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HOSPITAL CONSTRUCTION
HEARING*'
BEFORE
SUBCOMMITTEE NO. 5
OFTHE
COMMITTEE ON
THE DISTRICT OF COLUMBIA
HOUSE OF REPRESENTATIVES
NINETIETH CONGRESS
SECOND SESSION
ON
H.R. 6526 and S. 1228
TO AUTHORIZE PROJECT GRANTS FOR CONSTRUCTION AND
MODERNIZATION OF HOSPITALS AND OTHER MEDICAL
FACILITIES IN THE DISTRICT OF COLUMBIA
JUNE 17, 1968
Printed for the use of the Committee on the District of Columbia
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U.S. GOVERNMENT PRINTING OFFICE
95-621 WASHINGTON: 1968
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COMMITTEE ON~ THE DISTRICT OF COLUMBIA
JOHN L. McMILLAN, South Carolina, Chairman
THOMAS G. ABERNETHY, Mississippi ANCHER NELSEN, Minnesota
WILLIAM L. DAWSON, Illinois WILLIAM L. SPRINGER, Illinois
JOHN DOWDY, Texas ALVIN E. O'KONSKI, Wisconsin
BASIL L. WHITENER, North Carolina WILLIAM H. HARSHA, Ohio
B. F. SISK, California CHARLES McC. MATHIAS, JR., Maryland
CHARLES C. DIGGS, Ja., Michigan FRANK HORTON, New York
G. ELLIOTT HAGAN, Georgia JOEL T. BROYHILL, Virginia
DON FUQUA, Florida LARRY WINN, JR., Kansas
DONALD M. FRASER, Minnesota GILBERT GUDE, Maryland
BROCK ADAMS, Washington JOHN M. ZWACH, Minnesota
ANDRKW JACOBS, Jx~ Indiana SAM STEIGER, Arizona
E. S. JOHNNY WALKER, New Mexico
PETER N. KYROS, Maine
JAMES T. CLARK, Clerk
CLAYTON S. GASQUE, Staff Director
HAYDEN S. GARBER, Counsel
SUBCOMMITTEE No. 5
B. F. SISK, California, Chairman
BASIL L. WHITENER, North. Carolina WILLIAM H. HARSHA, Ohio
G. ELLIOTT HAGAN, Georgia FRANKUORTON, N~w York
ANDREW JACOBS, Jx., Indiana GILBERT GUDE, Maryland
H. S. JOHNNY WALKER, New Mexico JOHN M. ZWACH, Minnesota
(II)
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CONTENTS
Page
H.R. 6526 (McMillan, by request), a bill to authorize project grants for
construction and modernization of hospitals and other medical facilities
in the District of Columbia I
S. 1228 (Bible, by request), similar bill 3
S. Rept. 944 on 5. 1228 4
STATEMENTS
Broyhill, Hon. Joel T., Representative in Congress from the State of
Virginia 16,69
Children's Hospital, Wallace Werbie, President 47, 53, 61
Department of Health, Education and Welfare:
Graning, Dr. Harald M., Director, Division of Hospital and Medical
Facilities 30
Moscato, John, Special Assistant 30
l).C. Government:
Grant, Dr. Murray, Director, Department of Public Health, accom-
panied by Dr. Reinaldo A. Ferrer, Associate Director for Medical
Care 18
Moyer, Thomas F., Assistant Corporation Counsel 18
Georgetown University, Father R. Byron Collins, Vice President for
Planning and Physical Plant 47,51,59
Hospital Council of the National Capital Area, Inc., William M. Bucher,
Executive Vice President and Director 47
Hospital for Sick Children, Dr. Frederic G. Burke, Medical Director~_. 64
Medical Society for the District of Columbia, Dr. Henry D. Ecker, Im-
mediate Past President 45
Metropolitan Washington Health Facilities Planning Council:
Hannan, William, President 36
McKinney, John, Executive Secretary 36
Washington Hospital Center:
Loughery, Richard M., Administrator 47,50
Ordman, Dr. Charles W., President of the Medical Staff 47, 48
MATERIAL SUBMITTED FOR THE RECORD
Children's Hospital, Wallace Werbie, President, letter dated June 27, 1968
to Chairman Sisk 63
D.C. Government:
Hospital, chart showing needs for construction and modernization~. 22
Letter to Speaker of the House, dated Feb. 15, 1967, submitting draft
of proposed legislation 12
Letter to Chairman McMillan, dated May 31, 1968, reporting on
H.R. 6526 and S. 1228 14
Letter to Chairman Sisk, dated July 11, 1968, supplementing testimony
of Dr. Murray Grant 83
Public Health Advisory Council:
Letter to Chairman McMillan dated May 12, 1967, in support
of H.R. 6526 67
Letter to Chairman McMillan dated June 12, 1968, in support
of 5. 1228 69
Department of Health, Education, and Welfare:
Letter dated July 3, 1968 to Chairman Sisk 81
Letter dated July 10, 1968, to Chairman Sisk 79
Federation of Citizens Associations of the District of Columbia, Dr.
Edward A. Kane, Chairman, Health Committee, Resolution dated
June 8, 1968 67
Health Facilities Planning Council for Metropolitan Washington, D.C.,
William T. Hannan, Chairman, letter to Chairman McMillan dated
May 16, 1967 65
Hospital Council of the National Capital Area, Inc.; Letters dated June 24,
1968, to Chairman Sisk 78
(III)
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HOSPITAL CONSTRUCTION
MONDAY, JUNE 17, 1968
HousE OF REPRESENTATIVES,
S~co~r~ITa~E No. 5 OF TIlE
COMMITTEE ON TIlE DISTRICT OF COLUMBIA,
Washington, D.C.
The subcommittee met, pursuant to notice, at 10 a.m. in room 1310,
Longworth House Office Building, i-ion. B. F. Sisk (Subcommittee
Chairman) presiding.
Members Present: Representatives Sisk (Subcommittee. Chairman),
Whitener, Walker, and Gude.
Also Present: James T. Clark, Clerk; Hayden S. Garber, Counsel;
Sara Watson, Assistant Counsel; Donald Tubridy, Minority Clerk;
md Leonard 0 Hilder, Investig~itor
Mr SI5K The committee will come to 01 dci
Subcommittee No. 5 has before it this morning certain bills to au-
thorize project grants for construction and modernization of hospitals.
`mud other medical facilities heie in the Distiict
Without objection, H R 6526, by oui distinguished Chmm'in of
the full Committee, Mr. McMillan, will be made a part of the re.cord~
Also, S. 1228, by Senator Bible, the Chairman of the Senate Commit-
tee on the District of Columbia, together with the Senate Report (S.
Rept 944) thereon, will be made a p'irt of the recoid, to indic'ite the
extent to which thei e is `m difference in the two bills
(The bills, H.R. 6526 and 5. 1228, and S. Rept. 944 follow:)
(H.R. 6526, 90th Cong., 1st sess., by Mr. McMillan (by request) on Mar. 2, 1967)
A BILL To authorize project grants for construction and modernization of hospitals
and other medical facilities in the District of Columbia
Be it enacted by the Senate and House of Rpiesentatu es of the 11 nited Statcs
of America in Congress assembled, That this Act may be cited as the "District
of Columbia Medical Facilities Construction Act of 1967".
AUTHORIZATION OF APPROP1IIATION5
SFC 2 Tlieie ale authonzed to be sI)plopndted foi the fiscal ye ii ending
June 30, 1967, and for each of the next three fiscal years, such sums a,s may be
necessary to enable the Secretary of the Department of Health, Education, and
Welfare (hereafter referred to as the Secretary), to niake grants `to assist in
the modernization of public or nonprofit private hospitals and in the construction
or modernization of public health centers, long-term care facilities, diagnostic
or treatment centers, rehabilitation facilities, facilities for the mentally retarded,
and community mental health centers in the District of Columbia. Sums so appro-
priated shall iemain a~ ailable until expended
(1)
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APPROVAL OF APPLICATIONS
SEC. 3. (a) An application for a grant with respect to any project may be
approved by the Secretary under this Act only if an application for a grant
with respect to such project has been filed under the Medical Facilities Acts
(which for purposes of this Act means title VI of the Public Health Service Act
or, where appropriate, title II or part C of title I of the Mental Retardation
Facilities and Community Mental Health Centers Construction Act of 1963)
and-
(1) has been approved under the Medical Facilities Acts and the appli-
cation filed under this Act is for additional funds in connection therewith, or
(2) has been denied under the Medical Facilities Acts because insufficient
funds are available from the allotments of the District of Columbia under
such Acts to permit approval of the application.
In determining whether to approve an application for a grant with respect to
any project in the District of Columbia under the Medical Facilities Acts, the
availability of additional funds for such project under this Act shall be taken
iiito consideration; and, in any such case, approval under the Medical Facilities
Acts may be made contingent upon the approval of an application with respect
to such project under this Act and upon such additional funds being made so
available.
(b) The Secretary shall establish criteria for determining the order in which
to approve, under this Act, applications for grants with respect to projects. Such
criteria with respect to construction projects for the same type of facility (or for
modernization projects) shall be the criteria developed by the State agency of
the Ditsrict of Columbia pursuant to the State plan approved under the Medical
Facilities Acts.
(c) In the case of any project with respect to which an application for a
grant is filed under this Act and with respect to which an application for a grant
has been denied under the Medical Facilities Act, such application under this
Act may be approved only if there is compliance with the same terms and condi-
tions (including determination, in accordance with the applicable State plan,
that the project is needed) as are applicabie to applications for grants under
the Medical Facilities Act, other than the availability of sufficient funds in the
appropriate allotment of the District of Columbia.
(d) An application for a grant under this Act with respect to any project
may not be approved unless an opportunity to review the application has been
afforded to a body. found by the Secretary to be a responsible metropolitan area-
wide planning body, and any recommendations of such body that were timely
made have been considered by the appropriate State agency of the District
of Columbia and have been submitted to the Surgeon General in connection with
the ap~Tication.
PAYMENTS
SEC. 4. (a) Payments under this Act with respect to any project shall be
made in the manner provided under the Medical Facilities Act for payments
of the Federal share of the cost of projects for which applications are approved
under such Acts; except that such payments shall also be subject to such rea-
sonable conditions as the Secretary deems appropriate to safeguard the Federal
interest.
(b) The total *of the payments made under this Act with respect to any
project, together with any payments w-ith respect thereto under the Medical
Facilities Act, may not exceed-
(1) in the case of a construction project for a long-term care facility, a
diagnostic or treatment center, or a rehabilitation facility, 662/3 per centum
* of the cost of such project; and *
(2) in the case of any other project (including a .modernization project),
50 per centum of the cost of such project.
RECO%EPY OF PAYME~~TS
SEC. 5. Payments under this Act shall be subject to recovery or recapture
under the same conditions and to the same extent as is provided under the
Medical Facilities Acts w-ith respect to payments made thereunder.
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MEANING OF TERMS
SEC. 6. The terms used in this Act shall have, the same meaning as when used
in the Medical Facilities Acts.
(S. 1228, 90th Cong., 1st sess., by Mr. Bible (by request) on Mar. 8, 1967)
AN AC~~ To authorize project grants for construction and modernizatioa of hospitals
and other medical facilities in the District of Columbia
Be it enacted by the Senate and Honse of Representatives of the United States
of America in Congress assembled, That this Act may be cited as the "District
of Columbia Medical Facilities Construction Act of 1968".
AUTHORIZATION OF APPROPRIATIONS
SEC. 2. There are authorized to be appropriated for the fiscal year ending
June 30, 1968, and for each of the next three fiscal years, such sums as may be
necessary, not to exceed in the aggregate $36,227,000, to enable the Secretary
of the Department of Health, Education, and Welfare (hereafter referred to as
the Secretary), to make grants to assist in the modernization of public or
nonprofit private hospitals and in the construction or modernization of public
health centers, long-term care facilities, including extended care facilities,
diagnostic or treatment centers, rehabilitation facilities, facilities for the
mentally retarded, and community mental health centers in the District of
Columbia. Sums so appropriated shall remain available until expended.
APPROVAL OF APPLICATIONS
SEC. 3. (a) An application for a grant with respect to any project may
be approved by the Secretary under this Act only if an application for a grant
with respect to such project has been filed under the Medical Facilities Acts
(which for purposes of this Act means title VI of the Public Health Service
Act or, where appropriate, title II or part C of title I of `the Mental Retardation
Facilities and Community Mental Health Centers Construction Act of 1963)
(1) has been approved under the Medical Facilities Acts and the applica-
tion filed under this Act is for additional funds in connection therewith, or
(2) has been denied under the Medical Facilities Acts because insuf-
ficient funds are available from the allotments of the District of Columbia
under such Acts to permit approval of the application.
In determining whether to approve an application for a grant with respect to
any project in the District of Columbia under the Medical Facilities Acts, the
availability of additional funds for such project under this Act shall be taken
into consideration and in any such case approval under the Medical Facilities
Acts may be made contingent upon the approval of an application with respect to
such project under this Act and upon such additional funds being made so
available.
(b) The Secretary shall establish criteria for determining the order in which
to approve, under this Act, applications for grants with respect to projects. Such
criteria with respect to construction projects for the same type of facility (or for
modernization projects) shall be the criteria developed by, the State agency of the
District of Columbia pursuant to the State plan approved under the Medical Fa-
cilities Acts.
(c) In the case of any project with respect to which an application for a
grant is filed under this.Act and with respect to which an application for a grant
has been denied under the Medical Facilities Acts, such application under
this Act may be approved only if there is compliance with the same terms
and conditions (including determination, in accordance with the applicable
State plan, that the project is needed) as are applicable to applications for
grants under the Medical Facilities Acts, other than the availability of sufficient
funds in the appropriate allotment of the District of Columbia.
(d) An application for a grant under this Act with respect to any project
may not be approved unless an opportunity to review the application has been
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afforded to a body, found by the Secretary to be a responsible metropolitan
area-wide planning body, and any recommendations of such body that were
timely made have been considered by the appropriate State agency of the
District of Columbia and have been submitted to the Secretary in connection
with the application.
PAYMENTS
SEc. 4. (a) Payments under this Act with respect to any project shall be
made in the manner provided under the Medical Facilities Acts for payment
of the Federal share of the cost of projects for which applications are approved
under such Acts; except that such payments shall also be subject to such rea-
sonable conditions as the Secretary deems appropriate to safeguard the Federal
interest.
(b) The total of the payments made under this Act with respect to any
project, together with any payments with respect thereto under the Medical
Facilities Acts, may not exceed-
(1) in the case of a construction project for a long-term care facility,
including extended care facilities, a diagnostic or treatment center, or a
rehabilitation facility, 06% per centum of the cost of such project; and
(2) in the case of any other project (including a modernization project),
50 per centum of the cost of such project.
RECOVERY OF PAYMENTS
SEC. 5. Payments under this Act shall be subject to recovery or recapture
under the same conditions and to the same extent as is provided under the
Medical Facilities Acts w-ith respect to payments made thereunder.
MEANING OF TERMS
SEC. 0. The terms used in this Act shall have the same meaning as when
used in the Medical Facilities Acts.
Passed the Senate December 15, 1967.
Attest:
FRANCIS R. VALEO, &~cretary.
Referred to the Committee on the District of Columbia, House of Representa-
January 15, 1968.
[90th Cong., 1st sess., Senate Rept. No. 944, Calendar No. 929]
DISTRICT OF COLUMBIA HOSPITAL-MEDICAL FACILITIES
CONSTRUCTION~ ACT
The Committee on the District of Columbia, to which was referred the bill
(S~ 1228) to authorize the establishment of enabling authority legislation for
construction and modernization of hospital and other medical facilities in the
District of Columbia, having considered the same, reports favorably thereon with
amendments and recommends that the bill as amended do pass.
The amendments are as follow-s:
(1) On the first page, line 4, strike out "1967" and insert in lieu thereof
"1968".
(2) On the first page, line 7, strike out "1967" and insert in lieu thereof
"1968".
(3) On the first page, line 8, immediately after "necessary", insert a comma
and the following: "not to exceed in the aggregate $86,227,000,".
(4) On page 2, line 3, immediately after the second comma, insert the
following: "including extended care facilities,".
(5) On page 4, line 10, strike out "Surgeon General" and insert in lieu thereof
~`Secretary".
(6) On page 4. line 25, immediately after the first comma, insert the following:
"including extended care facilities,".
PURPOSES OF THE BILL
The purpose of the bill is to authorize supplementary Federal assistance for
the District of Columbia government for modernization of public or nonprofit
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private hospitals, and for the construction of such health centers, long-term and
extended care facilities, diagnostic or treatment centers, rehabilitation facilities,
community mental health centers, and facilities for the mentally retarded.
The bill would provide additional Federal project grants to those now available
under various programs provided by the Medical Facilities Acts (which for
purposes of this bill means title VI of the Public Health Service Act, including
the Hill-Burton program, or, where appropriate, title II or pt. 0 of title I of
Mental Retardation Facilities and Community Health Construction Act of 1963).
Briefly, this legislation establishes the administrative and programing machin-
cry for this intended or supplemental aid for projects required to be approvable
under construction aid programs-the Hill-Burton program, or the mental
retardation facilities of the mental health center construction programs. In
summary, the bill provides as follows:
(1) For the funding authorization, for purposes of the act for fiscal year
ending June 30, 1968, and for each of the next 3 fiscal years, commencing with
the fiscal year ending June 30, 1969, and concluding with the fiscal year ending
June 30, 1971.
(2) For a maximum funding authorization of $36,227,000, or the portion
thereof as is necessary and supported by the appropriate national program au-
thority and by approval of the Secretary of the Department of Health, Education,
and Welfare.
Supplemental aid would be conditioned upon the sole ground of insufficient
funds under the District's allotments under the respective nationwide programs.
(3) For two types of Federal grants to the District of Columbia government:
(a) Supplementary grants to make up the difference between funds proS
vided for a project under the regular, Federally sponsored Hill-Burton,
mental retardation ~r mental health center programs, and the amount of
funds required to constitute the higher Federal share authorized by this
new legislation; and
(b) Grants for projects enabled to qualify for grants under the Hill-
Burton, mental retardation or community mental health center programs,
provided an application has been filed for a grant under the appropriate
program and has been denied because the project had insufficient priority
or because sufficient funds were unavailable in the applicable allotment to
the District to permit approval of the application.
(4) For approval of grants for construdtion of long-term and extended care
facilities, diagnostic or treatment centers, or rehabilitation facilities that may
not exceed-
(a) 60% percent of the cost of long-term-care or an extendedcare facility,
diagnostic or treatment centers, or rehabilitation facilities; or
(b) 50 percent of the cost of any other project.
(5) For special Federal assistance only if `there is compliance with the same
terms and conditions (including determination that the project is needed in
aocordance with the appropriate State plan for health facilities in the District)
as are applicable to the grants under the Hill-Burton, mental retardation or
mental health center construction programs. Accordingly, such proposed projects
would be reviewed to assure compliance with the State plan and priority system
required under the Federal Hill-Harris mental retardation or community mental
health centers program. Such projects would be required to meet construction
and equipment standards contained in regulations adopted to implement such
programs.
(6) For a mechanism by which a responsible metropolitan areawide planning
body may comment upon the merits of each application. This particular phase
is especially noteworthy because it provides a device by which local representa-
tives, both professional and lay, may consider construction proposals in relation-
ship to the needs and plans of other health institutions or programs in the
Washington, D.C., metropolitan area, wherein the three jurisdictions of the States
of Maryland and Virginia and the District of Columbia are concerned.
BACKGROUND OF FEDERAL AID TO THE DISTRICT OF COLUMBIA
The unique responsibility of the Federal Government to provide financial as-
sistance for the construction of hospitals and other medical facilities in the
District of Columbia has been recognized by the Congress for more than 20 years.
In 1946, Congress~ enacted the Hospital Center Act, authorizing the appropria-
95-621-6S------2
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tion of Federal funds for the construction of the Washington Hospital Center as
a replacement for three independent, nonprofit hospitals. This act required the
District government to pay 50 percent of the net cost to the Federal Government
because at that time a serious hospital bed shortage was evident in the District,
and Congress felt compelled to meet that emergency.
Later extensions and amendments of that act took place, such as the 1951
amendment authorizing Federal grants of up to 50 percent of the cost of con-
structing or renovating hospital facilities generally within the District. The Dis-
trict of Columbia government was required to pay 50 percent of the Federal contri-
bution. Such was reduced to 30 percent by a congressional amendment in 1958
to the Hospital Center Act for grants made after that time. Under the 1951 and
subsequent amendments, grants totaling $17,420,453 were made for hospital
projects having an estimated total cost of $44,400,000, with the fact being today
that practically every public and private hospital in the District of Columbia
having participated in such program. That act expired in 1962.
In 1962 Congress enacted legislation (Public Law 87-460) authorizing special
Federal grants not to exceed $2.5 million for 50 percent of the cost of constructing
an addition to George Washington University Hospital. Funds for this purpose
were appropriated by Congress in fiscal year 1964, and the project is now
completed.
In addition to the Hospital Center Act and Public Law 87-460, both of which
applied solely to the District, Federal financial assistance has been given for the
construction of hospitals and other medical facilities generally in Washington
through two generally applicable Federal programs-the wartime defense hous-
ing and public works program, commonly known as the Lanham Act, and the
hospital and medical facilities construction program, usually called the Hill-
Burton program. Under the Lanham Act, two hospitals in the District received a
Federal contribution of $5,655,000. Under the Hill-Burton program, a total of
$7,194,000 in grants was approved through fiscal year 1966 for 27 projects in the
District of Columbia.
LOCAL PRIVATE FUNDING UNAVAILABLE
The medical necessity for the 1946 Washington Hospital Center Act and its
amendments thereto arose because of the inability of sponsors within the District
of Columbia to raise private capital for hospital construction to meet the
statutory matching requirements of the nationwide Hill-Burton program. As a
result, the District was unable to use certain funds allotted to it under that
program.
Consequently, in 1961 President Kennedy directed the Department of Health,
Education, and Welfare to examine into the District's continuing need for special
assistance to meet health needs because of the District's unique geographic loca-
tion. Factually, Washington, D.C., is the central city of a metropolitan area
wherein some 40 percent or more of the patients who are required to utilize
hospital facilities within the District of Columbia are residents of nearby Mary-
land and Virginia. This bill is the outgrowth of the findings of the Department of
Health, Education, and Welfare originally submitted to the Congress in 1965.
This bill is designed to meet special needs for hospitals and other medical facili-
ties in the District of Columbia by reason of its being the Nation's Capital and
the central city of a large metropolitan area, with an estimated 21/2 million
population expected to increase to 3 billion by 1970.
The special Federal aid made available by the Congress over the past 20 years
for construction of District medical facilities indicates that the Hill-Burton,
mental retardation and mental health center construction programs provide
only a partial answer to the problem of financing the construction of such
facilities in the District.
First, sponsors of projects for such construction in the District of Columbia
experience serious difficulty in raising the non-Federal share of the cost thereof.
Second, the allotment of Hill-Burton funds to the District, which in general is
based on per capita income and population, is low in relationship to the facility
construction demands, considering that hospitals within the District itself care
for a substantial number of residents from suburban Maryland and Virginia.
Nonprofit medical facility groups seeking contributions in Washington do not
have available to them much of the important support from corporate gifts
which are available in other communities. Corporate gifts generally make up to
60 to 70 percent of the total private funds subscribed for constructing hospitals
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in cities the size of the District ; ~ and more than half of these corporate gifts
come from manufacturing corporations. The District, however, has only about 14
percent of the per capita potential of metropolitan areas of comparable popula-
tion for receiving contributions from manufacturing corporations.
Another reason for the difficulty experienced by project sponsors in the District
in securing funds to meet the non-Federal share of the cost of construction of
hospitals and other medical facilities is that, although the average income in the
District is among the highest in the country, a large proportion of those on the
upper part of the income scale are temporary residents who do not feel an
obligation to support capital improvement drives to the same extent that perma-
nent residents here or elsewhere do, or indeed, to the extent that these same
temporary Washington residents feel in relation to their "home" communities.
This factor has made it difficult to raise money for these facilities in the amounts
which might be expected if the average income alone were used' as a guide.
Likewise, unique medical facility utilization and cOnstruction problems exist
in the District because of the large number of patients from nearby Maryland
and Virginia who occupy general hospital beds in the District.. A survey con-
ducted in 1958 showed that approximately 40 percent of the patients in District
hospitals came from outside the District, primarily from the Maryland and
Virginia counties in the metropolitan area.
A study of the residence of patients admitted to general hospitals in the
District during the week of February 25-March 3, 1962, showed similar results:
only 58 percent of those patients were District residents. If Distric't of Colum-
bia General and Freedman's Hospitals, which are operated locally by the District
and Federal Governments, respectively, were excluded from this latter study, a
significantly higher percentage of patients in all Di'strict of Columbia hospitals
from outside the District would be found, ranging up to nearly 60 percent in
the case of Georgetown' University Hospital. The Hill-Burton, mental retardation
and community mental health center čonstruction legislative provisions do not
recognize this factor in `the allocation of funds. As compared with other S'tates,
a wider disparity exists in the District of Columbia between Federal funds avail-
`ible for health facilities construction and tile need and dem'tnd for such funds
NEED FOil LEGISLATION
Your committee believes that this legislation is not only a necessary substitute
for the outdated Hospital Center Act but in addition, it includes legislative
features which (1) take advantage of advances made in recent years in the
planning, design, and construction of health facilities; and (2) provide an orderly
mechanism for consideration of construction proposals by local, District of
Columbia, and Federal officials who are skilled' in the planning, design, and
construction of hospitals and other health facilities, prior to consideration of
such construction proposals by the Congress.
Presently in the District of Columbia, there is a total of 4,879 general hos-
pital beds, with additional facilities for 200 more at `George Washington Uni-
versity and Georgetown University. Hospitals.
Statistics supplied to the committee by the Health Facilities Planning Council
for Metropolitan Washington showed that the total hospital beds in the District
of Columbia have an annual utilization rate of 84.7 percent. which means that
on a given day of the year an average of 4,147 beds is being utilized and of these,
at least 40 percent, or 1,659 beds, are being used by residents of nearby Mary-
land and Virginia, leaving 2,488 beds for use by District residents. Furthermore,
the average length of stay for a patient in any one of these beds is 8.1 days.
Obviously, the Maryland and Virginia residents either prefer the medical
facilities located in the District of Columbia or such facilities are not as readily
available in their States of residence. Whatever the reason, the District's hos-
pitals face a greater patient influx than would be the case if the District were
not the unique geographic and governmental unit it is.
Presently, excessive occupancy of acute hospital beds within the District must
continue until such time as sufficient nursing home beds become available. Esti-
mates place this need in the Washington metropolitan area at 3 000 beds of w hmch
1 "Survey of Municipal Hospital Facilities." by J. B. Steinle (l~957), indicating that
industrial and commercial concerns account for 70 to 80 percent of all private donations
to hospitals.
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more than 600 beds can be used immediately in the Di~trict. Presently, the
District has 2513 beds in. 26 licensed nursing homes which are being occupied
near the 100-percent figure throughout the year.
LONG-TERM-CARE FACILITIES INADEQUATE
The need for Federal aid is most acute in the case of long-term-care facilities,
one of the principal aims of the medicare program nationally and especially im-
portant in the District because Congress is expected to clear this session enabling
legislation already passed by both Houses, placing the District under medicaid
coverage. The lack of private fundraising potential for construction of these
facilities is even more pronounced, than in the case of short-term-care facilities-
as demonstrated by the fact that the District has been able to use little of the
money available to it under the Hill-Burton program for construction of long-
term-care facilities, due to inability to raise the required matching funds.
The District of Columbia Department of Public Health advised the committee
that 272 additional long-term-care beds are needed and 204 other long-term-care
beds require modernization or replacement in the District. Assuming an average
cost of $10,000 per bed, the total cost of construction and modernizing long-term
beds amounts to $4.7 million, whereas the annual Hill-Burton allotment to the
District of Columbia for this purpose is only $200,000.
For the reasons cited above, special Federal assistance for the modernization
of hospitals and the construction or modernization of other medical facilities in
the District of Columbia is clearly required. To make up for the loss of normal
private sources of support in the District, Federal grants should cover up to two-
thirds of the cost of construction projects for a long-term-care facility, a diag-
nostic or treatment center, or a rehabilitation facility. The urgency of the need
for such facilities and the relatively greater difficulty in securing financing for
the non-Federal share of the cost of their construction, justifies a higher match-
ing ratio than in the case of short-term-care facilities.
