STATEMENT OF MITCHELL GOULD, EXECUTIVE DIRECTOR, THE GOULD CONVALESARIUM, BALTIMORE, MD., ACCOMPANIED BY ARNOLD WEINER, ATTORNEY

Mr. GOULD. This is Mr. Arnold Weiner, my attorney.

Senator Moss. You may proceed, sir.

Mr. GOULD. Mr. Chairman, I join the many who have commended your committee for its effort on behalf of our aging and infirm. I am here today to add whatever I can to your fund of knowledge about the tragedy which struck our nursing home in July of this year.

As you are probably aware, I have cooperated fully with all interested agencies at every level of government to the end that effective preventative measures might avoid, if possible, a repetition of the sorrow which we experienced. I appear here at your invitation and not pursuant to any subpena or other legal compulsion.

I was born in 1919 and I have lived in Baltimore for most of my adult life. In 1939 I was employed by the U.S. Secret Service and I was stationed in Baltimore, Md., and Charlotte, N.C., with occasional tours of duty at the White House in Washington. I was also employed by the Office for Emergency Management as a special agent and, in addition, a special agent with the Federal Works Agency.

In 1945, following my discharge from the Armed Forces, I attended the Johns Hopkins University in Baltimore. I received a bachelor's degree, as well as a master's degree, in speech therapy. I have also taken courses in special studies at the University of California at Berkeley and at the Teachers College in Milwaukee, Wis. I attended the first semiannual course for nursing home administrators at George Washington University. I have taken most of the annual courses in relevant subjects which have been offered by the Maryland Department of Health, including courses in diet therapy and occupational therapy.

My own career in the administration of nursing homes has followed closely the history of this profession. Shortly after the war, when the demand for new construction was greatly in excess of the ability to build, most nursing homes were opened in structures which had originally been designed for other purposes.

The need for beds for the care of the elderly became acute and, as a consequence, private homes, former hospitals and former schools were frequently converted to nursing homes.

Within the next 15 years, however, funds and supplies for new construction became more readily available, and simultaneously, the standards for public buildings were raised. As a consequence, nursing homes, as other buildings used for public purposes, turned to new structures designed specifically for their special requirements.

In the early 1950's I opened a nursing home in Howard County, Md., in a stone mansion which had been utilized for many years as an exclusive girls' school. This home was licensed and approved for 68 patients. In spite of efforts at remodeling and repairing, however, the rise in the standards for public buildings made it impossible for this structure to meet the new requirements.

As a consequence, and when our lease expired at the end of the 3year period, this home was closed in August 1957. I also had a similar

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experience with a nursing home and a boarding home which had been located at Eutaw Place in Baltimore City.

It was evident to me that only newly designed facilities could provide the services which the times demanded. I sold both of the Eutaw Place homes, and, although they are still being operated today, I turned to modern construction.

As I discontinued my use of the older structures, I pioneered the construction of the first new nursing homes in our area. În 1958 I built and opened the first specially designed nursing home in Baltimore, in the 5800 block of Belair Road. Shortly thereafter, I built and opened a modern nursing home on Belvedere Avenue in Baltimore.

The tragedy struck us at the Convalesarium, our nursing home in the 6100 block of Belair Road in Baltimore. Many have wondered immediately about the quality of this facility. Some have assumed it to be an old plant, inadequately staffed and offering substandard care. Nothing could be further from the truth.

The Convalesarium was opened in December, 1964. It was the first FHA-sponsored multistoried home in Maryland to be planned from the ground up expressly for the care of older people. It was hailed, by the director of the Maryland Program for Occupational Therapy Assistance, as one of the few homes to provide fully equipped occupational therapy facilities.

In November 1965, after the home had been in operation for almost a year, the Baltimore Sun, in a feature article, noted that, "at the Gould Convalesarium *** there is much to be appreciated." The newspaper made special mention of the "bright and wide halls" which are "easily navigated, even by wheelchairs," the fact that the rooms are "gayly decorated" and that we had provided a number of special areas where the "patients can relax in the sun or play shuffleboard."

