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establishing such Department. We believe the original intent of that law was to make such requirement applicable only to physicians, dentists, and nurses. In any event, we are aware of no reason for continuing this special restrictive requirement since provisions applicable to Government employees as a whole have existed for many years and have proven to be generally effective.
This section would also delete references to the "Auxiliary Service" and to "Auxiliary” employees, consistent with the changes made by section 2 of this bill. In addition, it would substitute the current term "Director" for the outdated term "manager” which now appears in the law. Section 6
Section 4106 of title 38, United States Code, would be amended to read as follows:
“(a) Appointments of physicians, dentists, and nurses shall be made only after qualifications have been satisfactorily established in accordance with regulations prescribed by the Administrator, without regard to civil service requirements.
"(b) Such appointments as described in subsection (a) of this section shall be for a probationary period of three years and the record of each person serving under such appointment in the Medical, Dental, and Nursing Services shall be reviewed from time to time by a board, appointed in accordance with regulations of the Administrator, and if said board shall find him not fully qualified and satisfactory he shall be separated from the service.
"(c) Promotions of physicians, dentists, and nurses shall be made only after examination given in accordance with regulations prescribed by the Administrator. [Automatic promotions] Advancement within grade may be made in increments of the minimum pay of the grade in accordance with regulations prescribed by the Administrator.
"(d) In determining eligibility for reinstatement in Federal civil service of persons appointed to positions in the Department of Medicine and Surgery, who at the time of appointment shall have a civil-service status, and whose employ, ment in the Department of Medicine and Surgery is terminated, the period of service performed in the Department of Medicine and Surgery shall be included in computing the period of service under applicable civil service rules and regulations.
"(e) In accordance with regulations prescribed by the Administrator, the grade level and salary of a physician, dentist, or nurse changed from a level of assignment where the grade level is based on both the nature of the assignment and personal qualifications, may be adjusted to the grade and salary otherwise appropriate."
The change in terminology (i.e., “Automatic promotions” to “Advancement") has been proposed to make such language consistent with the general personnel terminology.
The new subsection (e), which would be added to section 4106, would provide specific statutory authority for administrative adjustment of grade assignments in those circumstances where the grade of a physician, dentist, or nurse is dependent upon a combination of qualifications. For example, a physician who is a Chief of Staff is entitled to be paid in the "executive" grade not solely because of his personal qualifications but also by virtue of his particular assignment. If he is later assigned to another position, for example, Chief of Surgery, it would be necessary to reduce him to at least a “Chief” grade. This would not be a disciplinary action, nor a demotion in the true sense, since the extra money provided an "executive” grade goes with the particular assignment. A similar situation exists with respect to a nurse who, following an assignment to a position for which the “Assistant Director” grade may be appropriate, is reassigned to another position. The new subsection would affirm authority inherent in the law and would provide a specific means for avoiding this implication of demotion or disciplinary action even though the reassignment results in a decrease in pay and grade. Section 7
Section 4107 of title 38, United States Code, would be amended to read as follows:
"(a) The per annum full-pay scale or ranges for positions provided in section 4103 of this title, other than Chief Medical Director and Deputy Chief Medical Director, shall be as follows:
SECTION 4103 SCHEDULE
Assistant Chief Medical Director, $25,382.
“(b)(1) The grades and per annum full-pay ranges for positions provided in paragraph (1) of section 4104 of this title shall be as follows:
PHYSICIAN AND DENTIST SCHEDULE
Director grade, $19,619 minimum to $25,043 maximum.
Assistant Director grade, $14,680 minimum to $19,252 maximum.
“(2) No person may hold the director grade unless he is serving as a director of a hospital, domiciliary, center, or outpatient clinic (independent). No person may hold the executive grade unless he holds the position of chief of staff at a hospital, center, or outpatient clinic (independent), [or the position of clinic director at an outpatient clinic,] or comparable position.
