where we have responsibility for the welfare of seamen, and by the Government Operations Committee. The staff of the Committee on Interstate and Foreign Commerce, of which I am also a member, went into these in considerable detail. There are problems in connection with these hospitals of which I think you and the members of this committee should be aware. One is the fact that we have an extremely difficult time in terms of attracting staff, and currently there is a tremendous staff shortage. Some of these hospitals are small. The Savannah Hospital is the smallest; Detroit is the second smallest, I believe. Mr. FLOOD. What do you mean by "small"? How many beds are there in the hospitals?

Mr. DINGELL. Detroit has a practical functioning level of around 147, and I think Savannah is around 80. Other hospitals are bigger but not appreciably so. Some are very large, going up to 800 beds, which is quite a large hospital.

In addition to the serious staff shortage, the smaller hospitals also have problems in procuring certain specialized equipment. However, this problem can be very easily met since most of these hospitals are in urban areas and tend to have large numbers of major hospitals close by to provide on a contract basis such needed specialized services. So this really is a relatively minor problem. The major problem is that of procuring staff. For the last few years they have had no problem in terms of procuring medical staff, that is, doctors, and so forth. The reason is that doctors, by preference, choose to go into the Public Health Service rather than a branch of our Armed Services to fulfill their military obligation under the doctors' draft.

However, when this law expires, Mr. Chairman, you can anticipate very major staffing problems in the Public Health Service hospitals. I think this committee could and should inquire very carefully of the Public Health Service as to what plans they are making with regard to that eventuality. Now, the problem of supporting staff, such as technicians and people of that kind, is not solved so easily. The Veterans' Administration hospitals are generally able to procure doctors in sufficient numbers and the reason is a very simple one: they have a large enough flow of patients so that the doctors can develop their specialties during the periods they choose to work as Government physicians and then move on out into the practice of medicine.

If some provision were made in these public health service hospitals to utilize the flow and interchange of physicians between those hospitals, Veterans' Administration hospitals and other Federal hospitals, I think you would find, first of all, that there would be a number of benefit increases. First of all, these are hospitals that are in being, their capital costs are low, and adequate use of this kind of facility can result in significant savings in money. They could be utilized, for example, for military dependents who are entitled to certain benefits at Government expense, and service-connected Veterans' Administration patients, as well as certain other categories of Government entitlements for health benefits and health care. Now, if these facilities were more fully utilized it should be possible to attract sufficient doctors and to expect over the long term to have an adequate flow of doctors into and out of these hospitals.

Now, this kind of problem in Detroit is not unique. It is met in all the hospitals. I would cite one last thing that you ought to keep in

mind in consideration of this closing, and that is that the chief official of the Public Health Service in charge of the hospital is strongly opposed to the closing.

Mr. FLOOD. What is his name?

Mr. DINGELL. I cannot give you his name right now. I will furnish that for the record.

(The information follows:)

The official referred to is Mr. Seward Proctor, administrator of Detroit PHS Hospital.

Mr. FLOOD. Mr. Michel.

Mr. MICHEL. Thank you, Mr. Chairman.

Our good friend from Michigan makes a very eloquent statement against the closing of the Public Health Service hospital in his own bailiwick. The only thing that distresses me about your statement, Mr. Dingell, is the fact that the inpatient capacity is 177 beds and operating capacity of 147 beds. According to your statement, during the July-September 1968 period an average daily inpatient load was experienced of 96, which suggests that at a time when we are hurting for adequate facilities to cope with all the patients around the country in other hospitals, where we hear of waiting lists and so forth, that maybe this is not the most efficient operation here, with only an average daily patient load of just a shade over half of its capacity, and that there is some justification for looking into the prospects of closing it.

I am not althogether familiar with what the average daily patient load might be in other Public Health Service hospitals as against their maximum capacity, but what would your comment be with respect to that observation?"

Mr. DINGELL. I think you are pointing up the very thing I am complaining about here. That is, that we are not making adequate use of these Public Health Service hospitals. I think with fuller use we could probably achieve significant overall savings to the taxpayer since the capital costs are low, these hospitals were built in years past, and are still adequate structures. I believe there ought to be a real effort to utilize this hospital rather than to phase it out.

