Page images
PDF
EPUB

"I am therefore happy to welcome my colleague today and to welcome the representatives of the National Kidney Foundation." Senator Tower, I am delighted to join also in welcoming you, and it is particularly appropriate that you are our first witness since you are a former member of this committee, and I know have a deep interest in the general field.

STATEMENT OF HON. JOHN TOWER, A U.S. SENATOR FROM THE STATE OF TEXAS

Senator TOWER. Thank you very much, Mr. Chairman.

I might note that you are a cosponsor of this measure; so I am particularly pleased to be able to appear in a friendly environment. It is not always thus.

Senator CRANSTON. Thank you.

Senator TOWER. Mr. Chairman, S. 2813 would add a special section providing assistance for kidney disease patients to the Vocational Rehabilitation Act.

Many Americans with end-stage kidney failure are alive today because of hemodialysis and kidney transplant, two modern medical miracles which have come into extensive use within the past decade.

Both of these forms of medical treatment are so effective that many people receiving them are able to work and carry on relatively normal lives. Each year, 7,000 to 8,000 patients suffering from end-stage renal failure could benefit from such treatment; however, only about 2,000 are able to receive it.

The remaining 5,000 or so die because they do not have access to treatment or are financially unable to accept it.

Costs, although lower than just a few years ago, are still beyond the means of many Americans. The legislation I have introduced, and which has been cosponsored by 33 or my colleagues, will help to provide lifesaving medical treatment which is financially inaccessible to large numbers of people at the present time.

After much deliberation, we chose the vocational rehabilitation program as the best means of providing this assistance. I would like to discuss briefly with you several of the reasons for our choice.

First, vocational rehabilitation is a well-established program in all States and has the machinery and funds to provide services to a variety of individuals in need of vocational rehabilitation. Both Federal and State funds are utilized in these programs, which are administered by the States. We, therefore, have a cooperative Federal-State program designed to assist individuals in returning to work after serious illness or in helping handicapped persons learn the skills necessary to begin making a living for themselves. The advantages of vocational rehabilitation are obvious to each of us.

Second, these programs help people to help themselves. Very often the individuals assisted under vocational rehabilitation are once again able to fully support themselves and their families where they otherwise would be dependent upon charity. Not only is this a humanitarian goal which provides handicapped workers with an increased sense of dignity and self-worth, by enabling them to earn their living, but also it is a very practical one. The cost to us all of maintaining people in institutions over a period of years is very high, indeed, when con

trasted to the relatively minimal cost of rehabilitation which enables them to support themselves. The advantages of vocational rehabilitation are obvious to each of us.

Third, vocational rehabilitation does not require pauperization of individuals to be eligible for assistance. Many middle-class families are unable to afford necessary medical treatment; however, to become eligible for assistance under medicaid they must reduce themselves to a state of abject poverty. With the use of vocational rehabilitation funds, families are able to maintain a reasonable standard of living while the head of the family remains eligible for needed assistance in preparing himself for employment.

Fourth, and perhaps most important, many people who are receiving treatment for end-stage renal failure are in real need of vocational counseling, training, and placement in addition to assistance with their medical problems. Having all these services available through one agency results in a coordinated and efficient means of serv ing these patients and preparing them to return to work or to continue working while receiving treatment. The experience of the State of Washington has shown that 80 percent of the kidney disease patients they have assisted have required some vocational rehabilitation.

Fifth, a number of State vocational rehabilitation agencies are already offering their services to kidney disease patients in a variety of ways, and, therefore, already have mechanisms established for kidney disease programs. Those who have not initiated such programs may certainly profit from the experience of their predecessors in the field. The State of Washington provides an example of a well-run integrated State program which utilizes vocational rehabilitation funds. Their program for kidney disease patients was established in 1962 by Dr. Belding Scribner, of the University of Washington, who was the pioneer in the development of chronic hemodialysis. It began with funds from a private foundation, but in the years following 1962 Federal and State funds were also utilized in the program.

In 1968, the State Division of Vocational Rehabilitation began to support some kidney disease patients, by supplying dialysis equipment, training in its use, vocational counseling and occupational retraining when necessary.

In the first 3 years of vocational rehabilitation participation, 76 percent of the individuals aided were able to return to gainful employment. The program has been so successful that officials associated with it believe that no one in the State has been refused help due to lack of financial resources.

Minnesota, too, has a well-executed State program which draws upon vocational rehabilitation resources, at present primarily for rehabilitation counselors. The vocational rehabilitation program in the State also assisted in the establishment.

One idea which has been emphasized in Minnesota is the economy, in the metropolitan area, of using one large ambulatory dialysis facility as opposed to numerous small facilities for persons who do not qualify for home dialysis.

Mr. Chairman, S. 2813 contains the following provisions:

1. The authorization of $25 million to be apportioned among the State vocational rehabilitation agencies for assisting individuals suffering from end-stage renal disease;

2. The authorization for the expenditure of these funds for (a) medical treatment such as kidney transplant and hemodialysis, (b) medical equipment, such as a dialyzer and its home installation, and (c) medical supplies.

