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Mr. ROUTSONG. You mentioned that, and I just wanted to inform you that Col. Forbes had anticipated it.

The CHAIRMAN. We have on page 20 an item that deals with medical and hospital services, which we will not take up until after lunch. In the meantime, I would like to ask whether you would like to have some of the Public Health officials here, as you allot most of these amounts to them, to help answer some of the questions that may be asked ?

Col. FORBES. Yes, sir.
The CHAIRMAN. What officials would you like to have?
Col. FORBES. Dr. Lavinder, of the Public Health Service.

MEDICAL AND HOSPITAL SERVICES.

ALLOTMENT OF APPROPRIATION,

The CHAIRMAN. We have before us an item, found on page 20 of the bill, of $43,691,803.44. The appropriations already made for the current fiscal year amount to $33,000,000. We would like to have somebody tell us how this $43,000,000 item is arrived at, what is intended to be done with it, how it is subdivided, how it is allocated, who has jurisdiction over its expenditure, and what particular activities are involved in the distribution of the fund.

Mr. ROUTSONG. Mr. Chairman, this appropriation is expended, in part, by the United States Veterans' Bureau and in part through allotments to the War Department, Navy Department, National Homes for Disabled Volunteer Soldiers, and the Public Health Service. We are directly responsible for the expenditures made direct by the Veterans' Bureau. This responsibility, I believe, is an implied responsibility as regards the allotment of funds to the branches of the service which I have enumerated. We have felt responsible to the extent of inquiring into the method of expenditure, the distribution of the expenditure, and the service rendered for the money so allotted.

NUMBER AND PER DIEM COST OF PATIENTS IN ARMY HOSPITALS.

I might say that in arriving at the total of the estimated expenditure for the current year, of $76,691,803.44, it was estimated that the average number of patients who would be placed in Army hospitals would be 1,247, which is the average number that would be there at any one time, and that the average cost per diem in Army hospitals would be $4.38.

The CHAIRMAN. For how long a period ?
Mr. ROUTSONG. This is throughout the year 1922.
Mr. Sisson. Did you say

the
per

diem cost was $4.38 ? Mr. ROUTSONG. Yes, sir; that is the estimated per diem cost. That, of course, does not include all of the overhead and other expenses to the Government, but the expenses which must be met out of this appropriation.

The CHAIRMAN. What do those expenses include; that is, what is covered by the $4.38 per diem ?

Mr. ROUTSONG. The War Department has, of course, its own patients and ours in addition. We are billed at the rate of $3.50 per

day, plus the pay of the additional personnel which they require to take care of our patients, and we allot them so much to pay the necessary personnel. We have included that amount in the total of $4.38 per diem.

The CHAIRMAN. Is $3.50 per diem the cost to the Army?

Mr. ROUTSONG. That is the cost to the Army; that is the prorated expense.

The CHAIRMAN. You say there are 1,247 patients ?
Mr. ROUTSONG. Yes.

Mr. Sisson. I do not know that I understand that exactly. How much did you say was the cost per patient?

Mr. ROUTSONG. $4.38 is the gross amount.

Mr. Sisson. And you say $3.50, plus a certain amount for overhead, is paid to the Army?

Mr. ROUTSONG. Yes, sir.

Mr. Sisson. And the overhead would be the difference between $4.38 and $3.50 ?

Mr. Routsong. Yes, sir.

Mr. Wood. You said that was not all the cost. What is the other cost, and if this other cost were included what would be the per diem cost ?

Col. PATTERSON. That would be for maintenance and repair; the per diem rate of $4.38 counts in everything but maintenance and repair. . Mr. Wood. You do not know how much that is?

Col. PATTERSON. No; but I could tell you what it was for last year. That depends on what repairs are needed during any year, and you can only make an estimate on that.

Mr. KELLEY. You mean you repair Army hospitals out of some funds in addition to this $4.38 ?

Col. PATTERSON. Yes, sir. If there was a repair necessary they would prorate it between the Army appropriation and the Veterans' Bureau appropriation, and the Veterans' Bureau would have to pay its share of the money expended in making the necessary repair.

NUMBER AND PER DIEM COST OF PATIENTS IN NAVAL HOSPITALS.

ment cost.

The CHAIRMAN. Please go on with the next item.

