In the Department of Labor, we find the ideal structure for this needed coordination. The Department was established to deal with the problems of workers in their every-day business of gaining a livelihood.

The personnel of the Department of Labor are familiar with the working of the workmen's compensation system. They are familiar with the employment services. The Department likewise recognizes the tremendous importance of coordinating all of these activities with the medical profession which must play a highly important part in the system which we visualize.

In that connection, I want to comment on the part the medical profession should play. The organized medical group that is closest to this problem, is the American College of Surgeons, and it should not be confused with the American Medical Association. We have found that the American College of Surgeons is fully aware of and sympathetic to the problems that confront working people in the field of rehabilitation for restoration to a job.

On its own motion, the American College of Surgeons, about 3 years ago, opened a series of discussions with organized labor, with the insurance companies, with the Public Health Service, and with the Department of Labor, seeking a formula for solving the problem of rehabilitation. Credit for that initial step must be given to Dr. Alexander P. Aatken, chairman of the American College of Surgeons' committee on trauma. Out of these initial discussions was formed an American College of Surgeons' subcommittee on industrial relations. The CIO, the AFL, and the UMW are represented on that committee. After many meetings and extended discussion, the subcommittee agreed on a set of principles which are called to the attention of your committee. They are as follows:

"1. Rehabilitation of the injured worker and his return to gainful employment should be the basic concept in an improved workmen's compensation system. We recognize that the disabled worker wants to be rehabilitated and restored to gainful employment. Settlement of cases on a basis of cash awards alone does not meet the continuing needs of the injured worker and his family. "2. The need for higher standards and broadened benefits in workmen's compensation is recognized. Such standards and benefits should be developed against the background of presently known advances in physical restoration and vocational rehabilitation and adequate standards of individual and family need.

"3. Full utilization of all our potential manpower is essential to the welfare and strength of the country at all times. The discarding of disabled workers is an economic extravagance detrimental to the welfare of our country, wholly aside from the personal effect on the worker and his family. Solution of the problems of trauma requires cooperation, and not competition, between all interested groups and agencies. We must therefore improve and expand all activities, public and private, that aid in rehabilitation of the disabled worker.

"4. The medical profession should adopt the concept that the responsibilities of the treating physician extend over the entire period of disability to the end that the patient is restored to gainful employment at his highest attainable skill.

“5. Rehabilitation and restoration to gainful employment of the injured worker must begin with first aid and continue through the period of disability. In order for a physician to carry out this responsibility, it is essential for him to recognize the total medical problem of the patient in addition to his injury, as well as his personal problems. The physician must bring to bear on these problems all the skills and disciplines that science and society can offer, and utilize all community resources which can assist him in the accomplishment of these objectives."

Some brief comment is in order on this set of principles. Your attention is directed to paragraph 5, which urges that the course of rehabilitation and restoration to gainful employment must begin with first aid and continue throughout the period of disability under direct supervision of the physician

or surgeon.

Our experience indicates that when a worker is stricken down by an accident, a physician or surgeon is usually available during the critical initial period of treatment. When there are, however, indications of recovery the medical and surgical services tend to fall off until they disappear entirely. The injured individual is thereafter left to his own devices. The service of the physician and surgeon is too important to be limited in that fashion. You cannot cut up a worker's whole problem and deal with the segments one at a time. Medical and

surgical supervision is a binding necessity in such cases throughout the entire period of disability: The physician and the surgeon must know the physicht and mental history of the patient. They must supervise the technicians who are employed in rehabilitating the individual and in retraining him for restoration to a job at his highest attainable skill.

I ask this committee to evaluate for a moment what happens when the period: of disability is prolonged over a period of time. Assume that a worker suffers a severe leg injury which takes 5 or 6 weeks in healing, followed by a prolonged period of convalesence. At the present time, the patient most likely sees nobody from a réhabilitation agency. He sees for a limited time the physician or surgeon who is handling the curative part of his problem. In most cases of this sort the physician or surgeon announces at the expiration of the curative period that he has done all he can do, and that the rest of the problem is up to nature. He withdraws from the case, and thereafter the injured, convalescing worker is left completely to himself. He may progress from bed, to wheelchair, to crutches. That may take 6 months.

