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Personnel and salary chart of subdistrict office United States Veterans' Bureau.

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Pay of commissioned officers, United States Public Health Service, does not include increase by act of May 18, 1920, commutation of quartors, heat, and light, or longexity pay. Salaries for clerical personnel do not include bonus.

The CHAIRMAN. Offhand, what would you think?
Col. PATTERSON. Including everything?

The CHAIRMAN. A suboffice. If I were making up the figures, I would know what the figures meant.

Mr. ROUTSONG. I would say that there are from about 20 to 100 men in a field force, dependent upon the size of the subdistrict office. This, of course, includes full-time and part-time physicians on duty in the dispensary.

COST OF FURNISHING SUBOFFICES.

The CHAIRMAN. How much will it cost to furnish a suboffice ?
Mr. ROUTSONG. On the average, approximately, $12,000.
The CHAIRMAN. For one suboffice with 20 men?

Col. PATTERSON. We have to have a dental clinic and an X-ray machine in each district and subdistrict office.

The CHAIRMAN. I should think that an office with 20 men could be furnished palatially for a couple of thousand dollars.

Col. FORBES. I cut the estimate submitted by the medical division almost in two.

Mr. ANTHONY. The $12,000 includes the X-ray apparatus?
Col. PATTERSON. Yes, sir; the dispensary and everything.
Col. FORBES. It costs about $2,000 for å dental unit.
The CHAIRMAN. To put a dental chair in operation!

Col. PATTERSON. And the equipment that goes with it; yes, sir. The operator's chair, cabinet, instruments, etc., I think will cost about $2,000.

The CHAIRMAN. Will there be one chair in each one of the suboffices?

Col. PATTERSON. Probably at least one.
The CHAIRMAN. That is about $2,000.
Col. PATTERSON. Yes, sir. Some offices will have to have more.

The CHAIRMAN. That leaves $10,000 for the rest of the furniture. I have furnished some offices at different times and I would not expect it to cost anything like that amount. Why do you not commence to think after the Government's side of the case once in a while ? What is the necessity of spending all of that money to organize these offices? They will perform just as good service if they are not organized on such a palatial scale. The men in the offices will do better work if given simple surroundings.

Mr. ANTHONY. How much of the expense of $12,000 is in the professional equipment?

The CHAIRMAN. $2,000 for a chair.
Mr. ANTHONY. How much for the X-ray apparatus?
Col. PATTERSON. $3,000 to $5,000.

Mr. ANTHONY. About one-half of the $12,000 is for professional equipment ? Col. PATTERSON. I should say more than that.

Mr. Gallivan. Does each one of these suboffices have an X-ray equipment ? Col. PATTERSON. It has not now, but will have.

Mr. GALLIVAN. And you will have on your rolls men who can operate the X-ray machines? Col. PATTERSON. Yes, sir. Mr. GALLIVAN. In each one of these suboffices? Col. PATTERSON. Yes, sir.

Mr. Wood. These 140 suboffices were put into the bill by amendment. It was only by a mighty close shave that they got in. It was never contemplated, in the first place. You do not have to establish 140 offices simply because it says you may.

The CHAIRMAN. They have 124.

Mr. Wood. The men at the time told me that under no circumstances would there be over 40 established.

Col. FORBES. You can not operate the bureau with 40 suboffices.

Mr. Wood. You would have operated without any of them. The original bill did not contemplate them. It was put in on an amendment just by a close shave.

Col. Patterson. The Sweet bill has opened the door wide and says that any man who has any degree of disability, even down to less than 1 per cent, can go to a dispensary and demand treatment.

The CHAIRMAN. Perhaps this might be useful to us. Is there anybody who has information which can be furnished to us which will show a typical suboffice organization, to include the personnel, the number of them; the titles, if they have any; the rate of pay allotted to each man; the character of the equipment in detail; the cost of each style of equipment--whether I state that correctly or not I do not know-with a detailed statement of the expense as

minutely as possible for one of the suboffices which is to be typical of the attitude of the bureau in its organization, and then, further than that, a similar statement of a district office? Probably that will give us the information.