Mr. Routsong. In the Navy hospitals it is estimated that we will have an average of 924 patients at a daily rate of $4.24. We are billed $3 per day by the Navy Department, and in arriving at this $4.24 we have figured the amount they have requested for the payment of the necessary personnel, just as we figured the War Depart

There is a slight difference in these two amounts of 14 cents per day which I have not analyzed, and I am not prepared to tell you just why there is that difference.

Mr. Wood. Why do you pay the Army $3.50 and the Navy $3?

Mr. ROUTSONG. They bill us for that, Mr. Wood, and apparently there is a difference in the cost as between the hospitals. Then, too, if you were to make an intensive study of that you would find that there is a difference in the cost, depending on the type of patients cared for. It costs more to take care of one type of patient than another. For instance, patients that are ambulatory, that is, able to be about, do not cost aa much as bed patients. Col. Patterson

could tell you more about that in detail, but there is that difference. The difference is explained in the character of the patients.

Mr. KELLEY. Of that $4.24 how much is allocated for the hospital ration ?

Col. PATTERSON. That is a varying figure and may be up to $2 or $3; the rest is for the pay of the personnel. The $3 would represent food, medicines, drugs, supplies, and all the other things that are given to a patient in a hospital.

Mr. KELLEY. You do not know how much the food is by itself?

Col. PATTERSON. I do not know what the Navy ration is at present. Of course, in the Army it varies according to what the Secretary of War announces it shall be during each year.

Mr. GALLIVAN. Would these patients eat the ration?

Col. PATTERSON. No, sir; they would not; they would eat it in part but they must also have special articles of diet.

Mr. KELLEY. What is the Army hospital ration?

Col. PATTERSON. That varies, you know. You mean, what it costs?

Mr. KELLEY. Yes.
Col. PATTERSON. That also varies,
Mr. KELLEY. Well, about what?
Col. PATTERSON. It would run from 75 cents to $2 a day.

Mr. KELLEY. Mr. Anthony, in making your appropriations for the Army do you not specify the hospital ration?

Mr. ANTHONY. No; it is not specified, but it runs just about double what the regular ration is.

Col. PATTERSON. I do not know what the value of the Army ration now is this year. It is about 53 cents, is it not, Mr. Anthony?

Mr. ANTHONY. We appropriated on the basis of 39 cents, but the Department has estimated a higher ration.

NUMBER AND PER DIEM COST OF PATIENTS IN NATIONAL HOMES FOR

DISABLED VOLUNTEER SOLDIERS.

The CHAIRMAN. Proceed with these items in order.

Mr. Routsong. In the National Homes for Disabled Volunteer Soldiers it is estimated we will have an average of 3,204 patients.

The CHAIRMAN. What is the rate?

Mr: ROUTSONG. I am not prepared to give you a figure as to the per diem cost in the National Military Homes, but I am prepared to give you an analysis of the amount they received last year and their estimates as to their requirements for this year.

The CHAIRMAN. Give us what it cost last year. There must be somebody who knows that.

Mr. ROUTSONG. I have that, Mr. Chairman. The gross cost was $5,070,000 last year.

The CHAIRMAN. Divided among how many patients ?

Mr. ROUTSONG. The average number of patients was 1,208, but you should bear in mind that this $5,070,000 includes $3,768,285.08 which was spent under the head of alterations and improvements in the military homes. The fact that it is possible to spend out of this appropriation for what might be called "capital expenses,” as well as operating expenses, makes it very difficult to actually arrive at what the per diem cost would be in the military homes, where there are

extensive changes and improvements, and I have been unable to get for you, for my own use, or for the use of Col. Forbes or Col. Patterson, a figure that I believe truly represents the actual per diem rate in the military homes.

Mr. ANTHONY. Have you gone far enough into the figures to find out that the actual per diem cost at the homes is less than that in either the Navy or Army? I mean for maintenance and not for construction or anything of that kind.

Mr. ROUTSONG. I think it is less because of the fact that they are well organizad and equipped and a going concern. You will understand that there is a great difference in the overhead cost.

Mr. ANTHONY. I wish you would put in the record the actual per diem cost of the maintenance of these men at the National Soldiers' Homes as compared with Navy and Army hospitals.

The CHAIRMAN. Cutting out the construction?
Mr. ANTHONY. Yes.

The CHAIRMAN. If you take out the construction, how much would it be? You can easily calculate that.