Federal grants under this bill would not b~ available to provide additional
short-term acute general hospital beds. The I-Iealth Facilities Planning council
for Metropolitan Washington has found that additional general beds in the
District of Colunibia will not be needed until after 1975. If this should change,
however, additional authority can be sought from the Congress to construct
additional general hospital beds, commensurate with the need existing at that
time.
Your committee believes that the emerging patterns of health care nation-
wide, as already evidenced within the medicare and medicaid programs, point to
the need in urban cities, such as Washington, D.C., for medical complexes rang-
ing, from specialized acute care-both physical and mental-to ambulatory
facilities, self-care units, and long-term-care facilities providing extended con-
valescent care. The bill under consideration provides a higher Federal share for
long-term and extended care and ambulatory care facility construction as an
incentive to the construction of these less costly facilities. This action should help
to stabilize the cost of medical care and at the same time reduce the pressures
for more acute care beds which are more expensive to construct and operate.
COST OF LEGISLATION
Supplementary Federal grants permitted under this legislation during the
period ending June 30, 1971, could not exceed $36,227,000 under the authorization
maxhnum of this bill. To support the physical need for this bill, the District of
Columbia Department of Public Health submitted the accompanying table set-
ting forth current plans for hospitals and other health facilities in the District
of Columbia.
While the justification for each of these construction proposals would be re-
quired to meet standards laid down in the appropriate sections of the Medical
Facilities Acts and the Mental Retardation Facilities and Community Health
Construction Act of 1963, the statistical table illustrates the magnitude of the
problem as viewed presently without attempting to project the need for 5 of
10 years in this fastest growing metropolitan area in the country. An example
of the inadequacy of Federal funds presently available to the District under
the Hill-Burton program to construct and modernize needed general hospital
facilities is the fact that the Hill-Burton allotment to the District Of fiscal year
1968 is $441,619 compared to the current need of $36,227,000.
PAGENO="0013"
CONSTRUCTION NEEDS FOR DISTRICT OF COLUMBIA HOSPITALS AND MEDICAL FACILITIES
Hospital:
Casualty 210
40 100 200 Medical education and staffing expansion of
physio-therapy and outpatient facilities.
200-bed nursing home
Emergency rooni and basement
11 45 0 Emergency power generator
Improvement and expansion of existing facilities_
89 0 New hospital3
50 30 Replacement and additional beds
30 Master plan, phases II and Ill
2 Emergency generator
Centralized nir conditioning for operating and de-
livery rooms, increase examining rooms, convert
pantry to 2-bed room, new flooring for central
sterilizing room, alteration of delivery suite, re-
placement and improvement of heating in nurs-
eries, installation of a pediatric laboratory, and
replacement of a roof.
140 Remodeling and expansion of present facilities_ - - -
10 Remodeling of 1948 building
Remodel emergency room
Remodel premature nursery
Remodel urology --
2d floor north-heart station and pulmonary func-
tion and treatment center.
ESTIMATED EXPENDITURES FOR GENERAL AND LONG-TERM HOSPITAL AND MEDICAL FACILITIES UNDER 5. 1228 THROUGH JUNE 30, 1971
Current bed
Number of beds
Planned
Present
estimated Federal
share
capacity
Name of facility - --
General Long
term
to be added
----- --- Other facilities
General Long
term
estimated
to be provided cost
(thou-
sands)
(thousands)
Estimated
date of
completion
-
Total
Hill-
Harris
5. 1228
Children's 205
Children's Convalescent
Columbia 152
Georgetown University 377 20
George Washington University 400
See footnotes at end of table.
$12, 350 $6, 174 0 $6, 175 (1)
5, 000 3,333 0 3,333 (1)
541 271 $200 71 (1)
93 47 31 16 October 1968.
2 905 146 146 0 December 1967.
22,000 11,000 0 11,000 1974.
1, 150 575 575 0 April 1968.
2,500 1,333 0 1,333 1973 and 1977.
55 18 18 0 November 1967.
154 77 38 39 April 1968.1
414, 871 2. 435 71 2, 364 December 1970.
~10, 500 3, 929 709 3, 220 November 1968.
474 237 183 54 December 1968.
30 15 0 15 Do.
50 25 0 25 Do.
1,500 750 0 750 1969.
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CONSTRUCTION NEEDS FOR DISTRICT OF COLUMBIA HOSPITALS AND MEDICAL FACILITIES-Continued
ESTIMATED EXPENDITURES FOR GENERAL AND LONG-TERM HOSPITAL AND MEDICAL FACILITIES UNDER 5. 1228 THROUGH JUNE 30, 1971-Continued
Name of facility
-
Ge
Current bed
capacity
-
neral Long
term
Number of beds
to be added
------------- Other facilities 1
General Long
term
Planned Present
estimated
o be provided cost -
(thou- Total
sands)
estimated Fed
(thousands)
eral share
.
.
Estimated.
--4----
Hill- :`
Harris
-----
5. 1228
date of
completion
Hospital:
Hadley
Morris Cat ritz Memorial
Sibley
Washington Hospital Center
85
298 82 100 Nursing home $1,300 $867 $578. $289 (1).
309
251 99 300 Modernization 276 138 78 60 (1).
Extended care unit 6,500 4,333 0 4,333 1972.
Emergency electric powerplant 800 400 0 400 (1).
Glenn Dale Hospital . 235 200 Bed expansion by use of existing porches 1,500 1,000 0 1,000 1972.
Modernization of kitchen, physiotherapy and occu- 500 250 0 250 1972.
pational therapy, and expansion of operating
suite.
83, 049 37, 354 2, 627 34, 727
6,000 3,000 1,500 1,500 1971.
Total, hospitals 2,287 438 585 860
Other: Area B (District of Columbia De- Comprehensive health center
partment of Public Health facility).
Total estimated expenditures 89,049 40,354 4,127 36,227
1 Not known.
Includes $393,000 NIH-funded project.
3 This replaces existing beds and adds 89 new beds.
4 $10,000,000 direct Federal grant for experimental purposes.
$2,500,000 congressional appropriation and $121,158 NIH project.
Note: In summary, it is estimated that the total expenditure for additions and improvements to
general and long-term hospital and other medical facilities in the District of Columbia through the
end of fiscal year 1971 will be approximately $89,000,000 of Which $4,100,000 will be covered by
the existing Medical Facilities Acts and $36,200,000 would be provided under S. 1228.
PAGENO="0015"
11
COMMIITEE AME\DME~ TS
Amendments 1 and 2 make the necessary date chaliges.'
Amendment 3: Your committee was unanimous in the judgment that an
authorization maximum for the aniount of supplementary Federal grants per-
mitted by this bill should be written into the legislation. The committee concluded
that $36,227,000 would meet the requirements for the period during which the
supplementary grant program would remain in effect for the District'of Columbia
under this bill. `This amount was supported' by particular project justifications
set forth in `the' table,' `entitled~ "Construction Needs for `District of Columbia
Hospitals and Medical Facilities," earlier in this report.
Amendments 4 and 6: As reported, these amendments, as set forth on page
1 of this report, would provide clarification of the term "long-term-care facilities"
by adding "including extended care facilities." Such amendments would include
"extended care facilities" as being available to receive supplementary Federal
grants to assist in their construction or modernization' along with the categories~
of facilities covered.
These amendments, advocated by the District of Columbia Medical Society,
w-ere supported on the basis `that the greatest need in health facilities construction
in the District is for extended care facilities. Witnesses testified such would
relieve the load on general hospitals and thereby reduce hospital costs to the
family, the insurers, and the' Government. Availability of extended care facilities
would permit patients to be released from general hospitals earlier. "Long-term-
care facilities" are ordinarily considered in medical terminology to be domiciliary
care for the elderly. Addition of "including extended care facilities" to the term
"long-term-care facilities" is designed to insure that the two health facility
designations will not be improperly~ confused and to clarify their differing
functions.
Amendment 5: A technical and clarifying amendment to substitute "Secretary"
for "Surgeon General" in the Department of Health, Education, and Welfare.
CONCLUSION
Public hearings were held August 21, 1967, before the Subcommittee of Public
Health, Education, Welfare, and Safety. Supporting. testimony was received
from the Department of Health, Education, and Welfare, the District of Columbia
government, the District of Columbia Medical Society, officials of the Hospital
Council of the National Capital Area, and the Washington Hospital Center. No
opposition was expressed.
Your committee is impressed with the urgency for this legislation because
of the manner by which it proposes to mesh with current national programs of
Federal aid and its comprehensive approach to orderly and effective implementa-
tion of the health care facility planning process and the safeguards included.
Therefore, your committee strongly recommends is passage, as amended.
SECTION-BY-SECTION ANALYSIS
The first section sets out the title "District of Columbia Medical Facilities
Construction Act of 1968."
Section 2 authorizes total appropriations not to exceed $30,227,000 for fiscal
years ending June 30, 1968, 1969, 1970, and 1971 for the Secretary of the Depart-
ment of Health, Education, and Welfare (hereinafter "Secretary") to make
grants to assist in the modernization of public or private nonprofit general
hospitals and the construction or modernization of public health centers, long-
term-care facilities including extended care facilities, diagnostic or treatment
centers, rehabilitation facilities, facilities for the mentally retarded, and corn-
munty mental health centers.
Section 3(a) provides that the Secretary may approve grant applications only
if an application has been filed under the Medical Facilities Acts (title VI of the
Public Health Service Act (Hill-Burton Act) or title II or pt. C of title I of the
Mental Retardation Facilities and Community Mental Health Centers Construc-
tion Act of 1963), and such application either has been approved under the
Medical Facilities Acts and the application is for additional funds, or it would
have been approved under these acts except that sufficient funds from District
allotments are not available to permit approval. ,
Availability of funds under this billas required to `be' considered in connection
with the possible approval of applications under the Medical Facilities Act.
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12
Section 3(b) directs the Secretary to establish criteria for the order of approval
of applications which shall be the same criteria as that developed by the District
of Columbia "State agency" pursuant to a plan approved under the Medical
Facilities Act.
Section 3(c) provides that applications for grants under the bill may be
approved only if they comply with the terms and conditions for applications under
the Medical Facilities Act, other than the availability of suf~cient funds in the
District allotment.
Section 3(d) provides that applications for grants under the bill may not be
approved unless the areawide planning body has an opportunity to review it and
that body's recommendations have been considered by the District "State agency"
and submitted to the Secretary in connection with the application.
Section 4(a) provides that payments shall be made in the manner provided
under the Medical Facilities Acts subject to reasonable conditions imposed by
the Secretary and section 4(b) specifies that total payments, together with pay-
ments under the Medical Facilities Acts, may not exceed-
(1) 66% percent of the cost of a long-term-care facility including extended
care facilities, a diagnostic or treatment center, or a rehabilitation facility; or
(2) 50 percent of the cost of any other project.
Section 5 provides that conditions for recovery of payments shall be the same
as under the Medical Facilities Acts.
Section 6 provides that the meaning of terms used in the bill shall lee the same
as under the Medical Facilities Acts.
Mr. .SIsK. In connection with the District Government's position on
these bills, without objection a letter dated February 15, 1967, signed
by the then President of the Board of Commissioners of the District
of Columbia, Hon. Walter N. Tobriner, will be made a part of the
record; and also a later letter, dated May 31, 1968, signed by Thomas
W. Fletcher, Assistant to Commissioner Washington, will be made a
part of the record.
(The letters referred to follow:)
GOVERNMENT OF THE DISTRICT OF COLUMBIA,
EXECUTIVE OFFICE,
Washington, Februarij 15, 1967.
The Honorable The SPEAKER,
United ~States House of Representatives,
Washington, D.C.
DEAR MB. SPEAKER: The Commissioners of the District of Columbia have the
honor to submit herewith a draft bill "To authorize project grants for construc-
tion and modernization of hospitals and other medical facilities in the District of
Columbia."
The first section of the bill gives it the title "District of Columbia Medical Fa-
cilities Construction Act of 1967".
Section 2 authorizes appropriations for fiscal years ending June 30, 1967, 1968,
1969, and 1970 for the Secretary of the Department of Health, Education, and
Welfare (hereinafter "Secretary") to make grants to assist in the moderniza-
tion of public or private nonprofit general hospitals and the construction or
modernization of public health centers, long-term care facilities, diagnostic or
treatment centers, rehabilitation facilities, facilities for the mentally retarded,
and community mental health centers.
Section 3(a) provides that the Secretary may approve grant applications only
if an application has been filed under the Medical Facilities Acts (title VI of the
Public Health Service Act [Hill-Burton Act] or title II or part C of title I of the
Mental Retardation Facilities and Community Mental Health Centers Construc-
tion Act of 1963), and such application either has been approved under the
Medical Facilities Acts and the application is for additional funds, or it would
have been approved under these Acts except that sufficient funds from District
allotments are not available to permit approval.
Availability of funds under this bill is required to be considered in connection
with the possible approval of applications under the Medical Facilities Act.
`Introduced as HR. 6526 by Chairman MeMillan (by request).
PAGENO="0017"
13
Section 3(b) directs the Secretary to establish criteria for the order of approval
of applications which shall be the same criteria as that developed by the District
of Columbia "State agency" pursuant to a plan approved under the Medical Fa-
cilities Acts.
Section 3(c) provides that applications for grants under the bill may be
approved only if they comply with hte terms and conditions for applications under
the Medical Facilities Act, other than the availability of sufficient funds in the
District allotment.
Section 3(d) provides that applications for grants under the bill may not be
approved `unless the areawide planning body has an opportunity to review it and
that body's recommendations have been considered by the District "S'tate
Agency" and submitted to the Secretary in connection with the application.
Section 4(a) provides that payments shall be made in the manner provided
under `the Medical Facilities Acts subject to reasonable conditions imposed by
the Secretary and section 4(b) specifies that total payments, together with pay-
ments under the Medical Facilities Act's, may not exceed-
(1) 66%% of the cost of a long-term care facility, a diagnostic or treatment
center, or a rehabilitation facility; or
(2) 50% of the cost of any project.
Section 5 provides that conditions for recovery of payments shall be the same
as under the Medical Facilities Acts, and secion 6 provides th'at the meaning
of terms used in the bill shall be the same as under the Medical Facilities Acts.
The purpose of the bill is to authorize Federal assistance for the District of
Columbia, supplementary to that now available under various programs pro-
vided by the Public Health Services A'ct, including the Hill-Burton program and
Mental Retardation Facilities and Community Mental Health Centers Construc-
tion Act of 1963, for modernization of public or nonprofit private hospitals and the
constructi'on of public health centers, long-term care facilities, diagnostic or treat-
ment centers, rehabilitation facilities, facilities for the mentally retarded,
and community mental health centers.
Private nonprofit medical facilities in the District of Columbia have been
unable to take full advantage of the Federal program~s for two reasons. First,
the allocation of funds is based on a formula which takes into consideration the
per capita income of the area. The high per capita income in the District of
Columbia results in a proportionately lower `allocation of funds than would be
the case if per capita income in the District were nearer the natio'nal average.
Presumably, there is `an expectation that the `high income group will readily
contribute toward meeting the non-Federal share of the cost of the project.
Experience in the District of Columbia has indicated, however, that this is
not the case. Many of the residen'ts of the District are in a very real sense
"temporary residents" (although for an indefinite period) whose loyalties
in the matter of contributions to the cost of a hospital project are directed
more toward projects in their home States than toward those in the District
of Columbia.
The `second reason for the inability of the District of Columbia to take full
advantage of these Federal programs is the unavailability in the District of
eorporiite donors, who are in other cities the largest contributors to such
projects.2
Consequently, less money can be expected to be collected for medical facilities
in the District of Columbia than is the case in other jurisdictions where there
is a `higher degree `of permanency of residence and a relatively high incidence
of commercial, manufacturing and industrial activities.
Similarly, in the case of public medical facilities in the District of Columbia,
the low District allocation of funds under these Federal programs and the sub-
stantial percentage of matching funds required from District appropriations
have inhibited participation in these programs by the District. One result of the
present situation was that the cost of a recent modernization program for
D.C. General Hospital was borne almost entirely by District appropriations.
As a result of thi's situation, representatives of the District of Columbia have
for some time worked with representatives of the Department of Health, Edu-
cation, and Welfare on draft legislation, similar `to this bill, which would com-
pensate for these special circumstances by making `additional Federal funds
2 Survey of Municipal Hospital Facflii~es by .T. B. Steinle (1957), Indicating that
industrial and commercial concerns account for 70 to 80 percent of all private donations
to bospitais.
95-621-68----3
PAGENO="0018"
14
available for District projects and which would increase the percentage of the
Federal share for such projects.
Section 3(d) of the bill requires review of application for grants by. a body
found by the Secretary to be a responsible metropolitan areawide planning body.
There is presently in existence and operation in this area the Metropolitan Wash-
ington Health Facilities Planning Council, an areawide planning body sponsored
by the Department of Health, Education, and Welfare. The Commissioners are
informed that if there were no such body in existence, the Department of Health,
Education, and Welfare would consider the requirement of section 3(d) inop-
erative. The Commissioners consider it advisable, however, that the legislative
history of the bill reflect this position of the Department of Health, Education,
and Welfare, so that there will be no problem arising at a later date. With this
understanding, the Commissioners strongly urge the enactment of this bill in its
present form.
The Commissioners have been advised by the Bureau of the Budget that,
from the standpoint of the Administration's program, there is no objection to
the submission of this prOposed legislation to the Congress.
Sincerely yours,
WALTER N. TOBRINER,
President, Board of Commissioners, District of Coinmbia.
GOVERNMENT OF THE DISTRICT OF COLUMBIA,
EXECUTIVE OFFICE,
Washington, D.C., May 31, 11~68.
Hon. JOHN L. MCMILLAN,
Chairman, Committee on the District of Columbia,
United ~8tates House of Representatives,
Washington, D.C.
DEAI~ MR. MCMILLAN: The Government of the District of Columbia has for
report HR. 6526 and 5. 1228, similar bills, "To authorize project grants for con-
struction and modernization of hospitals and other medical facilities in the
District of Columbia."
H.R. 6526 is identical to draft legislation submitted to the Speaker of the
House of Representatives by the President of the former Board of Commissioners
by letter dated February 15, 1967, a copy of which is attached to this report. For
the reasons stated in that letter, the Government of the District of Culumbia
endorses the enactment of legislation of this nature for the construction and im-
provement of medical facilities in the District of Columbia.
5. 1228, as introduced, was identical to H.R. 6526. It was, however, prior to
its passage by the Senate on December 15, 1967, amended to make necessary
changes in dates used in the bill, to include references to extended care facilities
for clarification purposes, and to establish a $36,227,000 authorization maximum
for the amount of supplementary Federal grants. (Senate Report No. 944,
December 14, 1967)
The Government of the District of Columbia concurs in the amendments made
in S. 1228 by the Senate, and recommends that S. 1228 be enacted in lieu of
H.R. 6526. If, however, similar amendments were made in the latter bill, the
District would also favor its enactment.
The Government .of the District of Columbia has been advised by the Bureau
of the Budget that, from the standpoint of the Administration's program, there
is no objection to the submission of this report to the Congress.
Sincerely yours,
/5/ Thomas W. Fletcher
THOMAS W. FLETCHER,
Assistant to the Commissioner.
(For Walter E. Washington, Commissioner).
PURPOSE AND BACKGROUND OF THE LEGISLATION
Mr. SI5K. It is my understanding that the purpose of these bills is
to authorize Federal project grants for the construction and moderniza-
PAGENO="0019"
15
tion of hospitals and other medical facilities in the District of
Columbia.
From the standpoint of background, the responsibility of the Federal
Government to provide financial assistance for the construction of
hospital and other medical facilities in the Nation's Capital has been
recognized by the Congress for the past 20 years.
In 1946, Congress enacted the D.C. Hospital Center Act (Public
Law 648, approved Aug. 7, 1946, 60 Stat. 896) authorizing the ap-
propriation of Federal funds in the amount of $35 million, or 50 per-
cent of the construction costs of the Washington Hospital Center as a
replacement for three independent non-profit hospitals. Since that
time, several extensions of and amendments to that Act were added
until a total of $44.4 million had been authorized, on a matching basis,
for construction projects in connection with every public and private
hospital in the District of Columbia. That Act expired in 1962.
In 1962, Congress enacted Public Law 87-460 (approved May 31,
1962, 76 Stat. 83), authorizing a special Federal grant of $2.5 million
as 50 percent of the cost of construction for an addition to George
Washington University Hospital. These funds were appropriated and
the project has been completed.
In addition to these ucts, Federal financial assistance for the con-
struction of District of Columbia hospitals has been obtained through
two generally applicable Federal programs-the Lanham Act and the
Hill-Burton Act.
Under the Lanham Act (Title 42, U.S.C. 1521), two D.C. hospitals
received a total Federal contribution of $5.655 million, and under the
Hill-Burton program (Title 5, U.S.C. 757) a total of $7.194 million in
grants was approved through fiscal year 1966, for 27 hospital projects
in the city.
PRESENT NEEDS
Today there is a demonstrated need for the $36,227,000 authorized
in the bill for the construction of needed medical facilities in the Dis-
trict, in addition to the $49 million in matching funds which the insti-
tutions themselves would be required to provide.
I might say right here it is possible there will be an amendment to
further increase that, maybe something like $4 million.
Under the formula for the allocation of Hill-Burton funds, the Dis-
trict of Columbia will be entitled to only $441,619 in fiscal year 1968,
on a matching basis. The demonstrated inability of District resources
to meet these capital needs is the same now as when the Washington
Hospital Center Act was enacted.
The most urgent needs of the D.C. medical facilities today are in
the area of extended care. This proposed legislation, in addition to
assisting with modernizwtion needs, would provide special incentives
to D.C. health care institutions to develop these extended facilities
and programs by providing Federal matching funds to the extent of
662/~ percent of the construction costs.
As to the `differences in the two bills which I requested be put in the
record, 5.1228, which was approved by the other body on December 15,
1967,. differs from H.IR. 6526, introduced `by Chairman McMillan, in
only one major respect. Whereas H.R. 6526 would provide for an "open
end" authorization for the appropriations, the Senate amended the
PAGENO="0020"
16
legislation to establish a ceiling of $36,227,000 for these appropriations,
which would be authorized over the next three fiscal years.
At this time the Chair would like to place in the record a statement
by our colleague, Mr. Joel T. Broyhill of Virginia, who had hoped to
be before the conmiittee this morning. Unfortunately, he is unable to
be here, and without objection Mr. Broyhill's statement will be made
a part of the record at this point.
REMARKS OP HON. 3~OEL T. BROYHILL, REPRESENTATIVE IN
CONGRESS PROM THE STATE OP VIRGThIIA
Mr. Chairman: I am delighted to support H.R. 6526 as a Bill that is
vitally necessary to provide hospital and medical center facilities in
the District of Columbia. This Bill recognizes the pressing and per-
haps staggering needs of the hospitals and medical centers that provide
essential patient care for the residents of the District of Columbia as
well as for the residents in the neighboring Virginia and Maryland
nearby areas. This Bill (which is under the sponsorship of the Hos-
pital Council of The National Capital Area) is the result of many years
of planning by the individual Hospitals and Medical Centers under
the guidance of the Hospital Council as the planning agency for the
area hospitals and medical centers. I have recognized that the Hill
Burton program for the District of Columbia do'es not provide either
adequate or fair funding for the federally impacted area of Greater
Metropolitan Washington. This Bill should be enacted immediately
so that the hospitals and medical centers can at once start to meet the
patient service needs that exist right nw.
This Bill has a well conceived planning structure to provide area
wide planning and coordinated effort of the hospitals and medical
centers as they struggle to meet the impact of Medicare and the metro-
politan area's strident growth.
There is one essential feature to make this program effective which
is not in the present form of the Bill. This feature is a provision for
federal loans at a low interest rate over an extended period of years.
The hospitals and medical centers need this loan provision if they
are to achieve their necessary construction to meet metropolitan area
needs.
It would be unrealistic to state that these private institutions could
raise the matching money without borrowing, since their public drive
support is principally used to meet operating expenses. The exceed-
ingly high rates of interest that these institutions would have to pay
from private financing in the present money market places an unbear-
able burden of increased repayment cost on the hospitals and medical
centers which would have to be passed on to the patient, raising the
patient costs to unprecedented high charges-perhaps even unbearable.
In order for these private institutions to meet the construction back-
log of pressing needs now, they need the availability of these loan
funds. To delay the timing of this necessary construction will only
increase the costs since construction costs climb every year.
There is another particular point in this Bill in which I am deeply
interested. That is the provision of allotment to Georgetown Uni-
versity Medical Center. The provision in the Senate version of this
PAGENO="0021"
17
bill showed Georgetown University at a construction program of
$14,871,000, with a request for $2,364,000 from funds under this Bill.
Since that time Georgetown University Medical Center `has under-
taken to start the `construction of diagnostic and treatment facilities
that are a planned part of the hospital bed renovation program. Also
the associated clinical instruction space for the professors and medical
and dental students `has started.
The costs of these facilities of the Georgetown University Medical
Center (undertaken `in its efforts to provide health service to the
District of Columbia and the metropolitan area) is $12.461,000. Of
this amount Georgetown University is in critical need of $3,820,000 in
the grant portion of this bill to complete its `facilities.
What are these `facilities? They are new buildings and renovations
to provide additional out patient facilities jo'ined together with special
facilities for mentally retarded `children. Also under construction is a
clinical instruction and research building with associated library space
and clinical dental building.
Are these facilities whi'ch `are being built an asset to the District of
Columbia and to the Washington metropolitan areas in Virginia and
Maryland?
Perhaps a recitation of some of the services that Georgetown Uni-
versity's Medical Center-a privately owned and privately supported
institution-provides through its physicians, dentists, residents and
clinical students will show how much they are needed and show that
indeed they are an asset.
Their faculty physicians, dentists, residents and students serve the
metropolitan community at its clinics and hospitals. In addition
Georgetown University gives medical services to D.C. General Hos-
pital, V.A. Hospital, Children's Hospital, Arlington Hospital and a
variety of clinics and special services of Health dep'artments and
private health agencies.
In 1966-67, there were 49,527 indigent D.C. resident clinic visits at
Georgetown University Medical Center. To this must be added the
several thousands of indigent cases `from the Metropolitan Area outside
the District boundary line. The costs to Georgeto'wn University above
the nominal `char'ges collected was `in excess of $350,000. Together with
its in patient services, the uncollected costs were in excess of $1,000,000.'
At D.C. General Hospital twenty-two members of t'he full-time
faculty of `Georgetown University School of Medicine supervise sixty-
five Georgetown interns and residents and twenty postdoctoral fellows.
The hospital swarms with Georgetown students. Many members of the
full-time and volunteer faculty serve as visiting physi'cians, assuring
that the least `fortunate of our citizens receive the same or better
medical `care than that re'ceived by our more fortunate citizens.
Of the full-time `faculty stationed at D.C. `General, ten receive no
income whatever from the District of Columbia. They are pa'id entirely
by Georgetown University. Georgetown has made a large `commitment
to servi'ce in our city hospital. To be sure, D.C. General provides a
magnificent training ground for our medical students and graduate
trainees in the numerous specialties of medicine. But Georgetown is
there because it wants to be there. Since Georgetown is in the business
of rendering health care, it has assumed the obligation of rendering
PAGENO="0022"
18
health care to all citizens of Washington and the Metropolitan Area,
regardless of economic status, in its own hospital and in the municipal
hospital. (Statistic: In 1965, 5,800 babies were born at D.C. General.
Of these, 2,000 were delivered by Georgetown people, teachers and
students.)
In its service to the federal government besides that of caring for
sick employees of the Federal government, fifty members of the full-
time faculty of the School of Medicine and many members of the
part-time faculty serve as consultants and committee members in the
health and other agencies of the United States government. Many are
members of committees and clinical study panels of the National Insti-
tutes of Health. Others serve the Armed Services, the Veterans Admin-
istration, NASA, the Social Security Administration, CIA and the
Civil Service Commission. All serve at significant material and tem-
poral sacrifice. All feel the obligation to assist in the smooth function-
ing of governmental operations by lending "know how" to the
government's programs in health, education, and research.
in the dental clinics 6500 new patients, many of them children, are
cared for. Of these 50% are from lower income groups.
In the Georgetown University's instruction and clinical programs
there are no re~trictions as to race, color or creed;
The graduates of Georgetown University Medical Center provide
the Metropolitan area with one-fourth of the area's doctors and 50%
of its dentists.
