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WEDNESDAY, APRIL 18, 1973

Opening statement of Hon. Alan Cranston, chairman of the Subcommittee

on Health and Hospitals---

Statement of -

Rufus Wilson, Associate Deputy Administrator, Veterans' Admin-

istration, accompanied by Dr. Marc J. Musser, Chief Medical

Director, Department of Medicine and Surgery; Winton D. Ross,

Director, Budget Service, Office of the Controller; Viggo P. Miller,

Assistant Administrator for Construction; and A. T. Bronaugh, As-

sociate General Counsel, the Veterans' Administration--

Dr. Michael E. DeBakey, president, Baylor College of Medicine,

Houston, Tex_-

Hon. Harrison A. Williams, Jr., a U.S. Senator from the State of New

Jersey

Dr. Stanley S. Bergen, Jr., president, College of Medicine and Den-

tistry of New Jersey, Newark, N.J---

Dr. Richard P. Schmidt, dean of the college of medicine, Upstate

Medicine Center, State University of New York, Syracuse, N.Y-----

Dr. Clayton Rich, dean of the school of medicine, Stanford University,

Stanford, Calif__

Dr. Edmund D. Pellegrino, president elect for the Association of

Academic Health Centers, vice president for health sciences, direc-

tor of the Health Sciences Center, professor of medicine, University

of New York at Stony Brook, N.Y.-

Col. Herbert M. Houston, director, national legislative service, Veter-

ans of World War I of the U.S.A., Inc-----

William J. Flaherty, deputy national director of legislation, Disabled

American Veterans--

Francis Stover, director of national legislative service, Veterans of

Foreign Wars_-

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Written statement of

Elizabeth Lundgren, director, division of allied health studies, Miami

Dade Junior College, Miami, Fla---
Rufus H. Wilson, Associate Deputy Administrator of Veterans Affairs,

Veterans' Administration.--
Dr. Michael E. DeBakey, president, Baylor College of Medicine,

Houston, Tex---
Dr. Stanley S. Bergen, Jr., president of medicine and dentistry of

New Jersey, Newark, N.J---
Dr. Richard P. Schmidt, dean of the college of medicine, Upstate

Medical Center, State University of New York, Syracuse, N.Y--
Dr. Clayton Rich, dean of the school of medicine, Stanford University,

Stanford, Calif---
Dr. Edmund D. Pellegrino, president elect for the Association of

Academic Health Centers, vice president for health science, director
of the health sciences center, professor of medicine, University of

New York at Stony Brook, N.Y..
Col. Herbert M. Houston, director, national legislative service, Vet-

erans of World War I of the U.S.A., Inc_----
William J. Flaherty, deputy national director of legislation, Disabled

American Veterans--
Francis W. Stover, director, national legislative service, Veterans of

Foreign Wars-
Charles E. Mattingly, deputy director, national legislative commis-

sion, the American Legion.-
E. H. Golembieski, director, national veterans affairs and rehabilita-

tion commission, the American Legion--Miscellaneous

Helping to meet the dental health care needs of the Nation: the

potential role of the dental service of the Veterans's Administra-
tion's health care system, a report of the Veterans' Administration

Advisory Council on Dentistry-
Position statement, possible association of Department of Health

Services with the Veterans' Administration, by director of Depart

ment of Health Services, Liston Witherill-Helping to meet the Health Care Needs of the Nation, a reprint from

the Journal of the American Medical Association, June 5, 1972,

volume 220--Letters to

Hon. Alan Cranston, chairman of the Subcommittee on Health and
Hospitals of the Committee on Veterans' Affairs, from:
Dr. Hamilton B. G. Robinson, dean, School of Dentistry, Univer-

sity of Missouri, Kansas City, Mo., dated May 4, 1973---
Dr. D. Cramer Reed, dean, University of Kansas School of Medi-

cine, Wichita State University, Wichita, Kans., dated May 15,

1973
Hon. Donald E. Johnson, Administrator of Veterans Affairs, Vet-

erans' Administration, with enclosures, dated April 17, 1973---
Dr. Hans Popper, dean, Mount Sinai School of Medicine, the City

