the chairman, and deal with that subject which you have just indicated you are now concerned about.

Dr. HALL. Is that satisfactory?

Mr. HARE. Certainly.

DISCUSSION OF INADEQUACY OF HOSPITAL FACILITIES FOR THE COLORED IN THE DISTRICT OF COLUMBIA

Dr. HALL. On the side of the community health problems: In the provision for general hospital beds-and that is where most of the medical care is needed-the facilities are far from adequate in the District of Columbia and metropolitan Washington for the Negro population. True enough, Gallinger does provide about half of its general beds for Negroes, but even if you add those to the number of beds in Freedmen's Hospital, plus the few beds in other hospitals, that will still show a picture that is not adequate.

Then we feel that with its large group of students-medical students, interns, residents, nurses, and dietitians, and so forth-the enlargement of the work at Freedmen's would do two things: It would provide the community with more adequate medical care and it would provide the country as a whole with a constant stream of prepared and well-trained physicians and surgeons, and so forth.

We have to turn away possibly one out of every three women who come to the hospital for delivery, and it is not unusual for us to send a woman away whose labor pains are appearing every 30 minutes to stay until the pains get to 5 or 10 minutes apart, because we do not have beds or because in the interim other women may come whose pains are from 5 to 10 minutes apart, thereby presenting an obstetrical emergency.

In this connection we are faced with another problem, due to the fact that many of these women do not have any place to which they can return, that has any facilities for home delivery.

Mr. KEEFE. Might some of these women whom you have just described be in the class of beneficiaries under the Emergency Maternity and Infant Care program?

Dr. HALL. Well, possibly a few of them. I have no really adequate idea how many, if any, of those turned away belong to this group.

Mr. KEEFE. The point that I am making is this, Doctor: I would be disturbed if I felt that the wives of servicemen, entitled to the benefits of the Emergency Maternity and Infant Care program, were being denied those benefits because of the inadequacy of facilities to provide those services.

Dr. HALL. Well, naturally, sir, we try to give every consideration possible to that group, but the total number of women that we know at this moment are going to present themselves for maternity facilities, is going to exceed the amount of facilities that we have by possibly one-third.

And we do not know any solution to that part of the problem because we are overtaxed right now. We occasionally receive women who have to be delivered on wheel trucks and we have deliveries when there are no beds available to put them in immediately, yet when we are faced with that problem-we feel we cannot send them home thereby creating additional hazards to both mother and infant.

That is one of the areas in which the facilities are decidedly inadequate.

Mr. HARE. You say, Doctor, you do not know how to solve that problem. It looks to me like you would just simply have to go out and say you have to have a larger number of rooms to meet the need.

Dr. HALL. Well, that is true. I mean, that is a part of the program concerning which we will have more to say. I hope to come to the Public Health Service, the Federal Security Agency, and the Bureau of the Budget and with their assistance to Members of Congress concerning a real program in this respect later on.

Mr. KEEFE. I think that ought to be presented to this committee right here.

Dr. HALL. Yes. May I develop further the idea I have in mind? Mr. KEEFE. Let me ask you this question first: Has the program reached the crytallization stage so you are able to submit a positive program here with the advice of the Bureau of the Budget, or is it still in a sort of suspense stage of investigation?

Dr. HALL. Well, in our own minds it is pretty well crystallized, that is, as to what the needs of the program are and how these needs should be met. We have taken the matter up with the United States Public Health Service and at time when members or representatives of the Federal Security Agency or the Bureau of the Budget have visited the hospital, after they have made their inspection of the hospital, we have talked over the matter of facilities with them.

Mr. MILLER. You realize, Mr. Keefe, I am sure, that the expansion of any hospital is governed by the policy fixed by the Federal Board of Hospitalization.

Mr. KEEFE. What is that Federal Board of Hospitalization? I never heard of it.

Mr. MILLER. The Federal Board of Hospitalization-I cannot give all its legal background-is a group of individuals, and I believe General Hines is the chairman, made up of the Surgeons General of the Army and the Navy and the Public Health Service, those four, and I can insert the complete membership, but they pass on all hospital construction of the Government, which will cover the expansion at Freedmen's Hospital.

