I cannot believe that out of 129,000-odd employees down there, somebody was not looking at St. Elizabeths falling apart. It did not fall apart in 2 years. I know, and I am not going to bang on my friends from the National Institutes of Mental Health, because I know they have been asking for the money. I just want to know what has been going on and why nothing has been done about it.

Could we have the courtesy of your proposals? I have suggested here that we integrate your proposals into our bill. It is costing the taxpayers money to work on, and I and others have spent a lot of time on it. My suggestion at this point is, I guess, why should we listen to any of you? Why should we not just do what we think we have to do? Enough said.

Mr. DELLUMS. Counsel for the majority?

ACCREDITATION TIMETABLE

Mr. BRAUER. Given the money needed, how long will it take to accredit St. Elizabeths?

Dr. BROWN. The accreditation parties have made it clear that when there is a plan for operating the environment, patients' safety, the buildings, they would resurvey us. It would be possible to reaccredit them, perhaps, 6 months after money is appropriated for a plan to make the living quarters up to standards.

Mr. BRAUER. And how much will the cost of the plan be?

Dr. BROWN. I will give a specific figure. There is a guestimate within the Department, a capital study which was requested by the congressional appropriations committee. A master plan for the grounds and facilities has been developed I think Dr. Dickson knows the latest on where that is. I think it is soon to be translated to the Congress.

Dr. DICKSON. That is right; it is in the Secretary's office. I judge that shortly he will be sending it to the Congress. It was a contracted study, and it has come through the system in that form. He is looking at it at this time.

Mr. BRAUER. As I listen to the Members, I believe everyone is of a mind that when it is feasible, and with the support of the Congress, they would in fact bring St. Elizabeths to the District of Columbia. But what if, in practical vote counting, it turns out that the Congress would not support a direct transfer within the foreseeable future to the District of Columbia? What would your druthers be as to keeping St. Elizabeths under NIMH or putting it under a corporation, as in H.R. 3335.

Dr. DICKSON. I do not think we are working in that direction. It sounds like a "Do you still beat your wife?" question.

Mr. BRAUER. Have you counted the votes? Do you have reason to believe that in fact you can pass the kind of bill you are advocating? Dr. DICKSON. Do I think we could?

Mr. BRAUER. Yes.

Mr. DICKSON. I do not know the answer to that.

Mr. BRAUER. Does the Assistant Secretary for Legislation?

Mr. SOPPER. We have not gone out and made a head count, so to speak, of the Members on this issue. I think the task before us right now is to get the legislation developed jointly with the District of

Columbia government and the city council as they participate in this process, and submit something to the Congress, and then do the job that is necessary to talk to the Congress about it. Obviously, we cannot ask them to take a position without having seen the specifics of the legislative proposal.

MINORITY PERSONNEL

Mr. BRAUER. It is my understanding that 80 percent of the employees at St. Elizabeths are minorities or nonwhites. Can you tell me the percentage of the management staff; that is, those above the level of supervising nurse, that are minorities?

Dr. PEELE. These figures are roughly a year or two old, and we' will update them for the record. But let me indicate what we have. Above a GS-9, the whites predominate. On wage boards, white predominate at the higher levels, and for the majority of wage boards, that is 54 percent of wage board employees are white. I should back up and say that roughly 70 percent of all employees are black, but we will get you more specific information on that.

AREA D DIRECTOR

Mr. DELLUMS. Just one question: Yesterday, we received testimony that the director of area D is in an acting capacity and has been in that capacity for 4 years. Is there any reason why we have an acting director for that rather substantial period of time?

Dr. PEELE. I think someone else might answer that question. That is the No. 1 personnel priority of the hospital.

