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sion, I would like to submit our full statement for the record and summarize very briefly some of its prominent features.

Senator CRANSTON. Thank you very much, it will go in the record at the conclusion of your statement.


Mr. FLAHERTY. At the very outset, Mr. Chairman, I should like to mention that the DAV, by reason of its essential character, has a very close and compelling interest in the Veterans' Administration hospital and medical care program.

In our view, the funds requested for VA medical care in fiscal year 1974 are grossly inadequate. It reflects an increase in budget authority for only $49.9 million over the 1973 level. Upon reviewing the massive needs of the hospital and medical care program it is readily apparent that the proposed increase is unrealistically low, and will inevitably result in the loss of services that are vitally needed.

The 1974 budget shows reductions in the level of medical personnel, in the daily patient census, in the staff-to-patient ratio, in the VA hospitals, in the hospital construction program, and in the important programs of medical and prosthetic research.

These reductions serve to cancel out the efforts of this distinguished committee and the Congress to improve hospital staffing and medical care. Additionally, the cuts impose inadequate employment levels at a time when many VA hospitals are facing a serious shortage of doctors, nurses, technicians, and other medical personnel to serve the increasing veteran population.

Mr. Chairman, the DAV feels very strongly that the VA ought to proceed urgently with the expansion of its hospital facilities, its medical services and the scope of its research projects. Much valuable work remains to be done and adequate funds must be made available to assure a high standard of care in VA hospitals.

We are certain, Mr. Chairman, that you and members of the committee will not allow the VA medical program to deteriorate and that you will continue your efforts to see that sufficient funds are available to enable the VA hospital system to fulfill the mission for which it was created many years ago.

Mr. Chairman, I want to express our gratitude for this opportunity to present our views on this most important subject.

Senator CRANSTON. Thank you very much. I want to thank you for your very kind remarks about the committee's work and current legislation. Mr. FLAHERTY. You deserve it, sir.

Senator CRANSTON. I want to ask you the same question I asked your predecessor. Will you and your organization stand with us in our efforts to restore the VA budget in full, so that it will contain the funds for medical care, construction, and research needed to insure that veterans receive first quality medical care?

Mr. FLAHERTY. Indeed, we will, sir.

Senator CRANSTON. Do you have any comments on the VA testimony?

Mr. FLAHERTY. I didn't hear it, sir. I am sorry.

Senator CRANSTON. Do you have any thoughts as to where we might find room for cuts in the VA budget?

Mr. FLAHERTY. Any cuts in the VA budget? No, sir.

Senator CRANSTON. If we are going to increase the budget and stay within the spending ceiling, we are going to have to cut someplace. So, outside the VĂ budget, where do you think that we might best find room for cuts?

Mr. FLAHERTY. Mr. Chairman, the DAV has always supported a strong national defense. We do now; but we think the VA appropriations could be offset by savings in the defense budget. We hear frequently of billions of dollars in cost overruns at the Pentagon. We think there could be some savings in this area. Foreign aid, which requires expenditures of several billions, is in many cases, a bad investment.

I have heard that better control of credit might ease inflationary pressures. These are just some of the areas that come to mind.

Senator CRANSTON. Thank you very much. That is very helpful.

One other question, I believe that many of the veteran organizations, and your own, are collecting samples of veterans turned down for care who wind up in community hospitals. Would you please submit that information to us as fast as you can put it together?

Mr. FLAHERTY. We will sir.

Senator CRANSTON. Thank you very much. We are delighted to have you with us.

[The prepared statement of Mr. Flaherty follows:]


LEGISLATION, DISABLED AMERICAN VETERANS Mr. Chairman and members of the subcommittee: I appreciate the opportunity to appear before you and express the views of the Disabled American Veterans on matters affecting the Veterans Administration's Medical and Hospital Program.

I want to say at the outset, Mr. Chairman, that the DAV is genuinely grateful for the outstanding services you and the members of the Committee are extending to those who were disabled in our Nation's Armed Forces. If one looks back over the record, one can see very clearly that America's disabled veterans are fortunate indeed to have you around to advance and protect their interests.

Our good fortune is, of course, particularly recognized when we think in terms of your special efforts to bring about improvements in the quality of care and treatment in the Veterans Administration's medical and hospital system. It is unfortunate that these efforts are often frustrated by the Office of Management and Budget when it substitutes its own notions of wise fiscal policy for the clear intentions of this Committee and the Congress.

