a Christmas party with a lot of children and couldn't come out to answer the telephone. Mr. ROGERS. It is amazing. Mr. DOWNING. Is anyone here this morning from HEW? (No response was noted.) The CHAIRMAN. That is good attendance. I would like to insert in the record, a joint statement from two of our colleagues, Hon. F. Edward Hébert and Hon. Hale Boggs. If there is no objection, it will appear at this point. (The joint statement follows:) JOINT STATEMENT OF REPS. F. EDWARD HÉBERT AND HALE BOGGS TO THE HOUSE MERCHANT MARINE AND FISHERIES COMMITTEE Mr. Chairman, we are grateful for the opportunity to offer our views regarding the U.S. Public Health Service Hospital System and particularly the essential role it plays in our own community, the City of New Orleans. The U.S. Public Health Service has maintained a medical facility in New Orleans since 1802 when Congress appropriated $3,000 to provide medical care for American seamen. Since that time, with the exception of the years of the Civil War, the Public Health Service Hospital has been an essential health care institution for our community and for our region. Today, the New Orleans hospital is one of eight general medical-surgical hospitals located in port cities around the country. The facility now serves Missouri, Arkansas, Louisiana, Tennessee, Alabama, Mississippi, Florida, and the Panama Canal Zone. It operates clinics in St. Louis, Memphis, Mobile, Tampa, Jacksonville, and Miami. In addition, there are 20 outpatient offices and 20 other areas within the district where medical services are provided. In addition to providing comprehensive medical care for American merchant seamen, the New Orleans facility now treats federal employees injured on the job, members of the Uniformed Services, and their dependents. With the closing of Camp Leroy Johnson in 1963, the New Orleans hospital became the only uniformed services hospital in the New Orleans area. Armed services personnel and their dependents now comprise approximately 50 per cent of the hospital's outpatient load and 23 per cent of its inpatients. Many of the patients treated by the hospital staff are armed service dependents living in New Orleans whose husbands or fathers are assigned to Viet Nam or other areas of the world where dependents cannot accompany them. The New Orleans hospital has set four institutional objectives: (1) to provide its patients with comprehensive medical care of the highest quality; (2) to develop and conduct training programs which are models of excellence and which contribute materially to the career development program of the U.S. Public Health Service; (3) to carry out clinical and administrative research and collaborative demonstrations with other health care facilities to find ways of improving health care delivery systems; and (4) to cooperate and collaborate with other institutions and organizations in health-related activities. During the past few years there has been a gradual but significant change between the hospital and the community. Achieving optimum patient care, research, and training programs has led to the hospital's involvement in the New Orleans medical complex. The result has been that today the Public Health Service Hospital in New Orleans is a vital part of our community's health care complex. During the past year, the hospital's outpatient load was more than 140,000 visits and its average daily inpatient load was 320. Each year the facility trains 18 medical interns and six dental interns. At present, its residency staff numbers 34 physicians in a variety of specialties. Many of these staff members have appointments with our two medical schools and other departments of our universities. At present the hospital is a partner in a number of joint research and training and treatment programs with other health care institutions in our community, including among other things a 24-hour-a-day Poison Control Center; a Preventive Medicine Clinic, which screens welfare personnel for Total Community Action; the New Orleans Office of Economic Opportunity organization; and a six-bed renal dialysis unit which, on occasion, has kept alive patients when other community facilities were not available. These are not the signs of an institution which has outlived its usefulness. These are the signs of a vibrant and innovative health care facility. We believe the New Orleans Public Health Service Hospital is performing a vital function in our community. In addition to fulfilling its primary role of rendering comprehensive health care to merchant seamen, fishermen, and members of the uniformed services, it is demonstrating that a federal medical installation has something to contribute to a community, that it can make its contribution without encroaching upon the private sector of medicine, and that all segments of a community can gain from its participation. The U.S. Public Health Service Hospital has become an essential component of our community's medical complex. It is inconceivable to us that the closing of such a facility could be seriously contemplated in these days of a serious hospital bed shortage and an oncoming crisis in health care. The CHAIRMAN. Mr. Earl W. Clark and Hoyt Haddock from the Labor-Management Maritime Committee, I understand you have been working on this problem? STATEMENT OF EARL W. CLARK AND HOYT S. HADDOCK, CODIRECTORS, LABOR-MANAGEMENT MARITIME COMMITTEE Mr. CLARK. Mr. Chairman and members of the committee, I think it is a fine thing which this committee has done and is doing on behalf of the merchant seamen of our country. At this point, here at the beginning, I would like to compliment the chairman and all members of this committee for another act, H.R. 15549, which you just passed through the Congress in behalf of the United Seamen's Service, which again was an act in behalf of our seamen and you certainly have our compliments for the splendid work that was done there. Mr. Chairman, I should like to take about 3 or 4 minutes to get back into the history of this merchant marine care in the hospitals of the Public Health Service. I am not going to dwell