the District of Columbia because of such loss of residence status, it seems appropriate to afford an opportunity for his hospitalization in a Federal institution. If, as the committee believes, this is fair and desirable in the case of American citizens in Canada, the opportunity of equal treatment as well as considerations of humanity require that Americans who become mentally ill in other foreign countries should not be discriminated against in this respect. This bill would eliminate such discrimination. The committee believes that to restrict eligibility for admission to St. Elizabeths Hospital in such cases to persons who have been legally adjudicated insane in a foreign country is unnecessarily stringent. The laws of some countries on the subject of legal adjudication of insanity are extremely complex, and the requirement has tended to work a hardship on those concerned. The bill contains the provision whereby, as above indicated, an appropriate certification from designated authorities in a foreign country could take the place of a legal adjudication of insanity in such country for the purpose of admission to the hospital. After such admission, appropriate commitment proceedings could of course be instituted in the District of Columbia if the patient does not desire to remain in the hospital as a voluntary patient and if the patient's release would create a danger to him of to others. Under the terms of the bill, as under the existing law relating to Canada, even a patient legally adjudged insane in a foreign country will be entitled on his own request or upon request of any relative or friend to have a judicial hearing in the District of Columbia upon his mental condition and upon the right of a superintendent of the hospital to hold him for treatment. The bill would repeal the act of October 29, 1941 (55 Stat. 756), which provides for the admission to St. Elizabeths Hospital of insane persons belonging to the Foreign Service of the United States. The reason for such repeal is that enactment of the bill would make this statute unnecessary. COMMITTEE AMENDMENTS All committee amendments are of a technical nature and do not change the provisions of the bill, as introduced. The first two amendments were necessary inasmuch as the Department of Health, Education, and Welfare was created after the date on which the bill was introduced. This new Department has taken over the functions of the Federal Security Agency and the Secretary of said Department has assumed the duties of the Federal Security Administrator. The third amendment was to correct a typographical error in the bill as to the date on which the law, repealed by section 3 of the bill, was approved. CONCLUSIONS The committee therefore recommends enactment of the bill, as amended. CHANGES IN EXISTING LAW In compliance with clause 3 of rule XIII of the Rules of the House of Representatives, changes in existing law made by the bill, as introduced, are shown as follows (existing law proposed to be omitted is enclosed in black brackets): "PUBLIC LAW 284, 78TH CONGRESS "[AN ACT To provide for the admission to Saint Elizabeths Hospital of insane persons belonging to the Foreign Service of the United States "[Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That upon the application of the Secretary of State, the Federal Security Administrator is authorized to admit to Saint Elizabeths Hospital in the District of Columbia, for treatment, American citizens who are Foreign Service officers, as defined in section 2 of the Act of May 24, 1924 (43 Stat. 140), as amended by the Act of February 23, 1931 (46 Stat. 1207; 22 U. S. C. 2), or who are clerks in the Foreign Service classified as provided in section 1 of the Act of February 23, 1931 (46 Stat. 1207; U. S. C. 23 (a)), or who are employees in the Foreign Service and stationed outside the United States, and who are legally adjudged insane in any foreign country and whose legal residence in one of the States, Territories, or the District of Columbia, it has been impossible to establish. Upon the ascertainment of the legal residence of persons so admitted to the hospital, the superintendent of the hospital shall thereupon transfer such 9581457 persons to their respective places of residence, and the expenses attendant thereon shall be paid from the appropriation for the support of the hospital. "[Upon the request of any such patient, his relatives or friends, he shall have a hearing in the District Court of the United States for the District of Columbia upon his mental condition and the right of the superintendent of Saint Elizabeths Hospital to hold him for treatment.]" Mr. ELLIOTT. The Subcommittee on Special Education will hear testimony today on H. R. 243, introduced by Congressman Judd, of Minnesota. This bill provides for the admission to St. Elizabeths Hospital, in the District of Columbia, of certain citizens of the United States adjudged insane in foreign countries. A similar measure was passed by the House of Representatives on July 29, 1953, but was not approved by the Senate. I will say to you, Congressman Judd, that we are happy to have you before this subcommittee, and you may proceed in any manner you desire. STATEMENT OF HON. WALTER H. JUDD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MINNESOTA Mr. JUDD. Thank you. I am pleased to be advised that the chairman himself has introduced a similar measure, so that ought to get favorable action upon it if anything could. Mr. ELLIOTT. Thank you. Mr. JUDD. Mr. Chairman, this matter was brought