parts of H.R. 10041 which affect the Virgin Islands, Guam, and American Samoa, and these Mr. Chairman, are the only three territories involved. We do not have Puerto Rico under our jurisdiction. The bill provides for the allotment of funds among the several States, and the three territories, for assistance in the construction or modernization of various types of health facilities. It provides that sums allotted to the territories for a fiscal year remain available for obligation for the next 2 fiscal years, in addition to the sums allotted for each of those 2 fiscal years. We believe this more generous treatment accorded the territories is fully justified in terms of the long leadtime which is required for the planning of construction, the ordering and delivery of materials, and construction itself in these relatively remote communities. We believe that the opportunity so to accrue funds for 1 additional fiscal year is also of substantial importance to the territories in terms of the communities involved. Each territory is small geographically and, while clinics and dispensaries have their appropriate and important roles, frequently the major need is for a relatively large facility beyond the financial capacity of the local community, and equally beyond the assistance which has been available in the past. The new language in H.R. 10041 should help overcome this problem. The legislation under consideration also provides that the formula allocation made to each of the territories may be increased to one-half the minimum allocated to the States, if the territory satisfies the Surgeon General, at such time prior to the beginning of such year as the Surgeon General may designate, that such allocation will be obligated in a timely manner. Such larger allotments are needed, we believe, not only in terms of the nature of the geography of the area but because each territory is, or will be, visited by increasing numbers of travelers. In the Virgin Islands, in 1962, the hospital on St. Thomas provided inpatient services to nonresidents which represented more than one-third the total number of patient days in the hospital. Thus, under the existing HillBurton formula, at least one-third of the care is not covered. A similar situation is likely to develop in American Samoa, where jet-plane service, and the development of hotel facilities, will increase the number of visitors in the territory for business or pleasure. Guam, too, is looking to transpacific travel as a growing element in its economy, and will likely be faced with providing medical and health services for transients. The critical need is to provide the territories with minimum sums of money which can be used effectively. The provisions of the bill authorizing obligation of funds for two additional fiscal years, and the opportunity to qualify for one-half the minimum amounts allocated to the States, are, we believe, steps in this direction. Mr. Chairman, I will be happy to answer whatever questions you and the members would raise, but let me say that I am not a doctor, and I have not been in this business of public health administration. Mr. DINGELL. You have made a very fine statement, Mr. Taitano, and the chair will be happy to state to you that I have observed, over the years, that nondoctors are very often better qualified to discuss some questions of medical care than are members of the medical profession. Mr. TAITANO. Thank you. Mr. DINGELL. The chair is happy to recognize Mr. Younger. Mr. DINGELL. Mr. Van Deerlin? Mr. VAN DEERLIN. No thank you, Mr. Chairman. Mr. DINGELL. Mr. Pickle? Mr. PICKLE. I just want to ask you one question. In making a request for larger allotments you pointed out that in the Virgin Islands in 1962 this particular hospital on St. Thomas has provided inpatient service to nonresidents and this represented more than onethird of the inpatient days. Is this because of the visitors or tourists of which you spoke? Mr. TAITANO. Yes, sir. In the same year, if I remember correctly, we had almost 300,000 visitors. I think the figure is 291,000. We only have a resident population on St. Thomas of 16,000. On all the islands together we have about 32,000, 35,000. It is a tourist area. Mr. PICKLE. Thank you. That is all, Mr. Chairman. Mr. DINGELL. Mr. Taitano, the Chair has observed during the several days we have been conducting hearings on this legislation that we have no statement from any witnesses to the dollar amount of the needs of the several territories for different types of hospital construction nor have we received any statement as to the number of rooms needed or backlog of inpatient or outpatient care which exists in the several territories. I think a statement of this kind would be particularly helpful for the record. I recognize you may not be able to provide it this morning. If you so choose the Chair would be very happy to receive this additional information to perfect the record. I think it would be most helpful. I would urge upon you that you submit this information so that the committee may have the advantage of it in its consideration. I am particularly interested in this because, as you know, we do provide for very substantial benefits to