on it long because I know you don't want to delve into antiquity here, but I think a little background may give us some insight into what is now occurring in this field. The first hospital care we know of in the English-speaking world followed the Spanish Armada in 1588. England created two hospitals, the Chatham Chest and one in Greenwich, near London. This extended on down through the colonial period. There has been no break since the Spanish Armada in the English-speaking world in this type of care for merchant seamen and throughout our entire colonial period, care was given under the English system. When our country became independent and our Constitution was adopted by the Congress, the United States at that time began to look into this problem and to determine what they would do to care for merchant seamen. This led up to enactment of a bill in 1798 and signed into law by John Adams, the then-President, creating the medical service for merchant seamen. The hospitals were known in those days as marine hospitals and carried that name up to 1912 when it was changed to the Public Health Service. I will dwell on that in a moment as to what those reasons were. From 1798 to 1844 the cost of providing this care was provided by a withholding of seamen's wages. It was in 1844 that the Congress passed a law levying a tonnage tax on all ships entering into our harbors and that tonnage tax was then devoted to the care of merchant seamen. These moneys went into a special fund directly for use by our "marine" hospitals and that continued up until 1905 when an amendment was passed by the Congress effective in 1906 whereby direct appropriations took over. But the tonnage tax was not excused and to this day that tonnage tax is charged on every ship, foreign as well as U.S. ships, that comes into an American harbor. The reason the Congress did that back in 1905, effective in 1906, was that shipping is an up and down industry. It is a cyclical thing. Its economy is up today and down tomorrow. The Government could not depend on adequate money to carry on the medical hospitals because if shipping was down, tonnage tax receipts didn't provide enough money while in good years there might even be more than needed. So the appropriation process was to give a continuity to financing marine hospitals. Since 1906 the tonnage tax has gone into miscellaneous receipts. Now there we stood until about 1965, which brings us to another episode. The movement to do away with marine hospitals, I think, carried through the Eisenhower administration, the Kennedy administration, the Johnson administration and now apparently the Nixon administration. Mr. Haddock will agree this emanates chiefly in the Bureau of the Budget. In 1965, however, I can tell you that the Health, Education, and Welfare Department, particularly the Public Health Service, was not in agreement with the Bureau of the Budget, and they gave Mr. Haddock and me permission to travel around this whole country and survey the hospitals from the standpoint of knowing where they were going, what they doing and how they were treating people medically. We produced this two-volume book in 1965 and we testified before seven committees of the Congress. I can tell you now that each of you who were here then have this book in your library. Volume 2 is now historical. It is statistical. I would not advise you to refer to it very much. Volume 1 is still as valid as it was then. We have these in very short supply, but I did provide for your staff, the other day, an extra set. In 1965 we surveyed practically every marine hospital in the United States with the permission of the Public Health Service and made a report because that agency was interested in knowing what industry and labor thought. I repeat-what industry and labor thought— the people directly affected with these seamen. I shall never forget the gracious approach they made to us and the liberality with which we moved around the hospitals just to see what was going on. Back in 1965, we testified before seven committees, as I said, and the Veterans' Administration, the Veterans of Foreign Wars and others testified along with us. Veterans' hospitals didn't want seamen transferred to them. It must be said that Mr. Bonner and this committee presented a very delicate question to the General Accounting Office. This was a question which I invite you to review and inspect in connection with your present problem. The point in question was, if seamen go into veterans' hospitals, where do they actually go? Can they get care? Can they get into the hospital? Can they move out with a ship that leaves in 5 days or do they go on a waiting line? The ruling of the Comptroller General was they must go below non-service-connected disability cases. We all know that the serviceconnected disability cases get preferential treatment and should. We also know the waiting line in the non-service-disability-connected cases is a tremendous standing line. I just checked the other day and found there are large waiting lists all over the country on this type of case. There was not much help until this committee moved on this in 1965. That is what helped to save those hospitals in 1965 and out of the seven committees we testified before, this is the committee that turned the trick. This was the committee that addressed the Comptroller General and got a ruling. It meant you would have to push seamen down below non-service-connected disability cases or not give them any care at all. A ship comes in and it has to leave. Today, if there is emergency care that must be done and the seaman does not have to leave his ship for a long, indefinite period of time, then he can get care in a "marine" hospital. That is what they are for. They are attuned and timed and organized for this. The veterans' hospitals are not. We didn't want seamen to go in there and the veterans didn't want us to. We went before seven committees of the Congress and this thing was killed, thank heavens. Let me go back. When the hospitals at Memphis, Tenn. and Chicago, Ill., were closed, we consented and agreed because