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(The matter referred to is as follows:)

Status of State-wide hospital and health center surveys in the 52 jurisdictions

eligible under S. 191 as of February 1, 1946

Intensive survey in progress : Arizona, Arkansas, Colorado, District of Columbia, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Oklahoma, Oregon, Rhode Island, South Dakota, Tennessee, Texas, Vermont, Washington, Wisconsin, and Wyoming; total, 31.

Intensive survey officially authorized, but not yet started : Delaware, Florida, Maryland, New Mexico, Ohio, Virginia, and West Virginia; total, 7.

No intensive survey planned, but preliminary survey completed : Alabama and Utah; total, 2.

No decisive action yet taken on survey: Alaska, California, Connecticut, Hawaii, Louisiana, Mississippi, Missouri, Nebraska, Nevada, Pennsylvania, Puerto Rico, and South Carolina; total, 12.

Dr. PARRAN. I would add by way of comment two observations: First, that the problem itself is one which the several States already are beginning to take the first steps toward solution; and second, that a framework is being developed within which hospitals and health center facilities can be developed as Mr. Priest so succinctly put it, Mr. Chairman, in accordance with specific health needs as determined by competent local authority, and not as an incident to a public works program or to some purpose not directly related to health needs as such.

Earlier, Mr. Chairman, I mentioned that I would have certain amendments to suggest for consideration by the committee.

The first has to do with the functions of the Federal hospital council. The bill provides that the council shall advise and otherwise assist the Surgeon General, and in addition, under section 622 and section 623 (b), the council is clothed with substantial executive and administrative authority.

In conferring on these provisions with the Senate committee, I indicated then that the provisions in question were a departure from the traditional pattern of Federal advisory bodies, but stated that the matter was, in my opinion, one primarily of legislative policy to be determined by the Congress; and that from an administrative point of view, our experience in the Public Health Service with the National Advisory Cancer Council and other similar bodies had been such that I believed the program could be administered effectively under either arrangement, namely, where the council had these executive functions or where its duties were solely advisory.

However, subsequent to Senate consideration of the bill, the President, on January 31, 1946, addressed a communication to Mr. Lea, chairman of the House Committee on Interstate and Foreign Commerce, making specific recommendations in reference to not only this question but also to the use of the United States circuit court of appeals by an applicant desiring to appeal from the action of the Surgeon General denying approval of a construction project.

The second amendment has to do with the court of appeals procedure (section 632 (b)) just alluded to above. Since this was also objected to by the President, I have no further comment except to say

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that in my conference with the Senate committee, I then pointed out what I considered to be the undesirable features of the provision and recommended that it be deleted from the bill.

Mr. HARRIS. Before you discuss that, I understand, as the bill passed the Senate, it provided that the Federal hospital council should give its approval on matters which are considered functions of the administrative agencies.

Dr. PARRAN. That is correct.

Mr. HARRIS. Under the proposal, it is after consultation with the Federal hospital council, the approval of the administrator shall be given.

Dr. PARRAN. That is correct.

Mr. Brown. Let us get that clear now: in other words, the Surgeon General would be the administrator, as I understand it; is that correct?

Dr. PARRAN. Under the supervision of the Federal Security Administrator.

Mr. Brown. But the Surgeon General, under the second arrangement, would not have to be guided by the judgment of the hospital council; all he would be required to do would be to consult with them and, if he did not agree, say: "I have consulted; now, I will do what I please"; is that the situation?

Dr. PARRAN. That, theoretically, would be possible; although Congress could be informed of such a situation, if the committee were to adopt an amendment to the effect that, in the annual report of the Surgeon General to the Congress, there should be a statement as to the number of times the council had been consulted; a statement of the recommendations and determinations of the Federal hospital council and the instances in which the Surgeon General took action contrary to their recommendations. Such a requirement in an annual report of the Surgeon General would certainly keep the Congress currently advised as to the relationship of the administrator to the council.

Mr. BROWN. My experience with these annual reports has been, first, that you do not get them until long after the act has been committed, and second, nobody reads them after you get them.