"(c) Notwithstanding any other provision of law, the per annum salary rate of each individual serving as a director of a hospital, domiciliary, or center who is not a physician shall not be less than the salary rate which he would receive under this section if his service as a director of a hospital, domiciliary, or center had been service as a physician in the director grade. The position of the director of a hospital, domiciliary, or center shall not be subject to the provisions of the Classification Act of 1949 as amended."
This amendment would delete the statutory language requiring that a person holding "the position of clinic director of an outpatient clinic" be placed in the "executive” grade of the pay schedule. Studies within the Department of Medicine and Surgery have shown, in many cases, that directors of outpatient clinics at regional offices do not have responsibility comparable to that of a chief of staff at a hospital, center, or independent outpatient clinic. Placing them in & salary grade comparable to such chiefs of staff therefore results in an inequitable salary situation.
Moreover, where economy and efficiency necessitate the consolidation of an outpatient clinic at a regional office with the outpatient services at the nearest VA hospital, salary complications result, where the incumbent is transferred into the outpatient service at the hospital.
Even with the elimination of the arbitrary executive grade requirement, the remaining statutory language would authorize sufficient administrative latitude and discretion, under the phrase "or comparable position,” to utilize such a grade level at several of the larger outpatient clinics, when deemed appropriate to avoid hardships or inequities to those persons now holding the position of director of an outpatient clinic, the proposed amendment contains, in effect, a savings clause to preserve the grade of such person so long as he continues to hold the position held on the date of the enactment of the bill.
This section of the bill would also add to section 4107 of title 38, a new subsection (c) which is, in effect, the language of the existing section 4111(b) of such title 38, with the addition of a sentence which makes it clear that the Classification Act of 1949 would no longer apply to the position of director of a hospital, domiciliary, or center when such position is not occupied by a physician.
The purpose of the transfer of the salary rate provision, applicable to nonphysician directors, now contained in section 4111, to section 4107, is merely to consolidate all pay provisions in one section. Such transfer supplements the recent action of the Congress in the enactment of the Federal Employees Salary Act of 1964 whereby the salary schedule for certain positions, previously listed in 38 U.S.C. 4103, was transferred to section 4107 of such title 38 (secs. 117-118 of Public Law 88 426). The language rendering the Classification Act of 1949 inapplicable to nonphysician directors eliminates the paperwork now required for various administrative actions, such as the classification of the position, or the processing of in-grade promotions. In view of the statutory provision which entitles a nonphysician director to the salary equivalent of that received by a physician occupying the same position, there is no practical purpose to be served in continuing to treat the position as if it were classified under the 1949 act. Section 8
Section 4111 of title 38, United States Code, would be amended to read as follows:
"[(a)] There shall be appointed by the Administrator under civil service laws, rules, and regulations, such additional employees, other than those provided in section 4103, paragraph (1) of section 4104, and those specified in section 4114 of this title, as may be necessary to carry out the provisions of this chapter.