I ask this committee to consider the possible mental state of that individual when and if he arrives at the point where he can seek a fairly normal existence in the community. During the entire period he has been afflicted mentally with physical inaction; he has been afflicted with the financial problems that his period of idleness has inflicted on him, on his wife, and his children; he is worried about the possibility that he may not be able to carry on at his old job or in a new job that will provide him with a sufficient livelihood. I think it is a fore gone conclusion that by the time too many of these patients are able to more about, their mental condition is such that they may well have become most difficult subjects for rehabilitation and retraining. Their impatience has boiled over and changed their whole outlook; they feel they have become the victims of injustice. We of the CIO believe they are victims of injustice.

Then too, if they do seek rehabilitation, they themselves must go look for it. They are confronted with a multiplicity of agencies. Nowhere do they find coordination or cooperation among them.

Let me now direct the attention of the committee to the experience of an American labor organization that has done some work in this field. As the committee knows, coal mining leads the industries of the Nation with its accident severity rate. Mining accidents are not trivial; they are extremely severe. Then again, we find coal mining distinguished by a high frequency rate of accidents. It is second in frequency only to the dangerous business of lumbering.

The appalling sequence of accidents in the coal-mining industry, plus the lack of adequate medical care, rehabilitation, vocational retraining, and job placement of the physically handicapped coal miner, were among the factors that caused the UMW to take the issue to the collective bargaining table. The UMW welfare fund thereupon came into being.

One of the activities the UMW turned its attention to was the plight of 50.000 permanently disabled coal miners who existed as mute evidence of so-called free enterprise in the coal-mining industry. Through June 30, 1952, a total of 8,693 of those handicapped had been selected and referred to local vocational and rehabilitation agencies throughout the country. Of the total number referred, 3,366 had been selected by the rehabilitation authorities as most likely to be rehabilitated so that they could either return in some capacity to the coal-mining industry, or could be retrained to take their place in some other gainful employ ment. As of the date mentioned, 929 of those cases had completed the services available to them and of that number 903 had returned to gainful employment. More than one-half of those referred were still in some phase of active vocational rehabilitation. Other referrals were still under consideration for services,

We, in the CIO had the highly impressive experience of attending a rehabilitation conference held here in Washington at the Department of Labor about 3 years ago. On that occasion, 1 of the private agencies that was utilized by the UMW welfare fund brought to Washington 5 or 6 former coal miners who had just about completed their rehabilitation and vocational retraining courses. It was an amazing demonstration. Here were six men, some of them permanently paralyzed from the waist down who had been retrained to get around under their own power and go back to their communities and enter gainful employment in new skills that had been taught them. Just a few years earlier those same men would have been thrown on the human scrap pile to live out the rest of their lives as bedridden individuals, most likely in a ward of a county poorhouse.

I recall that the cost of the rehabilitation and retraining was about $1,000 in the worst case. Balance that figure against the cost of maintaining that individual for the rest of his life at public expense. There's an item for tax-sensitive economists.

Gentlemen, the job can be done and it is the obligation of the Federal Government to give deadership to all the forces in the Nation to get it done. CIO will not be misled by arguments based on so-called States rights. In our judgment, >an American citizen is more than a citizen of the State in which he resides. He is also by constitutional definition, a citizen of the United States. If he travels abroad, the Government of the United States gives him a passport and in effect places its protective, arms about him while he is in a foreign country. If his rights are traversed, the Government protects him.

We, in the CIO believe that the protection of the Federal Government should also be extended to citizens of the United States within our continental border. We are for States rights as long as those rights are properly exercised. We deny, however, that any State has the right to misuse or neglect citizens of the United States. Our problem has always been getting the States to protect the rights of the individuals. When they do not act, the Federal Government must step in.

