DECREASE IN PERSONNEL

Mr. WOODRUM. But in spite of the liberalizing provisions of these four acts to which you have alluded, the amount of your estimate for personal services is less for the fiscal year 1936 than it was for

1935.

General HINES. Yes, or 1934.

Mr. WOODRUM. And the number of your personnel is less?

General HINES. Yes; that is brought about by the consolidation of activities and some reorganization and the effect of economic processes. Economy taught us some things, Mr. Chairman.

Mr. WOODRUM. There is a reduction of $792,026 in money, as mentioned on page 6 of your statement.

General HINES. Yes; and a decrease in personnel.

Mr. WOODRUM. Of 115 employees?

General HINES. That is in the central office; and 1,997 in the field.

Mr. WOODRUM. And that, notwithstanding the fact that there has been an increased number of beds and an increase in benefits and services.

General HINES. Yes, sir.

Mr. WOODRUM. Personally, I think that is a very creditable showing. Members of Congress will be very much interested in that

statement.

CONSOLIDATION OF OFFICES WITH HOSPITALS AND HOMES

General HINES. In connection with that, I am sure the committee will be interested to know this, because probably you will have some protests that we are still studying the proposition of bringing about a consolidation of offices with hospitals and homes. We have effected those in 25 States and the District of Columbia. We have never made a consolidation where service to the veteran is impaired. But we do feel that the hospitals and homes will be in the field for a long time, and wherever it is feasible, without impairment of service to the veteran, that economies can be brought about, regardless of the feeling of local business concerns, which are generally interested, and also probably the local veterans' organizations; but taking the State as a whole, we feel that those consolidations should be made.

Each consolidation is very carefully studied, first in the field and then by the central office, before it is submitted to the President for his approval.

Mr. WOODRUM. Would it not be a good idea to give us a list of those consolidations, with such explanatory information as you think will be of interest, showing the savings that have been made? General HINES. We will be very glad to that.

(The list above referred to is as follows:)

At this time there are in operation 27 facilities of this consolidated type located in the following States:

New Mexico

North Dakota

Oregon

South Carolina
Utah
Wisconsin

West Virginia
Wyoming

It is roughly estimated that a saving of approximately 10 percent in operat ing costs is obtained in making these consolidations and, in total, this recurring annual saving has reached an aggregate of more than $2,000,000 at the present time. These savings are reflected in such items as salaries, miscellaneous medical-fee services, miscellaneous supplies, telephone service, rentals, and miscellaneous contract services.

General HINES. I referred to one case of consolidation, where the saving has been quite large, particularly the saving in rental. We did not claim that in the consolidation of our own hospitals, because the Government has undertaken a large program of public building. We have taken advantage of the consolidation and moved into Federal buildings, to the extent that we have saved over $900,000 in 4

years.

Mr. WOODRUM. The cost of hospitalization is always a matter of considerable interest, apparently, to Members of the House during the debates on the floor.

COMPARISON OF HOSPITAL PER DIEM RATES

I notice in your statement on page 15 that the cost per diem at St. Elizabeths for mental cases is $1.90 per day for 1935 and $2.06 per day for 1936.

General HINES. I rather expected that you might refer to that subject. Mr. Chairman, and I had Mr. Moore work out in a little. more detail our per diem costs for the fiscal year 1934, and we have the per diem costs here in a table, given for other years.

This table shows that at tuberculosis hospitals the operating per diem cost was $3.98; at neuropsychiatric hospitals, $1.76; at general hospitals, $2.99, and the average for all types of hospitals was $2.51. The raw food ration cost at tuberculosis hospitals was 52 cents per day, at neuropsychiatric hospitals, 33 cents, at general hospitals, 40 cents, giving the average for all types as 38 cents per day.

For domiciliary service the operating expense per diem was 97 cents per day, and the raw food ration cost was 30 cents per day. To give a comparison of the cost of Veterans' Administration hospitals with hospitals operated by other Government departments, the per diem cost of Army hospitals in the War Department was $3.85; for naval hospitals, under the United States Navy, $3.09; for Marine hospitals, under the United States Public Health Service, $3.25, and for St. Elizabeths Hospital, under the Interior Department, it was $1.75.

(The table above referred to is as follows:)

Veterans' Administration, fiscal year 1934

Other Government departments:

War Department, Army hospitals_
United States Navy, naval hospitals_.

United States Public Health Service, marine hospitals.
Interior Department, St. Elizabeths Hospital...

Per diem

$3.85

3.09

3.25

1.75

Mr. WOODRUM. Why is there that discrepancy between the per diem cost in Army and Navy hospitals?

General HINES. In the case of the Army hospitals, primarily there the increased cost is due to the fact that we have a large number of tuberculosis patients in their hospital at Fitzsimons.

Mr. WOODRUM. That is an expensive type of hospitalization? General HINES. Yes. In other words, the most expensive type of treatment of groups in any hospital is that for tuberculosis. We have a large number of those men in the Fitzsimons Hospital, near Denver. They estimate their cost there at $4 per day, and that naturally brings up their average cost where they have so few general cases.

The per diem cost at the St. Elizabeths Hospital, under the Interior Department, is $1.75. One of the factors that causes the difference in the cost between St. Elizabeths and our own hospitals is in St. Elizabeths are not only veterans but the general public, with all types of cases, both men and women. They have a population there of over 4,000, and naturally that would give them a small per diem cost, although our operating cost, even for 1934, compares very favorably with theirs, and is lower in some respects. It is within 1 cent of their cost in 1934. Theirs was $1.75, and ours is $1.76.

There will be another question raised, undoubtedly, on the floor of the House, because it has come up to me, and that is the contention that civilian hospitals are willing to hospitalize our patients at less cost than we are paying. We have had that question up many times.