Mr. BROWN. That argument does not have a great deal of effect on me, because I do not want to take the responsibility of having to read through any more annual reports. I read enough of them now to cause me to champion this psychopathic bill we have over here, and I certainly do not want to have to depend upon any more annual reports for my information as to what is going on in these agencies. I would much rather have a law requiring you to do the thing that Congress wants to do first; which we will probably have in the end, I hope, but would safeguard against any of these contingencies.

Dr. PARRAN. I imagine, Mr. Brown, that if the Surgeon General and council were involved in any fight, you would hear about it and would not need to read a long report to know about such things.

Mr. BROWN. We might; yes. (Laughter.) Mr. HARRIS. Doctor, was this proposal submitted to the Senate committee and considered by that committee as this legislation was considered in that body?

Dr. PARRAN. There is a long and somewhat complicated history in reference to the matter. The debate on the floor of the Senate, the

hearings before the Senate committee, brought out arguments pro and con.

In the report of the Senate committee, Senator Murray, as chairman of the full committee, while not objecting to consideration of the bill, filed a report, entitled, “Personal Statement and Reservation."

He and Senator Wagner and other Senators objected to the executive authority of the council and certain other provisions of S. 191.

The statement by Senator Murray, which I referred to, is in Senate Report 674, on page 17, and is entitled, “Personal Statement and Reservation by Senator James E. Murray, Chairman of the Committee on Education and Labor."

Mr. Brown. This is the proposed amendment

Dr. PARRAN. I have not proposed an amendment; I have refererd to the objection which the President has made and, if the committee would permit me, I think it might be well for me to read the President's letter.

Mr. Brown. Yes; I would like to hear that.
Mr. HARRIS. Very well, you may read that.
Dr. PARRAN (reading):


Washington, January 31, 1946. My Dear Mr. LEA :

As you know, my message to the Congress concerning a national health program recommended a system of Federal grants for the construction of hospitals and related facilities. S. 191, passed by the Senate and now pending before your committee, translates into legislation many of the objectives I had in mind in announcing the construction aspects of my health program.

S. 191 contains, however, two particularly objectionable administrative provisions. It esetablishes a Federal hospital council which, but for the chairman, is composed of private citizens. Although I strongly believe in the use of advisory bodies of public and professional membership, the council set up by S. 191 would have important administrative duties, would act in a semijudicial capacity, and could veto action by the responsible administrator of this program which involves grants of large amounts of Federal money. In discussing the matter in the Senate, Senator Murray properly pointed out that the parttime members of this council are responsible to other employers and organizations and are “potentially responsive to interests other than those of the Federal Government."

The pending bill also provides that any applicant, a State, locality, or private nonprofit organization, which is dissatisfied with the action of the responsible Federal administrator denying a construction project may appeal to the United States Circuit Court of Appeals. For the first time under a Federal program of grants-in-aid this bill would sanction the judicial overriding of administrative discretion which Congress has entrusted to an official which it holds responsible for granting Federal funds.

I believe that these two provisions would lead to divided responsibility and confusion in the administration of this important piece of legislation. It would plant the seeds of disharmony in Federal-State local relationships. It could afford a precedent which would be disastrous to the developing system of Federal grants-in-aid, upon which much of our social legislation is based.

I urge you and your committee to give your earnest consideration to the implications of these provisions. They negative many of the worthy objectives which are expressed in the other provisions of the bill. Sincerely yours,

(Signed) HARRY S. TRUMAN. Mr. Brown. When was that dated ? Dr. PARRAN. January 31, 1946.

Mr. Brown. And do you know, or can you give the committee any information, as to the circumstances under which that was sent to Congress? Was that as the result of conferences of the President with anyone?

Dr. PARRAN. I am uninformed on the circumstances underlying the letter. I saw it in copy form for the first time subsequent to January 31.

Mr. Brown. Had this matter been discussed with you at any time?

Dr. PARRAN. It was not discussed with me by the President. I discussed the problem, as I have indicated, in the executive session of the Senate subcommittee which was handling the bill. I have already indicated the position I took in reference to the powers of the advisory council. On the Court of Appeals provision, I said that I thought we might have 5 years of legislation and 10 years of litigation. I objected to the court review provision.

