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· Mr. Sisson. That is all right, but you pay them back, do you not? Mr. ROUTSONG. No.
Mr. ANTHONY. That is, the expenses of the institution come out of their own fund ?
Mr. ROUTSONG. Yes, sir.
Mr. Sisson. Then, the cost per patient is arrived at by the number of hospital days and the amount of your money which they spend ?
Mr. KELLEY. You do not know how much it costs them and how much it costs you?
Mr. RouTSONG. Yes, sir; we know exactly.
Mr. ROUTSONG. For 1921 the total amount allotted to them was $5,070,000 and we estimated that allotment to be made to them, but as I explained before, that includes $3,768,000 which was disbursed for alterations and improvements. This year, 1922, we estimate that it will be necessary to allot them a total of $2,500,000, out of which we estimate $2,000,000 will be required for hospiltalization and $500,000 for alterations and improvements. That is approximately at the rate of $2 per diem-a little less than that.
Mr. Sisson. How many men will you put there?
Mr. ROUTSONG. We will have an average of 3,204. At the beginning of the year there were in hospitals of the soldiers' homes 2,429, and that number will gradually increase, we estimate, to 3,987, and the average will be, as I said, 3,204.
The CHAIRMAN. Let us see what they did last year. First, you allotted them $5,070,000, and $3,768,000 of that was for repairs and to make facilities for hospitalization ?
Mr. ROUTSONG. Yes, sir.
The CHAIRMAN. $1,302,000 was left, with which to provide the hospitalization. Divide that by 3,204Mr. ROUTSONG (interposing). You have 1921. The CHAIRMAN. I am talking about 1921. Mr. ROUTSONG. The average number in hospitals was 1,208.
The CHAIRMAN. That would be one thousand and eighty odd dollars a year or about $3 a day?
Mr. ANTHONY. A little less, about $2.75.
Mr. BYRNS. May I read a statement on that point from the hearings on the sundry civil appropriation bill:
The CHAIRMAN. If I get your figures correctly here with regard to your total estimates, they are for the treatment of 1,000 ex-service men 365 days in the year, and for that service, including this increase in the bonus, you are asking for $816,500, or about $2.20 per day. Col. WADSWORTH. That is about what it is.
The CHAIRMAN. According to these figures, your cost is $2.20 per day per man, whereas the Government is now paying for this same kind of treatment under the Public Health Service at least twice that much. Maj. WADSWORTH. Yes, sir. That was the statement made before the committee.
The CHAIRMAN. Permit me to ask this question in connection with this matter. Does the National Soldiers' Home Board bill you for the number of patients you have there; and if so, do they state the rate per day which they charge for these men in the bill or do they simply ask you for a lump sum and you allot it and they never pay any further attention to it?
Mr. ROUTSONG. That has been the way in which, that has been handled in the past.
The CHAIRMAN. Which way? I suggested two ways.
Mr. ROUTSONG. The lump-sum allotment has been made. I may say that it is the intention of the director that no future lump-sum allotments shall be made without a supporting detailed bill as to the past period and an estimate of the number of patients and the hospitalization cost per day.
The CHAIRMAN. Would you not think that the nicest way, the cleanest way, the most systematic and business-like way would be for them to bill you every month for the number of patients and then for you to send them a draft, because then you would know what it is costing?
Mr. ROUTSONG. Their answer to that--not my answer-is as regards allotments, that where they have to contract for any large amount, which is for the whole year or in the case of construction, alterations, or improvements, they must have transferred and available for their disposal the total amount involved in the obligation before they can close à contract of that kind. That has been their objection to proceeding on that basis.
The CHAIRMAN. Do they make an estimate of what the total cost of repairs will be before they get the allotment?
Mr. ROUTSONG. They have not done that in the past.
The CHAIRMAN. As a matter of fact, your section of the Government's activity in relation to these men, has no knowledge whatever, except the request of the other people, as to what is to be done with the money, how much it is going to cost, and what the accounting system will be ?
