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Mr. ROUTSONG. I have just been in conference with Dr. Lavinder. We have had several conferences and we are arranging now to have a monthly statement of expenditures for hospitals, which will show both the operating expenses, what we might call the direct expenses, and the indirect expenses and overhead, as represented by the capital outlay for each hospital.
The CHAIRMAN. These people in the Army-and the Public Health Service is a very close adjunct to the Army--do not know anything about money and they care less.
Mr. ANTHONY. Please do not mix the Public Health Service with the Army.
The CHAIRMAN. They do not know anything about money matters. The people that are working out in the fields throughout the rest of the country are anxious to find out what is being done with their money, why they are being taxed so much, and we want to give the people at least a partial insight into the necessity of some systematic way of conserving public funds.
Mr. Routsong. We have requested that sort of information.
The CHAIRMAN. You can not get it by requesting it; you have to insist upon it. We are not getting anything from you people by requesting; we have to drag it out of you with a corkscrew.
The law provides that “this appropriation shall be disbursed by the Bureau of War Risk Insurance.” That is what it says.
Mr. Wood. And there should be a penalty attached.
The CHAIRMAN. If these people to whom allotments are made are not complying with the conditions laid down and they fail to get another allotment, let them stand the responsibility before the public.
Col. Forbes. The responsibility is upon us to take care of the patients.
The CHAIRMAN. I know, but they will not turn the patients out. They are just as liable to criticism as you are.
Mr. Sisson. We will cross that bridge when we get to it.
Mr. KELLEY. What are the elements of cost in the Army and Navy hospitals over and above the elements that go into this soldiers' home cost that makes the difference of $2 a day?
Col. PATTERSON. I do not know whether I can answer that completely. I would say that the first thing would be that the personnel is a much more expensive personnel than that operated by the National Soldiers' Home for Disabled Soldiers.
Mr. KELLEY. Do the nurses cost more?
Col. PATTERSON. I think the national soldiers' homes pay less for their professional personnel and for their civilian personnel than is probably paid in either the Army or the Navy.
Mr. Wood. It is not because those who are receiving treatment in the soldiers' homes receive worse treatment; they get equally as good treatment?
Col. PATTERSON. In general, I think the treatment in the National Homes for Disabled Volunteer Soldiers is satisfactory, but I do not believe it is on the same professional standard as in the Army and
Mr. Wood. Do you not think it is because it is a new institution, created in abnormal times when abnormal prices were paid for every
Col. PATTERSON. I think that has a great deal to do with it.
Mr. KELLEY. There are a great many Navy and Army hospitals that are old and as well established as the soldiers' homes and as well organized and, perhaps, better?
Col. PATTERSON. Of course, they have been subject to a great many changes. You take the Walter Reed Hospital; that was expanded in the war to about 3,500 beds. It is now down to about 1,500.
In the sudden fluctuations there is bound to be some expense created that can not be prevented. I think in the case of the soldiers' homes they have a fairly constant attendance. They are now going into the hospital business on a larger scale than ever before. It will be interesting to see what it will cost them in the future as compared to the present. They are going to take more hospital patients than ever before. Most of their own people are merely domiciled in their institutions. They have small hospitals to take care of acute cases, whereas now we have to require them to have large hospitals to take care of the Veterans' Bureau cases.
HOMES VACATED AND TURNED OVER TO PATIENTS OF VETERANS' BUREAU.
Mr. Byrns. They have absolutely vacated some of the soldiers' homes, the homes for soldiers of past wars, and turned them over entirely to the Veterans' Bureau ?
Col. PATTERSON. No, sir.
Mr. Sisson. I thought that the home at Johnson City was practically abandoned, that all except the help had been taken away?
Col. PATTERSON. I think I saw a report of 38 or 39 of their own people yet there.
The CHAIRMAN. Please tell us about the new system that you have now?
Col. PATTERSON. I think Mr. Anthony could answer your question; with respect to the home in Leavenworth they have their old soldiers beside the Veterans' Bureau beneficiaries?
