Ohio, Wright State University. Oklahoma, University of Oklahoma-College of Allied Health Professions. Elizabethtown College-Elizabethtown. St. Francis College, Altoona Lakes Area Health Education Center. Tennessee, Vanderbilt University School of Allied Health Professions. Texas: Central Texas Regional Medical Education Foundation (Temple Junior College). St. Joseph's Hospital, Houston. University of Texas-San Antonio. Utah, Weber State College. Washington, City of Seattle-Schools and Colleges. Attachment D GENERAL INQUIRIES LOCAL ORGANIZATIONS AND GROUPS Arkansas: Arkansas State Medical Society. A practicing physician. Maine, Maine's Regional Medical Program. New York, 29th District of New York (Congressman Stratton)-Albany/Schnectady area. Ohio: "Interested citizens of Ross County" (Chillicothe area). Ohio State University-President's Office. Tennessee, Ralph F. Morton, M.D., Sevier Medical Group, Kingsport. ASSOCIATIONS AND SOCIETIES Association of American Medical Colleges. Association of Schools of Allied Health. American Medical Association-Council on Medical Education. American Podiatric Association. American Optometric Association. Association of Colleges of Pharmacy. LETTERS IN BEHALF OF POTENTIAL STUDENTS Senator Jacob Javits. Senator James Buckley. Senator CRANSTON. What is the status of regulations for implementing the present public law; when will they be issued? Mr. WILSON. Sir, we hope to have them published in the Federal Register within 45 days. As you know, we have had a great deal of difficulty with these regulations. This is a new field that we are entering and we have had difficulty with some of the questions that were posed by the law. These questions in large measure were submitted to our special medical advisory group [SMAG] which has now met upon them through a subcommittee and through the advisory group itself, and made recommendations back to the General Counsel. The regulations are in the process now of being finalized and submitted one more time, I think, to SMAG, and then they will be published in the Federal Register so that we may then receive comments from the general public. We hope to have this done in 45 days. Senator CRANSTON. If you would share the regulations with us, if you can, before they are formalized, we would appreciate it. Dr. MUSSER. Sir, they will be printed in the Federal Register first. [Subsequently, the Veterans' Administration submitted the following information:] Final draft of regulations for implementation of Public Law 92-541 are in preparation. It is expected that they will be published in the Federal Register on or before May 30, 1973, as proposed by Mr. Wilson at the time of his appearance before Mr. Cranston and the subcommittee. Senator CRANSTON. What are you doing to carry out the Regional Medical Educational Center Program which the VA was directed to establish in the public law in the new subchapter II, added to Chapter 73? Dr. MUSSER. Well, I must confess that I apparently hadn't read that part of the law well enough until the special medical advisory group met and then they called my attention to it. Since then we have been trying to develop a plan as to how we will implement that segment. Senator CRANSTON. Have any regional centers been identified? Dr. MUSSER. As you know, we already have become involved in eight so-called area health education centers, and one might get into a semantic exercise in this regard because these could be called medical educational centers just as well. So that in this sense we already have become involved in this type of activity. Senator CRANSTON. Have regulations been prepared in this area? Dr. MUSSER. No, sir. Senator CRANSTON. When will they be prepared? Dr. MUSSER. As I say, we are working on our plans and since these regulations will not require the approvals and the other regulations will, it would be forthcoming perhaps in a month or so. Senator CRANSTON. While I am talking about it, section 4121, "Designation of Regional and Medical Education Centers,"-subsection (a)-reads in Public Law 92-541: In carrying out his functions under section 4101 of this title with regard to the training of health manpower, the Administrator shall implement a pilot program under which he shall designate as Regional Medical Education Centers such Veterans' Administration hospitals as he determines appropriate to carry out the provisions of this subchapter in geographically dispersed areas of the United States. Are you saying nothing is being done under that? Dr. MUSSER. No, as I say, we already have eight hospitals designated as area health education centers, and for all practical purposes these are the same as regional educational centers. And, we are further planning the expansion of this particular activity. Senator CRANSTON. Well, I will submit the questions following up on that for the record, and I would appreciate it if you would take a personal interest in that authority, and I will indicate to you where I think there is a problem that ought to be attended to. Dr. MUSSER. All right. Senator CRANSTON. Dr. Musser and Mr. Wilson, could you both take a special interest in the three projects being proposed specifi 95-996--73- -17 cally for East L.A., Watts, and Sacramento, and come to see me in May, at a time when we can mutually arrange to report on progress specifically on them? Specifically I would like to know whether there are any fiscal year 1973 funds available to get started with an outpatient clinic at