Mr. GALLIVAN. It is $3 now. The CHAIRMAN. Why is it necessary to pay $5 for the examination of these men, when the Civil War and Spanish American War Veterans are examined for $3. Col. PATTERSON. I do not think you could get good examinations for less. Mr. KELLEY. What does the pension examiner get? Col. PATTERSON. I do not know. Mr. GALLIVAN. The pension doctor receives $3. It was only $2 until two years ago. Mr. ANTHONY. Do you use the local pension board in making your examinations? Col. PATTERSON. We have no authority to do that. The CHAIRMAN. The doctors making these examinations for this compensation are also the doctors who make the examinations of Civil War and Spanish-American War veterans, and the difference in the compensation is probably due to the fact that in the case of the Civil War and Spanish-American War veterans the fees are fixed by law, while in these other cases the fees are fixed by regulation. I think we should fix these fees by law if you are to squander money in that way. Col. PATTERSON. There is another way of looking at it. I do not believe you could get a competent examination made for less than $5. The CHAIRMAN. But we do get them made for these other men. Col. PATTERSON. I doubt the competency of the examinations. The CHAIRMAN. Nobody has ever complained about them. You are the first man that I have heard complain about them. Mr. GALLIVAN. It is fair to say that the pension examiners asked our committee to raise the fee from $2 to $4, and we compromised and made it $3. Mr. SISSON. That was because everybody else was getting higher pay under this new régime. The CHAIRMAN. The same doctors who make one examination are making the other examination, and they should not receive $3 for one examination and $5 for the other. You can not say that a doctor when he examines one is competent, and is incompetent when he examines another, if he is the same doctor. Col. PATTERSON. This examination is a complete examination of the man to show all that is wrong with him, and I do not believe that a man who would do it for $2 is qualified to make that kind of examination. The CHAIRMAN. They have always been glad to get the assignments, and we have never heard Civil War veterans or SpanishAmerican War veterans complaining about the adequacy of the examinations. It can not be said that those men are less worthy than the men who served in the late war. Col. FORBES. They are examined for specific disabilities, while men under the Veterans' Bureau are being examined thoroughly to detect any other disease than what they claim to have. The A. G. O. report on a man shows that he is suffering from some disability, but these doctors nevertheless make a complete physical examination of the man. That could be better understood by reference to the report that the doctor makes, showing the trouble that he goes to in making his report. Yet I think it is wrong to pay $5 for that service, because from some of the reports I have seen I do not believe that much service has been rendered by the man making the examination. The CHAIRMAN. It is outrageous. If we are to spend this money anyhow, I am not in favor of giving it away to the doctors, but I am in favor of giving it to the men who are to be treated. Col. PATTERSON. In that connection, it has often been found that those examinations are not really satisfactory for the purpose of making a rating, and sometimes you have to have very precise information to enable the medical officer who reviews the case to determine just exactly what disability the man has, and if those examination forms are not carefully filled out, we must scrap them and ask for other examinations. The director has recently determined that it will save money if we have these examinations made in the district offices and the local suboffices, dispensing as far as possible with the service of local examiners, who would not be used except in emergencies. When that is done, these fees will probably drop some. Mr. BYRNS. Is this examination made for the purpose of determining the question of compensation or for admission to a hospital? Col. PATTERSON. For both purposes. Suppose, for instance, a man comes in and says that he has tuberculosis and wants to be hospitalized. The first thing they do with that man, if they can not determine right off whether he has the disease, is to put him in the hospital and find out. Immediately he will make a claim against the bureau, and upon the basis of the physical examination made at the hospital he will be rated for compensation, and at the same time he will be in the hospital. Mr. BYRNS. That is for the purpose of determining whether he is entitled to hospitalization, and you would not require as rigid an examination for that purpose in the first instance as you would in the case of an applicant for compensation? Col. FORBES. He is often hospitalized before the complete examination is made. Col. PATTERSON. And the determination of the diagnosis is made afterwards. Of course, if it is an obvious case they can determine it right off. However, the man is hospitalized at first if there appears to be any doubt as to his condition. The CHAIRMAN. Do you mean that when any man who served in the Army comes along and makes application for examination they send him to a hospital and keep him there for a time or until he is examined? Col. PATTERSON. No, sir; he is given an examination immediately, but if it is not possible to decide upon the claimant's condition, he is sent to the hospital. Some conditions are obscure. For instance, a man may say that he has epilepsy, but no doctor could say that he was an epileptic unless he could observe him while having one of those fits. For that purpose he would be admitted to the hospital and observed. Some other man might think he had tuberculosis, but the doctor upon an examination of him might not be able to determine it right