Georgetown University's Medical Center's financial construction
need is critical and urgent in order to complete the program it has
courageously started in its efforts to provide its share of the Wash-
ington Area's health needs.
I recognize this need and the asset Georgetown Tjniversity's Medical
Center is to the community and give my assurance of help to this Bill
and Georgetown's additional request for funds;
I wish also to express my strong support for the amendments to this
proposed legislation which are being offered jointly by spoke:smen for
Georgetown University and for the D.C. Hospital Council.
Mr. SI5K. I understand Dr. Murray Grant has an appointment
this morning and does need to appear as soon as possible so, Dr. Grant,
the Committee will hea.r you to starf out this morning and any others
you might like to have appear with you at this time. Go right ahead.
STATEMENT OF DR. MURRAY GRANT, DIRECTOR, DEPARTMENT OF
PUBLIC HEALTH, DISTRICT OF COLUMBIA; ACCOMPANIED BY
DR. REINALDO A. FERRER, ASSOCIATE DIRECTOR FOR MEDICAL
CARE, DEPARTMENT OF PUBLIC HEALTH, DISTRICT OF CO-
LUMBIA; AND THOMAS MOYER, ASSISTANT CORPORATION
COUNSEL, DISTRICT OF COLUMBIA
Dr. GRANT. Thank you, Mr. Chairman.
I would like first to introduce the two gentlemen with me. To my
left is Dr. Reinaldo Ł Ferrer, Associate Director for Medical Care,
PAGENO="0023"
19
Department of Public Health, District of Columbia; and to my right
is Mr. Thomas Moyer from the Corporation `~ouns~l's Office of the
District of Columbia.
PURPOSE OF THE BILLS
Dr. GRANT. The stated purpose of these Bills is to `authorize project
grants for construction and modernization of hospitals and other
medical facilities in the District of Columbia, supplementary to similar
grants now available to the States and the District of Columbia
under the Hill-Harris and the Mental Retardation Facilities and
Mental Health Centers Construction Act of 1963.
DIFFERENCES BETWEEN THE BILLS
The texts of S. 1228 and H.R. 6526 are slightly different with re-
spect to the following sections of the Bills:
1. Under Section 2 of 5. 1228, "`such sums as m'ay be necessary, not
to exceed in the aggregate $36,227,000," are `authorized through June
30, 1971, while under the same section of H.R. 6526, only "such sums
as may be necessary" `are authorized to be appropriated.
2. Section 2 of 5. 1228 `authorizes grants for construction or modern-
ization of extended care facilities, but Section 2 `of H.R. 6526 does not.
3. Section 3(d) of 5. 1228 calls for submittal of applications for
grants under this Bill to the Secretary of Health, Education and
Welfare, while the same section `of H.R. 6526 calls for `submittal of
applications for grants to the `Surgeon General.
4. Section 4(b) (1) of H.R. 6526 excludes exlended care facilities,
while Section 4(b) (1) of 5. 1228 includes extended care facilities.
EFFECT IN THE DISTRICT OF COLUMBIA
These Bills are designed to provide for taking care of special needs
for modernization of hospitals and con~truction or m'odernization of
other medical facilities in the District of Colun~bia by reason of its
being the Nation's Capital and the central city core of a large metro-
politan area, now with an estimated 2.5 million population and ex-
pected to increase to 3.5 million by 1980.
It is noted that the* funds appropriated under the provisions of
Section 2 of these Bills are to make grants to assist in the moderniza-
tion of public or nonprofit hospitals, and in the construction or mod-
ernization of other medical facilities in the District of `Columbia.
Section 2 is not in harmony with the intended purpose of both bills-
"To authorize project grants for construction and modernization of
hospitals and other medical facilities in the District of `Columbia."
If the funds appropriated by these Bills `are limited to the modern-
ization of public or nonprofit hospitals, such provision would preclude
their utilization in the construction of a new hospital facility, such as
the proposed New Children's Hospital of the District of Columbia,
whch `has been estimated to cost $40.0 million.
PAGENO="0024"
20
NEED IN THE DISTRICT OF COLUMBIA
It has been determined by Congress many times in the past by
special legislation with respect to the expansion, construction, or
reconstruction of specific hospitals and medical facilities that there
are needs in the District over and above those `being met by the various
hospit'al and medical facilities construction Acts, which are applicable
to all the States and the Distri'ct of Columbia.
GENERAL HOSPITAL AND NURSING HOME BEDS
In the District of Columbia there is now a total of 4957 general
hospital beds in existence or approved for construction.' In accord-
ance with the statistical report for `the year ended June 30, 1967 of
the HeaJth Facilities Planning Council for Metropolitan Washington,
these hospital beds have an annual utilization rate of 84.7 percent
compared with a national average of 76.5 percent. This means that on
a given day of the year, an average of 4199 beds are being utilized and
of these it is estimated that 40 percent or 1680 beds are being used by
residents of the surrounding counties, leaving 2519 beds for use by
District residents. Furthermore, the `average length of stay of a patient
in `any one of these `beds is 8.1 days. Also, for the year 1965 2 the occu-
pancy rates of these beds per thousand Metropolitan Washington
Area residents was `as follows:
District of Columbia 1886
Maryland 477
Virginia 565
Comparison of the `above utilization data with that of the United
States indicate's that the beds in the District are being over-utilized.
This fact., plus the existing critical shortage of skilled nursing home
`beds in the District, is now and will continue to be a serious obstacle
in meeting the demands for beds under the Medicare and Medicaid
provisions `of the Social `Security Act. Excessive occupancy of acute
hospitals beds must continue until such time `as sufficient nursing home
beds become available. Estimates of this additional need in the District
range upward from 600. At present, we have in the District 2490 beds
in 26 licensed nursing homes which are being occupied for all prac-
tical purposes close to 100 `percent throughout the year.3
OTHER RELATED HEALTH CARE FACILITIES
Besides the known need for hospital and nursing home beds, annual
surveys made by the D.C. Department of Public Health for the prep-
aration of long range hospital and medical facilities construction plans
under the provisions of the Hill-Harris Act (formerly Hill-Burton)
`Hospital and Medical Facilities Construction Plan, 1968 Revision, D.C. Department of
Public Health.
2jbjd
81966 ~S'urvey of Ertended Care Facilities, D.C. Department of Public Health.
PAGENO="0025"
21
indicate that there is, and will continue to be, need for additional
health care facilities in the following areas: Public Health Community
Centers; Diagnostic and Treatment Centers; Rehabilitation Facilities;
facilities for the Mentally Retarded arid Community Mental Health
Centers within the District of Columbia. Toward the satisfaction of
this need, the Department of Public Health has, in the planning stage,
a health care facility for the near Northwest Area of the District which
will include all the facilities listed. This health care facility will be the
prototype for similar facilities in other areas of the City.
The District is also at a disadvantage in the allocation of funds
under the Hill-Harris Program because of the formula method used
which distrbiutes the funds according to the per captia income and
population of a given State. The District of Columbia has one of the
highest average per capita incomes in the U.S. but as such it does not
reflect the large proportion of the population at or below accepted
medically indigent income levels. Also, when classified as a "State"
for the allocation of Hill-Harris Federal Fund~, ~opu1ation-wise the
District is one of the smallest "States" of the T~nion. Because of the
absence of heavy industry in the area, philanthropic contributions are
not commonly available to help finance the cdnstruction of needed
health care facilities. Government, as the major source of employment
in the District, must replace the absence of this ~hilanthropic base.
At the present time, the District of Columbia is eligible for approxi-
mately $1 million a year for hospital and medical facility construction
as a result of existing Federal legislation. These bills being considered
today would enable the District of Columbia to receive additional
funds urgently needed for the construction of health care facilities.
Our estimated needs for these purposes through June 30, 1971, are
reflected in the attached chart. This document indicates that, over the
next few years, more than $90 million may well be needed for health
care facility construction in the District of Columbia, and that, of
this amount, only a little over $2 million will be available through
existing legislation. We are hopeful, Mr. Chairman, that the bifi being
considered here today will make available an additional $40 million in
Federal funds, still leaving approximately $48 million to be secured
through other sources.
In summary, Mr. Chairman, we recommend enactment of 5. 1228
with the following amendments:
1. In Section 2, the figure of $36,227,000 should be changed to
$40,434,000.
2. Section 2 should be further amended to prOvide that these funds
shall be available for construction as well as ior rnoderni~ation of
hospitals and other medical facilities.
(The following chart was submitted by Dr. Grant for the record:)
95-62i-65------4
PAGENO="0026"
CONSTRUCTION NEEDS FOR DISTRICT OF COLUMBIA HOSPITALS AND MEDICAL FACILITIES
ESTIMATED EXPENDITURES FOR GENERAL AND LONG-TERM HOSPITAL AND MEDICAL FACILITIES UNDER 5. 1228 AND H.R. 6526 THROUGH JUNE 30, 1971
Current bed
Number of beds to
Planned
Estim
ated Federal share
Name of facility
Ge
capacity
-________________
neral Long
term
be added
- Other facilities
General Long
term
estimated
to be provided cost
(thousands)
(thousands)
Estimated date
of completion
Total
--
Hill- H.R. 6526
Harris and S. 1228
Hospital:
Casualty 210 40 100 200 Medical education and staffing expansion of $12, 350 $6, 175 0 $6, 175 (9.
physiotherapy and outpatient facilities.
200 bed nursing home 5, 000 3,333 0 3, 333 (1).
Georgetown University 377 20 140 Remodeling and expansion of present facilities 2_ 14,871 2,435 $71 2,364 December 1970.
George Washington University 400 Remodel premature nursery 30 15 0 15 1969.
Remodel urology 50 25 0 25 1969.
2d floor north-heart station and pulmonary 1, 500 750 0 750 1969.
function and treatment center.
Children's Hospital 205 145 New hospital 40,000 20,000 0 20,000 1972.
Morris Cafritz Memorial 298 82 100 Nursing home 1, 300 867 578 289 (1).
Washington Hospital Center 773 300 Nursing home 6, 500 4,333 0 4, 333 1972.
Emergency electric power plant 800 400 0 400 (1)
Glenn Dale Hospital 235 200 Bed expansion by use of existing porches 1, 500 1, 000 0 1, 000 1972.
Modernization of kitchen, physiotherapy and
occupational therapy, and expansion of operating
suite.
______________________________________ 500 250 0 250 1972.
Total, hospitals - 2,263 377 385 800 84, 401 39, 583 649 38,934
Other: Area B. (District of Columbia De- Comprehensive health center 6, 000 3, 000 1, 500 1, 500 1971.
partment of Public Health facility).
Total estimated expenditures 90, 401 42, 583 2, 149 40,434
I Not known. Note: In summary, it is estimated that the total expenditure for additions and improvements to
2 $10,000,000 direct Federal grant for experimental purposes. general and long-term hospital and other medical facilities in the District of Columbia through the
end of fiscal year 1971 will be approximately $90,401 of which $2,149 will be covered by the existing
medical Facilities Acts and $40,434 would be provided under S. 1228 and H.R. 6526.
PAGENO="0027"
23
Mr. SI5K. Thank you, Dr. Grant.
Mr. Moyer, do you have a statement or any conmients you wish to
make?
Mr. Mo~i~. No. I would like to point out the District's position is
stated in our most recent letter of May 31, 1968, which you have in-
cluded in the hearing record.
Mr. Sisu. Do you have a statement, Dr. Ferrer?
Dr. FERRER. No, sir, no statement.
Mr. SI5K. To clarify your statement, Dr. Grant, the Senate bill as
written actually authorizes a sum not to exceed $36,227,000, while the
House bill is an open-ended authorization, and what you propose is
an amendment to raise the authorization by $4.2 million, is that.
correct?
Dr. GRANT. Yes, sir.
Mr. 515K. I am not sure I followed the first part of your statement.
`What is your specific reason for such increase at this time?
Dr. GRANT. Basically, Mr. Sisk, the construction costs for hospitals
and other medical facilities are continuing to rise. We have revamped
our estimates of what we believe would be the construction costs, and
we believe the figures that we have outlined in our statement are the
best estimates we can make as to the construction costs of this program.
BEDS AVAILABLE
Mr. SI5K. I notice you discuss at some length the relationship be-
tween bed occupancy in the District as compared to the national aver-
age, which would indicate it is somewhat higher in the District than
the national average and would indicate some additional need for
hospital beds in the District. Let me ask you whether or not you have
figures indicating the number of hospital beds available for M & S-
I am talking now about medicai and surgical beds-the average num-
ber of such beds available per capita in the District of Columbia
compared to the national average?
Dr. GRAi~r. I do not have that immediately available. We can sup-
ply that for the record. Our estimate of occupancy rate for those beds
in the District would be higher than the national average, and part
of this is related to the fact some 40 percent of the beds are occupied
by residents outside the District of ColumJbia. `While this is a situation
that obtains in other metropolitan areas as well, I would say our
average occupancy in the District of Columbia in the medical and
surgical `beds is higher than the national average.
Mr. SISK. What I was trying to determine, for example, as I under-
stand when applications by States are pending for funds under the pro-
visions of the Hill-Burton Act-or now the Hill-Harris Act-they
first go into an area and make an examination of a variety of things,
as, specifically, the number of beds compared to per capita population
in that area. As I understand, your statement is that use of District
of `Columbia hospital beds is being made by residents of Maryland
and Virginia. So apparently in these two States, particularly in the
suburban areas, there is a substantial need for additional hospitals to
take care of the residents of those States?
Dr. GRANT. We believe that is true. Those States are attempting
gradually to build up hospital beds but we think this is a great need.
PAGENO="0028"
24
Mr. Sisu. Under the Medicare and Medicaid programs, what is the
relative difference in handling by and `between residents of the Dis-
trict and those that are residents of Virginia or Maryland in District
of Columbia hospitals?
Dr. GRANT. There is no~ difference. They would be eligible for ad-
mission to hosptials in Washington as has been true previously.
Mr. Sisu. You mention the need for nursing home care. It is my
understanding, in talking to some people in the past few weeks, that
there is a great need in the District for so-called intermediate care
or nursing home care. Is that the area in which you find the greatest
need?
Dr. GRANT. Yes, sir, I think this is the greatest need and I think it
will rise both as the result of the Medicaid program and also because
our population in the area is increasingly becoming older. This is true,
of course, of the Nation as a whole, and I think the need for facilities
to take care of middle and old age people will continue to rise.
Mr. Sisu. What percentage of the proposed funds that would be
made available under this legislation, along with matching funds made
available by the District, would be used for intermediate or nursing
home care beds as compared to M & `S beds?
Dr. GRANT. It is difficult to answer that, but I would say that obvi-
ously the allocation of these funds would have to be in consonance with
our State plans for hospital construction, and in those plans we take
into consideration some of the factors presently under discussion along
with many others.
Mr. Sisu. How far along are you on the planning with reference to
the new proposed Children's Hospital here in the District? You made
a reference to that. Unfortunately, I can't pinpoint it, but I think some
$40 million is proposed in that plan, is that right?
Dr. GRANT. We believe that this is roughly the kind of figure we
would be talking about, yes, sir.
Mr. SIsK. As you understand, the bills as presently written do not
authorize money to meet that need?
Dr. GRANT. I would suggest that the way both of these bills are
written at the present time leaves this question up for interpretation,
and I think it would be possible, the way they are currently worded, to
have an interpretation that funds were not available for these purposes,
because the bills indicate clearly the funds would be available only for
modernization of hospitals and other medical facilities, and I think
that could be construed that if a new hospital were to be built there
would be some question as to whether that would come under the pro-
visions of the bills as presently worded. I would suggest an amendment
would be in order so that it would not be subject to that interpretation.
Mr. SISK. Is it your feeling that if the bills were passed with an
amendment raising it to $40 million-plus that such an amendment
would make it possible for funds to be used in new hospital construc-
tion, and would these funds, combined with such other funds that may
be available from the District of Columbia in the way of matching
funds, make it possible for the construction of that Children's
Hospital?
Dr. GRANT. Under the circumstances you cite these funds would be
available and could be disbursed to Children's Hospital in order to
PAGENO="0029"
25
assist them in the construction of a new hospital. Obviously they would
have to find funds from other sources to match the funds available
under this bill.
AVAILABLE FUNDS
Mr. SIsK. One final question: What is the total sum, or approxi-
mate sum, that will be made available to the District under existing
law for medical and hospital needs from the Federal Government?
Dr. GRANT. We receive approximately $1 million a year at the
present time from all sources from existing Federal legislation.
Through June 30, 1971, we will have a little over $2 million available
to us from all these sources for new construction.
Mr. SISK. Thai~k you..
The gentleman from New Mexico.
Mr. WALKER. Thank you, Mr. Chairman.
I have a couple of questions. In S. 1228, on page 1, line 7, I would
assume the reason we have the date June 30, 1968, is that was fixed as
the date when this legislation was started in the last session. I would
think now you would change that to 1969.
Mr. SI5K. Yes. That is a technical change we would want to make.
Mr. WALKER. I am not questioning the bill. It is a technical point.
Also, Dr. Grant, I notice you have left out of your list of hospitals
with construction needs, the D.C. General Hospital, yet you have
included the Glenn Dale Hospital in the program. For the record I
wonder if you will point out why Glenn Dale is included and not D.C.
General?
Dr. GRANT. This is primarily because we have recently completed
a rather large construction and expansion program at D.C. General
Hospital, and while it is true we have in mind certain additional con-
struction activities at D.C. General Hospital, I would doubt these
would be consummated before June of 1971, which is the date we are
discussing. I would assume it would be after that date that we would
be making further construction at D.C. General.
NON-RESIDENT PATIENTS
Mr. WALKER. You presented figures showing the number of patients
from the suburbs treated in the District of Columbia hospitals. Will
you. clarify why so many people from the suburbs use the District of
Columbia hospitals rather than their own hospitals? Aren't there
hospitals in the suburbs?
Dr. GRANT. There are some hospitals in the suburbs, but this relates
to a general question applicable to all metropolitan areas. There is a
tendency for patients residing in the suburbs to have doctors in the
cities, and the doctors are connected with City hospitals and for that
reason t~e patients are placed in one of the City hospitals. In addition
to that, there are not enoughhospital beds in the suburbs at the pres-
ent time to accommodate these patients, and until such time as this
situation is modified, there would be no alternative than for them to
continue to use hospital facilities in the District of Columbia.
Mr. WALKER. The people coming in from the suburbs to use the
District of Columbia hospitals contribute something?
PAGENO="0030"
26
Dr. GRANT. Yes, these are predominantly pay patients and they
themselves are required to pay or pay through third parties.
Mr. WALKER. So it would not make any difference to them if they
were using District of Columbia hospitals or suburban hospitals as far
as these funds are concerned?
Dr. GRANT. I am not sure I understand your question, but what I
think you are getting at is this: In terms of the development of hos-
pital and medical care facilities, if we were to expand these facilities
in the District of Columbia-and we believe this is logical at this
time-it would be important for us to take into consideration that we
will continue for an indefinite time in the future to serve residents of
Maryland and Virginia, and the monies we are requesting therefor
would go into the construction of these facilities in the District of
Columbia.
Mr. WALKER. I am still a little curious. If the Federal Government
furnished these funds to all States, I am curious as to why Maryland
and Virginia wouldn't develop their own facilities to provide for their
own needs?
Dr. GRANT. They have attempted to do so and are building hos-
pitals and medical care facilities but the population has risen at such
a rapid rate it has been impossible for Maryland and Virginia to keep
up with this rise to meet the needs under the Hill-Harris Act.
Mr. WALKER. The population in the District of Columbia has risen
too?
Dr. GRA1~n~. The population of the District of Columbia has in-
creased greatly. We are continuing to try to furnish hospital beds.
Mr. WALKER. I am not fighting the proposal. I am merely trying
to clarify the matter.
Dr. GRANT. I understand.
Mr. SIsK. Will the gentleman yield? You mentioned something
about the number of Maryland residents using District of Columbia
hospitals. Do you have a record of District of Columbia residents who
may be using hospitals in Maryland and Virginia? I assume there are
some.
Dr. GRANT. We do have some but it is very little. The move is in the
opposite direction.
Mr. SIsK. Thank you. The gentleman from Maryland, Mr. Gude.
Mr. GuiE. Thank you, Mr. Chairman.
Dr. Grant, with regard to the average length of stay in hospital
isn't 8.1 days an excessively high figure?
Dr. GRANT. No, sir. I don't know what it is for the country as a
whole but I believe it is about seven for the country as a whole, so we
are a little high but not too much.
Mr. GUDE. Does the lack of aftercare homes contribute to this
lengthy stay in hospitals?
Dr. GRANT. I think the lack or paucity of aftercare facilities does
contribute to this situation.
PATIENT COSTS
Mr. GUDE. What is the cost of keeping a patient in an aftercare
facility compared to a regular hospital?
Dr. GRA~r. The cost of hospitalization in the acute general hos-
pital in the District of Columbia varies from $38 to $83 a day, depend-
PAGENO="0031"
27
ing on the hospital. The cost of taking care of a patient in an inter-
mediate or nursing home facility would range between $20 and $30 a
day, much less than in a general hospital.
Mr. GtrDE. So there would be a considerable saving by. having more
aftercare facilities?
Dr. GRANT. I would think so, yes, sir.
`Mr. GIJDE. I understand there is a long waiting period for patients
seeking care at the emergency facility at D.C. General Hospital. Are
these all emergency cases? I have heard of people having to wait
eight hours for care.
Dr. GRANT. We have approximately 70,000 emergency visits at D.C.
General Hospital per year. Of this number, 70 percent are not emer-
gencies, but I would like to report to you that for the past two years or
more we have developed a system whereby every patient coming in the
emergency room at D.C. General Hospital is seen within fifteen min-
utes. The attempt is then made to distinguish between the cases
that are emergencies and those that are not. It is the 70 percent that
are not emergencies that sometimes have to wait for a certain length
of time.
* Mr. GimE. Is it economical to have these people come to D.C. Gen-
eral Hospital?
Dr. GRANT. We are attempting to develop a system `of neighborhood
facilities which we believe, when implemented, and when the Medicaid
program is implemented, should substantially reduce the nunther of
people who go to the emergency room at D.C. General.
Mr. GUDE. Are you getting the necessary funds for these neighbor-
hood facilities?
Dr. GRANT. We are getting funds to implement the Medicaid pro-
gram. We are attempting to change our program in order to develop
a neighborhood health center program.
Mr. GtmE. Thank you.
Mr. SI5K. May I inq~uire what is the average per bed per day cost
at D.C. General Hospital?
Dr. GRANT. The present cost at D.C. `General Hospital is $73.91 per
patient per day.
Mr. `SIsK. $73.91?
Dr. `GRANT. Yes, sir.
Mr. SI5K. Per `bed per patient?
Dr. GRANT. Yes, sir, per day.
Mr. SIsK. We are not talking about any doctor bills or anything of
that kind?
Dr. GRANT. No, sir, this is hospital cost.
Mr. SI5K. $73.91?
Dr. GRANT. Yes, sir.
Mr. SIsK. How does that compare with the national average?
Dr. GRANT. The national average at the present time is lower than
that. The latest figures are for 1965 so we don't have the up-to-date fig-
ures, but, as you know, hospital costs are increasing rapidly all over the
country and while that figure is a little `higher than the national aver-
age, I don't think it is much higher. I think you `will find that while
it is true many hospitals are lower than that, many are higher. Many
hospitals are rapidly approaching $100 a day.
PAGENO="0032"
28
Mr. SI5K. Do you happen by any chance to have that same figure for
1960?
Dr. GRANT. Not offhand, Mr. Chairman. I would have to supply it
for the record.
Mr. SIsK. Can you give me the percentage annual rate of increaseS
for 1962, 1963, 1964 and 1965?
Dr. GRANT. I can give the rate of increase from last year to this
year, which was between 16 and 20 percent. It is 16 or 20 percent higher
this year than last year.
Mr. SI5K. How do you account. for that?
Dr. GRANT. Primarily this year because of salaries, particularly for
the nursing staff and auxiliary staff. Nurses' salaries have gone up from
a starting salary of $5500 to a starting salary of $7,000 in the last two
years in the whole WTashington Metropolitan area. This has contributed
greatly to hospital costs because the nursing staff at D. C. General 1-los-
pital is between 40 and 50 percent of the total staff.
Mr. SISK. I am aware, of course, of the high cost of medical care
throughout the Nation. I Imow something about it in my home town
where we work closely with the managers of the various hospitals
I am curious as to where we are going nationally. I am not sure of
the exact situation, but I understand from the press and others that
there were much of the facilities in D.C. General Hospital unused for
a considerable period of time primarily because you didn't have the
personnel. What is the situation today?
Dr. GRANT. We currently have 324 registered nurses at D.C. Gen-
eral. We have 84 vacancies. This is better than was true in January
but it is still not good. With this rate of vacancies there are two things
we can do. We can either maintain a certain number of beds vacant or
we can attempt to recruit sub-professional staff such as nurse assist-
ants to provide the care now furnished by nurses. We have been en-
deavoring to follow the latter road and would hope to fill the beds
by this kind of a program.
Mr. SI5K. We are talking here about a construction program during
the next three or four years. $90 million, I believe, is the figure you
named as `the amount needed for health care facility construction in
the District of Columbia. If at the present time 20 or 25 percent of the
facilities of D.C. General Hospital cannot be used because of the lack
of personnel. What specifically are you and other concerned with this
situation in the District of Columbia doing to improve conditions as
to recruiting and training of personnel?
Dr. GRANT. I will be glad to relate to this. I would like to clarify
something before I report on that. What I have indicated as existing
in D.C. General Hospital does not obtain in all hospitals in the Dis-
trict. There is at least one hospital that is worse off than D.C. General,
but most are better off than D.C. General.
Mr. SIsK. Is that because of salary differentials or other things?
Dr. GRANT. There are a lot of fadbors involved in that. There is in
essence no major salary differential in the Washington area at the
present time, but I would hasten to point out you are absolutely cor-
rect that one of our most serious problems today relates to a severe
shortage of manpower. We have in fact endeavored during the past
four years to develop trarning programs in the District for nurses. We
have had refresher programs to bring nurses back in the fold, so to
PAGENO="0033"
29
:speak. And we are developing training programs for practical nurses
and ~thers, and have been endeavoring to develop a program for
practical nurses and others, and have been endeavoring to develop a
program for nurses' training and for the training of less highly skilled
personnel. I think the next few years will find an increased use of the
less qualified personnel to do work presently being done by nurses. We
think it is time to reduce the time spent by nurses on non-nursing du-
ties such as delivering reports and doing things that can be done by
messengers or less highly qualified personnel. I think we must reduce
the non-nursing type duties presently performed by nurses.
I would further submit, looking ahead perhaps ten years, that we
will see more practical nurses and nursing assistants taking over many
of the duties of ~professional nurses, and the professional nurses will act
as their trainers, because I think even bearing in mind there are addi-
tional nurses coming out of nursing schools, the need for them is in-
creasing and we will not be able to have sufficient of them by using
only professional nurses.
Mr. SIsK. Thank, you Doctor. Congressman Giide of Maryland
referred to your testimony that 8.1 days was the average length of hos-
pital stay per patient. Have you noticed any substantial increase in that
figure since the enactment and operation of the Medicare and Medicaid
programs?
Dr. GRANT. There has been essentially no change in this area of the
per diem utilization rate compared to what it was prior to Medicare.
There has been relatively no change.
Mr. SIsK. You do not feel, then, Dr. Grant, that the passage of
Medicare and the services made available under that Act have sub-
stantially increased hospital usage over and above the normal need for
hospitals?
Dr. GRANT. The big problem relates to one of the things that I have
indicated in my testimony, namely, that the current bed utilization rate
in the Washington area is so high, roughly 85 percent, that it would be
impossible really for additional patients because most hospitals are
pretty well occupied. The problem is waiting lists to get into the hos-
pitals. Until and unless we get to the point where we can construct
additional beds it is not possible for the utilization rate to go higher
because the beds are not available.
Mr. SIsK. Thank you, Dr. Grant. I think you have made a very
excellent witness.
The gentleman from Maryland?
Mr. GUDE. Dr. Grant, in regard to the $73.91 per day cost, does this
run higher than for other subdivisions of the country, such as States,
for example? Could there `be a higher cost here because of the high
caliber of the facilities whereas in some areas you have hospitals which
do not have these types of facilities.