Mr. KEEFE. Apparently from your statement I am to gather that the Congress would not have anything to say about this, that they have the final say in determining any expansion?

Mr. MILLER. Mr. Keefe, that is something that would have to be settled between you and the Federal Board of Hospitalization.

Mr. KEFFE. Do I understand then that this so-called program for the rehabilitation of Freedmen's Hospital, which this committee has heretofore indicated its interest in, and the Congress has indicated its interest in by making appropriation, must be approved by this National Hospital Board; do they act as another check on the Bureau of the Budget on all facilities?

Mr. MILLER. You have discussed the distinction between the allowances for rehabilitation which I believe is already in the present Budget.

Dr. HALL. Yes.

Mr. MILLER. Covering repairs and alterations, so to speak; and the expansions to which I was addressing my remarks, refer to an enlargement, increasing the bed capacity, or anything of that kind.

Mr. KEEFE. That goes all through the Public Health Service hospitals?

Mr. MILLER. Yes.

Mr. HARE. That Board passes on the necessity for additional veterans' hospitals to be built by the Federal Government.

Mr. KEEFE. I can see the over-all necessity, perhaps, of a general clearance of that kind, Mr. Chairman, and perhaps it is a good thing; but I would like to have you put in the record, Mr. Miller, a statement in connection with this Board and its set-up so I may understand it.

Mr. MILLER. Yes.

(The statement requested follows:)

EXECUTIVE OFFICE OF THE PRESIDENT,

BUREAU OF THE BUDGET, Washington, D. C., August 1, 1943.

BUDGET CIRCULAR NO. A-27

(FORMERLY NO. 419)

To the Heads of Executive Departments and Establishments.
Subject: Federal Board of Hospitalization.

1. There is hereby established a Federal Board of Hospitalization (hereinafter referred to as the Board) which shall serve as an advisory agency to the Bureau of the Budget.

2. The Board shall inititate studies of and analyze and review the hospital, convalescent, and domiciliary activities and programs developed and operated by all departments and establishments for the purpose of—

(a) Preventing the overlapping and duplication of service and overbuilding of facilities.

(b) Insuring the most efficient and complete utilization of the total services and facilities of the Federal Government by each department and establishment. (c) Determining the need for existing or additional facilities of each department and establishment.

(d) Determining the area or locality in which additional facilities should be provided.

(e) Determining the extent to which non-Federal facilities may be utilized in the administration of the hospital activities or programs of any department or establishment.

(f) Developing a complete over-all program for providing hospitalization for the veterans of World War II.

(g) Furnishing recommendations with respect to such matters as the Director of the Bureau of the Budget may refer to the Board.

3. The membership of the Board shall be composed of a Chairman, who shall not be deemed to represent any department or establishment, and the following officials representing their respective departments and establishments, namely:

4. The chairman shall be an official or employee of the executive branch of the Federal Government and shall be appointed by the Director of the Bureau of the Budget with the approval of the President. He shall (a) preside at meetings of the Board, (b) have supervision of any staff working under the direction of the Board, (c) be responsible for the expeditions handling of all matters referred

to the Board and for the efficient planning of the Board's activities, and (d) designate an acting chairman from the membership of the Board to serve during his absence. The Board shall meet at such time and place as may be designated by the Chairman. The Chairman shall be without authority to vote in any of the Board's deliberations.

5. Each member, other than the Chairman, shall designate to serve as his alternate on the Board the official or employee who regularly acts for him on other official matters during his absence.

6. No project for acquisition of additional beds by new construction, major alteration, or leasing of or contracting for existing facilities shall be undertaken by any department or establishment until it has been submitted to and reviewed by the Board as to need, location, type of construction, and any other factor which the Board may consider pertinent to the performance of its responsibilities, nor until the resulting recommendation of the Board has been transmitted and considered as provided in paragraph 8 hereof, and approved by the President.

7. Paragraph 6, above, nothwithstanding, (1) any department or establishment may acquire additional beds to meet a temporary seasonal, epidemic, or emergency requirement provided such acquisition does not require new construction, and (2) the War and Navy Departments may acquire limited hospital facilities involving temporary type of construction only and not exceeding 150 beds for any. one project provided no other Federal hospital facilities are available within a reasonable distance. Each project involving the acquisition of beds under this sub section shall be reported to the Federal Board of Hospitalization at the time approval thereof is given by the head of the department or establishment concerned.

