of them, end up in the professions, people that would stay in the health professions going off to other professions and you lose them. Mr. SARBANES. I am inclined to agree with the view that it ought to stay in the Health Committee. I think at some point the reach of the Education Committee's jurisdiction will have to stop and another body's jurisdiction should cut in at a different angle. Otherwise, you can run that education string from the cradle to the grave, to use a familiar term.

Mr. STEIGER. That is an excellent idea.

Mr. STEPHENS. Yes; it is like that manpower argument we had. At some point some other considerations come cutting in across another way and are very intimately related.

I think you have a problem in the health care field that there is a very direct and interwoven relationship there with the health services education.

Your whole resolution of the health care problem is very closely tied to this health services training, probably, I think, more uniquely so than almost any other field I can think of.

Mr. STEIGER. If you will yield, we made a judgment, if I recall correctly, in the Interior Committee where they have schools of mining. We left them there. I would tend to agree with Paul. The training of personnel needed for whatever delivery system exists for health is very specialized, very select, and deserves to be considered in the totality of the question of health rather than separated off in terms of a review of an education problem. I think it is a delivery problem and not necessarily education.

Mr. MEEDS. The whole field of health manpower? Doctors, nurse training, biomedical research?

Mr. SARBANES. I talked to some of the medical people up in Baltimore at Johns Hopkins, and they very much think it would be very helpful to have a single focus for health problems.

Aside from any substantive question of what health policy is, they have found that it is spread all over the place. They find the dispersion very difficult to deal with. They now have established, for instance, a school of health services, doing some interesting things with paraprofessional personnel, nurse practitioners and all the rest.

It is closely related to experiments they are trying with health care delivery and the whole complex of health care. It seems to me there is a very strong argument for holding health care issues all together.

Mr. WIGGINS. I think I agree, without being too wise on a subject about which I know very little. But if there is to be a dividing line between the education and the profession on the other hand, it probably ought to be somewhat based upon the extent to which the professionals are involved in the educational process.

If it is education for the sake of education, that seems to me to be an educational problem. But if the profession involved in the ultimate activity is intimately involved in the educational process, as I am told is the practice in this field, then there is some logic in keeping it where it is.

I was thinking whether or not the Judiciary Committee should take over law schools. I think that is preposterous, frankly. The legal community is not intimately involved in the legal education, except to write checks periodically.

But I don't think the same is true to the same extent as in health care field. You have doctors and those involved in the delivery of services intimately involved in the educational process.

Mr. STEPHENS. The clinical side of health is so interrelated to the education that it is an essential part of it. An essential part of the education is the actual delivery of services.

So you do have a connection there that is not present in law.

Mr. MEEDS. I think you have to ask yourself a question: How much of this education is taking place outside of the regular institutions of education? You said they should take over law schools. Law schools are under the Education Committee as far as I know.

Mr. WIGGINS. And I think they ought to stay there.

Chairman BOLLING. If you look at it from the clinical point of view, I happen to have in my area not a unique but an unusual experiment in setting up an integrated health educational-health delivery system. It is very complex and very difficult to put together. The guts of it are the teaching hospitals and clinical institutions. You can't conceive of a finished professional who hasn't been involved in an active institution as a student or as an intern, whatever the different terms are.

I think the point that Paul makes is a very important and I think valid point. I think the differentiation that Chuck makes is important. Mr. MEEDS. That is what I am saying. If you determine that a significant part of this education occurs outside of the area of the normal institution of education, then perhaps it ought to be separated from education, but I can't say that it is true.

Chairman BOLLING. I can't say that it is true. I am working not from a very broad knowledge but from a too broad knowledge which comes from coming from a family of surgeons and nurses, and a too narrow one which comes from coming from Missouri, that we are establishing branches of the University of Missouri just in the health field, a long way from where the University of Missouri complex is. That is one of the things I was talking about. It is going on in Kansas City. I think Paul's point is a valid one, and I think your point is a perfectly valid one in supplement. I am inclined to think that it deserves to stay in Commerce.

Mr. MEEDS. Could we ask staff what all is contained in health service. training? Obviously, it is nurse training.

Mrs. KAMM. It is also paraprofessionals.

Mr. MEEDS. The total field of health manpower, then.

Mr. STEIGER. This is where we get a problem. The Education and Labor Committee authorized the famous Scheuer-Nelson new careers program and, among other things, trained paraprofessionals in the health field. That was a part of what we did.

Mr. MEEDS. That was about 3 years before they every started thinking about it in Commerce, incidentally.

Chairman BOLLING. This is a field in which, when you are dealing with the problem of taking people who have no training whatsoever, and you are trying to train them to a skill or part of a skill, this is a field in which there is an incredible need for relatively unskilled man

power.

There is no way to automate a great deal of what goes on in a hospital, although they are doing a great deal more of it. There is inevitably a manpower connection somewhere along the line. I don't feel absolutely sure of it but I am inclined

Mr. MEEDS. Could we get staff or maybe the staff of the Commerce. Committee and the staff of the Education Committee to develop some pros and cons on this?