Col. PATTERSON. That will be done, sir. I would also like to insert the following statement in regard to dispensaries and dental clinics:

DISPENSARIES.

It is not at the present time possible to prepare a complete report on dispensaries, particularly in respect to the subdistrict offices, since the plans concerning this phase of the medical work of the United States Veterans' Bureau are largely in the formative stage. An intensive survey is now being made for the country as a whole to determine the real needs in each locality, and accurate data will not be available until the results of this survey have been compiled.

Although, to-date, the United States Veterans' Bureau has not in general been operating its own dispensaries, the necessary medical work of this character has been accomplished through two other agencies: (1) by dispensaries under the jurisdiction of the United States Public Health Service, located both in the district office cities and in certain of the subdistrict office cities, and attached as out-patient clinics of Public Health Service hospitals, or existing as separate dispensary units; and (2) by contract with private hospitals, physicians, or laboratories, on both a fee and salary basis.

The estimated expenditures for the examination and treatment of beneficiaries of the United States Veterans' Bureau by dispensaries under the jurisdiction of the United States Public Health Service for the fiscal year 1921 were $1,749,289. It was estimated that for the fiscal year 1922 there would be an increase of approximately 50 per cent in this work, making a total estimated cost for this work for the fiscal year 1922 of $2,623,933, not including the cost of equipping and maintaining (personnel and supplies) dispensary units for dental work. The estimated cost for dental equipment and maintenance for the fiscal year 1922 was $2,178,614.26. A detailed state. ment showing the proposed distribution of this item is attached.

Pending the results of the survey on dispensary facilities now being made which will determine the needs for this service in all localities, large and small, there is presented herewith two statements representing the standard requirements for two classes of dispensaries, Class A and Class B. Class A dispensary represents the requirements for a district office city, and certain other first class cities, such as Baltimore, Md., Detroit, Mich., etc. Class B dispensary represents the requirements for the majority of subdistrict office cities. In considering these two statements, it is of course to be borne in mind that actual requirements, city by city, will vary to a considerable degree, dependent upon probably volume of work, condition of the property, and factors of like nature. A number of dispensaries, adequate in every detail and conforming in general 'to the attached statements, have already been established, particularly at Denver, Colo., Washington, D. C., Los Angeles, Calif., and Baltimore, Md.

In applying these statements to the charts on district office and subdistrict office organization, it is to be borne in mind that in many instances, dispensary facilities are already available through the United States Public Health Service, even though such facilities may not be adequate to meet all needs. Moreover it should not be considered that in applying these statements to the organization charts it necessarily means an added amount in disbursements equal to the total operating cost of the dispensary, since in many instances the offices are already paying rent on space allotted to dispensary purposes, as also are they paying for personnel already engaged in dispensary work. However the attached statements do represent approximately the actual total cost for the equipping and operating for one year of the dispensaries described. Medical equipment in district dispensary or dispensary, Class A.

Cost of Sections:

equipment. General surgical, orthopedic surgery.

$500 Eye..

770 Ear, nose, and throat.

500 Urology..

1, 200 7621721 -27

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X ray

Cost of Sections Continued.

equipment. Internal medicine, neuropsychiatric, tuberculosis (no special expense

other than outfitting examination rooms). Dental (6 chairs and laboratory).

-$11, 200

5, 000 Physiotherapy

4,000 Clinical laboratory.

450 Pharmacy.

1, 400 Other equipment: Office furniture and equipment.

4, 500 Waiting room equipment..

900 Examining rooms (7 rooms).

945 Installation: Beating, wiring, plumbing, pla tering, etc.

20,770 Total cost of equipment and installation...

52. 135 Space necessary for above, approximately 8,464 square feet, at prevailing cost ($2.50) per square foot, $21,160.

Necessary personnel for above: Medical officer in charge, executive officer, 8 fulltime physicians, 13 part-time physicians, 6 full-time dentists, 1 pharmacist, i X-ray technician, 1 bacteriologict, 1 dental technician, 1 telephone operator, 6 social service workers (American Red Cros), 3 nurses, 3 physiotherapy aides, 1 secretary, 6 stenographers, 4 typists, 5 clerks, 1 chauffeur, 1 orderly, 1 maid, 1 messenger. Salaries for all above personnel, $127,678 per annum.

