HOSPITAL AND HOME CONSTRUCTION

Since February 1919 the Congress has specifically authorized the sum of $149,222,000 for new hospital, domiciliary, and out-patient dispensary facilities, of which $145,222,000 has been appropriated. In addition, there has been expended from July 1, 1923, to June 30, 1935, approximately $21,290,000 from regular fiscal funds for permanent improvements and extensions to Veterans' Administration Facilities. This latter figure, however, does not include expenditures for the purpose mentioned at the former national homes for disabled volunteer soldiers prior to consolidation with the Veterans' Administration in July 1930. Further, the Veterans' Administration has been allotted for improvements and new construction the sums of $3,006,650 under the provisions of the National Recovery Act of 1933 and $1,269,120 under the provisions of the Emergency Relief Act of 1935. As the result of such construction funds now available, it is anticipated that during the fiscal years 1936, 1937, and 1938 there will be constructed 11,065 additional hospital beds, together with a net increase of 1,143 domiliciary beds. By this means the 44,793 hospital beds under the control of the Veterans' Administration as of June 30, 1935, will have increased to 55,858 as of June 30, 1938, and during the same period domiciliary beds will increase from a total of 20,073 to 21,216.

It is not intended that this analysis shall represent to the committee the full extent of the activities of the Veterans' Administration. However, I believe that the major points have been covered, and I will attempt to enlarge upon these matters more specifically as they apply to the funds requested for the fiscal year 1937 as I take up each individual item of the estimate before you. I hope this summarization has given the committee a general idea of what we are doing, and I will now proceed with an analysis and explanation of each appropriation item in the order that they appear in the bill.

SALARIES AND EXPENSES

Mr. WOODRUM. The first item is for salaries and expenses, and is as follows:

Administration, medical, hospital, and domiciliary services: For all salaries and expenses of the Veterans' Administration, including the expenses of maintenance and operation of medical, hospital, and domiciliary services of the Veterans' Administration, in carrying out the duties, powers, and functions devolving upon it pursuant to the authority contained in the Act entitled "An Act to authorize the President to consolidate and coordinate governmental activities affecting war veterans", approved July 3, 1930 (U. S. C., Supp. VII, title 38, secs. 11-11f), and any and all laws for which the Veterans' Administration is now or may hereafter be charged with administering, $91,500,000: Provided, That not to exceed $3,500 of this amount shall be available for expenses, except membership fees, of employees detailed by the Administrator of Veterans' Affairs to attend meetings of associations for the promotion of medical science and annual national conventions of organized war veterans: Provided further, That this appropriation shall be available also for personal services and rentals in the District of Columbia and elsewhere, including traveling expenses; examination of estimates of appropriations in the field, including actual expenses of subsistence or per diem allowance in lieu thereof; for expenses incurred in packing, crating, drayage, and transportation of household effects and other property, not exceeding in any one case five thousand pounds, of employees when transferred from one official station to another for permanent duty and when specifically authorized by the Administrator; furnishing and

laundering of such wearing apparel as may be prescribed for employees in the performance of their official duties; purchase and exchange of law books, books of reference, periodicals, and newspapers; for passenger-carrying and other motor vehicles, including purchase, maintenance, repair, and operation of same, including not more than two passenger automobiles for general administrative use of the central office in the District of Columbia; and notwithstanding any provisions of law to the contrary, the Administrator is authorized to utilize Government-owned automotive equipment in transporting children of Veterans' Administration employees located at isolated stations to and from school under such limitations as he may by regulation prescribe; and notwithstanding any provisions of law to the contrary, the Administrator is authorized to expend during the fiscal year 1937 not to exceed $2,000 for acturial services pertaining to the Government life-insurance fund, to be obtained by contract, without obtaining competition, at such rates of compensation as he may determine to be reasonable; for allotment and transfer to the Public Health Service, the War, Navy, and Interior Departments, for disbursement by them under the various headings of their applicable appropriations, of such amounts as are necessary for the care and treatment of beneficiaries of the Veterans' Administration, including minor repairs and improvements of existing facilities under their jurisdiction necessary to such care and treatment; for expenses incidental to the maintenance and operation of farms; for recreational articles and facilities at institutions maintained by the Veterans' Administration; for administrative expenses incidental to securing employment for war veterans; for funeral, burial, and other expenses incidental thereto for beneficiaries of the Veterans' Administration accruing during the fiscal year 1937 or prior fiscal years: Provided further, That the appropriations herein made for the care and maintenance of veterans in hospitals or homes under the jurisdiction of the Veterans' Administration shall be available for the purchase of tobacco to be furnished, subject to such regulations as the Administrator of Veterans' Affairs shall prescribe, to veterans receiving hospital treatment or domiciliary care in Veterans' Administration hospitals or homes: Provided further, That this appropriation shall be available for continuing aid to State or Territorial homes for the support of disabled volunteer soldiers and sailors, in conformity with the Act approved August 27, 1888 (U. S. C., title 24, sec. 134), as amended, for those veterans eligible for admission to Veterans' Administration facilities for domiciliary care.

