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In Public Law 92-541, as well as in the new chapter 82, a new chapter II is to be added to chapter 73 of title 38, to create regional medical education centers at VA hospitals, specializing in continuing education for all VA health personnel.

If you would comment on that new subchapter, and if you would do so, too, Mrs. Lundgren, I would appreciate it.

Dr. REED. I would be pleased to do that, and I have been informed of this designation of the regional medical education centers. I would commend the author of this addition to the law because I concur with you, sir, that this is a very much needed component of allied health education.

Certainly, with the system of Veterans' Administration hospitals, that should make them a highly relevant modality of implementing continuing education in a meaningful way.

Senator CRANSTON. We know of nothing the VA has done to implement that provision in the law up to this point.

Mrs. Lundgren, could you provide for the record more details on the program of the Dallas County Junior College in Texas for additional training of returning medics?

Mrs. LUNDGREN. I am not familiar with the entire program, but it was funded by the Public Health Service, and was for the returning military people with a background in medicine.

Senator CRANSTON. Would you be able to get some additional information for the record?

Mrs. LUNDGREN. Yes, we can.

Senator CRANSTON. I would be particularly interested in the career for which these individuals receive additional training, the type of training, academic or clinical, and the duration of the courses, generally.

[Mrs. Lundgren subsequently supplied the following information:] PROJECT MED-VET-EL CENTRO COLLEGE, DALLAS COUNTY COMMUNITY COLLEGE DISTRICT, DALLAS, TEX.

On February 1, 1970, the Associate Degree Nursing Division at El Centro College of the Dallas County Community College District, initiated the "MedVet Project." Officially the title is "A Study to Develop, Implement and Evaluate a Planned Program of Associate Degree Nursing for Veterans with Military Corpsman School Training." This study was funded by grant No. DIO NU 00464-01, Division of Nursing, U.S. Public Health Service.

The project has two objectives: (1) to identify and use the training corpsmen received while in military service and (2) to provide in a community college program knowledge the veteran is lacking to enable him to progress to the level of a beginning practitioner of registered nursing.

The program is designed to encourage a number of the some 3,500 medically trained veterans returning to civilian life yearly to continue in the health services field as they reenter the civilian setting. Being able to work in a basic Registered Nurse position after graduation will guarantee them a degree of economic security, afford them a position of responsibility and hopefully relieve the present turnover, which is 40 percent annually.

The Med-Vet study was divided into four phases extending over some 4 years: Phase 1: Data (collection) such as expected terminal skills from the three service programs.

Phase 2. Designing evaluation tools to ascertain where the student is and developing curriculum to fill in what the veteran needs to progress to the basic R.N. level.

Phase 3: Admitting of students into the program.

Phase 4: A follow-up study of 18 months duration to gather information about the successes and problems of the graduates of this program.

The data collected served as a base for the nursing curriculum and, with the help of consultants, a comprehensive identification and testing process was developed. After the initial testing phase, students' strengths and deficiencies were noted and 29 students were enrolled in the courses in the fall of 1970.

Since the initiation of the Med-Vet project, 39 students have graduated. Of the 29 students who enrolled in the fall of 1970, 14 graduated in December 1971, three graduated in May 1972, and one graduated in December 1972.

Seventeen of these students have taken the Texas State Board Examination and one is enrolled in a B.S. program in New Mexico. Ten completed the examination on first attempt, two on second attempt, and four have not yet completed the examination. Ten students who enrolled in the fall of 1970 have dropped out of the program, and one student who dropped out is now reenrolled.

Fifty-one students enrolled in the program in the fall of 1971. Twenty of these students graduated in May 1972 and have taken the Texas State Board Examination, the results of which are not known at this time. Twenty, or 39 percent of the students who enrolled in the fall of 1971 have dropped from the program. The whereabouts of one student, who has not officially dropped, is unknown. Fifty-one students enrolled in the Med-Vet program in the fall of 1972. Of the 38 graduates of the Med-Vet program, 30 are employed full-time. Twenty-five are employed as staff nurses in general civilian hospitals; one is employed in a convalescent center and will soon become an assistant administrator; one is employed at an osteopathic hospital; one is employed at a veterans hospital; and two are at the School of Anesthesiology in Wichita Falls, Tex. Two graduates are employed part-time at an osteopathic hospital.

The Med-Vet staff is currently involved in phase IV of the project, gathering information about the successes and problems of the graduates of this program for a final report.

Senator CRANSTON. Do you have an estimate of the amount of funding which would be effectively used in expanding training programs at junior colleges affiliated with VA hospital facilities?

Mrs. LUNDGREN. There are about 84 junior colleges affiliated with Veterans' Administration hospitals, I believe.

Senator CRANSTON. How much funding would be required to use them effectively in training?

