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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.

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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

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,
COUNTY OF LOS ANGELES,

Los Angeles, Calif.

areas.

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 hand, the County Department of Health Services has extensive facilities concentrated in these 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 :

(1) The full range of inpatient and outpatient services would be available to VA patients.

(2) 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.

(3) Reimbursement for services provided to VA patients will equal the County's costs, as determined by the County Auditor-Controller.

(4) 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, etc.

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.

LISTON WITHERILL, Director,
Department of Health Services.

CHARLES R. DREW POSTGRADUATE MEDICAL SCHOOL,

Los Angeles, Calif., April 12, 1973. Hon. DONALD E. JOHNSON, Administrator of Veterans Affairs, Veterans' Administration, Washington, D.C.

DEAR MR. JOHNSON: In the meeting on April 4, 1973, the Board of Directors of the Drew Postgraduate Medical School strongly endorsed the resolution to initiate forthwith explorations and discussions for the purpose of effecting an affiliation between the Veterans Administration and the Drew Postgraduate Medical School, which would be designed as the framework for an agreement to establish within King-Drew Medical Center a VA ambulatory care facility. This unit would be enabled to utilize the secondary and tertiary care resources of the Los Angeles County-Martin Luther King, Jr. General Hospital in addition to the regional VA hospital.

In the judgment of the Board of Directors, it is a timely opportunity to expand the availability and scope of health services for veterans in Los Angeles within the setting of this medical school, utilizing a facility contiguous with a superb teaching hospital.

The resolution provides that a copy of the communication shall be directed to Senator Alan Cranston. Sincerely,

MITCHELL W. SPELLMAN, M.D.,

Dean. Senator CRANSTON. If you could also develop any tentative proposals with actual dollar tags on them, that would be helpful to us.

Do you have an estimate of the number of eligible veterans residing in the area served by USC-LA County Medical Center, and the number in the area served by the Martin Luther King, Jr. General Hospital ?

Mr. O'CONNOR. We don't sir. They usually don't appear at the county hospitals, knowing of the restrictions in the past.

Senator CRANSTON. Do you know how many live in the areas?
Mr. O'CONNOR. We can develop this.
Senator CRANSTON. Why don't they usually appear?

Mr. O'CONNOR. They have an appointment system with the Veteran's system which they elect, and that's despite the transportation, and so on.

Senator CRANSTON. How far is the Wadsworth facility in terms of time and distance ?

Mr. O'CONNOR. Wadsworth is approximately 16 miles—this would take in Los Angeles—over an hour or so.

Senator CRANSTON. Is there adequate public transportation available to permit those people, particularly those who are low income, to utilize the VA hospital at Wadsworth or the downtown outpatient clinic or Sepulveda?

Mr. O'CONNOR. Sepulveda, almost not at all; the downtown clinic, located at Fourth and Spring in downtown Los Angeles, is better served by public transportation from a few areas, that is.

Senator CRANSTON. Are many of these veterans generally outside the mainstream of health care?

Mr. O'CONNOR. The veterans we see are usually only in the emergency situation, or those communicable disease, custodial prisoners, and this type of thing. Again, most of the electives do not appear.

Senator CRANSTON. Getting back to public transportation, is there any that gets people to Wadsworth?

Mr. O'CONNOR. Yes. Wadsworth is served by one of the major lines, the Wilshire Boulevard line, with the central city approximately 1 hour away, 16 miles.

Senator CRANSTON. If a VA outpatient clinic was established at either of these locations, what specialized services at these facilities could be utilized on a shared basis with the VA?

Mr. O'CONNOR. Hopefully, with negotiation, all inpatient and outpatient services would be available to them.

Senator CRANSTON. I want to thank you very much for coming, and for your help. I have been personally very interested in this problem for several years now, and I hope we are reaching a point where we can make some progress. Thank you very much.

Mr. O'Connor. Thank you, sir.

Senator CRANSTON. Our next witnesses comprise a nursing and allied health panel, Dr. D. Cramer Reed, vice chancellor for health affairs, and dean of allied health, and acting dean of medicine, Wichita State University in Kansas, representing the Association of Schools of Allied Health Professions, and Mrs. Elizabeth Lundgren, director of allied health studies, Miami-Dade Junior College, representing the American Association of Community and Junior Colleges. We thank you both very much for your presence. STATEMENT OF DR. D. CRAMER REED, DEAN, WICHITA STATE

UNIVERSITY SCHOOL OF MEDICINE, WICHITA, KANS.

Dr. REED. Mr. Chairman, I wish to express my appreciation for having been invited to testify before the Veterans Affairs Committee of the Senate regarding Public Law 92–541, which pertains to the Vet

erans' Administration Medical School Assistance and Health Manpower Training Act of 1972.

I appear before you today as an immediate past dean of a college of health related professions concerned with the education and training of allied health workers, and presently a dean of a clinical branch of the University of Kansas School of Medicine, located in a community in which a regional Veterans Administration Center and Hospital is located. In these capacities, I have had the opportunity of working closely with the VAC, and, in doing so, I have developed an appreciation for its tremendous potential in terms of allied health and medical education.

This committee is aware that President Nixon's fiscal 1974 budget proposes to totally eliminate regional medical programs and all support for allied and public health schools. This means RMP demonstration, NIH special improvement and special project grants, traineeships for advanced training for allied health professions, as provided for by titles VII and IX of the Public Health Service Act, will either be terminated June 30, 1973, or must be phased-out during fiscal year 1974, regardless of the originally designated duration of the grant.

With the abrupt elimination of these support mechanisms, allied health education will have suffered the coup de grace because student tuition and local governmental funding of health manpower programs are simply not adequate to assure their continuation.

With this background, it is quite obvious why I speak in support of subchapters I, II, III, and IV of Public Law 92–541. Unless this authorization bill has funds appropriated for its implementation, there will be a number of allied health programs, and possibly several schools of allied health, that will not be able to survive sufficiently long to seek other sources of continuation funds.

While I have some personal reservation regarding full implementation of all components of subchapter I, I heartily endorse those sections authorizing grants for physical improvements in existing hospitals engaged in medical education and for the purpose of providing faculty support. Concomitant with such provisions is the necessity of assuring that the medical staff of the affiliating Veterans' Administration Center is academically qualified and oriented toward medical education. Without such staff competency and interest, it would be of little value to modify or improve the physical structure. In our particular case, it would be mutually advantageous if the Veterans Administration hospital could provide initial funding for support of certain faculty who could be shared by the hospital and our institution. Only through such an approach will community-based medical education programs such as ours be able to recruit well-qualified subspeciality faculty who often are much in need in the community.

The intent of subchapter II is highly commendable, in my opinion. However, rather than authorizing improvement grants to affiliated medical schools, I would prefer that such funds be allocated for the enrichment of Veterans' hospitals' teaching capability. This could be accomplished partly by house staff enrichment and improvement of “in-house” continuing education. In this latter context, the availability of a grant to the affiliated medical school for video taped duplication and for the production of other audiovisual materials could be

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