SURGEON QUICK: stated that he was connected with a Marine Hospital, which
did not take T.B. or N.P. cases; that the patients were beneficiaries of
the Veterans’ Bureau and were mostly of the surgical type; and that he
felt there was very little he could add to what had already been brought
to the attention of the gentlemen present. He stated that he believed
the large percentage of medical men would agree that rehabilitation was
more of a medical matter than an educational one.
He also expressed himself as being in favor of the dispensary plan for
the Districts; but added that he felt there must be a great deal of
cooperation between the District Managers and the Medical Officers in
hospitals; also, that medical officers in dispensaries should use a
great deal of judgment in referring cases to the attending specialists.
COL. FORBES: said that that was a medical question; that the District
Medical Officers should go the limit in providing hospital care if in
their judgment it is the proper thing to do.
COL. BRATTON: stating that he had charge of the Army and Navy General
Hospital at Hot Springs, spoke concerning the discharging of patients
from government hospitals by reason of disorderly conduct. He stated
that when such men were discharged they were not granted transportation
to their homes, and therefore became nuisances to the community there.
COL. FORBES: stated that there is a General Order providing for the payment
of such transportation.
COL. FORBES: inquired of this officer regarding the paper work of his
hospital.
COL. BRATTON: answered that he found it very cumbersome; that he has to make
triplicates; that two of these copies go to the District Manager who
sends one to Washington.
COL. FORBES: said he wished he would suggest to General Ireland a medium for
reducing this.
COL. BRATTON: said that he was running two sets of records,—Bureau and Army.
COL. FORBES: replied that he was dealing with two distinct sets of men.
COL. BRATTON: stated that he had just made out his annual report. He said
his place had treated 851 Veterans’ Bureau patients the last year, and
he told the different diseases involved. Added that in many cases
referred to them no trace of disease was found; also, that one man was
sent from Oklahoma and the only ailment discovered was one decayed
tooth.
COL. FORBES: replied to the effect that that man is entitled to vocational
training under Section 2.
SURGEON GARDNER (St. Paul): expressed himself as being in favor of the
dispensary project, as it would assist the medical officers greatly. He
added that he has two patients suffering from paralysis, and does not
know where to place them.
LIEUT. COMMANDER HIGGINS: stated that he is not in a hospital, but one thing
that impressed him in his contact with men in hospitals was Dr. White’s
“third class”, the border-line mental types. He said this type gave the
most trouble in hospitals, but that they do not get the sympathy of many
medical officers not accustomed to dealing with that type.
COL. FORBES: asked if he believed there were a lot of men hospitalized,
drawing compensation and taking vocational training from the Government,
who are not entitled to such.
LIEUT. COMMANDER HIGGINS: replied that it would be a very hazardous thing
for him to say because he had not been in contact with them; but that
from a civil standpoint that might be true.
COL. FORBES: asked Captain Blackwood if everyone in his hospital had a
disability.
CAPT. BLACKWOOD: answered in the negative; and added that at his hospital
they got diagnosis varying anywhere from baldness to flat feet; that the
man claims the disability, and when the hospital cannot find it, the man
is discharged. He cited one instance where a man came to the hospital
claiming that he was suffering from “Compensation”.
COL. FORBES: called upon Captain Dunbar, U.S.N.
CAPTAIN DUNBAR: said that he came prepared to offer statistics on the League
Island Hospital, and added that he thought that that hospital had been
doing as much work for the Veterans’ Bureau as any of the naval
hospitals; that out of so many sick days, one third of them had been
devoted to the patients of the Veterans’ Bureau. Remarked that during
the past year it had not been necessary to discharge a patient for
disciplinary action, but that so far this year two had been discharged
for peddling drugs. He also brought up the subject of treating patients
for disabilities other than those mentioned in the diagnoses upon
admission to the hospital, and gave as example a case diagnosed as
“chronic gastric catarrh”, but found to be an “ulcer” case. He said that
in emergency cases they went ahead and operated.
COL. FORBES: instructed him to go right ahead and operate completely.
SURGEON COBB: stated that he did not think that any of the gentlemen present
were aware of any General Order allowing the payment of transportation
after disciplinary discharge.
DR. LLOYD: gave information to the effect that that General Order was just
being printed.
COL. FORBES: stated that he would see that the proper authorization was
given, and that the travel blanks were placed right in the hospitals.
