visory Council on Health Manpower Shortage Areas might well be utilized in this capacity as well. The loan forgiveness program in section 4 is most welcome. The social conscience of medical students has led many into the areas of public health, but we feel many have been deterred simply due to the fact that their financial situation at the end of their long and expensive studies does not allow them to follow the best dictates of their conscience. We feel that this accelerated repayment program affords the opportunity of making an unhampered decision and opens the doors to those highly qualified and highly motivated professionals who would opt to serve in the Corps. We support the retention of section 5 dealing with malpractice and negligence suits but would like to mention the fact that we do not endorse the erection of barriers in the path of the truly aggrieved patient. Finally, we endorse the scholarship program designated as section 225, but recommend that every opportunity be given to the student to complete his professional training through residency before entrance into the Corps. This would allow an uninterrupted pursuit of his studies and further the purposes of the act by eliminating the possibility that the person leave the Corps in order to return to his studies. We feel that this would offer a much higher retention rate in the long run. We would like to make one additional suggestion, that being a provision in the amendments to place teams of health science students from medicine, dentistry, nursing, pharmacy in National Health Service Corps locations. Such student teams would be under the supervision of NHSC field personnel, take full part in the health services administered to the community in a manner consistent with their level of clinical training, and receive appropriate stipend for their work. Steps should be taken to qualify this experience for academic credit, with time commitments variable from 8 weeks to 1 year. Fiscal appropriations should allow the development and administration of a program to place 10 teams of four students the first year and 10 additional teams of four the second. Cost would run $400,000 the first, and an additional $400,000 the second year. Such a program will develop interest in the Corps and prepare students for service in the Corps since medical center training is not of the type that would be useful for optimal small community service. The program would also provide the added incentive to young physicians who wish to practice in a "teaching" situation with all its advantages and excitement. Appropriate consulting services can be provided for teachers and students alike-precedents for this already exist. This, in our estimation, is an even stronger incentive since the attraction of continuing education is what brings the young physician to the large city of the university med center. Consultation is the most effective form of continuing education. So it is that several important incentives are added to the Corps with this added provision for student teams in the field. Mr. Chairman, we thank you for this opportunity to comment and we welcome any questions. Senator JAVITS. Do either of you wish to add to the statement? Miss FALCAO. Concurring with Dr. Block's testimony concerning educational incentives to attract new doctors to the program, we speak to the desirability of offering exposure to the program at the undergraduate level. That is, we would like to see money provided to medical and other health care students to take elective time, with academic credit, from their professional training to actually experience the workings of the Corps by their on-location contributions to the needs of the community. Rather than duplicating services, it is our firm belief that the presence of student health care teams being trained under the Corps in residence would not only provide students with a three-dimensional concept of the reality of the Corps' benefits, but would also provide a very valuable educational stimulus to the local Corps. Any medical resident knows full well that he learns best when he is forced to teach students himself. There is no doubt that this opportunity to teach younger members of their profession plays a major role in attracting a resident to a university-based medical setting. It is our feeling that the presence of student health care teams would not only expose undergraduates to the Corps, but would also help to make the Corps more competitive with the benefits of a graduate university learning atmosphere. This would also help us all extend the concept that worthwhile health care exists beyond the university campus, as well as provide a valuable incentive to the student to return to that specific area or type of practice as a practicing professional. It is interesting to note that there is authority within the Comprehensive Health Manpower Training Act of 1971 to provide incentives to health education institutions to develop programs in primary care training, in the inderdisciplinary approach to the delivery of care, and to provide preceptorships in health education, encouraging students to help meet national needs. Our suggestion is completely consistent with this philosophy, and in removing it from the institution's administration, may well offer a more attractive incentive to the individual student. If this concept is as intriguing to you as it is to us, we would be pleased to meet with you to work out the appropriate phrasing. Senator JAVITS. Thank you very much. Mr. RIMM. Senator, in the interests of time, I will forego any elaboration. Senator JAVITS. One question of all of you, what do you think about the prime inducement to join the Corps being the draft? Mr. BLATTI. We think a lot of people are in the Corps now because of the draft. We would like to point out though that it has been our experience