to my attention because of some friends who served abroad for many years as missionaries. They had no legal residence in a given State in the United States. The wife and mother of the family became emotionally and mentally disturbed and had to be put into an institution. The question was, where could she be taken care of? The family resources simply could not provide for a private institution. The expenses were beyond their capabilities. They wrote me and wanted to know if there was any place in a Federal institution where she could be admitted, because she could not gain admission to any State institution, not being able to meet the residence requirements that exist for, I think, every State institution in the United States, and quite understandably so. I prospected around and found there was a law that allowed citizens of the United States who are in Canada and are adjudged insane there but who are not able to establish residence in a given State in the United States, to be brought to St. Elizabeths. Then I found that there was a law that allowed Foreign Service officers who were unable to establish residence in a given State or the District of Columbia and who required psychiatric or institutional care to be admitted to St. Elizabeths. It seemed to me there should not be discrimination, and I introduced a bill to provide that when any American citizens were adjudged insane by competent authorities in a foreign country and were not able to establish residence in a given State of the United States that would entitle them to admission to a State institution, they should be allowed to be admitted to St. Elizabeths. The question came up of the authorities that might adjudge a person insane in a foreign country. Some countries have very different standards than our own, very inadequate standards. So, at the suggestion of Dr. Overholser, whom I consulted, a provision was put into the bill that they could ask for, or their relatives could ask for, a psychiatric examination, or the Department of Health, Education, and Welfare could designate competent authorities able to pass upon the need of a given individual for such care, so that there would be no possibility of anyone being excluded or given improper assignment because of lack of competent psychiatric examination by properly qualified bodies in other countries. The bill is very simple, perhaps it is too simple, but it is an attempt. to meet a problem here which does not involve many citizens, probably only a few a year; but those whom it does involve, it involves in a catastrophic way. They cannot support and take care of their loved ones. This would take care of them in a proper way and is a proper concern of the Federal Government. It is provided that if at any later time they can establish residence in a given State, they would be transferred there from St. Elizabeths. I do not know that there is anything else to be said. The report prepared on the previous bill by the committee itself is very comprehensive and I think convincing. I shall be glad to answer any questions if the matter is not perfectly clear. Mr. ELLIOTT. Dr. Judd, is there any change in your bill, H. R. 243, from the manner in which it read when it was H. R. 1950 in the 82d Congress? Mr. JUDD. At that time, among other things we had the Federal Security Administrator, and that name was changed to the Secretary of Health, Education, and Welfare. And there are one or two technical changes. The date of the law I believe was wrong. But otherwise I think H. R. 243, at least when I introduced it, is in the exact form in which the bill was reported out when it was H. R. 304, after amendment by this committee. If there are further amendments that are needed, I am not aware of them. I sought to introduce it just as it was when it passed the House in 1953. Mr. ELLIOTT. Off the record. (Discussion off the record.) Mr. ELLIOTT. Mr. McGovern. Mr. McGOVERN. Dr. Judd, I know all of us have the highest regard for your knowledge in medical matters. It seems to me, from the first reading of this bill, that it is something that makes sense and that it is a practical solution to a problem that we ought to meet. I noticed in your statement you made mention of the fact that in the various countries there is a variance in the standards they use in judging a person's sanity. Do you see any problem that might arise. in view of such variance in standards? Mr. JUDD. No, I do not think so. As is stated in the committee. report at the top of page 2 Mr. ELLIOTT. What report is that, Mr. Judd. Mr. JUDD. House Report No. 906 of the 83d Congress, 1st session, by Mr. McConnell on H. R. 304. At the top of page 2 it discusses this very matter as to what authorities would judge them insane, and beginning on the third line it says: For example, in cases in which a medical officer of the Public Health Service qualified to make the necessary diagnosis is stationed in the country in question, the Secretary of Health, Education, and Welfare may find certification by such officer to be most appropriate. Again in some other cases certification by a consular officer upon the basis of examination by a qualified physician may be found the more appropriate method. In still other cases, the Secretary may find certification by qualified foreign authorities acceptable. That would be in a case like England and France, where they have the same medical standards as ourselves. But I think the provision has to be put in the bill "certified by appropriate authorities (as determined by the Secretary