Maintenance, general supplies, drugs, fuel, heat, light, water, etc., for above, approximately $10,000 per annum

Medical equipment in subdistrict office or dispensary, Cluss B. Sections:

equipment. General and orthopedic surgery,

$500.00 Eye.....

770.00 Ear, nose, and throat.

500.00 Urology..

600.00 Internal medicine, neuropsychiatry, tuberculosis (no special ex

penses other than outfitting examination rooms). Dentistry (2 chairs and laboratory).

3,900.00

5,000.00 Laboratory (clinical and bacteriological).

450.00 Pharmacy.

1, 400.00 Other equipment: Office furniture..

2, 250.00 Waiting room.

450.00 Examination rooms (4).

540.00 Installation: Heating, wiring, plumbing, plastering, etc.

10, 381.00 Total cost of equipment and installation.....

26, 744.00 Space necessary for above, approximately 3,975 square feet, at prevailing cost ($2.50) per square foot, $9,937.50.

Medical personnel necessary for above: Medical officer in charge; 2 medical offi. cers, full time; 7 attending specialists, part time; 2 dental officers, full time; 1 pharmacist; 1 X-ray technician; 1 bacteriologist; 2 nurses; 3 stenographers; 3 typists; 3 clerks; 1 orderly. Total annual salaries for above, $50,528.

Maintenance, general supplies, drugs, fuel, heat, light, water, etc., for above. per annum,

$4,450.

Cost of

X ray

Estimated expenditures for added dental facilities for fiscal year 1922.

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HOSPITALS-continued.
United States Public

Health Service Hos-
pital-Continued.
No. 63, Lake City, 1217

Fla.
No. 65, St. Paul,

1
Minn.
No. 68, Minneapolis,

HIT 1
14 Minn.
No. 69, Fort Thomas,
Ky.

Tweet
Fort Logan H. Roots,

1
Ark.
Walla Walla, Wash.,
Tort McKenzie, Wyo.
Gulfport, Miss.

2
Colfax, La
Excelsior Springs, Mo.
Dawsonsprings, Ky.

5.
Hanneman, Port-
land, Oreg.

2
To care for increase.

10

+
OUT-PATIENT CLINICS.
Boston (new)..

10

1 New York (new),

20
3

1
Philadelphia (increased). 6
Washington (increased)

1 Atlanta (new)..

6
New Orleans (new).

6
Cincinnati (increased).
Chicago (increased).

3
St. Louis (increased)

5
Minneapolis.
Denver ..
San Francisco.
Los Angeles.
Seattle.
Dallas (new).

1

1 Saranac Lake (new).

1

1 Salt Lake City (new).

1 Albuquerque (new).

1

1

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This makes a total of -
180 operating equipments at a cost of.

$301, 440.60 42 laboratories at a cost of..

23,076.90 28 X-rays at a cost of..

23, 230, 20 42 oral surgery outfits at a cost of..

11, 286, 66 Installing 180 operating equipments.

90,000.00 Installing 42 laboratories.

12,600.00 Installing 28 X-rays..

14,000.00 Supplies for the present 169 operators and 180 to be added, average duty 6 months. 518,000.00 Cost of present dental personnel, assuming that all will be commissioned at an early date, per annum..

644,979.90 Cost of new dental personnel, assuming that the average service will be 6 months each and the average pay will be $3,000 per'annum.

510,000.00 Total cost of new equipment and installation, and supplies, as outlined in the above report.. 993, 634. 36 Total cost or personnel as outlined in the above report..

1,184,979.90 Total cost of new equipment and installation, supplies and personnel..

2,178, 614.26 A committee has recommended to Congress that they pass a bill directing that a beneficiary of this bureau who has been in a hospital and stayed there six months be rated as permanently disabled.

Mr. Sisson. A committee of Congress?

Col. PATTERSON. The American Legion, I believe, is recommending that to Congress.

The CHAIRMAN. I should like to ask the statistician if he can give us the figures as to the number of men involved in this proposed ex

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