Dr. BROWN. The basic reason is that we consider that such an important post, Mr. Dellums, that it ought to be a supergrade that has our greatest support as a supergrade. We have several other priorities ahead of that supergrade. For example, Mr. Pitman, my executive officer on my left, one of the youngest winners of the Distinguished Service Medal, who oversees a $12 million program, is a GS-15. We have been trying to get him a supergrade, the head of my planning office, and one other. It has our full support, but it is basically the issue of the numbers of supergrades that are available to us. Mr. Pitman might want to expand a bit further, if I did not quite cover it accurately.

Mr. DELLUMS. I am not sure if I understand the answer to the question. I thought the question was rather straight-forward.

Dr. BROWN. The request is that we have supported fully at the hospital and NIH a supergrade position for the area D. That supergrade has not been made available to us.

Mr. MCKINNEY. What you are saying is, if he becomes available, you cannot jump him into a supergrade; you have to keep him "acting"?

Dr. BROWN. We do not want to make him into a permanent GS-15. Mr. DELLUMS. We would like very much, in the event that it is necessary, to submit to some of you additional written questions. Particularly, Dr. Peele, we have a substantial list of questions that we would like to ask you. They are not extraordinary, but given this particular forum, it would be tremendously time consuming. We

would like very much if the staff could present the questions to you; and where we have additional questions, we would like for you to respond in writing.

Mr. MCKINNEY. I would like to ask for advice. Here we sit on H.R. 3335, and I missed two other markups this morning being here. I am trying to figure out if we should just walk away from the whole mess, and wait for the administration's plan from here, or an HEW plan from there, and a city administration plan from somewhere else, and then put them all together; or should we continue to slug through this swamp.

Dr. DICKSON. Mr. McKinney, I think that no matter which road we go down, the road is not going to be an easy one. The basic reason, I think, is that while we are attending ourselves to considerations of health and mental health here, what we are really dealing with here is the process of what takes place on the road to self-determination in the District. This will not be an easy one, but I think that it has to be gotten on with in the spirit of a challenge both to leadership and to toil. I think it actually is out of messes like this, if you will, that the District will realize its destiny in time. I do not think either road will be easy.

Mr. DELLUMS. Secretary Dickson, Secretary Sopper, Dr. Brown, Mr. Pitman, and Dr. Peele, we deeply appreciate your presentations this morning. As I said, we would very much like to submit some additional questions for you, and you may respond in writing. We would appreciate it very much if you would do that.

Do we have any final remarks?

Dr. DICKSON. No, sir, we would be pleased to receive it, and we thank you all for your courtesy today.

Mr. DELLUMS. Thank you for your time, and thank you for your

responses.

Our final witness this afternoon is Dr. John L. Johnson, president of the D.C. Mental Health Association.

Mr. DELLUMS. Dr. Johnson, we welcome you this afternoon. We deeply appreciate the fact that you have taken a considerable amount of your time. We know you were supposed to be here yesterday, and we thank you for bearing with us.

I notice that you have a colleague with you. Please introduce that person for the record.

STATEMENT OF JOHN L. JOHNSON, ED. D., PRESIDENT, D.C. MENTAL HEALTH ASSOCIATION; ACCOMPANIED BY DR. GOTTLIEB SIMON

Dr. JOHNSON. Thank you, Mr. Chairman.

I have with me Dr. Gottlieb Simon.

Mr. DELLUMS. Dr. Simon, we welcome you.

Dr. JOHNSON. I would like to thank the committee for its invitation to us. We have been involved, as an association, with the issue of St. Elizabeths going back for some period of years. Members of our current Board sat on the Commission and has been keeping very active contact with this issue because of its critical importance to provision for mental health services in the District of Columbia.

I am John L. Johnson, president of the Mental Health Association. I do live in the District of Columbia and our association is a division of the National Association of Mental Health which was founded in 1953, and we have a membership of about 4,000 dues-paying members. We are here today to testify on H.R. 3335. By and large, our association can support the contents of this bill, which include a number of very desirable provisions. There is, however, one important provision whose desirability is not now clear to us and which we, therefore, are not ready to embrace.

