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found out how many doctors I employed, say, the surgical and medical specialists, how many cases they would have, based on past experience, how much each doctor got for each case, the average compensation he would receive if he were kept constantly employeu in this sort of work, and then I would be able to present the facts to the only body that is held responsible by the American people for the expenditure of this money, but that is not what you have done.
Mr. ROUTSONG. That has not been done because this data was not available.
The CHAIRMAN. But it was easy to get it; the Public Health Service ought to have it, and you should have required it of them. .
Mr. KELLEY. The colonel said he had great difficulty in getting what he did get.
Dr. LAVINDER. May I explain that I do not think you perhaps understand just the way we use attending specialists. We are operating about 67 hospitals all over the United States, and these men are attached to the staffs of these hospitals on a salary basis. They may see 25 cases one day and no more for a week, but we only pay them according to the volume of the service. We do not pay fees because it would cost too much money. We can supply you with data showing you the number of specialists we have, but we can not tell you the number of patients each specialist sees.
The CHAIRMAN. You could easily keep a record of all that and you would have to keep such a record if you were running a business, that is, if you were going to be successful. However, this is only the people's business and, of course, it is of no consequence to anybody except the people, and we are speaking for them because nobody else seems to be speaking for them.
Col. FORBES. We have a complete list of all the doctors employed in hospitals and in the various district offices, and we do know who the attending specialists are.
The CHAIRMAN. We ought to know.
Col. FORBES. Absolutely; I agree with you, and we will give you that information. A complete list will be submitted.
The CHAIRMAN. I will tell you this: We are going to make the system complete or we are going to refuse to make appropriations, and then we will let you gentlemen who are charged with the responsibility of administering the funds take the responsibility. We will go to the House of Representatives and tell why we did not do it, and you can answer it if you want to.
Col. FORBES. I want to state that the Veterans' Bureau is in a position to-day to answer every question having to do with the operation of the bureau.
Mr. GALLIVAN. That is all right; but you were not yesterday.
Mr. Routsong. Orthopedic supplies, $120,000. The amount expended last year was $127,888.88.
The CHAIRMAN. That is in cases where men have to have trusses?
Col. PATTERSON. Yes; glass eyes, braces, and things of that kind,
The CHAIRMAN. Go ahead.
Mr. Routsong. Hospital services, contract.
The CHAIRMAN. That is independent of the Public Health Service, is it?
Mr. ROUTSONG. Those are bills for hospitalization in civil hospitals used as extensions of the hospitals of the United States Public Health Service, at No. 51, Tucson, Aríz., and No. 32, Washington, D. C.
The CHAIRMAN. Under contract ? Mr. Routsong. Yes, sir; they have been under contract with the Public Health Service. I have made the present estimate simply on the basis that last year the amount disbursed for that purpose was approximately $135,000.
The CHAIRMAN. How much is your estimate now?
The CHAIRMAN. What is the next item?
The CHAIRMAN. The amount is $80,000 ?
The CHAIRMAN. All the men who are in hospitals and die there are entitled to burial by the Government ?
Col. PATTERSON. Yes, sir. Mr. ANTHONY. How about a soldier who dies outside of a hospital is he buried by the Government?
Col. PATTERSON. Not unless he is receiving compensation; if he is a claimant of the bureau he would be buried by us. Mr. ANTHONY. But not otherwise ? Col. PATTERSON. But not otherwise; no.
The CHAIRMAN. Give us the next item.
The CHAIRMAN. Did we not have that just a little while ago ? Mr. ROUTSONG. No; that was dental clinics. Dental services, $5,000,000.
The CHAIRMAN. What does that cover ?
Mr. ANTHONY. Are we not running a little wild on this dental business?
Col. PATTERSON. Yes, sir; very much so.
Col. PATTERSON. I will tell you what that means. In the past any man who has had any kind of a disability connected with his mouth has been going to dental people and getting his mouth fixed up. Some of these men have trouble with their mouths and the trouble is not connected with the service in any way, and yet many of them seem deserving. The director is of the opinion, as are others in the
bureau, that the bureau has been too liberal in the matter of dental treatment, and there is going to be a marked cut-down in that. The facts are that if a man has a dental disability connected with the service and he is living in some small town, he has to get dental, treatment and we have to pay on that basis.
The CHAIRMAN. How do you determine whether his dental troubles are due to the service ?
Col. PATTERSON. He is examined and is rated as to whether he has a disability or not and, if so, how much.
Mr. ANTHONY. But he has to prove that the disability is connected with the service?
Col. PATTERSON. Yes, sir.
Mr. BYRNS. Three years after the service how can a man prove, if he has a decayed tooth, that it was connected with his service ?
Col. PATTERSON. He would have a hard time doing it now. The way it is done is by affidavits; the men get people to swear that they had perfect teeth when they went into the Army, and that when they left the Army they were in bad shape, and such affidavits, plus an examination by some local doctor, have been the basis upon which a man has been awarded compensation.
Mr. Byens. I can see how that would be possible immediately after or within a reasonable time after the war closed, but the war closed three years ago, and it seems to me that a man who comes up' now with a decayed tooth would have a pretty hard time showing that it was connected with his service.
Col. PATTERSON. The Sweet bill opened up the door pretty wide and any man who has less than a 10 per cent, even 1 per cent, disability is entitled to treatment if the disability can be connected with the service. So a great many men are going to get treatment for years—those who do not need hospitalization-and it is going to cost the Government a great deal of money.
