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:]

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 information 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.

Sincerely

Encl.

Deputy Administrator in the absence of

DONALD E. JOHNSON
Administrator

QUESTION 2:

The impact of the five new hospitals and the new FY 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 in 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.

QUESTION 3:

The Average Daily Patient Census weekly, monthly, and annually from fiscal year 1971 through March, 1973 and a projection of fiscal year 1973 Average Daily Patient Census in VA Hospitals weekly to the end of FY 1973. Would you also provide the Subcommittee on a regular basis figures on the weekly ADPC?