sicians, dentists, and other health professionals will take advantage of the new provisions and practice in such shortage areas. The present 2-year service period may encourage more practitioners to take up permanent residence in the communities in which they serve. In our view, further changes in these provisions before their effects can be studied and evaluated would be premature. Section 3 of S. 3858 would establish a statutory process for notification of the Congress in regard to the Department's plan to convert the PHS hospitals to community management and use. As you know, Mr. Chairman, we have previously stated in testimony before Congress that the Department will not undertake any unilateral action with respect to the PHS hospitals. Let me reiterate that it is our firm intention to conduct appropriate briefings for the Congress in any and all cases when workable arrangements have been developed with respect to the disposition of PHS hospitals and before any final decision is reached. Therefore, we believe section 3 is unnecessary. Most objectionable is the provision which requires the 314 (a) and (b) State and area wide planning agency's approval prior to any disposition of PHS facilities. We have continuously solicited the review and comments of these planning agencies on the proposals that have been submitted to the Department for the conversion of the PHS hospital to community management and use. Our guideline stipulates that these proposals must be in accord with the health plans of the community, and we would not accept a proposal which significantly deviates from these established plans. However, the provision contained in S. 3858 would give unwarranted and unprecedented authority to a non-Federal agency over a direct Federal program and thus would severely restrict the Secretary's authority to conduct programs for which he alone bears statutory responsibility. Most importantly, we remain committed to the position that no beneficiary will be deprived of medical care, no needed resources will be withdrawn from the respective communities, and no final actions will be taken without giving the Congress an opportunity to study them in advance. The bill would provide scholarships of up to $5,000 per year to individuals who would agree to serve in the regular commissioned corps of the Public Health Service for 6 months for each academic year a grant is received. This provision would appear to go far beyond the scope of the National Health Service Corps and cover the whole range of our health programs. In our judgment, this bill is not an appropriate vehicle for dealing with the Department's across-the-board personnel requirements in the health fields. Section 5 of S. 3858 is also similar to section 784 of the Public Health Service Act, added by the Comprehensive Health Manpower Training Act of 1971. That section authorizes the Secretary to award scholarships of up to $5.000 per student per year, to medical students who agree to practice primary care in a physician shortage area or in a place or facility where a substantial portion of patients served are migratory agricultural workers or their families. Mr. Chairman, we strongly oppose this provision of S. 3858 as duplicative in the case of physicians and we believe that the preferred treatment accorded the Commissioned Corps as against the civil service in the loan forgiveness and scholarship provision of the proposed bill would be a step in the wrong direction. With the end of the draft, the Department will be confronted with critical problems of recruiting personnel in these relatively scarce categories for all of its programs, including those involving assignments to remote areas of Indian reservations and to relatively unpleasant duty in Federal prisons as well as those to the National Health Service Corps. The Department is currently in the process of developing a specific plan for meeting its future needs for health professionals, with particular reference to the special problems involved in obtaining physicians and dentists. As part of this process, we are, at the request of the Director, Office of Management and Budget, chairing an interagency committee which includes representatives from the Department of Defense and the Veterans' Administration, and the Civil Service Commission to examine the executive branch's needs for physicians in the context of overall national needs. Outstudy encompasses the matters of projected requirements for physician manpower and alternative ways of meeting those requirements, projected levels of supply, and the implications for the Federal and non-Federal sectors of alternative concepts of compensation and other benefits of Federal employment. With this study as the basic analytical tool, we expect to be able to submit such legislation as may be necessary to the Congress at the beginning of its next session. In the meantime, we strongly urge that no piecemeal action be taken on this important matter. As I indicated earlier, we are currently reviewing the National Health Service Corps authority at this time to determine what, if any, changes need to be made. This review is part of an overall review of PHS authorities which expire at the end of fiscal year 1973, with a view to identifying necessary and desirable amendments. We anticipate submitting our detailed legislative recommendations in connection with the fiscal year 1974 budget. Accordingly, we request your cooperation in not extending this legislative authority at this tmie, and therefore recommend against the enactment of S. 3858 at this time. Senator KENNEDY. Thank you very much, Dr. DuVal. That mimeograph machine over there, it seems to be opposing much of the legislation, and it is getting a pretty good workout. If my statistics are right, this is the eighth act that we are considering which the administration has expressed reluctance to extend, and as you understand full well, we will have 17 pieces of health legislation expiring in June of next year, and with the reorganization of the Congress, meaning that we will probably get started, as a practical matter, some time in March or early