We have been visited, as you know, by Mr. Val Halamandaris of your staff. He was received with courtesy and there was no phase of our operation which was not open to him. I wish that it would have been possible for you, the members of this committee, to have visited us as well.

I have brought with me some photographs, which were taken just this past week, which can illustrate for you the kind of place we have. These photographs show the outside of our building, our lounge, a typical room, nurse's station, kitchen and general hallway area.* May I bring this up to the chairman?

Senator Moss. Yes, you may bring them up here, if you would like. We would be glad to see them.

Mr. GOULD. This will show the two wide elevators, one for passengers and one for wheelchairs. This is a picture of a lounge.

We took these just this week in contrast to some other older ones to show this building is up to date at this time. The nurses' stations, charts and the charts for nurses. This is a photograph of the building as it exists today. It was taken at that particular angle, Mr. Chairman, to show the relationship of certain properties immediately adjacent to the building which I would like to talk about in a few moments.

This is the physiotherapy equipment. This is a typical two-bed room, showing the fire protection, with 8-inch concrete floors, interior

Photographs retained in subcommittee files.

hoses under high pressure, cubical dividers between the patients for privacy.

This is a picture of a lounge. We have already put up some of our Christmas decorations.

This is an area of the kitchen and the food is being prepared. This is a separate area showing the dishwashing room, completely away from the rest of the food service.

Senator Moss. Thank you.

Mr. GOULD. I should like to tell you something about our staff. Unlike most homes, we have an administrator on duty 7 days a week for 12 hours a day. This doesn't mean it is the same person for the same period of time. But there is some administrative person on duty for these hours.

In addition, we have four registered nurses full time and one part time. We also have three licensed practical nurses. There are also 35 to 40 nurses aides and ancillary staff. Between seven and 11 of our personnel are employed in the kitchen. Our staff, at any given time, is between 75 to 80 persons. When all of our beds are at full capacity, and we are licensed for approximately 150 patients, we have a ratio of approximately one person employed for every two patients.

Our key employees have been with us since the day we opened and the members of our staff have dear ones from their own families as patients. Two of our registered nurses have had their own mothers in the home for several years, and they are still there as of today. Our former principal physician had his mother-in-law in our home as a patient. Several physicians and clergymen in the neighborhood, who have regularly visited or treated patients at the Convalesarium, have also had their own mothers or fathers stay with us.

Services are also supplied to us by outside contractors. The Hamilton Cleaning Corp., under contract, has employees at the Convalesarium 7 days a week. We have a dietician consultant who advises us on dietary problems. We have also engaged an expert sanitarian, Dr. Bernard Krafchick, who, together with his staff, inspects our facility, particularly the kitchen, on a weekly basis. At our instructions, Dr. Krafchick's inspections are without advance notice so as to maintain a constant vigil over our employees.

The distinguished panel which investigated us on behalf of the State health department concluded that:

All of the evidence suggests that the Gould Home was and is a better than average nursing home.

The panel's report also noted that:

It must be reiterated that the quality of the Gould Convalesarium equals or is better than most nursing homes in Maryland or the United States.

Dr. John DeHoff, acting commissioner of the Baltimore City Health Department, testified that our records are "of the quality one would expect in a reasonably good hospital." When he was asked to rate our home, Dr. DeHoff replied that only those homes who do not accept incontinent or terminal patients would be rated higher.

In this connection, I should point out as Father Sellinger said, that we have always accepted incontinent and terminal patients in spite of the added burdens associated with such patients. If we did not accept them, where would they go and who would take care of them?

One of the most difficult questions which has faced us has related to the cause of the salmonella outbreak. The panel's report has stated that:

Despite efforts by members of the Federal, State, and city health authorities, the origin of the outbreak and the source of the salmonella contamination remains unknown.

To the suggestion that the epidemic was "food borne," the panel responded emphatically that there are many features of the epidemic which are not answered by this conclusion, most notably that, for example, many of the patients who were sick were apparently unable to eat and were not receiving food. Indeed, a number of the employees also became sick at the same time and they too had not eaten any of the food.

The only common denominator which anyone could suggest is the city water supply. The Convalesarium is located at the end of an old 6-inch cast-iron waterline. Water samples which have been collected from this line and which have been tested have indicated that there is little or no chlorine in the water when it reaches our area.

