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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.

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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. DE GEORGE. 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?

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Mr. LANGER. In numbers, in some places, yes; in quality, I don't believe that anyplace it is sufficient. If you had a staff ratio of 5 to 1, with the quality we have now, I would say no. But, I will say that the quality is improving under the new leadership in spinal cord injury.

Senator CRANSTON. Is there a morale problem, or what is the problem with staffing?

Mr. LANGER. I think there is a morale problem everywhere, not only in spinal cord injury, but throughout the VA system; drugs in the system.

Senator Cranston. What is the reason for that morale problem?

Mr. LANGER. On spinal cord injury, I would say the lack of definitive leadership at the local level, too much free time. People are not being told “You have to go to therapy.” They have a big board up, and they say, "John Jones goes here at 9, here at 10, here at 11.” If John Jones doesn't show up, nobody cares. At 5 o'clock, everything stops. It's 9-to-5 therapy, Monday through Friday.

Senator Cranston. Why doesn't he get to therapy when he is supposed to ?

Mr. LANGER. John Jones doesn't feel like getting out of bed and no one is pushing him out of bed.

Recently, I was at a civilian spinal cord injury center in Phoenix, Good Samaritan. Here, people pay $150 a day for their rehabilitation and they go. At 9 o'clock, they are where they are supposed to be; at 10 o'clock, the same thing. And, these people are in and out of the hospital in a much shorter time than we are in the VA, and there is no morale problem.

Mr. DEGEORGE. If I may, Senator, I would like to add a comment. One of the reasons for not going is shortage of physical therapy staffing, or the patient goes into the clinic and he is made to wait for hours, or he is not even given the care that he is in need of.

Senator CRANSTON. If they all went to therapy when scheduled, would there be enough staff to handle them?

Mr. LANGER. Definitely not.

Senator CRANSTON. Is that one reason why they aren't pushed to go?

Mr. LANGER. Probably.

Senator CRANSTON. What is the present ratio of staff to patient in SCI?

Mr. LANGER. It's about 2 to 1.
Senator CRANSTON. What should it be?
Mr. LANGER. About 2 to 1. Some places, it's 2.6 to 1—

Senator CRANSTON. What should it be to have enough staff to handle the work?

Mr. LANGER. With a quality staff, I would say 2 to 1 would be sufficient, 2.5 to 1, at the most; otherwise, you would people stepping all over themselves.

Senator CRANSTON. When we started out, it wa'; 1.25 to 1. So, it has improved.

Mr. LANGER. Oh, yes; it has improved.

Senator CRANSTON. Are there no recreational programs now for SCI patients? You referred to the need for new programs.

Mr. MAYE. Very, very few. As we stated before in the testimony,


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from 9 to 5 there is structured therapy. But, hours afterward, when people tend to have emotional problems, getting into drug use there is no directed activity.

All activities are primarily volunteer activities, people coming from the outside to do volunteer work; this is good. But, it is really based on the whims of the individuals who are conducting the recreational leadership.

Mr. LANGER. If I may add, in some hospitals, thev say, "We have a recreation program. We show movies every night.” But, what they aren't telling everybody is they are showing the same movie five nights a week, and there is no recreational therapist on duty Saturday and Sunday when they are needed. Senator CRANSTON. If

you could give us some more material for the record on the need for therapy, staffing and cost estimates, it would be helpful to us.

Mr. MAYE. Yes: I will.

Senator CRANSTON. You refer, later in your testimony, to the contemplated addition of rehabilitation counselors. Where are the funds in the budget for that purpose ?

Mr. LANGER. There are none.

Mr. MAYE. That's correct. The job description has been made under the SCI leadership, but there have been no funds made available.

Mr. LANGER. This proposal was supposed to go to the executive committee of the Veterans Administration, and was roadblocked.

Senator CRANSTON. So, except for what has happened at West Roxbury, there has been nothing done about this innovative proposal ?

Mr. LANGER. Except for the training program and home-based hospital care, which has been moving in the proper direction.

Senator CRANSTON. In my opening statement, I indicated my interest in finding where savings could be made in the present budget, as well as where money is needed.

Where would you recommend we could cut the Federal budget, if at all ?

Mr. MAYE. Well, within SCI centers, I would say one of the primary places to start is with the rehabilitation counselors. A tremendous amount of money is being spent on education for Vietnam veterans and disabled veterans, in particular.

A lot of these people are utilizing their educational benefits. They are going to school, maximizing the amount of time they can be in school, enjoying full benefits. And, the only real gain they are getting out of their education is the financial aspect received through vocational rehabilitation or the GI bill.

I think that with the proper direction of individuals, such as provided by rehabilitation counselors, veterans utilizing their educational benefits would have a goal to work for during school, and it would be a more profitable one.

Senator CRANSTON. Are you saying the money is being wasted because they are not adequately guided in these programs?

Mr. MAYE. Well, it's hard to say "wasted." It's hard to waste money on education, per se. But, I do not think it is being utilized as well as it should.

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Senator CRANSTON. Would you go over the VA budget and see if you can identify any other places where you feel there might be savings that would make room, then, for the more necessary programs?

Mr. MAYE. Yes, sir; I will.
Senator CRANSTON. For the record, not now.

Do you have any thoughts on any cuts that you would like to see elsewhere in the Federal budget that would enable us to stay within the spending ceiling, but do what is needed for veterans? Do you want to think about that and submit it in writing?

Mr. MAYE. Yes, sir. It will take a lot of thought.

Senator CRANSTON. I thank you very much, and I appreciate your coming

Before we recess this hearing, I would like to note the presence here today of Dr. John Mallan, who is the director of veterans' affairs for the American Association of Community Junior Colleges. He has now left, but he was here.

He and that association have been an absolutely indispensable ally on all veterans' legislation, particularly the development of the GÍ bill legislation, to serve educationally disadvantaged veterans. Dr. Mallan's program has done a tremendous service and been very effective, funded most generally by the Carnegie Corp., and some Office of Education money. He has served also, as a sort of informal ombudsman for the GI bill.

We now stand in recess until 9:30 a.m., Wednesday, the 18th, in this room, and we will have quite a long hearing that day.

Thank you all for your presence. [Whereupon, at 4:10 p.m., the Subcommittee on Health and Hospitals adjourned, to reconvene at 9:30 a.m., Wednesday, April 18, 1973.]


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