Mrs. LUNDGREN. We are a rather large community, and for next year, if we had two salaries, instructional salaries, to use within the VA hospital itself for their new employees, as well as the upgrading of their GS-4's, 5's and 6's, somewhere between $25,000 and $30,000 would certainly help in a rather large community.

In a smaller one, it would depend upon what kind of services that particular agency would be providing, as to what extent they would want to carry on this activity.

Senator CRANSTON. What type of program do you feel the junior colleges can best develop for returning servicemen with health experience, who would like to pursue a health-oriented career?

Mrs. LUNDGREN. In the programs we have in the college in Miami, the servicemen, or anyone else, for that matter, with previous experience or formalized training, recorded formalized training, will be allowed to challenge any one of the 10 programs presented at the college.

We had one young man interview with us about 2 weeks ago, who was a medic. To us, he appeared so well prepared that we would feel he could almost challenge the entire program in nursing. That varies, of course, from individual to individual, but there are people in physical therapy, assistant-level people, medical lab technologists, who have completed in as little as one semester by challenging the program.

[Mrs. Lundgren subsequently supplied the following information:]



Programs within the Allied Health Studies Division (AHS) at Miami-Dade Junior College frequently have the opportunity to give students college credits and/or advanced standing in a particular curriculum via the mechanism of: credit by examination, equivalent credit, germane credit and/or directed individual studies (DIS).

Each of these procedures is a legitimate process for obtaining college credits at Miami-Dade Junior College consistent with official college policy. However, because of the unique accreditation requirements and restricted enrollments in many of the Allied Health Programs, these procedures are sometimes used in special ways.

The following is a statement of clarification on these policies as they relate to each program in the Allied Health Studies Division.

Department of Nursing

1. Licensed Practical Nurses (LPN's) with Florida licensure who have completed six (6) credit hours at Miami-Dade Junior College are eligible to take credit by examination for Nursing 177 (Nursing I). Upon passing this exam with a "C" or better and completing the co-requisite sciences, the student may enter the nursing program in Nursing 178 (Nursing II) or be eligible for the "transitional" program.

2. Students transferring from other college nursing programs may be given equivalent Miami-Dade credit for courses which are determined by the department chairman to have similar course objectives.

3. Students entering Miami-Dade Junior College from diploma nursing programs may challenge nursing courses by the credit by examination procedure if it is determined by the department chairman that the curriculum and course objectives are similar.

4. Transitional Pilot Program-Florida L.P.N.'s who are high school graduates with one year experience in Medical Surgical Nursing and have successfully completed the Nursing 177 (Nursing I) exemption exam are eligible for the "Pilot Program" which is 12 calendar months long. Upon successful completion of this program, students receive an A.S. Degree in nursing and are eligible to write the State Board Professional Licensure Exam. At this time there is limited space in this program.

Department of Allied Health Technologies (AHT)

1. Students entering any of the AHT programs who have met similar course objectives via previous classroom and/or laboratory experiences may request to challenge individual courses by the credit by examination procedure. Eligibility to use this option is determined on an individual basis by the appropriate program coordinator. Because of the difficulty in evaluating clinical skills by written examination, students are not usually allowed to fulfill clinical course objectives by this procedure.

2. Students who transfer into a particular AHT program from another accredited program with similar objectives may be given equivalent Miami-Dade credit for course work successfully completed. This is determined on an individual basis by the appropriate program coordinator.

3. A student may receive germane credit and advanced standing in a particular program if he has successfully completed the requirements for registry and/or certification in his health specialty. Presently this is an option in X-ray Technology and Respiratory Therapy Technology. Eligibility for this option is determined by the appropriate program coordinator. Those students determined to be qualified must complete the basic education requirements of the program and a clinical course in his particular specialty area. This later process is usually handled by the DIS procedure. (See No. 4 below.)

4. With permission of the appropriate AHT program coordinator, students may fulfill the course objectives and receive credit for any course by directed individual study (DIS). This procedure may be used for regularly scheduled courses or for a new specifically designed course. The advantage of the DIS in a regularly scheduled course is that it can be taken any semester even if out of sequence. The specifically designed DIS course may be accepted as equivalent credits or as the advanced standing course required in the special degree programs described in No. 3.

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Senator CRANSTON. Do you run into rigidity in the VA in recognizing skills that people acquired in the service or elsewhere in permitting them to use their services, or use their skills in the VA system? Mrs. LUNDGREN. As employees, no. In our community, we may be different. I can only judge from our immediate community, they are given preferential treatment in terms of employment.

Senator CRANSTON. At what institution?

Mrs. LUNDGREN. At the VA hospital, as well as some of the other community hospitals.

Senator CRANSTON. What proportion of the programs would depend on the use of the VA hospital as a clinical training facility? Would that be a pretty necessary element of the program?

