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“For the purpose of extending benefits to veterans and dependents, the Administrator of Veterans' Affairs may, 'to the extent he deems necessary, procure the necessary space for administrative, clinical, medical, and outpatient treatment purposes by lease, purchase, or construction of buildings

**' 38 U.S.C. 5012(b). The Administrator also has the authority to 'construct and maintain on reservations of Veterans' Administration hospitals and domiciliaries, garages for the accommodation of privately owned automobiles of employees at such hospitals and domiciliaries.' 38 U.S.C. 5004.

“In view of the broad leasing authority of the Administrator, and the congressional policy of providing for the accommodation of privately owned automobiles of Veterans’ Administration hospital employees, there appears to be for consideration only the question of the availability of Veterans'

Administration funds for the contemplated lease. Cf. 43 Comp. Gen. 131.” Notwithstanding the foregoing, it is desirable to have specific statutory authority for the establishment and operation of a parking system which would explicitly provide that fees for the use of such parking facilities may be established not only for employees, but also for visitors and others having business with the facility and that such fees need not be uniform with respect to the various classes of persons.

More specifically, subsection (a) of the amended section 5004 is a repetition of the existing statutory authority to construct and maintain garages for the accommodation of privately owned automobiles of employees, with the exception of the deletion of the last sentence thereof, which now provides that the money received from the use of such garages shall be covered into the Treasury of the United States as miscellaneous receipts.

Subsection (b) is entirely new.

Paragraph (1) thereof provides the basic authority for the establishment, maintenance, and operation of parking facilities.

Paragraph (2) gives the Administrator authority to establish rates and collect fees. It would recognize that such rates could vary when applied to different categories of users, and different circumstances. These rates, however, must be determined on the basis of what is (1) reasonable under the circumstances, (2) necessary in order to amortize the cost of land acquired for parking purposes after the date of the bill's enactment (which would include the fair value of land acquired by trade, transfer or other means), and (3) necessary in order to amortize the cost of improvements and recover the cost of maintenance and operation.

Paragraph (3) authorizes the Administrator to lease or otherwise contract with responsible persons, firms, or corporations for the operation of such parking facilities. This provision would permit sufficient flexibility in the operation of the facilities so that the Administrator may enter into contracts, either in the nature of a concession agreement or a service contract, whichever is deemed appropriate under the specific circumstances. It is contemplated that in some situations, where use of the parking facility is of such volume as to permit a commercially profitable venture, a concession agreement could be reached which would result in payment by the concessionaire for the privilege of operating the facility. On the other hand, there may be situations where it will be necessary to pay for the operation of the parking facility by means of a service contract.

Subsection (c) would provide that money received from the use of the garages and parking facility operations authorized by this section may be credited to the applicable appropriation charged for the cost of operating and maintaining the facilities. Any amount not needed for the maintenance, operation, and repair of the facilities shall be covered into the Treasury of the United States as miscellaneous receipts. Under the existing language of section 5004, the Comptroller General, in an opinion dated January 26, 1965 (B-100883), held that the gross proceeds from the rental of garages, whether collected by payroll deductions or otherwise, must be covered into the Treasury as miscellaneous receipts. In his decision of July 9, 1965, previously cited, the Comptroller indicated that he could not distinguish proceeds received for the rental of garages from those reseived for the rental of parking facilities, and held that the gross proceeds from the rental of parking facilities must likewise be covered into the Treasury of the United States as miscellaneous receipts.

The proposed change in fiscal procedures would be similar to the provisions of section 5012(a) of title 38, United States Code, which provide that the proceeds from leases, less expenses for maintenance, operation and repair of buildings leased for living quarters, shall be covered into the Treasury of the United States as miscellaneous receipts, and would permit the Veterans' Administration to handle all proceeds from the use of living quarters, garages, and parking facilities in the same general manner.



Except for the proposed authority in section 9 of the bill to pay expenses of part-time and temporary full-time physicians, dentists, and nurses while attending professional meetings, there would be no additional expenditure of public funds resulting from the enactment of this bill. While we cannot give an exact estimate of the cost which would be attributable to section 9, we can state definitely that it would be minimal.

Dr. ENGLE. Mr. Chairman, I hope this will receive early and favorable consideration.

Medical sharing bill: S. 2748—A bill to assure adequate and complete medical care for veterans by providing for participation by the Veterans' Administration in medical community planning and for the sharing of advanced medical technology and equipment between the Veterans' Administration and other public and private hospitals.

