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

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 have people stepping all over themselves.

Senator CRANSTON. When we started out, it was 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,

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.

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 GI 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.]

OVERSIGHT OF THE VA HOSPITAL PROGRAMS, 1973

WEDNESDAY, APRIL 18, 1973

U.S. SENATE,

SUBCOMMITTEE ON HEALTH AND HOSPITALS OF THE
COMMITTEE ON VETERANS' AFFAIRS,

Washington, D.C.

The subcommittee met at 9:45 a.m. in room 412, Russell Office Building, Hon. Alan Cranston (chairman of the subcommittee) presiding.

Present: Senators Alan Cranston (presiding), Strom Thurmond, and Clifford B. Hansen.

OPENING STATEMENT OF HON. ALAN CRANSTON, CHAIRMAN OF
THE SUBCOMMITTEE ON HEALTH AND HOSPITALS

Senator CRANSTON. The meeting will please come to order.
On Monday, I stated the theme of these hearings as:

"Is it the policy of the American people and its Federal Government that when the shooting ends, so does the compassion and concern for the veterans of the Indochina war and the veterans disabled from earlier wars?"

At today's hearing I believe we will begin to answer this question. First, I have a brief scheduling announcement: We had originally planned to run these hearings through to 3 p.m. or so without a lunch break. However, since there is a rollcall scheduled at noon, and because of other scheduling problems, we have revised this plan. We will now recess the hearing at 12 noon and reconvene at 1:45, running until 4 or 4:15 p.m. this afternoon. We have worked out a schedule which will allow each witness following the Administration about 20 minutes not only to present his statement but also to cover questions.

Returning to the theme of these hearings, we find that the proportion which Vietnam-era veterans comprise of VA medical treatments continues to grow steadily. In fiscal year 1972, 26.2 percent of all veterans discharged from VA hospitals after treatment for service-connected conditions were Vietnam-era veterans.

So we will be attempting to learn at these hearings:

How has the treatment of sick and disabled Vietnam-era veterans been affected by President Nixon's impoundment of $64 million in fiscal year 1973 medical care funds? By the OMB's order that the VA hold back $4.8 million appropriated for medical and prosthetic research? By the fact that $35 million in fiscal year 1973 appropriations that was supposed to have been used to increase medical staffs in Veterans hospitals has been used for pay raises instead?