the Martin Luther King Jr. General Hospital. Dr. MUSSER. Yes, sir. Senator CRANSTON. We will submit detailed questions to follow up on each of those three points. In the interest of time, because we are expecting a rollcall, we have some additional questions that we will submit for the record. So, I thank you very much for your great help to this subcommittee, and your attendance, and your information responses this morning. I would like to say to my colleagues that because there is now a rollcall scheduled for precisely 12, which is going to occur, I suggest that we recess now and reconvene at 1:30. Is that satisfactory? Mr. WILSON. Senator, do you expect us back at 1:30? Senator CRANSTON. No, you do not need to be back, we are finished. Mr. WILSON. Thank you very much. We always appreciate the courtesy of the committee. Senator CRANSTON. Thank you very much. If a representative of yours can be here to hear what transpires this afternoon, we would like to have him. Mr. WILSON. There will be someone here. [The prepared statement of Mr. Wilson follows:] STATEMENT OF RUFUS H. WILSON, ASSOCIATE DEPUTY ADMINISTRATOR OF Mr. Chairman and Members of the Subcommittee: It is a privilege to appear before your Subcommittee today. We are grateful for this opportunity of reviewing the current status of programs in the Department of Medicine and Surgery. Initially, Mr. Chairman, I would like to make a few preliminary remarks and then call on Dr. Marc Musser, the Chief Medical Director, for a more indepth review of the DM&S medical program. We are currently operating 168 hospitals, 206 outpatient clinics, 18 domiciliaries, and 81 nursing home care units. In addition, VA patients are cared for under VA auspices in non-VA and State hospitals, State domiciliaries, and community and State nursing homes. The Veterans Administration also authorizes, on a fee-for-service basis, visits to non-VA physicians and dentists for outpatient treatment. During FY 1972, the number of VA patients treated rose to record-breaking levels. Over 944,000 were treated, representing a 3.5 per cent increase from the previous year and the highest number ever for a single year. Also, outpatient medical and dental workloads reached the highest levels since World War II. Treatment of veterans for drug dependence received increasing emphasis. A total of 26 drug dependence treatment centers were added to the six previously activated. The Budget for the Department of Medicine and Surgery exceeded 2.3 billion dollars in Fiscal Year 1972, an increase of 18 per cent over Fiscal Year 1971. Regionalization, the delivery of health care on an area basis, was completed in Fiscal Year 1972 and continued to prove its effectiveness. Looking at Fiscal Year 1973-both the magnitude and quality of VA's hospital and medical program are at an all-time high. Our budget of $2.7 billion for the program is the highest in history-up $320 million over last year. We will spend almost $76 million for medical and prosthetic research-up $7 million over FY 1972. A record-high average of 162,000 veterans will receive VA hospi tal and medical care on a given day. We will provide care for one million veteran patients this year-an increase of 130,000 over last year. Similarly, the 11 million outpatient visits to be funded by VA this year is an all-time high-over 2.1 million more than last year. We have activated 12 new Drug Dependence Treatment Centers since the start of this Fiscal Year, bringing to 44 the number of these specialized units put into operation in a little more than a year, and enabling VA to care for 40 per cent more patients than the 20,000 treated last year. By the end of this Fiscal Year, we will have increased the number of personnel in VA's hospital and medical care program to a record high 154,000, up 8,000 over last year and 19,000 over Fiscal 1971. VA hospital staffs have grown from 117 employees for each 100 patients in Fiscal Year 1968 to 146 for each 100 in Fiscal Year 1972. VA's 1974 request now before Congress asks for an increase to 150 employees for each 100 patients. The number of full-time VA physicians increased from 5,085 in 1968 to 5,374 in 1973. Despite the fact that nurses are in generally short supply, the VA has done well in the recruiting market and now has more nurses on duty than ever before in history. (There are now 21,279 nurses in the VA, approximately 30 per cent above the 16,399 in 1969.) Medical training this year in VA's 168 hospitals will be provided to 62,000 people, the greatest number in VA history, and an increase of 10 per cent over a year ago. These medical and paramedical personnel will be trained in 60 professional and technical categories. Other positives of VA medicine in 1973 are the addition of 248 specialized medical units in our hospital system, and the more than 5,000 research projects that will be conducted by upwards of 5,400 Research Investigators. Looking forward to Fiscal Year 1974, the President's overall budget has been guided by his promise to the American people to do everything in his power to avoid the need for a tax increase. He considers this to be a solemn commitment, and he is very serious about remaining within a spending ceiling for this Fiscal Year 1974. Even within these restraints, the VA has fared very well for 1974. Of our total appropriation requirements for 1974, $2,761,600,000 or approximately 23 percent is for medical programs. Our estimates provide for improvement in both inpatient and