Dr. GRANT. Let me try to respond in a different way. The only valid
kind of comparison you can make would be between this and another
similar type of hospital, of which there are many throughout the
country.
I would suggest to you in making that kind of comparison you would
find that some of these hospitals have a per diem rate lower than D.C.
`General and some would be higher.
i~5-G21-68-5
PAGENO="0034"
30
Mr. GUDE. My point was whether the fact that in some areas you
have general hospitals which do not have facilities for intensive heart
care, for example, which are to be found in nearly every hospital in the
District-
Dr. GRANT. I really do not think that is the major factor involved.
The major factor involved here, I think, is the effect of the Federal
Civil Service salary structure upon the salaries of clerical staff, partic-
ularly, which tends to be higher in the Washington area than in other
areas of the country. That is true of some of the lower G.S. staffs. Our
salaries tend to be a little higher than in some other areas but we have
to maintain these levels in order to maintain our competitive situation
in the Washington area.
Mr. GUDE. Has your Department been able to evaluate the exact
cost of a private patient as opposed to the cost of a patient who is on
welfare? You have paying patients at D. C. General and then you have
patieiits who are under public care?
Dr. GRANT. That is correct, but we make no distinction between
these patients and therefore the per diem cost is identical for both.
Mr. GUDE. 1-lave you ever attempted to evaluate whether the cost is
greater in the case of a public patient as opposed to a private patient?
Dr. GRANT. I don't know how we can do that. As an example, we do
not even know in most cases whether in fact the patient is a public
patient or a private patient until after we have seen them, examined
them, made the diagnosis and often treated them. We often do not
Imow that until we have made our financial determination which in
many cases is not made until substantially some time after the patient
has been admitted, and in some cases even after the discharge. There is
no essential difference in the way we handle these patients.
Mr. GUDE. It was my understanding from some of the work I have
seen in Maryland that generally the cost of caring for a public patient
is greater than that of a private patient.
Dr. GRANT. I think what you are saying is that if we use the well-
known dictum that the lower you go down the social economic ladder
the higher the prevalence of disease, if you use that, the point is well
taken; namely, the tendency would be for the stay to be greater on the
part of public patients than private patients for that reason. This point
may well be a good one.
Mr. WALKER. I have no questions.
Mr. SIsK. Dr. Grant, you have made an excellent witness this morn-
ing artd we appreciate your statement.
At this time I believe we have witnesses from the Department of
Health, Edcation, and Welf are.
Dr. Gra.ning, I see you have a statement. You may read the state-
ment or you may extemporize.
STATEMENT OP DR. HARALD M. c-RANING, DIRECTOR OP DIVISION
OP HOSPITAL AND MEDICAL FACILITIES, DEPARTMENT OP
HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY YOHN
MOSCATO, SPECIAL ASSISTANT
Dr. GRANING. Thank you. By way of introduction I have responsi-
bility for the construction of Hill-Burton facilities. I have with me
Mr. John Moscato, Special Assistant to me.
PAGENO="0035"
31
I am pleased to appear before this subcommittee of the House Dis-
trict Committee to present the views of the Department of Health,
Education, and Welfare on H.R. 6526, which is dientical to 5. 1228, a
companion bill that passed the Senate.
They have as their purpose the authorization of project grants that
would assist the construction and modernization of hospitals and other
medical facilities in the District of Columbia.
The Department's views were previously presented before the Senate
Subcommittee on Public Health, Education, Welfare and Safety of the
Committee on the District of Columbia. We are in accord with its
objectives and principal provisions and as the Agency responsible for
administering the proposed grant assistance we recommend its favor-
able consideration by the Congress.
FEDERAL ASSISTANCE
The responsibility of the Federal Government to provide financial
assistance for the construction of hospitals and other medical facilities
in the District of Columbia has been recognized by the Congress for a
number of years. In 1946 Congress enacted the Hospital Center Act,
which authorized the appropriation of Federal funds for the construc-
tion of the Washington Hospital Center as a replacement for three
independent nonprofit hospitals and required the District government
to repay 50 percent of the net cost to the Federal Government.
In 1951 the Hospital Center Act was amended to authorize grants
of up to 50 percent of the cost of constructing or renovating hospital
facilities in the District. The District of Columbia was required to
repay 50 percent of the Federal contribution. This was lowered t~
30 percent in 1958 with respect to grants made after that time. Under
the 1951 and subsequent amendments, grants of $17,420,453 have been
made for projects having an estimated total cost of approximately
$44,400,000. This act expired in 1962.
In 1962 legislation (Public Law 87-460) was enacted authorizing
grants of up to $2.5 million for 50 percent of the cost of constructing
an addition to George Washington University Hospital. Funds for
this pui~pose were appropriated by the Congress in fiscal year 1964
and the project is now complete.
In addition to the Hospital Center Act and Public Law 87-460, both
of which applied solely to the District, Federal financial assistance
has been given for the construction of hospitals and other medica.l
facilities in Washington through two generally applicable Federal
programs-the wartime defense housing and public works program,
commonly referred to as the Lanhain Act, and the program acnthoi~ized
by the title VI of the Public Health Service Act, ~ommonly calle'd the
Hill-Burton program. Under the Lanham Act, two hospitals in the
District received a Federal contribution of $5,655,000. Under the Hill-
Burton program, a total of $7,194,000 in grants was a~pproved through
fiscal year 1966 for 27 projects in the District.
As the special Federal aid previously given for construction of Dis-
trict medical facilities indicate, the Hill-Burton, mental retardation,
and mental health center construction programs provide only a par-
tial answer to the problem of financing the construction of such facili-
ties in the: District. First, sponsors of projects for such construction
PAGENO="0036"
32
in the District of Columbia experience serious' difficulty in raising the
non-Federal share of the `cost thereof. Second, the allotment of funds
to the District, which takes into account per capita income and popu-
lation, is now in relationship to the facility construction problem.
Nonprofit medical facility groups seeking `contributions in Wash-
intgton do not have available to them much of the important support
from corporate gifts which is available in other communities. Cor-
porate gifts often make up 60 to 70 percent of the total private funds
subscribed for constructing hospitals in cities the size of the District;
and more than half of these corporate gifts come from manufacturing
corporations. The District, however, has only about 14 percent of the
per capita potential of metropolitan areas of comparable population
for receiving contributions from such manufacturing corporations.
Another reason for the difficulty experienced by project sponsors
in the District in securing `funds to meet the non-Federal share of the
cost of construction of hospitals and other medical facilities is that,
although the average income here is among the highest in the country,
a large propo'rtion of those on the upper part of the income scale are
temporary residents who do not feel an obligation to~ support capital
improvement drives to the same extent that permanent residents here
or elsewhere do, or indeed, to the extent that these same temporary
Washington residents feel in relation to their own "home" communi-
ties. This factor has made it very difficult to raise money for these
facilities in the amounts which might be expected if the~ `average in-
come alone were used as a guide.
A unique medical facility utilization and construction problem
exists in the District because of the large number of patients from
other "States" who occupy general hospital beds in the District. A sur-
vey conducted in 1958 showed that approximately 40 percent of the pa-
tients in Di~trict hospitals at that time came from outside the District,
primarily from the Maryland and Virginia counties in the metropoli-
tan area. A study of the residence of patiente admitted to general hos-
pitals in the D'istrict during the week of February 25-March, 3, 1962,
showed similar results; only 58 percent of those patients were District
residents.
If District of Columbia General and Freedmen's }-Iospitais were
excluded from this latter study, a significantly higher percentage of
patients from outside the District would be found, ranging up' to
nearly 60 percent in the case of Georgetown University Hospital.
The need for Federal aid is most acute in the case of long-term care
facilities. The lack of private fundraising potential for construction
of these facilities is even more pronounced than in the case of short-
term care facilities-as demonstrated `by the fact that the District has
been unable to use much of the money available to it under the 1-lill-
Burton program for construction of long-term care facilities, due to
inability to raise the required matching `funds.
For the reasons cited above, special Federal as~istance for the mod-
ernization of `hospitals and the constructi'on or modernization of ot'her
medical facilities in the District of `Columbia is clearly require'd. To
make up for the loss of normal private sources of support caused by
the presence of the Federal Government in the District, we believe it
is necessary to have the Federal grants cover up to two-thirds of the
cost of construction projects for a long-term care facility, a diagnostic
PAGENO="0037"
33
or treatment center, or a rehabilitation facility. The urgency of the
need for suoh facilities and the reiatively greater difficulty in securing
financing for the non-Federal share of the cost of their construction,
justifies a higher matching ratio than in the case of short-term care
facilities.
Grants under this legislative proposal would not be available to
provide additional short-term, acute general hospital beds since the
Health Facilities Planning Council for Metropolitan Washington
has found that additional general beds in the District of Columbia
will not be needed until after 1975. If, however, Mr. Chairman, this
contra-indication should change, however, we may, of course, request
authority to construct additional general hospital beds, commensurate
with the need existing at that time.
PROPOSED AMENDMENTS
While we support the principal provisions of the bill, we would like
to suggest two n'iinor amendments. First, since the first fiscal year for
which appropriations would be authorized has already ended, an ap-
propriate modification should be made in section 2 of the bill. Second,
to conform to the provisions of Reorganization Plan No. 3 of 1966,
the reference to "the Surgeon General" in section 3(d), should be
changed to "the Secretary." Subject to these minor amendments, we
would recommend enactment of the bill.
INCREASED COST OF HOSPITAL CARE
Mr. SISK. Thank you, Dr. Graning.
Dr. GRANING. I shall be pleased to answer questions.
Mr. SISK. I believe you were here and heard my discussion with Dr.
Grant with reference to increased hospital costs. He gave us a figure
of $73.91 per bed per day in the District.
In your capacity with the Department of Health, Education, and
Welfare, does it fall within your area of interest to make studies on
where we are going with regard to these costs of hospital care? Do
you have any projections?
Dr. GRANING. Mr. Chairman, we have indeed, and we have been
concerned and yet understanding of what has been going on in this
field.
Modern technological advances are constantly calling for more ad-
vanced ways in which to manage patients. It is true that we have in
a sense become hung up on the term "per diem costs."
It is a very unfortunate way of designating costs, and a hospital
administrator in one of our large university hospitals has expressly
forbidden anyone to use the term "per diem costs", because it is much
more reasonable to talk in terms of service charges.
If one thinks in terms of service charges one can readily see that the
cost for service will vary tremendously with whatever the particular
hospital is proposing to provide.
It should be noted that it was just two years ago or two and a half
years ago that the Congress enacted the Minimum Wage Law. The
Minimum Wage Law really provided a mechanism for correcting a
long-standing social injustice. There were countless hospitals in the
PAGENO="0038"
34
United States in which medical care had in effect been subsidized by
the salaries that were being paid to unskilled personnel in the hos-
pitals. Hospitals had been experiencing a very high personnel turn-
over rate. This has been extremely inefficient. It has been recognized
as being a place where you could go to get a position if no other place
was available, but as soon as you could aspire to a better job people
left these hospitals, and as a result, hospitals were confronted with a
situation in which they had complex equipment cared for by unskilled
personnel, with high turnover rates; they were cognizant that some
of these pieces of equipment were being improperly managed.
A second force has been the introduction of unionization into the
hospital field. These union groups have been asking for what they
considered an appropriate salary for personnel.
As Dr. Grant pointed out in his testimony, the brunt of the rising
costs have been attributable to personal services which in hospital
operations represent about 70 percent of the operating costs.
The service charge as carried by the District of Columbia General
Hospital is certainly within the range of service charges offered by
hospitals of comparable size in the United States.
We have pointed out in our testimony the need for additional long-
term care facilities and extended care facilities in the District. Mani-
festly, if there is a shortage of such facilities it means that patients
have to be cared for in an acute care facility where obviously the
service charge will be much higher than in a long-term care or ex-
tended care facility.
Thus, by building more extended care facilities one could expect
to make a contribution toward reducing the total cost for hospitaliza-
tion.
I would like to point out, sir, that while the service charge has been
going up in hospitals the length of stay has been going down, so the
cost of illness in many instances has been much less, or it has not
been increasing at any rate. You can pay more but you stay a shorter
period of time. Thus theoretically the return of a person to a useful
occupation comes about at an earlier point.
We also feel that there has been far too much attention given to the
care for the horizontal patient and not enough care for the vertical
patient. In this regard hospital communities are given increasing at-
tention to the provision of ambulatory care facilities, and you will
notice in the legislation before you that the higher participation per-
centage is included at 66 and two-thirds percent for long term care
facilities, for ambulatory care facilities (or diagnostic care facilities)
and rehabilitation facilities because we view these as being of greater
public interest.
Mr. SIsK. Thank you, Dr. Graning.
Mr. WHITENER. I have no questions.
Mr. WALKER. I have no questions.
Mr. GUDE. Dr. Graning, in your testimony you mentioned that in
some areas they have corporate support of hospital facilities. Could
you give us some specific examples compared to the situation here in
the District of Columbia?
Dr. GRANING. I can offer this bit. of information. Last year in terms
of philanthropy for various causes throughout the entire United
States health became the second cause-religious causes were first,
PAGENO="0039"
35
education has been second, and health has been third. Last year, how-
ever, for the first time philanthropy contributed more to health than
it did to education.
As I indicated in my testimony, corporation giving in the fund
drives which normally take place in communities where nor~profit
hospitals are proposed, represents the great bulk of the money that
is raised as the matching share.
As I tried to point out in my testimony, the District `of Columbia
does not, according to people who are knowledgable on such matters,
have the potential for corporate giving that Detroit, Chicago, New
York, Cleveland, New Orleans, and other big cities would have.
Mr. GUDE. Do you think you would be able to supply for the record
a comparison of what some of these large cities receive in this area?
Dr. GRANING. We would be very happy, sir.
Mr. GUDE. Compared to what is received in the District of Co-
lumbia?
Dr. GRANING. I would be happy to.
Mr. Gui~. Mr. Chairman, it seems to me it might be important to
have information provided regarding the Federal-local fund ratios
with regard to Federal programs.
Dr. GRANING. Mr. Gude, at the present time, and I was cognizant
of this as I was thinking about appearing this morning, the Federal
share for the country as a whole ranges from one-third to two-thirds
for the construction of facilities.
Here in the District the pres'ent practice has been to give one-third
Federal share for the construction of new hospitals and for modern-
ization and 50 percent for long-term care, diagnostic and treatment
facilities and rehabilitation facilities.
The amount of money which has been made available has not been
adequate and the Federal share has not been enough particularly with
reference to long-term care facilities. This legislation proposes to make
66 and two-thirds percent available for the three categories I men-
tioned earlier.
One clarifying point. I heard the discussion with Dr. Grant regard-
ing modernization and the interpretation of modernization, and also
what could or could not be built in connection with this legislation.
SCOPE OF LEGISLATION
Mr. SISK. Will you comment on that, then, in connection with the
language in your statement at the top of page 6 with reference to the
uses which could be made of the moneys authorized in this proposed
legislation?
I assume that you were saying in this first sentence that there was
not an intention that such funds would be used for the construction
of the new Children's Hospital.
I don't want to put words in your mouth but in line with what you
were about to say I thought you might expand on that.
Dr. GRANING. I appreciate that. The term "modernization" includes
complete replacement, and modernization as administered in the Hill-
Burton Law and as proposed to be administered here, could include a
complete replacement of a facility at another location.
PAGENO="0040"
36
As far as expansion is concerned, if they wish to add additional
beds as that particular project does, then the additional beds could
not be paid for out of this legislation but the replacement of the facili-
ties with the same number of beds could be supported in its entirety by
this legislation. Whether the amount of money made available would
permit it is something else again, but the authorizing legislation has
no contra-indication in it to paying for the modernization of any
facility which includes total replacement. As long as they abandon the
facility they have and move to a more appropriate site and build the
facility that will continue to serve this interest, taking advantage of
modern tecimology, and so on, improving their services, this is entirely
in accordance with the law.
Mr. SIsK. I appreciate having your interpretation. In other words,
it would be permissible under the language of this bill, assuming there
were sufficient money available, to replace a 500-bed hospital outright
by a new facility at a new location or even at the present location.
Dr. GRANING. That is right.
Mr. SI5K. But if you were to add 250 beds to an existing 500-bed'
facility you could not do it, under your interpretation of the language'
within this bill?
Dr. GRANING. That is correct.
Mr. SISK. I am sure you heard Dr. Grant also with reference to the'
proposed amendment to increase the amount by about $4,200,000, which
would bring the total to over $40 million rather than $36.2 million.
Do you support that amendment?
Dr. GRANING. I would think this would be a very conservative fig-.
ure. sir. We would support the amendment.
Mr. 515K. If there are no further questions, thank you very much
for your appearance this morning, Dr. Graning.
We have next a representative from the Metropolitan Washington
Health Facilities Planning Council. Mr. William Haiman.
We are pleased to welcome you, Mr. Hannan.
Without objection your statement can be made part of the record
and you may read it or you may extemporize, which ever you prefer..
STATEMENT OF WILLIAM HANNAN, PItESIDENT, IVIETROPOLITAN'
WASHINGTON HEALTH FACILITIES PLANNING COUNCIL, ACCYOM-
PANIED BY JOHN MeKINNEY, EXECUTIVE SECRETARY
Mr. HANNAN. The Executive Secretary of the Metropolitan Wash-
ington Planning Council, Mr. John McKinney, is here to give me
and you whatever technical information our discussions might bring
forward.
I should like to submit the statement as written by the Health Facil-
ities Planning Council.
With your permission I should like to take a few pieces from it and
then briefly comment on them.
I am William T. Ha.nnan, Chairman of the Board of the Health
Facilities Planning Council for Metropolitan Washington. The Coun-
cil appreciates this opportunity to appear in support of the proposed'
"District of Columbia Medical Facilities Construction Act of 1968"
now before you as H.R. 6526 and the Senate passed bill S. 1228.
PAGENO="0041"
37
H.R. 6526 is identical in substance with l-LR. 15070 in the 89th Con-
gress. Its companion in the Senate, S. 1228, was amended in Committee
and passed by the Senate on December 15, 19~7. I will comment on the
Senate changes a little later on.
PURPOSE OF LEGISLATION
As did their predecessors, these bills embody the Administration
proposals for a temporary program of supplemental aid for moderniza-
tion of hospitals, and for modernization and construction of other
types of health facilities in the District of Columbia. To qualify for
such supplemental aid projects would have to be approvable under
construction aid programs-the Hill-Burton program, or the Mental
Retardation Facilities of the Mental Health Centers Construction
programs. Supplemental aid would be conditioned upon such approval
or the denial of approval upon the sole ground of insufficient funds
under the District's allotments under those programs.
SENATE AMENDMENTS
The Senate amendments make two substantive changes in the pro-
posal. First, an aggregate ceiling of $36,227,000 is imposed on the 4-year
appropriation authorization; and second, clarifying amendments
assure that extended care facilities are included in the types of facilities
for which supplemental grants are authorized. The Council has no
disagreement with these changes.
NEED FOR LEGISLATION
The proposed legislation grew out of growing concern for the pat-
tern of special aids for individual hospital construction projects in the
District-under the Washington Hospital Center Act of 1946 and later
extensions and amendments of that Act. This pattern arose because
the ability of District sponsors to raise private capital does not square
with the basic premises of the nation-wide Hill-Burton program and,
as a result, the District was unable to use considerable sums alloted to
it under that program. In 1961 the Department of Health, Education,
and Welfare was directed by the President to look into the District's
continuing need for special assistance of this kind. The proposed legis-
lation is the outgrowth of the Department's findings. The District's
special difficulties in obtaining the necessary capital financing for
health facilities are amply documented in the Department's July 22,
1965 transmittal letter of the original draft legislation. The Council
emphatically agrees w-ith the Department's conclusion that there
is great need for special assistance for construction and modernization
of health facilities in the District and that such an assistance program
should be put on an orderly basis, subject to review under the same
type of procedures that govern project approval under the basic
construction programs.
The Planning Council was established in April, 1962 with the
assistance of the Public Health Service and under the sponsorship of
the Metropolitan Council of Government. Its purpose is to encourage
area-wide planning for health facilities within the Metropolitan Wash-
95-621-68--------6
PAGENO="0042"
38
ington community in order to further effective expenditure of
available construction dollars and to avoid unnecessary operating
costs. The bill would strengthen such planning efforts by making
review of applications for supplemental grants by a responsible metro-
politan area planning body a required stage in the project approval
procedures. The recommendations of such a body would have to be
taken into account by the District's Hill-Burton agency and submitted
to the Surgeon General; the planning group's views would not be
controlling, however.
AMENDMENT FOR ADDITIONAL BEDS
The Council again urges the Committee to give serious consideration
to broadening the bill to permit supplemental grants for construction
of additional beds. Unless the suburbs can build additional beds to
keep pace with their population growth the pressures on District
hospitals will increase. District hospitals provide annually about two
thirds of all patient. days of hospital care in the entire metropolitan
area. Furthermore, with emerging patterns of care that tend to
concentrate the more costly and complex procedures in institutions
which are at the heart of urban complexes, there may be special
expansion needs in central city hospitals that cannot well be brought
under the "modernization" category. We believe this suggested relaxa-
tion in the uses permitted for supplemental construction grants would
make for a more flexible program without encouraging over-building
in the District. Required review Procedures and current planning
efforts, under this and other programs, should continue the impetus
toward health facility construction in nearby suburbs.
Passage of the "Demonstration Cities and Metropolitan Develop-
ment Act of 1966" (P.L. 89-454) authorized a program of supple-
mental aid for metropolitan development projects. Under title II
of the Act, it would be possible for a hospital or health facility
project that was in accordance with and would further metropolitan
area-wide comprehensive planning and prograniming to obtain a sup-
plemental grant of up to 20% of tile cost of construction, with an
overall ceiling of 80% for total Federal contributions. It is our under-
standing, however, that no appropriations have so far been made to
carry out this program.
After July, the designated area-wide comprehensive planning
agency would also review applications for projects within the metro-
l)olita11 area for construction grants under the basic construction
programs, including the Hill-Burton program. Thus that Act
strengthens over-all metropolitan area planning and provides addi-
tional incentives, through supplemental grants, for an economic and
balanced distribution throughout the area of needed facilities in the
Federally assisted categories (including health facilities).
The partnership for Health legislation further strengthens efforts
toward sound plamming for an effective use of our costly health care
resources.
In conclusion, the Council reaffirms its strong support for 1-LR. 6526
a.nd S. 1228 and urge.s prompt enactment. With the passage of
legislation to enable the District to participate in tile Federally-aided
PAGENO="0043"
39
medical assistance program under Title XIX of the Social Security
Act it is essential to overcome the District's deficit of long-term beds.
The program authorized by the Bills be-fore you should provide sub-
stantial encou~ageinent for sponsors of such projects. The proposal
itself recognizes the great need for such facilities by including them
within the group for which there is a higher matching ceiiing-662/3 %.
Mr. Chairman, the Metropolitan Council of Governments is com-
pletely non-governinentai. We have to go to the private sector of the
community to get budget support. We are a low budget organization
with a huge amount of work done by leading volunteers of the city in
professional field.
We heard Dr. Grant state that as the bill is written there is no pro-
vision for additional beds. You could build a whole new hospital but
you cannot build additional beds.
We feel that this amendment is very much called for.
Mr. SISK. Are you saying that the amendment should be changed
to make it possible for enlargement?
Mr. HANNAN. Yes, sir.
Also, with emerging patterns of care that tend to concentrate the
more costly and complex procedures in institutions which are at the
heart of urban complexes, there may be special expansion needs in cen-
tral city hospitals that cannot be brought under the modernization
category. There are real vital issues. There are serious problems facing
some of our in-town hospitals just in this particular consideration, such
as George Washington University Hospital.
EXTENDED CARE
Now to comment on that which we feel is of uppermost need with
relation to this legislation:
First, there are the extended care facilities. That is the half-way bed
from the hospital. It takes very little observation to conclude that we
cannot longer in this community nor in this country proceed to give
$70 to $80 a day care for patients who could be taken care of in a $20
to $30 facility. This is for the patient passed through the critical post-
operative stage. This could immediately solve two things-first, a
huge cost of hospitalization; a.nd, secondly, the crowding of those acute
beds which we have at the present time.
We feel in the Council that there is a need in the metropolitan area,
and an immediate need, for 2500 such extended ca-re, or so-called long-
term, beds to relieve the acute facilities and to cut in half the cost of
the treatment.
Third, it would make more available the under-trained-not the
graduate nurse but the under-trained. In this the District has a high
hope. If we can implement the program with our new Washington
Technical School whereby you can have two-year programs in this,
it has been demonstrated that we have ample labor potential in the
District of Columbia particularly suited for this.
Therefore we urge that this be made available and that the bill he
adopted in the way it is now presented and with the suggested
amendments.
Mr. SIsK. Thank you for your statement, Mr. Hannan.
PAGENO="0044"
40
As I understand it., you say that an amendment is needed to permit
the addition of beds to already existing hospitals, and that an amend-
ment is also necessary to permit nursing home care or extended care?
Mr. HANNAN. We feel, Mr. Chairman, that an amendment is re-
quired so as to permit, for example, the suburbs to expand their bed
capacity, and having in mind that the bill provides that this should
always be done under a viewing body, a planning body, who would see
to it that there was no over-expansion, that you did not get out of line
with the needs of the whole metropolitan area.
Secondly we feel that the bill as written does permit for extended
care facilities construction, new construction.
However, if there is any doubt in anyone's mind, and it is too late
after it is written, I should like-
Mr. SIsK. I would like to get this pmnecl down. As you know,
we discussed to some extent with Dr. Grant and with Dr. (3-raning.
I see Dr. Graning shaking his head a bit. I hesitate to get out of
order, but., Dr. Graning, did your answer to my question earlier
cover Georgetown Hospital, for example? Let us assume they
desired to build 200 extended care beds as an addition to that hospital.
WTould they be precluded from using this money for that purpose in
your opinion?
Dr. Gn~&NING. Yes, as I understood it, the witness spoke to the need
for being able to build additional beds in a suburban area. We recog-
nize the need for additional beds in the suburban area, but this would
have to be funded under the regular Hill-Burton construction program.
There is no intent that this money would be made available for build-
ing anything in a suburban area. This is limited specifically to the
District.
Mr. Sisic. That is right. Certainly all this money has to be spent
in the District of Columbia.
Dr. GRANING. I support t:he point of the witness that there is need
for additional beds in the suburban area, but those beds would have to
be funded through the Hill-Burton Program.
Mr. HANNAN. That is right.
Dr. GRANING. As far as additional beds in the District are con-
cerned, this legislation does not provide for additional acute care beds,
and as the witness stated it does provide for additional long-term care
beds or extended care beds.
Perhaps the witness can clarify his anwer.
Mr. HANNAN. We are in agreement on this.
Mr. SIsK. Maybe I am the one who is a little slow in the uptake.
I thought I understood you to say, Dr. Graning, in answer to my
initial question, that it would not permit Georgetown-and I cited it
as an example-to build 200 additional beds to their present hospital
for extended care.
Dr. GRANING. For extended care this is possible, yes.
Mr. SI5K. All right. I want that clarified. Perhaps you did not
hear that portion of it. I added "for extended care." I was thinking
of this intermediate care situation which Mr. Hannan was discussing.
You do take the position that this bill does provide for inter-
mediate care beds to be made additional to an existing hospital under
the terms of this legislation?
PAGENO="0045"
41
Perhaps my terminology is not correct, Dr. Graning. When I say
intermediate care I refer to the long-range care, extended care, or
what we call nursing home care at times.
Dr. GRANING. With that interpretation of your meaning of "inter-
mediate care" the bill does provide for the construction of such beds,
yes, sir.
Mr. SI5K. Thank you. I wanted it clear for the record.
Mr. HANNAN. We are agreed, then, sir.
This completes our statement, Mr. Chairman.
Mr. SI5K. Do you support the additional $4 million-plus in the
proposed amendment to this legislation?
Mr. HANNAN. Absolutely. We, too, feel this is a low figure.
Mr. 515K. Thank you, Mr. Hannan.
The gentleman from North Carolina, Mr. Whitener.
NON-RESIDENT PATIENTS
Mr. WHITENER. Mr. Hannan, as I understand your testimony, two-
thirds of the patient load in the District of Columbia hospitals
comes from outside the District of Columbia. Is that correct?
Mr. HANNAN. Our survey shows that.
Mr. WHITENER. Has there been any program for additional fees
to a non-resident in any of these hospitals?