S. 2748, which was also introduced by the chairman, would authorize the Administrator, when he determines it to be in the best interest of the prevailing standards of the Veterans' Administration medical care program, to enter into agreements providing for the exchange of use (or under certain conditions, the mutual use) of specialized medical facilities between Veterans' Administration hospitals and other public and private hospitals or medical schools in a medical community.

Any such arrangement would include a provision for reciprocal reimbursement based on a charge, unit or otherwise, which covers the full cost of services rendered or supplies used. Any proceeds to the Government resulting from such arrangements would be credited to the applicable Veterans Administration medical appropriation.

In the past decade the dramatic advances in medical science and technology have produced highly specialized and costly staff, procedures, and equipment. Because of the cost of such equipment, and the scarcity of the technical staff required, the availability of such resources is extremely limited. In the ever-changing complex of medicine with all its ramifications, the cost of medical care and treatment will continue to climb for all users. This applies to the Veterans' Administration Department of Medicine and Surgery as well as to community medical facilities.

The Veterans' Administration, which operates the largest single system of medical facilities in the world, has within its system a portion of these scarce medical resources in various locations, and has provided considerable leadership in the field of medical research. This leadership, however, has its attending obligations. Today, the health needs of many communities are not being met either because of the complexity of the problems, or the magnitude of the resources required.

While current law permits the use of our facilities by nonveterans in emergencies for humanitarian reasons, we are unable to permit the use of such facilities and equipment, as well as expertise of our staff, for nonemergent situations even if there are no other similar facilities available. This situation exists even though these scarce medical facilities are not always utilized to the maximum and could be available to the community, without detriment to the care and treatment of veteran beneficiaries, during periods when our immediate needs do not require maximum utilization.

Possession of the newer complex medical diagnostic or treatment modalities in the Veterans' Administration, and others by affiliated or local hospitals, with shared use of each by both groups, would make for more efficient utilization of such diagnostic or treatment modalities at lower unit costs for all. For example, very special facilities, staff, and equipment are necessary for hemodialysis. This is the artificial kidney unit. Sharing some of the costs for such services by mutual use on a time-available basis could have the effect of increasing the Nation's limited supply of scientists and equipment in this field. Senator YARBOROUGH. Doctor, may I interrupt you one moment?

I Dr. ENGLE. Yes, sir.

Senator YARBOROUGH. Is it not true that certain heart operations, as well as this artificial kidney require very expensive equipment? The artificial heart—there are very few places where that can be done.

Dr. ENGLE. Yes, sir; although it is primarily our intent to foster better utilization of the equipment and particularly facilities relating to out-patient attention, rather than to the kind of care that might demand in-patient care.

Senator YARBOROUGH. Rather than to major surgery, like that involving the heart or kidney?

Dr. ENGLE. Yes, sir.
Senator YARBOROUGH. Go ahead.

Dr. ENGLE. Benefits will be gained by both the Veterans' Administration and the entire medical community if we can enter into agreements for the mutual use, or exchange of use, of specialized medical resources. Cooperative use of such equipment should result in a much broader therapeutic armamentarium. In addition, such shared usage of facilities would reduce the need for each hospital to have on its staff highly trained scarce categories of professional personnel. Accordingly, we believe that the proposed agreement will improve our capability to provide complete medical care for veterans.

We do not anticipate that the enactment of the proposed legislation will result in any additional expenditure of public funds. It should, instead, reduce the overall medical costs to the Government for certain of its complex medical-care obligations. As a result, such legislation will in the long run, undoubtedly, result in economic gain to the Government as its full potential is achieved.

Mr. Chairman, we likewise hope that this bill will receive early and favorable consideration by the subcommittee.

H.R. 203—A bill to amend title 38, United States Code, to set aside funds for research into spinal cord injuries and diseases.

The objective of this bill is to require the Administrator to set aside out of appropriated funds at least $100,000 for each of 6 successive fiscal years to be used in conducting research into spinal cord injuries and diseases, and other disabilities that lead to paralysis of the lower extremities.

Mr. Chairman, I would like to point out in the beginning that by its terms and in its context the bill would require the use of funds provided for prosthetics research rather than funds appropriated generally for medical research. The research covered by this bill is not directed to the field of prosthetic and orthopedic appliances and it is our thought that if the bill is favorably considered it should be amended to provide that funds shall be set aside from the general appropriations, for medical research. We shall be glad to cooperate in drafting an amendment to that end if desired.

We estimate that approximately $200,000 was expended in fiscal year 1965 for research directly related to spinal cord injury and disease. There is every reason to expect that the Veterans' Administration will continue to engage in an ample measure of research in the field to which this bill relates and that this will involve expenditures exceeding the amount required to be set aside by the bill each year. Unless there is some thought of supplying statutory emphasis in this area, it is difficult to perceive any justification for this legislation. As indicated in the Administrator's report, we think it would set an unwise precedent for earmarking research funds for various neurological disabilities and diseases, of which there are many.

