TO AMEND THE VOCATIONAL REHABILITATION ACT

TUESDAY, MARCH 30, 1965

U.S. SENATE,

SUBCOMMITTEE ON HEALTH OF THE

COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C.

The subcommittee met, pursuant to recess, at 10 a.m., in room 4232, New Senate Office Building, Senator Lister Hill, chairman of the full committee, presiding.

Present: Senators Hill (presiding) and Javits.

Also present: Senator Kennedy of New York.

Committee staff members present: Stewart E. McClure, chief clerk; Robert W. Barclay, professional staff member; and Roy H. Millenson, minority clerk.

The CHAIRMAN. The hearing will kindly come to order.

I am happy to have with us this morning Dr. Rusk, chairman of the Department of Physical Medicine and Rehabilitation, New York University Medical Center, and director of the Institute of Physical Medicine and Rehabilitation of New York.

Dr. Rusk in a great leader in this field of physical rehabilitation and I say "great leader" not only in our own country but throughout the world.

We are glad to have you here, Dr. Rusk.

STATEMENT OF DR. HOWARD A. RUSK, CHAIRMAN, DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION, NEW YORK UNIVERSITY MEDICAL CENTER, AND DIRECTOR, INSTITUTE OF PHYSICAL MEDICINE AND REHABILITATION, NEW YORK, N.Y. Dr. RUSK. I appreciate the privilege, Mr. Chairman. I will file a formal statement, and will not take up your time to read it.

I am here to speak hopefully in the strong affirmative for S. 1525 and all of its sections.

The CHAIRMAN. We will have your statement appear in full in the record, and you may proceed as you deem best. (See p.91)

Dr. RUSK. Mr. Chairman and members of the subcommittee, there are certain points that I would like to emphasize and that I hope to illustrate.

The first is the section of the bill that specifies grants to State agencies to determine vocational rehabilitation potential. I would like to give you an illustration of this, because this has been one of the great problems in the past. In our own center we have not the usual type of program, because we have had such a tremendously large percentage of severely disabled people. It is only very recently that the State agencies have thought that they could refer to us young

people with broken necks-quadriplegics, paralyzed in both arms and limbs-because they feared there was no vocational potential. We have just done a survey of 365 quadriplegics that we have seen at the institute in the last 5 years as to what they are now doing; 52 percent are either in college or at work in competitive industry and this does not include those who are working at home.

The CHAIRMAN. Might I interrupt you there? You speak about working at home what might they do at home?

Dr. RUSK. Well, I know of two that run telephone answering services. Some do television monitoring. Others do telephone sales. It is in that field where they can use their voice and their personality and they do not need their hands and locomotion.

When I testified before your committee some 3 weeks ago with Dr. DeBakey and my other colleagues on the President's Commission on Heart Disease, Cancer, and Stroke, I reported to you and to the committee a case, the second in medical history following surgery called hemicorporectomy, which is the removal of the lower half of the body. This young 42-year-old man with a family had cancer of the bladder and was given the choice of either 3 months to live and a painful death, or the chance of the operation, if the cancer had not spread, just above the pelvis. He chose the surgery and he was amputated and I reported to you 3 weeks or so ago that he had just come to us and was just able to sit up for a few minutes time.

When we brought him in, he was not a client of the vocational rehabilitation program because he did not at that time have vocational potential. However, in a matter of weeks, we were able to demonstrate to their satisfaction that he could be rehabilitated. This man is now sitting up 12 hours a day. He exercises in a gymnasium. We have just made the first pair of limbs for this individual ever made. for a patient of this type, and he will walk out of the institute and be able to drive a car.

The head of his union has already been contacted and has come to see him and has offered him a position in the union office when hist treatment is finished.

The problem presented by this individual is multiplied by tens of thousands throughout the country. I feel very deeply about this, because as you know, Senator Hill, in medicine we have never shirked the hard tasks and I think that now that we have the general program running to meet the usual run-of-the-mill needs of the disabled that we need opportunity for long-term evaluation of the severely disabled, and especially the mentally retarded, because it is only with that that we can come to definite conclusions. And I think that the money will be well spent, because I believe that those who we can get back into life again-those we can help-will pay severalfold over in taxes on their earnings because of their rehabilitation.

