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In February, 1954, there were 119 potential hospital projects in the State with estimated construction costs of $343,218,139.

These were on the basis of surveys made as to the individual hospitals.

Approximately one-third of this cost was for projects envisaged under voluntary nonprofit and church auspices; one-fifth for Stateoperated mental and tuberculosis hospitals; and one-half for improving the municipal hospital system in New York City. And I have supplied an exhibit in that connection.

Senator PURTELL. Without objection, that exhibit will be made a part of the record.

(The exhibit referred to is as follows:)


Review of hospital projects in construction, architectural planning or discussion stage in New York State which are eligible for consideration of Federal aid for construction and equipment under the Federal Hospital Survey and Construction Act without reference to the availability of Federal funds, February 26, 1954. Summary of:

I. General and chronic hospital projects approved on split-project basis with partial financing in fiscal year 1954-55.

II. General and pediatric hospital projects programed, on basis of anticipated Federal funds for inclusion in fiscal year 1954-55.

III. General and chronic hospital projects expected to be ready for consideration for Federal grant, fiscal year 1954-55, if sufficient funds were to be available.

IV. General and chronic hospital projects expected to be ready for consideration for Federal grant, begin. ning fiscal year 1955-56, if sufficient funds were to be available.

V. State mental and tuberculosis hospital projects.

1. General and chronic hospital projects approved on
split project basis with partial financing in fiscal
year 1954-55 (project No., name of hospital, and

NYS-90. St. Luke's-Memorial Hospital Center,

NYS-92. South Nassau Communities, Ocean-
NYS-93. Nassau, Mineola.

NYS-94. Long Beach Memorial, Long Beach..
NYS-95. North Shore Hospital, Manhasset..
NYS-96. Mercy Hospital, Rockville Centre.
NYS-100. Booth Memorial, New York City

Total, New York State.

IL General and pediatric hospital projects programed,
on basis of anticipated Federal funds for inclusion
in fiscal year 1954-55 (see exhibit No. 1): 5
hospital projects...

III. General and chronic hospital projects expected to
be ready for consideration for Federal grant, fiscal
year 1954-55, if sufficient funds were to be availa-
ble (see exhibit No. 2): 37 hospital projects..
IV. General and chronic hospital projects expected to
be ready for consideration for Federal grant,
beginning fiscal year 1955-56, if sufficient funds
were to be available (see exhibit No. 2): 63
hospital projects..

V. State mental and tuberculosis hospital projects
(see exhibit No. 3): 10 hospital projects.


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Estimated cost of this project fluctuating.

$1,870,459 allocated from available apportionments to New York State.


121, 150

99, 550

528, 574

1,448, 574

3,718, 333

26, 215, 180

176, 222, 628

58,740, 873
20, 478, 000

61, 434, 000

313, 218, 139 112, 471, 419 31, 382, 087

Fiscal years beginning 1955-56


$58,740, 873

20, 478, 000

79, 218, 873

Based on intensive survey December 1952, revised on the basis of information currently available to the Commission.

Dr. BOURKE. Further evidence of hospital needs in New York is that the legislature has just passed a bill authorizing a public referendum on a $350 million bond issue for the construction of additional State mental-hospital facilities.

Physical facilities, though necessary and desirable, represent only one aspect requisite for adequate hospital care. Therefore, it is most heart warming to report that in New York the Hill-Burton Act has stimulated communities to thinking about the relationship of their hos pitals to other community professional and health services; that it has created an interest in the quality of care provided; and that it has encouraged architects, engineers, and the building trades to show ingenuity in hospital planning and in the use of structural materials developed during World War II.

Moreover, the fact that the Hill-Burton Act required the development of a statewide plan for hospital construction has given growth to discussion among various interests in the health field addressed to providing more effective facilities, freeing many rural and small urban hospitals from isolation, and fostering an interchange of specialized medical skills between the medical teaching centers and the smaller hospitals.

In brief, the interest created is resulting in a better understanding of the role of the hospital in serving its community more adequately. For example, in the course of planning, many of the smaller communities realized that it was neither feasible nor economical for them to provide the full range of hospital facilities and medical skills. Their answer was to develop working relationships with larger neighboring hospitals to insure good care for their people. To this end, they have made arrangements for the part-time services of radiologists, pathologists, specialized surgeons, and internists from the larger hospitals and teaching centers.