Mr. ANTHONY. I think three of the soldiers' homes have been practically depleted of the older residents, Johnson City, Marion, and Milwaukee.
Col. PATTERSON. Although they have some at each of those homes? Mr. ANTHONY. Yes, sir.
Mr. CANNON. I think that more of the soldiers of the Civil War and Spanish War were sent to Danville than anywhere else. Mr. ANTHONY. That is right.
Mr. CANNON. I doubt if the Danville Home has any of the soldiers of the late war.
Col. FORBES. Danville has a few vacant beds for War Risk beneficiaries.
Col. PATTERSON. There are 22 men, Veterans' Bureau patients, in Danville at the present time only.
Mr. CANNON. They must have come from the other soldiers homes.
The CHAIRMAN. Is there anything further you wish to say as to the Public Health Service ?
ESTIMATED NUMBER AND COST PER DAY OF PATIENTS.
Mr. ROUTSONG. It is estimated that there will be an average of 16,821 patients throughout the year, and we have estimated that the amounts chargeable to the cost per patient day in hospitals when summed up and divided by the total number of patient days would be approximately $4.64.
The CHAIRMAN. Indicating that the Public Health Service is rather more extravagant than any other place?
Col. FORBES. I should like to take an exception to that. I do not think that the Public Health Service hospitals are being operated for $4 a day.
The CHAIRMAN. This is $4.64. Mr. KELLEY. What do you think it costs? Col. FORBES. Nearer $7. The CHAIRMAN. Per patient. Col. FORBES. Yes, sir. Mr. ANTHONY. That is when you take into consideration the cost of construction ?
Col. FORBES. No, sir; the cost of operating the hospital, including its overhead.
The CHAIRMAN. The Surgeon General is present and perhaps he can answer that.
Dr. LAVINDER. May I say a word about hospital costs, Mr. Chairman?
The CHAIRMAN. Certainly.
Dr. LAVINDER. I spent a lot of time in computing hospital costs. It is not a standardized thing. It depends on how you figure. Possibly, if a man figures the overhead cost and the invested capital it would run higher than stated here.
The CHAIRMAN. $4.64?
Mr. KELLEY. Nobody figures on the invested capital. Neither the Army nor the Navy does that.
Dr. LAVINDER. No, sir. If you are not figuring the large construction cost, I think that is probably a fair statement of the cost per day. The Public Health Service is in somewhat a different position from any other governmental agency that is running hospitals for the reason that we have to be an adjustable agency and we are required to meet any condition, to open a hospital where it did not exist, and to close one when not needed. It is very expensive to go out and rent a building not intended for a hospital, open it and use it for a while, and then close it down. It has been my experience that when you open a new hospital and furnish the personnel and the patients come in slowly that it sometimes costs $45 to $60 per day per patient while filling up and before your costs come down, but that is unavoidable.
The CHAIRMAN. Give us the rest of that.
Mr. ROUTSONG. In addition to this total amount of $28,493,000
The CHAIRMAN (interposing). We are now dealing with the number of patients in the different hospitals. Are you through with that?
Mr. Routsong. We still have patients in contract hospitals.
The CHAIRMAN. We want them all now. We have a statement covering 22,225 and you said
you have 30,000, and we want to know what has become of the remaining 7,775.
Mr. ROUTSONG. Perhaps I had better enumerate the other amounts that will have to be allotted to the Public Health Service which we do not feel should be included in the $4.64 per diem. That is opening new hospitals, $2,000,000, dental service and clinics
NUMBER AND COST PER DIEM OF PATIENTS IN CONTRACT HOSPITALS.
The CHAIRMAN (interposing). We are getting off of what we started
We want to keep on with the thing we started with. We want to know where these other patients are.
Mr. ROUTSONG. It is estimated that there will be an average of 9,162 patients in contract hospitals throughout the year. We have estimated the average per diem cost there for the purposes of this deficiency estimate at $3.68 per day.
