Mr. STOVER. We will give you every one of them, yes, sir. Senator CRANSTON. I thank you for your very kind remarks about what we on this committee have managed to accomplish. I want to reiterate that we would not have achieved much of that without your help. I am delighted that, as you indicate, you are urging VFW members to tell it loud and clear about the true situation, Frank, about veterans hospital care. We are trying to do the same thing in our way. I think the statement by Patrick Carr, the commander-in-chief of the VFW, that there is only one way that the President can provide veterans with the medical care and needs in this area is to release the money he has arbitrarily impounded, which Congress appropriated and directed to be spent, is very appropriate. I hope he will get the message through loud and clear to the President on that. Mr. STOVER. We are doing our darndest. Senator CRANSTON. I thank you very, very much. [The prepared statement of Mr. Stover follows:] STATEMENT OF FRANCIS W. STOVER, DIRECTOR, NATIONAL LEGISLATIVE Mr. Chairman and members of the subcommittee: The Veterans of Foreign Wars is extremely pleased that you are holding these hearings at a very crucial time in our history on veterans programs of intense concern to the 1.8 million members of the Veterans of Foreign Wars. My name is Francis W. Stover and my title is Director of the National Legislative Service of the Veterans of Foreign Wars of the United States. The Veterans of Foreign Wars has been deeply distressed that the Veterans Administration hospital system has been continually shrinking over a period of years. The source of this policy is the Office of Management and Budget. There is irrefutable evidence that the Office of Management and Budget and its predecessor, the Bureau of the Budget, have been pursuing a policy to continually reduce veterans hospital care. To accomplish this purpose, the Veterans Administration has come under the thumb of the Office of Management and Budget. In its reaction to OMB control, VA Hospital Directors and other VA spokesmen are issuing confusing and misleading information regarding VA hospitals. This is a most disturbing and alienating development, Mr. Chairman, and for this reason alone these hearings are most important and significant. In the last analysis, it is the Congress, an equal branch of our government, which can set the record straight regarding veterans hospital care. We are urging VFW members to tell it like it is. The American people, especially the approximately 100 million veterans and their dependents, want to know the truth about VA hospitals and veterans medical care. In that regard, Mr. Chairman, the Veterans of Foreign Wars commends you and this Subcommittee for the extremely important evidence obtained by your Subcommittee in previous Congresses. Your personal appearances before your own Appropriations Committee to make comprehensive recommendations for additional funds, personnel, and services for VA hospital and medical programs were crucial in obtaining favorable consideration by your Appropriations Committee. The full Senate and the Congress prevented an even deeper cut in veterans hospital care. As the result of the action of this Subcommittee and the leadership of its Chairman, Mr. Cranston of California, over $400 million was added to the VA hospital and medical care budget above the amount requested in the President's budget for the VA in recent years. Without this extra money the Congress forced the VA to accept and spend, conditions in VA hospitals would be much worse. It is hoped that as the result of these hearings that you will obtain the evidence and documentation to leave no doubt that the VA hospital system is in desperate need of a massive infusion of funds and personnel if it is to continue to provide the high quality medical care for veterans which Congress has authorized and which veterans deserve. Unfortunately, as this Committee knows, the Veterans Administration is not spending all of the funds which Congress has appropriated for this current year. The faceless, anti-veteran officials of the OMB and other high-policy making officials in the Administration have decreed that some money appropriated by the Congress for veterans medical and hospital care shall not be spent this year. I am referring, Mr. Chairman, to an amount which totals about $135 million, which was earmarked for veterans hospital and medical care programs for fiscal year 1973. Most tragic is the $64 million which is being spent for veterans hospital care. This includes the extra $54 million added by the Congress to carry out the Congressional mandate that the VA shall maintain a minimum level of inpatient care in VA hospitals. Very amazing to our concept of orderly process and good Government is the VA's thumbing its nose at the Congressional mandate that the VA maintain an average daily patient census in its VA hospitals on an annual basis of not less than 85,500 and that it operate not less than 98,500 beds. A recent survey by the General Accounting Office reveals that the VA is not carrying out this mandate. In other words the VA is knowingly and wilfully violating a Congressional mandate. To compound the situation, the VA is not spending the $54 million together with another $10 million of regularly approved funds for medical care, which, if spent, would go a long way toward fulfilling the Congressional mandate of maintaining an average daily patient census of 85,500. In this regard, Mr. Chairman, the V.F.W. issued a statement on April 11, 1973, calling upon the President to release these impounded or unspent funds, which have been authorized by the Congress for veterans hospitals and medical care programs. This is the statement of our Commander-in-Chief: V.F.W. URGES PRESIDENT TO RELEASE IMPOUNDED VETERANS FUNDS WASHINGTON, D.C.