This proposal went to the National Research Council, which set up the committee, and I was transferred to the National Academy of Sciences to work there for another 6 months at the end of the war. I was still on active duty, and we established the Veterans Follow Up Agency, which really began the first research program in the Veterans' Administration.

In 1955 they started the intramural research program, which was a great addition to the research program.

In brief, let me say that I think the Veterans' Administration research activities have contributed enormously to the medical care. for veterans themselves, but also to the quality of the general medical care in the Nation.

It is very difficult, I think, to set a size to the whole veterans program, and particularly the veterans-not only medical care program, but the veterans research and training program, and to separate it from the whole national program. It is an integral part of the total national activity in this area. That is why it assumes great impor

tance.

Now, to illustrate this importance is to illustrate its relation to our own program. In our own institution, as well as in many other parts of the country, we have a very close relationship between the Veterans' Administration program, not only medical care program, but research and training program with our own Baylor College of Medicine program.

We expanded our enrollment beginning 3 years ago, but 2 years ago in a very active development of doubling our enrollment of our medical students, largely because Veterans' Administration hospital was a closely affiliated hospital with our program. That was the only basis for being able to enlarge our class to be able to use more doctors. The Veterans' Administration hospital in Houston assumes a very important role in our total academic activity.

The cutbacks that are taking place and projected in research and training from the Federal Government, and particularly for the National Institutes of Health will actually affect our academic pro-. gram by something on the order of about a $9 million reduction of our total expenditures, which means about a one-third reduction in our faculty personnel.

We are going to be very hard put to make up this deficit in the Veterans' Administration hospital, which we are making up now because of the lack of funds in the Veterans' Administration hospitals to support these activities.

The funding that they provide us, or which is provided for research in the Veterans' Administration hospital, is of course a very important source of research, but because of the lack of adequate funds, the patient care suffers, and we have had to make this up from our budget, the Baylor College of Medicine budget in order to provide the proper level and quality of medical care and training.

This is a very critical time because I doubt seriously that the quality of medical care that we have been able to provide the veterans can continue into next years' activities with this much cut in the overall budget. I am afraid this is going to take place across the country, so it is all very well and good to hear about the high qual

ity of medical care you want to provide the veterans coming back home, and particularly the increasing number of veterans we are now having to assume following the Indochina war. It is not going to be possible to maintain that level if we have to continue at the funding level that we now have, and projecting for the next year in almost every area of special activity in our hospital (and we are one of the hospitals that has the special activities such as kidney dialysis, renal transplantation), it is not possible to do renal transplantation at our Veterans' Administration hospitals despite the fact that we are a dialysis center. If it were not for the fact that we had Baylor supporting the renal transplantation, and if it was up to the VA, they simply couldn't do it, because they don't have the funds to provide it. So, we have to provide the personnel that does it. This is true in almost every other specialized areas.

Coronary artery disease is, as you know, an increasing disease in this country. It affects the veterans as it affects everybody else. So with the newer developments in the treatment of patients for coronary artery disease, and especially with some of the newer developments, we are hard put at the Veterans' Administration hospital, for example, to provide this kind of service and this quality of medical care, because we are short of personnel there, owing to the funding level of the hospital. This is pure medical care.

We can do this at the private hospitals; we can do it at the city or county hospitals, but we are hard put to give it to the veteran-unless we can transfer him to a private hospital.

The same is true in terms of space. Now, I heard the testimony that was given on construction. I must tell you that I can't understand that testimony in relation to our own requests for additional space at our own hospitals, which has now been in their hands for more than 2 years. Maybe they are phasing it over the next 5 or 10 years, but we need that space right now, and we need it badly, and it is going to be impossible to provide the quality of medical care that we are accustomed to providing the Veterans' Administration, and which we are all saying we want to give the veteran population. We are going to have to continue to operate in the kind of constraints of space and the space limitations that exist in our hospitals today in terms of our population, so, I just don't understand the statement about what they are providing in the way of funds over the next year, as though these are all the funds that can be used.

We can use these funds right now, and unless we get some additional funds in a year from now or 2 years from now, the quality of medical care is not going to be at the same level. And secondly, you are not going to be able to provide all the veterans the medical needs that they will require.

Senator HANSEN. Mr. Chairman, if I could just say a word to Dr. DeBakey.

I think his summarization is extremely good, and I am certain that it will be given very serious consideration by this committee because certainly you are highly regarded, as I needn't tell you. And, I think what you have to say will be given extremely serious and earnest consideration as far as I am concerned.

Dr. DEBAKEY. Thank you very much.

