actual and potential Veterans Administration support be recognized and understood. Only by becoming closely integrated with the community it serves, and collectively a national resource for health care, can the Veterans Administration health care system and its dental service be assured that it can continue to serve not only veterans but their families and neighbors by cooperatively working with the institutions that serve them, as well. Therefore, it is recommended that a strong public and professional educational program be implemented to educate the public about the mission, activities, and potential of the Veterans Administration Dental Service. ■ Demonstrations of model care systems: It has been pointed out that the magnitude, scope, and diversity of the Veterans Administration health care system make it an ideal base for new and improved methods of delivery of dental care. By demonstrating innovative approaches in this effort, the Veterans Administration Dental Service could make an invaluable contribution toward helping to solve national oral health care problems. Therefore, it is recommended that the dental service immediately embark on a series of studies and demonstrations to develop and test new ways of delivering care to patients and to improve the use of dental manpower and facilities. ■Role of the Advisory Council on Dentistry in the future: The Advisory Council on Dentistry presents this report to the Chief Medical Director through the Assistant Chief Medical Director for Dentistry and asks that, if appropriate, it be forwarded to the Administrator of Veterans Affairs. If some or all of the recommendations are adopted, the council also suggests that there be periodic review and assessment of their value. This supports the realization of the council that these recommendations should not be considered as a rigid plan, but rather as a flexible pattern on which additional future programs and activities can be developed. In order to serve effectively, the Advisory Council on Dentistry believes that it must be involved in such continuing efforts, including the evaluation effort, so that it can continue to make meaningful revisions to the recommended programs and study and suggest other areas of action. During the forthcoming period of rapid changes in the nation's health care policies, the role of the council should be reappraised. In this regard, consideration should be given to broadening the composition of the Advisory Council on Dentistry to ensure that it is more representative of all aspects of dentistry, as well as integrated with other areas of health care activities. In addition, better coordination of overall planning would encourage closer ties between the Advisory Council on Dentistry and other advisory bodies of the Veterans Administration's Department of Medicine and Surgery, especially the Special Medical Advisory Group. To carry out such expanded functions and fulfill its responsibilities, the Advisory Council on Dentistry should be kept fully informed of all health care activities of the Veterans Administration and of the operation of its existing and developing programs. Mechanisms such as more frequent council meetings, representation on the Special Medical Advisory Group, inclusion in conferences, briefings, and site visits are all encouraged. I enjoyed the opportunity of appearing before your committee and was greatly pleased at the interest you evidenced in the Veterans Administration dental program and your knowledge of the recommendations made by the Dental Advisory Council. I have prepared and returned the material from the hearing with necessary corrections and additions. In answer to your specific questions included with your letter of April 24, I can give the following: Where would you recommend we cut the 1974 budget for D. M. &S.? I do not believe that we can afford to make cuts in the D. M. &S. program as there are veterans who are entitled to even more care than can be provided by the present budget. The other VA programs. I believe that we must consider the veterans benefits as a debt of the nation resulting from our military activities and hope that the nation can see fit to provide for those who served their country in this capacity. I believe I expressed myself at the hearing that the general feeling I have observed among my colleagues and associates is that we should reduce our military spending and our spending in foreign programs and concentrate on domestic programs at the present time. For the first time since World War II there is a potentially reduced level of funding for VA medical research programs. In Fiscal Year 1973 the VA appropriation for medical and prosthetic research was 76.8 million and in Fiscal Year 1974 the requested appropriations amount is 71 million. What do you be lieve the level of funding for VA research programs should be in Fiscal Year 1974? I believe that in order to maintain the present level of research in the Veterans Administration, which in the long run may reduce the cost of care of veterans and others, the minimum for FY 1974 should be 88 million dollars. By what percentage do you estimate the research funding must increase in FY 1974 just to maintain program levels. I have used the figure of approximately 5.5%. Although this is low, we are struggling along with this at our university level in hopes of maintaining the present level of activities and simply meeting inflationary costs. If I can be of any further help, I shall be pleased to respond. Again thanking you for your deep interest in our programs. Sincerely, ALBL Hamilton B. G. Robinson HBGR:ma Senator CRANSTON. Our next witness is Mr. John O'Connor, director of contracts and community relations, department of health services, County of Los Angeles, Calif. Mr. O'Connor, we are grateful to you for your presence. I guess you have come the farthest of anyone today. STATEMENT OF JOHN O'CONNOR, DIRECTOR OF CONTRACTS