is an urgent need for a central collection of data from a variety of programs and activities that can be more economically accomplished by concentration into a single operation rather than by fragmentation. The paucity of relevant data for planning future programs, for evaluation of current efforts, for cost and value assessment, and for improved services argue for usage of this new technology. I would like to support the proposal to increase the maximum period of educational training and support from 2 to 4 years. Experience in our medical and training programs of professionals in rehabilitation has clearly shown the need for more extensive and specialized training, and the development of adequate demonstrational resources in which to accomplish this training. The availability of this financial assistance through a 4-year period, where needed, would contribute materially to the preparation of more promising young people for successful careers in rehabilitation and would thus help us all meet some of the serious shortages which surround our efforts at present. In the absence of specific recommendations in the proposed legislation, it should be noted that there is a need for special Federal multi-State projects which would deal with the actual cost and value of providing comprehensive rehabilitation services in special situations like stroke, spinal cord injury, and severely retarded where universally there is a catastrophic impact upon the patient, his family, and society, outstripping available financial resources. Because highly specialized centers and continuing experience are needed to deal with problems generated in this situation, it is recommended that regionalization of special resources for such catastrophic disabilities makes excellent economic and practical operational sense. The fight against the human and economic loss caused by disability in this Nation is a matter of national concern. No nation can afford this waste in misery nor can long endure the loss of retrievable human resources. The United States is one of the leaders in this great campaign primarily because of its central concern for the individual in contrast to the attitude of many societies. The practical implication of this attitude is the viewpoint of the disabled person who should not be kept from rehabilitation because of where he lives, the nature and name of his disability, or because of the absence of personal financial resources to pay for the necessary services. We need to recognize that the practical goals of comprehensive rehabilitation services extend in many directions, including the opportunity for work and education, the opportunity for a life that is independent of institutionalization and public welfare, and the reduction in physical handicap, pain, and discomfort. Our challenge is, therefore, to find individualized, realistic, practical, imaginative, and efficient ways to meet such needs. In conclusion, we strongly urge your committee in the Senate to take favorable action on this bill. We have stressed our support for those sections which are most directly related to our areas of competence, experience, and interest. Our endorsement of other equally important provisions of this amendment is implied and equally sincere. While we have recommended additional amendments they have been made in the spirit of strengthening and improving the bill rather than to criticize what has been proposed. The association appreciates this opportunity to present the views of its membership and wishes to express its appreciation to the Congress of the United States for the far-reaching legislation it has approved in the past and is now considering for the improvement of rehabilitation services for the disabled of our country. The CHAIRMAN. Let me ask you this question. With reference to the workshops, you know how very important they are Dr. SPENCER. Yes; right. The CHAIRMAN. What about the personnel, as of now, for them? Dr. SPENCER. I think there are two things I can say in response to this question. No. 1, in general, the vocationally oriented type of facility has not enjoyed the degree of development either in construction or staffing that it truly deserves. This is primarily because of lack of financing for construction which this bill attempts to correct. Secondly, the staffing, as you pointed out, is an essential ingredient. It is one thing to build a house. It is another thing to have a family in that house who can work. And unless we insure, by the type of provision which this bill has, for providing staffing support in a progressively decreasing manner now, as the facilities get more and more independent, you can be assured that when the program starts it will be first class with high-quality services which can be provided and when it has the opportunity to attract good people. If it has to support itself out of the fee-for-service income initially it cannot get off the ground. Studies have been done which already demonstrate that this is true throughout the rehabilitation movementreally throughout the Nation-that, until there are sponsors for the service, and until there is a strengthening through subsidy of strong programs, you just cannot mount an adequate program. That is a fact of life. The CHAIRMAN. Have you seen any trend in the numbers of medical students taking resident training in physical medicine and rehabilitation? Dr. SPENCER. I do not think that we have seen the trend that we would like to