Senator THURMOND. Mr. Chairman, I would just like to express my appreciation as a member of this committee to Dr. DeBakey for

his presence here today, and say that I think his comments constitute a very fine contribution to this hearing.

Dr. DEBAKEY. Thank you.

Senator CRANSTON. Dr. DeBakey, I know that you have been in many ways the father of research in the VA, and your leadership in this field has been absolutely tremendous.

We face another problem in the fact that other aspects of the budget mean that affiliated medical schools are also going to be cut back right and left on research, and that in turn is going to affect the research that relates to veterans care.

Would you give us for the record your recommendation as to what the VA research budget should be for 1974? Could you do it for the record?

Dr. DEBAKEY. Mr. Chairman, I would be hesitant to give you an off-the-cuff figure, but I would be glad to do it for the record.

Senator CRANSTON. We heard this morning that although research support is being reduced, the reduction will not have any impact on the research that can be achieved in the VA hospitals. This statement, I am sure, is rather difficult to support.

Dr. DEBAKEY. I think that statement can be challenged very easily.

Senator CRANSTON. Are you aware of programs which have been eliminated or reduced as a result of these cuts specifically?

Dr. DEBAKEY. Yes, I can supply those for the record, too.
Senator CRANSTON. Would you please do that?

Dr. DEBAKEY. I can also supply for the record some programs that we have been trying to initiate, which we have been unable to initiate because of lack of funds in certain instances.

Senator CRANSTON. I am sure you were glad to hear the VA's assurances that the term "outlay savings" used to describe future research allocations doesn't mean a planned reduction in those programs.

Have you, through your close association with research efforts nationwide, gotten the same impression that no general research reductions are planned in the future?

Dr. DEBAKEY. That is contrary to the experience that I had, and encountered everywhere across this country.

In our own institution we are cutting back, and already we are laying off people. We expect something on the order of about a $9 million reduction, in our overall program around $24 million. It is serious. Now, that money can't be found anywhere else, and the only result will be to have these people laid off and find other sources of work and income, and those research activities will be gone completely.

[Dr. DeBakey subsequently supplied the following information:] SUBSEQUENT INFORMATION SUPPLIED BY DR. MICHAEL E. DEBAKEY, PRESIDENT, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEX.

I. INTRODUCTION: THE PRESIDENT'S PLEDGE TO THE VETERANS

Fulfilling the Nation's obligation to its veterans is a matter of justice and national honor. Meeting their medical needs is one of our highest national priorities. To insure that they are met, I intend to maintain and reinforce the independent system of Veterans Administration health care facilities when and as required. (President Nixon's dedication speech of V.A. Hospital at Columbia, Missouri).

This statement by the President is a logical extension of the V.A. policy memorandum #2 of January 3, 1946, which encouraged the development of a partnership between Veterans Administration Hospitals and the nation's medical schools. Since 1946, this partnership has improved the quality of health for the veteran and helped to achieve educational goals in medicine for the country as a whole. By accomplishing both objectives, the nation's health has been strengthened and improved. The veteran not only has obtained the highest possible quality of medical care, but the Veterans Administration has participated in the development of new knowledge applicable not only to veterans but to sick people everywhere.

At the present time the nation has 95 V.A. Hospitals affiliated with 81 medical schools. Almost 12,000 medical students train in these hospitals, and on any given day about 4,500 residents, under the supervision of full-time V.A. staff physicians and consultants from the affiliated medical schools, render patient care to veterans.

II. THE HOUSTON VETERANS ADMINISTRATION HOSPITAL

The mutual respect and confidence that has grown out of this partnership, which was bolstered by the President's statement led Baylor College of Medicine and its Dean's Committee, in cooperation with the staff of the V.A. Hospital in Houston, to develop a five-year plan to improve patient care; a copy of this proposal is enclosed.

The Houston V.A. Hospital ranks among the three most active and productive institutions in the V.A. System. A review of fiscal year 1972 workload data shows that the patient turnover rate and the hospital occupancy rate in the Houston V.A. Hospital are the highest in the country for the volume of patients treated. Last year in this Hospital 14,722 patients out of 33,471 applicants were admitted, and 103,000 outpatient visits were made.

The Houston V.A. Hospital has for a number of years, served as a major referral center for specialized medical problems, and this function has increased when the V.A. regionalization policy was adopted and implemented. Among the various specialized medical programs in the Hospital are those shown in Table 1:

The 1972 per diem in Houston was $57.50, whereas the national average for comparable general hospitals was $63.73. Thus, despite our many specialized services, highest percent occupancy, and highest turnover of patients, similar V.A. hospitals elsewhere are costing the taxpayer 10.83% more.