AND COMMUNITY RELATIONS, DEPARTMENT OF HEALTH SERVICES, COUNTY OF LOS ANGELES, CALIF. Mr. O'CONNOR. Mr. Chairman, I am John O'Connor, director of health care, community relations-contracts and community relations, I should say, County of Los Angeles. I was also the administrator of the Martin Luther King, Jr. Hospital in the Watts-Willowbrook area and associate director of the LAC-USC Medical Center, two of the hospitals mentioned in the text of the position statement which I am submitting for inclusion in the hearing record. First, I would like to give our unreserved support to the allocation of adequate funds for the viable, medical support system that is the Veterans' Administration, funds for the support of not only the patient care aspect, which is primary and obvious, but also for the teaching and research aspects, that the past three speakers have addressed themselves to. It is only in this manner that medical care can advance. The Veterans' Administration, and other teaching hospital training groups, really is the watershed of medical talent for all of the hospitals, community and otherwise. Parenthetically, I believe one of the speakers spoke to the ratio of two employees per patient, a 2-to-1 ratio at community hospitals. I learned that the VA is 3 to 1. In most university teaching hospitals, it's between 4 and 5 to 1 because of this additional obligation of medical and paramedical training. Also, parenthetically, on gerontology, the aging veteran, many schools, including the University of Southern California, have established institutes of gerontology. Also, parenthetically, in terms of the dental aspect, this is really the dark continent of medical care, replacing emergency medicine which, thanks to your office's help, is showing signs of much life. I would like to address myself very briefly to one aspect in the Los Angeles area. The Veterans' Administration hospitals, and this is probably true nationwide, but especially in Los Angeles County, are generally situated away from densely populated, inner city areas. On the other hand, the county department of health services has extensive facilities concentrated in these areas. This is a collection of about nine hospitals in 60 district health areas that are concentrated in these inner city areas. Presently, county residents who are Veterans' Administration patients must, in many cases, travel long distances and undergo other inconveniences to avail themselves of VA care. Public transportation is inadequate in the Los Angeles area. Community groups in the south central and east Los Angeles areas in recent months have raised the issue of whether, to better meet the health care needs of veterans in the areas they represent, the Veterans' Administration should make arrangements with the county department of health services for VA patients to be served at Martin Luther King, Jr. Hospital and the LAC-USC Medical Center. Both are full service teaching hospitals in the Watts-Willowbrook and east Los Angeles community respectively. In furtherance of the policy-adopted in 1970 by the board of supervisors that Los Angeles County should adopt a personal health care delivery system linking hospitals, diagnostic clinics and ambulatory care centers "in a community-based network utilizing both public and private resources," the Department of Health Services would welcome entering into a cooperative relationship with the VA in areas where the county has health care facilities. We suggest, number one, the full range of inpatient and outpatient services would be available to VA patients. This is the full range from emergency care, which is exotic in medical specialties, to home care. Two, because of the immediacy of the problem, VA patients could be taken into the mainstream of county hospital treatment, and served on the same basis as other patients in the system. Three, reimbursement for services provided to VA patients will equal the county's costs, as determined by the county auditor-controller. Four, a number of VA patients to be treated, types of care to be rendered, and county hospitals to be involved, will be arrived at by discussion and negotiation, considering such factors as location, variation in the size and scope of available county facilities, timing, et cetera. In summary, the County of Los Angeles will work closely with the representatives of the Veterans' Administration in establishing supplementary medical services for veterans, especially in the inner city areas. Senator CRANSTON. To what extent have you discussed this with the VA, and what response have you gotten from them? Mr. O'CONNOR. I am fairly late on the scene with the Veterans' Administration. I spoke before coming to a representative of the regional office who would welcome affiliation on the grounds or near the medical school, USC particularly. We will make every effort to advance on this. Senator CRANSTON. Haven't other county officials or others had exploratory discussions with the VA? Mr. O'CONNOR. Yes, Senator. The USC County Medical Center, through the administrator himself, with the east Los Angeles veterans' group, has explored this, and also the administrator of Martin Luther King, and they plan to go forward on this. Senator CRANSTON. When you get back, could you do whatever exploration is necessary, and then submit to us a statement of exactly what negotiations or consultations have occurred, and what the response has been from the VA? Mr. O'CONNOR. Will do, sir. Senator CRANSTON. Is there any correspondence that we could have copies of, if it exists? Mr. O'CONNOR. Yes. [Mr. O'Connor subsequently supplied the following information:] CHIEF ADMINISTRATIVE OFFICER, POSITION STATEMENT, POSSIBLE ASSOCIATION OF DEPARTMENT OF HEALTH SERVICES WITH THE VETERANS' ADMINISTRATION The various Veterans' Administration hospitals in Los Angeles County are generally situated away from densely populated inner-city areas. On the other |