"[(b) Notwithstanding any other provision of law, the per annum salary rate of each individual serving as a director of a hospital, domiciliary, or center who is not a physician in the medical service shall not be less than the rate of salary which he would receive under section 4107 of this title if his service as a director of a hospital, domiciliary, or center had been service as a physician in the director grade. This subsection shall not affect the allocation of any position of director of a hospital, domiciliary, or center to any grade of the General Schedule of the Classification Act of 1949, except with respect to changes in rate of salary pursuant to the preceding sentence, and shall not affect the applicability of the Performance Rating Act of 1950
to any individual.)” This amendment merely deletes the language of existing section 4111(b), containing a pay provision involving nonphysician directors, which would be transferred to section 4107 of title 38, by section 7 of the bill. As previously stated, this transfer is being proposed merely to consolidate pay provisions in one section. Section 9
Section 4112 of title 38, United States Code, would be amended to read as follows:
“8 4112. Medical advisory group
"The Administrator shall establish a special medical advisory group composed of members of the medical, dental, and allied scientific professions nominated by the Chief Medical Director, whose duties shall be to advise the Administrator, through the Chief Medical Director, and the Chief Medical Director direct, relative to the care and treatment of disabled veterans, and other matters pertinent to the Department of Medicine ard Surgery. The special medical advisory group shall [conduct regular calendar quarterly meetings.] meet on a regular basis as prescribed by the Administrator. The numbers, terms of service, compensation, and allowances to members
of such advisory group shall be in accord with existing law and regulations." This amendment would delete the present statutory requirement that the special medical advisory group, authorized by section 4112 of title 38, United States Code, shall conduct regular calendar quarterly meetings, and substitute a requirement that such group meet on a regular basis as prescribed by the Administrator. The requirement that the meetings be held at specific time intervals is much too rigid. It deprives the Administrator of the flexibility that is necessary to adjust the interval of such meetings to meet his needs. The proposed change would permit the Administrator to prescribe meetings for tliis group of advisors at intervals consonant with the need for advice or assistance on pertinent topics. Section 10
Section 4113 of title 38, United States Code, would be amended to read as follows:
"The Administrator may pay the expenses, except membership fees, of employees described in section 4103 (and paragraph (1) of section 4104), paragraph (1) of section 4104 and physicians, dentists, and nurses appointed on a temporary full-time or part-time basis under section 4114 of this title detailed by the Chief Medical Director to attend meetings of associations for the pro
motion of medical and related science." This amendment would authorize the Administrator to pay the expenses of physicians, dentists, and nurses, appointed on a temporary full-time or art-time basis in the Department, detailed to attend meetings of associations for the promotion of medical and related sciences. This authority is currently limited to physicians, dentists, and nurses appointed on a career basis under section 4104 of title 38. Since Public Law 87–574 amended section 4104 of title 38, United States Code, to remove the time limit upon temporary full-time and part-time appointments of physicians, dentists, and nurses, it has become desirable to detail such appointees to attend meetings of professional societies on the same basis as career appointments under section 4104. Section 11
Section 4114 of title 38, United States Code, would be amended to read as follows:
"(a)(1) The Administrator, upon the recommendation of the Chief Medical Director, may employ, without regard to civil service or classification laws, rules, or regulations
“(A) physicians, dentists, nurses, dietitians, social workers, librarians, and other professional, clerical, technical, and unskilled personnel (including interns, residents, trainees, and students in medical support programs) on a temporary full-time (or part-time), part-time or without compensation basis; and
“(B) physicians, dentists, nurses, and other professional and technical personnel on a fee basis. “(2) Personnel employed under paragraph (1) of this subsection shall be in addition to personnel described in section 4103, paragraph (1) of section 4104 and section 4111 of this title and shall be paid such rates of pay as the Administrator may prescribe.
“(3)(A) Temporary full-time appointments of physicians, dentists, and nurses may exceed ninety days only if the Chief Medical Director finds that circumstances render it impracticable to obtain the necessary services through appointments under paragraph (1) of section 4104 of this title. Temporary full-time appointments of other personnel shall not exceed ninety days.
"(B) No part-time appointment shall be for a period of more than one year, except for appointments of physicians, dentists, nurses and interns, and residents and other trainees in medical support programs.
“(b) The Administrator shall have authority to establish residencies and internships; to appoint qualified persons to such positions without regard to civil service or classification laws, rules, or regulations; and to prescribe the conditions of such employment, including necessary training, and the customary amount of terms of pay during the period of such employment and training.
"(c) When the Chief Medical Director determines that it is not possible to recruit qualified citizens for the necessary services, appointments under this section may be made without regard to the citizenship requirements of section 4105 of this title or of any other law.