Ten to fifteen percent of the veterans currently requiring hospitalization have recently returned from the Vietnam War. These young men are hospitalized for diseases and injuries that were peculiar to this war, such as:

1. Spinal Cord Injury.-The Houston V.A. Hospital is one of eight in the United States to have a specialized center for this severe disability. At present. 40 veterans with either quadreplegia or paraplegia secondary to spinal cord injury are in this Center. To serve the veteran population of Houston, we need a 100% increase in number of beds allocated for this severe disability, and with it, an increase in the number of M.D.'s and the necessary allied health manpower required for optimal management of these patients. Furthermore, this national health problem is sufficiently important to warrant the establishment of a training program for physicians and supporting personnel. After learning the optimal management of these veterans in this specialized Center, these health professionals could go out to other areas of the country and provide these services closer to the home of the disabled veteran, for

indeed, here is a classical example of a situation in which an ounce of prevention is worth a pound of cure. Bedsores, bladder infections, for example, are the plague of these patients; they can be acquired in a very few days, they take weeks to cure.

2. Mental Health and Drug Abuse.-One of the benefits of the V.A. Research Program has been that a great number of patients with emotional problems can be safely maintained outside the hospital through Mental Hygiene Clinics and Day Hospitals, such as the ones operated by the V.A. Hospital in Houston. Whenever a patient has to be hospitalized when he could be maintained as a day or outpatient, the costs to the taxpayers as well as to the man and his family rise.

We should look carefully at the impact on society of any thing less than adequate care to the sick veteran. These men have given up a good part of their lives in the national interest; we do not want our promises to them to fall short of good medical care. Of 1,200 beds in this Hospital, 400 are devoted to psychiatry, of which 70 are concerned exclusively with drug abuse. In addition, 307 outpatients are enrolled in a V.A.-supported drug-dependence program. Most of these veterans are dependent on heroin, and two-thirds are on treatment with methadone. With our current staffing ratio in psychiatry, we have 17.1 doctors caring for 431 patients, or an average 25 beds per doctor. More doctors will be needed for our drug-dependence program and our mental health hygiene clinics, or the costs to society will increase in many ways. Some of these veterans will have recourse to the crime scene in which case economists estimate that the ultimate cost to the taxpayer will be tenfold that required to maintain good health care as a preventative measure. Houston has a number of excellent psychiatrists that we would like to add to our staff, but because of inadequate funds, we are not able to do so.

3. Multiple Amputees.-For the five years since the height of the Vietnamese War, the Houston V.A. Hospital has had an average of 37 service-connected amputees in the hospital on any given day. A rehabilitation service was established to bring the latest in biomedical engineering research, including the development of new prostheses, to rehabilitate these men. I have had a personal interest in the development of bioengineering as a profession. The National Institutes of Health, the National Science Foundation, and the National Academy of Engineering have recognized and supported collaborative programs between engineering and medicine. At the present time, we need additional personnel to provide a total rehabilitation program. The creation of multidisciplinary centers is sufficiently important to be designated as being in the national interest. These centers would not only rehabilitate these Vietnam amputees to the extent possible, but they would also establish a follow-up program in the veteran's home town to ensure them an opportunity to lead a productive life.

In addition to this special workload that resulted from the Vietnam War, we have had to continue to maintain the best patient care to eligible veterans who have the usual illnesses for their age groups. The present staffing of the Hospital should be increased to give the new veterans the type of care to which we aspire. Similarly, supporting services, such as radiology and laboratories should be increased to continue to give medical care that is competitive with our best private hospitals to the enlarged veteran population.

Moreover, because of the effectiveness of the partnership between the nation's medical schools and the Veterans Administration Hospitals, many educational opportunities have been developed in undergraduate and postgraduate medical education and in allied health training. Indeed, the Houston V.A. Hospital was the first such hospital in the nation to develop a Physician's Assistants Program. There are now about 18 VA Hospitals with such academic programs. At Houston, Baylor has established a joint program with the College of Business at the University of Houston for management development in the health care industry. The administrators of the V.A. Hospital and its professional staff are participating in this program at no cost to the Veterans Administration. This important recent development will help insure top level management officials for the V.A. in the future.

III. WHY DOES THE HOUSTON V.A. HOSPITAL URGENTLY REQUIRE FURTHER SUPPORT ? In section II, I have stated that the Houston V.A. Hospital ranks among the three most active and productive institutions in the V.A. system. Without arguing about exact numbers, my twenty-five years of intimate association