such that the Alaska Department of Health is continually-has reached the end of their waiting list and the Veterans' Administration has reached the end of their waiting list. We have hospitalized patients from those two agencies, plus the United States Public Health Service. So the burden has been split up between the three agencies. However, the Veterans' Administration and the department of health have reached the end of their waiting list, so we have fewer patients from that source, and they have an established maximum they can put in Seward Sanatorium. So as we lose patients from the other departments, we don't have patients from the United States Public Health Service to replace them.

Mr. DAWSON. Do you have a rating system with the National Tuberculosis Association that would rate this sanatorium here, or any other way of judging the quality of your care?

Mr. NELSON. The Joint Commission on Hospital Accreditation is the oranization that does that work. They are represented by the American College of Surgeons and American Medical and Hospital Association, and American College of Physicians, and Canadian Association, and they accredit hospitals on a voluntary basis and determine the quality of the care. If you become accredited, it is proof you are giving quality of care above the minimum standards.

Mr. DAWSON. I take it what you are asking for is not direct Government aid but simply the Government doesn't take business away from this sanatorium that should be going here rather than down to the States. Is that it?

Mr. NELSON. Yes. I think it is fine to utilize the beds in Washington, but I don't believe they should be utilized in sacrificing beds up here.

Mr. DAWSON. I want to commend the Seward Sanatorium and the Methodist Church for having the sanatorium. This is the very type of thing we need in Alaska. As long as you can get people who are willing to come up here and, through church organizations and other nonprofit organizations, do something about the situation, the very least that we could do as officers of the Federal Government is to see that these people who suffer from tuberculosis here in the Territory at least go to a sanatorium in their own Territory. I think it is absolutely shameful that we let people go out of this Territory when we have facilities here that are provided by broadminded people who seek to do something for humanity. That is the way I feel about it. And the same goes for the native hospital down at Anchorage.

The report reached us that there had been in Anchorage native patients sent down to the States, yet one whole wing of that hospital was vacant. That is the report we had. That is one thing I hope you committee members will check into when you get down to Juneau where I understand you have a witness from the Native Health Service.

Mr. BARTLETT. Mr. Utt, do you have any questions?

Mr. UTT. I have no questions, except to associate myself with Mr. Dawson's remarks.

Mr. BARTLETT. Mr. Dawson, unfortunately for us, is going to leave the committee tomorrow. Before he departs, Mr. Nelson, I think we might well take up a minute or two in explaining to him what

happened when that first appropriation was made for the hospitalization of the Alaska tuberculars in Washington.

Is it not correct to say that that appropriation was made to supplement the care that could be given in Alaska; it was not intended to take Alaskans from institutions within the Territory and remove them to Washington State? But is not that exactly what happened last year?

Mr. NELSON. You are speaking of the 400 beds they are utilizing in Washington State?

Mr. BARTLETT. Yes.

Mr. NELSON. And that did happen last year. It happened last February and March. They were sending patients outside and we were without patients. They would set a maximum on how many patients they could send to Seward Sanatorium, which was 90 at the time.

Mr. BARTLETT. Was it not your understanding that these Alaska institutions were to take care of as many patients as possible and the overflow would go to Washington State?

Mr. NELSON. Yes, that was my understanding, and that would be my hope they would continue that policy.

Mr. BARTLETT. The policy determination, for reasons we are not fully aware of, was exactly the opposite, and because of that you lost patients here and Anchorage lost patients.

Mr. NELSON. Yes, that is correct.

Mr. DAWSON. I would think they should not send them down there unless they have a certificate from the available services here there is no space available.

Mr. BARTLETT. That would be a good suggestion, in my opinion. I think it is very shameful, the manner in which that program has been administered to the detriment-I don't care so much about the sanatorium here or the hospital in Anchorage as I do the patients themselves who are required to go so far away.

I recall one Eskimo. I was told the story of one Eskimo at Anchorage who couldn't speak a word of English, and he was shattered when he was removed and taken all alone to one of these sanatoriums in Washington State.

Mr. DAWSON. You simply provide custodial care here, you don't attempt to do any lobectomies?

Mr. NELSON. We have a thoracic surgeon. We have an anesthesiologist coming up the first of October who was at Western Reserve University. Our thoracic surgeon is connected with the University of Chicago clinic. He is very highly recommended and well known. Mr. BARTLETT. How many beds do you have?

