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NUMBER OF DOCTORS IN PROPORTION TO INMATES.

Mr. Sisson. Will you state about how many doctors you have in proportion to the inmates?

Gen. Woon. Yes, sir; we have 8 doctors to a membership of between 1,700 and 1,800.

Mr. Sissóx. You have in this home an average of about 2,000 inmates with eight doctors?

Gen. Woon. Yes, sir.

Mr. ANTHONY. The Army has one surgeon allowed for every 1,000 men of strength?

Gen. Woon. Yes, sir.

Mr. ANTHONY. But your doctors have a l:rger percentage of sick people, and, of course, a great deal more to do?

Gen. WOOD. Yes, sir.

The CHAIRMAN. I suppose the proper comparison would be to take the number of doctors and the number of hospital patients. That is one thing we would like to have for our information, because we might want to compare it with some other activities along the same line.

Gen. Woon. It the Southern branch we have one doctor to about 80 patients. In that connection, I might say that the sick call in an old man's home is quite a large item, because the old men are pretty great on coming up in the morning to get a cathartie, liniment, or something of that kind. In fact, the sick call in the morning is quite a large one, and that applies also to the camps. The cathartics and all those things constitute quite an item.

Col. WaDsWORTH. For instance, take the Mountain branch, which is for tubercular patients only: We have a schedule there of 22 doctors for 1,000 beds, and the Marion branch, of the same capacity for neuropsychiatrie cases, has practically the same schedule.

The CHAIRMAX. That would be about 48 men to the doctor?

Col. WADSWORTH. Yes, sir. Over at the Central branch, where we have about 1,000 beds and, in addition to that, have 2,000 men in camp, we have 15 doctors. Of those 1,000 beds only about 200 are tuberculosis beds and the rest of them are general, and, as I have said, there we are handling the situation with 15 doctors. Therefore, the number of doctors assigned to each place is dependent upon the class of work.

The CHAIRMAN. How does the number of doctors in proportion to the men at the Marion branch compare with the number of doctors at this home?

Gen. Woon. It is higher.
The CHAIRMAN. How much higher?

PAY OF MEDICAL DIRECTOR AND SUPERINTENDENT AT THE MARION HOME.

Gen. Woop. At Marion the schedule was largely drawn up or sug. gested by the neuropsychiatric board, and our medical director and superintendent there gets $6,000.

The CHAIRMAN. What else does he get?
Gen. Wood. Quarters.

Mr. Wood. Were those salaries fixed after it was taken over by the Veterans' Bureau?

Gen. Wood. No, sir; after “it was completed for our use. It is still under our control.

Mr. Woon. But those new salaries were fixed at that time! Gen. WOOD. Yes, sir. The CHAIRMAN. What did you pay before that? Gen. Woop. $3,000 to the chief surgeon. The ('HAIRMAN. They have doubled his pay! Gen. Woon. Yes, sir; but, of course, he is a specialist. The CHAIRMAN. Your man was not a specialist? Gen. Wood. No, sir. The CHAIRMAN. Do you consider the increase justified on account of the increased knowledge required?

Gen. Woop. When the facilities of the homes were to be changed and used for the needs of the present war, the Veterans' Bureau indicated that their greatest needs were for tuberculosis and neuropsychiatric beds. To carry out this idea the Marion Home was changed into a neuropsychiatric home and the Mountain Home into a tuberculosis home, all former staff and patients being moved away. The board of managers, having no practical experience as to the management and staff necessary for special institutions of this kind, consulted in the matter of the tuberculosis plant with Dr. Pattison, seeretary of the American National Tuberculosis Association, Dr. Garvan, of Detroit, and other experts in tuberculosis. In the neuropsychiatric matter we consulted with Dr. Salmon, of New York, Dr. Barrett, of Ann Arbor, and Dr. Singer, of Chicago, who indicated to us the schedule giving the necessary medical and nursing personnel to care for 1,000 patients of each of the two classes indicated, also indicating what would be the proper salary to pay, so that we might be able to secure men, specialists in this line, who could furnish the patients that medical treatment and care which they should have.