Mr. HANNAN. First of all, the majority of those people who come
in are ordinary paying patients so that they are treated like every-
body else. This is the great majority of them.
Mr. WHITENER. Is there any additional charge made for a non-
resident for hospital service in the District of Columbia?
Mr. HANNAN. No, sir.
Mr. WHITENER. We have had other hearings here which indicate
that a great many of the physicians and surgeons maintain their
offices in the District of Columbia as a matter of convenience but
maintain their residences in the suburban areas, and patients are
directed to Washington hospitals by physicians and surgeons in
many cases because of the convenience of the particular hospitai in
the pattern of practice of that physician or surgeon without regard
to the residence of the patient or physician.
As I interpret your statement you are asking that the taxpayers
of North Carolina and California be asked to supply funds for the
people of Maryland and Virginia which are not available to people
in North Carolina or California. Is that what you are asking?
Mr. HANNAN. First of all, any of these funds come from all over
the country, and it could be from anywhere.
Specifically, however, these patients come because they have avail-
able to them the medical services that that particular hospital and
that particular doctor furnishes.
Mr. WhITENER. That the doctor prefers them to have.
Mr. HANNAN. Prefers medically.
Mr. WHITENER. The same medical facility may be available in
Virginia, near the residence of the patient, but the patient does not
make the decision to come to the hospital in the District. The surgeon
makes that decision because it best accommodates the physician or
surgeon. Is that so?
PAGENO="0046"
42
Mr. HANNAN. Frankly our surveys do not encompass this point.
I am not qualified to answer that.
Generally speaking, however, it is because the particular suburban
hospital didn't have the facility that this patient was required and
this doctor thought he could be best taken care of in the District.
All of this stems from the nature of Washington.
As Dr. Grant said, we have no large corporations here. We have a
completely governmental employee makeup both in Washington and
in Metropoltian Washington.
These people we are talking about are all the same. Indeed, when
you speak of the Virginia hospitals and Maryland hospitals, we are
talking here of the metropolitan hospitals.
Mr. WHITENER. What I am talking about is what the taxpayer in
North Carolina who has no connection whatever with the Washing-
ton metropolitan area is called upon to do for the metropolitan area
here that which the government will not do for the sick peple in
North Carolina.
Mr. HANNAN. Because they are not the Federally oriented people
that the metropolitan area of Washington is, whether they are inside
the District or out..
LOCAL RESPONSIBILITY AND FINANCING
Mr. WHITENER. The record shows that in the District of Columbia
and in its metropolitan area you have the highest per capita income.
I have counties in my district which do not have medical facilities.
\i\That you gentlemen are asking is that the resident of one of my
counties, whch has the second lowest per capita income of any county
in North Carolina, pay taxes to help the high income population of
the District of Columbia and the metropolitan area here to get some-
thing which is not available to that taxpayer in his own State.
Mr. HANNAN. Hill-Burton funds are available to your people, too,
aren't they?
Mr. WHITENER. They are available, but there are not enough Hill-
Burton funds to meet the needs. For your information the people of
my county, who are 80 percent textile workers, have just voted a $10
million bond issue to build a hospital in my home county. Why are
they not entitled to a little bit of help in addition to Hill-Burton?
Mr. HANNAN. The point is this: We may have the highest aver-
age income, but I assure you we have the highest mobility of any
population. These people have their roots in your place and not our
place. These people feel they have their roots there and do not con-
tribute for ~apital things in Washington because they do not consider
wTashjiigtoii their home.
They may have lived here for twenty years but it is not their
home. They still vote in your county and not here.
Mr. WHITENER. That is not an accurate statement. We have testi-
mony here from the District Government asking us to relieve those
people you are talking about from paying any taxes on certain things
which you and I would pay taxes for. If this is so distasteful that you
have a mobility of population then the District Government is taking
an inconsistent position when they testify on the revenue bill and when
they testify on the hospital bill.
PAGENO="0047"
43
Mr. HANNAN. Now I am out of my field.
Mr. WHITENER. Of course, our field is to see that justice and equity
is done. I cannot conceive of an area which has the highest per capita
income in the Nation not being a more fertile area for public sub-
scription to private hospitals than would be true in a low income area.
This is the thing I just do not follow.
I am very interested in helping the Nation's Capital, but I think it
is easier to come here and testify for 30 minutes and get millions than
it is to roll up your sleeves and go out and launch a public subscrip-
tion campaign to get the money. That may be the problem.
If my `district came here and made the presentation that you are
making for itself because it is a poor area I do not think they would
even get off the ground and nobody would pay any attention to them.
Mr. 1-TANNAN. Of course, we cannot have a bond issue without, this
Committee's agreement. In the past this never has been done here for
the reasons I have already stated. We are not allowed to promote a
bond issue here.
Mr. WHITENER. You have a right, and the government does, to fix
taxes on real estate. They have the same fund raising opportunities
that others have.
I might point out that my district does not have any Federal Pay-
ment, either, from which you derive a substantial amount of money.
I believe our folks would trade their right to vote bonds on which
they have to pay taxes to liquidate in exchange for a Federal payment.
I might submit that issue, too.
I am not hostile to hospitals but I just do not understand why it
seems to be the attitude that people here should do nothing for them-
selves but that the people who work in the cotton mills of my district
or on the tobacco farms with less than an acre's allotment or working
in a furniture factory should be paying the cost of hospitalization for
two-thirds of the patients who live in other areas and who constitute a
population which has the highest per capita income in the country.
It does not make sense to me.
I think I can mount a plat-form in any area outside the metropolitan
area and make any member of Congress who felt that way look pretty
stupid.
Mr. HANNAN. Of course, I do not know your county, sir.
EXTENDED CARE
Mr. WHITENER. And you talk about extended care. Do you know
what they are doing all over this country? Medicenter, a private enter-
prise organization, is building extended care facilities in my hometown
and all over the country to take care of the problem that you talk
about. Private enterprise can do that and apparently make a profit
out of it.
Has anything been done here on that?
Mr. HANNAN. Apparently Medicenter has been to Washington and
surveyed this area and found, first of all, that the cost of land is so
high as to send them back before they start. I have spoken to those
people and attempted to have them interested in some of our places.
Secondly, our zoning laws are such as to preclude in many instances
the establishment of this type of center upon the areas which usually
surround our hospitals in the residential areas.
PAGENO="0048"
44
Mr. WHITENER. You mean this is the only regulation which would
preclude the building of a domiciliary facility near a hospital? Who
wrote those laws? Congress did not.
Mr. HANNAN. Yes, it did.
Mr. WHITENER. I think we should look at that, Mr. Chairman.
Mr. HANNAN. It comes closer to being a motel. Obviously zoning
laws would preclude putting a motel anywhere near a hospital.
Until this is clarified, and our planning council is already working
on this, we are afraid it will deter the establishment by private funds
of these facilities.
Mr. WHITENER. Thank you.
Mr. GUDE. I can appreciate Mr. Whitener's concern. I think it might
well be pointed out that many of the Federal establishments we have
here just do not serve the metropolitan area. The Department of De-
fense, the Department of State, the Department of Commerce, for
example, are established to serve all of the citizens of the country
across the board.
Mr. WHITENER. If the gentleman will yield I might point out-
Mr. GUDE. Let me finish my point here.
I know that each area has its problems. I know we have our problems
around Washington
Our neighbor, Baltimore County, where they have a tremendous
company, Bethlehem Steel, perhaps the largest single steel plant in
the world, it makes quite a substantial contribution to community facil-
ities. I know we have nothing in this area comparable to it. I think
the Federal Government stands somewhat in place of such an establish-
ment in our community.
I do not know about the future manufacturers or the textile manu-
facturers or those in these other areas and what their concern is here.
Mr. WHITENER. Your argument could be used by the Fort Bragg
area. There is not just the local interest, but there is the military hos-
pital and the responsibility of that community for medical and hos-
pital facilities of this type. There is no special program for that other
than Hill-Burton which would help them.
The same might be said of Cherry Point Marine Base and Camp
Lejeune Marine Base. That argument does not add a great deal of
weight because it is a bigger burden on the people of a little commu-
nity than it is for this whole metropolitan area here.
Mr. SIsK. If I am comment briefly on this, the anticipated need is
approximately $90 1nilliOn for the next three or four years. This bill
would provide only some $40 million even if the amendment is adopted.
Without joining the discusion there is a substantial contribution on
the part of the local area which will have to be made. They will have
to come up with some $50 million, although this is a special type of
legislation in addition to the Hill-Burton law.
Mr. WHITENER. There is one little town in my home county where
the doctors have traditionally taken their patients to Charlotte, North
Carolina because of the convenience to the doctors. They have been
considering putting an additional fee on any residents of counties
other than the county where Charlotte is located. They raised the
money by public subscription to provide these hospital facilities along
with Hill-Burton and other state assistance programs.
PAGENO="0049"
4:5
I personally have never argued with our neighbors that they were
not right in considering this. It is my feeling that my home county
should not become a burden to our neighboring county. However, I
am a great advocate of hospitals and have a great affection for these
institutions of learning here which are interested in this.
However, I think we will have to try to in some way reach a solution
other than testifying before Congress for three days and getting funds
from the taxpayers of North Carolina and the 50 States.
Mr. GUDE. One of the reasons I am such a strong supporter of the
impacted aid bill is because I think this is a great help to communities
such as yours, those which suffer with military installations. I think
this also can be extended to other things such as hospitals and other
burdens put on the community because of the location of these Federal
installations. I agree.
I also might say that I feel many citizens in our area do not have
enough community spirit and do not support some of the facilities
we have here, and Children's Hospital is a. good example. We have
a wonderful modern facility for children which more of our citizens
should be aware of and support because you can get the best medical
care for a child there than anywhere else in the world.
Mr. `WHITENER. Let me say this. I voted against the impacted aid
bill a few days ago because it has been my experience that every time
the government starts to cut out one phase of any one of these oper-
ations that the people say are such a burden to them, we have delega-
tions from North Carolina of people wanting us to talk to the Depart-
ment of Defense to preserve them. If you started to move one of these
agencies of government out of Maryland or Virginia. they would be
over here marching on the Capitol protesting that it is a great burden.
Mr. SISK. If the Chair might intervene, this legislation will be dis-
cussed in executive session. I appreciate the attitude of my good
friends from North Carolina and Maryland.
Mr. Hannan, we appreciate very much your being here this morn-
ing to give your testimony.
I would like to proceed now with Dr. Ecker, Past President of the
D.C. Medical Society, and I understand a group may come up with
Dr. Ecker. The House has gone into session but I would like to pro-
ceed, if we could, and see how nearly through we could get this
morning.
Mr. BUCHER. Mr. Chairman, immediately after Dr. Ecker finishes
his testimony we can present the testimony of the Hospital Council
of the National Capital Area.
Mr. SIsK. Very well, Dr. Ecker, you may proceed.
STATEMENT OP DR. HENRY D. ECKER, IMMEDIATE PAST PRESI-
DENT, MEDICAL SOOLETY FOR THE DISTRICT OP COLUMBIA
Dr. ECKER. Thank you. Mr. Chairman, I am here to present the
position of the Medical Society of the District of Columbia with
reference to H.R. 6526. The Medical Society of the District of
Columbia wishes to be placed on record as endorsing HR 6526, the
"Thstnct of Columbia Medical Facilities Construction Act of 1967,"
PAGENO="0050"
46
with certain suggestions which we believe will make the enactment of
such legislation more effective.
The p~reatest need in health facilities construction in the District of
Columbia is for extended care facilities both long term and short term.
HR 6526 includes-
Grants to assist in the modernization of public or nonprofit private
hospitals and in the construction or modernization of public health
centers, long-term care facilities, diagnostic or treatment centers, re-
habilitation facilities, facilities for the mentally retarded, and com-
munity health centers.
While continuing to update and increase all health facilities is im-
portant, primary emphasis in this supplementary-grants bill should
be on facilities designed to relieve the load on the general hospital.
Despite all efforts by the medical profession to help reduce hospital
costs to the family, to insurers, and to government, we all recognize
that~ many patients could be released earlier from general hospitals to
less costly facilities, either the short term requiring less expensive
personnel and equipment, or the long-term nursing home type with a
general hospital affiliation. This situation will be aggravated when title
XIX of the Social Security Act is implemented in the District of
Columbia.
Whether such emphasis or priority can be included in HR 6526 or
should be made a part of the intent of Congress, is a matter for your
committee to ascertain. We do believe, however, that some such em-
phasis or priority is essential to best serve the immediate needs.
With reference to the terminology as presently stated in the bill, I
would like to make this comment. The medical society objects to the
"long-term" phraseology because what hospital boards and hospital
administrations and the medical profession are trying to develop in
these days is progressive care. This range is in the spectrum from the
intensive care unit to the domiciliary care type for elderly people
who are unable to care for themselves. The greatest gap in this chain
of progression from intensive care of a seriously and a critically ill
patient to the well patient is in the extended care phase of movement.
The general hospital is still taking care of people who do not require
the sophisticated nursing care and equipment that exists on the acute
wards. They are not quite able to go to self-care units which have
been developed in a number of hospitals.
So, they are kept in the standard ward environment and it is
not only costing them more but they are depriving other potential
patients from entry into our already overcrowded hospital system.
Therefore, we would prefer to see the term "extended care" substi-
tuted for the term "long care."
I would be happy to answer questions, if there are any.
Mr. SIsK. Thank you, Dr. Ecker.
Does the gentleman from North Carolina have any questions?
Mr. WHITENER. No questions.
Mr. SIsK. Thank you, Dr. Ecker. I appreciate your statement this
morning. I believe there will be no questions at this time.
Now we have the Hospital Council of the National Capital Area.
You may proceed, Mr. Bucher.
PAGENO="0051"
47
STATEMENT OF WILLIAM M. BUCHER, EXECUTIVE VICE PRESI-
DENT AND DIRECTOR, HOSPITAL COUNCIL OF THE NATIONAL
CAPITAL AREA, INC., ACCOMPANIED BY: DR. CHARLES W. ORD-
MAN, PRESIDENT OF THE MEDICAL STAFF, WASHINGTON
HOSPITAL CENTER; RICHARD M. LOUGHERY, ADMINISTRATOR,
WASHINGTON HOSPITAL CENTER; FATHER R. BYRON COLLINS,
VICE PRESIDENT FOR PLANNING AND PHYSICAL PLANT,
GEORGETOWN UNIVERSITY; AND WALLACE WERBLE, PRESI-
DENT, CHILDREN'S HOSPITAL
Mr. BUCHER. Mr. Chairman, my name is William M. Bucher. I am
the Executive Vice President and Director of the Hospital Council of
the National Capital Area, Inc. If I may, I would like to call the next
four witnesses to sit with me here. They are: Dr. Charles W. Ordman,
Mr. Loughery, Father Collins, and Mr. Wallace Werbie.
I have a statement which I would like to have entered into the
record, and I would like `to make other housekeeping comments as we
proceed.
Mr. 515K. I believe there are four statements. You have a statement,
Mr. Bucher, and there are statements by Dr. Charles W. Ordman,
Richard M. Loughery, Father Collins, and
Mr. BUCHER. Mr. Werble.
Mr. SI5K. I don't have one for Mr. Werble.
Mr. WERBLE. Here it is.
Mr. SI5K. Actually there are five statements?
Mr. BUCHER. Yes.
Mr. SLSK. Without objection, those five statements will be made a
part of the record at this point.
STATEMENT OF WILLIAM M. BUGlER, THE HOSPITAL COUNCIL OF THE
NATIONAL CAPITAL AREA, INC.
Mr. BUOHER. Mr. Chairman, my name is William M. Bucher, Execu-
tive Vice President and Director of the Hospital Council of the
National Capital Area, Inc.
I am pleased to have the opportunity to testify in support of HR-
6520 as the subject matter of this proposed legislation is of consider-
able importance to the continued provision of economical health care
in the District of Columbia. My statement will be brief and `will cover
primarily the urgent need for this enabling legislation at the earliest
possible date.
Within the District of Columbia there are only a token number of
extended care facilities available for the treatment of patients who do
not require expensive acute general hospital services. For example, the
only non-governmental facilities which could provide the acute general
hospital some relief in the care of such patients are nursing homes
which `are continually occupied at capacity. However, even if nursing
home beds were available, this type of facility does not me~t the specific
needs of most extended care facilities. It has been estimated in the
Washington metropolitan area that upwards of 20% of our patients
could be moved immediately into `an extended care facility, if it were
available.
PAGENO="0052"
48
1 am sure you will appreciate the tremendous savings to be effected.
by the construction of extended care facilities rather than general hos-
pital facilities when you are aware of the difference in cost. The average
cost of construction of an extended care bed is less than 35% of the cost
of an acute general hospital bed. In addition, the expense per day to
the patient may run as little as one half of the expense of care in an
acute general hospital. This principle was soundly recognized by the
Medicare legislation which provides for benefits within the extended.
care facility. Also, placement of patients in an extended care facility
will enable acute general hospitals to ease the shortage of nurses and
other limited personnel categories by using such individuals where they
are needed most-in the care of the acutely ill.
Because the District of Columbia is a unique Federal jurisdiction,.
the remedies available to the states do not solve the problems here.
Under the Hill-Burton Hospital construction program, the District of
Columbia receives an extremely limited annual allocation of approxi-
mately $400,000 per year for all types of health facility construction.
We support the contention of the Metropolitan Washington Health.
Facilities Planning Council in that the existence of neighboring State
boundaries contiguous to the District of Columbia is inconsequential
when related to service programs of our Washington hospital centers.
You will recall that the Presidential Commission on Hospital Costs
called for sweeping innovations in the health care system to reduce the
costs involved. We believe that this program for construction of ex-
tended care facilities coordinated with or adjacent to the major hospi-
tal centers is just such a dynamic new approach.
I should like to express, on behalf of myself personally and on be-
half of the entire hospital community, our deep appreciation and
thanks to House District Committee Chairman M.cMifla.n for his con-
tinuing interest and effective assistance over the years in assisting this
community to meet its health care facility needs.
STATEMENT OF DR. CHARLES W. ORDMAN, PRESIDENT OF TI-IE MEDICAL
STAFF WASHINGTON HOSPITAL CENTER
Dr. ORDMAN. Mr. Chairman, thank you for the privilege of appear-
ing at this hearing.
My name is Charles W. Ordman. I am President of the Medical Staff
of the Washington Hospital Center and I appear with our Adminis-
trator, Mr. Richard M. Loughery, to testify in favor of HR 6526 be-
cause of this community's real need for this proposed legislation.
The Washington Hospital Center is a private voluntary nonprofit
hospital and serves in fact the greater Metropolitan Washington area,
some 50% of our patients coming from outside the District of Colum-
bia itself. The Center has now approximately 820 beds, and since its
opening has kept abreast of the changing needs of medical practice
and advancements in patient care by its addition of several units: Self
Care, Medical and Surgical Intensive Care and Coronary Care and
a recently endowed research facility. Because of the virtual explosion
in knowledge pertaining to diagnosis and treatment of disease and the
facility requirements concurrent in this progress, we are planning to
enlarge and expand those areas for the treatment of the acutely ill
patient. We have conducted our activities with some modicum of
PAGENO="0053"
49
success in the past and will, hopefully, continue to do so as the science
of medicine and care of our patients advance. What we have not been
able to do is to provide that facility required for after-care. The sub-
acute patient whose condition has been stabilized in the acute hospital
and who now needs controlled convalescence and/or rehabilitation
before being referred to a nursing home or to his own home. This
facility gap has caused a break in our being able properly to imple-
ment the concept of progressive patient care. This concept, providing
for the right care at the right time at the right place and at the right
price, means that the patient admitted to the hospital acutely ill needs
more vigorous care than he does as his illness wanes and that he can
he exposed to decreasingly intensive yet graded care as he convalesces.
We who practice in general hospitals are forced to keep our patients in
the general acute hospital at regretably higher costs than necessary for
a longer period than necessary simply because there is no appropriate
facility available for that period of their care preceding their ability
to be self-sufficient or to be cared for at home or in a nursing home.
These patients no longer need the intensity of services provided in
the acute hospital, but they do need professionally conducted and con-
trolled care for an extended period of time. This phase in our patients'
program of care could be more properly served and it could be served
at considerably reduced cost to the patients and to the community.
We of the Medical Staff of the Washington Hospital Center have
been vitally interested in this potential for many years. Through ap-
pointed committees of the Medical Staff we have conducted research
and an analysis of our patient's needs and have developed evidence
indicating the true extent of this problem and the urgency for its
recognition. Although the average stay of an acutely ill patient in the
Center is less than 8 days, detailed analysis of our patients staying
in the general hospital over three weeks showed their length of stay
~o be from 34 to 55 days, with an average of 41 days. Our Utilization
and Audit Committees point out that this is an improper use of our
acute hospital beds. There is usually little need for the orthopedic pa-
tient following a hip nailing, the medical patient who is recovering
from a coronary attack or admitted because of uncontrolled diabetes
and its complications, or for many others with postoperative situa-
tions whose conditions are stabilized to remain in a high cost facility
were an extended care facility available. Our analyses further showed
that the specialties of Medicine, Surgery and Orthopedics accounted
for some 75% of these longer-staying patients and that 50 + percent
of them would be ambulatory in a facility encouraging convalescence
and rehabilitation. Our surveys were conducted exclusively on the
Hospital Center's patient population. They indicated then a potential
of some 75,000 patient days annually at the Center alone. This situa-
tion pertains to other Area hospitals and the magnitude of our pa-
tients' need becomes quite impressive. Should the plans of our Medical
Staff and the administration of our hospital become a reality through
favorable action of this proposed bill, it would be our intent to serve
as much of the Washington community's Area hospitals' total need
as is possible.
Thank you, Mr. Chairman, for this opportunity to express on behalf
of our Medical Staff our concern and interest in this bill.
PAGENO="0054"
50
STATEMENT OF MR. RICHARD M. LOUGIIERY, ADMINISTRATOR
WASHINGTON HOSPITAL CENTER
Thank you, Mr. Chairman, for the privilege of appearing at this
hearing.
Today, hospitals are faced with increasing pressures to find ways
and means to reduce the costs of hospital care. These are legitimate
pressures. We for some time have been deeply concerned with rising
hospital labor cost-s needed to keep pace with wages paid in the
community as well as those increasing costs caused by the rapid
progress of medical science. It is a-n -acknowledged fact that the quality
of care and the saving of lives h-ave advanced notably in the last
decade alone. We in hospital management have not been able to in-
stitute some of the measures which would control these rising costs.
Dr. Ordman h-as indicated the professional views of our Medical
Staff, their justifiable concerns for their patients, and their efforts to
determine a better way to serve their patient-s. Concurrent with the
actions of the Medical Staff, we began planning in the early 1960's
with the assistance of nationally known consultants a-nd architects to
design a facility appropriate for t-he extended care patient. This plan-
ning cost in excess of $30,000 but did result in a program and detailed
plans for appropriate -and effective medical care at reduced cost-s. Our
research further indicated that:
1) A survey by t-he Hospital Advisory Council to the District of
Columbia Department of Public Health showed only 26% of needed
long-term ca-re beds were available in 1964 and recommended 300 to
400 convalescent rehabilitative beds at the Hosiptal Center.
2) Survey of District of Columbia Medical Society physicians
showed doctors overwhelming urged expansion of long term (ex-
tended) care beds.
3) 25% of the Hospital Center's patient days were represented by
patients who could he better and more economically served in a-n ex-
tended or -after-care facility.
4) Professional -activity study of -patients 65 years and older in 100
U.S. short term general hospitals showed a 21% rise in bed use by
our elderly, Medicare patients (this trend will continue).
In August of 1967, -our studies showed that for the first six months
of that year we could have, with the right kind -of facility, provided
"extended care" for over 2000 of these p-atients at considerably reduced
costs for the over 32,000 days they required in our hospital. This situa-
tion is costly to the patient., the community, and the taxpayer. Further
it is an inefficient system for providing needed health care and should
be improved.
Our proposal is simply to preserve crucial, highly trained medical
manpower and avoid duplication of facilities by extending these
existing adequate services of our general acute hospital to our planned
convalescent~reh:abilitative care facility.
By this I mean the whole range of supportive services, i.e. dietary,
housekeeping, engineering, computerized accounting and reporting,
medical records, purchasing, laboratory, X-ray, and so on-to name
but a few. By doing this we are able to provide a very real savings
to the patient and the community. We expect these savings-consistent
PAGENO="0055"
51
with Secretary Marion B. Folson's recommendations made in 1965
to represent at least one third of current general hospital costs.
Because the Hospital Center is in fact a creation of the Congress,
and because provisions of Hill-Burton legislation in the District
are inadequate, we have continued to seek the Congress's support since
the early 1960's. Our particular plan has been carefully conceived and
has the endorsements of the Health Facilities Planning Council, our
own Medical Staff, GHI (Blue Cross and Blue Shield), and the find-
ings of the Hospital Advisory Council to the District of Columbia
Department of Public Health. Past testimony by the Department of
HEW and District of Columbia Director of Public Health vouch both
for the validity of the need and our program.
We strongly favor the legislation now being considered as we see
it as the only way to overcome the major obstacle of capital financing
for this type of needed facility in the District of Columbia. The nature
of this federal community makes it particularly difficult for us to
promote by fund drives the matching funds required under existing
legislation. Almost 50 percent of our patients come from outside the
District and their interest in fund drives, quite understandably, re-
mains in their local communities. This proposed legislation would
alleviate this dilemma. It provides specifically for the particular type
of facilities especially needed. We have been and are ready now to
immediately build a modern extended care, convalescent-rehabilita-
tive facility to better serve at lower costs the well documented. need
of these patients in the metropolitan community. We urge favorable
action and any such measures necessary to allow us to immediately
proceed.
Thank you, Mr. Chairman. I will do my best to answer any ques-
tion you may have.
STATEMENT OF REV. T. BYRON COLLINS, S.J., GEORGETOWN UNIVERSITY
Father COLLINS. Mr. Sisk, I am T. Byron Collins, S.J., Vice Presi-
dent for Planning and Physical Plant of Georgetown University.
Georgetown University is vitally interested in H.R. 6526. The funds
requested in the grant portion of this bill are so necessary to the pro-
gram of construction that has already started in our Medical Center
that without Congress' help in this Bill our construction program will
be unable to be completed.
Why should Georgetown University Medical Center appeal to Con-
gress for help to finish its construction program? First, let us look
at the facilities that are being constructed. They are out-patient facili-
ties which will enable us to increase our services by 50 to 100 percent.
The demand for the services in the planned program for Georgetown's
share in providing metropolitan area health service is absolutely
necessary.
In addition, a facility for mentally retarded children and instruc-
tion of the parents of these children is being provided.
Associated with this facility is additional space for teaching medical
students, residents and interns and faculty in a building that is de-
signed to teach students how to diagnose and treat patients and then
have them actually do this in their educational program. Another
PAGENO="0056"
52
building will be a new dental clinical building. What is the purpose
of these buildings? These privately owned and privately supported
medical and dental schools are the largest in the District of Colum-
bia. Present entering classes: Medical-121; Dental-ill. Expansion
program will increase enrollments. 1970 entering classes: Medical-
145; Dental-131. Student body from 50 states, over 100 different col-
leges, with no restrictions as to race, color or creed. These schools
produce the physicians and dentists for the Washington Metropolitan
Area; one-half of the practicing dentists and one-quarter of the prac-
ticing physicians are Georgetown graduates.
Faculty physicians and dentists, resident and students serve the
community in Georgetown University clinics and Hospital; D.C.
General Hospital; the V.A. Hospital; Children's Hospital; Arling-
ton Hospital; and a variety of clinics and special services of Health
Departments and private health agencies.
6,500 new patients are seen each year in the Dental clinics. Eighty
percent of these patients have family income levels below $10,000;
and 50 percent are from family units of four or more persons.
In 1966-67, there were 3,980 indigent D.C. resident inpatient days
at Georgetown University Hospital. Over and above reimbursements,
the cost to the University was $112,300.
In 1966-67, there were 49,527 indigent D.C. resident clinic visits at
Georgetown University Hospital. Over and above reimbursements,
the cost to the University was $302,600. In addition, indigent patients
from the metropolitan area increased our costs to in excess of $350,000.
Together with indigent inpatient service, our unrequited cost was in
excess of one million dollars.