see. The CHAIRMAN. Is there a continuing trend? Dr. SPENCER. I think this is a very important question, for this reason: Rehabilitation and the interest of physicians and other professional people in it grows out of demonstration of exemplary care, not out of demonstration of failure. And until we get regional research and training centers until we see the hope in new appropriationsthat we can no more than mount a flag in a medical school and wave it about rehabilitation, not until then will we have a first-rate program equivalent to that of medicine, psychiatry, surgery, et cetera. We are not going to be able to bargain with the medical student's interest. He wants to see success. He wants to identify himself with success. The approach of failure is not going to do it. I think this is a very important significance of strengthening the training both in this legislation and in appropriations pending, to allow the setting up of demonstration units which are models that will attract the students. I think this is true of all of us. I think it is a human characteristic. I am very encouraged rather than discouraged. The CHAIRMAN. You think this legislation would attract and challenge the young medical students where they have not been attracted or challenged in the past; is that right? Dr. SPENCER. Yes, sir; this legislation and also appropriations for increasing the training budget of the agency concerned, I think, will definitely do this. The CHAIRMAN. Thank you. Senator Yarborough. Senator YARBOROUGH. I have no questions, Mr. Chairman. Thank you, Dr. Spencer, for your very fine statement. In line with the chairman's question I have here a little sketch of Dr. Spencer as to his training and accomplishments and educational accomplishments, and professional accomplishments and I would like to have this put into the record at this point. The CHAIRMAN. Without objection, that will be made a part of the record. (The biographical sketch of Dr. Spencer follows:) 45-602-65--6 BIOGRAPHY OF DR. SPENCER Spencer, William A. Born: Oklahoma City, 1922. B.S.: Cum laude, Georgetown. M.D.: Johns Hopkins, 1946. Intern and resident at Johns Hopkins Hospital, 1946-48. Instructor, pediatrics, assistant professor, physiology, Baylor Medical School, 1958-. Medical director, Southwestern Polio Respiratory Center, Jefferson Davis Hospital, Houston, 1950-58. Held posts with National Foundation Infantile Paralysis, Vocational Rehabilitation Administration. Professor and chairman, Department of Rehabilitation, Baylor Medical School, 1957-. Director, Texas Institute of Rehabilitation and Research, 1958-. One of ten Outstanding Young Men in America, U.S. Junior Chamber of Commerce, 1955. Phi Beta Kappa and numerous medical societies. Author and editor: Treatment of acute poliomyelitis, 1954. The CHAIRMAN. Dr. Spencer, you have brought us a most helpful and excellent statement, and I want to thank you. Dr. SPENCER. Thank you. Senator YARBOROUGH. Thank you, too. The CHAIRMAN. Our next witnesses are Dr. Frank Krusen and Dr. Paul M. Ellwood. Dr. Krusen is chairman of the Expert Medical Committee of the American Rehabilitation Foundation and professor and coordinator of the Department of Physical Medicine and Rehabilitation at Temple University School of Medicine and Hospital of Philadelphia, Pa. Is that correct? Dr. KRUSEN. Yes. The CHAIRMAN. And Dr. Ellwood is the executive director of the American Rehabilitation Foundation in Minneapolis, Minn. Dr. ELLWOOD. Yes. The CHAIRMAN. We are very glad to have you both here. Will you proceed in your own way. STATEMENT OF DR. FRANK KRUSEN, CHAIRMAN, EXPERT MEDI- Dr. KRUSEN. Thank you, Senator Hill. It is a pleasure to appear before you again, and to pay tribute to what you have done for the field of medicine and your magnificent direction of the development of research and training programs. We are particularly grateful to you for what you have done in supporting the field of medical rehabilitation so wisely. I think you know, Senator Hill-I do not know whether Senator Yarborough knows it that this expert medical advisory committee of the Rehabilitation Foundation is a group of approximately 20 leading professors of physical medicine and rehabilitation in medical schools all over the United States. Dr. Lehmann from the Univer sity of Washington; Dr. Worden from the University of California in Los Angeles; Dr. Gersten from the University of Colorado; Dr. Kottke from the University of Minnesota; Dr. Rae from the University of Michigan; Dr. Robcliffe Jones from Yale University; Dr. Robert Jones from Harvard University-it seems that they like the name Jones at Yale and Harvard-they have two R. Joneses. Dr. John Goldschmidt from Jefferson Medical College where you and I dedicated a new rehabilitation center a couple of years ago, Senator Hill. And other leaders of medicine from Senator Yarborough's State, Dr. Spencer who has just testified is a member of this committee; and my own nephew, who is at the Baylor Hospital in Dallas and at Southwestern University, as the head of Physical Medicine and Rehabilitation, also is on this committee. Senator YARBOROUGH. Dr. Krusen, one man that you have not mentioned that I propably have discussed this problem with more than any other person is Dr. Rusk, of New York State. Dr. KRUSEN. Howard Rusk, yes, works very closely with it. It happens that on our American Rehabilitation Foundation Medical Advisory Committee he is Dr. Rusk's right hand of Dr. Edward