-April 11, 1973,—The Veterans of Foreign Wars of the U.S. today strongly urged President Nixon to carry out his pledge of two weeks ago to "keep faith with our returning veteran." Patrick E. Carr, Commander-in-Chief of the 1.8 million member V.F.W., said "There is only one way that the President can provide the veteran with the medical care he needs and deserves. That is to release the money he has arbitrarily withheld after the Congress appropriated it and directed that it be spent." Carr did not discuss the legal aspects of Presidential impoundment of appropriated funds. He said, "This clearly is a moral issue. As the President said in his radio address on March 24, 'Words of thanks are not enough . . . we must demonstrate the gratitude we feel by the actions we take.'" ... Carr pointed out that in 1972 the Congress, indicating the will of the people who elected them as legislators, required the VA to provide 98,500 beds in VA hospitals and care for an average of 85,500 patients each day. To assure the veteran the care he needs, Congress voted $54.5 million for this purpose. Ignoring the will and direction of Congress, the President not only withheld the amount approved by Congress, but refused to spend a total of $64,080,000 for medical care in VA hospitals so that the veteran today is unable to get the medical care he needs. The Acting Comptroller General of the U.S. recently informed Congress that, "The Veterans Administration has not provided an average of 98,500 beds, nor has it furnished treatment to an average daily patient load of 85,500 . In our opinion, the Veterans Administration has not complied with the law." In addition to the $64 million for medical care, more money for medical associated items is being held back although Congress has approved its expenditure. Over $70 million has been impounded which should have been spent this year for the construction of hospitals and medical research. Carr said, "The President, in his radio broadcast, indicated the VA hospital system was providing high quality hospital care, but that 'We intend to keep improving on this record.' If this is the case, why has the President not spent a total of almost $135,000,000 of Congressionally approved funds for medical care and facilities? "If the President is serious in his pledge to assist those who have served America and need help, let the government machinery needed to release approved money be put into motion," said Carr. Carr suggested that the taxpayer not be made the scapegoat for needed veterans care. "An increase in income taxes caused by necessary veterans pro grams does not seem to be needed. What is needed is a look at priorities. Cut waste and inefficiency rather than required medical care for the needy veteran who has given so much for his country." The V.F.W. holds to the thesis that the costs of veteran medical care are an extension of the costs of war. Coupled with this thesis is that those who have made one sacrifice by their service in the Armed Forces in time of war or great national peril should not be required to make a second sacrifice at the expense of their health. That is why the delegates to V.F.W. National Conventions have repeatedly urged that there be no budget cutting or personnel restrictions at the expense of veterans programs. VA hospitals need more personnel. Despite what the VA is telling the Congress and the public, more and more veterans are beginning to realize that they are not getting the service which comparable community hospitals are providing. More and more are telling us about their problems. Examples are long waits for admission to a VA hospital; lack of service in wards, practically no usual hospital services in some hospitals at nights and on weekends, overcrowding and similar instances caused by budget cutbacks and reductions in personnel. The program requiring the VA to deescalate its grades has had a bad effect on employee morale. In addition, because of the grades having to be deescalated, lesser experienced personnel are being hired, which has its effect on the quality of care. Bear in mind, the V.F.W. commends the dedicated personnel in VA hospitals who are doing a tremendous job under very trying circumstances. It is not their fault if there are instances of less than the best care. VA hospital personnel are doing all they can under the personnel and budgetary restrictions under which they must work. The VA hospital Directors have been muzzled. Some appear intimidated when the answer to a question contravenes VA policy. The employee situation has steadily deteriorated, and unless the VA is permitted to hire the people it needs, there is no question that the quality of medical care in VA hospitals will continue to go down. Basic to good medical care are the buildings in which VA hospitals are located. The VA has a number of hospitals which are 20 years or older. The VA must continuously carry on a renovation, and modernization program for the approximately 5000 buildings which comprise the VA hospital and medical care system. Again, we see a callous disregard for this physical