I mentioned that during the previous year they had something like 27,000 patient-days. They anticipated that during this fiscal year they would have 30,000 patient-days, which would be an increase to significantly over 100, probably on the order of 110 to 115 on a daily load basis if they were to utilize this hospital. I point out, too, that during the time you and I are discussing there were two buildings at the hospital entirely closed. They had been set up for an Urban Job Corps training program for medical technicians, and so forth. The buildings are beautifully furnished, they have fine carpets on the floors. But they were closed; in fact, those buildings have been lying idle and closed for a number of years.

We have this crying need for technicians, and are failing to utilize this hospital where health technicians could be well trained, probably at less cost than in other facilities. Now, what I am saying is that not only do you have a fiscally unwise judgment being made here but, in fact, you find a situation where the facilities are not even being used the way they should be.

Mr. MICHEL. You will have to agree there is much more to a hospital than simply a building.

Mr. DINGELL. I thoroughly agree.

Mr. MICHEL. Somewhere in your testimony there was mention made of the need for modernization.

Mr. DINGELL. There is not a really great need for physical modernization. In a hospital operation you have your choice between good and great, let's say, or adequate and superb. You can find hospitals, not so much in this country but in other countries, where the main physical plant is 100 years of age providing high quality medical care. The plant here dates from the middle 1930's which is not excessively old in terms of the age of hospitals in this country. It does not really require much modernization. Certainly, new equipment could be used, certain kinds of specialized health equipment would be desirable, but they are not absolutely essential to first class medicine, since within a matter of a few miles you have hospitals well equipped with this precise kind of thing and which, on the basis of some of the things we have done legislatively in my committee, could be and should be providing an interchange both of personnel, skills, equipment, et cetera, with other hospitals in the area. Right now in terms of the Hill-Burton extension, which my committee is presently voting on, we are considering the whole concept of regional health centers and regional care.

Mr. FLOOD. The Hill-Burton authority expires in June of this year, does it not?

Mr. DINGELL. I do not know whether it is June, but very shortly. There is no reason why every hospital in this area has to have, for example, a cobalt bomb, or must provide gynecology treatment, obstetrics, and so forth. You will find hospitals are making judgments that there are other hospitals in the immediate area which can provide these services better. Therefore, some hospitals will provide certain specialized care only on an emergency basis, and will emphasize other areas. Now, during the past year we tried to set up permission in the law not only for tax treatment but actual Federal grants for construction of certain kinds of auxiliary services; for example, joint diagnostic centers and computer banks, certain kinds of specialized equipment like cobalt bombs, specialized X-ray treatments, things of this kind, to be done centrally for a whole group of hospitals. In the Detroit area we have a major hospital complex just a few miles from the point where this Public Health Service hospital happens to be. So, this really is not a major problem. We have a hospital; it is in-being.

Mr. MICHEL. Are you saying this one could be used for extended care, utilized more for extended care?

Mr. DINGELL. It could be utilized more for extended care. You see, there is one other flaw in the position of the Departments; that is, they propose to keep open the outpatient services. I have not even calculated those services in my costs. By providing outpatient services only, you will find they are going to become very expensive without the previous daily patient to fully utilize certain services and prevent a great deal of idleness in these services.

Mr. MICHEL. I will be interested in reading your letter that you will submit for the record and see if we cannot get some kind of response to it, because I think you pose some very basic questions.

Mr. DINGELL. I urge you to look at this with great care because I am convinced the assumptions on which the Department finds savings are entirely spurious and erroneous.

Mr. FLOOD. Mr. Smith?

Mr. SMITH. I am very interested in the statement. You brought out several points I was not aware of. I had heard of the problem but not in the detail that you bring it out. I think you really pose some important questions when you talk about it costing more to close it than to keep it open.

Mr. FLOOD. Mr. Shriver?

Mr. SHRIVER. I was wondering why the facilities which were fixed up for the training of professional people were closed.

Mr. DINGELL. I think it was a budgetary judgment. Only so much money had been afforded for the type of Job Corps training that they proposed and it was not enough to get over into this area.

Mr. SHRIVER. You do not know whether it is a problem of getting people to go into that type of training?

Mr. DINGELL. No. I happen to know there are many people of limited but adequate educational background who would be more than happy to get into this kind of training.

Mr. SHRIVER. There is a great need for it at this time. Now, you have hit upon a great problem.

Mr. DINGELL. Not only for schools of nursing-which are in demand-but for nurses' aides.

Mr. SHRIVER. Don't they use Cuban doctors, foreign doctors, in the Public Health Service? You mentioned the Veterans' Administration. I know they do.