Georgetown University Hospital is not a community hospital in
the usual sense of the term. It is a university teaching hospital with
special educational and research objectives. In order to best. fulfill
these objectives, it is obliged to provide the ve.ry best patient care,
and in its beds, laboratories, operating rooms and clinics it has touched
intimately the lives of hundreds of thousands of residents of the Wash-
ington area. Many hearts continue to beat, many kidneys continue to
purify the blood, and many minds continue to function creatively
because of the special talents offered by scientists and teachers of
Georgetown.
Hundreds of physicians of our faculty serve their patients in hos-
pitals affiliated with our medical school-District of Columbia Gen-
eral Hospital, Veterans Administration Hospital, Children's Hospi-
tal, Arlington Hospital, and others. These hospitals provide superior
medical care because of the education and research atmosphere created
in them through the inquiring presence of our faculty, interns, resi-
dents, and medical students.
The District of Columbia General Hospital (more popularly known
as D. C. General: is a 1,250-bed general hospital which serves as the
municipal hospital for the District of Columbia. It is operated by
the D.C. Department of Public Health, which receives its financial
support directly from the Congress. Medical care at D.C. General
ranks with the very best of the municipal hospitals in the United
States. Twenty-two members of the full-time faculty of Georgetown
PAGENO="0057"
53
University School of Medicine supervise sixty-five Georgetown in-
terns and residents and twenty postdoctoral fellows at D.C. General.
The hospital swarms with our students. Many members of the full-
time and volunteer faculty serve as visiting physicians, assuring that
the least fortunate of our citizens receive the same or better medical
care than that received by our most fortunate citizens.
Of the full-time faculty stationed at D.C. General, ten receive no
income whatever from the District of Columbia. They are paid en-
tirely by Georgetown University. Georgetown has made a large com-
mitment to service in our city hospital. To be sure, D.C. General
provides a magnificent training ground for our medical students and
graduate trainees in the numerous specialties of medicine. But we are
there because we want to be there. Since Georgetown is in the busi-
ness of rendering health care, if has assumed the obligation of render-
ing health care to all citizens of Washington, regardless of economic
status, in its own hospital and in the municipal hospital. (Statistic:
In 1965, 5,800 babies were born at D.C. General. Of these, 2,000 were
delivered by Georgetown people, teachers and students.
Fifty members of the full-time faculty of the School of Medicine
and many members of the part-time faculty serve as consultants and
committee members in the health and other agencies of the United
States government. Many are members of committees and clinical
study panels of the National Institutes of Health. Others serve the
Armed Services, the Veterans Administration, NASA, the Social
Security Administration, CIA, and the Civil Service Commission.
All serve at significant material and temporal sacrifice. All feel the
obligation to assist in the smooth functioning of governmental opera-
tions by lending "know how" to the government's programs in health,
education, and research.
Why did Georgetown University undertake this program? We felt
we must supply our share of the health resources necessary for the
Washington area. Georgetown University was confronted with the
question go or stop. We went, in the spirit of faith and hope. I trust
that this Committee will enable us to fulfill this faith and hope.
STATEMENT BY WALLACE WERBLE, PRESIDENT, CHILDREN'S HOSPITAL
Mr. WEEBLE. As president of Children's Hospital, I am grateful for
the opportunity to appear before you on behalf of our board, medical
staff and sick children.
When you get right down to the heart of the matter we are discussing
today, it is appropriate to point out that, whenever the board of a
hospital makes a significant money decision, it most often involves, in
one way or another, a single, but difficulty question: How much is
life worth?
At Children's Hospital, the underlying question always confronting
the board is: How much is the life of your child or grandchild worth?
My child or grandchild? Or Joe Smith's child or grandchild?
Boards of general hospitals are confronted with the question of how
much is the life of any human being worth-your life, my life?
PAGENO="0058"
54
If you think this is putting the subject in terms that are too strong
or too dramatic, let me be very candid with you. Ninety to ninety-
five percent of the patients handled by Children's and the other
excellent hospitals in the Washington area would recover if our
institutions were oniy half as good and three-fourths as costly as
they actually are.
Looking at the situation pragmatically, this becomes a matter of some
importance, if `you or I happen to be caught in that extra five or ten
percent that is responsible for the additional costs which are always
increasing in the continuing effort of hospitals to deliver the highest
quality health care and medical service.
Lets take the example of a child suffering from leukemia. I think
that Children's is the major conimunity resource for the handling of
these unfortunate cases. When I first became associated with the
hospital 20 years ago in a volunteer capacity, the average span between
the diagnosis and death of a child suffering from leukemia was 18
months.
Though we unfortunately have no cure for this dread disease, I
understand that it is now possible to keep children suffering from
leukemia alive for as long as six years. This is expensive. Why do we
dothis?
One reason we do this is that the saving of a human life as long as
reasonably possible is a basic ethic of our western civilization.
But, to be pragmatic again, there is even a more practical reason.
Who knows when our vast national biomedical research program will
produce the miracle of a true cure or treatment for leukemia. It couId~
happen today, tomorrow,' next month, or next year.
Every child suffering from leukemia today should be given a chance
to benefit from this miracle-if and when it comes-and therefore
every effort is made to keep every patient alive as long as possible
because you or I never know what today or tomorrow will bring.
This is not intended as a plea for-or a defense of-unrestrained
increases in the costs of delivering medical care. As we all know, there
has been an' explosion in this area as costs catch up with the advances
in biomedical sciences and what I choose to call the end of "slave labor"
in our hospitals.
But it is intended to put into context one of the reasons why Chil-
dren's and the other hospitals that have a vital interest in this' bill
are here today. We are not only faced with `the constant problem of
delivering better medical care to more people, in an era of rising costs,
but we are also confronted with the kind of extra expenses involved in
maintaining the emergency and other life-or-death services that,
frankly speaking, involve only a relatively small percentage of our
patients.
I do not believe there is any quick, sure or miracle cure for the dra-
matic rises in the costs of medical and hospital care. It is something
that everyone in this area must work at-day-in and day-out.
But I have a personal view that, over the long haul, the best hope
for cutting the costs of hospital care, nationwide, is the development of
a new plant with every possible cost-saving device built in.
If you were the owner of a steel plant, and found that your costs
of operation were pricing your product out of the market, you would
be confronted with a cold business decision on whether to go out of
PAGENO="0059"
55
business or build a new plant that could meet competitive costs. Under
these circumstances, to stay in business, you would go to banks, the
stock market or some other element in the private financial commurnty
for the money to rebuild.
But hospitals can't do that. When confronted with the same situa-
tion, they have to go to the community, and more recently to the
government, for their financial resources.
Lest anyone get the mistaken idea that I am advocating the enact-
ment of this bill on the promise that it will cut costs of hospital care
in the Washington area, let me make it clear that the measure we are
considering is designed primarily to increase plant capacity to the
point where it can handle patient load-the one in existence today
and the one we can anticipate from demographic studies for the next
decade.
Our expert consultants tell us that the pediatric population m the
Washington metropolitan area will more than double by 1980. Our
own Children's Hospital is already overcrowded, and we are spilhng
over into rented buildings and even garages in the neighborhood to
maintain current research, teaching and health care programs.
Because of the million-and-a-half dollar annual deficit we are in-
curring from the handling of charity and welfare patients, we have
not until now been able to give adequate attention to the future.
Despite the day-to-day financial and other problems of keeping our
institution going at its current level of quality medical service, we have
finally been able to begin to plan for the future. As you may have
noticed in the newspapers, we have accepted an offer of land from
the Washington Hospital Center for the construction of a new
children's medical center.
If we had the money today, we would still be from three to four
years away from opening the doors to a new Children's Hospital.
Without the money provided in the bill we are discussing today-
and without the loan authority sought in an amendment to it-a
new children's medical center for the Washington Metropolitan Area
is impossible.
Even with enactment of this bill-and inclusion of loan authority-
we will still have to go to the national and local community for millions
of dollars of voluntary contributions in order to provide the metro-
politan area with the kind of children's medical center that our chil-
dren and grandchildren deserve.
The volunteer board of Children's Hospital is willing to make this
massive effort, once the Congress gives us the clear signal that the
dream can become a reality. For the future of our own institution and
all other hospitals in Washington-and for the benefit of the patients
we all serve-we hope you will look with favor on the bill pending
before you.
Mr. BtTOHER. In addition to that I would like to have submitted for
the record a spread sheet of estimates and various statistics, both finan-
cial and other details, that has been placed before you, and attached
thereto are the statements of several organizations proposing amend-
ments to the legislation which I will be pleased to speak to.
Mr. SIsK. Without objection, the material referred to will be made
a part of the record at this point.
(The material follows:)
PAGENO="0060"
Hospitals:
Casualty.
Children's
Columbia
$12, 350 $6, 175 0 $6, 175
5, 000 3, 333 0 3, 333
541 271 $200 71
93 47 31 16
1 905 146 146 0
22,000 11,000 0 11,000
1,150 575 575 0
2,500 1,333 0 1,333
55 18 18 0
154 77 38 39
~27, 340 6,260 71 6,189
310,500 3,929 709 3,220
474 237 183 54
30 15 0 15
50 25 0, 25
1,500 750 0 750
1,300 867 578 289
276 138 78 60
6, 500 4, 333 0 4, 333
800 400 0 400
41,500 1,000 0 1,000
4500 250 0 052
46,000 3,000 1,500 1,500
H.R. 6526-ESTIMATE OF FEDERAL FUNDING REQUIREMENTS
(For inclusion in Report by William M. Bucher)
[Dollar amounts in thousands]
Current
Name of Facility
General
Bed Capacity
Long-Term
Number of Beds to be
Added Other Facilities
General Long-Term
Planned
to be Provided Estimated
Cost
Present
Estimated Federal
Share
Total
Hill-Harris
H.R. 6526
210 40 100 200 Medical education and staffing expansion of physio-
therapy and outpatient facilities.
200 Bed Nursing Home
Emergency Room and Basement
205 11 45 0 Emergency Power Generator
Improvement and expansion of existing facilities
(205) (11) 339 11 New Hospital
Children's Convalescent 50 30 Replacement and additional bed
30 Master Plan Phase II and Ill
152 2 Emergency Generator
Centralized air condition for operating and delivery
rooms; increase examining rooms; convert pantry
to 2 bed rooms; new flooring for central sterilizing
room; alteration of delivery suite; repacement and
improvement of heating in nurseries; installation of
pediatric laboratory; and replacement of a roof.
Georgetown University 377 20 140 Remodeling and expansion of present facilities in
diagnostic treatment and Medical Center Instruction
areas.
George Washington University 400 110 Remodeling of 1948 buildiog
Remodel Emergency Room
Remodel Premature Nursery
Remodel Urology
2nd Floor North-Heart Station and Pulmonary Func-
tion and Treatment Center
Morris Cafritz Memorial 298 82 100 Nursing Home
Washington Hospital Center 813 300 Modernization
Extended Care Unit
Emergency Electric Power Plant
Glenn Dale Hospital 235 200 Bed expansion by use of existing porches
Modernization of kitchen, physiotherapy and occupa-
tional therapy and expansion of operating suite.
Department of Public Health, Comprehensive Health Center
Area D
Total Funding Requirements 101, 518 44, 179 4, 127 40,052
Grant 40,052
Loan 44,700,000
O $2,500,000 Congressional appropriation and $121,158 NIH Project.
4 D.C. Funds Ineligible for Loan $3,750,000.
`Includes $393,000 NIH Funded Project.
2 $10,000,000 direct Federal Grant for experimental purposes.
PAGENO="0061"
57
PROPOSED AMENDMENT-LOANS FOR CERTAIN HOSPITAL AND HEALTH FACILITY
CoNsTRUCTIoN
section -(a)
In order to aleviate hardship on any recipient of a grant under section ( ) of
this title, to assure the immediate planning and construction of those projects
to meet demonstrated community needs, to meet Congressional directives to con-
trol the costs of health care services, and to meet increased constructional costs
(over the estimated cost of such project on the basis of which such grants were
made and those previously estimated) through no fault of such recipient, the
Secretary is authorized to make a loan to such recipient not to exceed 50 per
centum of such project costs, as determined by the Secretary if the Secretary
determines that such recipient is unable to obtain such an amount for such
purposes from other public or private sources.
(b) Any such loan shall be made only on the basis of an application sub-
mitted to `the Secretary in such form and containing such information and assur-
ances as be may prescribe.
(c) Each such loan shall bear interest at the rate of 21/2 per centum per annum
on the unpaid balance thereof and shall be repayable over a period determined
by the Secretary to be appropriate, but not exceeding fifty years.
(d) There are hereby authorized to be appropriated $44,700,000 to carry out
the provisions of this section.
FURTHER COMMENTS
Mr. BUCHER. In addition to that I would like to call your attention
to the fact that while we do not have all the participating financial
hospitals present here, we have representatives in the audience of the
three hospitals not participating:
Miss Elizabeth M. Rogers, President of Casualty Hospital.
Mr. Victor F. Ludewig, Administrator of George Washington Uni-
versity Hospital.
And Mr. George T. Stafford, Administrator, Morris Cafritz Me-
morial Hospital.
Mr. SIsK. Will they please stand?
(The persons named stood.)
Mr. BUCHER. There is also present Dr. Robert Parrott, Director
of Children's Hospital.
I would like to attempt to answer some queries that were not
answered.
Mr. Walker spoke of the proportion of the amount of funds we are
talking about relating to aftercare facilities. Approximately $33 mil-
lion out of the $42 million is related to the extended care or nursing
care facilities. The combination of a portion of these funds and the
remaining funds is related to modernization.
The additional point Mr. Whitener made concerning the use of
funds available here in the District and not available to his home
State, I think should' be looked into in terms of the allocation to the
major medical center in North Carolina wherein funds similar to what
we are talking about here may have been made available by the Fed-
eral Govermnent over and above the matching funds available to
the State.
In connection w.ith the point that Mr. Gude raised on the availability
of educational programs to staff some hospitals, I would call your
attention to training programs in the District of Columbia through my
organization which have turned out in excess of 300 new hospital em-
ployees within this past year. We are supported by the Department of
PAGENO="0062"
58
Labor, on-the-job training contracts, nursing refresher contracts, and
under the recent Heart, Cancer and Stroke legislation we have a
full-time staff working on this very point of increasing the numbers
and the quality of hospital personnel available to man the hospitals we
are contemplating building.
The fourth point I caJl to your attention is the point made by
Mr. Whitener that there was within his own environment a $10 million
bond issue floated to meet the needs above the needs provided by the
Hill-Burton legislation. I would like to call your attention to an
amendment which we are asking in the legislation here, that there be
a comparable addition to the existing legislation of some $40 million.
And if I may, would you be good enough to turn to the second sheet
of the spread sheet which shows that while local hospitals under
H.R. 6526 would receive upward of $2,052,000 in grant, there still re-
mains a total of $44,700,000 yet to be received in order to make these
hospitals operate. In Mr. Whitener's home environment the $10 mil-
lion bond issue was set forth by the government to meet this very
classification, this requirement, in addition to the donations from the
local population.
PROPOSED AMENDMENTS
Furthermore, as was set forth in the hearing on the legislation on the
Senate side, I ask that the amendments suggested by Secretary Cohen
be added to the bill and that the adjustments in the language of the
Senate Bill be accomplished in the House in H.R. 6526 as follows:
First, since the first fiscal year for which appropriations would be
authorized has already ended, an appropriate modification should
be made in section 2 of the bill.
Second, to conform to the provisions of Reorganization Plan No. 3
of 1966, the reference to "the Surgeon General" in section 3(d) should
be changed to "the Secretary".
There are three other specific amendments I would like to call to
your attention.
For clarity of intent Section 2, line 2 on page 2, should also include
the terms "and medical centers".
Mr. SI5K. You are talking about the House bill now?
Mr. BtIOIJER. Yes, sir.
Mr. SIsK. Would you repeat that last statement? It is on line 2 of
page 2?
Mr. BUOHER. Yes. For clarity of intent, after the word "hospitals"
add "and medical centers".
Again, Mr. Gude asked Dr. Grant what type of facilities we are
talking about. I do agree that we might put in the definition as it
stands now.
Also, for a similar purpose, on line 3 page 2, add the words "and
medical" before the term "centers".
Aagain these are polishing amendments that should make clear the
question raised about Children's Hospital and its construction.
The fourth amendment is in accordance with the national legislation
revisions in process in the Department of Health, Education and
Welfare. We would like on line 13, page 2, after the words ~~Title VI",
add "and Title VII" so it would read "Title VI and Title VII". This
PAGENO="0063"
59
has come about primarily because of the revision in the duties and
responsibilities and format of the Department of Health, Education
and Welfare.
I am reminded this also is the vehicle which Senator Lister Hill has
introduced for nationwide legislation in order to assure that funds
under each title will be used as Mr. Hannan suggested, that all Federal
funds should be used most effectively and not geared to separate sec-
tions or titles or separate types of facilities.
We ask that the loan provision attached to this document which you
here already made a part of the record, be added at the appropriate
place within the bill. I believe you have that attached to your spread
sheet. The suggested language for the loan amendment was forth-
coming from Senator Hill's bill which is before the Senate and which
will apply to nationwide legislation. Specifically, what this does is
what Dr. Grant and several others have mentioned. While we have
funds forthcoming under the Hill-Burton legislation to provide match-
ing funds for construction, we are in the same position as, for illustra-
tion, Mr. Gude is in Maryland, where the State has provided some $70
million of loan funds in order to permit the individual hospitals to
obtain sufficient funds to complete their construction.
I would like to turn now to ask Father Collins, on my right, who is
deeply involved in both health care and the hospital end of it, to sup-
port only the one particular point as to the availability of loan funds
for health care and educational facilities. After that I would like to
turn this discussion over to Dr. Ordman to proceed with testimony of
the Washington Hospital Center.
Mr. SI5K. All right, Father Collins.
GEORGETOWN UNIVERSITY HOSPITAL
Father COLLINS. The purpose of this legislation is to enable the
hospitals and medical facilities in the District of Columbia to supply
a need that is upon us now. This program has been under study for
seven or eight years. All of us have participated through the centralized
planning efforts in the District of Columbia and in truth the entire
metropolitan area in the planning for health facilities and health care.
The specific problem which I would like to illustrate from experience
at Georgetown University Hospital, which I know also to be the case
of other private institutions in the District, is in answer to Mr. Whit-
ener's quest: "Why does not the community of the Greater Metropoli-
tan Area respond to the needs that is so obvious?"
I can only answer from experience of the Georgetown University
Hospital in three years of an intensive nationwide effort trying to
supply funds to meet critical needs in its shared responsibility with
the District, that there is no response from the Washington area. I
don't know if that is because of the transient nature of the area, but
the fact is that the funds are not forthcoming even though a great
deal of effort has been made by myself and others at Georgetown
University in the Washington area. Our own analysis is that it is
because of the turnover, that the roots of the people here are at the
places from which they come.
So I think the responsibility for supplying these needs should be on
the ones who cause the needs. We all owe a service to the Federal
PAGENO="0064"
60
Government. The District of Columbia services the people of North
Carohna; it serves Mr. Gude's State of Maryland; and it serves my
own State of Pennsylvania. So that would be my basic answer to him.
The responsibility of putting up these facilities requires the avail-
ability of loans in order for all of us to start our projects that are
ready to go. Other States, other communities, provide these funds
from either loca.l grants from the State of North Carolina or from his
own county, or from interest rate subsidized loans of State funds, and
this precisely is our request here. We ask the District of Columbia to
recognize the unique position that Washington is to the entire country
and make available to us loans that will be provided in legislation at a
later date for the entire country, and the same principle on which these
loan dollars would be availa~ble would be mainly there is a need of our
local government, which in a sense really is our Federal Government,
to supply this need for us to go on with the job we have at hand.
Thank you.
Mr. SIsK. Thank you, Father Collins, for your statement. As I un-
derstand, according to this memorandum I have here showing the vari-
ous needs within the Washington, D.C. area for the various hospitals,
Georgetown University Hospital proposes to add 140 beds to its pres-
ënt facilities. These would be GM&S beds rather than long-term ex-
tended care beds.
Mr. Bucher, do the amendments you propose now qualify these for
such funds as would be involved?
Mr. BUCHER. No, they do not. The total cost of construction at
Georgetown University Hospital amounts to $27 million. Out of the
current legislation, either Hill-Burton or Hill-Harris and H.R. 6526,
there is a total of about $6,300,000.
Mr. SIsK. What portion of that $6.3 million would come as a part of
the grant under this proposed legislation? What I am considering here
is the interpretation of the uses of these funds as indicated by Dr.
Graning awhile ago. I am trying to clarify for my personal knowledge
exactly what the status would be, because it is n& my understanding
that as to this proposal for Georgetown-and the same would be true
of George Washington University-they would qualify for these
funds without amendment to the pending legislation.
Mr. BUOHER. Mr. Chairman, there is no provision in this legislation
that would permit construction of brand new additional general acute
hospital beds. All the funds you see here, including some of the sta-
tistics you see here, may include them because they are part of the
over-all project of construction, but they are not included in the dollar
grant provisions. In other words, we have set forth the authorization
for Georgetown, that they plan to add 140 general beds. We have set
forth that part of the total cost of these 140 beds is in the $27 million,
but the participation in both pieces of legislation we are speaking to
will not provide matching funds for the 140 beds. It is purposely set
forth this way to give us the illustration that these hospitals are not
limited.
Mr. SIsK. I understand that, but to get back to what will be done
with the $40 million-plus that we make available, if we do make it
available under this legislation, I wanted to have a clear understand-
ing in my own mind as to what that portion of that would go to
PAGENO="0065"
61
Georgetown University or George Washington L nivčrsi'ty or any
of the other hospitals dealing in what we call general beds. I am sure
you are aware there will be questions raised on this legislation in execu-
tive session and I am trying to clarify the facts. To the extent money is
made available under the pending legislation, of course, there will be
matching funds required, and I am trying to determine how much of
these funds, if they were made available, would be used or could be
used in the proposed construction set forth on this sheet.
Mr. BUOHER. The answer to that is in the last three columns. The
funds requested under this legislation are requested in addition to the
Hill-Burton language, and the second column on your sheet is a total
column. This means `a total grant in aid. The first column is the over-all
planned construction cost.
Mr. SIsK. The first column is $27,340,000. The next column is $6,-
260,000. $71,000 of Hill-Harris deducted from the $6,260,000 comes to
$6,189,000. Are you saying that out of this $40 million they would re-
ceive a grant in this amount if this legislation was passed?
Mr. BUOHER. Yes, sir.
Mr. SI5K. Now in line with the discussion earlier, that $6,189,000
will have to be used for extended care or for those types of facilities
and not GM and S beds.
Mr. BUCHER. Specifically it will be used for the purposes as set
forth just to the left of that. It may be extended care facilities or diag-
nostic treatment, medical center instructional areas, and those which
are diagnostic care facilities and the types of facilities and service pro-
grams which will keep the patient out of a general acute bed. That is
the entire thrust of this.
Mr. SI5K. I think I have it clear. For the record I want to be sure of
exactly what we are talking about.
Does anyone else have a statement now?
Mr. BUCHER. Dr. Ordman.
Dr. ORDMAN. Thank you for the privilege of appearing. My state-
ment was submitted earlier, Mr. Chairman.
Mr. SIsK. Thank you, Dr. Ordman.
I believe we now have Mr. Werble, of the Children's Hospital.
All of these statements, gentlemen, have been made part of the
record. We have only a very few moments left because of quorum call.
Is there anything you wish to add, Mr. Werbie?
CHILDREN'S HOSPITAL
Mr. WERBLE. We have a slightly different problem from the others.
I certainly support Dr. Grant's amendment, to make it clear that new
beds can be built with this money.
We `currently have 225 beds we hope to relocate in the Washington
Hospital `Center. If in the doing of that it becomes wise and prudent
and economic for the long term future to add some beds we would like
not to be barred from doing that and just replacing 225.
I would like to make this comment, too:
I do not `believe that anyone could win an argument with Mr. White-
ner because it is a basic `philosophical discussion. I can share some sym-
pathy for the way he feels, however.
PAGENO="0066"
62
As the volunteer president of a Volunteer Board we lose each year
one and a half million dollars taking care of charity and welfare pa-
tients for whom we either get no pay `at all or inadequate pay because
we operate under an 1870 charter which requires us to give service to
anyone who comes to our door without regard to race, creed, color, or
ability to pay.
We have seen this happen year in and year out. How do we do this?
First we go to the community and we raise about $700,000 a year in vol-
untary contributions. The rest of it comes from unearmarked bequests
that people give us. If a bequest is earmarked for some purpose our
trusteeship will not spend that on operating expenses, but we are some-
what in the same position here. We have been spending money that
should be going into capital funds. These bequests we get should have
gone either into an endowment or building fund and we have been
taking care of our charity loads.
I would like to make one more comment. The idea of the Washington
hospitals, all of them that are included, or virtually all of them in-
cluded in this bill, work on what is known as the regional concept.
It is the new concept in the delivery of medical care.
The regional concept adds something to medical care. It also takes
into account a standard `of excellence, a striving for excellence. I am
not saying that all hospitals do not give good care but some hospitals do
give specialized care. I think Children's veers toward the life and death
type case. If anyone troubles to read my seven-minute statement he
will see it is pretty much a tear-jerker, but it is not out of bounds.
In North Carolina you have two regional centers, one at Durham-
Duke and one at Chapel Hill.
These centers got funds outside of the Hill-Burton structure. The
people in Mr. Whitner's district do go to those centers when they
need open heart surgery and they will continue to go there even after
their new hospital, I daresay, is built with this $10 million bond issue.
Washington is an inusual situation. Every metropolitan center
in the country faces the problem of regionalization. Here we face
it doubly because of the unique District of Columbia boundary. You
can no more rim economic quality health care facilities in the Washing-
ton metropolitan area without a regional concept than you could run
the airports and the seaport of the New York area without the New
York Port Authority compact. This is what we are here for.
Give me one minute more for the sick kids. We talk about $40 mil-
lion. If this bill were passed we get $11 million in grants. If we were
lucky enough to get the loan authority it would be $22 million. If
we sold our current property we would have five. 22 and 5 are 27. There
is $13 million shy. Here is a lay board of just interested citizens who
are in effect willing to imdertake to try to raise, in spite `of all that we
are told you cannot raise it in the District of Columbia, $13 million.
l~\Te hope to get it nationally because of this regional concept.
VVe will talk about treating patients, yes, from as far south as North
Carolina. By takmg a regional approach to the fund-raising we hope
we will be able to raise the rest of the money necessary to do a job
for the community of Washington.
Thank you, Mr. Chairman.
Mr. SIsK. Thank you, Mr. Werble.
PAGENO="0067"
63
(Subsequently, Dr. Werbie submitted the following additional
information:
CHILDREN's HOSPITAL OF THE DISTRICT OF COLUMBIA,
Washington, D.C., June 27, 1968.
The Honorable, B. P. SI5K,
Chairman, Subcommittee No. 5, House District Committee, U.S. House of
Representatives, Washington, D.C.
DEAR CONGRESSMAN SI5K: I hope this supplementary statement can be made
a part of the record of your hearing, held June 17, by your subcommittee on
HR 6520 dealing with government grants and loans for the construction of
hospital facilities in the District of Columbia.
As you may recall, I filed a brief general statement, as president of Children's
Hospital, and added several moments of oral comment at the tag end of your
hearing.
Primary purpose of this statement is to furnish additional information on the
tabulation of funding requirements, placed in the record by Mr. William M.
Bucher, as spokesman for the Hospital Council of the National Capital Area. This
tabulation lists the estimated cost of a new Children's Hospital at $22 million. It
is based on a figure supplied by our institution to the Hospital Council many
months ago when work on this legislation was first initiated.
This figure represents our earliest estimate, calculated before we had moved
very far into the planning process. According to the latest estimates from the
hospital planning consultants we have retained, the figure will be in the range
of $30 million to $40 million, probably closer to the latter.
This is important `because the point was raised during the subcommittee hear-
ings on the willingness of residents of the Metropolitan Washington Area to un-
dertake voluntary action to match government aid in developing and maintaining
the kind of hospital and medical facilities that are required for the Nation's
Capital and the area that surrounds it.
Assuming a cost figure of $35 million for rebuilding Children's Hospital on the
Washington Hospital Center grounds, the funds authorized by HR 6526 would
provide a federal grant in the order of only $11 million, based on the Hospital
Council's tabulation that was made part of the Senate committee report on the
companion bill which has been passed.