away, and he would be put in a hospital to be placed under observation. Mr. KELLEY. Where are the 287 doctors that you referred to on duty? Col. PATTERSON. There are 61 of the Public Health Service in the bureau here, and the rest are in the districts. Our statement already given shows their distribution. Mr. KELLEY. Under this new plan you propose to put into effect most of the examinations will be conducted by them? Col. PATTERSON. A great many of them will be conducted in the district offices and suboffices. Mr. KELLEY. And then the fees will drop off? Col. PATTERSON. Yes, sir; the fees should drop off. The CHAIRMAN. How would the fees compare with the salaries paid to those men? Col. PATTERSON. I think it would save money to the bureau to have the men on the salary basis always. The CHAIRMAN. You think that, but have you any facts for a basis? Col. PATTERSON. Yes, sir; I have known doctors in the Army who have operated on enough cases in a day to pay in fees under civil life conditions five or six thousand dollars. There a man in one day will save his full salary to the Government. If Mr. SISSON. How about the question of accessibility to the men? you have a limited number of doctors, you will have them traveling around to find the men, will you not? Col. PATTERSON. We would still retain local examiners for the emergency cases. Otherwise it will be advantageous to have the men go to the nearest suboffice. Mr. SISSON. And you would pay their expenses? Col. PATTERSON. Yes, sir. Mr. SISSON. Then I do not know that you will save much on the examination. At best, a diagnosis is usually only a good guess. Col. PATTERSON. I am afraid I can not agree with you on that. Mr. SISSON. Of course, if you have a man with an arm cut off, you know that his arm is off. That is true, because anybody can see it and can diagnose it as a case of lost arm. Here a few years ago, in the District of Columbia, I was examined by two of the most reputable doctors in the city, and they said I had tuberculosis. I knew that was not so. I knew I did not have tuberculosis. Admiral Braisted heard that I was not right well, and he sent me to the naval hospital, and I never had doctors to go through with me in as many different ways as they did down there. When they got through with me they laughed at the suggestion that I had tuberculosis, because I did not have the slightest tinge of it. Yet, as I have said, two of the most reputable doctors in Washington said that I was suffering from tuberculosis. Col. FORBES. Your statement is borne out by the fact that in many of our examinations no two doctors will agree. Mr. SISSON. Therefore, a diagnosis at best is nothing more than a good guess, at least, and after these boys pass your examination at the local offices, it is not worth very much, and after you get them into the hospitals they are given further examinations? Col. PATTERSON. Yes, sir. Mr. SISSON. That first examination is largely for the purpose of admitting them, and the doctors in my town and in my district, at least most of the reputable doctors, make the examinations for the boys and they would make them as best they could for nothing if the boys really needed hospitalization. So I do not think you get very much better service through having a hospital doctor and by paying a fee of $2, $5, or $20. MEDICAL AND SURGICAL FEES, SPECIAL. The CHAIRMAN. Give us the rest of the figures. Mr. ROUTSONG. Medical and surgical fees, special, $725,000. Mr. ROUTSONG. That includes specialists who are called in for special cases and special purposes. The CHAIRMAN. These are the cases where you pay them over $5? Col. PATTERSON. Yes, sir. These are the men who are called in to give the men the benefit of special skill and knowledge. Col. FORBES. Should not that be charged to the cost per diem? Col. PATTERSON. Yes, sir; they are expensive people. Col. PATTERSON. I do not know exactly offhand, but I will have a statement prepared for inserting in the record. Statement of attending specialists available to the United States Veterans' Bureau classified by districts, not including attending specialists at United States Public Health Service hospitals. List of attending specialists on duty at Public Health Service hospitals, by station, paid out of appropriation " Medical and hospital services.' List of attending specialists on duty at Public Health Service hospitals, by station, paid out of appropriation "Medical and hospital services"-Continued. Hospital. Corpus Christi, Tex., P. H. S. No. 31.. Washington, D. C., P. H. S. No. 32.. Jacksonville, Fla., P H. S. No. 33. East Norfolk, Mass., P. H. S. No. 34.. St. Louis, Mo., P. H. S. No. 35. Boston, Mass., P. H. S. No. 36.. Closed. Billard, Chas. L.. Carmichael, R. B. Erving, Wm. G. Ellison, Everett M. Hickling, D. P. Lehr, Louis C. Moore, Wm. C. Vaughan, Geo. T. Webb, Walter D. Closed.. Thom, Douglas A. Campbell, O. H. Luedde, W. H. Lyman, H. W Leighton, Wm. E. Stone, Chas. A.. Mook, W. H.. Unterberg, H. Loeb, Virgil.. Ernst, Edwin C.. Harris, D. L. Young, H. M. Joseph, Geo. E. Arnold, Horace. Cotton, Fred. J. E. E. N. and T Int. diseases. Orth. surg.. $1,800 840 1,440 (1) 2,700 3,000 1,560 1,440 Facial max. 2,700 Gen. surg. 1,200 1.200 600 N. P. 1,200 Stomatology 600 360 Clin. path. 600 G. U 1,200 1,200 Med. 1.200 Surg. 1,200 O'Brien, F. W. Roent.. 1,800 Porter, C. T. E. N. and T 1,200 Rogers, Mark H.. Orth. surg.. 1,200 Kasangian, V. H. Plastic surg. 1,200 Wafker, T. Chandler. Int. med 1,200 Waukesha, Wis., P. H. S. No. 37. New York, N. Y., P. H. S. No. 38. 1,200 Consult. surg. 900 900 Throat spec. 900 Urologist.. 600 Cons, orth. surg. 900 Orth. surg.. 2,400 .do... 2,400 Ma ig. and allied dis. 1,200 Otology. 2,400 N. P 3,600 Brain surgery 1,200 4,800 1,900 2,400 1 1 Deming, N. Mex., P. H. S. No. 46.. Boise, Idaho, P. H. S. No. 52. Fort Bayard, N. Mex., P. H. S. No. 55. 1 Fee basis. King, Edward. Closed.. |