In the first place, civilian hospitals are not prepared (and the American Medical Association and the American Hospital Association will so advise you) to take care of mental cases, nor are they prepared to take care of tuberculosis cases. The cases they are primarily interested in are the general cases, the general emergency cases that come to them from their particular community. Local doctors and hospitals would like to get such cases.

We have had to use civilian hospitals for emergency cases which we feel it would be dangerous to transfer to our own institutions. Those are the only kind of hospitals, assuming they were prepared to take care of the proposition, that we would use. We worked out, based on the average number of cases, approximately 2,993 out of 187,975 patient-days, the cost in civilian contract hospitals, and that per diem, covering 142 hospitals, averaged $3.90 for the straight hospitalization per day.

Then in addition to that, they charge for special services; there is extra charge for operations, for the operating room, for dental services, clinical laboratory tests, X-ray treatment, physio-therapy treatment, hospital visits, and additional hospital supplies, such as drugs, and so forth. There are a number of things that they charge extra for, and that brought the per diem up to $7.38 per day.

But we could undoubtedly make a contract for less than $7 per day. I am satisfied we could make a contract for the general run of cases, where there is no particular operation, for probably $4.50 a day. But I doubt if the veterans would be satisfied with the character of treatment that they would get.

Mr. WOODRUM. What is the comparative cost to the Veterans' Administration for the same items?

General HINES. For the general cases the cost would be $2.99 per day. But the Federal Board of Hospitalization adopted after considerable study a reciprocal rate for all Government patients, so for a general patient who goes into an Army or Navy or Public Health Service hospital we pay $3.75.

Mr. WOODRUM. That includes everything?

General HINES. That includes everything. If they go into a Veterans' Administration hospital, as the C. C. C. boys are now doing, they pay us $3.75 a day. We do that in order to avoid a lot of unnecessary bookkeeping, because in that case it is the Government dealing with the Government, anyway, one department of the Government dealing with another department of the Government.

Mr. WOODRUM. You think even if you could make a comparable rate with the private institutions the service would be so greatly curtailed that the veterans would not be satisfied?

General HINES. I feel confident of that.

Mr. WOODRUM. They would not get the same high-class service that they get in Government hospitals?

General HINES. I imagine that generally in these communities, particularly in the best quality of hospitals, they have the best civilian consultant staff they can get. But I feel that the members of the staff are not the type of our own staff, without meaning to reflect at all upon the civilian doctors or the hospitals. But I believe the veteran is getting as good treatment and is better satisfied in a Government hospital than in a private institution.

MISCELLANEOUS FEE SERVICES

(See p. 178)

Mr. WOODRUM. On page 6 of your statement, under the heading "Miscellaneous fee services", you make the statement that

During the fiscal year 1934 an average of 623 beneficiaries were hospitalized in these contract institutions involving an average cost per day of $2.16. Mr. MOORE. Statement no. 2 in your book will give you that detail. Mr. WOODRUM. On page 8 of your statement, you stateIncluded in this increase are several completely new facilities which were in operation only a part of 1934.

General HINES. That is right.

Mr. WOODRUM. Would you be good enough to insert in the hearing a list of those places?

General HINES. Yes; Fayetteville, Ark.; Des Moines, Iowa; Wichita, Kans.; Biloxi, Miss.; Batavia, N. Y.; Roseburg, Oreg.; Cheyenne, Wyo.

Mr. WOODRUM. What tables of these have you put in?

General HINES. Only the one.

Mr. WOODRUM. So far nothing has gone in excepting your state

ment.

General HINES. That is right; and I have left it for the committee to decide as to which tables should go in.

Mr. WOODRUM. Are there any of those statements you think ought to go in? We do not want to encumber the record, but we want to have as complete a story as possible.

General HINES. I would suggest it be left to the secretary of this subcommittee and Mr. Moore to select the tables that will be helpful to you in handling this appropriation on the floor, or that will be helpful to any member of the committee.

RENTAL OF MOVING-PICTURE MACHINES AND FILMS

Mr. WOODRUM. On page 10 there is an item of $207,302 for rental of sound-picture apparatus.

General HINES. Yes.

Mr. WOODRUM. That is moving-picture machines and films?

General HINES. You have to rent the machine and you also rent the films. We usually run two pictures per week in our institutions, and as many as three at isolated stations. That covers the rental of pictures and machines.

Mr. WOODRUM. You cannot buy the machines?

General HINES. No, sir.

Mr. WOODRUM. It is like those patented adding machines and calculating machines-they won't sell them.

General HINES. We, of course, advertise for bids and many of the companies compete. We award to the lowest bidder on pictures. And that same thing on machines. But they are really leases; that is what they are; they are leased to us. I think that holds generally true throughout the Government service as far as I know.

FUNERAL EXPENSES

Mr. WOODRUM. The Economy Act cut the funeral expenses to $75, and Public, No. 141, reinstated it, or was that a Presidential regulation that reinstated it back to $100?

General HINES. The President raised the rate to $100 on the recommendation of the Veterans' Administration. We felt we were not giving the type of funeral that was creditable to the veteran and to the Government.

The committee may be interested in the prospective cost of burials. I have a table worked out projecting the cost forward from 1935 to 1945. The World War group, of course, is a larger group than we have ever dealt with before. They are dying now at the rate of about 80 per day and, projecting the cost forward to 1945, we found the disbursements, assuming we still have the present rate of $100, will amount to $5,708,022 for that year.

Mr. WOODRUM. In 1945 for burial expenses?

General HINES. For burial expenses. It is estimated there will be 53,346 veterans die that year.