Let them become advocates for their position a little bit. I feel uneasy about this and I don't know exactly why.

Chairman BOLLING. Let's do that. That could be done relatively easily.

We have 5 more minutes according to the desires of the members. Mr. STEIGER. Can you answer the first unresolved issue by saying no? Chairman BOLLING. Yes; you can say no. Should the U.N. organization World Health Organization be placed here? No.

Mr. SARBANES. Does that indicate the judgment that international organizations other than the banking organizations should be in Foreign Affairs?

Chairman BOLLING. Yes.

Mr. SARBANES. Where is the ILO?

Mr. STEIGER. That is a different problem.

Chairman BOLLING. They just send observers. That is what it is. Mr. SARBANES. Who has jurisdiction?

Chairman BOLLING. Foreign Affairs has jurisdiction but Labor goes. Mr. STEIGER. That was part of our trade. We took ILO from Foreign Affairs to Labor.

Chairman BOLLING. We have a real expert on that subject right here beside me.

Do you have any other easy questions?

Mr. SARBANES. I would like to throw out a tentative answer to the last one. I think when we were considering Agriculture we were thinking about moving some things from there to the Energy and Environment Committee.

I think that will require us to take another look at what the scope of that Energy and Environment jurisdiction is and whether it creates a problem by being too heavy. If it does, it seems to me a possibility for making it lighter would be to take those environmental matters for which a very good rationale can be made that they are very heavily health oriented or connected and bring them back into the health package.

Whether these are the specific items, or all of them or some of them, I don't know. But I just think it is the way to approach that problem. Mr. STEIGER. I would not want to see us take clean air out of Energy and Environment.

Mr. MEEDS. No. Radiation and toxic substances certainly fit the description, I think, that Mr. Sarbanes mentioned.

Mr. STEPHENS. Does it include pesticides?

Mr. STEIGER. No. That stays in Agriculture.

Chairman BOLLING. Is there any consensus on this? Is it a half and half split, clean air and clean drinking water staying in Energy and Environment and radiation and toxic substances staying in Health? Mr. SARBANES. That is not the clean water program that Public Works has.

Chairman BOLLING. I understand.

Mr. SARBANES. That is your local health department in every community across the country.

Mr. STEIGER. We are fluoridating the water, is that right?

Chairman BOLLING. I don't know why you had to bring up the nasty word.

Mr. STEIGER. What do we do in clean drinking water? Do we pass a clean drinking water bill?

Chairman BOLLING. Congress had jurisdiction over a bill that passed on clean drinking water.

Well, let's leave that at this point and we will adjourn.

The committee stands adjourned. I assume, unless I see a quorum around next week, we will stand adjourned until Wednesday, February 20.

[Whereupon, at 4:30 p.m., the committee adjourned, to reconvene Wednesday, February 20, 1974.]

COMMITTEE REFORM AMENDMENTS OF 1974

WEDNESDAY, FEBRUARY 20, 1974

HOUSE OF REPRESENTATIVES,

SELECT COMMITTEE ON COMMITTEES,

Washington, D.C.

The committee met, pursuant to notice, at 2:15 p.m., in room 321, Cannon House Office Building, Hon. Richard Bolling [chairman of the committee] presiding.

Present: Representatives Bolling, Stephens, Culver, Meeds, Sarbanes, Martin, Wiggins, and Steiger.

Also present: Charles S. Sheldon II, chief of staff; Melvin M. Miller, deputy chief of staff; and Gerald J. Grady, Spencer M. Beresford, Linda H. Kamn, Robert C. Ketcham, Walter J. Oleszek, Roger H. Davidson, Terence T. Finn, Mary E. Zalar, Linda G. Stephenson, and Joan Bannon Bachula, staff members.

Chairman BOLLING. The committee will come to order. I would like to dispose of a few scheduling matters.

The first is the appointment of an individual, a secretarial person, to replace a vacancy. I would like the committee's approval for the employment of Lorren V. Roth, as replacement secretary, on the majority payroll, effective February 25. This is a straight replacement. Without objection, it is so ordered.

Then we have a couple of important matters but they are matters that we cannot control. I propose that any transcripts not returned within 3 working days will be corrected by staff as the only way to put them in print in a timely fashion. That is pretty drastic.

I will tell you what I am doing. I am letting mine go raw to the printer. I am not recommending that to anybody else.

Mr. MEEDS. We are not all as articulate as you are.

Chairman BOLLING. Nor are you as willing, I guess, to have your deathless words be pretty deadly.

But I think it is important when we conclude that people have an opportunity to look at the transcripts of these mark-up sessions. The only way we could possibly keep up with the printing problem is by some such very rigid rule. I cite my own example.

Up until a certain point Charles was looking at mine and then I said. "Just fire them." I have discovered, after being around here awhile, that those words are not quite that deathless and it doesn't really make that much difference.

Mr. SARBANES. Is this a prospective ruling rather than retrospective? Chairman BOLLING. It is prospective. It will have to be prospective. If you want to follow my example, you can

Mr. SARBANES. No, I read them and I don't want to follow your example.