Mr. Routsong. Because of the fact that in the national military homes our medical and hospital appropriations has been used in effect as a deficiency appropriation, it is practically impossible for me to give you a truthful per diem cost. For instance, if they have so much appropriated for a given subject at one of the homes-take Dayton, for example—and that particular appropriation is exhausted, they supplement that appropriation with an amount sufficient to carry them through the remainder of the year.

The CHAIRMAN. Supplement it from what?

Mr. ROUTSONG. From medical and hospital services by requesting an allotment; they have done that in the past.

Mr. Sisson. Is the statute creating this activity sufficiently broad to justify that?

Mr. ROUTSONG. It is.

Mr. ANTHONY. What you mean is that they have replenished the funds that were originally voted to them by Congress by money which you pay them for the support of the patients there?

Mr. ROUTSONG. Yes, sir.

Mr. ANTHONY. That is, they will allocate that to the various homes?

Mr. ROUTSONG. Yes.

The CHAIRMAN. Let us understand this thing. The appropriations up to this time for the National Soldiers' Homes were made for the care of veterans of the Civil War and Spanish American War, and after it was decided to send soldiers of the late war to these homes, of course the funds appropriated for the care of the other soldiers would not be sufficient, and they would then be required to call on you for the amount necessary to maintain those that were sent by you to these homes, and naturally they would use such funds for the maintenance of the homes?

Mr. Routsong. There is nothing questionable about that procedure and I simply stated it to show you the difficulty in arriving at an actual per diem cost of our patients apart from the cost of the regular inmates of the homes.

Mr. Sisson. That of itself would be sufficient to make very strong grounds for criticism because you can not keep up with your funds.

PER DIEM COST OF MAINTENANCE OF HOMES FOR DISABLED VOLUNTEER SOLDIERS.

The CHAIRMAN. At the last hearing at which Col. Wadsworth appeared he submitted, at the request of the committee, a statement showing the per diem cost of maintaining the homes, and it was divided in this way: $0.012 for general headquarters, expenses of board of managers, including salaries of officers and employees, headquarters office, traveling expenses, etc.; current expenses, salaries of all officers and employees engaged in connection with the management of the branch, $0.11; subsistence, salaries of all employees engaged in connection with the preparation and serving of meals, $0.409; household, $0.204; hospital, $0.146; transportation, $0.004; repairs, $0.097; farm, $0.039; and clothing, $0.054; making a total of $1.075.

Col. PATTERSON. That is for the inmates of the soldiers' homes and does not refer to our people, because they cost a great deal more than the regular men who are domiciled in the institutions.

The CHAIRMAN. Of course, that is the average cost. Col. PATTERSON. That is the average cost of the men who are domiciled there, but our men go in as hospital patients, and, of course, cost a great deal more.

Mr. ANTHONY. My experience with the soldiers' homes has been that they are the most economically operated branch of the Government service that I have ever come in contact with. I have not always agreed with them; I have opposed them because they have been too economical, but they certainly do get 100 cents on the dollar for the money we appropriate.

The CHAIRMAN. You were allowed to put the World War patients into these soldiers' homes for hospital treatment, is that right!

Mr. ROUTSONG. Yes, sir.

The CHAIRMAN. You must have made some arrangement with the management as to the cost of the maintenance of the men who were placed there, or somebody must have done that.

Mr. Routsong. There has been no per diem cost agreed upon; they have requested, just as the other branches of the service have requested, an allotment in advance. I think they use for their own purposes the figure of $2 per diem in requesting their allotments, but that, I believe, bears no relation to the actual cost of our hospitalized patients in their homes. I might say that I made a trip to Dayton for the purpose of making a very intensive study of their accounting methods, and they are now setting up a system which, I believe, will give us a true picture of the cost of caring for the Véterans' Bureau patients, but up to this time they have not segregated that sufficiently for us to obtain a comparison as between the soldiers' homes and the other branches of the service.

Mr. Sisson. It looks to me as though it would be a very simple proposition to get the per diem cost. You allot them a certain amount of money, and then during that time you have a certain number of hospital days, so that it seems to me it would be easy to determine, by reason of knowing the number of hospital days, the daily cost per soldier. It seems to me it would be a very simple proposition if you made an effort to do that.

Mr. ROUTSONG. It would were it not for the fact that they use their own appropriations for the Veterans' Bureau patients.

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