“(d) The Chief Medical Director may waive for the purpose of appointments under this section the requirements of section 4105(a) of ihis title that the licensure of a physician or dentist, or the registration of a nurse must be in a 'State', il
"(1) in the case of a physician, he is to be used on a research or an academic post or where there is no direct responsibility for the care of patients, or
“(2) in any case, where the individual is to serve in a country other than the United States and his licensure or registration is in the country in which
he is to serve." This amendment would clarify the legal authority to appoint employees on a without compensation basis, within the Department of Medicine and Surgery. Existing language of section 4114 authorizes without compensation appointments if the are designated either part-time or temporary full-time employees. This designation has the effect of limiting the appointments to 90 days if they are fulltime employees and to 1 year if they are part-time employees. Such limitations are not desirable from an administrative standpoint and, although the existing language of section 213 of title 38, United States Code, has been assumed to be broad enough to authorize without compensation appointments for longer periods of time, it is felt desirable to provide specific language in section 4114 authorizing this type of appointment.
Section 4114 would also be amended to permit the appointment on a temporary full-time or part-time basis of a physician who is used on a research project, in an academic position, or where there is no direct responsibility for the care of patients, even though he holds a foreign, rather than a United States, license or registration. There are times where it is deemed desirable to obtain the services of eminent research physicians who either hold foreign licenses, or in rare instances, a physician who holds no license. Present law precludes their appointment in the Department of Medicine and Surgery and such necessary services can only be obtained by use of a personal service contract. This amendment would permit the appointment of the needed person on a temporary or part-time basis.
Finally, a problem has occasionally arisen, as for example, in our regional office in Manila, Philippines, where it has been necessary to appoint a physician who is licensed under the law of the country where employed but who is not licensed in a "State” as required by the current language of section 4114. Specific authority for the appointment on a temporary full-time or part-time basis of a physician, dentist, or nurse in such circumstances would be authorized by clause (2) of the proposed subsection. Section 12
Section 5004 of title 38, United States Code, would be amended to read as follows: "5004. Garages (on hospital and domiciliary reservations] and parking
facilities “(a) The Administrator may construct and maintain on reservations of Veterans' Administration hospitals and domiciliaries, garages for the accommodation of privately owned automobiles of employees of such hospitals and domiciliaries. Employees using such garages shall make such reimbursement therefor as the Administrator may deem reasonable. [Money received from the use of such garages shall be covered into the Treasury of the United States as miscellaneous receipts. ]
"(b)(1) The Administrator may establish, operate, and maintain, in conjunction with Veterans' Administration hospitals and domiciliaries, parking facilities for the accommodation of privately owned vehicles of federal employees, and vehicles of visitors and other individuals having business at such hospitals and domiciliaries.
“(2) The Administrator may establish and collect (or provide for the collection of) fees, for the use of the parking facilities, authorized by subsection (6)(1) of this section, at such rate or rates which he determines would (A) at least a mortize the cost of lands acquired after enactment of this section, (B) amortize cost of improvements and recover cost of maintenance and operations, and (C) be reasonable under the particular circumstances.
"(3) The Administrator may contract, by lease or otherwise, with responsible persons, firms or corporations, for the operation of such parking facilities, under such terms and conditions as he may prescribe, and without regard to the lase concerning advertising for competitive bids.
"(c) Money received from the use of the garages and from the parking facilities operations authorized by this section, may be credited to the applicable appropriation charged with the cost of operating and maintaining these facilitues. Any amount not needed for the maintenance, operation, and repair of these facilities shall be covered into the Treasury of the United States as miscellaneous
receipts." This section would extend the current provision of law authorizing the Veterans' Administration to construct and maintain garages on reservations of its hospitals and domiciliaries for the use of its employees, to provide (1) express authority for the establishment, operation, and maintenance of parking facilities, in conjunction with such hospitals and domiciliaries, and (2) administrative procedures for the operation of such facilities.
The Veterans' Administration has long provided parking lots for visitors and patients at certain of its hospitals and domiciliaries. Moreover, the Comptroller General has recently recognized that the Veterans' Administration has basic authority to run such a system and collect fees for the use thereof, at least insofar as employees are concerned.
In response to our request for his views as to our authority to lease land for such purposes, the Comptroller General, in a decision of July 9, 1965_(B-156496), stated: