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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.

Department of Health Services.

Los Angeles, Calif., April 12, 1973.


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,



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.


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

tremendously helpful. Such soft and hardware are often not included in emerging medical school budgets and could be shared with the Veterans' Administration hospital to enhance its professional continuing education program.

The provisions of subchapter III, which provide for improvement and expansion of allied health programs, are especially attractive, if not imperative, in view of the elimination of all other forms of Federal support. An example of the potential significance of this provision is the fact that the College of Health Related Professions at Wichita State University stands to lose as much as $250,000 in the next fiscal year due to probable nonrenewal of four new programs for which developmental support was originally provided by either the Kansas regional medical program or the Bureau of Health Manpower Education of the National Institutes of Health. Each of these programs could be adapted quite well to the Veterans' Administration format. Furthermore, with the proposed financial assistance, it would be possible to accept additional numbers of students in certain allied health programs, thus reducing the recognized deficit existing in these disciplines. As an example, I would cite our dental hygiene program. At present, our clinical facilities will only accommodate 26 students; yet there are consistently over 120 qualified applicants each year for the program. We utilize the dental clinic at the Wichita Veterans' Administration Hospital, which will accommodate only three students. If the latter facility could be expanded, it would be possible to accept additional students in the program; thus helping to reduce the nationwide shortage of dental hygienists. Examples of other programs of equal merit could be cited.

The allied health continuing education program provision, cited in subchapter III, is most significant because it constitutes the only remaining potential Federal source of funds with which I am familiar for an activity all of us in allied health education consider to be of the highest priority. Important as it is, few States provide funds for such activities. If only one subchapter of Public Law 92-541 could receive appropriations, I would select this one above all others that deal with allied health.

Subchapter IV, providing physical improvements to facilitate teaching in health manpower education programs, is also most appealing. A not uncommon example of the importance of this provision can be cited. The Wichita State medical technology program would like to utilize the veterans' hospital clinical laboratory as a major teaching resource. This is not possible, however, because the physical plant is not adequate to accommodate a sufficient number of students or to merit approval by the AMA Board of Schools. A similar example is the fact that the university's physician's assistant program, presently housed in a Veterans' Administration hospital at Wichita, cannot expand unless education remodeling funds are made available.

I have attempted to cite specific examples of how the Veterans' Medical School Assistance and Health Manpower Training Act of 1972 would assist programs with which I am associated. However, these should be considered only as examples and represent only a fraction of a much larger problem; a problem that confronts the entire membership of the Association of Schools of Allied Health Professions.

Gentlemen, in behalf of my peers currently engaged in allied health and medical education, I seek your support in pressing for the appropriation of funds for this needed legislation.

My sincere thanks for permitting me to appear before you today. Senator CRANSTON. I thank you very, very much.

Mrs. Lundgren, are you going to proceed first, and then I can question both of you or do you wish to proceed in another manner? Mrs. LUNDGREN. That is at your pleasure, Mr. Chairman. Senator CRANSTON. Why don't you proceed.

Mrs. LUNDGREN. All right. In the interest of time and so we do have a longer time to chat with you on any questions you may have, I request that my written statement be entered into the record.

Senator CRANSTON. It will at the conclusion of your testimony, and I appreciate that approach.


Mrs. LUNDGREN. I would like to emphasize two or three things very briefly. You were involved, so I am sure you will remember in May of 1971, when the original legislation was proposed, there were probably three main issues.

I think, judging from the statements of the other individuals here today, and from the news that we all have, that we don't have to worry about duplication of HEW manpower programs anymore, from the standpoint of funds from Veterans' Administration. I recall in the transcript there was a long dialog on that.

I would also like to emphasize the 2-year college as a receiver of the returning veteran in education, and that one of our largest components in allied health education is the returning veteran. And, this is not in just one kind of field, but across the board in terms of a specialty group.

Third, I would like to tell you and the other individuals here about a program we are doing with our local VA hospital, which may not be well-known as yet, which is a pilot-in-agency program for the employees of the Veterans' Administration to upgrade the nursing care personnel who are presently at the GS-4, GS-5, and GS-6 level.

With the help of the Veterans' Administration and with some funds to the college, we have been able to have the first step in the State law in nursing licensure change in Florida. Our next step will be to let the GS-4's, 5's, and 6's, with some additional education, be licensed as practical and/or registered nurses.

And, with that, I will let you ask your questions.
Senator CRANSTON. Thank you very, very much.

Dr. Reed, turning first to you, how many schools of allied health professions does your association represent?

Dr. REED. At the present time, I would have to defer that to Mr. Samuels, in the office. The exact number-I'm sorry, my colleague tells me it's 116 today. This changes by the week.

Senator CRANSTON. How many of those schools have an affiliation with a VA facility?

Dr. REED. Strictly from the allied health point of view, I am not able to respond to that, but I could get the information for you.

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