authorization which will allow only limited progress in hospital modernization in view of present-day costs. I will appreciate, and I know the Oklahoma Hospital Association also will be grateful for, any consideration which may be given their suggestions. Sincerely, CARL ALBERT, Member of Congress. OKLAHOMA HOSPITAL ASSOCIATION, INC., Hon. CARL ALBERT, U.S. House of Representatives, DEAR CONGRESSMAN ALBERT: The Oklahoma Hospital Association has reviewed H.R. 10041, Hospital and Medical Facilities Amendment of 1964, with representatives of the American Hospital Association. We are greatly pleased that the Federal Congress has seen fit to assist in the modernization of the older hospitals, but were distressed that the Congress authorized only $160 million for the 5-year period. We sincerely believe that this is not a realistic figure considering the great number of our larger hospitals, particularly the medical centers, most pressing needs for modernization. We further believe that this money should be allocated for modernization purposes only, as this is the most pressing need, rather than new beds. We also question the advisability of transferring the present mortgage insurance for proprietary nursing homes from the Federal Housng Administration to the Public Health Service. We noted that the rate of interest on short loans is available to health facilities for 62 percent. We believe this woudl be prohibitive to nonprofit health facilities as they would not be able to retire the principal and pay the interest without a substantial increase in their charges to their patients. Since the sick patients will be paying this interest, we think it would be justifiable for the program to offer long-term, low-interest, direct Federal loans. We would greatly appreciate your taking time to study this important piece of legislation and consider our suggestions. Again, we would like to thank you for your splendid cooperation with the Oklahoma hospitals. Sincerely, CLEVELAND RODGERS, Executive Director. STATEMENT OF THE AMERICAN OSTEOPATHIC ASSOCIATION, BY CARL E. MORRISON, D.O., CHAIRMAN, COUNCIL ON FEDERAL HEALTH PROGRAMS, WASHINGTON, D.C. The American Osteopathic Association appreciates this opportunity for comment on H.R. 10041, 88th Congress, a bill revising and extending the Hill-Burton program for an additional 5 years to June 30, 1969. The American Osteopathic Association is a nonprofit, tax-exempt federation of divisional societies of osteopathic physicians and surgeons, the first objective of which, as set forth in its constitution is "to promote the public health." Our support of a national hospital program of Federal assistance for building new hospitals and providing additional beds in existing hospitals, in accordance with State plans, to increase the availability of hospital care, particularly in rural areas, dates back to 1940, S. 3230, 76th Congress, and has continued throughout the years. On May 30, 1940, a national hospital bill, S. 3230, passed the Senate. It included provision for a National Advisory Hospital Council to consist of eight members to "be selected from leading medical, osteopathic, or scientific authorities who are outstanding in matters pertaining to hospitals and other public services." When the Hill-Burton bill was finally adopted in 1946, the areas for appointment to an eight-member Federal Hospital Council were couched in general terms. The act of October 31, 1963, Public Law 88-164, increased the membership of the Federal Hospital Council to 12 members and in so doing reverted to particularity of some of the fields to be represented. H.R. 10041 retains the increase to 12 members and since no authority in the field of the osteopathic profession and hospitals has been appointed to the Council, we feel that such an appointment is long overdue. Section 2 of H.R. 10041 authorizes $45 million for special project grants to assist public and nonprofit agencies in areawide planning of health and related facilities. A report of the Joint Committee of the American Hospital Association and the Public Health Service (PHS publication No. 855) on "Areawide Planning for Hospitals and Related Health Facilities" points out that planning agencies may find it advisable to "refuse to recommend projects for Federal or State assistance and discourage actively the use of capital funds from any source for construction which is not consonant with the plan." Manifestly, the osteopathic profession is vitally interested and should have a voice in the resolution of such planning problems as duplication of facilities, maldistribution, underutilization, understaffing, and shortage of trained personnel. We hope the legislative history will make clear the desirability of osteopathic representation wherever available on the areawide planning agencies assisted in this program. The following statistics for the year 1962, the latest available, were prepared by the American Osteopathic Hospital Association, an affiliate of the American Osteopathic Association: All hospitals included in the above statistics are professionally directed by osteopathic physicians and surgeons. Ninety-five percent of the beds are in hospitals accredited by the Bureau of Hospitals of the American Osteopathic Association. Accreditation standards relating to professional staff include, among others, the following provisions: "The hospitals must be able to show evidence of maintaing a qualified and well-organized professional staff. "(a) There must be a minimum of there organized professional departments as follows: "(1) Osteopathic medicine. "(2) Obstetrics and gynecology. "(3) Surgery. (b) "Radiology and pathology services must be provided. "The staff must be composed of licensed osteopathic physicians who are members in good standing of their national and divisional associations, and local associations where such exist. "Courtesy staff privileges may be accorded, other licensed physicians and dentists who are members in good standing of the American Medical Association, American Institute of Homeopathy, American Dental Association, and their respective component societies, each in his proper category." (Excerpted from "Requirements for the Training of Interns and/or Residents as approved by the American Osteopathic Association.") Since the inception of the Hill-Burton program, 65 osteopathic projects have been approved involving a total