We come now to the matter of security for the worker who is injured to such a degree that he cannot follow his regular job. This is particularly important when the injury is one that inflicts upon him a permanent physical handicap. It will be argued, of course, that all of the suggestions we offer here today, including this one, represent "creeping socialism." That, of course, is one of those nasty slogans that are advanced to negate logical argument. You will be told that the obligation of the individual to the community is paramount. We agree that the individual does have a high obligation to the community. At the same time, we point out that the community has an equally high obligation to the individual. Mutual obligation is the keystone of orderly human society. We believe that a worker This matter of security for the individual is vital. who is injured or stricken down by disease should have decent security for him-self and his family during his period of recovery and during his retraining, if We that be necessary. We do not consider such security a dole in any sense. consider it a matter of simple justice. The CIO insists that when a worker incurs an injury that totally incapacitates him he should at once begin to draw his full benefits from the social security system. There is no element of charity in that. Social security funds accumulate out of payments which constitute part of the wage structure. The benefits of the system have already been earned by the recipient. So much for the worker covered by social security.

When permanently disabled persons are not covered under social security, Nation and State join together in a financial assistance program.

I have already pointed out to the committee that the average worker who incurs an injury does not want charity. He does not want to live out his life on the relief rolls. He wants to get back to work and provide for himself and his family. For those who choose to disregard the human aspect and argue that the integrated program we are advocating for the physically handicapped is too expensive to maintain, we repeat that it would cost society far less to rehabilitate a huge number of our handicapped people and retrain them for work at the highest ..attainable skill than to support them in enforced idleness. I have already cited the actual experience of the UMW in this field of endeavor. Men have been rehabilitated and restored to useful employment, who, 15 years ago, would have been thrown permanently on public relief.

Your committee has a rare opportunity to devise a legislative formula that will redress the heavy injustice and ill treatment now visited upon physically handicapped persons. We urge the committee to keep real economy in mind and eliminate the confusion that exists rather generally on this subject.

In our judgment, we repeat that the entire program should be centralized eventually in the United States Department of Labor. The integrated system should have as one of its component parts a public advisory committee made up of representatives from management, from labor, from the medical profession, from the medical technical field, from education; and most certainly it should include job placement experts.

Pending before the Senate are several bills, among them S. 2570 which calls for an extensive and integrated overall Federal program.

The CIO is definitely for this legislation in principle. That bill would provide the bringing together in a separate agency of all physical rehabilitation activities

of the Federal Government. For housekeeping purposes we urge that such an agency be placed in the Department of Labor. The whole problem is one of great complexity and S. 2570 gives recognition to all or most of the factors involved.

We also have before the Senate S. 2759 and S. 3039, both of which are referred to in the newspapers as the administration bills. Presumably they are designed to cover the improvement in performance recommended by President Eisenhower in his message to the Congress on social security.

Our criticism of these bills consists mainly in the fact that they are piecemeal measures in general keeping with the rest of the crazy-quilt pattern that has grown up in this country in the field of rehabilitation. It is true that the bills represent some improvement in general. They do not, however, begin to approach the main problem.

Certainly the CIO is for increased facilities; certainly we are for better performance. We are looking for progress but we do not want that progress to proceed at a snail's pace.

But we also have added criticisms of S. 2759. For example, we do not believe that the Federal Government can again pass the responsibility along to the States and leave its fate to the imagination of statisticians or the machination of the usual opposition. The job has been left to the States for too long and the performance has been extremely poor.

S. 2759, for instance, attempts to deal generally with the necessity of the States setting up so-called workshops to provide remunerative employment to severely disabled individuals who cannot be readily absorbed in the competitive labor market. This is a most praiseworthy effort, but the establishment of workshops must have thrown around them definite protective regulations to prevent the exploitation of handicapped persons. Our position on this is not based in fear that the work done by the so-called workshops will compete with the work in full-time industry where able-bodied workers are employed.