This concept foreshadows the development of new administrative techniques and methods for the more adequate care of patients-for those in the hospitals, for those attending hospital clinics, and for those under care at home-if we are to avoid overbuilding and unnecessary costly capital construction. It brings into focus the need for nonbed facilities devoted to the prevention of illness and rehabilitation, wherever possible.

Therefore, I respect fully recommend the passage of Senate bill 2758, which will assist communities to construct and equip muchneeded diagnostic and treatment centers, rehabilitation facilities, hospitals for the chronically ill, and nursing homes.

Many authorities in the field of hospital planning recognize the expanding role for the general hospital into a focal point for the integration of the health services of a community.

Such a hospital should provide preventive services as well as cure disease. Its facilities and staff should be devoted to the maximum rehabilitation of patients and concerned with the care of long-term illness and convalescence.

These recommendations are consistent with the findings of the National Commission on Hospital Care, established by the American Hospital Association in 1945, which included representatives of the medical profession, medical schools, hospital trustees and administrators, industry, labor, and agriculture.

Diagnostic and rehabilitation facilities: If the general hospital is to be of assistance to the local practicing physician and exert influence in decreasing the demands for bed care, its facilities should be made available to ambulatory as well as hospitalized patients.

Medical successes in the communicable-disease field during the last 50 years have largely been due to the preventive programs of immunization, sanitary control of the environment, early case finding and, more recently, the effects of some of the newer drugs. Yet, this success is tending to change the character of the illnesses necessitating hospitalization, for many of the diseases and disabilities now becoming more important tend to be of a chronic nature. Here early diagnosis is essential, if the condition is to be arrested, and rehabilitation procedures are of prime importance if the patient is to return to a productive life.

Modern medical science provides diagnostic and treatment techniques, but many require elaborate and expensive equipment which the average practicing physician cannot afford personally. Therefore, if he is to have access to them, it is important that they be available at a center for his use if he is to detect disease early and achieve adequate, correct diagnoses.

Similarly, rehabilitation centers could do much toward stimulating hospitals and physicians to return patients to normal activity, or at least to self-sufficiency. If located in the proper setting, they should be a vital force in improving educational programs for nurses, physicians, and rehabilitation technicians, and in lessening the burden of public support for many handicapped. Their efficacy and importance to our economy has been demonstrated by those sponsored by private interests and the success of the National Vocational Rehabilitation program. Therefore, the services of rehabilitation centers should be available to all and rehabilitation not limited solely to those for whom job opportunities are waiting.

Rehabilitation is a concept and an attitude rather than a medical specialty. It should permeate all stages of medical care. Hence, the success of any rehabilitation program will depend largely upon the advice, assistance, and understanding which the medical profession brings to State and community planning.

With regard to nursing homes, there are 8,000 beds in nursing homes in upstate New York generally housed in unsafe, overcrowded, converted dwellings. Most are operating under proprietary auspices. Half their patients are supported by public funds.

Although these homes are rendering a greatly needed service, the question arises as to whether the quality of care could not be improved, rehabilitation be made more effective and quarters be made safer in better and larger facilities which could operate more economically.

Preferably, these facilities should comprise units of suitable, wellequipped general hospitals which are capable of providing medical and nursing care of high quality.

With regard to chronic hospitals, it is essential to distinguish between hospital and nursing home care of the chronically ill. The former is requisite for the patient needing active, clock-around medical and professional nursing care and observation which can be secured only through use of the range of services and equipment available in

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a hospital setting. For example, hospitalization would be necessary when difficult diagnostic procedures are indicated, when the severity of illness requires constant medical observation, when highly skilled nursing techniques must be applied. But when the diagnosis has been made, when the course of treatment has been determined and assured, when there is no immediate danger of relapse, and when the plateau of illness has been reached, it may be psychologically desirable and economically prudent to transfer the patient to nursing home care if his condition warrants his being seen only periodically by a physician and being cared for by nurse-attendants under professional nurse supervision.

In brief, chronic hospital care should be used only for those patients truly needing the battery of hospital skills and equipment. Any other course would be wasteful of facilities, skills, time, and money.