Mr. ROUTSONG. We have been unable to control their accounting methods.
Mr. Wood. Have you ever figured out from one of these hospitals how much it is costing you per man per day as compared to what it is costing you per man per day at another hospital, to see whether they are tracking along about alike?
Mr. ROUTSONG. We have not been able to do that.
Mr. BYRNS. You said that you could not control their accounting methods. Can not you do that when they call on you for an allotment, ask what they want to do and how many men they intend to care for ?
Mr. Routsong. Up to this time lump-sum allotments have been made. It is the intention of Col. Forbes that future allotments will not be made without supporting statements as to the expenditure over the period which the previous allotment covered and the estimated requirements over the period for which the allotment is requested.
ALLOTMENTS FOR ALTERATIONS AND REPAIRS. Mr. Byrns. Do I understand that it has been the custom under the past administration of the bureau for them to make a request for an allotment of, say, $100,000 with no statement as to what they wanted to do with it?
Mr. ROUTSONG. Not a detailed statement; it has been a general statement that it was for alterations or improvements.
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Mr. BYRNS. Would they not tell them how much they needed for alterations and improvements ?
Mr. ROUTSONG. There was not a detailed statement.
Mr. ROUTSONG. No; Dr. White's committee
Col. PATTERSON. The White committee concerns itself solely with the construction of new hospitals and up until August 9 the Veterans Bureau had practically nothing to say as to the expenditure of this fund. .
Mr. ANTHONY. But Dr. White's committee would have charge of the allotment of this money from the Veterans' Bureau to the Soldiers' Home Board for construction purposes?
Col. PATTERSON. No, sir. The Secretary of the Treasury approves that. There are four of those in the process of construction, for the enlargement of existing soldiers' homes, which have been approved by the Secretary of the Treasury, and, I may say, also by the President, by Col. Forbes, and those who decide upon the policy of the Veterans' Bureau. Following that policy, since the date mentioned at the request of the Director of the Veterans' Bureau the White committee are undertaking certain new construction and they have the matter now in hand.
Mr. Sisson. Going back now to this item and using the figures which Mr. Byrns used, say, $100,000, for improvements or construction, who checks up the expenditure of that fund ?
Mr. ROUTSONG. All of these allotments were made prior to the organization of the Veterans' Bureau.
Mr. Sisson. But who checks that up to see that it is properly expended ?
Mr. Routsong. In answer to your question I will say it was felt that it was the business of the War Department to spend economically that fund which was allotted to it and to check it up.
Mr. Sisson. Congress appropriates the money and yet the department that actually takes that money out of the Treasury by alloting it to these other people has not had any checking account of any kind to determine how the money has been spent. In other words, it does strike me as being a very loose system of transacting business. I believe you stated that $3,000,000 had been allotted for improvements ?
Col. PATTERSON. $3,768,285.08 in 1921. Mr. Sisson. Somebody ought to be able to voucher the expenditure of that money. Suppose that this committee, which is a committee of Congress, or a subcommittee should ask for the vouchers, which they might sometime do, if they are willing to go over them, and that would certainly be the case if some wrong should occur requiring a congressional investigation, you gentlemen would just say, “We transferred it to their credit on the books of the Treasury." Whose duty is it, under the law, to voucher all of this money?
Mr. ROUTSONG. After the allotment has been made our obligation as to its economical expenditure and the accounting for it
Mr. Sisson (interposing). Ends?
Mr. ROUTSONG. Seems to end. The War Risk Insurance Bureau, if the allotment was in the hands of the Public Health Service, would have to look to them for an accounting of the amount which was allotted to them.