This provision is not designed to limit the State agencies, but rather to provide a congressional mandate for the State agencies to develop programs to meet the needs of the patient;

3. A 6-month extension of the time limitation for evaluation of kidney disease patients. On-going programs indicate that the complexity of the criteria in evaluating an end-stage renal patient warrants this time extension; and

4. A requirement that the Secretary of Health, Education, and Welfare submit an accounting of the kidney program in his annual report on the Vocational Rehabilitation Act.

Mr. Chairman, at this time, I would like to address some of the questions which have been raised concerning this legislation.

First, this measure complements, rather than duplicates, existing Federal programs in the area of kidney disease. Although our knowledge of kidney disease and its treatment has increased in recent years, there are still many questions which are yet unanswered, and new questions are being posed each day. The National Institute of Arthritis and Metabolic Diseases will continue to search for these

answers.

Our next responsibility is to insure the efficient dissemination of these new instruments, and new techniques of detection and treatment, throughout our health care delivery system. The regional medical programs have made great strides in establishing kidney treatment facilities and training kidney treatment teams. Although such facilities and staff are still inadequate in some parts of the country, the regional medical programs can remedy these shortages with our continued support.

The legislation I am proposing will provide the final. but necessary link. All of our research, our facilities and our highly trained personnel are, to a great extent, wasted if the majority of the patients cannot afford the treatment.

S. 2813 will put our existing technology and resources within the financial reach of those who need them. In this way, we have an opportunity here to provide the means for saving thousands of lives annually.

Second, I feel that I would emphasize that the treatment of endstage renal disease is far more complex than a mere provision of medical care. In 1966, the Vocational Rehabilitation Administration issued a general moratorium to the State agencies, saying, in part:

"This is a relatively new type of treatment and a new venture for vocational rehabilitation agencies. The rehabilitation plan for each client should anticipate all problems he will face upon return to work-social, economic, vocational, as well as medical." As the kidney treatment program of the State of Washington has demonstrated, over 80 percent of its patients require the supportive services of vocational rehabilitation.

Third, the assertion that the Vocational Rehabilitation Administration already has the authority to assist kidney patients is without merit. Although over 40 State agencies have assisted at least one

patient, which is an indication of their willingness, most of these programs are quite limited. There are simply no funds available under existing legislation for initiating and conducting comprehensive programs.

Fourth, the medicaid program has been suggested as an alternate program for assisting kidney patients. Very few States, however, allow assistance to kidney patients under medicaid; and, as I have previously stated, those who do require that the patient first pauperize himself to qualify for this assistance.

Furthermore, while he receives assistance to pay for his treatment, he is not permitted to work. This approach is the antithesis of the vocational rehabilitation program, which works to maintain or return the individual to his useful and productive role in society.

Finally, it has also been suggested that this matter would be more appropriately incorporated in the various national health insurance proposals now pending before Congress.

Mr. Chairman, promises for tomorrow are a small comfort to the thousands of kidney patients who need treatment today.

At this time, I would like to enter into the record of these hearings, several letters I have received from the Kidney Foundation of Houston and the Greater Gulf Coast, the Kidney Foundation of the Texas Panhandle, the Kidney Foundation of Texas, the Kidney Foundation of Oklahoma-Southern Kansas, indicating their support for this support for this legislation.

Senator CRANSTON. The letters will all appear in the record at this point.

(The letters referred to follow :)

K

KIDNEY FOUNDATION OF HOUSTON AND THE GREATER GULF COAST

SUITE 22

AN AFFILIATE OF NATIONAL KIDNEY FOUNDATION

1310 MCDUFFIE · HOUSTON, TEXAS 77019 . (713) 522-1669

April 4, 1972

Senator John G. Tower

Old Senate Building
Washington, D. C. 20510

Dear Senator Tower:

Houstonians have watched with increasing interest the excellent progress of your Bill, S. 2813.

Senator, as time approaches for testimony relative to all amendments to the Vocational Rehabilitation Act, I would like to add our specific support to this vital

measure.

While I am aware of the wide scope of investigation you have made relative to this Bill, the Board of Trustees of the Kidney Foundation of Houston and the Greater Gulf Coast would like to remind you of the unjust situation Texans find themselves in relative to Kidney problems. The need in Texas for the passage of S. 2813 is immense. We are able to treat less than one-half of those requiring treatment due simply to the lack of funds. It is difficult today in our affluent society to reconcile with the fact that we have medical solutions to Kidney problems, yet our fellow Texans are dying because there is no money to provide assistance. Our need is great. You have given substantial hope to many who will otherwise die without the means provided by this Bill. We support you wholeheartedly and we are prepared to back this support with fact and figures to substantiate our statement of need. Should you need more visible signs of our support of S. 2813, kindly advise how we may be of assistance.

Sincerely yours

никогд

William F. Dougl
President

Kidney Foundation of Houston

and the Greater Gulf Coast

WFD-1m

« PreviousContinue »