SURGEON COOK (Houston): asked if such transportation would take the man to
his home or to place of hospitalization.
COL. FORBES: replied that transportation would be to the legal residence or
to place hospitalized.
COL. FORBES: called upon Dr. Guthrie to inform the doctors present
concerning the difficulties in the Veterans’ Bureau.
DR. GUTHRIE: said he had been inclined to listen because he felt that the
reactions from the field had been more than the Bureau’s. He informed
the doctors that Col. Patterson had deemed it necessary to place a
Bureau representative in each hospital—the larger ones—in order to take
care of the very things that the doctors had been bringing up in the
conference. He added that many such matters would be discussed later in
the conference in addresses.
SURGEON KOLB (Waukesha): suggested that a hospital to take care of less than
100 patients be established, preferably on an island, for the care of
drug addicts and pronounced psychopaths.
COL. FORBES: suggested that Surgeon Kolb present that as a resolution a
little later when such were in order.
COL. DE WITT, (U.S.A.): expressed a need for a Bureau representative at his
hospital at Ft. Sam Houston, where there were 246 patients,
beneficiaries of the Veterans’ Bureau.
COL. FORBES: assured him that a representative would be placed there.
SURGEON RIDLON (New Haven): remarked that the Sweet Bill made provision
concerning Pulmonary T.B., but that he felt that T.B. of the bone should
be considered in the same class. He also suggested that the period of
two years be extended to three, stating that in many cases a boy is not
examined for two years; he comes to the medical officer shortly after
the two years have expired; the medical officer is pretty certain he has
had T.B. within the two years after discharge, but by reason of the two
year limit, the claim cannot be settled in favor of the boy.
COL. FORBES: replied that that was a matter for the medical men to decide,
but that he could see no reason why the boy’s claim should not be
adjudicated.
GENERAL SAWYER: “Many times I have complaints coming through my office. I
wonder if you gentlemen would really like to know what my office
represents. I am the liaison officer between yesterday and tomorrow. Any
difficulties of any kind that ever come through my office are those that
do not get through anybody or everybody else. So a number of these
complaints about the extensive and exhaustive records and the paper work
that is being carried on in the various departments come to me. I think
the matter is of such importance that I should like, Sir, to make this
motion:
‘That a committee of five, representing each of the
departments, be selected to take under advisement the matter
_MOTION_ of the paper work of the various departments and to make such
suggestions and recommendations as they may deem advisable;
this, regarding hospitals’.”
Motion was seconded by Surgeon General Cumming.
Motion carried.
SURGEON KOLB: offered a resolution:
‘That there be established a special hospital of 100 beds for treatment
of beneficiaries of the Veterans’ Bureau who are pronounced psychopaths
or drug addicts.’
Then followed a general discussion by Dr. Klautz, Dr. Cobb, and others
regarding drug addicts who have T.B., regarding the manner of retaining
such patients in hospital contemplated.
DR. GUTHRIE: stated that the Bureau is investigating such a matter and
invited suggestions from the doctors.
The above resolution was offered as a Motion, and was seconded by Dr.
Wilbor.
Motion carried.
DR. FOSTER: suggested the cutting of the man’s compensation as a means or
help toward keeping him in the hospital,
COL. FORBES: replied that when a man has become hospitalized, and his
disability has been connected with service, he is entitled to $80 a
month.
It was here remarked by a conferee that General Order No. 27 would take
care of such patients; that if he left the hospital his compensation
would be cut and he would not be readmitted within so many months.
SURGEON CHRONQUEST: offered the resolution that action be taken by the
Hospitalization Committee toward the establishment of a Federal
commitment law in psychopathic cases.
COL. FORBES: replied that there had been decisions made against such a
suggestion, by reason of the fact that it interfered with the
prerogative of the States.
SURGEON CHRONQUEST: mentioned the possibility of a suit being filed against
the commanding officer of a hospital for the illegal detention of a
patient.
DR. WHITE: explained that a man in the service—Army, Navy, etc.—could be
sent by the Secretary of War, of the Navy, to St. Elizabeths as well as
anywhere else; but that the courts in the District state that as soon as
the man changed to civilian status his commitment ends, and he is
illegally detained.
COL. FORBES: suggested that the question be referred to the Legal Division
of the Veterans’ Bureau.