The DAV recognizes that fiscal and monetary restraints in the domestic economy may be necessary to help defeat inflation. However, we find it hard to accept a reduction in funds requested for the care and treatment of veterans who have suffered disabilities while serving their country in times of war. In this connection, it is the feeling of the DAV that the Veterans Administration budget for fiscal year 1974 is insufficient to allow the VA to effectively deliver health services that veterans need and are entitled to under the law. This is so, despite the fact that the 1974 budget indicates an increase of $49.1 million over fiscal year 1973 for medical care. However, it is certain that this relatively small increase will be wiped out by creeping inflation and rising costs. This will in turn contribute to a shortage of doctors, nurses, technicians and other medical personnel. Meanwhile, the VA, under pressure from the OMB, continues to deny that it needs additional funds for the medical programs.

The members of this distinguished Subcommittee will recall a situation last year when, despite evidence to the contrary, VA officials made similar denials of the need for additional funds to operate the hospital and medical program. When the true facts were placed before the Congress, however, a conclusion was quickly reached that there was a clear and pressing need for additional funds, and for far more resources than had been requested by the Veterans Administration.

Finally, in the face of vigorous opposition from the Administration, the Congress, in the Appropriations Act for Fiscal Year 1973 (P. L. 92–383), authorized an increase of $54,580,000 to insure an adequate level of medical care for the Nation's veterans. This law required the VA to maintain an average daily patient census of no less than 85,500 and an average staff to patient ratio of no less than 1.49 to 1 in all VA hospitals during fiscal year 1973. The VA, however, proposes to achieve this Congressionally requested staffing ratio by reducing the average daily patient census to 82,000. The budget request for fiscal year 1974 proposes still further reductions, with an average staff to patient ratio of 1.5 to 1 based on an average daily census of only 80,000 patients.

Moreover, instead of increasing the number of its medical employees by 3,725, as provided for in the fiscal year 1973 Appropriations Act, the VA plans to reduce its inpatient care employment by 1,832 in fiscal '73, and by another 2,180 in fiscal '74.

These reductions in medical personnel and the average daily patient census not only abolish the efforts of Congress to improve hospital staffing and medical care, but also impose unrealistic employment levels at a time when many VA hospitals are facing serious shortages of employees and hospital beds to provide direct medical care for the increasing veteran population.

Other deficiencies in the VA medical budget would result in a reduction of $6 million for medical and prosthetic research, and a reduction of $81 million in hospital construction. No funds are available in the budget for the 8 new medical schools authorized by the Congress last year under Public Law 92–541.

Mr. Chairman, the DVA feels very strongly that the Veterans Administration must proceed urgently with the expansion of its hospital facilities, its medical services, and the scope of its research projects. Much valuable work remains to be done, and adequate funds must be made available to assure a high standard of care in VA hospitals. We feel that the VA must go forward with positive programs that provide greater health services to more patients with increased effectiveness. In our opinion these things can be accomplished, in large measure, by enactment of S. 59, the Veterans Health Care Expansion Act of 1973.

This bill, Mr. Chairman, which you introduced and which was co-sponsored by your Committee colleagues, passed the Senate March 6th by a vote of 86 to 2. It contains a wide variety of provisions designed to strengthen the VA hospital system and enhance the quality of care in all VA medical facilities.

We salute the Committee for initiating this useful and necessary legislation, and for working so effectively to achieve its passage by the Senate. We also take this opportunity to commend and thank the Committee members for their untiring efforts which brought to passage on March 6th, the National Cemeteries Act of 1973.

We are all keenly aware of the fact that the cemeteries and health care measures were both passed unanimously by the House and Senate last year, in essentially the same form. Unfortunately, these measures-along with 10 other bills not related to veterans' affairs—were, in the name of economy, pocket vetoed by the President after Congress had adjourned in late October. This package of bills, which the President again threatens to veto, has been described as an extension of benefits associated with "social service" programs. While this description may correctly be applied to some of the programs involved, the system of benefits for the country's war veterans cannot, in any sense of the word, be classified as a “social service” program.

The American people have been constant in their recognition of the fact that war veterans are in a special category, and one to which the Nation owes a very special debt. Indeed, the measure of the Nation's gratitude is its ability and willingness to pay the price of reasonable benefits for those who served in times of war, and for those who took unprecedented risks to preserve our heritage and way of life. They did these things without counting the price which they were called upon to pay, and have since paid for every day of their lives. Mr. Chairman, as I mentioned earlier, the DAV is deeply distressed by the extent to which the Administration's budget priorities distort and frustrate the intentions of this Committee and the Congress.

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In our view, the President has available to him many other, and better, ways of fighting inflation than vetoing urgently needed VA appropriations for research and health services.

Even in a period of serious inflation the VA hospital and medical care program, which represents a long term investment in the health and well-being of our sick and disabled war veterans, should not only be preserved, but should also be enlarged as the needs so require.

We feel that the insensitive cuts thoughtlessly ordered at a time when the needs of our veterans are the greatest, poses a real threat to the present and future operation of the hospital and medical care program.