construction cost of $51,387,242, including the Federal share of $17,514,198. These projects provided 3,096 beds, of which 1,379 or 44.5 percent were in new hospitals. Categories represented include 51 general hospitals, 7 diagnostic and treatment centers, 4 nursing homes, 2 chronic disease facilities, and 1 rehabilitation facility. We are pleased that the bill includes a new program of grants for modernization of hospitals and other medical facilities. In our presentation to this committee in 1958 we requested that the program be expanded in this respect. We .stated: "Ninety of the hospitals containing 40 percent of the beds are located in cities of over 100,000 population. A substantial number of these need to replace obsolete beds, but they are prevented from Hill-Burton participation for the purpose due to the operation of a priority system that has become unrealistic in this respect." The bill also authorizes a new program of mortgage insurance for construction and modernization of hospitals and other medical facilities. The insured loan could not exceed 50 percent of the value of the facility after completion of the project, and could not, when added to the amount of any Federal grant for the project, exceed 75 percent of the value of the facility after completion. The insured loan could not exceed 40 years and must be completely amortized by periodic payments. The interest rate could not exceed 6 percent. The program would apply to nonprofit hospitals and medical facilities and to proprietary nursing homes. Insofar as it applies to nonprofit facilities, we urge that the loans be made directly by the Federal Government and that the interest rate be equated with the going Federal rate for numerous other programs. Hon. ANCHER NELSEN, MINNEAPOLIS, MINN., March 5, 1964. New House Office Building, Washington, D.C.: The Minnesota Hospital Association has heard that House bill 10041 will be heard on Monday or Tuesday of next week. It is our understanding that this bill would make the bulk of Hill-Burton money available for the building of new hospitals. This might be desirable in some States, but Minnesota now has a hospital within 20 miles of almost everyone in the State. Any moneys available to Minnesota should be for renovation or improvement of present facilities. Good medical care would be served better if we could enlarge present units or renovate and improve the equipment in present units. We hope that any bills that might be promoted in this area, you will keep this viewpoint in mind. GLEN TAYLOR, Executive Secretary, Minnesota Hospital Association. WASHINGTON, D.C., March 20, 1964. Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, The National Association for the Advancement of Colored People urges that the present nondiscrimination clause in the Hill-Burton Act be retained with the deletion of its "separate but equal" provision when the act is amended by H.R. 10041 now being considered by your committee. Experience has shown that Federal agencies are reluctant to act against discrimination in the programs they administer without a clear congressional mandate. Moreover, failure to enact a nondiscrimination clause in clear terms would represent a retreat by Congress from its original action when it passed the Hill-Burton Act. We, therefore, ask the Committee on Interstate and Foreign Commerce to amend H.R. 10041 in order that the nondiscrimination provision of the act (42 U.S.C. 291E(f)) be retained and applied to all provisions of the amended act with the deletion of the following language: "But an exception shall be made in all cases where separate hospital facilities are provided for separate population groups if the plan makes equitable provision on the basis of need for facilities and services of like quality for each such group." We request that this telegram be made part of the record of the hearing on H.R. 10041. CLARENCE MITCHELL, Director, Washington Bureau, NAACP. NATIONAL ASSOCIATION FOR THE Hon. JOHN D. DINGELL, U.S. House of Representatives, Washington, D.C. DEAR CONGRESSMAN DINGELL: Reference is made to my telegram of March 20 to Congressman Oren Harris, chairman of the Interstate and Foreign Commerce Committee, on H.R. 10041, a copy of which was sent to you. We wish to reiterate the necessity of strong clear prohibitions against racial discrimination being written into any bill extending and amending the Hill-Burton hospital program. Our experience with the Department of Health, Education, and Welfare indicates that its officials are reluctant to act to implement the nondiscrimination provision even against hospitals that have contractually committed themselves to a program of nondiscrimination. It is our belief that this reluc tance can be overcome only by a congressional mandate couched in the strongest possible language. We have been advised that the American Medical Association in testifying on H.R. 10041 requested an amendment declaring that the acceptance of funds by a hospital will not be construed as making a private facility a public institution. We oppose this proposed amendment. We view it as an attempt to circumvent the effect of the decision in Simkins v. Cone Memorial Hospital, 325 F. 2d 959, cert. den., 32 U.S. L.W. 3304. The decision in this case held the "separate but equal" provision of the Hill-Burton Act to be unconstitutional and held that hospitals receiving assistance under the act were involved in State action within the meaning of the 14th amendment. Since there was no occasion to raise the issue of the effect of the act on private hospitals prior to the decision in the Simkins case, we believe the only purpose in raising it now is to undermine the effect of that decision. We urge you to oppose this and any other attempts to revert to the "separate but equal" practice. Sincerely yours, Hon. OREN HARRIS, CLARENCE MITCHELL, Director, Washington Bureau. UNITED STATES CONFERENCE OF MAYORS, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: The United States Conference of Mayors and the American Municipal Association have supported the Hill-Burton program of grants for the construction of hospital facilities since its inception. We are pleased at this time to advise you of our support for a 5-year extension of the program as provided for in your bill, H.R. 10041, the Hospital and Medical Facilities Act of 1964. The basis of our support is embodied in the attached