The CHAIRMAN. We get that cheaper than the rest?
Mr. ROUTSONG. That is the bid that the contract hospitals gire the Veterans' Bureau for the service.
Col. PATTERSON. That varies as high as $4.
The CHAIRMAN. I only know about one place personally, and while we are talking about hospitals, I suppose this would be the proper place to call it to your attention. At Chicago they built what was known as the Speedway Hospital, at a cost of about $3,500,000, and I am told that there are only about five or six patients there.
Col. PATTERSON. There are in that hospital right now (Oct. 27, 1921) 472 patients.
Mr. Byrns. What is the capacity of that hospital?
Col. PATTERSON. One thousand beds in all for both patients and employees.
The CHAIRMAN. Have you taken them away from Oak Forest, out at the Cook County Poorhouse?
Col. FORBES. There are still patients there. Col. Patterson states that that hospital has a capacity of 1,000 beds: It was intended to be a 1,000 bed hospital, but 337 rooms in that hospital are set aside for employees. The Public Health Service made a contract with the town of Maywood to house in a hotel 125 additional employees that could not be accommodated in the Speedway Hospital.
The CHAIRMAN. Does it take that many employees to wait on 1,000 patients ?
Col. Forbes. No, sir; that hospital will only accommodate about 700 patients.
The CHAIRMAN. Does it take 500 employees to wait on 700 patients
Col. FORBES. In some hospitals it takes one employee for each patient. At Fox Hills, New York, when I was there the other day, they had almost 800 patients and over 800 employees.
The CHAIRMAN. How does that compare with private hospital service?
Col. FORBES. There are more employees than in some private hospitals, or at most private hospitals that we have been able to learn of.
The CHAIRMAN. Do they get better care here than in private hospitals?
Col. FORBES. They have more freedom. There is not the discipline exercised in our hospitals that they have in private hospitals, but they come and go practically at will.
The CHAIRMAN. What effect does that have upon the cost of attendance? Does it have any?
Col. FORBES. No, sir.
Mr. GALLIVAN. Do you know of any private hospitals where they would average as many as one attendant per patient?
Col. FORBES. No, sir.
Col. PATTERSON. I can answer that question. At the Peter Bent Hospital, in Boston, they have 600 people taking care of 200 patients. That is a private hospital.
Mr. GALLIVAN. They were left millions of dollars to take care of the institution, and probably they are trying to spend it. (Telegrams sent and received by Hon. J. A. Gallivan:)
NOVEMBER 8, 1921. SUFERINTENDENT PETER BENT BRIGHAM HOSPITAL,
Boston, Mass.: Col. Patterson connected with medical department, United States Veterans' Bureau, testifying before my committee on appropriations to-day alleged that in your hospital there were employed 600 persons to take care of but 200 patients. Is this statement in accordance with facts? Desire this information at once, because of important legislation now pending in my committee with reference to cost of operating Public Health Service hospitals which are housing veterans of World War. Please send me wire reply to-day to room 526 House Office Building, Washington, D. C. Thanks in advance.
JAMES A. GALLIVAN, M. C.
BROOKLINE, Mass., November 8, 1921. Hon. Jas. A. GALLIVAN,
Washington, D. C.: There are present 327 people employed here who care for an average of 190 ward patients. This includes 132 nur:e3 and 31 re ident phy-icians. Don't count 18 visiting physicians nor 16 pupils listed in training school, but at other hospitals with which we are affiliated does include in addition to above the care of an average of 150 out patients daily.
J. B. HOWLAND, M. D.,
Superintendent Peter Bent Brigham Hospiial. The CHAIRMAN. Does the Public Health Service now control the Speedway Hospital ?
Col. PATTERSON. Yes, sir.
The CHAIRMAN. We have reached the total number of assignments to hospitals, and the different hospitals have been indicated. Now, we would like to know what other expenses there are connected with this estimate of $43,691,000.