Mrs. LUNDGREN. Yes. We are heavily in the VA hospital from the standpoint of nursing education and practical nursing education. The VA hospital locally has now asked us to act as consultant in setting up their respiratory therapy service. This had been one of their areas of need. In dental hygiene, we have used, in a minimal way, their dental clinic.

Also, in recreation areas and physical therapy, rehabilitation, our mental health technology students are assigned there, and working very well, and we appreciate the supervision they do have at that facility.

Senator CRANSTON. Both of you came, I know, on very short notice, and I am particularly grateful for that. And, if you have any other thoughts based upon what has transpired here today and wish to, for the record, give us any further comments, I would appreciate it very much. Thank you very, very much.

Dr. REED. Thank you, sir.

[The prepared statement of Mrs. Lundgren follows:]


Mr. Chairman and Members of the Committee: I am Mrs. Elizabeth Lundgren, Director of the Division of Allied Health Studies, Miami-Dade Junior College, Miami, Florida. I am testifying at the request of this committee, on behalf of the American Association of Community and Junior Colleges, about P.L. 92-541, the Veterans Administration Medical School Assistance and Health Manpower Training Act of 1972. I am very pleased to have the opportunity to do so.

Public Law 92-541 was designed to help to meet the nation's very urgent need for more trained health personnel at all levels-physicians, nurses, allied health workers, and others; to expand present Veterans Administration programs for the training and upgrading of health personnel; and to create new programs and institutions where necessary to accomplish this purpose.

The American Association of Community and Junior Colleges is in complete agreement with this goal. There are now approximately 1140 two-year community and junior colleges in the nation, enrolling approximately 2,866,000 students. These colleges already provide health-related programs for the training and upgrading of large numbers of nurses, allied health workers, and others in related fields.

We are informed by the Veterans Administration that at least 84 two-year colleges already cooperate with Veterans' Administration hospitals in providing clinical training for students enrolled in health-related fields. Many two-year colleges have had a long and close relationship with Veterans' Administration hospitals. Others would be most interested in developing such relationships.

Our colleges are also very interested in developing programs for returning servicemen who have had experience as "medics" or in other health-related work, and who would like to continue in these fields. During the past two years, Dallas County Junior College in Texas has had a grant from the U.S. Public Health Service for a program to train returning medics in these fields. We hope that this

program may serve as a model for similar programs elsewhere. Returning veterans with health-related backgrounds could be employed very effectively in many Veterans' Administration hospitals, it would seem, and might at the same time be upgraded in their fields at a nearby junior college.

We hope that some of the funds for P.L. 92-541 are used to encourage such programs for Vietnam era veterans, as the law states in subchapter IV.

We are very disappointed that the administration has not requested funding for Public Law 92-541 for either the remainder of the fiscal year 1973 nor for the fiscal year 1974. We feel that the program could be very beneficial both for the expansion of existing allied health education programs and for the establishment of new programs where they are needed. We believe that at this time the country needs more programs for the training of allied health and nursing personnel, not less. We hope very much that this program will be adequately funded, and that it can get under way as soon as possible.

Senator CRANSTON. Our next and final witness is Mr. James Maye, executive director of Paralyzed Veterans of America, accompanied by Frank R. DeGeorge, president of Paralyzed Veterans of America, and Alan S. Langer, national service director. Thank you very much for your presence.

Mr. MAYE. Thank you very much for your kind invitation. Again, I would like to introduce Mr. DeGeorge, our National President, and Mr. Langer, our National Service Director.


Mr. MAYE. Senator, the Paralyzed Veterans of America is deeply concerned and involved with the quality of health care and hospital facilities within the Veterans' Administration. In past testimony before this committee, we have supplied you with all the information available to PVA and relevant to medical care and conditions in VA hospitals. In turn, you have been very effective in bringing about corrective action when called for. It is with this feeling of confidence and trust in the committee that we present our testimony today.

Mr. Chairman, the 92d Congress passed, and the President signed, Public Law 92-383, which mandates the Veterans' Administration to provide for not less than an average of 98,500 operating beds, to furnish inpatient care and treatment to not less than an average patient load of 85,500, and to maintain an average staff/patient ratio of not less than 1.49 to 1 for fiscal year 1973.

As of February of fiscal year 1973. the average patient census has been 82,286. The average number of operating beds has been 98,197. Seven months through the fiscal year and the VA has not complied with the provisions of this law. The result of such impropriety is loss of valuable medical care dollars.

I received a copy of a letter to the Administrator of Veterans' Affairs, Donald E. Johnson, from Congressman William Jennings Bryan Dorn, chairman of the House Veterans' Affairs Committee, in which Congressman Dorn states that $54,580,000 in medical care funds appropriated for fiscal year 1973 will lapse on June 30, 1973, due to arbitrary personnel ceilings and budget constraints exercised by the VA. Everyone is aware of the consequences a private citizen must experience when he ignores a law. My question is, what happens to a

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