The procedure required by this bill would not seem warranted in view of the other means available to the Congress to hold the executive branch fully accountable for its actions and would make more difficult the process of assessing how well the necessary resources are being organized and utilized by the Public Health Service in carrying out its responsibilities.

Furthermore, the requirement that there be approval by congressional committees before any service at any institution, hospital, or station of the Public Health Service is discontinued would raise serious questions from the standpoint of the separation of the powers of the legislative and executive branches. It is, incidentally, unclear whether the term "appropriate committees" is intended to refer to the congressional committees having legislative jurisdiction over the Public Health Service Act, the committees concerned with the Merchant Marine Act, the Appropriations Committees, or all of them.

We would, therefore, recommend against the enactment of S. 1917. We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely yours,

WILBUR J. COHEN,
Under Secretary.

Senator BARTLETT. The next witnesses are Hoyt Haddock and Earl W. Clark, codirectors, Labor-Management Maritime Committee. Also let the record show that the statement of Mr. Haddock and Mr. Clark is joined in by Alvin Shapiro and John N. Thurman, the latter of whom is present physically today.

STATEMENT OF EARL W. CLARK AND HOYT S. HADDOCK, CODIRECTORS, LABOR-MANAGEMENT MARITIME COMMITTEE; ACCOMPANIED BY JOHN N. THURMAN, VICE PRESIDENT, PACIFIC AMERICAN STEAMSHIP ASSOCIATION, AND SUPPORTED BY ALVIN SHAPIRO, VICE PRESIDENT, AMERICAN MERCHANT MARINE INSTITUTE

Mr. THURMAN. Mr. Chairman, I have a short statement. As you know, I represent the shipowners in this instance, and we are worried about what is happening. This has been a longstanding problem, it is getting more difficult to get good medical care for our seamen. We have to drop men off on various coasts, pick up fill-in replacements, and if they close more hospitals we are going to have more problems.

I would like to point out, though, a parochial view, and that is that on the west coast we have come out pretty well. We have an excellent hospital in San Francisco that they have agreed to maintain at least for the present, and one in Seattle. It is when our ships are on the east coast that we are really worried right now.

Now I will turn to my colleagues, who have gone into this matter very extensively.

Senator BARTLETT. All right. Thank you.

Mr. CLARK. Mr. Chairman, we have deposited with your clerk a copy of a formal statement which we would like to file at this time. I would like to inquire if you have that.

Senator BARTLETT. Yes.

Mr. CLARK. We would like to have that placed in the record. Senator BARTLETT. It will be placed in the record in full.

(The complete statement follows:)

STATEMENT OF THE LABOR-MANAGEMENT MARITIME COMMITTEE, AFL-CIO MARITIME COMMITTEE, AMERICAN MERCHANT MARINE INSTITUTE, AND PACIFIC AMERICAN STEAMSHIP ASSOCIATION ON PROPOSALS TO CLOSE PUBLIC HEALTH SERVICE AND VETERANS' ADMINISTRATION HOSPITALS

On January 19, 1965, the Government announced plans for the closing of Public Health Service hospitals at Chicago, Ill., Memphis, Tenn., Savannah, Ga., Boston, Mass., Galveston, Tex., Norfolk, Va., and Detroit, Mich. Thus, 7 out of the existing 12 general Public Health Service hospitals are scheduled for termination. These hospitals were formerly called marine hospitals, and approximately 50 percent of the patient load is still merchant seamen. Marine hospitalization has been carried on in Government hospitals for almost 14 centuries (since 1798) as a means of protecting the Nation's health from importation of diseases from abroad; for maintaining efficient seamen for our fourth arm of defense, and for helping to promote the transportation and foreign commerce needs of the Nation.

Over the past decade, the Bureau of the Budget has persistently attempted to close several of these hospitals. More particularly it has demonstrated a desire to bring about a termination of the whole program of medical care for merchant seamen, questioning even the fundamental policy itself. This has been consistently rejected by the Congress.