outpatient programs, increases in the number of inpatients treated and outpatient medical visits, activation of additional medical and research facilities, and augmentation of the continuing educational program for medical personnel. A total 1974 increase of $48 million over 1973 is requested for medical appropriations. For the Medical Care appropriation, we are requesting $2,656,000,000, an increase of $49.9 million over 1973. On a program basis, however, this represents an increase of $114.0 million over the obligations level for 1973. This program increase will provide for: Inpatient treatment for a total of 1,108,900 beneficiaries, an increase of 27,500 over 1973 and 164,711 over 1972 experience. Outpatient medical visits totaling 13,549,000, an increase of 1,916,079 over 1973 and 4 million or 42 percent higher than 1972. A total of 275,000 outpatient dental examinations and 264,000 outpatient dental treatments. The training of 62,000 physicians, dentists and other health service personnel in VA facilities. Activation funds for 6 hospitals and other new facilities and systems. A composite VA hospital staffing ratio of 150 employees per 100 patients, an increase of 1 over 1973 and 4 over 1972. Our request of $71 million for the Medical and Prosthetic Research appropriation is $5.8 million less than for 1973. However, the total program level for 1974 will be $78.4 million or $2.6 million higher than for 1973, taking into account the use in 1974 of funds available from 1973 appropriations. This program increase of $2.6 million will provide for an average employment increase of 100 which, coupled with responsive shifts in emphasis, will permit: Initiation of research programs in new and replacement hospitals and other expanded laboratory facilities. Expansion of VA cooperative studies in areas such as hypertension, sickle cell disorders and alcoholism. Expansion of prosthetic research and development activities-particularly the strengthening of biomedical engineering activities. We are requesting $32.6 million for Medical Administration and Miscellaneous Operating Expenses in 1974, as compared to $28.7 million for 1973. This increased of $3.9 million will provide for an employment level of 810, or 75 over 1973 of which 50 relates to medical automatic data processing activities previously funded under the General Operating Expenses appropriation. In addition to strengthening and improving management appraisal and evaluation activities and program development, the increase will provide for additional tuition and other educational support funds for medical-administrative personnel; expansion of the Exchange of Medical Information program; and additional studies or projects related to improved health services delivery and medical program effectiveness and economy. An appropriation of $100 million is requested for construction of hospital, nursing home and research and educational facilities in 1974. This provides $61,299,000 for Construction-Major Projects, and $38,701,000 for Construction -Minor Projects. It provides funds totaling: $37.0 million for hospital replacement and modernization-consisting of: construction funds for new clinical support facilities at Boise, Idaho, and partial construction funding of the replacement hospital at Bronx, New York; the new hospital bed building at Columbia, South Carolina; the relocation hospital and nursing home at Loma Linda, California; the Los Angeles replacement hospital, and the West Roxbury spinal cord injury rehabilitation center and modernization. $37.0 million for other hospital improvement projects. $5.7 million for research and educational facilities. $10.5 million for nursing home care projects. The remaining $9.8 million is for operating expenses of the Office of Construction which is responsible for facility design and construction. Mr. Chairman, this will give you and the Members of the Subcommittee an idea of the operation of our hospital and medical care program during the past several years and our plans for the coming year. Senator CRANSTON. Dr. DeBakey has informed us that he cannot stay, so we will proceed very briefly with Dr. DeBakey. Doctor, can you summarize very briefly your written statement for us? STATEMENT OF DR. MICHAEL E. DEBAKEY, PRESIDENT, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEX. Dr. DEBAKEY. I would be glad to, Mr. Chairman. Senator CRANSTON. Your full statement will of course go in the record, and I apologize for the lateness of the hour, but I know you are aware of the fact that we had to ask those questions. Dr. DEBAKEY. I understand. I am just sorry I can't change my plans, but unfortunately I can't, as I must take a flight this after noon. I do want to thank you for the opportunity to appear before you. And, to summarize, let me say that the testimony which I have formally submitted for the record and which you have very kindly agreed to accept for the record, has indicated my own personal in terest. I think you will find that I have a very personal interest in the research training program, and in the whole VA program. This emanated from the time that I was in the Surgeon General's Office in 1946, and it is as a consequence of my experience there that I made a proposal to the Surgeon General that a VA research program be started to follow up medical observations on all the veterans returning, and to establish a program that would develop an inquiry into matters relating to the medical problems of the veterans. |