the caseload went down and they had not built up other caseloads where care was needed, to throw them into the public sector to create a load. The caseload, as I say, was low and we did not fight these closings. In the closing of Savannah and Detroit last year, I want to point out to this committee that a representative of the Public Health Service came to our office the day the announcement was made to close Savannah and to close Detroit-the very day. There was no opportunity to go out and look at the hospitals or to deal with the problem again in advance. There was no opportunity to review management and labor's position to see what we thought about this situation. The representative from HEW came the very day the public announcement was made and strangely enough at 10 o'clock in the morning he was called on my phone and told the announcement had been made. I say that because it is a different situation. Now I want to point out to you, if I may, and again I don't want to talk too long, that Dr. Walsh, who is head of the Hospital Division, had a plan which I think was excellent. He later left the Public Health Service and is now head of medical services at Tulane University. He had a plan to expand these services because we are yelling on one hand about needing beds and hospitals, we need services. The lack of medical care is a terrible thing in this country in its current status. So he went to Savannah and tried to bring together all of the needs of that community to see if the program could not be expanded. This was not done and the hospital was closed, and the same thing was tried in Detroit and it was not done and the hospital was closed. We wanted to keep Detroit because it was the only hospital left in the interior. All of the other general hospitals are on the coasts. So Detroit is gone now, also. Now, in connection with our present problem, Mr. Chairman, we filed with this committee yesterday-all members a letter stating our position and I must say that there is an ecumenical movement here. The Transportation Institute will testify and we agree with their position. We are all together in this, labor and management, regardless of any other divisions within our industry. At this time I would like, with the permission of the Chair, to file into this record the letter we sent to you yesterday. The CHAIRMAN. There is no objection. (Letter follows:) Hon. EDWARD A. GARMATZ, LABOR-MANAGEMENT MARITIME COMMITTEE, Chairman, Merchant Marine and Fisheries Committee, DEAR CONGRESSMAN GARMATZ: We wish to bring to your attention a matter which we consider to have an urgent health priority. Once again, a concerted assault on the Public Health Service hospitals and clinics is being mounted. It has been reliably reported that a proposal is in the White House which, if approved by the President, would order the closing of all Public Health Service hospitals and outpatient clinics. We feel that these facilities are a vital national asset and that their closure will have very serious, long-term consequences. At present, the Public Health Service, through its Federal Health Programs Service, operates eight general hospitals and 30 outpatient clinics and contracts with 203 health providers for delivery of health services to nearly one-half million beneficiaries. Nearly one-half of these beneficiaries are American seamen, while the remainder are active and retired members of the Armed Forces, Coast Guard, Public Health Service and National Oceanic and Atmospheric Administration. As many as 130,000 BEC cases are handled annually. Nearly 300 physicians and dentists are in training in internship and residency programs; and an additional several hundred nurses, pharmacists, dietitians, medical record librarians and medical and x-ray technicians are trained each year. Almost $6,000,000 annually supports research programs conducted either individually or jointly among the hospitals. The average Public Health Service hospital has 335 beds, admits 5,000 patients annually and has an average daily census of 250. In addition to protecting the health of the Nation from disease importation, the program of marine hospitalization serves to strengthen our U.S. flag merchant fleet personnel and thus, in turn, the advancement of our import and export commerce and our national defense. The type of care given at Public Health Service hospitals is patterned to achieve these purposes. Although American seamen constitute only 45% of these admissions, the shrinking of the American merchant fleet and decline in the number of American seamen has left the hospitals' inpatient services modestly under-utilized, while the outpatient facilities handle approximately 1.75 million patient visits each year. The maritime industry, both labor and management, have noted over the years a lack of support by the Bureau of the Budget in maintaining the marine hospitalization program at required standards. Every effort to secure modernization funding has been delayed pending sequential feasibility studies; and, in recent years, Public Health Service facilities and equipment have become inadequate and, in many cases, obsolete. In spite of these facility shortcomings, the training programs, both in-Service and sponsored outside the Service, have yielded enormous dividends in highly trained personnel who now staff the facilities and provide them with multi-specialty staffs. Many of these professionals have moved into other Federal and non-Federal programs. Under staff direction, medical care, teaching programs and research have been carefully nurtured throughout much adversity. As a consequence, in an era of impending national medical crisis, a cluster of professional excellent, though physically neglected, medical facilities located strategically in urban-coastal population centers are facing closure for lack of a commitment to the future. Those who would close these facilities argue that they are antiquated, obsolete, and would require as much as $150,000,000 to modernize or replace; further, that the eligible group of American seamen has declined reducing the need for such |