The Bureau of the Budget has not only refused to approve appropriation requests for adequate funds to maintain these hospitals in proper status, but has placed such continuing restrictions on capital improvements and major repairs as to bring about a progressive state of deterioration.

In 1956 the then Surgeon General arranged for special surveys of the hospitals by independent outside medical experts, who studied the conditions and reported their findings. Their conclusions forcefully condemned the practice of budgetary privation, holding that unless there was a change in such practices, the program was in danger of further deterioration and selfdestruction.

In spite of appeals from these experts, from labor, from maritime organizations, from other members of the medical profession, and from Members of the Congress, the policy of budgetary privation as applied to capital improvements, major repairs, and even proper maintenance persisted. It seems all too clear that the Bureau of the Budget has been intent on an eventual elimination of the program.

Now, without further consultation with maritime labor and the shipping community and, more importantly, the Congress of the United States, the announcement is made that 7 out of 12 of the existing Public Health Service general hospitals are to be phased out, beginning this year. The five remaining ones are to be modernized and ultimately turned over to the Veterans' Administration. Seamen in other hospitals are to be transferred to veterans hospitals at a time when 11 veterans hospitals and certain clinics in some 12 States are also scheduled for closing.

We oppose this move. The Public Health Service care is superior for merchant seamen to that available in private or community hospitals. This results from the fact that the types of hospital and medical services rendered are tailored to meet the specific needs of the ship. The limitations of port time, the short periods between checking out and the signing on of shipping articles, the necessity for timely medical treatment after long periods at sea, the problems of meeting all physical requirements promptly before shipping to sea, including fitness-for-duty declarations, all these are matters requiring a medical program directly related to the needs and the time schedules of the ship. The marine hospitalization program of the Public Health Service meets all these special needs. The programs of private, community, and even other Government hospitals are not conceived to meet these requirements.

Despite the policies of attrition and budgetary privation practiced by those who have sought to destroy it, the program of marine hospitalization has been one of the finest of its kind in the history of the country.

The fine dedicated members of the PHS staff have maintained a high standard of service in spite of the frustrations heaped upon them, in spite of the persistent rumors that the Bureau of the Budget sought the closing of the hospitals, and in spite of the fact that they were forced to improvise at every turn to maintain a high level of service.

The ax, however, has now fallen. At 2:30 on the afternoon before Inauguration Day, all the staff of the seven hospitals to be closed were notified. There

will now be added to budgetary privations and administrative attrition an immediate decline in staff morale, which will eat further into the heart of the program if this ill-conceived action is not reversed.

The statement of Health, Education, and Welfare that this move will improve the quality of patient care and that the Public Health Service will be better able to meet its needs for trained health personnel is open to grave question. Training programs conducted at the Public Health Service hospitals have provided a significant source of recruitment for numerous activities. For decades, this service has operated as a training ground for other national programs-even the Veterans' Administration-and has provided experienced national leadership in clinical care, research, and other health services.

When the veterans hospital program was established, the Public Health Service provided the training of its doctors and staff and practically set it up. When NASA was developed, the Public Health Service was a major factor in its medical training program. Its medical services have been vital to the quarantine service, the sanitary engineering program for ship inspection, cancer research, cardiac dilation research, the study of hypertension, oral malignancies, and a myriad of other diseases. As late as December of 1964, the President's Commission on Heart, Cancer and Stroke recommended that "The Division of Hospitals of the Public Health Service be appropriated funds necessary for renovation and the development of research space in existing facilities, and for increased research and training activities." It further urged "that the smaller but still significant Public Health Service hospital system, which has taken promising steps toward an increased research and training program in recent years, be supported in the development of its full potential for research and training as well as patient care."

It has specialized in preventing disease importation at our maritime gateways. One of the vital programs of PHS is first aid at sea and air rescue. All PHS hospitals are integrated into civil defense emergency planning. Mobile civil defense field hospitals are stored in Public Health Service hospitals. These hospitals have been the prime institutions in medical programs for nuclear ships. It has been the chief source of medical help in hurricanes and flood disaster. It has been the mother agency of most Government medical efforts in the protection of all our people.