It is our conviction that for research purposes the nervous system should not be considered in a piecemeal fashion and exclusively in relation to specific disabilities. As an example, multiple sclerosis affects all parts of the nervous system, even though it is also a disease seriously involving the spinal cord. To pursue our research efforts on a fragmentary basis might impair total research in the field of many disabilities related to paralysis of the lower extremities. For these reasons, it is our view that the research program of the Veterans' Administration would be better served if no limitation of this specific nature were enacted.

Mr. Chairman, that completes my statement. We would be happy to answer any questions the members of the subcommittee might have on these proposals.

Senator YARBOROUGH. What about S. 3086, the broad bill?

Dr. ENGLE. Yes, sir. We personally had an opportunity to read this in the Congressional Record of March 15. The agency is in the process of actively evaluating it, but we have not completed our discussions on this proposed legislation and have no formal position on the bill at this time.

Senator YARBOROUGH. I believe my staff has had some conversation with Dr. Wells on this matter. I would like to address a question to Dr. Wells.

Dr. Wells, I believe that if the VA is to assume this major role in forwarding the health aspirations of the country, and this statement so well given by Dr. Engle shows a concept in this regard, it will have to rely heavily on the kinds of people who are generally found in the research and education activities of those institutions where Veterans' Administration hospitals are working in conjunction with some medical schools or some local hospitals or medical institutions. I wonder if you could give us your thoughts on how the VA would work in actually carrying out these objectives, both educational and cooperational?

Dr. WELLS. Mr. Chairman, as you know, we have since 1946 had a very broad program of cooperation, not only with medical schools but with universities that have curriculums pertinent to the health service fields. This involves some 78 of the medical schools and more than 200 universities that cooperate with us in these various programs.

You are quite correct in saying that this is absolutely essential, because by the very nature of the Veterans' Administration service, it is not one that involves all categories of disease, or all categories of patients, and therefore, we have to lean heavily on cooperation. As a matter of fact, I think it may sound a little harsh, but correct, to say that we really do not have training programs of the Veterans'

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Administration. We cooperate in training programs between ourselves and the universities of the Nation.

This is true in all of the types of categories that we conduct. We have put in the Congressional Record of October 18, 1965, in connection with Mr. Teague's bill, a tabulation of an on-duty group of our trainees. We have some 23,000 stipended trainees representing 33 health occupational groups.

Senator YARBOROUGH. How many thousands do you have?
Dr. WELLS. We have a little over 23,000.

Senator YARBOROUGH. That are working for the Veterans' Administration?

Dr. WELLS. At the present time, yes.

Senator YARBOROUGH. And when they complete this training they will go into the health professions of some kind?

Dr. WELLS. Yes, sir; but these people are actually working with the VA at the same time that they have various categories of enrollment with the universities and medical schools. These are all shared programs between us and the schools.

Senator YARBOROUGH. That is 23,000, you say?
Dr. WELLS. Yes, sir.
Senator YARBOROUGH. They are not all in medical schools, are they?

Dr. WELLS. Oh, no, sir; there are many in the ancillary sciences. When we speak of the potential of expansion of the Veterans' Administration in a cooperative way to really make a contribution to the health service manpower field, I think we should give a great deal more emphasis than perhaps we have in the past to our potential to contribute to the ancillary groups, not necessarily the medical and dental groups. After all, this is something we have to wait for the medical schools themselves produce. There is really not much point, for example, in our creating additional positions for interns and residents in the Veterans' Administration, although we certainly make good use of this particular program in the interest of the veteran population, but we, like all other institutions, have something in the order of 18 to 20 percent unfilled positions in the intern and residency fields. So it is not rational to try to expand particularly on this objective. When we speak of expansion, we have in mind, for instance, in the nursing occupations, where there is a tremendous shortage and where we have great facilities that could be used for this. We talk about the social work service groups, the clinical psychology group, the various health occupations that pertain to physic medicine and rehabilitation. We have enormous facilities potential for training in these areas.

It would certainly seem to me that this is where we can make the largest and the most valuable contribution to the Nation's manpower and to health service.

Senator YARBOROUGH. Of course, the Veterans' Administration has a peculiar and varied experience with rehabilitation of injured people.

Dr. WELLS. Right.

Senator YARBOROUGH. I saw the data for the last available year that 52,400,000 Americans were injured in accidents-over 25 percent of our total population. I think it is estimated that, from accidents, there are about 3 million totally disabled people in the country, not counting veterans.

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