If I may, I would like at this time to express my personal appreciation to you and to the Congress as a whole for the support of this program over the last decade. You have made it possible for us to do what we do in the field by increasing the funds available by tenfold in this period of time and I would like to feel that this is a vote of confidence not only in the program but in the disabled people themselves, because now I think that we have been able to show without question that given the opportunity, they can deliver.

The CHAIRMAN. It is also a vote of confidence, Doctor, in you good people who have administered these programs.

Dr. RUSK. We thank you, sir.

I would like to speak briefly to the second point, the construction of rehabilitation facilities and workshops which I think now is the phase of the program which is all important, where these individuals can be taught vocationally to do the things that they are evaluated for and we feel are able to do from a medical standpoint.

I think this need is ever increasing due to the aging population. I think that we need research in this field to learn new methods and new ways in which we can gear this type of program to our national needs. I give you an example.

Mr. Viscardi of Abilities, Inc., a program you are familiar with, has now had more than 2 years' experience working with the retarded in the computer field, and he has found actually that they have been more accurate, made fewer mistakes, and cut the cost more than 25 percent working alongside the normal. This opens up a whole new field of workshop training geared to present national needs.

I think the questions in some people's minds have been: Will there be teachers available? In my opinion there will be.

The CHAIRMAN. Do you think that there will be the teachers available?

Dr. RUSK. Yes, sir; I think that there is a great reservoir in retired teachers, where the age of retirement in many places is very rigid. And I would say that a majority of those retired teachers are eager to continue teaching in some capacity. They not only have the experience but they have the wisdom that comes with that experience and I think that this would be an ideal group as our first line of defense, the teachers. And I believe that we will have no trouble in getting the teachers for this type of program.

The CHAIRMAN. That is very enlightening and hopeful and encouraging.

Dr. RUSK. I think it is important in this workshop program that we must include allowances for trainees, and provisions for continuing reevaluation of the programs themselves, as well as the technical experience of a certain number of experts.

You know, most of these people-I think around 19 percent of those rehabilitated each year under the State and Federal programs are on public welfare of some kind, and they will have to have a living stipend while they are training. Here again, I think that this money will be well spent.

I would like to comment briefly on the architectural barriers program in this bill which I have been interested in for many years. The CHAIRMAN. You were one of the very few people who have been interested.

Dr. RUSK. Well, we designed the first kitchen that could be operated from a wheelchair, crutches, or with one hand, when our institute operated in an old loft building up on 38th Street, and this was in

1947.

To start the original program we put a string on the spron of one of our paraplegics and gave her a recipe to bake a cake. It took her 356 steps. And we called in Dr. Lillian Gilbreth, the great teacherand by the way, next month she is having her 94th birthday-to come in and do a time and motion study. Three weeks later the same

person baked the same cake with 127 steps. Then we saw that we had a tool, and we designed this kitchen, which has now been copied in principle all over the world. I have seen it in New Zealand and in India, in Pakistan-all over Europe and I think that this was the first step.

Then we designed a house where a person could live and operate it entirely from a wheel chair. And then we realized that many of our patients who needed to go to the post office and to the library and to public buildings to meet those who represented them and to bring them their problems were barred. So a campaign was started about the country in many different spots. And I think it has proven tremendously successful. It is now going on at advanced tempo with the Easter seal organizations, and we have had one very interesting experience in New York.

Five years ago when the Lincoln Center was in the planning, I asked for permission to have lunch with the architect. And I described the need to Mr. Bramowitz and to Mr. Harrison. And the whole Lincoln Center is so designed now so that disabled persons can go any place in the Lincoln Center without a single step. Every toilet room has one cubicle with a wide door that they can get in. Areas are set up so that patients can even go in on a stretcher.