8. The recommendations of the Board accompanied by complete substantiating data in support of the proposals shall be transmitted by the chairman to the Director of the Bureau of the Budget for the consideration of the President. Whenever the adoption of any recommendation is not unanimous, such recommendation shall be accompanied by a summary of the views or objections of the minority members.

By direction of the President:

HAROLD D. SMITH, Director.

Mr. KEEFE. Getting back to my statement, Doctor, concerning Freedmen's Hospital, aside from the fact that there are a certain number of beds provided in Gallinger and to some other hospitals utilized by colored people in this community, Freedmen's Hospital, nevertheless, by and large, is the one institution that is set up to take care of the community needs and other needs, so far as training of nurses and doctors, and so on, is concerned, for the colored people; is that right?

Dr. HALL. That is right.

Mr. KEEFE. Is that a fair statement?

Dr. HALL. That is a fair statement.

Mr. KEEFE. And therefore it becomes important, so far as I am concerned, for this committee, to understand whether or not the community needs in that field are being adequately and properly fulfilled. I might say to you that I am a great believer and advocate of proper health facilities and I would like to understand this a little bit: What proportion of colored people are admitted to other hospitals in the District of Columbia; do you have those figures?

Dr. HALL. Gallinger Hospital admits about 50 percent white and 50 percent Negro patients; in hospitals the number does not amount to any great figure. But if you combine the facilities-the general hospital facilities for Negroes in Gallinger and in Freedmen's which constitute the two dependable places-they are still inadequate, and very definitely inadequate, to say nothing of the significance of the hospital as a facility for training medical students, interns, residents.

student nurses, dietitions, laboratory technicians, and so forth. I have information from the record of last year in this statement

Mr. KEEFE. You are going to put that in the record of this hearing? Dr. HALL. Yes.

Mr. KEEFE. That will be available to us.

Dr. HALL. Yes.

Mr. KEEFE. Are the facilities at Gallinger Hospital that you have referred to a separate and segregated part of that institution?

Mr. HALL. I frankly cannot answer. I think there is some flexibility in Gallinger in the number of Negro patients admitted.

Mr. BURBRIDGE. I think that an attempt is made to group the colored patients in areas by themselves. They try, I think, at Gallinger Hospital, to make available as equal facilities for colored as they do for whites. However, in the voluntary hospitals in the District the policy varies.

But the point I would like to make here is the fact that Freedmen's Hospital is the only hospital in the District of Columbia in which a colored patient can have his or her own private physician. If they go into other hospitals they must be treated by the staff physician. By and large, when people are in need of hospitalization and are able to pay for it, they want to be treated by their own physicians.

Mr. KEEFE. And they cannot be treated, as I understand it, by their own physician in other hospitals?

Mr. BURBRIDGE. No; because the Negro physicians do not have staff privileges at the other hospitals.

Mr. KEEFE. Then the cooperative character of Freedmen's Hospital, in connection with the medical school of Howard University offers a tie-up and link-up which makes this a significant institution, as you have indicated.

Dr. HALL. Surely.

Mr. KEEFE. In the training of colored doctors, technicians, nurses, and that sort of thing. Is that right?

Dr. HALL. That is absolutely right.

Mr. KEEFE. I make one reservation here, for my information, that this Federal Board of Hospitalization is concerned exclusively with hospitals to be constructed and maintained by the Federal Govern

ment.

The question now being considered is the enlargement of hospitalization arising out of the necessities of the war. I assume that in this hospital program that probably will be inaugurated some time soon, there will be adequate provisions made for the accommodation of all veterans. Whether that will mean the separation of white and colored people, I do not know. I see from the press that there may be separate hospitals entirely. There may be someone that is asking for hospitals of that kind in the District; I do not know, or nearby.

I note that a few days ago the colored people were asking for a special hospital in my State. I do not know whether they will get it; I do not know what is going to be provided for them. But there certainly should be adequate provision made for all white and colored veterans, returning veterans and that to a certain extent would at least reduce the number of the normal patient load in Freedmen's Hospital.