No part of this appropriation shall be expended for the purchase of any site for or toward the construction of any new hospital or home, or for the purchase of any hospital or home; and not more than $3,543,656 of this appropriation may be used to repair, alter, improve, or provide facilities in the several hospitals and homes under the jurisdiction of the Veterans' Administration either by contract or by the hire of temporary employees and the purchase of materials.

General HINES. The estimate for this purpose for the fiscal year 1937 is $91,500,000. This appropriation covers all expenses of administration, including salaries and operating expenses of the central office in Washington, the field offices, hospitals, homes, and supply depots; the cost of travel and examination of beneficiaries; payment of burial expenses and reimbursement for such expenses; repairs and alterations to hospitals, homes, and other property in which the Veterans' Administration facilities are housed: payments to contract facilities wherein Veterans' Administration patients are hospitalized; reimbursement to States at the statutory rate for those veterans cared for in State soldiers' homes who are eligible for admission to Veterans' Administration homes for domiciliary care; in general, all items of expense which are not direct monetary benefits to the

veterans.

ELIMINATION OF LANGUAGE IN APPROPRIATION TEXT

No changes in wording are requested for the fiscal year 1937 in the way of additions to the language contained in the 1936 appropriation. Other than the changes for the purpose of making the

wording applicable to the fiscal year 1937, only two changes will be observed. The first of these is an elimination of the following wording:

Provided further, That when found to be in the best interest of the United States, not to exceed $500,000 of this amount may be used for payments to State institutions caring for and maintaining veterans suffering from neuropsychiatric ailments who are in such institutions on the date of the enactment of this act.

The original purpose of this language was to authorize payment for hospitalization in State institutions of those veterans so cared for and who could not be safely moved at the time of the passage of Public No. 2, Seventy-third Congress, which limited hospitalization and domiciliary care to the extent of available Veterans' Administration facilities. However, Veterans' Regulation No. 10 (b), issued by the President on July 28, 1933, defines in such broad terms the words "Veterans' Administration facilities" used in Public No. 2, so as to make the retention of this language unnecessary. These regulations issued by the President have become law by reason of the lapse of the statutory period, and although the Congress placed this proviso back in the appropriation for 1936, I am again advocating the elimination of the wording in the interest of simplification and deletion of unessential matter from the appropriation text.

Mr. WOODRUM. If I may interrupt you at this point, General; that is the language that the Illinois delegation insisted on going into the bill, and I think you told us last year that it was unnecessary.

General HINES. I hope that they will be convinced by what I have said here and, in addition, the further statement that I have no intention, certainly during the next fiscal year, of dropping the load at Elgin and Jackson.

Mr. WOODRUM. I think that reassurance will probably take care of the situation. Will you proceed with your statement, General?

General HINES. The other change in wording concerns the deletion of language authorizing an expenditure not to exceed $10,000 for experimental purposes to determine the value of certain types of treatment. It is considered that this authority is no longer required and that such work may now be discontinued.

INVESTIGATION OF BUERGER'S DISEASE

If you recall, that was in reference to Soap Lake. We feel that we have sufficient information on the treatment of Buerger's disease, all the information that is necessary for any study. I cannot imagine that any special funds are necessary for that purpose and I hope that we will not establish the precedent of including items of that kind, which might bring others following in their wake. If we did, we would have a lot of institutions all over the United States.

Mr. WOODRUM. Has any experimental work been done there! What is being done there?

General HINES. We have had a few patients during the past year and we have expended the amount which Congress has given us. The medical authorities feel, as they did originally, that the treatment of that disease can be accomplished equally as well in other places, in our own institutions, by forms of treatment other than bathing in this particular lake. I feel confident the final report will be along that line.