Mr. Byens. Suppose an ex-service man applies for dental work and is put in charge of a dentist; the dentist attends to him, treats his teeth and discharges him; then in the course of a year if he has another decayed tooth, or something of that sort, are you going to make it a practice to continue treating him from year to year?
Col. PATTERSON. Only if it can be shown that that disability is due to his service. Of course, you are quite right, and it is impossible for many of them to connect such a disability with the service at this late date, and there should be a comparatively small number who can connect such a disability with the service, but it has been done, and the director has just issued some revised dental rating tables which will cut that down a great deal. I think they have been too liberal in their interpretation in the past and the director feels this to be so, and that he must make strict rules in order to enable the dental referees to reach an accurate conclusion and form a judgment which will be both fair to the men and in the interest of the Government.
Mr. ANTHONY. Is it not a fact that right after the war you confined your dental treatment to physical injuries of the mouth and teeth ?
Col. PATTERSON. Yes; I believe so.
Mr. ANTHONY. And that subsequently an interpretation was made which covered all classes of dental work?
. Col. PATTERSON. Yes, sir; if they were at all connected up with the service.
Mr. GALLIVAN. May I ask how this estimate compares with the appropriation made last year?
Col. PATTERSON. For dental fees the appropriation last year was $1,864,877.50.
Mr. KELLEY. How many cases do you expect to treat for dental reasons?
Mr. Routsong. That is a very difficult question to answer, due to section 13 of the Sweet bill, which makes it almost necessary to extend these dental examinations, and we do not know.
Mr. KELLEY. Do you think there will be 100,000 ?
10, 254 June...
13, 045 July.....
10, 103 August..
9, 870 September...
8. 202 October..........
8, 353 Total.....
..... 67, 455 Average......
................ 9, 635 Estimated total for 12-month period, 115,620. Mr. KELLEY. That would be $50 a man.
Col. FORBES. The average is about that, but the evil of it all is this that the dental examiner is also the workman; the man who examines a man's teeth does the work.
Mr. KELLEY. What is the average bill?
Col. PATTERSON. At present about $50, Mr. Kelley. With about 115,000 dental examinations per annum, at $50 an examination, there would be expended nearly $6,000,000.
Mr. Sisson. Of course, I do not know how much there is to the modern theory among physicians and dentists as to the various ailments of the human family due to bad teeth, but if it should be true that a bad mouth and bad teeth resulted in a disease like rheumatism, etc., it seems to me it would be more economical to take care of the teeth and avoid these other diseases. Suppose a man is able to trace the beginning of the teeth infection to the period during which he served in the war; it seems to me it would be vastly more economical to fix up his mouth, even if it cost you $100, than to let it run and have the man become an invalid. Of course, my suggestion is based on the idea that it can be conclusively shown that the teeth trouble did originate in the war.
Col. PATTERSON. That is exactly what they are doing now.
Mr. Sisson. So I believe it would be a matter of great economy, as well as a piece of very great humanity, if a man can prove that his mouth trouble grew out of the war, to give him dental treatment rather than to allow it to go on until it runs into something else.
Col. PATTERSON. That is what they are doing and that is why they have connected so many with the service.
Mr. GALLIVAN. I would like to come back to this estimate. What was that estimate?
Mr. ROUTSONG. $5,000,000.
Col. PATTERSON. No; it is less. We estimate for this year more than for last year.
Mr. GALLIVAN. That is what I want to come to. Is not this true, that you had to fire a lot of your dentists because you found that they were crooks?
Col. FORBES. Yes, sir.
Mr. GALLIVAN. They entered into a conspiracy to rob the Government, did they not?
Col. FORBES. Whether it was a conspiracy to rob the Government or not I do not know.
Mr. GALLIVAN. Did you not try to get various United States district attorneys in several parts of the country to indict these dentists for conspiracy?
Col. FORBES. I did not.
Mr. GALLIVAN. I do not mean you; but I mean the Public Health Service?
Dr. CUMMING. Soon after we began this dental work we were afraid there might be some fraud, so we sent out an inspector, and as a result of that I think we turned over some eighty-odd cases to the Department of Justice, and I think that had a very salutary effect. Mr. GALLIVAN. Those eighty-odd dentists were all dropped ?
Dr. CUMMING. I do not know what the Department of Justice did with the cases.
Mr. GALLIVAN. I mean they were dropped from your rolls ?
Dr. CUMMING. They were not on our roll; they were just employed to make these examinations.
Mr. GALLIVAN. Who paid them? · Dr. CUMMING. They were paid by a fee. Mr. GALLIVAN. But their bills came in to your department ?
Dr. CUMMING. Oh, yes; and we found that some of the bills were fraudulent, and we turned them over to the Department of Justice for action.
Col. FORBES. They were not employees, as I understand it; but they acted in the capacity of dental examiners and workmen.
Mr. GALLIVAN. But they were appointed by the Public Health Service?
Col. FORBES. Yes.
Mr. KELLEY. Have you established or attempted to establish a scale of prices for dental work?
Col. PATTERSON. Yes, sir.
Mr. Anthony. The law which authorizes this dental treatment is very specific. It says:
Or by reason of any aggravation of a preexisting injury or disease, specifically noted at examination for entrance into or employment in the active military or naval service.