4. Roll call of the attendants will be taken at the beginning of each
meeting.
5. Reports of all proceedings of sufficient importance will be recorded
by the expert stenographers in attendance.
6. This is a business affair and should be so considered by all
present. We are here to develop plans. We are here to receive
suggestions and get in line for the execution of orders which will
lead to the development of the highest order of hospital care and
treatment. With these suggestions we will proceed to the carrying
out of the program.”
“I have pleasure at this time in introducing to you Colonel Charles R.
Forbes, who will speak to you on the ‘Relation of the Veterans’ Bureau
to all Hospitalization Activities’.”
COLONEL FORBES: Addressed the conference as follows:
“Upon the signing of the Armistice on November 11, 1918, there was
immediately commenced the demobilisation of the armed military and naval
forces of the United States, comprising approximately 4,000,000 men and
women. As an aftermath of war service from the result of battle wounds,
gassing, injuries and disease it was anticipated that there would be a
large number of men and women who would be physically disabled, either
temporarily or permanently, partially or totally. While it was known
with a reasonable degree of accuracy how many there were who has been
discharged from the several services on Surgeons’ Certificate of
Disability and the number discharged with disability noted at the time
of discharge, it was not possible to foretell the magnitude of that
considerable body of men and women who though discharged from the
service apparently in good health would subsequently develop a
disability traceable to military service. Even at the present time, more
than three years after the Armistice it is not possible to state the
exact magnitude of the medical problem confronting the United Veterans’
Bureau, since new claims for compensation because of disability are
being filed at the rate of approximately 541 per day. As an index
however to the magnitude of this problem, gentlemen, let me tell you
that to date have been filed more than 762,000 claims for compensation
for disability and death incurred in military or naval service. While
this total number of claims have not all been allowed, this number does
constitute the present potential load for the United States Veterans’
Bureau.
By the original War Risk Act and subsequent acts amendatory thereto,—the
United States Government recognized its very great obligation to the
ex-service men and women who had become disabled through service, and by
these Acts provided not only financial aid to the disabled veterans but
also all reasonable medical and surgical treatment and care, whether in
a hospital, out-patient office, or at home.
The problem of hospitalization itself soon became of paramount
importance. It was initially recognized that, in spite of the meagre
governmental hospital facilities then available for the care of
beneficiaries of the United States Veterans’ Bureau, it was essential
for the best administrative control of veteran patients and for the best
professional control over their treatment to place the beneficiaries of
the United States Veterans’ Bureau under government supervision in
government owned or operated institutions. The carrying out of this
policy has been proceeding steadily at a rate commensurate with the rate
at which additional government hospital beds have been made available.
At no time however has it been possible to discontinue the use to a
considerable degree of contract civil institutions. Even at the present
time the United States Veterans’ Bureau is utilizing approximately 757
civil institutions for the care of approximately 8,924 of its
beneficiaries, and has contracts with a total of 1,524 civil
institutions for such care. It is however significant to note while in
July 1920 more than fifty percent of Veterans’ Bureau patients were in
contract hospitals, on January 1, 1922, but 30 percent of patients were
in contract hospitals. Furthermore the number of hospitals being
utilized at any time had dropped from approximately 1200 to 757.
The curtailment in the use of private facilities was of course the
direct result of increased facilities in government operated hospitals.
The United States Government had originally stipulated that the
hospitalization of veterans of the World War should be provided for the
United States Public Health Service through its Marine hospitals and
such other hospitals as it had been authorized to acquire. When however
it was discovered that the immediate facilities offered by these
hospitals were insufficient to meet the demand for hospitalization, the
hospital services of the United states Army, the United States Navy and
the National Homes for Volunteer Disabled Soldiers were to a certain
extent made available to the United States Veterans’ Bureau.
In March, 1919, the United States Public Health Service was operating
but 21 small Marine Hospitals. In order to meet the demand made upon it
by the then Bureau of War Risk Insurance, additional hospital facilities
were rapidly acquired, so that by November, 1919 there were in operation
a total of 38 hospitals with a total bed capacity of approximately
7,625. A year later namely on November 1, 1920 there had been made
available a total of 52 hospitals representing 13374 hospital beds. At
the present time, January, 1922, there are available 65 United States
Public Health Service Hospitals representing approximately 18,200
hospital beds. It is true that due to the necessity of securing with the
least possible delay adequate hospital beds, it was necessary to make
use of certain Army cantonment hospitals of temporary structure.