Mr. ANTHONY. General, did you find that the more you consulted the experts the higher the cost of the enterprise became?

Gen. Woop. Why, yes, sir.

The CHAIRMAN. Did you adopt the recommendations made by these men ?

Gen. Woon. Very largely; yes, sir.
The ('HARMAN. "Both as to salaries and schedule of personnel?
Gen. Wood. Yes, sir.

The CHAIRMAX. How would that schedule and the compensation compare with schedules that you have had in force for the care of hospital patients in other branches of your jurisdiction?

Gen. Wood. Very much higher, sir.

The ('HAIRMAN. Would it be 30 per cent or 75 per cent or 100 per cent higher

Gen. Wood. Pretty close to 75 per cent or 100 per cent.

Mr. Woop. And prior to your adoption of this new schedule for these new patients, you were treating in your various hospitals mental disease and T. B. patients, were you not?

Gen. Woon. We were treating a few T. B. patients, but we were not treating mental cases. The only mental cases we had before this war were either senile dementia, which is really a question of care.

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or the violent insane which we turned over to Dr. White at St. Elizabeths.

The CHAIRMAN. As a matter of fact, you were treating a great many tuberculosis patients at the Southern Branch and at the Mountain Branch prior to this, were you not?

Gen. Woon. We were treating some, but not a very large number. We averaged at all of our homes in T. B's before the war probably between 250 and 300 scattered all over the country. To-day, we are treating well up to 1,500.

The C'HAIRMAN. Is it fair to say that they were as well treated under your former jurisdiction as they are now!

Gen. Wood. Well, they probably were not treated as scientifically.
The CHAIRMAN. Just what do you mean by "scientifically"?
Gen. Wood. Well, there is the question of rest hours, for instance.
The CHAIRMAN. Do you mean to say you worked the patients?

Gen. Wood. No; we lid not work them. There is a difference, Mr. Madden, in the modern treatment of tuberculosis as emphasized by the doctors of to-day. There are quite a number of rest hours insisted upon when the men have to lie in bed without reading, without talking, and without any form of amusement for a certain number of hours a day.

Mr. Wood. That does not cost you anything. does it?

Gen. Woop. No, Mr. Wood, it does not. Before that we simply treated the tuberculosis cases as ordinary patients.

Mr. BYRNs. Is not the difference now that, to a very large extent at least, you have concentrated these classes of patients?

Gen. Wood. We have concentrated them at Johnson City and at the Central Branch.

Mr. Byrys. And this schedule which was suggested by*this board applies to only those two branches?

Gen. Woon. It applies only to Johnson City for T. B. patients and to the Marion Branch for the N. P. patients.

INCREASE IN SALARY AND PERSONNEL AT BRANCHES.

Mr. Byrns. Has this suggestion of the board caused the board of managers to increase the personnel and salaries at other branches?

Gen. Woon. Yes; it has had a certain effect, because when you raise salaries at one place it makes it pretty difficult not to raise them at other places.

Mr. Byrns. To what extent has it had that result?

Col. WADSWORTH. It would be a little hard to answer that. Perhaps the greatest influence, I believe, that we would be able to determine is the change in the medical attitude of wanting to specialize, which brings in constantly a demand for something we never heard of before. For instance, take these T. B. cases. You remarked awhile ago that it did not cost us anything to keep them in bed. Quite the contrary is true. It does cost us. We have two or three records to keep, and we have to have the men to watch them, and we do about five times as much clerical work as we did before. Then we have to have another class of people to play with them and furnish them something to do when they are at their waking hours. So we have a

lot of things that we did not have a few years ago, and I do not believe they had them in other hospitals.

Mr. Byrns. If you have concentrated all this class of patients in two branches, why should it serve to cause an increase in the personnel and salaries of other branches?

Col. W'ADSWORTH. But we have not done that.
Mr. Byrxs. I thought that was the object of the board.

