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:]

STATEMENT OF MRS. ELIZABEth Lundgren, DIRECTOR, DIVISION OF ALLIED HEALTH STUDIES, MIAMI-DADE JUNIOR COLLEGE, MIAMI, FLA.

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.

STATEMENT OF JAMES A. MAYE, EXECUTIVE DIRECTOR OF THE PARALYZED VETERANS OF AMERICA, ACCOMPANIED BY FRANK R. DEGEORGE, NATIONAL PRESIDENT AND ALAN S. LANGER, 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

governmental department such as the Veterans' Administration when it fails to operate within the law? Such mandates of Congress are of little use without proper implementation.

Veterans' Administration statistics indicate a rejection rate of 35 percent of all those who apply for hospitalization and medical care. Two hospitals reported rejection rates over 70 percent. It is inconceivable that this high number of people are simple doddering hypochondriacs. What is the reason for such high numbers of veterans being refused medical treatment?

If, in fact, 98,187 beds are operable, and only 82,286, on the average, are filled, there must be 15,901 empty beds somewhere. I suspect a percentage of those unoccupied beds are in storage rooms somewhere waiting to be broken out, assembled, and pushed into already overcrowded hospital wards when a Senator or Congressman seems likely to appear with a tally sheet in hand.

With 28.8 million veterans in the United States, and their numbers increasing annually, it strikes me as totally illogical for the Veterans' Administration to reduce its number of available beds, annual patient census, and staff members and expect to successfully do its job.

Reductions, rejections, and refusals to comply with established law all seem a strong indicator of destruction of the VA system from with

in.

Dissatisfaction and discontent exist in many VA hospitals. In some instances, this has grown to distrust and fear. There is documented evidence of patients harboring weapons while hospitalized. I would think if the social environment of a hospital had deteriorated to such a degree that any patient felt it necessary to arm himself, it would justify close scrutiny by this committee.

Aside from our disappointments and disillusion with the Veterans' Administration, we also have constructive comments. The Spinal Cord Injury Service, under the Department of Medicine and Surgery, has come up with some innovative ideas which deserve not only recognition but expanded funding.

One of the most noteworthy programs they have under study is a team concept of training and staffing a Spinal Cord Injury Center. The medical and paramedical personnel would become specialists in the care and treatment of spinal cord-injured patients. Their pay and prestige would reflect the extra effort required by those working in this specialty area.

Included in this new program would be recreational programs to occupy the hours between prescribed medical programs and necessary hours of sleep and the long empty weekends when boredom and depression set in. The therapeutic benefit of such a program is extensive and most valuable in that it provides a healthy outlet for excess energy, promotes participation on the part of the patients, and can ignite the spark of motivation necessary for rehabilitation.

Another contemplated addition to the rehabilitation of the paralyzed veteran is the services of a rehabilitation counselor. This specialized position would entail services to the veteran beginning soon after injury and continuing through physical restoration, education and retraining, placement back into society, and a job, and followup to assure complete and satisfactory adjustment by the disabled veteran. This whole process would take place under the expert guidance and

supervision of one individual. The rehabilitation counselor would serve to coordinate all services rendered by the VA to the veteran from bedside to job site.

This type of innovative thought needs to be pursued. Funds should be available along with the necessary staff to achieve the ultimate goal; restoration of the disabled veteran to a level where he can retain his personal dignity and become a productive element in society.

Mr. Chairman, I have attempted to keep my statement brief in order that I might attempt to answer questions you might have pertaining to VA programs and their effect upon the spinal cord-injured veteran. Again, I thank you for this opportunity to speak and your attentive interest.

Senator CRANSTON. I appreciate very much your coming here and your helpful and constructive testimony.

In your statement, where you refer to "documented evidence of patients harboring weapons while hospitalized," what is that evidence?

Mr. MAYE. In late January, the Veterans' Administration security felt it necessary to conduct a raid on one of the VA hospitals. Senator CRANSTON. Where was that?

Mr. MAYE. Hines VA Hospital, sir.

And, in doing so, they came up with a number of weapons, one of which was an automatic rifle and two automatic pistols.