Mr. NELSON. We have 155.

Mr. BARTLETT. Mr. Nelson, I think you ought to have opportunity to comment on the criticisms that have been voiced locally in respect to some phases of the vocational rehabilitation program. It has been said that the sanatorium operates a grocery store in that program and sells groceries at retail for a lesser cost than local merchants can. And it has been additionally said that the sanatorium operates a service station and sells petroleum products for lower prices. Would you care to comment on the allegations?

Mr. NELSON. There have been statements we are operating Government-subsidized retail activities out there. That was when we first started out. I haven't heard a great deal of criticism. But, just assuming there is a lot of criticism that I haven't heard, these retail activities are all self-sufficient. They all have to operate on their own budget. Their sales have to make up enough to pay their clerks and pay the expense of the building and so forth, and amortization of the loans and so forth. It is the only way we can control a training program for these patients.

The reason is that it has been told to us by people that have studied the native people that retail merchandising is the most important thing we can teach these people. At the present time the department of education says their teachers out in the villages not only have to do the teaching but they have to help operate the store and have to help with the post-office work, and those jobs should be done by the native people.

Mr. BARTLETT. You operate a grocery store; is that right?

Mr. NELSON. Yes.

Mr. BARTLETT. You operate a service station?

Mr. NELSON. Yes.

Mr. BARTLETT. And what other programs?

Mr. NELSON. We have a shoe-repair shop and a photofinishing shop and sewing class and sewing shops.

Mr. BARTLETT. And the groceries are sold to the public?

Mr. NELSON. The groceries are sold to the public on a competitive

basis.

Mr. BARTLETT. What is the average level of prices, the same as

Mr. NELSON. Our markup is a little bit higher. We had an expert retail merchandiser from the States, and our markup was a little bit higher than the markup in the States, which I think averaged around 25 percent.

Mr. BARTLETT. Do you pay rent?

Mr. NELSON. They pay rent to the sanatorium. That is another source of income that we use to help take care of the patients.

Mr. BARTLETT. Are the prices on the average the same as the level in Seward itself, higher or lower, aside from the markup?

Mr. NELSON. I have heard comments both ways. I have heard some people say they can buy cheaper in town.

Mr. BARTLETT. How about the price of gasoline?

Mr. NELSON. Gasoline is the same. We try to cooperate. I mean we didn't want it to be a price-cutting program. We have never advertised lower prices out there of any kind. We have never advertised prices of any sort.

Mr. BARTLETT. How many natives have been graduated from the grocery-store program?

Mr. NELSON. There are probably 4 or 5 right now. We have just been going a little over a year, and we are just at the point where we are starting to hire the ones that have started in the first class.

Mr. BARTLETT. Do you know if any of those graduates have received employment elsewhere in that field of activity?

Mr. NELSON. In the grocery store there is one man that has gone to-I believe he went to Point Barrow. There are 3 or 4 that are employed. They have gone to the little village stores.

Mr. BARTLETT. That is all. I just wanted you to have an opportunity to comment upon that feature of the situation.

Mr. TAYLOR. Is this grocery an innovation in Seward or is this the usual practice in tuberculosis sanatoriums elsewhere?

Mr. NELSON. The rehabilitation?

Mr. TAYLOR. This type of rehabilitation, with the food shop and so forth.

Mr. NELSON. I think this particular rehabilitation program is peculiar to this locality. In most localities they have a rehabilitation program that goes toward factory help, but we have no factories or industry up here, and there is a big need for retail clerks.

We get reports from the department of education continually that they don't want their teachers to help in these other departments because it is taking them away from their teaching, which is what they are sent out there to do.

Mr. TAYLOR. How much of a rotation do you have among the patients? By that I mean, How many are sent home during a year? Mr. NELSON. At the present rate there are probably 125.

Mr. TAYLOR. They have been released from the sanatorium and gone back home?

Mr. NELSON. Yes.

Mr. TAYLOR. Cured or on the road to recovery?

Mr. NELSON. We send them home arrested, and sometimes they come back. I think our rate of return has been just about less than any on the record.

Mr. DAWSON. Return to the sanatorium?