Col. WADSWORTH. Take the Mountain Branch, it is practically filled to its capacity. To-day we have about 300 tuberculosis patients at the Central Branch. We have nearly 200 at the Pacific Branch, and we have got probably 50 or 60 up at Battle Mountain, and we have a smaller group in the Eastern Branch.

The CHAIRMAN. Is it your experience it costs more or less as the number increases?

Gen. Woon. It costs less per capita because there is less overhead. The administrative cost is much less, although the medical side increases.

The CHAIRMAN, If your overhead per capita for salaries increased at the rate of 100 per cent, it would not cost much less, would it?

Gen. Wood. Yes, it would in this way: If you have an increasing number of patients, say, from 600 to 1,000 at a branch, you would require practically the same force in the managerial department and the same force in your subsistence department and the same force in other departments. The number of your nurses would increase and the number of medical men, but the administration could do their work just as well for 1,000 as for 600.

The (CHAIRMAX. On the advice of the experts whom you have enumerated, has there been increase in the cost of any other part of the personnel through an increase in salaries?

Gen. Wood. The nonprofessional side has not increased. We have kept that at about what it was before.

The CHAIRMAN. How far has the increase extended down through your personnel ?

Gen. Wood. It would include your doctors and, of course, it would include your therapeutic aids, which we never had before, really. The CHAIRMAX. How about the nurses? Gen. Woon. It would include your nurses.

The (HAIRMAN, How does the compensation paid to nurses compare under this new plan?

Col. W'ADSWORTH. It added $10 a month at the Central Branch and at the Moutain Branch $20 and at Marion $20. It has had this effect. Naturally when the people who are attending to the tuberculosis patients at the Mountain Branch are getting a higher rate of wage or a special rate of wage, the people who are attending tuberculosis patients at the Central Branch become rest less and we had to advance

their pay.

The CHAIRMAX. What has been the rate of advance?

Col. WADSWORTH. We were paying $3,600 for the chief man there and prior to that time our highest rated man there was $2.710 and we have had to put on two other higher-priced men there and about the same thing is true of the Pacific Branch. Then we have had to add to the nurses who were engaged in handling tuberculosis. Seventeen nurses went over in one group and we advanced them $10 a month.

REPAIRS.

The CHAIRMAN. Is this $3,000 item you are asking for in order to increase compensation?

Col. WADSWORTH. No, sir; that is for repairs for the upkeep of the plant. In submitting our estimates we can never tell in advance just what we are going to have and we have run into more things under this item than we expected.

The Chairman. And this is an actual necessity?
Col. WADSWORTH. Oh, yes, sir.

FARM.

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The CHAIRMAN. Take up the next item of the farm, for pay of farmer, chief gardener, harness makers, farm hands, etc.

Col. WADSWORTH. That, sir, is another misleading wording. There is not any such thing as a farm down there, but this appropriation cares for all our transportation, our upkeep of the ground, roads, walks, and everything of that kind.

The CHAIRMAN. And also the cemetery?

Col. WADSWORTH. We have no cemetery at this branch. We use the national cemetery outside. It is for the other items such as transportation and hauling, etc.

The CHAIRMAN. And you are asking for $2,500 under this item?

Col. WADSWORTH. We are asking $2,500 and that amount is actually needed. It is nearly all paid out in the salaries of the mien we have to employ to do this work.

The CHAIRMAN. Could you get along with any less than that?

Col. WADSWORTH. No, sir; that is based upon an actual statement of the needs.

The CHAIRMAN. Is any of this for an increase in pay?

Col. WADSWORTH. No; in fact, we are keeping our men very low there. There is one item that has militated, perhaps, against this appropriation. When we had stronger men there we had moro men who would violate the rules and would be sentenced to some little light duty like picking up leaves or keeping the roads clean, but as the men grew older that source for getting a little work done has been wiped out entirely.

The CHAIRMAN. Will you be kind enough to put in the record the condition of the present appropriation, if you have it?

Gen. Wood. I have here a rough statement showing that made up on the 31st of October.

The CHAIRMAN. Does that statement show the unexpended bal. ances ?

Gen. Wood. Yes, sir.

STAPO VERARIES

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