of Health, Education, and Welfare)" to provide the flexibility necessary to take care of the varying standards that exist in the various countries. Mr. McGOVERN. Thank you. Mr. ELLIOTT. Mr. Nicholson. Mr. NICHOLSON. What procedure do they go through to commit a man to one of these institutions, just one doctor? Mr. JUDD. Overseas? Mr. NICHOLSON. Yes. They bring them here, do they not, from overseas? Mr. JUDD. Yes. In most of these cases there is not much question about the diagnosis, because a foreign American community is usually so small. The consul and Government representatives and a few business representatives and a few missionary representatives, that is the American community in a foreign country, generally, outside of the big capitals of Europe. Mr. NICHOLSON. I suppose the laws under which they are admitted to State institutions are different in every State? Mr. JUDD. Yes, each State can determine its own commitment laws. Mr. NICHOLSON. In my town if we want to commit somebody to a mental hospital it has to be done by three doctors. Mr. JUDD. Yes, in many States it is three doctors. I think in my State it is three doctors. Mr. NICHOLSON. Here you have only one doctor, so they might be railroaded. Mr. JUDD. That is why section 2 is in the bill. Section 2 says: Upon the request of any person admitted to Saint Elizabeths Hospital under the first section of this Act, or upon the request of any relative or friend, he shall have a hearing in the district court of the United States for the District of Columbia upon his mental condition and the right of the superintendent of Saint Elizabeths Hospital to hold him for treatment. That is to avoid anybody possibly being railroaded through a decision in a foreign country by an inadequately trained individual or by less than three, perhaps. That would give that individual the safeguards that anybody else in the United States has. Mr. NICHOLSON. Do you know whether or not we have many cases of this sort? Mr. JUDD. No. I asked Dr. Dodd, and now Dr. Foreman-he is head of the council of the 300 or 400 missionary hospitals that United States churches support abroad, and they also supervise the health of the missionaries. He said they average about 1 or 2 a year out of all the American missionaries overseas, and that accounts for probably 20,000 or 25,000 people. As I said before you came in, it does not affect many individuals, but those it does affect, it affects in a catastrophic way. Would Mr. ELLIOTT. Congressman Judd, I think you cited an example that had come to your attention, before Mr. Nicholson came in. you mind repeating that for him? Mr. JUDD. Certainly. By inadvertence I did not bring my file along. I have a file with a dozen or more cases. The first time it was called to my attention, the wife of a friend of mine who had been a missionary for 20 years became emotionally disturbed and was threatening not only her own life but the lives of other people. He came from the State of Minnesota and his wife was from Connecticut, I believe, or some eastern State. They had been home on furlough for a year, every 7 years, but missionaries do not establish a residence during the period they are here because they are sent around the country to make talks and they live at Ventnor near Atlantic City or one of the other places for missionaries, and they cannot establish residence in a given State in the United States. So this wife could not be admitted to an institution in Connecticut, she had not lived there for 20 years; and she could not be admitted to an institution in Minnesota. Where could be send her? He could not afford to put her in a private institution. They wrote and asked me for help. "Isn't there some way you can help us in this situation?" I consulted Dr. Overholser and we found there was no way under existing law of getting her into St. Elizabeths. It seems to me it is a legitimate responsibility of the Federal Government to take care of these individuals until some other way of taking care of them can be provided. Mr. NICHOLSON. I do not know exactly what the law is, but it is the same as in the case of paupers; when they need relief you have to give it to them and charge it back. Mr. JUDD. Charge it back to whom? Mr. NICHOLSON. Where the person comes from. If he has no State, the local settlement. Mr. JUDD. But suppose he does not have a local settlement or a State? Mr. NICHOLSON. You will give him a Federal Government institu tion under this bill. Mr. JUDD. Yes, for these few people, until such time as they can establish a residence. Mr. NICHOLSON. We have no Federal institution except in the District of Columbia, I do not think. Mr. JUDD. That is right. That is why I knew of no other way to handle this. Mr. NICHOLSON. Does Dr. Overholser approve this bill? Mr. ELLIOTT. Congressman Judd, as I read this bill I believe it provides that the application for admission in all cases will be made by the Secretary of State? Mr. JUDD. That is right, because you see we have various laws dealing with the care of Americans abroad. Some get in trouble with the law; some become paupers; and there is a law-we revised it a few years ago in the Congress-that provides that where a United States citizen becomes a public charge in a foreign country, the Government will pay his transportation back to the United States. Just as St. Paul said, "I am a Roman citizen," and that meant something. So as a matter of national pride we do not want to have American citizens living abroad under circumstances that are disgraceful |