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Senator PCRTELL. 4,500 beds, and you have set up rather rigid standards as to the operation of those. Mr. PARMELEE. Yes, sir, Senator PURTELL. And you must be licensed as a type of hospital; is that correct? Mr. PARMELEE. That is correct. Senator PURTELL. Under State supervision? Mr. PARMELEE. That is correct. Senator PURTELL. And that supervision, I might say, is rigid, too; isn't it?

Mr. PARMELEE. It is very rigid, and justly so. Senator PURTELL. What you are worried about is the investment you have made, with the acknowledgment on the part of the State that your operations must be of the highest type, because you have State patients, have you not, referred to you by hospitals in many instances; is that correct? Mr. PARMELEE. That is correct.

Senator PURTELL. And where hospitals are filled, is it correct the State sends you patients who would have otherwise gone to the general hospitals!

Mr. PARMELEE. Well, usually that is in reverse. They go to the general hospital first and back to the nursing home. Senator PURTELL. Yes. Aren't there cases—I am thinking of Middlesex County particularly-I have been informed, anyway, that you have had cases there where the hospital was filled and it was felt your accommodations met the needs, anyway, of cases which would ordinarily go to the general hospital? Vír. PARMELEE. I think those cases are rare, Senator. Senator PURTELL. I think they are rare, but, anywayMr. PARMELEE. They exist; yes. Senator PURTELL. It was an acknowledgment of the fact that your standards were high enough in the operation of those hospitals, at least in that vicinity, for the State to recognize that it was serving the need of a general hospital in the cases referred to it; is that correct? Mr. PARMELEE. That is correct. Senator PURTELL. I am not trying to put words into your mouth. I am trying to develop something that I had been informed in Connecticut, anyway, was true. What you object to, then, is having set this high standard of operation there, acknowledged by the very fact of the State use of the facility, you find now the Federal Government offering to set up in competition with you like facilities through the use of Federal funds ? That is what you are objecting to, is it not? Mr. PARMELEE. They are worried, first, that they do not wish to be eliminated, and, second, they do not believe in this particular part of your proposed program that expansion by public, nonprofit institutions is justified in our area. We can't speak for the rest of the country. Senator PURTELL. You feel you can take care of the expansion if some funds through some other agency were made available to you on a loan basis for expanding; is that what your thought is?

Mr. PARMELEE. I think they may be taken care of regardless, pos

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Senator PURTELL. Thank you.
Senator Hill has some questions.
Senator Hill. You say they may be taken care of regardless?
Mr. PARMELEE. They may possibly.
Senator Hill. They may possibly.

Mr. PARMELEE. You see, this type of loan is not a popular loan among our Connecticut banking people.

Senator Hill. Anyway, you have a good system, we will say, of nursing homes. According to my information, you have one of the best certainly in the United States.

Isn't that true?

Mr. PARMELEE. That is what we claim, sir, and I believe that it has been so stated by disinterested persons.

Senator Hill. Then the question would come: You have that system. Certain funds were earmarked solely and only for the construction of nursing homes. Your State might not be interested in using its share of funds so earmarked for nursing homes; is that correct?

Mr. PARMELEE. Well, that is a possible truth, but there are certain officials in our State that we understand think otherwise and who would like to build some experimental institutions along this line.

Senator Hill. I see, but there might be a question there as to whether or not your State would use or take advantage of its full share of Federal funds; is that right?

Mr. PIRMELEE. That is correct.

Senator Hill. If the earmarking, then, was too rigid, there wasn't any flexibility there, any opportunity for interchange of funds, you might well then lose your share; is that right?

Mr. PARMELEE. Yes, which should not be done to the good State of Connecticut.

Senator Hill. Then you would go along, I take it, pretty strongly with Mr. Bugbee and Dr. Ferrell that these funds ought to be interchangeable; is that right?

Mr. PARMELEE. I certainly would endorse it.

Senator Hill. So that Connecticut might get its rightful share, just as I would seek at any time that Alabama might get its rightful share; is that correct?

Mr. PARMELEE. We will endorse that, Senator.
Senator Hill. All right.

Mr. PARMELEE. I may say, as a private citizen, the larger part of this bill I am heartily in favor of.

Senator Hill. Thank you.
Senator PURTELL. Thank you, Mr. Parmelee.

We will stand in recess until 10 o'clock tomorrow morning in this room, at which time the first witness will be Dr. Howard A. Rusk of New York University, Bellevue Medical Center.

(Whereupon, at 12:33 p. m., the subcommittee recessed until 10 a. m. Friday, March 19, 1954.)

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PRESIDENT'S HEALTH RECOMMENDATIONS AND

RELATED MEASURES

FRIDAY, MARCH 19, 1954

UNITED STATES SENATE,
COMMITTEE ON LABOR AND Public WELFARE,

SUBCOMMITTEE ON HEALTH,

Washington, D. C. The subcommittee met at 10:05 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, Cooper, Hill, and Lehman.

Also present : Melvin W. Sneed and William G. Reidy, professional staff members.

Senator PTRTELL. The hearing will come to order. Our first witness this morning is Dr. Howard A. Rusk, one of our very eminent men in the profession, and we are very happy to have you with us this morning, Doctor, to help us in our deliberations.

Is it your intention to read this statement in complete detail-it isn't long-or do you have a longer statement, or do you wish to have this statement in the record and perhaps talk extemporaneously in addition to it?

Dr. Rusk. I would prefer, Mr. Chairman, if I may, to have this statement in the record and talk extemporaneously and informally. Senator PURTELL. It will be so ordered. Dr. Rusk. Thank you. Senator PURTELL. Go right ahead, Doctor.