The impact of a move to close them, if allowed to persist, will undoubtedly be severe. Recently, the national commander of the American Legion stated in testimony before the Subcommittee on Veterans' Affairs of the Senate Labor and Public Welfare Committee, and we quote:

"We understand that certain patients previously hospitalized in Public Health Service hospitals will be eligible for care in VA facilities. We are unable to ascertain to what extent it would decrease the ability of the Veterans' Administration to care for war veterans. We fear that the VA hospital system as established by Congress is in jeopardy."

If the ability to adequately serve veterans is in jeopardy by the transfer of seamen and other beneficiaries to the already overcrowded veterans facilities, then the service to seamen and these other beneficiaries will most likely also be in jeopardy. We agree heartily with the position of the national commander of the American Legion.

The Commissioned Officers Association of the U.S. Public Health Service, commenting on the position of the national commander of the American Legion, states (February 4, 1965):

"It is difficult to understand how the patients from the Public Health Service hospitals can be cared for by the VA hospital system when many of the VA hospitals that these patients are to be referred to are already operating at maximum patient capacity and have long waiting lists for those veterans with non-service-connected disabilities."

The commissioned officers of the Public Health Service are dedicated men who know their jobs and have had long years of experience in the dispensing of medal and hospital care. Note what they say further on this subject, using Galveston, Tex., as an example:

"The Public Health Service hospital in Galveston, Tex., had a daily patient load in the fiscal year 1964 of 139, or 176 percent of capacity. Most of these patients are to be cared for at the Houston VA hospital. However, we have been informed that constructed bed capacity of the Houston VA hospital is 1,242 and the patient load is 1,219.

"Further, there is a long waiting list for those veterans with non-serviceconnected disabilities. It is, therefore, impossible to comprehend how over 100 patients can be cared for in a hospital that has only 23 beds available."

This is a most demolishing statement and leaves little justification for the January 19 announced closing statement on Galveston except the abstract comment that "closing the Galveston PHS hospital will result in average savings of about $150,000 taking into consideration amortized costs of capital improvements."

One wonders if the principal motive of the Bureau of the Budget is the squeezing out of dollars from both the PHS and the VA hospital systems to divert to other programs. The pronouncement of the late President Kennedy to expand medical and hospital care for our citizens is not advanced by an attack upon two of our oldest hospital institutions serving respectively the seamen who constitute our fourth arm of defense and the men and women who fought for their country in two world wars.

With reference to bed capacity in terms of patient load, the medical profession normally considers approximately 80 percent occupancy to total bed capacity as maximum. The leeway provided by the remaining beds is utilized for special isolation cases, adjusting room space between the sexes, emergency cases requiring special facilities, overlapping between check-in and check-out patients and a myriad of other needs. In terms of this accepted pattern, it is helpful to examine the VA regional facilities statistics in areas where hospital closings are planned. The following figures are from official statistics of the Department of Health, Education, and Welfare-Public Health Service-submitted as of February 5 this year. While the VA hospitals selected are in the areas where PHS hospitals are scheduled for closing, the patients may not necessarily be transferred to all of these particular institutions. they are set forth for comparison.

However,

The proposal is to transfer patients to a new veterans hospital being constructed at Charleston, S.C.

Thus, in terms of overload, the veterans hospitals are all over the 80 percent maximum operating efficiency level accepted by the medical profession. Most are well over 90 percent with some almost 100 percent. While the percent of maximum capacity may be liberalized some in hospitals where chronic patients predominate, the status of the above hospitals is not even conducive to this. This is one of the reasons why the national commander of the American Legion is concerned. This is undoubtedly one of the reasons why the Commissioned Officers Association of the Public Health Service is disturbed. This is why both the veterans and the seamen are concerned.