Mr. NELSON. Because of breakdown.

Mr. BARTLETT. Mr. McFarland?

Mr. MCFARLAND. I have no questions.

Mr. BARTLETT. Thank you very much, Mr. Nelson.

(Discussion off the record.)

(Subsequently Mr. Nelson filed the following additional state

ment:)

SUBCOMMITTEE ON INSULAR AFFAIRS,

Washington 25, D. C.

(Attention: Representative Dawson.)

NOVEMBER 1, 1955.

DEAR REPRESENTATIVE DAWSON: This is to follow up testimony given here to your Subcommittee on Insular Affairs in Seward, Alaska, on September 24, 1955. My particular interest is the position of your committee with respect to utilizing hospital beds in Alaska for Alaskan patients when they are available in an accredited institution in preference to sending them to hospitals in the States.

At the time of the hearings, you expressed the opinion that the situation of utilizing beds in Alaska could be remedied by requiring the Federal agency responsible for hospitalizing patients to acquire a certificate from Alaska hospitals stating they could not hospitalize the patients.

In spite of our efforts to utilize the beds for tuberculosis care in Alaska, the complete efficient utilization of the facilities never seems to materialize, and we continue on with approximately the same number of empty beds as we had a year ago even though congressional committees and other authorities have assured us that beds in Alaska should be utilized before patients are sent to sanatoriums outside.

We are concerned with this situation here at Seward Sanatorium because, by running our hospital at full capacity, we can operate more efficiently and offer more complete services to the patient.

It was my understanding that after the hearings in Seward, you would be unable to continue with the committee on the hearings in Alaska. We were

indeed fortunate that your schedule permitted you to be with us here, but unfortunate that your schedule made it impossible for you to be at Mount Edgecombe. I understand there was considerable discussion about hospitalizing Alaska Native Health Service patients, but no mention of a statement from Alaska hospitals stating they had no beds available before sending the patients to hospitals outside. The policy, as it stands today, is that Riverton and Laurel Beach, a hospital operating for profit in Seattle, shall be maintained at full capacity with Alaska patients, while Alaska hospitals are left with quotas which sometimes fall good deal short of full capacity.

It is hoped that you will be able to act on this at an early date as we have worked a great deal harder to establish and maintain an accredited program here than similar institutions in the States. It is to the advantage of our Government to support an accredited program in the interest of an orderly development of the Territory. We need this support if we are to maintain our standards.

I am enclosing a copy of my statement to your subcommittee for your convenience as a reference.

Sincerely,

PAUL W. NELSON, Administrator, Medical and Hospital Association, Seward Sanatorium. Mr. BARTLETT. The next witness is Mr. Hall.

STATEMENT OF STANLEY HALL, UNITED STATES COMMISSIONER

Mr. HALL. I am Stanley Hall, and I am United States Commissioner.

As you mentioned before, you have probably heard thousands of words on mental health. I would wish to say a few words.

I think the present system of Alaska mental-health procedure is criminal in itself. Under my direction I have had the unfortunate responsibility of sending two cases where the patient has died either en route or immediately upon arriving in Morningside.

I have no condemnation or criticism of either the United States commissioner or the Marshal's office or the prison system or the officers at Morningside, but the procedure under which the people are declared to be insane and thence transported to Morningside is a blight on any man's conscience. I can't condemn it too strongly.

I wish also to mention that the Territory of Alaska should provide more and better constructed laws for taking care of juvenile delinquency.

This is the entire subject that I wish to say to the committee.

Mr. BARTLETT. Mrs. Pfost, do you have any questions?

Mrs. ProST. No questions.

Mr. BARTLETT. Mr. Dawson?

Mr. DAWSON. No questions, except to compliment Mr. Hall. I have known him for a good many years, a fellow townsman of mine, and I am glad to see him up here doing a job for Alaska.

Mr. BARTLETT. This is of special interest-that a committee member is acquainted with Mr. Hall.

Mr. Utt?

Mr. UTT. I have no questions. I just want to say to Mr. Hall we have given a great deal of time to that question, and some of our committee have visited the people who are being detained for hearing and commitment, and I have certainly had my eyes opened as to the need for speed in the procedure. The other can be handled over a period of time, but the procedure thing should be effected immediately.