If the House bill is amended to include loan authority, proposed by the Hospi-
tal Council and supported by a number of institutions-including Children's, we
might become eligible to borrow another $11 million for 50 years at a low rate
of interest.
This would give us a base of $22 million. To this, we can add an anticipated
yield from the sale of our present property-perhaps several mililon.
But the difference between this and the $35 million to $40 million `anticipated
total cost would have to be raised by a vigorous voluntary fund campaign, un-
dertaken in the Metropolitan Area and, hopefully, on a national basis. The rais-
ing of $10 million to $15 million is a massive undertaking for the citizens of the
community who serve as volunteer members of the Children's Hospital Board.
An effort to explain the motivation for this effort was made in my brief prepared
statement, already a part of the record.
Children's also would like to go on record as favoring the proposed amend-
ment permitting the use of funds for the construction of new beds, as well as the
replacement of existing ones.
We now have a 225-bed hospital. Our consultants tell us that this number does
not permit the most economical operation of a regional medical facility that
seeks to achieve excellence in the kind of situations which might mean the dif-
ference between life and death. We are advised that a 350-bed hospital may be
required for efficient and effective operations.
We appreciate the time and thoughtful consideration given by you and the
members of your subcommittee to the problem of maintaining adequate medical
facilities in the Nation's Capital to serve the surrounding area and region.
Sincerely yours,
WALLACE WERBLE, President.
Mr. SIsK. Now we have Dr. Burke.
PAGENO="0068"
64
STATEMENT OP DR. P. G. BURKE, I~LEDICAL DIRECTOR, HOSPITAL
FOR SICK CHILDREN (FORMERLY CHILDREN'S CONVALESCENT
HOSPITAL)
Dr. Buiuii~. Mr. Chairman, I am Dr. Frederic Gerard Burke, Medi-
cal Director of the Hospital for Sick Children, formerly the Children's
Convalescent Hospital in Washington, D.C. I appreciate the privilege
of appearing before this committee to support your favorable con-
sideration of the proposed legislation (HR 6526) to provide supple-
mental aid for modernization of hospitals in the District of Columbia.
We are particularly in support of those parts of the proposed legisla-
tion that identify the needs for extended hospital care facilities.
The Hospital for Sick Children, formerly the Children's Convales-
cent Hospital in MTashington, D.C., is the only intermediate stay
pediatric facility providing multidisciplinary hospital care for chlid-
ren suffering from a variety of illnesses in the Washington Metropoli-
tan area. The patients admitted to this thirty to ninety day, with ex-
tensions, hospital are largely referred from the several acute short
stay hospitals in the area.
The medical needs and programs for children afflicted with long-
term sicknesses are considerably different from those provided in
acute short stay hospital units and are the basic therapeutic thrust of
our hospital staff. These deal with the important psychologie and socio-
behavioral needs besides the medical and surgical ones.
The Hospital for Sick Children is now in its 85th year of operation
and recently changed its name from the Children's Convalescent Hos-
pital in order to comply wit-h the semantics suggested -by the Blue
Cross Association in order to obtain a hospital contract with that pre-
pay organization. The word "convalescence" has become associated
with nursing homes in current times and ours is a licensed intermediate
stay and rehabilitation hospital.
Under the Hill-Burton program we are just completing a-n eighty
bed -addition to the hospital which will help us meet the extended
hospital care needs of this community's small children. Because of
shortage of Hill-Burt-on funds when this building program ftn-ally got
underway, the modernization and renovations of the older structures
and other sharp curtailments of our bui-ld-ing plans had to occur.
Specifically, the lack of sufficient funds to modernize and replace the
old and decrepit beds and facilities result-ed in elimination of be-ds for
thirty to forty adolescent children. In addition, the proposed ambula-
tory and rehabilitation facilities for outpatients suffering from chronic
illness wa-s eliminated. It is estimated that approximatley three inil-
lion dollars will be required to modernize the existing hospital to
accomplish this building program.
In addition t-o meeting the specific medical needs of these sick
children, with chronic heart, lung, bone and neurologic diseases to
name a few, the reduced medical costs and opportunities for train-
ing of medical a-nd paramedical personnel must be stressed in a pedi-
atric extended care facility. The costs are generally one-third those
of acute s-hort-stay hospitals, a not inconsiderable savings. Pre and post
doctoral training programs are conducted for physicians, and nursery,
and other hospital aids are trained to help meet the medical manpower
PAGENO="0069"
65
shortages in many areas. These training plans will be greatly expanded
in our new facilities.
The proposed legislation (HR 6526) and (S 1228) would signifi-
cantly encourage the construction of much needed, low operating cost
extended hospital care program for children in this area and I heart-
ily endorse your favorable consideration.
Mr. SIsK. I am sure there are questions we could ask of you gentle~
men.
Mr. Gude, do you have a question?
Mr. GtTDE. No, sir.
Mr. SIsK. I am sorry we had to rush this portion, but I am anxious
to get these hearings completed. Your complete statements are m
the record, and the Committee can take a look at them.
I have great sympathy for the problems you have, and I am hope-
ful that from all this we can develop something that will be of benefit
to the community.
I appreciate all of you gentlemen joining together and giving us the
expression of your views.
I know of the concern Children's Hospital has and I am inclined
to be sympathetic to giving you some flexibility.
Thank you, gentlemen.
The record will be kept open for one week that we may include
various material requested, and any other. matters received for the
record.
Also, there will be included in the record at this point certain cor-
respondence sent to Chairman McMillan in support of this proposed
legislation.
(The matters referred to follow:)
HEALTH FACILITIES PLANNING CouNCIL,
FOR METROPOLITAN WASHINGTON, D.C.
Washington, D.C., May 16, 1.967.
Hon. JOHN MOMILLAN,
Chairman, District of Columbia Conimittee,
U.S. House of Representatives
Washington, D.C.
DEAR Mn. CHAIRMAN: The Health Facilities Planning Council for Metropolitan
Washington wishes to make known to your committee its great interest in H.R.
6526, a bill "To authorize project grants for construction and modernization of
hospitals and other medical facilities in the District of Columbia."
This proposal is identical in substance with H.R. 15070 in the 89th Congress.
The Senate District Committee held hearings last year on the companion bill,
S. 2622. By letter of January 8, 1966 and again in an oral statement at the hearings,
the Planning Council strongly supported this urgently needed measure.
As did its predecessor, H.R. 6526 embodies the Administration proposois for
supplemental aid for modernization of hospitals, and for modernization and
construction of other types of health facilities in the District of Columbia. To
qualify for such supplemental aid, projects would have tO be approvable under
construction aid programs-the Hill-Burton program, or the Mental Retardation
Facilities of the Mental Health Centers Con~tru~tion programs. Supplemental
aid would be conditioned upon such approval or the denial of approval upon the
sole ground of insufficient funds under the District's allotments under those
programs.
The proj~osed legislation grew out of growing concern for the pattern of special
aids for individual hospital construction projects in the District-under the
Washington Hospital Center Act of 1946 and later extensions and amendments
of that Act. This pattern arose because the ability of District sponsors to raise
PAGENO="0070"
66
private capital does not square with the basic premises of the nation-wide Hill-
Burton program and, as a result, the District was unable to use considerable sums
allotted to it under that program. In 1061 the Department of Health, Education,
and Welfare was directed by the President to look into the District's continuing
need for special assistance of this kind. The proposed legislation is the outgrowth
of the Department's findings. The District's special difficulties in finding the
necessary capital financing for health facilities are amply documented in the
Department's July 22, 1965 transmittal letter of the original draft legislation.
The Council emphatically agrees with the Department's conclusion that there
is great need for special assistance for construction and modernization of health
facilities in the District and that such an ~tssistance program should put on an
orderly basis, subject to review under the same type of procedures that govern
project approval under the basic construction programs.
The Planning Council was established in April, 1962 with the assistance of
the Public Health Service and under the sponsorship of the Metropolitan Coun-
cil of Governments. Its purpose is to encourage area-wide planning for health
facilities within the Metropolitan Washington community in order to further
effective expenditure of available construction dollars and to avoid unnecessary
operating costs. The bill would strengthen such planning efforts by making review
of applications for supplemental grants by a responsible metropolitan area plan-
ning body a required stage in the project approval procedures. The recommenda-
tions of such a body would have to be taken into accont by the District's Hill-
Burton agency and submitted to the Surgeon General; the planning group's views
would not be controllinz. however.
The Council again urges the Committee to give serious consideration to broad-
ening the bill to permit supplemental grants for construction of additional beds.
Unless the suburbs can build additional beds to keep pace with their population
growth the pressures on District hospitals will increase. District hospitals last
year provided 63% of patient days rendered in the entire metropolitan area.
Furthermore, with emerging patterns of care that tend to concentrate the more
costly and complex procedures in institutions which are at the heart of urban
complexes, there may be special expansion needs in central city hospitals that
cannot well be brought under the "modernization" category. We believe this
suggested relaxation in the uses permitted for supplemental construction grants
would make for a more flexible program without encouraging over-building in
the District. Required review procedures and current planning efforts, under this
and other programs, should continue the impetus toward health facility construc-
tion in nearby suburbs.
Passage of the "Demonstration Cities and Metropolitan Development Act of
1966" (P.L. 89-754) authorized a program of supplemental aid for metropolitan
development projects. Under title II of that Act, it would be possible for a hos-
pital or health facility project that was in accordance with and would further
metropolitan area-wide comprehensive planning and programming . to obtain a
supplemental grant of up to 20% of the cost of construction, with, an overall
ceiling of 80% for total Federal contributions.
After July, the designated area-wide comprehensive planning agency would
also review applications for projects within the metropolitan area for construc-
tion grants under the basic construction programs, including the Hill-Burton
program. Thus that Act strengthens over-all metropolitan area planning and
provides additional incentives, through supplemental grants, for an economic and.
balanced distribution throughout the area of needed facilities in the Federally
assisted categories (including health facilities).
In conclusion, the Council reaffirms its strong support for H.R~ 6526 and urges
its prompt enactment. With the expected passage of legislation to enable the
District to participate in the Federally-aided medical assistance program under
title XIX of the Social Security Act (S. 3469, and H.R. 3972 on which hearings
have been held in the House) it is essential to overcome the District's deficit of
long-term beds. The program authorized by H.R. 6526 should provide substantial
encouragement for sponsors of such projects. The bill itself recognizes the great
need for such facilities by including them within the group for which there is
a higher matching ceiing-66%%. .
* Sincerely yours,
WILLIAM T. HANNAN,
`Chairman.
PAGENO="0071"
67
FEDERATION OF CITIZENS ASSOCIATIONS OF THE DISTRICT OF COLUMBIA
RESOLUTION
Subject: S. 1228
WHEREAS 5. 1228 is a bill to authorize project grants for construction and
modernization of hospitals `and other medical facilities in the District of `Columbia,
and
WHEREAS this bill will authorize appropriations for each of the next three
fiscal years, such sums as may be necessary to enable the Secretary of the Depart-
ment of Health, Education, and Welfare to make grants to assist in t'he moderniza-
tion of public or non-profit hospitals and in the construction or modernization of
public health centers, long-term care facilities~ facilities for the mentally retarded,
and community `mental health centers in the District of Columbia, and
WHEREAS, with Medicare in operation, there Will be an increas'ing need of
the above-mentioned medical facilities, now, therefore, be it
RESOLVED that the Federation ~of Citizens Associations of the District of
Columbia, in regular meeting on June 8, 1967, does recommend passage of S.
1228.
Approved by the Federation June 8, 1967.
Dr. EDWARD A. KANE,
Chairman, Health Committee.
MABEL E. MORRIS,
Mrs. Edward B. Morris,
Seeretary.
GOVERNMENT OF THE DISTRICT OF COLUMBIA,
PUBLIC HEALTH ADVISORY COUNCIL,
Washington, D.C., May 12, 1967.
Hon. JOHN L. MCMILLAN,
Chairman, Committee on the District of Columbia,
House of Representatives, U.s.,
Washington, D.C.
DEAR MR. CHAIRMAN: I acknowledge receipt of your letter dated May 8, 1967
replying to my letter of May 2~ 1967 which transmitted the plea of the Public
Health Advisory Council for an early and favorable action upon H.R. 6526-a
bill to authorize project grants for the construction and modernization of hos-
pitals and other medical facilities in the District of Columbia.
The statement that the enactment of HR. 3972-a bill to enable the District
of Columbia to participate in the health and medical assistance benefits made
available by Title XIX-P.L. 89-97, would not require additional health care
facilities and might reduce the requirement for these facilities by providing
medical attention before critical health problems develop, is a correct one when
viewed only within the context of the immediate and long range objectives pur-
sued by the proposed Medical Assistance Program of the District of Columbia
under Title XIX-P.L. 89-97.
The immediate implementation of this Medical Assistance Program calls for
the effective' and orderly utilization of `existing health care facilities and other
health care resources. Therefore, no additional new facilities are required or are
new available for its immediate implementation. Likewise, by attempting to
develop and utilize now new alternatives for patient care,' such as private physi-
cians' offices and services, medical care at home and through organized public and
private ambulatory clinic facilities, the Medical Assistance Program could con-
tribute to reducing the future need for inpatient~care facilities, hospitals and
skilled nursing homes within the District of Columbia.
Thus, any unjustified deterrent to the immediate implementation of this Med-
ical Assistance Program is a force now enhancing the future need of additional
health care facilities and programs within the District of Columbia.
HR. 3972, if enacted, would permit the District of `Columbia to provide medical
assistance to the categorically and medically needy under the provisions of Title
XIX-P.L. 89-97 within the existing public and private health care facilities in
the District of Columbia. Conversely, the enactment of HR. 6526 would provide a
more effective fiscal vehicle for financing the additional health care facilities that
may `be needed in the years ahead to satisfy the health needs of the total popula-
tion within the District of Columbia.
PAGENO="0072"
68
The future need of inpatient beds, whether public or private, to satisfy the
health needs of the total population of the District of Columbia including the
categorically and medically needy population, under the proposed D.C. Medical
Assistance Program-Title XIX, for the years 19~8-71, is estimated by the D.C.
Department of Public Health to be as follows:
1968
1969
1970
1971
General medicine-surgery
Mental health
4, 958
333
5, 085
352
5, 085
374
5, 225
374
Long-term care
445
475
475
475
Tuberculosis
Totals
472
472
472
472
6, 208
6, 384
6, 406
6, 546
Under the financing formula provided by H.R. 6526, the construction cost of
these additional new beds that could be needed is conservatively estimated to be
as follows:
a. Construction cost per each type of bed:
General medicine-surgery
Mental health
Long term care
b. Total new beds needed by type and year:
1969 1970 1971
Gen med-surg 127 140
Mental health 19 22
Long term care 30
Tuberculosis
Total 176 22
c. Total construction costs (estimate) of needed beds by type and year:
1969 1970 1971
Gen med-surg $4, 445, 000 $4, 900, 000
Mental health 475, 000 $550, 000
Longterm care 600,000
Total 5, 520, 000 550, 000 4, 900, 000
d. Distribution of construction costs of needed beds under financing formula of HR. 6526:
19
S.S.~
S.S.~
69 1970 1971
F.S.~ S.S. F.S. S.S. F.S.
F.S.~ S.S. F.S. S.S. F.S.
Gen med-surg $2, 222, 500
Mental health 237, 500
Long term care 200, 000
$2, 222, 500 $2, 450, 000 $2, 450, 000
237, 500 $225, 000 $225, 000
400, 000
Total 2, 660, 000
2, 860, 000 225, 000 225, 000 2,450, 000 2,450, 000
*SSSponsor's share of the cost.
**F5__Federal share of the cost.
I hope that this information will contribute to the favorable con-
sideration of H.R. 6526 by your committee.
Sincerely yours,
L0RIN E. KERR, M.D.,
C1uth~man.
$35,000.00
25, 000. 00
20,000.00
140
PAGENO="0073"
69
GOVERNMENT OF THE DISTRICT OF COLUMBIA,
PUBLIC HEALTH ADVISORY COUNCIL,
TVashington, D.C., June 12, 1968.
Re S. 1228-A bill to authorize project grants for construction and modernization
of hospitals and other medical facilities in the District of Columbia.
Hon. JOHN L. MCMILLAN,
Chairman, Committee on the District of Columbia,
House of Representatives,
Was1i,~ngton D C
DEAR Mn CHAIRMAN The Public Health &dvlsoi3 Council con'ists of a glOlil)
of 21 members, residents of the District of Columbia who advise the Director of
Public Health in matters pertaining to health and medical care. This Council is
very actively engaged in considering matters relating to the evolution of a
comprehensive health and medical care prOgram for the District of Columbia,
particularly under the provisions of P.L. 89-97 and P.L. 89-749.
In the process of these recent deliberations this Council has discerned an
alarming gap in the continuum of services requisite to the operation of a medical
care program that will be capable of providing an acceptable quality of care at
the level needed by each person who is cared for in the District of Columbia.
This gap is the result of a deficiency in the number of acceptable long-term
care and skilled nursing home beds in the District of Columbia. Estimates of
additional need in the District for such beds, which were made prior to the
enactment of P.L. 89-97 (Medicare-Medicaid), showed the need for construction
of 600 additional extended care beds. The extent to which the need for utilization
of this type of facility will be increased as a result of the forthcoming implementa-
tion of the District's Medicaid Program under P.L. 89-97 is not yet known, but
there is no doubt that this increased need will be substantiaL
As a result of the insufficient number of extended care beds, much more costly
short-term hospital beds are occupied by patients who could be moved to extended
care beds if they were available. The adverse conditions resulting from this
excessive utilization are further compounded by the need by 1970 for the mod-
ernization of existing short-term hospital beds.
Only by encouraging the construction and modernization of medical facilities
can we hope to have available an adequacy of beds to meet the needs of the people
of the District of Columbia. It has been many time demonstrated in the past by
the enactment of special legislation that the needs of the District of Columbia
are over and above those which can be met by the vai-ious existing medical
facility construction Acts.
For these reasons, the Public Health Advisory Council endorses this proposed
bill and urgently recommends that it be approved.
Sincerely yours,
ROBERT S. JASON, M.D.,
Acting Chairman.
(Whereupon, at 12:40 p.m. the hearing adjourned.)
(Subsequently, the following additional documents were filed for
the record:)
SUPPLEMENTAL STATEMENT OP HON. JOEL T. BROYHILL, REPRE-
SENTATIVE IN CONGRESS PROM THE STATE OP VIR~llNIA
JvJNE 28, 1968.
To The Honorable B. F. SIsK,
Chairman, Subcom'inittee #~,
Committee on the District of Columbia.
Mr. Chairman, I desire to submit the following additional informa-
tion on the program for HR 6526. I have organized the text informa-
tion in the following categories:
I. Legislative Summary
II. Justification for Construction and Fund Requirements
A. Hospital and Medical Center Facilities Program
B. Funds
1. Grant-$40,052,000
2. Loan-$40,575,000
PAGENO="0074"
70
III. Construction and Fund Requirements
A. Individual Institutions
B. Summary ....... ..
IV. Similar Programs in Certain States Compared to the District, of
Columbia for fiscal 1966 and 1967 .:
A Specific St'tte Funds
Fed. Grants $149, 000,000
Public Grants 130, 000, 000
Public Bonds 533, 000, 000
B District of Columbi't
Fed Grants $882 000
Public Grants 0
Public Bonds 0
17 Status of Legis1'~tion
HR 6525 Comparison to the Companion Bill, 5 1228 passed
by the Senate
VI. Specific Questions aI)out HR 6526
I. L~~is~riru SUMMARY OF HR 6526
Heard Monday, June 17, 1968, by Congressman B. F. Sisk, Chair-
man, and members of the House District Subcoimnittee #~.
PURPOSE OF LEGISLATION
To authorize project grants and loans for construction and mod-
ernization of hospitals and other medical center facilities in the Dis-
trict of Columbia, to correct an eight year backlog of demand caused
`by Federal legislative inequities in the Federal Health Facilities Acts
as they apply to t.he District of Columbia, and to provide a program to
meet these needs in the most effective, economical manner.
NEED FOR LEGISLATION
Grant Need: 1968 and subsequent annual Federal Legislation for
construclion of such facilities in the District of Columbia amounts to
$441,619 which is to be compared to a demonstrated researched need of
$40,052,000 of grants-in-aid. Prior legislation (Washington Hospital
Center Act.) sets specific precedent for special assistance to the District
of Columbia and such grant-in-aid programs.
Loans Need-illatc/iing Requirements: The demonstrated inability
of private local resources to provide the necessary matching require-
ments because of the lack of area industry and the transient nature of
`Washington area population requires the majority of the matching
funds to be borrowed in order that t.his backlog program may start
within a reasonable time.
The current high interest rates make it infeasible to borrow money
on private market without raising hospital charges to an unreasonably
high rate.
Therefore, the matching requirement of $40,575,000 is to be. supplied
by long term, low rate Federal borrowing as a method comparable to
that offered by other states, coimties, and cities by their bonds and
loan programs and also comparable to other Federal programs in
education and housing.
PAGENO="0075"
71
SPECI &L EMPH &SIS IN LLGISLATION
The dynamic and critical `ippro'tch to meeting community needs `~s
set forth within this legislation emphasizes the use of low cost extended
care facilities within the existing hospitaland medical center complexes
inclusive of the replacement of outmoded, uneconomical and inefficient
facilities Inducement to obtun the programs ~nd resulting community
services includes adjustments of Federal matching fund ritios to 50
per centum of modernization construction `md 662/3 pei centum for
extended care and other low cost facilities.
HISI OPIC B ~CKGROTJND
This legislation represents the eight ye'~.r ~tccumul'~tion of indi~ idu'tl
`tnd colleotr~ e efforts of these he'dth c'tre institutions to meet the ex
pressed and researched community needs. Areawide regional planning
concepts as well as the endorsement of these plans has been accom-
pli~hed. The legislation requires that each project submitted meet the
community fa~~l'ity plans and those of the Secrdtary of HEW. This
process is a continuous one for each of the grant and loan requests.
ROLE OF FEDERAL GOVERNMENT AS A STATE-COUNTY GOVERNMENT FOR THE
DISTRICT OF COLUMBIA
In local city, county, and State jurisdictions throughout the country,
financial assistance to meet matching funds is forthcoming from the
government itself in addition to individual and `industrial contribu-
tions. The requested loan amendment is equivalent to the bond issues
in other jurisdictions. Because of the uniqueness of the Nation's capital
where upwards of 70% of the population is employed by the United
States Government or by its supportive service industries, no such
possibility exists.
II. JUSTIFICATION FOR CONSTRUCTION FUND REQUIREMENTS
A. HOSPITAL AND MEDICAL CENTER FACILITIES PROGRAM
This bill is designed to provide for special needs for hospitals and
medical center facilities in the District of Columbia by reason of its
being the Nation's Capital and the central city core of a large metro-
politan area, now with an estimated 2.5 million population and ex-
pected to increase to 3.5 million by 1980.
General Hospital and Nu' sing Home Beds
In the Di~tric't of Columbia there is. now a total of 4957 general hos-
pital beds in existence or approved for `con~truction. In accordance
with the statistical report for the year ended June 1967,. of the Health
Facilities Planning Council for Metropolitan Washington, these hos-
pital beds have an annual utilization rate of 84.7 percent compared
with a national average of 76 5 percent This me'tns th'~t on `t given
day of the year, an average of 4199 bed's is being utilized and of these
it is estimated that 40% `ire being used by residents of the surround
ing counties, leaving 2519 beds for use by District residents Fui ther
more, the average length of stay of a patient in any one of these beds
PAGENO="0076"
72
is 8.1 days. Also, for the year 19f~5 the occupancy rates of these beds
per thousand Metropolitan Washington Area residents was as follows:
D1~ft1ct of eolnnibia 1886
Maryland 477
Virginia
Comparison of the above utilization data with those of the United
States indicates that the beds in the District are being over-utilized.
This fact, pins the existing critica:1 shortage of skilled nursing home
beds in the District, is now and will continue to `be a serious obstacle
in meeting the demands for beds under the Medicare and Medicaid
provisions of the Social Security Act. Excessive occupancy of acute
hospital beds must continue until such time as sufficient extended care
and nursing home beds become available. Estimates of thIs additional
need in the District range upward from 800. At present, we have in
the District 2490 `beds in 26 licensed nursing homes which are being
occupied for all practical purposes close to 100 percent throughout the
year.
Other Related Health Gave Facilities
Besides the known need for hospital and nursing home beds, annual
surveys made by the D.C. Department of Pnblic Health for the prep-
aration of long range hospital and medical facilities construction plans
under the provisions of the Hill-Harris Act (formerly Hill-Burton)
indicate that there is, and will continue to be, need for additional
health care facilities in the following areas: Public Health Community
Centers; Diagnostic and Treatment Centers; Rehabilitation Facilities;
facilities for the Mentally Retarded; and Community Mental Health
Centers within the District of Columbia. Toward the satisfaction of
this need, the Department of Public Health has, in the planning stage,
a health care facility for the near Northwest Area of the District which
will include all the facilities listed. This health care facility will be
the prototype for similar facilities in other areas of the city.
Because of the previously noted medical care shortages, it is esti-
mated that the following are required to alleviate the existing inade-
quacies:
1. Extended Care Beds-$17,950,000-860 beds. The basic patient
bed need of District of Columbia Hospitals and Medical Centers in
serving the Metropolitan Area is to provide new extended care beds,
i.e., nursing and convalescent beds. This type of bed is less expensive
to build and costs much less to operate. Costs to the hospital patient
will be reduced since an estimated 20% of patients do not need full
hospital bed care or costs but should be in extended care beds. These
facilities should be constructed a.nd operated by existing hospitals or
medical centers in order to keep the charges to the patient as low as
possible. The present structure of medical practice in the District,
wherein doctors are affiliated with specific hospitals and medical cen-
ters, makes a private hotel approach for this type of facility imprac-
tical in the District.
2. Outpatient, Mentally Retarded, and Health Instruction Facili-
ties-$40,903,000. Additional diagnostic and outpatient treatment fa-
cilities are urgently needed to meet the expanded population of the
District as indicated in surveys by the Health Facilities Planning
Council.
PAGENO="0077"
73
3. Bed Replacement and Renovations-$42,665,000. Certain beds
existing in old facilities are inefficient and ineffective for the practice
of modern medicine and should be replaced. Where economically feasi-
ble, other facilities are to be renovated to meet Public Health Facilities
standards. It has been determined by Congress many times in the past
by special legislation with respect to the expansion, construction, or
reconstruction of specific hospitals and medical facilities that there are
needs in the District over and above those being met by the various
hospital and medical facilities construction acts, which are applicable
to all the States and the District of Co1un~bia.
B. FUNDS
1. Grant for HR 6526-$40,052,000. The responsibility of the Fed-
eral Government to provide financial assistance for the construction
of hospitals and other medical fathlities in the District of Columbia
has been recognized `by the Congress for a number of years. In 1~46
Congress enacted the Hospital Center Act, which authorized the ap-
piopriation of Federal funds for the construction of the Washington
Hospital Center as a replacement for three independent nonprofit
hospitals and required the District Government to repay 50 percent of
the net cost to the Federal Government.
In 1951, the Hospital Center Act was amended to authorize grants
of up to 50 percent of the cost~ of constructing or renovating hospital
facilities in the District. The District of Columbia was required to re-
pay 50 percent of the Federal contribution. This was lowered to 30
percent in 1958 with respect to grants made after that time. Under the
1951 and subsequent amendments, grant's of $17,420,453 have been
made for projects having an estimated cost of approximately $44,-
400,000. The Act expired in 1962. In 1962 legislation (P.L. 8'T-460)
was enacted authorizing grants up to $2.5 million for 50 percent of
the cost of constructing an addition to George Washington University
1-lospital. Funds for `this purpose were appropriated by the Congress
in the fiscal year 1964 `and the project is now complete. In addition to
the Hospital Center Act and P.L. 87-460, both of which applied sole-
ly to the District~ Federal financial assistance has been given for the
constru~tion of hospitals and other medical facilities in Washington
through two generally applicable Federal programs-the wartime de-
fense housing and public works program, commonly referred to as
the Lanham Act, i~nd the program authorized by Title VI of the Pub-
lic 1-Iealth Service Act, commonly called the Hill-Burton program.
Under the Lanham Act, two hospitals in the District received a Fed-
eral contribution of $5,655,000. Under the Hill-Burton program, a
total of $7,194,000 in grants was aproved through fiscal year 1966 for
27 projects in the District. The allotment of funds to the District,
which takes into account per capita income and population, is low
in relationship to the facility construction problem.