April, and these expiring in June, it seems to us to be the better part of wisdom to move ahead, and certainly those most affected by the pieces of legislation have supported that. We have mental health, allied health, public health, medical libraries, migrant corps, and service corps. Those are eight pieces of legislation that we have been considering, which will expire, and which we want to act on. Let me ask, I was interested in the comments about the provisions of the legislation that require the approval of the local health and State health planning councils, and the reservations which the administration has, and is not that a recommendation which was made by the administration to apply to various hospitals that are participating in medical care? To my understanding, the administration wanted the local health planning councils as well as the State health planning councils to approve various expansion programs within the private hospitals, other hospitals not qualifying for medical care, under amendments to H.R. 1? Dr. DUVAL. You are correct. It is also in the amendment package to the National Health Insurance Partnership Act. You are correct, in that analysis. There is a substantial difference between the points you just made and the one that we attempted to make in the opening testimony. Apropos the opportunity for the local health planning agency to consider and even to veto a projected capital expansion of a local facility, this is a nonprofit enterprise in a community seeking a Federal grant. The local people have a right to determine whether or not that should come forward. That is quite different than having the Congress mandate the program to be carried out by the Department of Health, Education, and Welfare as a direct Federal service, then having the local group say I am sorry, you cannot do it in this area, so they do come out different. Senator KENNEDY. Does not the closing, or the terminating of these facilities have an impact on the local services as well? Dr. DU VAL. Yes, any investment we make under the National Health Service Corps, so to speak, through the appropriate contract arrangement with the community would ultimately entail deliberations with the local agency, and as a matter of fact, we would not wish and not plan to come into the communtiy except with the concurrence of the local planning agency, with their knowledge, and with the understanding of what the impact would be, and we have done that to date. Senator KENNEDY. It seems to me we are providing Federal funds to support local planning councils, and to get an input from the local community. All we are trying to do is insure that we are going to get that kind of an input. That is obviously helpful to any of us, I would think, in both the administrative or legislative branch. Dr. DUVAL. I would repeat, Mr. Chairman, we agree that input is valuable. We have sought it each time, and we would continue seeking it. The input would be in the direct Federal service, whether or not the local planning agency would say you cannot do it here. This is the matter at issue. If they said, I am sorry, you cannot run a program taking care of Indians in our area, we would construe that to be a local override of the Federal mandate, and we would have to treat that differently than the issue of an application that arose for a nonprofit enterprise for Federal help. Senator KENNEDY. You mentioned, I think, the problem of underserved areas. Dr. DUVAL. Yes, sir, 144. It is communities that have been screened. Senator KENNEDY. That qualify? Dr. DUVAL. Yes, sir. Senator KENNEDY. Now, have you had any other areas that would qualify, but for one reason or another have been discounted, because of local medical groups or for other reasons? Dr. DUVAL. We have another 50 under review at the moment that may prove to be eligible, and any details about those 50 would be for Dr. Rimple to explain. Senator KENNEDY. Have you had some that have been disapproved because of the objection of local medical societies? Dr. DUVAL. On the first go-round, approximately 15 percent of the applications when first submitted did not have the concurrence of the medical societies. One by one, as the negotiations had been provided, however, the differences have been resolved, and I do not know whether there are any remaining on that list. Senator KENNEDY. Do you have somebody there? Dr. DUVAL. Dr. Rimple. Dr. RIMPLE. The current stage Senator KENNEDY. Just so I understand, there are 20 medical society turndowns and 21 dental society turndowns. My question, What was the reason for the turndowns? Were they justified? Dr. RIMPLE. The turndowns, Senator, have been because, in the opinion of the medical and dental societies, those communities were not a critical dental or health shortage area, in the same sense that other communities that we have approved are. Senator KENNEDY. How do they know? How does the local group know whether he is less underserved than some group out in Montana? Dr. RIMPLE. They look at local statistics and figures in connection with the population ratios. However, Senator, what we have found in many instances is that, by working more closely with the local medical societies in such communities, we have been able to resolve these differences, and that in several instances, medical societies and dental societies have retracted their original positions and have come around to approving the applications. Senator KENNEDY. Could you give us how many? Why don't you give me how many have retracted their objections, and where they are. what part of the country they are in? Dr. RIMPLE. A total of four or five have retracted in Pennsylvania; and in Arkansas, and in the Southwest, Arizona, they have retracted. Senator KENNEDY. Where are the remaining 15? sir. Dr. RIMPLE. In those various areas, sir. Senator KENNEDY. In Pennsylvania, Arkansas? Dr. RIMPLE. In Texas, in Arkansas. Senator KENNEDY. Any other States? Well, could you submit those? Do you have those there? Dr. RIMPLE. We can provide that information for you specifically, (The following was subsequently supplied for the record:) 84-847 O - 72 - 3 |