ficer trained in radiological health practices must be assigned to the crew of each nuclear powered ship from the time of initial criticality of the reactor until 1 year after the ship has been in commission. At the present time 21 medical officers are serving in the nuclear propulsion program (19 submarine, 2 surface). By the end of fiscal year 1962, 37 will be required (34 submarine, 3 surface). The fleet ballistic missile submarines have expanded this problem since they have two crews and hence require two medical officers. A 12-month period is required to train these medical officers. Eleven were placed in training for the nuclear submarine program this fiscal year. In order to provide for the new billets and timely reliefs for the officers currently in the program, it will be necessary to place a total of 20 in training during the next fiscal year. Our radiological health program is a

success.

In 6 years of operation we have not encountered a single sailor exhibiting any harmful biological or clinical indication of radiation exposure. The maintenance and repair work carried out on our submarines has not produced a single case in which evidence of the ingestion or inhalation of radioactive material could be detected.

We must, however, be constantly aware that great care must be exercised in nuclear operations. In suport of this program, a Radiation Exposure Evaluation Laboratory called the REEL Laboratory at Bethesda was constructed. This laboratory will enable physicians to determine the location, amount, and kind of radioactive material retained in the body of individuals who have been exposed to a nuclear incident. This laboratory will also support the various Navy laboratories and hospitals where radioactive isotopes are used in research and treatment.

The most pressing medical problems in the operation of nuclear submarines continue to be those surrounding life in a sealed environment. Data concerning the atmospheric contaminants are being collected on every prolonged submarine cruise. The health hazards involved in inhaling these contaminants are evaluated as rapidly as possible. Increased emphasis has been given to the mental health of the POLARIS submarine crews. These are highly skilled men, the product of many months of training. Every effort must be made to preserve their health and promote their efficiency.

PLANNED PROGRAM FOR FISCAL YEAR 1962

The primary responsibilities of the Medical Department are: (1) to protect the health and to maintain personnel of the Navy and Marine Corps in a high state of physical readiness; and (2) to determine and relate human limitations to weapon system developments, In order to carry out these responsibilities, the budget before you provides in the coming year for:

(1) Inpatient care, each day, of an average of 13,298 patients. Of these, 10,302 will be cared for in naval hospitals; 567 in ships; 1,308 in other Federal facilities, including Army, Air Force, and Public Health Service hospitals; and 1,121 in civilian facilities. We estimate that 36,500 babies will be born in naval hospitals in the coming year; (2) Outpatient care, supplementing inpatient care, of almost 9 million patients, involving over 16 million outpatient services. These services consist of physical examinations, tests, immunizations, and

such adjuncts as X-rays, laboratory, and pharmacy services. Our outpatient program represents one of our major undertakings;

(3) Dental care, approximately 3 million examinations, treatments, and operations during the year;

(4) Care of remains of 1,641 estimated deaths; and

(5) Training and education of a daily average of 4,026 enlisted and officer personnel, including 2,210 in our Medical Department schools; 1,472 in naval hospitals and other medical facilities and 344 in civilian institutions.

FINANCIAL SUMMARY

Details of our financial requirements and changes in specific programs, are included in justification material which has been provided to your committee. In summary, our appropriation request in the coming year amounts to $92,520,000. This is approximately $4,100,000 more than our current fiscal year availability and is required in the following areas:

(a) Additional personal services in naval hospitals, primarily in nursing care, both inpatient and outpatient, and food service for patients..

$1,700,000

1,300,000

700,000

(d) Other maintenance and operation requirements in medical treatment facilities.

(b) Additional requirements for care in nonnaval facilities for de-
pendents ($1,200,000) and retired personnel ($100,000) ___
(c) Replacement of diagnostic, therapeutic, and related technical
medical equipment in naval hospitals_--

400,000

Total____

4, 100, 000

ANALYSIS OF REQUIREMENTS

There is a series of charts attached to this statement which we feel will assist the committee in analyzing our requirements. With your permission, I would like to say a few words on each of the six charts.

Chart No. 1, lists the types of medical facilities supported in whole or in part by the funds provided by the budget activity "Medical Care," and is indicative of the scope and magnitude of the Medical Department's mission. Our responsibilities, both professional and financial, extend throughout the Navy and Marine Corps, including both the Shore Establishment and the operating forces.

Chart No. 2, summarizes the population served by the Medical Department of the Navy.

This is our potential population totalling 2,191,485. There are 800,000 active duty Marine Corps and Navy personnel, or 36.5 percent of this total. Dependents of active duty Navy and Marine Corps total 920,000, or 42 percent. Retired personnel amount to 141,000, or 6 percent, and civilian employees who are entitled to on-the-job type care, 330,000.

Chart No. 3, depicts our estimated hospital workload in 1962. Ap proximately 62 percent of our patients will be active duty Navy and Marine Corps personnel; the remaining 38 percent will be supernumeraries, of whom 47 percent will be dependents of military personnel.

Out of the total patient population in naval hospitals of 10,302, 6,000 and some will be active duty Navy and Marine Corps members. These will constitute 61 percent. Of the supernumerary block, the Army will have 434 patients. These are Army personnel who are hospitalized under the joint utilization program in naval hospitals. The Air Force will have 272 patients. There will be a total of 1,854 dependents; 405 veterans whom we have been authorized to hospitalize throughout the hospital system; 790 retired personnel; and 175 others.

There will be 212,000 anticipated total admissions to hospitals. The average length of patient stay, we anticipate, will be 17.7 days. As I mentioned before, we anticipate over 36,000 births.

We will see over 312 million outpatients in our offices and clinics in naval hospitals and we will provide to this group of people over 9 million professional services.

Chart No. 4, shows our total requirements (including reimbursements) by budget program. The major portion of our total requirements, amounting to nearly 57 percent, is for program 1810, supporting naval hospitals and specialized medical facilities. This requirement, together with program 1820, which provides for care abroad ships and other units of the operating forces, and program 1835, which is for care in nonnaval medical treatment facilities, such as those of the Army, the Air Force, and civilian facilities, accounts for over 92 percent of our total needs. Thus, over 92 percent of our requirements are for direct medical and dental care. The remaining 8 percent covers such programs as education and training, nonrecurring procurement, medical material support, care of the dead, and departmental administration.

Chart No. 5, reflects our estimated obligations per patient day in naval hospitals during 1962, by major categories of expense. Civilian personal services in hospitals will account for approximately 53 percent of our obligations; subsistence, almost 10 percent; and 37 percent for maintenance and operation.

This is a breakdown of the $16.83 per day, the distribution of that amount of money by the various services provided. As you can see, the personal services, which always constitute a major factor in the operation of medical treatment facilities, constitute well over 50 percent of these dollars.

Chart No. 6, reflects our actual average cost per patient day in naval hospitals, during fiscal year 1960. This chart includes military pay, which is not financed by this appropriation and is, therefore, not entirely comparable with our budget.

(The charts referred to above follow :)