So much foreign matter is present in the water that special filters have had to be installed to keep the appliances in our nursing home from breaking down.

It is significant that at the very same time as our patients became ill, there was, in our immediate neighborhood, an outbreak of gastrointestinal illness which was identical in its symptomatology. I have here a document signed by 42 neighboring families which confirms this fact.

Senator Moss. That will be included in the files of the subcommittee. Mr. GOULD. These are the people who live in the houses that I indicated on the picture immediately adjacent to the nursing home.

The neighbors, unfortunately, were not tested until long after the epidemic, when traces of the infection would not be expected to have remained. The city of Baltimore, in recognition of the danger, has promised to replace the ancient pipeline with a modern one, but we are still waiting. Members of 19 out of 50 neighboring families became ill. We are told this is normal in a city.

If that were so, in the city of Baltimore we would have had an epidemic of perhaps 250,000 persons ill at that same time. One of the ladies whose children were ill asked the city health department what she could do to insure the fact that her children would not become ill. She was told to boil the water-in the city of Baltimore, in 1970. Symptoms of the illness were first noticed in the early hours of Monday, July 27, 1970. They consisted of various combinations of diarrhea, nausea, and temperature elevations. I should point out that there never was any attempt on our part to hide this fact. As soon as the patients became ill, the physicians were called immediately and they began prescribing treatment.

I have for you a list of the 32 physicians who were notified and who treated the patients for their illness. I have also prepared a chart which summarizes, by patient, the times of the onset of the illness, the notification of the physician and the initiation of treatment. You will find that our staff made every effort to get whatever outside help ap

5 See app. B, p. 865.

peared necessary at the time. These charts are attached to the state

ment.

Senator Moss. They will be included.

Mr. GOULD. Not one of the many physicians who attended patients at the beginning of the outbreak expressed any undue concern or thought it necessary that the State authorities be notified. In fact, several of these physicians volunteered that they were seeing other patients in their own offices with similar symptoms and that we were probably experiencing only an outbreak of a summer virus.

By the second day, Tuesday, July 28, 1970, more patients were taken ill. I telephoned our hospital adviser, the State health department representative who was in charge of our home, and I told her that we had an unusual number of patients with diarrhea.

I did this, not out of legal duty, but as an effort to keep the authorities advised of those things which transpired in our home. You may find it noteworthy, in retrospect, that there are serious deficiencies in the Maryland law with respect to the reporting of infectious illnesses. There is a serious question as to whether nursing homes are required to make any reports. Even physicians are required to report only diarrhea in newborn children. While salmonella is an illness which is to be reported, the existence of this illness can be determined only after laboratory results have been obtained.

Throughout the time of the illness we were in constant consultation with our principal physician. He concurred in our suggestion that a no-visiting sign be posted and that specimens be sent for laboratory analysis.

On Tuesday, Wednesday, and Thursday specimens were taken from ill patients. They were sent not only to private laboratories, but to the laboratory of the State health department as well. On Thursday afternoon, we received the first results, these from the private laboratory, and they were negative for salmonella. Late Friday afternoon however, we received the first word, this from the State health department laboratory, that salmonella was detected.

Officials from the State health department and from other agencies appeared on the scene late Friday afternoon. I think that you should know that these officials, out of some deference to the private physicians who were treating their patients, did little or nothing about the medical treatment which was being administered.

Their suggestions were limited to the removal of certain patients to general hospitals, but only at the discretion of the attending physicians. The patients who were removed, moreover, received the same type of treatment in the hospitals as they had been receiving from their physicians at the nursing home.

Dr. William B. Greenough, III, the chief of the division of infectious diseases of Johns Hopkins Hospital, has investigated the clinical aspects of the outbreak. I have brought with me copies of Dr. Greenough's reports. I call your attention to his conclusions that the staff of the nursing home did all that might be expected of it. Dr. Greenough has concluded that the State health authorities, who are to be expected to know how to handle infectious diseases, failed utterly to generate an appropriate change in treatment.

Perhaps the most significant lesson to be learned from this tragedy, therefore, is that the State health authorities must make themselves See app. B. p. 867.