We are certain, Mr. Chairman, that you and the members of the Committee will not allow the program to deteriorate, that you will continue your efforts to see that sufficient funds are available to enable the VA hospital system to effectively fulfill its stated mission of providing medical care “second to none”.

In closing, Mr. Chairman, I again want to express our grateful appreciation for giving us this opportunity to express our views on a subject of vital importance to America's war veterans.

Senator CRANSTON. Our final witness will be Francis Stover, director of National Legislative Service, Veterans of Foreign Wars. I might explain that Ed Golembieski of the national veterans affairs and rehabilitation commission, The American Legion and Charles E. Mattingly, deputy director, national legislative commission, the American Legion, were scheduled to appear, but because of time problems they have submitted their statements for the record. The same holds true of Kenneth R. Hubbs, national legislative director, Military Order of the Purple Heart of the U.S.A. We are grateful to them for their statements. They will appear in the record, and I regret that we are not able to ask them some of the questions that their testimony will provoke and the general situation invites.

Frank, we are delighted to have you with us, and thank you so much for being willing to be switched to the end.

Mr. STOVER. Thank you for the opportunity to be the anchor man or the man who winds it all up, and put it all together, I hope.

Senator CRANSTON. Let's see if you can outdo our previous man.



Mr. STOVER. First, Mr. Chairman, I would like to reiterate that the Veterans' Administration hospital system is a great national asset. It has 168 hospitals, as you know, 16 domiciliaries and a large group of other buildings. And, of course, its primary purpose is to take care of veterans, which it does.

But it also has an educational and training program which was eloquently described by previous doctors and members of the medical school facilities, and other witnesses. The VA also has an excellent research program which has made a significant contribution, not only to the health of the patients, but to the health of the Nation.

So, what I am trying to say is while the Veterans Administration hospital system is primarily for veterans, it is doing a tremendous job and is a national asset for all. It does perform a service for all Americans, especially when we realize that over half the doctors of the Nation received some training from the VA at some time during their educational process.

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The same is true of nurses and other so-called paramedical personnel or health manpower personnel. The VA helps train a large number of these and, of course, this was the reasoning behind Public Law 92-541, the VA medical school assistance law. The medical assistance bill, H.J. Res. 748, 92d Congress, got impetus from the fact that these 168 VA hospitals, were an ideal national asset to conduct these kinds of educational programs contemplated by this law.

With a shortage of 50,000 doctors, this is what is being cited, plus 250,000 other people that are needed in the civilian health world the VA could do an awfully good job in helping to reduce this medical health personnel shortage as envisioned in Public Law 92–541.

So, the VFW, by national mandate, supported that legislation, H.J. Res. 748, and we were very, very pleased when the President did sign it. However, we now think that maybe he signed it reluctantly because, as you know, there is not one thin dime in this year's 1974 budget to implement this law that would help establish eight new medical schools in conjunction or in cooperation with the Veterans' Administration.

I may add also, Mr. Chairman, that the record should show, and I believe that this is correct, I just remembered it today, that you did and were successful in having added an amendment to an appropriations bill, I think it was $40 million last fall, in the waning days of the 92d Congress to fund this bill, H.J. Res. 748, before it was actually signed by the President.

Senator CRANSTON. That's right. With your help we did.
Mr. STOVER. And it did pass the Senate, but the House refused to

. leave it in the bill because it had not been signed. So, it does show that the Senate does want Public Law 92–5–1 funded and we are still working on that. We are very, very unhappy that it has not been funded as yet.

An outstanding example for funding immediately the VA medical school assistance program is in New Jersey. The State of New Jersey needs a VA medical facility in South Jersey, and this kind of an authorization for a new medical school in conjunction with VA facilities in New Jersey would be very helpful in getting that off the ground, and would lend salary assistance on a declining basis for 6 years until the medical school got going.

But the second point I wanted to make is of serious importance to VFW, Mr. Chairman, because we know from experience in previous Congresses, and I think the last 4 years, you and your Subcommittee on Veterans of the Labor and Public Welfare Committee, and the Health and Hospital Subcommittee here have built up a record which could not be denied by any reasonable person. And this record has been extremely helpful with the Appropriations Committee. And we want the record to show that VFW highly commends you, personally for holding these hearings today and as chairman of the subcommittee going before the Senate Appropriations Committee in previous years which demonstrated to your colleagues that extra money was needed if the veterans of this Nation are to receive the highest quality medical care. We are confident these hearings will adduce sufficient evidence to demonstrate beyond any doubt to a reasonable person that veterans' hospitals need more funds and staff.

Now, you asked the previous witnesses about—no, before I address myself to that point, I want the record to show that over $450 mil

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