plant of the VA hospital system, as evidenced by the impounding of another $65 million appropriated by the Congress last year for construction and maintainance of VA hospitals. These VA hospitals must be kept in first-class condition and be operative to the service which they carry out. They must not be permitted to deteriorate and become obsolete, as has happened to the hospitals embracing the Public Health Service. Public Health Hospitals provide an example in miniature of what could happen to VA hospitals. The Office of Management and Budget has starved the Public Health hospitals to death over a period of years. Now the agency having the responsibility over Public Health hospitals, the head of HEW, is closing these hospitals on the argument that its personnel can obtain better medical care some place else, and that these hospitals are worn out and obsolete. This could well be what the OMB has in mind for a large number of our VA hospitals. Funds for construction and medical care are the two major programs for which funds are being impounded or not being spent. There is money, being impounded however, for research and administration, which are also very important. The total not being spent is around $135 million. It is the hope of the V.F.W. that this money will be released by the President in time to be put to effective use before the end of this fiscal year, and we will keep urging him to do so. Mr. Chairman, the 1974 VA budget was received by the V.F.W. with the greatest of alarm. At our recent Washington Conference, which was held here in Washington, D. C., March 2-6, 1973, the callous and indifferent VA budget was given the highest attention by our National Officers and Department Commanders from all over the nation. In that regard, there was issued at the VFW Conference material outlining that the regressive 1974 VA budget contemplates saving over $1 billion. Programs will be drastically reduced, while other programs are recommended for elimination. It will be deeply appreciated, Mr. Chairman, if copies of this material, identified as "VA BUDGET HURTS YOU" will be made a part of my remarks at the conclusion of my statement. At the time the VA budget was sent to the Congress, Commander-in-Chief Patrick E. Carr issued a statement, dated January 30, 1973, which contains the reaction of our organization to this budget which Commander-in-Chief Carr characterized as being a callous disregard for the needs of America's former fighting men, particularly the Vietnam veteran. It will be appreciated if Commander-in-Chief Carr's statement of January 30, 1973, will also be made a part of the hearing record. Most disturbing to the VFW is the announced intention of the Office of Management and Budget to further reduce the average daily patient load in VA hospitals by another 2000 for fiscal year 1974. The VA's continuing cut in veterans hospital care is the equivalent of closing many large VA hospitals. VA spokesmen, however, continue to state that the Veterans Administration is taking care of all the veterans who need hospital care and that no veterans are being turned away who need care. A recent study, however, conducted by the VA shows that of 1000 applicants for VA hospital care about one-half of them never make it to a VA hospital bed. They were rejected, withdrew their applications, or just faded away. We are in the process of finding out who some of these veterans are, and will furnish your Subcommittee with actual, concrete cases of veterans who applied for VA hospital care, but had to go to community hospitals for the care which they could not afford or, in extreme cases, died as the result of rejection by a VA hospital. Mr. Chairman, the name of the game in the VA is to continually reduce the average daily patient census while at the same time hire less people to take care of those being cared for. So long as the average daily patient census continues to decline, the average number of people taking care of veterans will remain constant or even increase. That is why the Office of Management and Budget is so violently opposed to a provision in the bill, S. 59, which would require the VA to improve its staff patient ratio to the same level as provided in a comparable community hospital. A statutory requirement that the VA staff its hospitals at least to the staff patient levels of a community hospital galls the OMB. Unfortunately, this is the way it has to be done. The V.F.W. commends this Subcommittee for including the provision in S. 59 to increase staff patient ratio together with a minimum level of care by the VA. The V.F.W. regrets that the OMB and Administration policy makers do not have sufficient compassion for quality medical care for veterans to make such a provision regarding staff patient ratios a part of their recommendations in the annual VA budget request. Another cost not provided for in the 1974 VA budget, is the employee salary increases. Much of these increases must be absorbed by the VA, as they were in the 1973 budget. As an actual practice the money for the salary increases comes out of the appropriation for veterans medical and hospital care. This requires adjustment by VA Hospital Directors, of budget allocations to take care of salary increases out of existing money, to the detriment of veterans hospital care. As indicated, the V.F.W. is fearful that some VA hospitals may be closed because of the budgetary cuts and restrictions on the VA hospital system. In that