University of New York, New York, N.Y., dated April 30, 1973_-
Hon. Donald E. Johnson, Administrator of Veteran Affairs,

Veterans' Administration, with enclosures, dated May 23, 1973-
James A. Maye, executive director, Paralyzed Veterans of Amer-

ica, dated June 26, 1973_-
John A. 1). Cooper, president, Association of American Medical

Colleges, Washington, D.C., dated July 19, 1973_--
Hon. Elmer B. Staats, Comptroller General of the United States, Gen-

eral Accounting Office, Washington, D.C., from Hon. Alan Cranston,
chairman of the Subcommittee on Health and Hospitals of the Com-

mittee on Veterans Affairs, dated July 9, 1973_,
Hon. Donald E. Johnson, Administrator of Veterans Affairs, Veterans'

Administration, from Dr. Mitchell W. Spellman, dean, Charles R.
Drew Postgraduate Medical School, Los Angeles, Calif., dated

April 12, 1973..
Vice President, 2660 Connecticut Avenue NW., from Clinton E.

Wooster, legislative counsel, Legislative Counsel Bureau, Carson
City, Nev., dated May 14, 1973-

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OVERSIGHT OF VA HOSPITAL PROGRAMS, 1973

MONDAY, APRIL 16, 1973

U.S. SENATE,
SUBCOMMITTEE ON HEALTH AND HOSPITALS OF THE
COMMITTEE ON VETERANS' AFFAIRS,

Washington, D.C.
The subcommittee met, pursuant to notice, at 1:30 p.m., in room 412,
Russell Office Building, the Honorable Alan Cranston, chairman of
the Subcommittee on Health and Hospitals, presiding.

Present: Senator Alan Cranston, chairman.

OPENING STATEMENT OF HON. ALAN CRANSTON, CHAIRMAN OF

THE SUBCOMMITTEE ON HEALTH AND HOSPITALS

Senator CRANSTON. The hearing will please come to order.

The hearings this afternoon, and those scheduled for a full day this Wednesday, the 18th, are designed to answer the question, "Whether or not it is 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 our earlier wars?"

These hearings are the third set of VA medical care oversight I have chaired since coming to the Senate in 1969. The first two were in 1969–70 and 1971. Based on the extensive data developed at those hearings, I made comprehensive recommendations to the Appropriations Committee Subcommittee regarding the VA hospital and medical program budget items for each of the last 3 fiscal years.

The result has been that the VA hospital and medical program budgets were increased by $450 million above the President's initial budget requests over the last 3 fiscal years. Other members of this committee and the House committee as well as the congressional leadership and members were involved in all of this and of course played a significant part in those increases.

On the basis of the data developed from these hearings, which we are about to begin, I plan to make similar such comprehensive recommendations on the VA fiscal year 1974 budget as well as on the implementation and nonimplementation of the fiscal year 1973 VA medical and hospital appropriations items. So, we will be looking at the VA hospital program with these budgetary considerations very much in the forefront. But, I wish to stress that our concern is not merely with finding areas requiring more money, but also finding areas in which savings can be effected.

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We will also be focusing specifically on the VA's failure to issue regulations or take any other steps to carry out the provision of Public Law_92–541, the “VA Medical School Assistance and Health Manpower Training Act of 1972,” which the President signed last October 24. In addition, the President's fiscal year 1973 and 1974 budget requests contained no funds to carry out this new law.

These questions must be viewed in the context of the steadily increasing demands being made on the VA in- and out-patient medical programs by Vietnam-era veterans. According to the most recent data, during fiscal year 1972, Vietnam-era veterans constituted 15.9 percent of all veterans discharged from VA hospitals, as compared to 13.2 percent in fiscal year 1971 and 9.9 percent in fiscal year 1970. The same pattern exists with respect to outpatient visits. In fiscal year 1972, Vietnam-era veterans accounted for 17.8 percent of all VA, staff and fee, outpatient visits, as compared to 14.9 percent and 10.8 percent in fiscal years 1971 and 1970, respectively.

Of particular significance, it seems to me, is that Vietnam-era veterans constituted 26.2 percent of all veterans discharged from VA hospitals in fiscal year 1972 after treatment for service-connected disabilities. Although the trends I have outlined toward greater care of Vietnam-era veterans by the VA hospital and medical program will not continue indefinitely at the same upward pace, I am aware of no indication that they will not continue upward over the next several years.