Our concern is with the handicapped persons themselves who would be employed in these workshops whether or not they are set up under the guise of nonprofit rehabilitation facilities. We do not want their services exploited by those who buy the goods and products. Such private or even public rehabill tation facilities which engage in the production of goods should operate under definite minimum wage arrangements. The safety of the work place should be under the same supervision exercised over other work places by the public authority. Health facilities and all of the other items must be religiously observed.

A stronger criticism of S. 2759 is a proposal to greatly reduce the area of Federal discretion and give the States correspondingly wider discretion in planning their own programs. This is hardly a step forward in view of the past performance of the States. In addition to this proposal, the bill drops the present requirement that the Federal agencies shall define the classes of employable individuals who shall be eligible for vocational rehabilitation. Be cause the bill proposes to use Federal funds we think the taxpayers are entitled to more control over those funds, not less. Finally, the bill fails to authorize Federal regulations as to maximum schedules of fees for surgery, therapeutic treatment, hospitalization, medical examination, and prosthetic devices. The setting of these standards are left to the States. We are casting no reflections on the medical profession as a whole. We believe that most doctors are human. We are also convinced that other doctors are inhuman. We will not belabor that point.

We suggest that this committee give its attention to devising a bill that will place initial responsibility for rehabilitation of the physically handicapped in the Federal Government where it belongs, with the authority retained to insist that Federal funds are properly used by the States to do the job that the people of this country want done. The legislation should provide that where a State fails or falters, the Federal Government go ahead by itself under the authority vested in it by the Constitution to promote the general welfare.

Mr. READ. I am appearing before your committee to set forth the views of the Congress of Industrial Organizations on proposed legislation to meet the grave and growing problem of permanent disability among the American people. Joining with me in this statement is Mr. Michael J. Quill, vice president of the CIO and chairman of the national CIO Committee on Safety and Occupational Health. I am

the secretary of that same committee and I can assure you that these views of our committee reflect the decisions of our CIO conventions and our 6 million members throughout the country.

Now I would like to make a summarization of it and emphasize certain points. I want to comment at this point on the statement submitted by the American Federation of Labor, and I will not bother you to dwell on any statistics because they were all in that statement and you will find no variance in the position taken by the two federations of labor, representing millions and millions of workers in the United States.

Our convention resolution, among other things, suggested that a survey be held by the Federal Government, an impartial survey or census, to ascertain just what the extent of this problem is. We are satisfied that there are millions of people who could be rehabilitated, but no one knows precisely how many. We think that that can very well be undertaken by the Federal Government.

Since Congress these days seems to be in a highly investigative mood, I believe we might arouse some interest on that proposal here on the Hill.

Senator GOLDWATER. You know in this bill there is a provision for survey funds.

Mr. READ. That is excellent, but we do not want it dropped out or eliminated.

Senator GOLDWATER. I do not think it will be, particularly after the testimony this week from the Kansas City Rehabilitation Center, where they undertook such a survey with mostly private funds, and it produced such remarkable results. I do not think there will be any inclination on the part of this committee to do other than go along with the Department's recommendation.

Mr. READ. That is fine. The workers of this country mainly who pay the penalty for these crippling accidents and congenital conditions that handicap people-it falls mainly on the working population and their families. I point that out merely to stress the importance of this to the workingman of the United States.

The total injury rate for the country was, as the American Federation of Labor pointed out to you, 10 million injuries each year. Those injuries, if you please, are by no means minor. They are all the types of injuries that entail lost time from work, that is, lost time from work on the part of the worker. In other words, he loses his income for the period of disablement.

On the figures stated by the President of the United States in his message to the Congress it is very apparent today that 111,000 handicapped people who come into our population each year through one means or another have no rehabilitation services available to them. This extremely minor figure set by the President of 60,000 who receive some services seems to be the extent of our effort. It is a measure, of course, of our awful, awful extravagance in this country.

We have built a civilization at the expense of a great many valuable. things. I suppose we had to do that in the course of our development. We had to be prodigal of natural resources. We had to get ahead with the job. But unfortunately we also acquired the rather pernicious habit of being prodigal with our people and their well-being. Human waste was thrown on the scrap heap just like wasted material.