STATEMENT OF DR. HOWARD A. RUSK, PROFESSOR AND CHAIR-
MAN, DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITA-
TION, NEW YORK UNIVERSITY COLLEGE OF MEDICINE, CHIEF.
PHYSICAL MEDICINE AND REHABILITATION SERVICE, BELLEVUE
HOSPITAL, NEW YORK CITY, AND DIRECTOR, THE INSTITUTE
OF PHYSICAL MEDICINE AND REHABILITATION, NEW YORK
UNIVERSITY-BELLEVUE MEDICAL CENTER
Dr. Rrsk. I practiced internal medicine in St. Louis for 15 years
before the war, and it fell my lot to establish the convalescent and
rehabilitation program in the Army Air Forces during my service

After this service. I couldn't go back to internal medicine as I had known it, because I saw what could be done for severely disabled people with an adequate program. So, I went to New York, where

career.

I head the department of rehabilitation at New York University, at the Bellevue Hospital, and at the Goldwater Memorial Hospital.

In addition to that, for the last 3 years, we have had an institute of rehabilitation as a part of our medical center, which I also have headed.

I have also served as consultant in rehabilitation to the New York City Department of Hospitals, the office of vocation rehabilitation.

I worked with General Hawley in the early days of the Veterans' Administration program and assisted in the establishment of that program, which I think has done a magnificent job.

I think I might illustrate what has happened in the veterans' program by citing you the problem of the paraplegic.

In World War I there were 400 paraplegies. They were no great problem because 90 percent of them died the first year of kidney infection, and only one-third got back to this country. There are only two alive today.

This time we had 2,500 and they didn't die because with antibiotics and the advances in medicine their lives were saved and they had strong arms and good minds and their lives before them, and they wanted to live the best lives they could with what they had.

With the help that you gentlemen have made available to them, and with the medical skill and devotion in the veterans' hospitals, 1,763 of the 2,500 are living in their own homes, driving their own cars. and 80 percent of that group are either in school or in jobs.

But while we got 2,500 as a result of the war, when we went into the problem we had some 10,000 as a result of disease and accidents in civilian life, and there were no places for them to go, especially designed to meet their needs.

So, some of us who were interested felt there should be a third phase of medical care-the first obviously being prevention, the second definitive medical and surgical care, and the third phase is what happens to the person from the bed to the job.

In the last 8 years we have made some progress. It is thought by my profession to be a third phase of not only care, but responsibility; and we have some experience now that lets us believe this is not only good for the individual, but it is good economically and it is a basic tenet in democratic living, that is, that every man has a chance to live the best life he can with what he has left, and that in a democracy we provide him with such opportunity.

Now the emphasis is swinging from the disability to the ability, and we have learned that a thing we should have known a long time ago that society today doesn't pay for brute strength; it only pays for the skill in your hands and what you have in your head.

You can be the finest doctor or lawyer or diamond cutter or technician and not have to run the 100-yard dash in 11 seconds, and that is the whole philosophy of our program, and now we have some experience and facts to back it up.

In the last 5 years in our own program at Bellevue Hospital we have seen a thousand individuals with strokes of apoplexy. The average age was 6:3. The average time from the stroke until we saw them was 9 months, and in an average time of 7 weeks 900 we were able to sond home to live noninstitutional lives, to care for themselves, and 400 went back to some type of gainful work.

A million five hundred thousand people in this country have had strokes, and in the past these were felt to be hopeless problems. They aren't hopeless. They have great hope.

So, it is very heartening to those of us who dedicated our lives to the field to see Senate bills 2758 and 2759, because I believe that this has given the program the greatest impetus of anything that has happened since the understanding during the war years that such a program was possible and profitable.

I have outlined the reasons in my statement why I feel these bills are good economics and good democracy. I might comment briefly on just 1 or 2 points. I think the way that this program will sweep the country is not by any specific results, but by demonstration.

When we first started to talk about rehabilitation a decade ago, very few people understood it. They didn't understand the civilian need was eight times that of the veterans' need. They didn't understand what the program was, and I think this provision for studies, demonstrations, teams that go through the country, see patients, hold clinics for demonstration with physicians and it might interest you to know, which gives you some idea about how my own profession feels about rehabilitation, that of all the private patients who come to our institute, one-third are either doctors or doctors' families, and I think with such teams going throughout the country, seeing the crippled in the community working out a program, that the doctor can carry on there for the simple cases, and helping them to understand what can be done and what the mechanisms are to do it will be invaluable.

We are just in the beginning of our research and training aspects of the program because it is so new.

We have just finished a 3-year followup study with our institute patients, many of them coal miners with broken backs, many of them from the vocational rehabilitation program, and we find that, although they go out of our institute ready to go to work, there is great need for understanding in the community and that if they aren't picked up there and made to feel a part of the community, then certain of our training time is wasted; but if they are, and if they are made to feel a part and given an opportunity, that they take their place back in society and pay real dividends to themselves and to the country that trained them.

I think the bills are sound in concept, substance, and detail. I think there is one point that I would like to make, which I think is a dividend that we get, and maybe in some ways the dividend may he more important than the principle, and that is that this program is a tool for international understanding.

As consultant to the United Nations and the World Veterans' Federation and the International Society for the Welfare of Cripples, I have been on many missions throughout the world— Poland, Israel, ustria, Finland, and recently twice to Korea---and the people in these parts of the world don't ask, first, how many cars do you have, or how high are you building; but they want to know what opportunities crippled children have, what we do for disabled workers, and how about old people do they have a chance to live the best lives they can—and they want to share what they have learned with us, and they are avidly

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