Thus, this is the time of the very greatest demands on the VA system by our most recent and, as our prior hearings illustrated only too plainly, our most seriously disabled veterans. This, then, is obviously no time for cutbacks in the quality and quantity of the VA medical program. We must consolidate the gains made over the last 3 fiscal years and continue to improve and expand the system and to stress the need for maximum responsiveness on an individualized, personalized basis.

Instead, preliminary indications are that OMB is once more in the process of imposing restrictions, freezes and other funding controls with a view toward seriously constricting the scope and effectiveness of VA treatment programs; $64 million appropriated by the Congress for the VA for this fiscal year have been impounded, and another $35 million of that medical care appropriation have been applied to pay for the January 1973 pay raise for the Department of Medicine and Surgery. In addition, the one-tenth of a grade rollback imposed by OMB continues in force at least through fiscal year 1973, with the effect through January 8, 1973, that of 22,457 essential promotions reported by each of the 168 VA hospitals throughout the country, only 2,610 of these 22,457 were accomplished. The resulting serious, negative impact on overall VA hospital staff morale, accompanied by the loss of medical care competence and experience as lesserqualified staff must be hired to replace existing hospital workers leaving under normal attrition, poses a continuing serious problem for the caliber of care for our disabled veterans.

Also, regarding the fiscal year 1973 budget, $1.8 million is being held back by OMB directive which was appropriated for VA medical and prosthetic research.

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The situation regarding the fiscal year 1974 budget request of the President can only be viewed in the context of these fiscal year 1973 aspects. But, there is plenty of bad news itself in the VA fiscal year 1974 budget submissions. The most serious of these is the requirement that the VA reduce the average daily patient census in existing hospitals by 2,698, which in individual patient-care terms translates down to denying VA hospital care to between 20,000 and 54,000 disabled veterans who would otherwise receive it.

All of this will come if the Congress permits it—at a time when the VA will be activating 5 new hospitals and 17 new affiliations with medical schools—all requiring millions of new dollars and hundreds of new staff in order to be carried out.

I plan to make additional comments about the fiscal year 1974 budget at Wednesday's hearing when the VA witnesses appear. But, I think I have said enough to indicate that this is the year of decision. If OMB succeeds in its effort to arbitrarily reduce the VA hospital average daily patient census down to 80,000 from the most recent level of approximately 83,500 at present, the downward trend and the steady erosion of the VA hospital system may well be irreversible. In my view, this would be an enormous tragedy both in terms of meeting our obligation to care for those who have served our Nation in times of national emergency, and in terms of wasting, and inviting dissipation of a highly cost-effective national medical care resource, which performs an indispensable role in the total provision of health care in America.

In terms of the failure to carry out Public Law 92-541, through the end of February of this year the VA received more than 40 expressions of interest from State governments, medical schools, nursing and allied health schools, universities and other health manpower training institutions about utilizing the new authorities in that public law, to establish new medical schools using VA clinical facilities, or to expand the education and training capacities of medical and other schools affiliated with existing VA health facilities.

We have a very distinguished list of witnesses this afternoon and on Wednesday, April 18, 1973, representing not only the leadership of the Veterans' Administration and its extremely able and dedicated Department of Medicine and Surgery, but also some of the most outstanding medical school and other university and health manpower institution officials and experts in the Nation. We will also receive testimony from all the major veterans' organizations and look forward to their special insights and always valued contributions.

Now, proceeding with the witnesses, our first witness is Dr. James L. Dennis, vice president for health sciences, University of Arkansas Medical Center, Little Rock, Ark. Dr. Dennis, we welcome you.

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STATEMENT OF DR. JAMES L. DENNIS, VICE PRESIDENT FOR

HEALTH SCIENCES, UNIVERSITY OF ARKANSAS MEDICAL CENTER, LITTLE ROCK, ARK.

Dr. DENNIS. Chairman Cranston, distinguished colleagues, fellow veterans, I am Dr. James L. Dennis, vice president for health sciences at the University of Arkansas Medical Center.

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