Senator CRANSTON. Did they have ammunition?

Mr. MAYE. Yes, sir; there was ammunition, too. Also a number of knives and various other instruments which could be classified as weapons.

Senator CRANSTON. Who conducted the raid?

Mr. MAYE. I would like to turn that over to Mr. DeGeorge, who is from the Chicago area, and could probably give you a better answer. Mr. DEGEORGE. I'm certain it would be the Security Service within the VA system.

Senator CRANSTON. And, the VA, of course, is well aware of the whole incident?

Mr. DEGEORGE. Yes, sir.

Senator CRANSTON. Why were these patients harboring weapons? Why did they feel it necessary?

Mr. DEGEORGE. As we know, over the years, there has been patient intimidation, an allegation that is hard to prove.

Senator CRANSTON. Intimidation by whom?

Mr. DEGEORGE. Staff.

Senator CRANSTON. Have you developed any documented evidence of intimidation that led to this at that particular place?

Mr. DEGEORGE. Very minimal, sir.

Senator CRANSTON. Do you believe this happens elsewhere?

Mr. DEGEORGE. Yes, sir.

Senator CRANSTON. On what do you base that belief?

Mr. DEGEORGE. By reports from our traveling national officers, and also from our chapter offices within the chapters that are located near spinal cord injury centers.

Senator CRANSTON. Are you referring to intimidation or the harboring of weapons?

Mr. DEGEORGE. Intimidation, sir.

Senator CRANSTON. Do you have any documented statements concerning this intimidation?'

Mr. DEGEORGE. Like I said, Senator, very minimal.

Mr. MAYE. Sir, they are very hard to acquire. I would like to make it clear, not only are patients being intimidated by staff, but, obviously, when patients are armed, the staff is going to be intimidated by patients.

But, to get a patient who is frightened, a person who is totally dependent and has not been able to leave a veterans' hospital, to give sworn testimony against a staff member is most difficult.

Mr. DEGEORGE. Senator, if I may, as Mr. Maye has said, there have been instances where not only has the staff threatened patients, but patients, in return, have threatened staff with weapons. So, it becomes a whole breakdown of morale and self-respect and mutual respect, a situation of patient versus staff.

Senator CRANSTON. Were these patients at Hines in one particular ward, or were they scattered around?

Mr. DEGEORGE. They were in several wards, sir.

Senator CRANSTON. Were these service-connected disabled veterans, or what were they?

Mr. MAYE. Both service-connected and non-service-connected veterans. More information, I am sure, could be acquired through the Administrator of Veterans' Affairs. He has a list of all of the confiscated materials, including some drugs. Primarily soft drugs such as marihuana. There were also drugs that had been hoarded, regular prescription drugs, that rather than being taken had been set aside.

Senator CRANSTON. Going down to the next paragraph in your prepared statement you refer to the SCI service coming up with some innovative ideas, and you say some of these programs are under study. What has performance actually been so far in regard to those innovative ideas?

Mr. MAYE. Well, sir, they are planning an experimental program in West Roxbury. I would like to have our National Service Director, Mr. Langer, make a comment on that.

Senator CRANSTON. Fine.

Mr. LANGER. The first program was to acquire the services of Dr. Alan Rossier of Geneva to initiate a complete new program at the West Roxbury VA Hospital in the rehabilitation of spinal cord injury patients. This means starting from the ground up, staff and facilities. A new building is being scheduled to be built there, completely to Dr. Rossier's specifications. He has had a free hand in hiring the staff. He has been at West Roxbury since April 1. So, this program hasn't really gotten underway, but he is presently hiring some staff.

The second program was new ideas and concepts in training people. The first training session on the team concept was held at Castle Point VA Hospital 2 weeks ago; a 2-week session with a complete orientation of what happens to a spinal cord injury patient, how he should be treated and why he should be treated that way.

This was not only for doctors and nurses, but the entire staff, psychologists, social workers, nurses' aides, neurological technicians; everybody involved with the spinal cord injury patient.

Senator CRANSTON. Is the staff-to-patient ratio at SCI units adequate now, in your opinion?