Yet, what is really needed is hospital care for such chronically ill persons and this can be provided in an adequate general hospital as well as in a chronic hospital. In fact, many highly competent physicians and hospital administrators are convinced that the general hospital is the better locale where the patient has constant access to the medical specialists. Also, the integration of general and chronic hospital care in one facility should insure more flexible and more economical use of the capital structure.

In this connection, New York State in 1947 formulated recommendations for a comprehensive, statewide program for the care of the chronically ill but, unfortunately, little progress has been made in bringing these proposals to fruition."

In that connection, I have submitted a summary of that program. However, I think it may be a little unjust to ask that it be made a part of the record.

Senator PURTELL. That is this document entitled "Summary of a
Program for the Care of the Chronically Ill in New York State"?
Dr. BOURKE. That is right.

Senator PURTELL. All right.

Dr. BOURKE. With regard to funds for planning and research, the Congress has shown true wisdom by including in Senate bill 2758 provision for grants to the States toward planning, study, and research addressed to diagnostic and treatment centers, rehabilitation centers, chronic hospitals, and nursing homes,

Knowledge is limited in these fields and the need for experimentation


The sums proposed for actual construction are conservative in relation to need but should serve as an incentive to States and localities to initiate pilot-type projects.

Much will be learned from these new facilities and the concurrent study and research so that, should greater capital sums become available in the future, a new body of knowledge will be available, based on facts and experience.

It is recognized that problems of geography, economics, and the wishes of the people differ among States and, within States, among communities. Although the following suggestions are based upon situations and experience in New York State, they are respect fully submitted for your consideration.

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1. Where possible, diagnostic and rehabilitation centers, chronic disease facilities, and nursing homes constructed under the program set forth in Senate bill 2758 should be contiguous to or an integral part of community general hospitals meeting national accreditation standards.

2. In ascertaining the potential location of such facilities, careful consideration should be given to the sponsoring community's actual need, its ability to use fully the contemplated units, the quality of service which it is prepared to render, and the flexibility of usage which it is willing to insure. For example, the construction of a chronic-disease hospital requiring certain diagnostic and treatment facilities and equipment might be envisaged for an isolated location, while an accessible, existing general hospital is fully equipped and staffed. In such an instance, economies in capital construction and operation might be effected by planning the chronic disease hospital as a unit of the existing general hospital. This arrangement might also be desirable from the standpoint of changing patient demands, i. e., should the general care load decrease and the chronic load increase, the combined plant would still operate at a desirable occupancy


3. Since the public assistance programs of many States now provide for the purchase of medical and hospital care for many dependents, the traditional concept of providing hospital care for the needy only in public facilities has become outmoded. Therefore, any facilities constructed in these four categories should be available, in my opinion, to all economic groups, just as so many hospitals constructed under the current Hill-Burton program are now operating.

4. The proposed bill specifically apportions the amount of money to be expended by the States in each of the four categories of facilities. It is possible that some States may have difficulty in developing suitable projects in one or more of these categories. Therefore, to encourage sound planning and full utilization of the authorized amounts, the interchange of funds among categories should be permitted.

Although potential sponsors might be interested in developing certain types of projects, they may hesitate to do so because of inability to envision sources of support for their operation. This may prove particularly true of chronic hospital and nursing-home facilities caring for long-term, expensive illnesses. This uneasiness about maintenance funds for hospitals, related facilities, and supporting services probably will not be resolved until the relationship of the various sources of support to the hospital become more clearly defined. These sources include the patient and his family, Blue Cross and Blue Shield plans, workmen's compensation programs, philanthropy, commercial insurance carriers, and government at all levels.

Thank you, sir.

Senator PURTELL. Thank you, Doctor.
Senator Hill, have you some questions?

I am sure you have.

Senator HILL Doctor, it seems to me your thought is, insofar as possible, chronic disease hospitals and nursing homes should be contiguous to or an integral part of what we call a general hospital?

Dr. BOURKE. Yes. There may be geographic factors in other parts of the country which preclude that.

Senator HILL. But as far as New York is concerned

Dr. BOURKE. We have, Senator Hill, from the very start of the program in our State plan had a minimum size for general hospitals because of our geography transportation, of 50 beds, and have specified the basic specialties that should be found in that community hospitala qualified surgeon, radiologist, pathologist, and internists-and we have deviated in only 2 instances from that.

Senator HILL. In other words, your general rule has been to tie them in there?

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