regard, the V.F.W. strongly supported legislation which resulted in Public Law 92-541, the Medical School Assistance Act. Part of the rationale for the support of this bill was the establishment of medical schools in cooperation with the VA at so-called remote VA hospital stations. Many of the VA hospitals are located in areas far removed from medical and urban centers. Accordingly, these remote VA hospitals have difficulty recruiting and retaining medical personnel. The establishment of a medical school nearby would be extremely helpful in upgrading the quality of medical care being provided at these VA hospitals and at the same time attract many who would seek employment in the VA hospital. Establishing a medical school in conjunction with a VA hospital would improve the quality of veterans medical care. It would also be extremely helpful to the health of all Americans by the training of doctors and other health manpower personnel so desperately needed throughout the nation. Although the President signed this bill, he may have done so with some reluctance because his 1974 budget contains no money to carry out the law. This is just one more example of how the OMB is calling the shots for the VA and is continuing to exert every effort to cripple and destroy the Veterans Administration hospital system. So that there will be no doubt as to who is running the VA regarding its medical appropriations, policies, and legislation, the record should include a letter from the then Director of Office of Management and Budget, Caspar Weinberger, to VA Administrator Donald E. Johnson, dated January 26, 1973. It would be appreciated if the full text of that letter could be made a part of my remarks. The most significant paragraph is the last one which reads as follows: "The President expects each and every official in the Veterans Administration actively to support the budget set forth in this letter and its enclosures. This support should be given in testimony before congressional committees, in informal contacts with Members of Congress and their staffs, and in speeches and meetings with outside groups." So, Mr. Chairman, this paragraph in the above letter leaves no doubt that the Veterans Administrator is being muzzled by the OMB. VA spokesmen are duty bound to support the 1974 VA budget, even though many know full well that it is not an adequate budget and does not begin to fulfill their requests for funds, personnel, and the mission of the VA to provide the finest quality of medical care to veterans. Lastly, Mr. Chairman, a heart rending development is the lack of compassion and consideration for the returning Veitnam veteran, as evidenced by the 1974 VA budget. At the precise time that the prisoners of war were coming home and being seen on national television as they stepped on American soil for the first time in years, the 1974 VA budget contemplated cutting Vietnam veterans compensation payments to the tune of $160 million. In the same way, the 1974 hospital and medical care budget plans to save money at the expense of the returning Vietnam war veteran, which has been accurately described as the most crippling war in our history. More and more of VFW members are beginning to understand that anti-veteran policies of the Office of Management and Budget must be stopped. Therefore, we are looking to the Congress for action to reverse the anti-veteran trend so much in evidence in the 1974 VA budget and administration opposition to needed legislative proposals, such as S. 59 and S. 49. The V.F.W., therefore, is extremely hopeful that this Subcommittee will develop sufficient evidence to demonstrate that the VA budget must be increased if the veterans of this nation are to continue to receive quality medical care. While time is running short, Mr. Chairman, we are still hopeful that the President will personally intervene and take the necessary action to release the funds appropriated by the Congress for this year's 1973 hospital and medical care budget. Thank you. Senator CRANSTON. Without objection, at this point in the record, I order to be printed all prepared statements and other pertinent materials subsequently submitted for the record. The hearing is now adjourned. We thank everyone who participated and who is with us. [Whereupon, at 3:50 p.m., the hearing of the Subcommittee on Health and Hospitals of the Committee on Veterans' Affairs was adjourned.] [The material referred to above follows:] STATEMENT OF CHARLES E. MATTINGLY, DEPUTY DIRECTOR, NATIONAL Mr. Chairman and members of the subcommittee: The American Legion appreciates the opportunity to appear before this distinguished Subcommittee to make its views and recommendations known to the Congress on the operation of the VA hospital and medical program, and the impact on the program by FY 1973 and recommended FY 1974 VA medical budgets. Commencing with the 92nd Congress, the Subcommittee on Health and Hospitals of the Senate Committee on Veterans Affairs, and the predecessor Subcommittee of the Committee on Labor and Public Welfare, both under your Chairmanship, have been responsible for the enactment of several pieces of legislation of widespread benefit to our Nation's sick and disabled war veterans, including your advocacy of sufficient funds for the agency to continue to provide first class medicine. The oversight hearings you are presently conducting is but a continuation of that advocacy and we thank you for your keen interest in this regard. |