Hospitals of this type are admittedly unsatisfactory, and it is my
earnest desire to close such hospitals just as soon as properly located
hospitals of permanent construction are available to take their place.
Although prior to July, 1920, there had been a limited use made of the
facilities of the Army, Navy and National Soldiers’ Homes in the case of
Veterans’ Bureau patients, it was not until that date and in accordance
with provisions of the Sundry Civil Act of the 66th Congress that a
systematic and more extensive use of these facilities was proposed. It
was perceived that with the general reduction in the Army and Navy
personnel a number of large and well equipped government hospitals were
not being utilized to their full capacity. The utilization of these
facilities would have a two fold result, first, the placing of a larger
number of patients under direct government medical supervision, and
second, a more pronounced curtailment in the use of contract civil
facilities.
In June, 1920, under plans agreed upon by the representatives of the
then Bureau of War Risk Insurance and of the several government services
there were immediately made available 4181 hospital beds, not including
those in operation by the United States Public Health Service divided
among the services as follows: Navy Department Hospitals, 1760; War
Department Hospitals, 1510; National Soldiers’ Homes, 911. Additional
plans contemplated increased facilities by all those services. At the
present time, January 1922, in accordance with these plans the following
number of beds have been made available by these three services: Navy
Department, 3396; War Department, 2917; National Soldiers’ Homes, 3317;
Total, 9630.
I have briefly outlined the growth to the present time in government
hospital facilities available to the United States Veterans’ Bureau.
Combining the figures I have enumerated it is seen that the total number
of available government hospital beds has increased during a period of a
little more than two years and a half from a few thousand beds in 21
Marine hospitals to a total of 28655 beds in 94 government hospitals.
Let me now outline briefly the growth in our hospital population over
this period. In September, 1919 there were recorded a total of 6003
patients of the Bureau of War Risk Insurance, which total had increased
by January 1920 to 10907, and by July 1920 to 19,489, averaging over
this period a monthly increase in hospital patients of approximately
1225. From July 1920 to January 1922 the hospital population increased
from 19,489 to 29,263.
These 29,263 patients are hospitalized to the following extent in the
several classes of facilities: United States Public Health Service,
13,874; United States Army, 1530; United States Navy 1473; National
Soldiers’ Homes, 2637; St. Elizabeth’s Hospital, Interior Department,
825; Contract Civil Hospitals, 8924. By general class of disease,
these patients are divided as follows: Tuberculosis, 11,822;
Neuro-psychiatric, 8,414; General medical and Surgical, 9027.
Of the total number of 28,655 government hospital beds available, 20,339
are occupied at the present time, leaving a balance of 8,316 unoccupied
hospital beds.
As previously stated, it is the policy of this Bureau wherever
practicable, to remove beneficiaries of the Bureau from contract
institutions and place them in hospitals operated by the governmental
medical services. If it were possible at the present time to fill every
vacant government bed by patients in contract hospitals we would still
be obliged to continue 608 cases in contract institutions.
An analysis of the vacant government beds shows that they fall under the
following category:
For tuberculosis 2,292
For neuro-psychiatric 748
For general medical & surgical 5,276
—————
Total 8,316
An analysis of the patients in contract hospitals shows they are
classified as follows:
Tuberculosis 2,930
Neuro-psychiatric 4,004
General medical & Surgical 1,990
—————
Total 8,924
A review of these two sets of figures shows that although there are
apparently ample facilities for the care of general medical and surgical
cases, there is a real and serious shortage of government beds for the
care of tuberculosis and neuro-psychiatric cases.