2. Loans for HR 6526-$40,575,000. As the special Federal aid
previously given for construction of District medical facilities
indicates, the Hill-Burton, mental retardation, and mental health cen-
ter construction programs provide only a partial answer to the prob-
lem of financing the construction of such facilities in the District.
Sponsors of projects for such construction in the District of Columbia
PAGENO="0078"
74
experience serious difficulty in raising the non-Federal share of the
cost thereof.
Nonprofit medical facility groups seeking contributions in WTash~
ington do not have available to them the important support from cor-
porate gifts which is available in other communities. Corporate gifts
often make up to 60 to 70 percent of the total private funds sub-
scribed for constructing hospitals in cities the size of the District;
and more than half of these corporate gifts come from manufactur-
ing corporations. The District, however, has only about 14 percent of
the per capita potential of metropolitan areas of comparable popula-
t.ion for receiving contributions from manufacturing corporations.
Another reason for the difficulty experienced by project sponsors
in the District in securing funds to meet the non-Federal share of the
cost of constructing hospitals and other medical facilities is that, al-
though the average income here is among the highest in the country,
a large proportion of those on the upper part of the income scale are
temporary residents who do not feel an obligation to support capital
improvement drives to the same extent that permaiient residents here
or elsewhere do, or indeed, to the extent that these same temporary
Washingon residents feel in relation to their "home" communities.
This factor has made it impossible to raise money for these facilities
in the amounts which might be expected if the average income alone
were used as a guide.
A unique medical facility utilization and construction problem
exists in the District because of the large number of patients from
other "States" who occupy general hospital beds in the District. Ap-
proximately 40 percent of the patients in District hospitals come from
outside the District, primarily from the Maryland and Virginia coun-
ties in the metropolitan area. These areas are considered as part of
the impact of the Federal Government concentration in this metro-
politan area and is an additional reason for special aid to the D.C.
hospitals and medical centers.
The need for Federal aid is most acute in the case of long-term
care facilities. The lack of private fund-raising potential for con-
struction of these facilities is even more pronounced than in the case
of short-term facilities-as demonstrated by the fact that the District
has been unable to use much of the money available to it under the
Hill-Burton program *for construction of long-term care facilities
due to inability to raise the required matching funds.
For the reason cited above, special Federal assistance for the
modernization of hospitals and the construction or mOdernization of
other medical facilities in the District of Columbia is clearly required
to make up for the loss of normal private sources of support. caused
by the presence of the Federal Government in the District. It is
necessary to have the Federal loans at a low rate of interest on a long-
term basis if these pressing needs are to be constru~ted when they
are needed now and over the next 3 years.
The low interest rate allows the borrowed money to be paid back
with no appreciable increase in the per diem rates to the patients.
This type of program of Federal borrowing exists in the field of
education and studept housing, where the need is perhaps even less
critical. The rate proposed is 21/2% at 50 years in accordance with a
similar bill in Current nationwide legislation in Senate Coimnittee.
PAGENO="0079"
H.R. 6526 grant
Casualty $9,579,000
Construction of a 200-bed extended care facility,
expansion of physiotherapy and outpatient depart-
ments, and renovation of the emergency room and
basement areas will fill a 10-year lag in construction
in this inner city neighborhood hospital.
Children's 11,016,000
Replacement of present antiquated 205-bed build-
ing with a modern structure on Washington Hospital
Center grounds, plus 11 extended care beds. Private
funds will be used for 45 additional beds, need dem-
onstrated by continual high occupancy.
Hospital for Sick Chtdren (formerly Children's Convales-
cent) 1,333, 000
Replacement of 50 extended care beds and con-
struction of an additional 60 extended care beds for a
total of 110 beds for children requiring long-term
treatment or rehabilitation efforts.
Columbia Hospital for Women 39, 000
A number of small renovation projects will
modernize and improve efficiency, such as central-
ized air conditioning for operating and delivery
rooms.
Georgetown University 6, 189, 000
Remodeling and substantial enlargement of out-
patient and medical center instruction facilities in-
cluding a unit for the mentally retarded. An addi-
tional 140 beds required by demonstrated need will
be constructed with funds from an experimental
grant.
George Washington University 4, 064, 000
Remodeling a 1948 building will renew its capabil-
ity to rerve as a modern hospital. Areas aso slated
for remodeling are the emergency room, premature
nursery and urology. 2d floor north will be site for
construction of a heart station and pulmonary func-
tion and treatment center.
Morris Cafritz Memorial 289, 000
Construction of an adjacent nursing home would
increase extended care beds by 100 in the far south-
east section of the city.
Washington Hospital Center 4, 793, 000
An extended care unit of 300 beds will relieve
acute beds for urgently ill-at the same time effect-
ing a saving of roughly 50 percent for those not re-
quiring the complicated equipment and care needed
instantly in acute care areas. Funds are also needed
for modernization and for an emergency electric
powerplant for the entire Hospital Center complex.
Glenn Dale 1,250,000
The number of extended care beds would be in-
creased by 200 by remodeling existing porches.
Funds are also requested for modernization of
kitchen, physiotherapy and occupational therapy
areas and expansion of OR suite.
Department of Public Health 1,500,000
Comprehensive Health Center area D.
Total 40, 052, 000
I Includes $393,000 NIH funded project.
2 $10,000,000 direct Federal grant for experimental purposes.
$2,500,000 congressional appropriation and $121,158 NIH project.
B. StTMMARY
Eight voluntary hospitals and two D.C. Government hospitals have
requested a total of $40,052,000 in grant funds under HR 6526. In addi-
tion loans requested by these institutions under HR 6526 total ~pprox-
imately $40,575,000. Hill-Harris funds required but available only in
part, amount to $4,127,000.
Total Federal loans and grants (including $13,014,158 in other Fed-
eral monies from `NIH and special appropriations) amount to $93,-
518,000.
75
Ill. CONSTRUCTION AND FUND REQUIREMENTS
H.R. 6526 loan
Total Federal
Hill-Harris loans and
grants
$200,000 $8,112,000 $17,891,000
177,000 11,412.000 122,998,000
575, 000 1, 742, 000 3, 650, 000
56,000 114,000 209,000
71,000 11,080,000 227,340,000
892, 000 4, 976, 842 312, 554, 000
578, 000 433, 000 1, 300, 000
78, 000 2, 705, 000 7, 576, 000
0 0 1,250,000
1, 500, 000 0 3, 000, 000
4, 127, 000
40,574, 842.
93, 518, 000
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In addition to the loan monies requested above, individual hospitals
must seek out an estimated $20-$30 million from private resources.
Children's Hospital must raise, for illustration, a sum of $13,000,000.
Georgetown University Hospital must raise over $3,500,000. The above
funds are inclusive of the essential initial operation fund advance.
IV. SIMILAR PROGRAMS IN CERTAIN STATES COMPARED TO THE DISTRICT OF COLUMBIA'
(Dollars expressed in millionsj
State
Hill-Harris
allotment,
1967-68
State, county,
or municipal
matching funds
Additional
State, county,
or municinal
funds alloted,
1967-68
State, county,
or municipal
loans or bonds
authorized,
1967-68
California
Georgia
Indiana
Maryland
Minnesota
New Mexico
New York
North Carolina
$29.2
11.1
12.8
6.8
10.1
3.5
30.8
19.5
$21.8
19.8
29.7
10.8
3.6
2.7
8.2
10.2
(1)
$8.2
(1)
2.9
(`)
(`)
(2)
12.7
(1)
(I)
(1)
$50.0
3.6
(1)
500.0
312.7
Ohio
Total, 1967-68
District of Columbia
25.2
(1)
(1)
(1)
149.0
.8
$106.8
0
$23.8
0
$553.6
0
`County, municipal amounts nat available.
2 Not applicable.
3 Funds provided by bond issues or tax levies at local level.
Source: Information provided by appropriate State agency, June 1968.
CONCLUSION
Because it is a federal district, D.C. hospitals would receive
through loans and grants from the federal government the funds nor-
mally provided by the States for health care facilities within their
constituencies.
~,T STATUS OP LEGISLATION
HR 6526-Companion Bill to :S 1228 Passed by the Senate. The
sponsors of HR 6526 find no thjections to the amendments adopted
by the Senate. Since the introduction of the legislation, because of a
critical re-evaluation of the institu~ional financial abilities in terms
of the current loan market and in order to make language fit current
national programming, the following amendments are proposed.
1. Proposed Loan Authority~ Section. See Attachment A for work-
ing detail.
2. Proposed amendments: Add for clarity, line 2, page 2, "for med-
ical centers" and the words. On line 3, page 2, add, "and medical"
prior to the word "center". On line 13, page 2, add "and Title VII"
in accordance with national program changes.
ATTACI:IMENT A.-LOANS FOR CERTAIN HOSPITAL AND HEALTH FACILITY
CONSTRUCTION
Section -(a) In order to alleviate hardship on any recipient of a
grant under section ( ) of this title, to assure the immediate plan-
nmg and construction to meet demonstrated community needs, to meet
Congressional directives to control the costs of health care services,
PAGENO="0081"
:77
and to meet increased constructional costs (over the estimated cost of
such project on the basis of whidh such grants were made and those
previously estimated) through no fault of such recipient, the Secre-
tary is authorized to make a loan to such recipient not to exceed 50
percenturn of such project costs, as determined by the Secretary if the
Secretary determines that such recipient is unable to obtain such an
amount for such purposes from other public or private sources.
(b) Any such loan sudh be made only on the basis of an applica-
tion submitted to the Secretary in such form and containing such in-
formation and assurances as he may prescribe.
(c) Each such loan shall bear interest at the rate of 2% per centum
per annum on the unpaid balance thereof and shall be repayable over
a period determined by the Secretary to be appropriate, but not ex-
ceeding fifty years.
(d) There are hereby authorized to be appropriated $40,575,000
to carry out the provisions of this section.
VI. SPECIFIC QUESTIONS ABOUT H.R. 6526
1. Why should taxpayers of th~ot:her states supply funds to people
of the District that are not available to the people in other states?
The District of Columbia metropolitan area is a federally created
being which serves all states. The people in the District metropolitan
area should have the same opportunity. to have proportionate medical
center facilities that the 10 states represented by the members of this
subcommittee have.
The present Hill-Harris grant formula for the District prevents
this. This bill makes the D.C. area residents who serve all states equal
to the state citizens. The loan provision in the bill takes the place of
state, county and municipal grants and bonds in these states.
2. Why do not the D.C. Hospitals and Medical Centers roll up their
sleeves and raise the facility money?
The D.C. Hospitals and Medical Centers have done this. They have
struggled to raise money to meet operating deficits with some success.
They will have to raise some $20,000,000 in addition to the funds in
this bill for programs associated but not in this bill. Of special note is
the effort of Children's Hospital requiring the raising of some
$13,000,000.
The fund raising potential to meet such capital requirements as
provided by this legislation simply does not exist elsewhere.
3. Why do not private profit organizations such as Medi-center con-
struct the extended care facilities?
Two institutions in the District have considered this approach in
depth and found it infeasible here. There are two basic reasons that
militate against this approach in the District.
The first is that the private entrepreneurs raise the per diem costs
by cost of land and private borrowing rates and profits to the point
that no sizeable economy would be available to the patients. The second
reason is that the medical professions' affiliation and association with
the existing medical care institutions make affiliation with a profit-
making corporation very difficult. The anticipated ease of transfer of
patients has been the basic problem where such private motel-type
facilities have been constructed.
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HOSPITAL COUNCIL OF THE NATIONAL CAPITAL AREA, INC.,
Washington, D.C., June 24, 1968.
Re H.R. 6526.
The Honorable B. F. SIsK,~
Chairman, Subcommittee #5,
Committee on the District of Columbia,
TVashington, D.C.
DEAR MR. SI5K: Your letter of June 20th requests some information which
I regret is not immediately available in this office. After a conversation with Staff
Clerk James Clark, I believe that the detail will be forthcoming from Dr.
Granning of HEW who also testified at the hearing.
I note, however, that under the Lanham Act, two District hospitals received
a total of $5,655,000. Through 1966 a total of $7,194,000 has been made available
by the Hill-Burton program. The Washington Hospital Center Act, with amend-
inents, and special grants to each of the medical school affiliated hospitals have
also been made.
In response to your second question, I have included the cost information under
a separate letter of this date.
Again, many thanks for your help.
Sincerely yours,
WILLIAM M. BUCHER,
Ewecutive Vice President and Director.
HOSPITAL COUNCIL OF THE NATIONAL CAPITAL AREA, INC.,
Washington, D.C., June 24, 1968.
The Honorable B. F. SIsK,
Chairman, Subcommittee #5,.
Committee on the District of Columbia,
Washington, D.C.
DEAR Mn. SI5K: I have gathered additional financial data to illustrate the
magnitude of that section of the hospital industry involved in H.R. 6526.
Listed by hospital are the total annual operating costs as well as the most
recent per patient day operating Costs. The range in operating costs is justified
by the variable levels of quantity and quality of services, the composition of such
services, the relationship with the medical center and other factors.
1. Children's Hospital of the District of Columbia:
a. Patient days operating cost (1/1/68), $70.65
b. Annual operating cost (4/30/68) $6, 939, 431
2. Morris Cafritz Memorial Hospital:
a. Patient day operating cost (4/30/68), $78.71
b. Annual operating cost (fiscal 1968) 544, 349
3. Eastern Dispensary and Casualty Hospital:
a. Patient day operating cost (4/30/68), $58.59'
h. Annual operating cost (Estimated 1968) 3, 878, 513
4. Columbia Hospital for Women:
a. Patient day operating cost (12/31/67), $80.69
ii. Annual operating cost (Estimated 1968) 3, 482, 904
5. Georgetown University Hospital:
a. Patient day operating cost (5/31/68), $76.78
b. Annual operating cost (Estimated 1968) 11, 454, 590
6. The Hospital for Sick Children, (formerly Children's Convalescent
Hospital) :
a. Patient day operating cost (12/31/67), $34.59
b. Annual operating cost (fiscal 1968) 544, 349
7. George `Washington University Hospital:
a. Patient day operating cost (3/31/68), $71.43
h. Annual operating cost (fiscal 1988) 11,800, 000
8. Washington Hospital Center:
a. Patient day operating cost (5/31/68), $80.35
`b. Annual operating cost (fiscal 1968) 22, 000, 000
Annual Operating Cost Total 68, 954, 737
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As you well know, the operating costs many times exceed the construction
costs of such an operation. I do hope the above information will be helpful to
you.
We all are indeed grateful to you for your assistance in moving H.R. 6526
through the legislative procedures.
Sincerely yours~
WILLIAM M. BUCHER,
E~vecutive Vice President, an4 Director.
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,
PUBLIC HEALTH SERvIcE,
Silver Spring, Md., July 10, 1968.
Hon. B. F. SIsK,
Chairman, Subcommittee No. 5, Committee on the District of Columbia, U.S.
House of Represeatatives, TVashin.gton, D.C.
DEAR MR. SIsK: Attached is some additional data in support of my testimony
before the Committee regarding HR. 0526 and 5. 1228.
The American City Bureau/Beaver Associates is widely respedted in the area
of fund-i~aising ~onsuttation, and we believe th~ir information files and sources
to be thorou~ghly reliable. The percentage of total campaign funds raised by the
business community in each of the four cities of conspaeable size to Washing-
ton, D.C., further illustrates the wide gap in availaible community resources
between the Di5tti~t of Colutabia and other similar localities.
We hope this information will be of uso to the Con mistee.
Sincerely yours,
Enclosure.
(s) HARALD M. GRANING.
PAGENO="0084"
CONTRIBUTIONS BY INDUSTRY IN JOINT HOSPITAL CAMPAIGNS
Total
Year Approximate Amount raised Amount given Percent of Amount given Percent of amount given Percent of
Location campaign population at time of by major amount by commerce amount by business amount
completed report firms raised and industry raised community raised
Cincinnati, Ohio 1957 495, 000 $12, 100, 767 $6, 964, 139 57. 5 $1, 143, 653 9. 5 $8, 107, 792 67. 0
Indianapolis, nd - 1967 515,000 14,644,434 7,052,937 48.2 349,990 2.4 7,402,927 50.6
Minneapolis, Mien 1959 450,000 17,068,814 8,123,844 47.6
Newark, N.J 1968 385,000 12,863,625 5,528,000 43.0 349,120 2.7 5,877,120 45.7
Note: Population was taken from the `Rand McNally Atlas," 43d edition, 1967; "Employee giving" the final campaign report, except for Newark, which was based on the campaign progress report
(i.e., payroll deductions for pledges, etc.) is not included in these figures; all data was taken from dated June 12, 1968.
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81
D~ARTMENT OF HEALTH, ~DUOATION; AND Wm~ARE,
July 3, 1968.
Hon B F SI5K
U.S. House of Representatives, . .. . .
TVashington, D.U.~ . . . . . .. . .... . .... .... .. ..
DEAR Mn. SI5K:
`This is in reply to your letter of June 21, 1968. We are enclosing a complete
summary by year of initial, approval of all Hill-Burton grants made to medical
facilities in the District of Colum~bia from the beginning of the Hill-Burton
program to date. You should also be aware that the Division of Hospital and
Medical Facilities provided $230,000 in 1964 and $6.9 million in 1966 to Georgetown
University Medical Center under the experimental construction category of our
research and demonstration grant program.
We also enclose a summary of all assistance provided to District of Columbia
hospitals by the General Services Administration under the D.C. Hospital
Center Act.
Concerning the Lanham Act which was administered by the Federal Works
Agency and was succeeded in 1947 by the Hill-Burton program, we have been
a~le to secure the following information:
Both George Washington University Hospital and Georgetown University
Hospital participated in that program. George Washington received a grant in
1944 for approximately $2.5 million. Georgetown received approximately the
same dollar amount atabout the same time.
We hope that this information will be helpful to you.
Sincerely yours,
HARALD M. GRANING, M.D.,
Assistant Surgeon General, Director,
Division of Hospital and Medical Facilities.
GRANTS UNDER D.C. HOSPITAL CENTER ACT (P.1. 221, 82ND CONGRESS) TO THE DISTRICT OF COLUMBIA
Year of grant Name of hospital Total cost
Federal funds
Type of construction
$3, 502, 318
873, 542
8, 265, 467
3, 526, 971
$441, 913
234, 000
4, 097, 040
1, 300, 000
New hospital building.
New research building and other
hospital improvements.
New 350-bed hospital.
2 new 4-story wings `and moderniza-
tion work.
7, 302, 780
3, 000, 792
2, 170, 000
2, 290, 000
Nurses' home, new diagnostic build-
ing, medical-dental dormitory,
modernization work and research
reading room.
New wing and modernization work.
8,777, 197
23,405, 849. 35
9, 188, 000
4, 374, 000
23, 405, 849. 35
3, 375, 000
New 350-bed hospital, nurses' home
and school and interns' residence.
New 800-bed hospital.
New Hospital.
1953 Children's Hospital
1957 Children's Hospital
1953 Providence Hospital
1953 Eastern Dispensary and
1956 Casualty Hospital.
1958
1957 Georgetown Hospital
1960
1954 Columbia Hospital
1957 .
1959
1958 Sibley Memorial HospitaL - -
1953 Washington Hospital Center_
1962 Southeast General Hospital
(New Cafritz Memorial
Hospital). _________________________________
Total 67, 842, 916. 35 41, 687, 802. 35
Source of isformation: General Services Administrat:on, Feb. 8, 1966.
GRANTS UNDER PUBLIc LAW 82-221 ADMINIsTERED BY GENERAL SERvIcEs
ADMINIsTnATI0N
Purpose and Description
This Act modified Public Law 79-648, approved August 6, 1946, which author-
ized funds for the construction of the Washington Hospital Center.
Public Law 82-221, approved October 23, 1951, authorized Federal loans or
grants for the construction of hospitals in the District of Columbia. Subsequent
amendments named the particular hospitals which were to receive assistance and
the amount of funds allowed.
The Act provided for outright grants to hospitals. However, the District of
Columbia must repay either 50 percent of the Federal grant or 30 percent of the
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82
grant depending on the percentage specified in the legislation. The original legis-
lation provided a 30 percent repayment. Act was later amended to 50 percent but
was not made retroactive.
The District of Columbia is not required to pay inteiest on the loan portion
SUMMARY OF APPROVED PROJECTS IN THE DISTRICT OF COLUMBiA UNDER THE HILL-BURTON PROGRAM FOR
194948 FISCAL YEARS ::
Name of facilities Total cost Federal Beds
share provided
D C General $3 757 161 $924 014 308
Childrens Hospital .~ .. 4,977,272 1,480,255 1 20
Warwick Cancer Clinic 668,996 18, 414
Childrens Convalescent Home 1 907 884 830 862 134
George Washington University Hospital ~_.. 2, 734,572 933, 781
Georgetown University Hospital 4 740 308 1 258 208 20
Casualty Hospital 1,248,886 577,072 .. .40
Davis Memorial Rehabilitation -. 1 459 515 150 000
Childrens Treatment Center 301 254 127 917
Columbia Lighthouse 290 462 19 841
Childrens Hearing Speech . - 605, 338 296,929
Cafritz Memorial Hospital 2 720 377 1 295 244 78
Hillcrest Childrens Center 1,829,404 595,963 12
Columbia Hospital for Women 55, 700 18, 567
Washington Hospital Center 187, 746 62, 582
Sibley Memorial Hospital 303 000 14 290 13
Total 27, 787, 875 16,376, 579 725
APPROVED DISTRICT OF COLUMBIA PROJECTS UNDER THE HILL-BURTON PROGRAM, BY FISCAL YEAR OF INITIAL
APPROVALi
Name of facility Total Federal Category Beds
cost share provided
1949 fiscal year: D.C. General. $2,432,909 $525914 General 128
1950 fiscal year: Childrens Hospital 3,556,393 814,929 do 98.
1953 fiscal year:
D.C. General EQ 7,800 .2,600 do
-. WarwickCancerClinic,EQ .660,996 18,414 do --
Total, 2 projects 676,696 21,014
1954 fiscal year:
Childrens Convalescent Home 420, 276 255, 862 Long-term care 50
George Washington University Hospital ASF_ 224, 534 30, 000 General
Total, 2 projects 644, 810 285, 862 50
1955 fiscal year: Georgetown University NH___ 1,591,390 314, 138 do
1957 fiscal year: . .. . . .
Casualty Hospital 864, 511 432, 255 do 40
Davis Memorial Rehabilitation 1, 459, 515 150, 000 Rehabilitation facilities
Georgetown University DTC 2,286,421 575,000 Diagnosticcenters.
Georgetown University RF 237, 981 50, 000 Rehabilitation facilities
Total, 4 projects 4,848,428 1,207,255 40
1958 fiscal year: Child Treatment Center RF___ - 301, 254 127, 917 Rehabilitation facilities
1959 fiscal year: Columbia Lighthouse RF 290,462 19,841 do
1960 fiscal year: . . . ... .
Children's Hospital 113,282 34, 581 General 22
Georgetown University 56,982 27,523 do 20
Georgetown University DTC 454,034 220,414 Diagnostic centers
Total, 3 projects 624,298 282,518 42
1961 fiscal year: .
Child Hearing Speech RF 305,828 151,184 Rehabilitation facilities
Children s Hospital DTC 1 214 297 599 645 Diagnostic centers
D.C. General Hospital 1,316,452 395,500 General 180
Total, 3 projects 2,836,577 1,146,329 180
Footnotes at end of table.
PAGENO="0087"
Name of facility Total
cost
Federal Category Beds
share provided
1963 fiscal year
Cafritz Memorial Hospital 623,461 311,731 Diagnostic centers
Do 1,966,817 918,464 General 78
Total, 2 projects 2, 590,378 1, 230,195 78
1964 fiscal year:
George Washington University Hospital RF 252,819 122,326 Rehabilitation facilities
George Washington University Hospital 694, 819 342, 034 Diagnostic centers
Total, 2 projects 947, 638 464, 360 --
1965 fiscnl year: -
1-filicrest Childs Center 697 133 174 074 Mental 12
Do 1,132,271~ 421,889 . Diagnostic centers
Total,2 projects 1,829,404: .595,963 .12
1966 fiscal year:
Cafritz Memorial Hospital 130, 099 65, 049 Long-term care
Child Hearing Speech 299, 510 145, 745 Rehabilitation facilities
Total, 2 projects 429, 609 210, 794
1967 fiscal year:
Children's Convalescent Hospital 1, 487, 608 575, 000 Long-term care 84
Columbia Hospital for Women 55,700 18,567 General
George Washington University HospitaL - - 150, 000 44, 605 do
Do 600, 000 200, 000 _...do
Washington Hospital Center 187, 746 62, 582 do
Total, 5 projects 2,481,054 900, 754 84
1968 fiscal year:2 . .` . . ,.
Children's HospitaL ` . 93, 300 31, 100. General
Georgetown University Hospital 103,300 34,433 __do
Do 110 200 36 700 do
George Washington University Hospital 474; 200 144, 816 Diagnostic treatment.center
Do 338,200 50,000 Rehabilitationtacility 13
Sibley Memorial Hospital 303 000 14 290 General 13
Casualty Hospital . 384;'375 144, 817 Diagnostic or treatment center
Total,:7 projects . 1, 806, 575 456, 156 13
Fiscal years included only if there were approved projects in the year.
2 July 1, 1967, through June 27, 1968.
Source: Department of Health, Education, and Welfare, Public Health Service.
GOVERNMENT OF THE DISTRICT OF COLUMBIA,
DEPARTMENT OF PUBLIC HEALTH,
Washington, July 11, 1968.
lion. B. F. SISK,
U.s. House of Representatives,
Was hington, D.C.
DEAR CONGRESSMAN SI5K: This will reply to your letter of June 20 and will, I
believe, provide additional information to amplify and further clarify my testi-
mony before Subcommittee No. 5 of the House District Committee in respect to
HR. 6526 `and 5. 1228 on hospital construction.
1. The present estimated cost at D.C. General Hospital of $73.91 per day does
include the cost of the medical staff. The hospital admits between 23,000 and
3Q,000 patients per year and sees some 160,000 patients in its outpatient clinics';
in addition, approximately 70,000 patients visit the emergency room each year.
Approximately 7% of the total cost of patient care at D.C. General Hospital has
been reimbursed each year by the patients themselves or through insurance com-
panies through fiscal year 1966. Beginning, however, with fiscal year 1967 with
the advent of Medicare, this figure is now rising to approximately 14%. This
percentage will increase still further as we begin to implement the Medicaid
(Title XIX) Program.
2. The estimated cost per day at Glenn Dale Hospital at the present time is
$30.89. I should hasten to point out that this is not really comparable with the
figure at D.C. General Hospital because Glenn Dale Hospital is a chronic disease
83
APPROVED DISTRICT OF COLUMBIA PROJECTS UNDER THE HILL-BURTON PROGRAM, BY FISCAL YEAR OF INITIAL
APPROVAL 1-_Continued
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84
and tuberculosis hospital which cannot really be compared in terms ~$f per diem
cost with a general hospital. The estimated per diem rate at Freedmen's Hospi-
tal is $67.00.
3 The national a~eiage ho~pit~1 cost pei p'ttient da~ foi genei al liospetals
is $60.71.
4. D.C. General Hospital has received federal funds for new construction and
modernization under the Hill-Harris Act (formerly the Hill-Burton Act) as
follows:
Project Year Total cost
of project
Federal share
of project
Children's building 1948-49 $2,432,909 $525,914
Air conditioning operating room 1952 8, 250 2, 600
Psychiatric convalescent rehabilitation build:ng 1960-1961 1, 316, 451 395, 500
5. With respect to federal funds available under other legislation, the D.C.
Government hospital has benefitted as follows:
Manpower Development & Training Act of 1962 $13, 101
NURSE TRAINING ACT OF 1964
Available for School
student reimburse-
loans ments
Fiscal year:
1966
1967
1968
9,000
9,000
9, 000
7,500
11,250
16, 900
During the course of my testimony you asked for iuforn~ation concerning
occupancy rates at different hospitals. May I indicate that the national average
for hospital occupancy rates for the year ending September 30, 1967 was 77.6%.
In the District of Columbia the average was 83%.
I do hope this iafovmation will be of assistance to you. If there is any further
information you desire we shall be most happy to try to provide it.
Very sincerely,
MURRAY GRANT, M.D., D.P.H.,
Director of Public Health.
0