H.R. 3335 PROVISIONS ENDORSED

But first let me list some of the features which we endorse. We endorse budget authorizations for operating expenses which will keep up with the hospital's costs.

We endorse the authorization of capital improvement funds for use in meeting "needs of patients placed in community settings," where there has been a pressing need to do this for too long.

We agree wholeheartedly that the hospital should conduct a thorough review of its operations and develop a comprehensive plan for its future operation as outlined in section 6.

We also agree that the hospital should report regularly on its activities and its progress in improving its services. We agree that the hospital should seek to integrate its services with the D.C. government's mental heatlh program and we support the proposition that all mental health programs in the District of Columbia should "ultimately" be administered by a single body.

OPPOSES GOVERNMENT CORPORATION

There is one provision, as I said, that we are not prepared to endorse at this time, that is, the transfer of the hospital from HEW to an independent government corporation.

None of the provisions that we have endorsed above from appropriation authorizations to comprehensive planning to improved coordination of District of Columbia and St. Elizabeths Hospital services requires the creation of a special government corporation.

CONGRESSIONAL MANDATE

The hospital should be mandated to carry out its responsibilities just as it is, and we would again respectfully urge the Congress to pass legislation-perhaps a "St. Elizabeths Hospital Act of 1977" which would incorporate the many positive features of H.R. 3335 which we support.

In addition to our testimony, we would urge that by doing this, this committee and the Congress itself would have taken a significant step to resolving the continuing problem of St. Elizabeths, and the mandating of these provisions to NIMH would bring change in new movement rather than where we see ourselves now, and even if my colleague would point out, back in 1969 we were still testifying about the same issues.

We are not necessarily inalterably opposed to transferring the hospital to a special government corporation. If it could be demonstrated persuasively that a hospital run by an autonomous Board of Directors could more easily regain accreditation or deliver better patient care and achieve the other objectives contained in this bill than a hospital responsible to the Director of the National Institute of Mental Health, if this could be done, we would certainly support it. We have not seen that evidence yet.

ST. ELIZABETHS' DEFICIENCIES

We have seen that the hospital suffers from a myriad of problems, some of which we listed in our testimony before this committee last fall. They include old and inadequate buildings, the retention of people who do not require 24-hour hospitalization, poor staff morale, and a lack of coordination with the District's mental health program. The recommendation by the Joint Commission on Hospital Accreditation that St. Elizabeths not be accredited as a psychiatric hospital remains as one of the most serious problems. We said last fall and we say again now, that we do not see how merely transferring the organizational position of the hospital will, in itself, help solve any of these problems.

ACCREDITATION

I'd like to make one addendum; that is, that we see the accreditation study as being not simply a matter of buildings. It is our understanding-we would have to go over and look at this that there are parts of St. Elizabeths that are accredited as a hospital. For instance, it is my understanding that the medical laboratories have a very high accreditation and our concern is really to try to find out what psychiatrically about the hospital is unaccredited. And we do not really believe it is just buildings.

To continue, the hospital should not be bounced to a new spot on the Federal Government's organizational chart unless such a change will clearly lead to resolving its serious problems. This is not to say that HEW or NIMH have always provided the hospital with a good home. They haven't. But if the hospital has been something of a stepchild at NIMH, H.R. 3335 threatens to make it a bureaucratic orphan.

It is hard to see what advantages will accrue to the hospital by placing it in the same category with the U.S. Spruce Production Corp., the Inter-American Navigation Corp., or the Warrior River Terminal Co. It's not immediately apparent that this arrangement would assist the hospital in obtaining the resources or the means to meet its primary responsibility of providing "high quality mental health care."

Furthermore, the creation of a new administrative authority in the midst of current litigation, that is, Dixon v. Weinberger, may serve to diffuse and confuse responsibility for serving patient's rights, the provisions of section 4 notwithstanding. We could see the prospect where now the debate seems to be between the administration and the