Lincoln Center has found many people who were interested in giving funds to the Lincoln Center so that disabled people could be cared for. So this has been bread cast on the water that has come back, not only with a little butter but maybe a little jam, too, for the Center itself.

I had a letter from a disabled person in Europe who wanted all the data because they were building a new stadium in one of their cities, and he had never seen a soccer game because he could not get in and out. So it is rolling, and I think that this type of support as outlined in S. 1525 will add to its velocity.

I would like to speak especially to the needs for training. As you know, in the President's Commission's report, every subcommittee on heart disease, cancer, and stroke stated unanimously that any program of this type had to be underpinned by a comprehensive rehabilitation program which would meet the needs in all three of these areas. I believe that if funds are made available that dedicated, brilliant young people can be recruited to be trained, particularly multidisciplinary training like the young neurologist who came into my office yesterday afternoon. With 3 years formal training and 2 years in the armed services, he now wants to come back and take 2 years in rehabilitation. This will be the teacher of the future. Many of our young people, among the 60 that we train regularly, would like to have a year in neurology or a year in cardiology. By this cross-fertilizing I believe we see our great hope for the future.

I would like to say a word, too, for the general practitioner, because we have found more and more trainees who are mature practitioners who just cannot keep up with the drive of general practice and who have been frustrated by the unmet needs of their disabled people. Where they dedicate themselves to training in rehabilitation, they go out as mature individuals to meet the needs of the community. Unfortunately for every trainee there are 20 jobs available and great pressure is put on to get these people.

In addition to that, the research and information section of this bill is a very fundamental one. Here, I do not believe that this can be

accomplished if the salary ceilings are held at civil service levels. I think that special incentive salaries will have to be provided as has been done in the Public Health Service, as you well know, because you were the leader in making this possible.

And then there is also the need for automated data systems so that we can all be on the same ground rules and a person can be evaluated in California and we will know what they are talking about in New York and vice versa.

That will be another boon of the computer.

In the training programs it has been stated over and over again that there is a great dearth of therapists in all of the categories. I think the ceiling needs to be raised for the Department so that we can cover that. Now it is 3 years for doctors and 2 years for these other individuals. Those who are going to be teachers really need a year or two more of time. I would like to see this left to the discretion of the Administration, because I believe that if we do not tie their hands, we will salvage some of the teachers and research leaders in this field who now are being lost or are not being totally trained.

It would be my hope that there could be some consideration as to some undergraduate scholarships in the ancillary fields, possibly on a matching basis with the communities, so that if a community was setting up a rehabilitation center, the first one in the community, they know perfectly well and we know perfectly well that the only way we are going to get people is to steal from somebody else. If we could set up a policy whereby the community, for every person they needed, would set up a fellowship for one of their high school youngsters, matching Federal money, then we could get the interest and the knowledge and the understanding so that we would keep bringing more young people into these careers.

I only wish that the Veterans' Administration had done this when they started their program in 1945, because then they would have fed back into the pool thousands of therapists that were taken out of general circulation.

The CHAIRMAN. And this would be a challenge to the people, to the young ones?

Dr. Rusk. That is right, the high school people.

The CHAIRMAN. Is that correct?

Dr. Rusk. Yes, sir. So I would say again that I think that this is a magnificent piece of legislation. I endorse it not only endorse it but will enthusiastically fight for it in any way that I can. And I would like again to express my personal appreciation and that of my colleagues as well, if I can, to be the spokesman for the disabled of the United States and the world, for what you have made possible through your understanding and support.

(The prepared statement of Dr. Howard A. Rusk follows:)

PREPARED STATEMENT OF HOWARD A. RUSK, M.D.

Mr. Chairman, I am Dr. Howard A. Rusk, professor and chairman of the Department of Physical Medicine and Rehabilitation, New York University Medical Center.

I am most grateful, Mr. Chairman, for your invitation to speak with you and your distinguished committee on legislation of such transcendent importance to the future of millions of disabled American citizens. I wish you and the committee to know, at the outset, that I am here today to strongly support S. 1525 and to urge its enactment into law this year.

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