Mr. DINGELL. They do. Their biggest supply of doctors comes from, frankly, people who would rather serve out their military obligation in the Public Health Service than serve in the military.

Mr. FLOOD. Mr. Hull?

Mr. HULL. I think our good friend from Michigan, Mr. Dingell, has made an excellent presentation on this problem.

Mr. DINGELL. Thank you very much.

Mr. FLOOD. Mrs. Rield?

Mrs. REID. No questions.

Mr. FLOOD. Thank you.

Mr. DINGELL. I do have two other things I should like to submit for the record. One is the response of Anthony Celebrezze to Chairman Staggers which set out some of the reasons of the previous administration for keeping this hospital open after having previously determined they would close it. The other is the release of April 2, informing that this particular hospital would be closed. I think both of those would be useful for the purposes of the record.

(The documents follow :)

THE SECRETARY OF
HEALTH, EDUCATION, AND WELFARE,
Washington, D.C., May 10, 1966.

Hon. HARLEY O. STAGGERS,
Chairman, Committee on Interstate and Foreign Commerce, U.S. House of
Representatives, Washington, D.C.

DEAR MR. CHAIRMAN. Because of the interest you and your committee have shown in the future of the Public Health Service general hospitals in Detroit, Mich., and Savannah, Ga., I am writing to inform you of our recent decision on these facilities. You will recall that Secretary Celebrezze ordered a reevaluation of the Department's plan to close the Public Health Service general hospitals at Savannah and Detroit. This plan, as announced on January 9, 1965,

had rested primarily on the assumption that Public Health Service beneficaries served in these hospitals would receive care through referral to Veterans' Administration hospitals and, in some instances, to other Federal facilities and community hospitals.

As a result of the ruling of the Comptroller General that Public Health Service beneficiaries could not be given priority in admission to Veterans' Administration hospitals, further study was undertaken in July 1965 to determine whether other suitable hospital facilities would be available to provide comprehensive, economical, and accessible care to Public Health Service beneficiaries if the hospitals in Savannah and Detroit were closed.

I am pleased to be able to inform you that, based upon the findings of this study which was recently completed, the Department has made the allowing decisions:

1. The hospital at Detroit should be modernized and continued in operation as a Public Health Service general hospital.

2. The Public Health Service should continue to operate a general hospital at Savannah. Negotiations are being undertaken with the Department of Defense to acquire the modern hospital facility at the Hunter Air Force Base for operation by the Public Health Service. Sincerely,

H. CELEBREZZE,

Secretary.

U.S. DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE,
OFFICE OF THE SECRETARY,
Washington, D.C., April 2, 1969.

Conversion of the Public Health Service hospital at Detroit to an outpatient clinic was announced today by the Department of Health, Education, and Welfare. Effective date is June 30, 1969.

In announcing the move, the Department said the declining caseload and the limited size of the hospital make it no longer feasible or economical to continue operating as an inpatient facility.

The Detroit Public Health Service facility, located at 14700 Riverside Drive, is one of a nationwide network of such facilities operated by the Federal health programs service, a component of the Health Services and Mental Health Administration.

The Detroit hospital has an operating bed capacity of 147. The average daily patient load in fiscal year 1968, the last full 12-month period for which final figures are available, was 76. The hospital recorded 35,328 outpatient visits in the same period.

The new outpatient clinic operation, to be housed initially in the existing hospital building, will be geared to handle the current and foreseeable outpatient treatment requirements.

Patients who require hospitalization will be cared for in a number of ways. They may be referred to other PHS hospital installations, or to other hospitals, Federal and non-Federal. This will provide care at installations closer to places of beneficiary residence.

Personnel on duty at the hospital, as of January 31, 1969, numbered 200, of whom 26 were Public Health Service commissioned officers and 174 were civil service employees. Eleven PHS officers and 31 civil service employees will be retained to operate the outpatient clinic.

The 15 remaining PHS officers will be transferred to other installations within the PHS system. The 143 civil service employees will have a number of options. They may be transferred elsewhere within the system or elsewhere within the Public Health Service; they may seek employment with other Federal agencies or in community health facilities; in some instances, employees may be eligible for retirement. In all cases, however, personnel specialists will be assigned to counsel the employees about these options and to refer them to appropriate agencies.

Mr. FLOOD. We will resume again at 1:30. Thank you very much.