Lowman. Dr. Lowman has served since the beginning of this work, since 1957. Senator YARBOROUGH. As a point of explanation and as a comment on this bill, there was an article published on March 28 in the New York Times by Dr. Howard A. Rusk and I ask permission to put that into the record. The CHAIRMAN. I have it here and we will put it in at the conclusion of Dr. Krusen's statement. Senator YARBOROUGH. Thank you for identifying the members of your group. Dr. KRUSEN. Senator Hill will recall that I wrote to him recently recommending support of the testimony that Dr. Kottke had introduced which was included in the testimony on S. 596 in which he recommended that 10 regional centers be supported in approximately the amount of $1,500,000 a year, and I pointed out that this would be an annual expenditure of $15 million to support 10 regional research and training centers at large medical university centers and that this would be extremely small as compared with what is given to just one of the National Institutes of Health which is somewhere between $110 million and $165 million a year. And that what could be accomplished by giving this amount of $15 million a year to these 10 medically oriented regional research and training centers would be of tremendous significance to the rehabilitation of the handicapped throughout the Nation. And, Senator Hill, you replied that up to that time you had not yet received a measure from the Department of Health, Education, and Welfare for legislation to strengthen and to expand programs of the Vocational Rehabilitation Administration. Well, shortly thereafter this bill, S. 1525, on which Dr. Ellwood and I propose to testify this morning, was introduced and our American Rehabilitation Foundation Medical Advisory Committee met here in Washington 10 days ago and went over this bill, S. 1525, line by line and made our own reactions and recommendations as a group. This is a significant group which meets here three or four times a year to discuss how to advance the rehabilitation of the handicapped from the medical as well as from the vocational standpoint. We have certain recommendations then to make with regard to this bill, S. 1525. To begin with, our opinion was that the $10 million in the President's budget to implement this very significant piece of legislation was, perhaps, insufficient; that it was inadequate to achieve the goals which are so significant and the promise of this bill. We feel that this is the most significant bill to be introduced with regard to rehabilitation of the handicapped since the legislative action of 1954. We feel, too, that our American Rehabilitation Foundation's appearance before your committee, Senator Hill, in 1960 and the further development of the medical program was a significant step forward but this is even more significant if this legislation can be passed. We felt that with regard to the first measure which was to begin in 1967 that it might well be started, that is, the construction might well be started in the 1966 instead of the 1967 fiscal year and we wish to make that recommendation. Now, we who are medically oriented and who are concerned primarily with medical rehabilitation are strongly of the opinion that we cannot achieve much in regard to the medical rehabilitation of the handicapped unless we have parallel development of the vocational rehabilitation programs, and we were very happy to see grants made this year to establish increasing programs in rehabilitation such as the center in Hot Springs and the center in my own State of Pennsylvania at Johnstown, and we feel that this is extremely significant. As I worked in the early days in this field in the Mayo Clinic in Rochester, Minn., I became keenly aware of the needs for the parallel development of medical and vocational rehabilitation, so much so that I went to work and got established in that small community our own vocationally oriented center, the ability building center, as we called it, the ABC center. When I worked as medical director at the Kenny Institute in Minneapolis and as president of the Board of Health of the State of Minnesota, I took steps with the board to get the Minneapolis Rehabilitation Center which is vocationally oriented and the medical rehabilitation center, the Kenny Institute now directed by Dr. Ellwood next door to each other, so that they could work in parallel fashion to serve the handicapped of this Nation. Now, this bill produces very significant increases in the development of vocational rehabilitation programs which we believe are so extremely important, because we believe that we should parallel the rehabilitation of the handicapped through these increasing programs in medical rehabilitation and vocational rehabilitation. In the center that I am endeavoring to develop now in Philadelphia, Pa., at Temple University, we are negotiating and developing close liaison with the vocationally oriented Goodwill workshops which are in our community and we plan a joint effort once more just as we had in the Rochester, Minn., area and in the Minneapolis, Minn., area. Again, this bill strengthening the workshop programs, the vocational rehabilitation programs, will be of tremendous significance in serving the handicapped of this Nation. The CHAIRMAN. And you have brought the Minnesota plans to Temple University? Dr. KRUSEN. Yes, sir. As you know, I graduated from Jefferson Medical College where your father once did graduate work. I am |