The announcement of the Secretary of Health, Education, and Welfare on January 19 seems to offer three principal reasons for closing PHS hospitals: 1. Dollar savings (with disproportionate consideration for the human values).

2. A lack of affiliated university training and research program.

3. A claim of more comprehensive care in larger hospitals.

Let us look at each of the above items separately.

1. The dollar savings motive

The justification here is that many of the PHS hospitals are in such need of major repair and capital improvement that more can be saved by scuttling

them. If this is so, the Bureau of the Budget made it so. The Bureau's budgetary privation policy was so bad that Senator John Sherman Cooper, of Kentucky, wrote that agency on June 3, 1958, asking for its position. The agency replied, "It is by no means the intention of the Bureau to abolish the Public Health Service general hospitals through the medium of attrition" and that, "The Bureau of the Budget does not intend to use the budget process to reduce or impair the level of care."

However, on April 16, 1958, the Bureau had already issued its now famous order to the Commissioner, Public Buildings Service, which we quote:

"The need for the Federal Government maintaining general public health hospitals is under intensive study by the Department of Health, Education, and Welfare and the Bureau of the Budget. It is possible that some of these hospitals will be closed or transferred to non-Federal agencies. Under these circumstances, air conditioning or repairs other than those required by emergencies or the safety of the occupants would not be in the best interest of the Government.

"You are, therefore, requested not to proceed with contracting for design or repair work on these hospitals (excluding minor recurring maintenance) without prior clearance with this Bureau. The hospitals covered by this letter are the Public Health Service hospitals in Baltimore, Norfolk, Memphis, Savannah, San Francisco, Chicago, Detroit, Seattle, Staten Island, Boston, Manhattan Beach, Galveston, and New Orleans."

These limitations were so severe as to bring about a progressive deterioration of the PHS hospitals. It was the clear intent of the Bureau then to do exactly what the Health, Education, and Welfare Department announced on January 19, 1965. This was in spite of the findings of five outside medical experts employed by the Public Health Service in 1956 to survey the hospitals and who condemned this practice most vigorously. This was also in spite of the position taken by the Congress. In dealing with appropriations for the PHS hospitals for 1963, the U.S. Senate Committee on Appropriations (Independent Offices, Rept. 1923, 87th Cong., 2d sess., Aug. 27, 1962) also condemned this practice, pointing out to the Bureau of the Budget that the PHS hospital program was "a matter of congressional policy-not one for abstract executive discretion."

"The committee points out that this hospital program has been in effect for well over a century and a half and that its continuance is a matter of congressional policy-not one of abstract executive discretion. The committee believes that these Public Health Service hospitals should be maintained in good and serviceable condition in accordance with modern standards."

Yet by pure executive discretion, PHS beneficiaries will be piled in upon the veterans if these plans persist.

As late as August 17, 1964, the Appropriations Committee of the Senate directed Health, Education, and Welfare as follows:

"The committee noted that funds for repairs and maintenance of the Public Health Service hospitals are included in the 1965 estimates as directed in last year's report.

"However, the amounts and projects requested appear to reflect only the minimum necessary for emergency repairs to keep the hospitals in operation. Many of the Public Health Service hospitals are obsolete and overcrowded and in need of major modernization.

"The committee will, therefore, expect to be presented with a plan for the modernization of the entire Public Health Service hospital system before January 1, 1965, and expects the 1966 budget estimates will contain the funds necessary to initiate this plan."

Instead of following this advice from the Congress, PHS beneficiaries are to be added to the responsibilities of the VA Administration.

It seems clear that the dollar savings which the Bureau now claims can be effected are, to a very substantial extent, the result of its own purposeful creation achieved against the wishes of both the medical profession and the Congress.

There are many, including the Commissioned Officers Association, who question whether, in fact, any extensive dollar savings will result from these proposed closings when viewed against the increased costs in other institutions and the long-range need for hospitals.

Look at the situation on the South Atlantic seaboard. When the Savannah and Norfolk PHS hospitals are eliminated, where are the nearest VA hospitals