with students we placed in Appalachia that there is a strong desire on the part of these students to return to the area. Last week we produced a large number of names of people who went there as student and intend to go back into that area to practice primary care, certainly not under the sanction of any draft. Second, one of the individuals in the Corps, in Mann, W. Va., was in Mann under the Appalachia program; he told us he was "turned on" to that area as a student, and that he wanted to return; and that he would liketo have more students go down and also eventually return in the Corps. In review, I am not sure I can provide accurate data for you, but I would suggest that in looking at the applications of the National Health Service Corps, you might find 50 or 75 people out of 800 applications that did serve some time in our Appalachia project, so that an incentive to serve the American people and serve the public would provide enough people for the Corps if the draft were eliminated. Senator JAVITS. Thank you very much. I thank you all, and I do appreciate your appearance. Our next witness is Mrs. Luana Reyes, director of the Seattle Indian Health Board. Senator Magnuson has commended you to us. He thinks very highly of you. We are very honored to have you before us. Will you tell us what you can about this bill? STATEMENT OF MRS. LUANA REYES, DIRECTOR, SEATTLE INDIAN HEALTH BOARD, SEATTLE, WASH. Mrs. REYES. Thank you very much, Mr. Chairman. The Seattle Indian Health Board is a community controlled health program designed to address some of the very evident health needs of the urban poor in the Seattle area with particular emphasis on the urban Indians. The program delivers health care services to low-income people on the basis of need and regardless of ethnic background. Recent statistics indicate that 79 percent of the population served have an annual income of $4,000 or less, and an average family size of 4.6. The Seattle Indian Health Board was started by a group of Indians and non-Indians who organized and operated a medical and dental clinic on an entirely volunteer basis for over a year. Since April 1971, we have received Federal and State funding to supplement the volunteer effort. At the present time, the Seattle Indian Health Board program provides medical services for approximately 2,500 people and dental services for 800 people, registering in total over 8,000 patient visits per year operating on a limited time schedule. Since the demand for health services far outstrips our ability to supply services; for example, we currently have over 350 people waiting for dental appointments, the Seattle Indian Health Board applied for a doctor, dentist, and a nurse from National Health Service Corps. We planned to use these resources to improve the quality and quantity of services provided. We are attaching a copy of our original application to the National Health Service Corps. (The information referred to follows:) PROPOSAL Assignment of Personnel under Emergency Health Personnel Act to This brief proposal is submitted by the Seattle Indian Health Board, Ind., the sponsor of the free Indian Medical and Dental Clinics which serve the 12,000 urban Indians in the Seattle area. We are requesting assignment of a dentist or dental hygienist, a public health nurse and a doctor. The proposal seeks to outline the health needs of urban Indians, the role of the Indian Clinics in meeting those needs and ways in which personnel assigned to the Indian Clinics under the terms of the Emergency Health Personnel Act could significantly increase the clinics' effectiveness in improving the health status of the urban Indian. It is by no means a comprehensive proposal and will be followed by a more detailed proposal as soon as possible. The health status of the urban Indian is perhaps the lowest of any group in contemporary American society. Statistics bear witness to the fart that in terms of health, the Indian community as a whole, is some 70 years behind modern American society. A life expectancy of 44 years, an incredibly high level of dental caries and inner ear disease, an infant mortality rate higher than that of any other group in the nation are among the statistics that can be cited to back up this contention. However, these statistics refer to the entire Indian community whereas there is an important distinction to be made between the urban and reservation Indian which is particularly crucial to the question of health care. Indians on reservations, and those who have not left the reservation for more than one year are eligible for coverage under the Indian Health Service. However, Indians who have been off the reservation for more than a year are generally ineligible. In practice this means that urban Indians have no coverage. Yet urban Indians, and their numbers are growing as a result of BIA policies, are generally unprepared for urban life. They lack occupational skills and education, they are totally unfamiliar with the urban bureaucratic maze and their high unemployment rate and low incomes (a 1969 survey indicated a 50% unemployment rate and an annual per capita income of $500*) make purchase of health care out of the question. Furthermore the situation is complicated by the fact that the legal status of the urban Indian is shrouded in misunderstanding. There is a misconception on the part of the non-Indian community that all Indians are "taken care of" by the BIA or Indian Health Service. Hence most urban Indians are shuffled backwards and forwards between agencies none of whom will take responsibility for providing health care for the Indian and ail of whom define themselves as the agency of last resort. It takes more than *The Nutritional Status of a Group of Urban Indian Families living in Seattle, Deccaber 1963. Nathan J. Smith, M.D., Seattle, Washington. |