufficient number for all members of the committee? |