In considering the use of government hospital beds at present reported
vacant, it is of course entirely impracticable to attempt to accomplish
the complete filling up of all government hospitals. As you all realize,
this is due to a number of reasons, chief of which are (1) the
administrative necessity at all hospitals of maintaining a surplus of
beds amounting to from ten to fifteen percent of capacity to allow
flexibility in case of epidemic or sudden emergency; and to permit
unhampered the routine admission and discharge of patients, (2) the
location of vacant beds away from the points of greatest demand, and (3)
the fact that the vacant beds available are not of the type required at
points where the Bureau needs them.
From an analysis of this whole situation it is believed that we have
sufficient beds available for the care of general cases with the
exception of two or three areas of the country, such as Memphis,
Tennessee, and in the metropolitan district of New York. Some provision
must be made to care for cases of a general nature because facilities at
these points are totally inadequate. In New York, the existing
facilities must be given up by June 1922.
However, the number of general medical and surgical cases requiring
treatment will steadily diminish and contract hospitals in many
instances would ultimately be able to care for their needs. On the other
hand, the Bureau must make provision for the care of tuberculosis and
neuro-psychiatric cases for many years to come.
The general medical and surgical cases are a type which justify the use
of contract institutions more than the other classes referred to, by
reason of the comparatively short length of time that treatment is
indicated: emergency conditions which require immediate hospitalization
where the patient may be; and the disinclination on the part of
claimants to be far from home, especially when a surgical procedure is
indicated.
The hospital program of the Veterans’ Bureau is meant to provide
approximately 20,500 permanent beds for the treatment of tuberculosis
and mental cases. It is estimated that between the present time and the
end of 1923 the Veterans’ Bureau will lose the use of approximately
5,400 beds because the hospitals will have to be abandoned by reason of
expiration of lease, temporary nature of the structure, or for other
cogent reason.
The hospitals being constructed out of the Langley Bill (Act of 4 March
1921) and appropriations for the Public Health Service made either by
the Secretary of the Treasury or the United States Veterans’ Bureau
which will become available during the two years ending with the
calendar year of 1923, will only provide 7,198 beds, while during the
same period of the time the Bureau will lose 5,397 beds for the reasons
already indicated. The ultimate loss of beds by reason of expiration of
lease, temporary nature of the structure, etc., will be approximately
4,875 greater than the beds which will be provided as result of
construction now going on under existing appropriations.
From careful studies that have been made, it is evident the Bureau will
require additional hospital facilities at the following points:
500 beds for tuberculosis patients in the State of California;
500 beds for insane in California;
200 beds in Chicago to enable the Edward Hynes Jr. Hospital to be
converted into a hospital for mental cases;
150 beds for general medical and surgical cases in the vicinity of
Memphis;
600 beds for general medical and surgical cases in the metropolitan
area of New York;
250 beds for general medical and surgical cases at the Walter Reed
Hospital
_____
2,200
It has recently become apparent that the neuro-psychiatric hospital at
Marion, Indiana, operated by the National Home for Volunteer Disabled
Soldiers, can only care for nervous and mild mental cases, and is not
prepared to handle definitely insane. Development in the future may make
it necessary, therefore, to ask for further provision for insane at that
or some other point in the country east of the Mississippi River.
Estimating that we will have approximately 2,000 or 2,500 cases in
contract institutions for many years, the Bureau is endeavoring to
provide for a maximum load of about 32,000 cases, the peak probably
being reached in 1922. It is estimated that the general medical and
surgical cases will diminish rapidly, but that permanent beds for the
treatment of approximately 13,000 tuberculosis, and 9,500
neuro-psychiatric cases must be available.
Gentlemen, I have attempted briefly to outline the growth and the
magnitude of our hospitalization program, and have told you roughly what
the expectation and needs of the United States Veterans’ Bureau in
regard to hospitalization facilities are. It is all summed up in our
earnest endeavor of the United States Government to provide every
ex-soldier, sailor, marine or nurse who becomes a beneficiary is the
United States Veterans’ Bureau with the best medical treatment available
under the best conditions possible. But in spite of our needs for
additional governmental hospital facilities, I want to assure you all
that to my best knowledge there is not a single veteran of the World
War, eligible for treatment and who has applied for hospital treatment,
for whom hospital facilities have not been found or who has not been
offered hospitalization.”