RESULTS FROM TREATMENT OF ARTHRITIS

For the information of the committee I may say that we are getting rather unusual results in the treatment of arthritis, arthritic cases, and cases of a character similar to this, at our institution at Bay Pines, Fla., where we have on the Gulf a special hydrotherapy set-up, using the bathing and hydrotherapy in a building which we put up there. Water taken from the well is used in the treatment.

I know of my own knowledge from two veterans down there the beneficial effects of that treatment. During my visit there they came to me and said that when they went into that institution they were carried in on a stretcher and they could not walk. They could not move their arms. At that time both of these men-the time of my visit-were walking around on the beach and bathing in the water. Of course, it is too much to expect that we have discovered a sure cure that will become final-a cure of arthritis-but most certainly we have discovered a treatment that greatly improves and helps the patient, both through the diet, the bathing, and the sunshine that they get at that particular point.

ITEMS ENTERING INTO INCREASE IN ESTIMATE FOR SALARIES AND EXPENSES

The appropriation requested for 1937 in the amount of $91,500,000 is an increase of $4,800,000 compared with the appropriation of $86,700,000 for 1936 and an increase of $4,759,901 over the appropriation for 1935. However, it will be noted from the schedule of obligations that expenditures for 1935 will aggregate only $79,285,623. This indicates an increase in 1937, as opposed to 1935 experience, totaling $12,214,377, which must be analyzed and explained in order to understand the necessity for an appropriation for 1937 in the amount requested.

In making this analysis attention is first invited to the fact that during 1935 expenditures for salaries constituted only 95 percent of the base for 9 months, full restoration having been authorized by Public Resolution No. 3, Seventy-fourth Congress, approved February 13, 1935. The deduction of 5 percent for the period during which this decrease was in effect totaled $1,829,527.

During the fiscal year 1935 the average number of beds available in Veterans' Administration facilities totaled 65,969. These beds were utilized to the extent of 75 percent during this period, and expenditures for supplies and materials, including provisions, averaged 81 cents per patient-day. Due to the fact that new construction will provide a greater number of beds in 1937 it has been determined, based upon expected dates of completion of the new facilities, that there will be a total average of 69,393 beds in use. Applying to this number of beds the approximate experienced utilization prior to the enactment of Public, No. 2, Seventy-third Congress, namely, 88 percent, it is found that a total of 22,179,728 days of hospital and domiciliary relief may be expected which, at the rate of 81 cents per day for materials and supplies, will entail an expenditure of $17,965,580, or $3,371,768 more than was expended for similar purposes in 1935. The recently authorized construction programs will provide an estimated increase of 14,476 new hospital and domiciliary beds which must be equipped initially from this appropriation. Expenditures for initial equipment in 1935 totaled $299,172 as opposed to an

amount of $2,444,700 included for this purpose in 1937. The 1937 estimate is based upon experienced costs in 1935 for the type of facil ity to be equipped, and it appears from this analysis that in this phase of the 1937 estimate allowance must be made for $2,145,528. Additional personnel are required to operate the increased number of beds to be available in 1937. During the fiscal year 1935 there were employed in Veterans' Administration facilities a total of 27,722 personnel with a maximum of 66,839 beds in operation. Applying standard ratios of varous types of personnel to the total new beds to be available, the 1937 estimate provides for an aggregate maximum of 29,845 employees to operate a total of 73,422 beds. This is an experienced average of 1 employee to 2.4 beds for 1935, which average has been reduced in connection wth the 1937 estimate to an average of 1 employee to 2.5 beds during that fiscal period. During the fiscal year 1935 the salaries of the employees referred to totaled $33,498,892 as opposed to an estimate of $38,692,580 for 1937. This increase of $5,193,688 is a further item of expense to be experienced in 1937 which did not obtain during 1935.

These differences between the 1935 actual obligations and 1937 estimated expenditures, all of which may be termed as nonoccurring items in 1935 and indispensable items in 1937, indicate from the analysis that the 1937 estimate when reduced to comparable figures reflects a net decrease in remaining items totaling $326,124. Some items of expense naturally follow an upward curve in direct ratio to the increased load. These increased expenditures, such as travel of beneficiaries, repairs and maintenance, fuel, water, and so forth, are more than offset by reduced expenses for controllable items such as rental, equipment, supplies, and miscellaneous contract services.

A summary of the differences referred to is as follows:

I will now proceed to take up the explanation of the 1937 estimate in detail by object of expenditure and the attention of the committee is invited to chart no. 1 in the books before you under the title "Salaries and expenses." With your permission I will insert this chart in the record at this point.