Mr. Brown. In that connection, did it occur to you that perhaps the Congress, was wanting to write in a new formula into this bill because of past experiences? We have had a great deal of experience in the last few years with Federal grants, and Federal aid to States, and we have had a great deal of experience with the sole power of administration, being placed in the hands of individuals, I think we have talked before on this same issue and that you appreciate this philosophy does not apply to you as an individual, because, as I have said before, I have a lot of respect for you, but you may not always be Surgeon General.

Dr. PARRAN. Definitely, I shall not be.
Mr. BROWN. Age does creep up on us.

Does it ever occur to you that perhaps the reason why Congress is writing this new formula into this law is because of these past experiences ?

Dr. PARRAN. Mr. Brown, that is a very searching question, and I may say a very fair question.

Mr. BROWN. A very important question.
Dr. PARRAN. I shall attempt to respond, and shall try to be brief.

The Senate Committee on Education and Labor, as the reports and the Congressional Record will show, gave very searching thought to how the grant-in-aid principle could be improved in this particular legislation.

Senator Taft notably took great personal interest in trying to develop what he considered to be improvements in grant-in-aid. A number of provisions suggested by Senator Taft were accepted by the committee.

In section 612, there are a list of provisions which the State must include in its plan, and on page 4, it is provided that the Surgeon General shall approve an application which complies with the provisions set forth.

Again, in section 623, dealing with State plans, the State plan must do certain things set forth in the bill.

The Senate committee asked me if I could think of any other requirements which we should put in the State plan. All of the requirements which seemed to several of us appropriate were put in.

Then the bill provides, on page 12 ((b) of section 623, that the Surgeon General shall approve a State plan which complies with the provisions mentioned.

I could go into more detail, but I think this much testimony, Mr. Brown, indicates the Senate committee went to great length, I am glad to say, in defining precisely the intent of the Senate in connection with

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this bill and in circumscribing the discretion of the Surgeon General.

Mr. Brown. Including the requirement that the action of the Surgeon General be approved by the council?

Dr. PARRAN. I favor the circumscription which the Senate has made to the authority of the Surgeon General except in the respects to which the President has objected.

Mr. BROWN. And to which you object ?
Dr. PARRAN. To which I object, too.

Mr. WINTER. Why do you object to private citizens being on the committee?

Dr. PARRAN. I do not object to private citizens being on the committee. I am objecting to the Court of Appeals provision, because I think it is likely to tie up any action for, maybe, for extended periods.

In respect of the objections to the power of the council, I want to be perfectly fair and repeat that I said to the Senate committee that this is a matter for the Congress to determine. The Surgeon General, I feel, could administer the bill either way. The President has spoken on this score and I support his point of view.

Mr. WINTER. As I remember the President's letter, he objected to private citizens being on the committee because their interest might be something other than the interest of the Government. - Dr. PARRAN. I am afraid I did not make that point clear.

The President does not object to private citizens serving in a consulting capacity. All of us agree that the council should be consulted frequently and intimately concerning the many professional, scientific questions, and questions of policy which will arrive under the bill; the objection raised by the President is to give them veto authority, to give such private citizens who are per diem employees of the Government while attending meetings, to give such a group veto authority over the responsible Federal administrator.

The President points out the implications of such a precedent in connection with other legislation, also, which I had not considered in my testimony before the Senate committee. Mr. Harris. Who composed the Federal hospital council ?

Dr. PARRAN. It is composed of the Surgeon General, as chairman, and eight citizens of whom three should represent the consumers of hospital service, five should be informed concerning hospital and health problems.

Mr. HARRIS. What section? What section of the proposed bill is that?

Dr. PARRAN. Page 23, beginning with line 10, the qualifications; they are set forth there.

Mr. HARRIS. You may proceed.

Mr. GILLETTE. I would like to ask the doctor who designates the State agency.

Dr. PARRAN. The State itself.

Mr. GILLETTE. Is that done by the Secretary of Health or the Governor or who?

Dr. PARRAN. It will be a matter of State law in most instances. Possibly the Governor would have authority in many States to designate the State survey and planning agency, which is the first step in connection with the bill. In most States it would be the State health agency.

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