Mr. BYRNS. I recall, when the committee decided to put some of these men, permitted them to be placed in hospitals in the soldiers' homes, that the director at that time very strongly insisted that he was responsible for the hospitalization of the ex-service men, and he ought to have control of the funds in order that he might know just what it was costing and to keep track of every dollar which was spent, and the committee, realizing that he was responsible, placed under the director this fund, so that he could make these various allocations to the soldiers' homes. Now, I understand, as a matter of fact, that there has been no close supervision of the fund or information obtained as to just how it is to be expended and as to what the hospitalization of these ex-service men in the soldiers' homes is costing:
Mr. ROUTSONG. I feel, Mr. Chairman, that that is a subject which the Director himself should discuss more in detail. I have told you of the policy in the past.
The CHAIRMAN. I understood you to say just a short time ago, I think in response to a question by Mr. Anthony, that you had no control over the accounting. You are an intelligent man and you do not mean to tell us that anybody who has the power to allot has not the power to make the conditions of the accounting before he makes the allotment.
Mr. ROUTSONG. I did not say that. I said that it was not done · before the organization of the Veterans' Bureau.
The CHAIRMAN. That is equivalent to saying it. That is still worse. If you were to admit that you had not the power to do it, there would be some excuse. There is absolutely no excuse to say it was not done when you had the power and must by inference admit that you had the power.
Mr. ANTHONY. In looking over the language of the law I find it provides that this money shall be allotted and transferred from the Veterans' Bureau to the Public Health Service or the Soldiers' Home Board, transferred to their credit for disbursement.
The CHAIRMAN. But it does not provide that it shall not be transferred without conditions ?
Mr. ANTHONY. It provides that it shall be transferred to their credit for disbursement.
The CHAIRMAN. It might provide that you would have the power to sign a check for an account which I would render, but you would not sign that check without examination ?
Mr. ANTHONY. I agree that since the activities are consolidated the Veterans' Bureau should obligate itself, but undoubtedly Congress gave them absolute authority to transfer this money to these other bureaus for disbursement.
Mr. Sisson. The auditor would not allow the accounts without that authority; that right of allotment does not mean that you must make the allotment without conditions.
The CHAIRMAN. I am going to say this in response to my colleague's statement. The law provides that the money shall be allotted from time to time to the Public Health Service and to the Board of Managers of the National Home for Disabled Volunteer Soldiers. It does not say that you shall allot indiscriminately, without rhyme and without reason or condition-you may allot, but it does not say that you must allot without any conditions. It would be absurd to assume that any sane man would allot to some other man just because the law suggests that he may allot and that then the other man can do with it as he pleases.
Mr. Sisson. If you will excuse me for a minute, I want to call the attention of the committee and the representatives of the War Risk Insurance Bureau to this particular language: This appropriation shall be disbursed by the Bureau of War Risk Insurance
Please listen, now. and such portion thereof as may be necessary shall be allotted from time to time to the Public Health Service.
But you will notice that the distribution of this fund is particularly under the control of the War Risk Insurance. If I had the manage ment of it I would want to know exactly how you were going to spend it and then want you to voucher me for it so that I could account back to this committee or to the Secretary of the Treasury, in the event he should ask me to do so.
The CHAIRMAN. What is the policy now with respect to this proposed appropriation ?
Mr. Routsong. I am very glad to hear the position of this committee because I have heard very explicitly what Col. Forbes said about how he wanted these accounts kept and the sort of report that he wanted as regards past expenditures and the purposes for which allotments were to be niade. I have written repeated letters to every branch of the service on that very thing. There has been only a partial response. We know how many patient days we have for each hospital. That is quite different from having detailed information as to where the money went and the exact purpose for which it was spent. We get a gross estimate on the number of patient days that we are providing for when we allot a certain amount of money to the War Department or to the Navy Department.
The CHAIRMAx. Knowing the conditions when you made that allotment, it should be accounted for?
Mr. Routsong. That we have done.
The CHAIRMAN. It is being done? That is to cover this fisca! year? Mr. Rousong. Yes, sir.
The CHAIRMAN. How often do you require these statements to be sent in?
Mr. Routsong. In the instance of the Public Health Service, the Army and Navy, their allotments have been made quarterly.
The CHAIRMAN. How often do you require the statements to come in as to the way the sum is being used ?