COL. FORBES: “The conclusion of this session precludes me from any further
activity here. There is a little lack of enthusiasm here. I want you to
remember that we have asked you gentlemen here by and under proper
authority, and that it cost a good deal of money to bring you here,
which money is coming out of my appropriation. Now you have got to come
through with everything that is in your systems; you have got to give us
resolutions, advice, etc., and as long as I am coming to these meetings
I want to see lots of interest and enthusiasm shown, especially by you
gentlemen who are commanding large institutions. Surely you have known
lots of improvements you could suggest. I want you to make such
suggestions.
During tomorrow’s session when we are having motions and resolutions,
have something to offer. We are here to serve the Government and the
ex-service men. I want you to help me, because in helping me in my work
you are doing what the law has provided for the ex-service men.
I have been in your hospitals, most of them and I am wonderfully well
satisfied with the work you are doing. I am wonderfully happy because of
the spirit shown and the accomplishment you have made. You have worked
against odds many times, and I know there has been lack of appreciation.
What moneys you need for medical service it is my duty to see you are
allotted. I want you to know that we are not opposing any of the medical
activities, because as I said, I believe and I am satisfied that our
greatest problem in this work is one of a medical nature. Of course the
Veterans’ Bureau must properly operate through its doctors, and those of
you who are handling this big medical problem must help me, and I must
do what you decide is best to be done in the interests of the men.”
MEETING ADJOURNED—4:30 P.M., Jan. 17, 1922.
_Third Session_ Wednesday, January 18, 1922.
At 10:00 A.M. the meeting was called to order by General Sawyer.
The roll was called by Dr. W. A. White.
GENERAL SAWYER: Called attention to the fact that is had been discovered
during yesterday’s afternoon session that a number of resolutions would
probably be presented during the Conference, some of which would require
very close attention, and that the Federal Board of Hospitalization is
of the opinion that it is quite necessary to appoint a Committee on
resolutions, whereupon the following Committee was appointed.
Committee on Resolutions.
Major General Merritte W. Ireland, U. S. A.,
Rear Admiral Edward E. Stitt, U. S. N.,
Surgeon General H. S. Cumming, U.S.P.H.S.
In accordance with a resolution passed during yesterday’s session, the
following Committee was also appointed:
Committee on Forms:
Captain Norman J. Blackwood, U.S.N.,
Surgeon M. C. Guthrie, U. S. Veterans’ Bureau,
Asst. Surg. Gen. J. W. Kerr, U.S.P.H.S.,
Colonel James A. Mattison, N.H.D.V.S.,
Major L. L. Hopwood, U.S.A.
General Sawyer urged that the Committee on Forms meet at the earliest
possible moment in order that plans may be devised to take up
immediately the work involved in this connection and that suggestions be
obtained from the Committee, which will necessarily be brought to the
attention of the heads of the Departments represented in the Federal
Board of Hospitalization. He stated that every endeavor will be made to
simplify matters in order that clerical work may be reduced to the
lowest point consistent with the requirements of law. He pointed out in
this connection that the requirements of this nature had recently been
modified by over fifty per cent and that the Internal Revenue Service is
now taking up this same subject.
General Sawyer introduced Major General Merritte W. Ireland, who
presided over the morning session.
GENERAL IRELAND: requested those present to make extensive notes as to the
points brought out by the various speakers relative to such matters it
was desired to discuss later, stating that the papers would first be
read and would then be open for discussion.
COL. P. S. HALLORAN: read a paper on the subject of “U.S. Veterans’ Bureau
Inspections, U. S. Veterans’ Hospitals”, as follows:
“The inspections of the U. S. Veterans’ Bureau hospitals were formerly
made by the General Inspection Service of the U. S. Public Health
Service.
In October 1921, the Director authorized in General Order #39, the
organization of an Inspection Service of the Medical Division of the
Bureau under the provisions of sections 2 and 9 of the Act of Congress
approved August 9th, 1921, commonly known as The Sweet Bill.
In carrying out Section 6 of the Sweet Bill which authorized the
decentralization of the Veterans’ Bureau, the Inspection Section was
organized to consist of the Chief and several assistants located in the
Central Office, and an Inspection Section in each District Office.
The Section in the Central Office functions under Assistant Director of
the Medical Division, and the Inspectors of the District Offices
function under the immediate supervision of the District Medical
Officer.