these territories in terms of Federal funds and I am sure we provide them on a very favorable basis, perhaps a good deal more so than the several States which will probably contribute the larger part of the benefits to be provided for the several territories and their residents, so I hope that you will extend to us some justification for this kind of participation by the territories in the benefits of this legislation. Mr. TAITANO. I will be delighted to have that done, sir. For the moment_let me say just in general terms what our needs are in the areas. Let me start with American Samoa. In American Samoa we have a hospital building there that was built by the Navy while they were in the territory. This is a frame structure. The building is just about ready to collapse. Let me say, however, Mr. Chairman, that we have gotten some money from Congress to totally replace the building. We do not anticipate help from the Hill-Burton funds to replace the existing hospital in American Samoa. In the future we may need funds for clinics in the outlying areas. The number of clinics will be at a minimum, not more than three or four. In the Virgin Islands, sir, we have three hospitals, one on St. Thomas, about a 149-bed hospital; one in Christiantsed on St. Croix, a 60-bed hospital; and a 10-bed hospital in Frederiksted also on St. Croix. Our latest survey of these three hospitals indicates that all of them are not only overloaded but obsolete in construction and design. The latest statement, which I still have not ascertained is true, is that on St. Thomas the occupancy is 104 percent. I just don't know what in medical parlance a statement like that means, 104 percent occupancy. The statement goes on to say that the patients are overflowing into halls and corridors. The present plan of the government of the Virgin Islands is to replace all these three hospitals by the construction of two new hospitals in different locations, one on St. Thomas and only one for St. Croix. I imagine that the new facilities will exceed over 200 beds. It may cost over $8 million. On the hospital at Guam, the civilian hospital for Guam-it is run by the government-is a 260-bed hospital, 200 beds for general service and about 60 beds for TB. Let me say at this point that in 1951 we built a TB hospital of over 200 beds. We have controlled the TB program to the extent that we have reduced it down to 60 beds at the present time. The hospital was devastated by the last two typhoons, one occurring in April of this year and one last November, which just almost totally destroyed it. The only thing that remained was the concrete structure. Because of the application of the Federal Disaster Act we are presently getting assistance for the rebuilding of the existing facility. I understand that the recent invitation for bids indicated approximately over a million dollars that will go into the rebuilding of the structure. The survey of this structure, however, by the Public Health Service indicated that it should have been replaced by another building. The amount, however, the minimum amount estimated to reconstruct a new building or to replace the hospital is anywhere between $8 to $10 million. This is just too much money for the community, a community whose average per capita income is about 50 percent of the national average here in the United States, so we decided that we can go along with the hospital for a little while, the existing building, anyway, for maybe a decade, if not more. In Guam, however, there is a military hospital-Navy-but the hospital serves only their own personnel and their own civil service workers. Those, sir, in general, are the problems that we have in the territories. Mr. DINGELL. I am sure they are very severe. I think it would be also useful, Mr. Taitano, if you were to submit to the committee some statistical evidence indicating the number of beds needed, and so forth. You might also choose to give the committee your comments: with regard to per capita income of these areas which seems to be rather relatively small. Mr. ROGERS of Florida. Would the gentleman yield? Mr. DINGELL. Yes; be happy to. Mr. ROGERS of Florida. What is the civilian population of Guam? Mr. TAITANO. Today. Mr. ROGERS of Florida. And this is the only hospital then to serve them? Mr. TAITANO. We have a clinic, a Catholic medical clinic, but it is not a hospital. I don't believe it has any beds. Mr. ROGERS of Florida. Are there any other clinics. Mr. TAITANO. There also is a smaller clinic run by the Seventh-day Adventists. These are the only two clinics that I know of, sir. Mr. ROGERS of Florida. Could you let us know the extent of those clinics? Mr. TAITANO. Yes, sir. Mr. ROGERS of Florida. And on the Virgin Islands now on St. Thomas what is the civilian population? Mr. TAITANO. The resident population for the island of St. Thomas is approximately 16,000, 17,000. Mr. ROGERS of Florida. And St. Croix is, I guess, much smaller? Mr. TAITANO. No; about the same. Mr. ROGERS of Florida. About the same. Mr. TAITANO. Yes. Mr. ROGERS of Florida. St. John is the one that is less. Mr. TAITANO. Yes; about a thousand. Mr. ROGERS of Florida. They have to come from St. John to St. Thomas? Mr. TAITANO. That is correct, sir. Mr. ROGERS of Florida. Thank you very much. Mr. DINGELL. Thank you, Mr. Taitano, for your testimony this morning. Mr. TAITANO. Thank you very much, sir. (The following information requested by the committee was later submitted by Mr. Taitano:) DEPARTMENT OF THE INTERIOR, OFFICE OF TERRITORIES, Washington, D.C., April 7, 1964. Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C. DEAR MR. HARRIS: As requested in the course of hearings on H.R. 10041, a bill to improve the public health through revising, consolidating, and improving the hospital and other medical facilities provisions of the Public Health Service Act, the following information is furnished for the record. On page 281 of the transcript of the hearings a question is noted as to the dollar needs of the several territories for different types of hospital construction. The following is submitted: Project Sinajana Agana Heights___ Guam Replacement of Inarajan Health Center___ 100, 000 125,000 (1) Catholic Medical Center, Inarajan Clinic (new facility) – facility)-- Within 5 years a 30-50 bed hospital sanitorium combination____. 1 Not available. Rehabilitation of typhoon damage to the Guam Memorial Hospital with OEP funds will provide a total of 260 beds and supporting facilities. number will be sufficient for approximately 2 to 3 years. Virgin Islands This Existing facilities presently badly overcrowded with an average occupancy exceeding 90 percent. A rapid population increase is exected as is a substantial increase in nonresident transient population composed of tourists, resident alien workers, crews and passengers of ships in port, and military personnel on leave. The problem of providing adequate medical facilities is compounded by high construction cost and some duplication required by distance between main islands of St. Thomas and St. Croix. Estimated long-range total dollar needs: Hospitals (500 beds at $30,000 per bed). Long-term care (200 beds at $10,000 per bed). Resident quarters-- Research centers. Public health and diagnostic centers--- Samoa $15, 000, 000 2,000,000 400,000 800, 000 550,000 Adequate facilities planned for construction. Such facilities to be financed through direct appropriation. On page 282 of the transcript reference is made to what justification exists for participation by the territories in this particular Federal assistance program. With respect to American Samoa, we would note that Samoa does not now participate and, at least for the foreseeable future does not intend to request such assistance, since upon adequate justification funds are made available to the Government through direct appropriations in the forms of grants. However, Guam and the Virgin Islands are not provided for in this fashion. These territories have reached a degree of development which largely obviates the need for direct appropriations or grants. There does exist Federal subsidization, of course, in the form of retention of internal revenue proceeds in both Guam and the Virgin Islands, and, in the case of the Virgin Islands, a substantial return of taxes collected on Virgin Islands products imported into the United States. Since these revenues together with local revenues must be used to finance the entire governmental activity of these territories, and are in fact barely adequate in the face of an ever-expanding population and need for services, it is important for both Guam and the Virgin Islands to participate in Federal programs such as Hill-Burton aid. On page 285 of the transcript information is requested as to per capita income. The following figures, based principally on the 1960 census, may be of assistance in demonstrating both the small population base, and the generally low income. 1 Does not include approximately 30,000 military personnel and dependents utilizing separate medical facilities. Finally, on page 286 of the transcript information is requested in connection with the two private clinics in Guam. The Catholic Medical Center has an outpatient program in Agana (the principal urban center) and employs six qualified doctors. These doctors have medical staff privileges at the Guam Memorial Hospital and admit patients on a private basis. During calendar year the outpatient visits totaled 32,015. Outpatient treatments have increased rapidly. In 1959 the visits totaled 16,797. There are no private medical facilities south of Agana and one of the new facilities contemplated is a second Catholic clinic in Inarajan. The second private clinic is the Far Eastern Island Mission Medical Clinic, operated under the auspices of the Seventh Day Adventist Mission, at Agana Heights. This clinic employs two doctors having the same privileges as the doctors of the Catholic clinic. Outpatient visits for 1963 totaled 30,000, again a substantial increase over the 14,040 visits in 1959. This clinic also proposed an expansion program in the form of a diagnostic center and ultimately a 30-50 bed hospital and sanitorium. Neither American Samoa nor the Virgin Islands have any private clinics. It is hoped that the foregoing adequately responds to your several questions. Sincerely yours, RICHARD F. TAITANO, Director. 30-883-64--13 |