resolution approved by the membership of the United States Conference of Mayors in May of 1963 and by the attached policy statement adopted by the membership of the American Municipal Association at its annual meeting in August of 1963. You will also note in reviewing the resolution and the policy statement that in addition to supporting the extension of the Hill-Burton program both organizations most strongly urge the enactment of amendments to the basic legislation which will provide Federal assistance for modernization and renovation of existing hospital facilities. As administration witnesses have testified, the backlog of need for reconstruction and modernization of hospital facilities amounts to approximately $4 billion and this backlog is growing. It has been conservatively estimated that it will take at least $150 million a year in grants for renovation and modernization purposes over a 10-year period to make any significant inroads into this serious deficiency. Even a program of this size would not provide for the additional urban hospital demands which grow out of population growth and accelerated urbanization. We therefore urge your committee to approve your bill, H.R. 10041, as introduced, with an amendment authorizing $150 million a year for renovation and modernization programs, which would be in addition to the authorization of a minimum $225 million annually for the traditional new construction programs. In conclusion, Mr. Chairman, we emphasize the urgency of the need for assistance to the Nation's major medical complexes, which are for the most part located in our metropolitan areas. These hospital centers serve as a training ground for nearly all of the Nation's practicing doctors and nurses, and in addition, provide highly specialized treatment and facilities which are available to and used by all the people of the Nation. Respectfully, JOHN J. GUNTHER, Executive Director, United States Conference of Mayors. P.S.-We would greatly appreciate your including this letter, along with the attachments, as part of the record of the public hearings on H.R. 10041. Enclosures. RESOLUTION ADOPTED, 30TH ANNUAL CONFERENCE OF MAYORS, UNITED STATES CONFERENCE OF MAYORS, HONOLULU, HAWAII HOSPITAL FACILITIES Whereas the construction and operation of hospitals and other health facilities involve substantial investments of funds by private groups and local, State, and Federal governments, and every effort should be made to insure that (1) existing health facilities and services are well coordinated and are utilized fully, effectively, and economically; (2) additional health facilities are constructed where and only where they are needed; (3) expensive services, facilities, and equipment are not unnecessarily duplicated; and Whereas the current deficit of quality nursing homes will become more serious as our aged population continues to increase, and the construction of additional long-term care facilities in a community will relieve some of the pressure for the more expensive general hospital beds and facilities; and Whereas the Public Health Service determined through a study made in cooperation with State agencies that the cost of modernizing and replacing health facilities throughout the country amounts to more than $3.6 billion, and hospital and community leaders agree that (1) many of the quality-care hospitals located in the more densely populated areas of each State are structurally or functionally obsolete, and can no longer provide efficient and economic service; (2) smaller rural and suburban hospitals must depend on the larger facilities located in urban centers for specialized services and care; (3) facilities located in our urban centers cannot receive effective financial aid from the Hill-Burton program because of the limited funds available and the priority accorded projects which provide additional beds in rural and suburban areas; and Whereas the Hill-Burton program-now due to expire on June 30, 1964-has proved to be an effective stimulant to the construction of sorely needed hospitals, public health centers, nursing homes, diagnostic and treatment centers, and rehabilitation facilities, and States and communities report that the need and demand for additional facilities continue unabated; now, therefore, be it Resolved, That the United States Conference of Mayors urge amendments of the Hill-Burton legislation to (1) Authorize special project grants to stimulate the activation and operation of planning bodies in communities, areas, regions, and States for the purpose of developing comprehensive plans for the construction, utilization, and coordination of all types of health facilities. (2) Increase the annual appropriation ceiling for construction of nursing homes from $20 million to a higher figure more commensurate with needs. (3) Authorize a grant program designed to assist the States and communities in modernizing and replacing hospitals and other health facilities throughout the country, giving special consideration to those located in the more densely populated areas. (4) Extend the life of the Hill-Burton program for 5 years beyond the expiration date of June 30, 1964. NATIONAL MUNICIPAL POLICY OF THE AMERICAN MUNICIPAL ASSOCIATION HOSPITAL CONSTRUCTION The provisions of the Hill-Burton Act have probably accounted for the greatest single contribution to the health of this Nation in recent years. Properly directed toward providing hospitals in rural and smaller population areas, the results have more than justified the vision of the sponsors. However, while the Hill-Burton program has accomplished a great deal to improve the Nation's hospital plant, it has done so primarily in terms of new construction and has left virtually untouched a serious and rapidly growing need for renovation and modernization of our older hospital facilities. The channeling of the bulk of Hill-Burton funds into new construction rather than renovation, together with the emphasis which that program places on rural areas, has produced in many cases a pattern of modern and efficient small hospitals in regions surrounding metropolitan areas, while the metropolitan areas themselves are served by institutions many of which are far from being either modern, efficient, or fire safe. The plight of these urban hospitals and the growing deficiency of their physical plant are important to the total health picture. |