The Chief of the Inspection Section directs and co-ordinates the duties
of all personnel assigned to Inspection Section including those
temporarily assigned to it for special duty, for example, various
specialists at the Central Office are available to investigate matters
pertaining to their specialty, and for this purpose, are temporarily
assigned to the Inspection Section and work under the direction of the
Chief of the Section to whom their report is submitted.
Ordinarily the District Inspectors make all inspections and
investigations within their respective districts when directed by the
District Manager or the Director of the U.S. Veterans’ Bureau. Only
special cases are investigated by the Central Office.
In general, the duties of the Inspection Section are to make such
inspections and investigations as may be necessary in order to
standardize the character of examinations, medical care, treatment,
hospitalization, dispensary, and convalescent care, nursing, vocational
training, and such other services as may be necessary for the welfare of
beneficiaries of the U. S. Veterans’ Bureau.
Upon the organization of the Inspection Service in each District,
instructions were given from the Central Office, that the work of the
Inspection Service would first be to make complete inspections of all
Contract Hospitals caring for ex-service men. The inspection of
Governmental Hospitals to be delayed until the Contract Hospitals had
all been inspected. This course was taken due to the fact, that is was
generally known Governmental Institutions were well organized, and had
recently been inspected by Officers of their respective services.
The inspections of Governmental Institutions made by the Inspection
Section of the Bureau are limited to matters which directly concern the
welfare of the beneficiaries of the Bureau. Investigations of the
official conduct of acts or officers of Governmental Services ordinarily
are conducted through the regular agencies of those services which are
organized to guide and control their own personnel, and to whom such
matters are referred through proper channels to the Director of the
Bureau for transmission to the services concerned, for their
investigation and administrative action.
See General Order No. 28—U. S. Veterans’ Bureau.
It is the policy of the Director to cause an investigation to be made of
all complaints received which concern the welfare of the ex-service man,
although it is realized that often complaints are grossly exaggerated.
During the comparatively short period which the Inspection Section has
been functioning, the following are a few of the principal complaints
received and investigated:
(1) Loss of property such as valuables and clothing of patients.
Investigation has shown, that patients were not informed of the
hospital regulations regarding the disposition to be made of these
articles upon admission; adequate lockers not available, or total
disregard by patients of existing hospital regulations.
(2) Preparation and shipment of remains of deceased;—casket too small,
shabby lining; no flag furnished; shipping-box broken, due to lack
of reinforcements; shroud of cheap material.
Investigation usually shows gross exaggeration. In some instances
specifications for the casket, shroud and shipping-box have been
such that cheap material is provided. Due to this fact the
contract price has been too low. The Director is willing to
provide sufficient amount and desires that presentable casket and
substantial shipping-box be furnished.
Investigation has also shown that record is not always kept that
the remains have been inspected by a medical officer, before
shipment.
(3) Poor food, especially weak coffee, and food cold when served.
Investigation usually shows fares as a rule, are good, the
complainant usually being tired of institutional menus.
(4) Cooks and other food handlers not examined for venereal diseases
and carriers.
(5) Mixing colored and white patients in wards and dining rooms.
(6) Rough handling of patients by attendants. Reports are usually
greatly exaggerated, or without foundation.
(7) Arrogance and overbearing on the part of Medical Officers towards
the beneficiaries. Such charges have not been substantiated.
(8) Sputum of T. B. patients not examined routinely at stated
intervals. Temperature of T. B. patients not taken.
(9) Rest periods not enforced.
(10) Insufficient bed clothing. Investigation has shown a few instances
where blankets through long service are much worn and have lost
their warming properties.
(11) Insufficient heating. In a few instances, it has been shown that
T. B. patients have no warm place to dress and undress in, when
taking open air treatment.
(12) Fire drills not held, and regulations not posted.
(13) Delay in making physical examination after admission of the
patient to hospital.
(14) Beneficiaries claiming they were not informed of the provisions of
General Order #27, U. S. Veterans’ Bureau, 1921, upon admission to
a hospital.
(15) Bed linen not changed sufficiently often.
In general, the above list of complaints are rarely received from
Governmental Institutions. When Inspectors have found unfavorable
conditions effecting the welfare of the beneficiaries of the Bureau in
Governmental Institutions, prompt remedial measures are usually
instituted to correct the conditions by the Commanding Officer of the
Hospital.”