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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?

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How can the administration justify a proposed cutback in fiscal 1974 VA hospital patient loads that will deny hospital care to 30,000 disabled veterans next year and perhaps even twice that number?

So let us prepare ourselves for the same old OMB- dictated denials, obfuscations, and generalities and anticipate that our experts who will follow the VA will be able to help us get to the bottom of the real situation in the VA hospital program under the fiscal year 1973 budget and 1974 budget requests.

I would like to say parenthetically that I think that the VA witnesses would also help us get to the bottom of this were they not under certain constraints in their testimony.

Our public witnesses this morning and afternoon are uniquely qualified to speak about the importance of keeping VA medicine healthy and vibrant both in terms of veterans' care needs and the national care and health manpower pictures. At Monday's hearing, Dr. James L. Dennis, vice president for health sciences at the University of Arkansas School of Medicine, warned that because of proposed budget restrictions, staff-to-patient ratios in VA hospitals could drop so low as to be dangerous for patients. He said that he personally would not want to be a patient with that staff-to-patient ratio.

We will follow up on this grave matter today.

Yesterday, I received from the VA responses to 15 of 18 detailed questions I submitted last week. Many of these answers were enormously helpful, and I want to express publicly my gratitude for the responsiveness generally in the answers and the speed with which they were provided. I look forward to receiving the material not yet available as soon as possible, as the Deputy Administrator promised in the April 17 transmittal letter.

We will put in the record at this point these questions and the VA replies received thus far and the rest of the answers as they come in.

[The documents referred to above follows:]

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Pursuant to your request of April 10, 1973, I am submitting herewith certain information relating to the Veterans Administration medical program. The response to each question you submitted is contained as a separate exhibit. However, because of the shortness of time, and since some of the infor-. mation will have to be obtained from appropriate studies, which we are now in the process of initiating, we have not prepared complete responses to questions 1, 6, and 7. We are also not able to respond, at this time, to the unnumbered request contained at the end of the letter, for a paper on the programs of the Department of Medicine and Surgery of the Veterans Administration which might have impact on the provision of emergency medical services in the community, and on the possibilities of VA hospitals and other facilities coordinating their programs and providing support to community programs for the provision of emergency medical services. This information will be furnished as soon as possible.

Your continued interest in the VA medical care program is appreciated, and I hope the information furnished will be of assistance to you in connection with your oversight of this program.

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QUESTION 2:

The impact of the five new hospitals and the new PY 1974 Specialized
Medical Services on the Average Daily Patient Census and the Staff to
Patient Ratios?

ANSWER:

1. A total average census increase of .902 is projected in FY 1974 of which 204 average census will be a tradeoff within the existing facilities at Lexington, Ky., and White River Junction, Vt. The full-time equivalent employment related to this net increase of 698 ADPC will be made available through employment reductions applicable to a 2,698 ADPC decrease in existing facilities.

2. The increase in the funding for Specialized Medical Services in
FY 1974 over FY 1973 is $17,260,000. This represents an increase of
508 FTE and $7,210,000 to annualize the activation which took place
la FY: 1973; the upgrading of the Drug Dependence Treatment Program
with 48 FTE and $863,000, an increase in fee basis services also for
the drug program of $720,000, an lastly an increase of $8,467,000
for the Home Dialysis estimated workload increase.

3. These increases are reflected in applicable Bed Section staffing ratios and is the average for all VA hospitals indicated in the budget at 1.50.

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