I might go on to cite many such cases, but my time allotted is
insufficient. My purpose is simply to inform you that it is the wish of
the Director and his associates in the Veterans’ Bureau that it and its
co-operating agencies may give to each case a human touch, reflecting
personal interest and I can think of no better maxim for our guidance
than the title of Charles Reade’s book, “Put Yourself In His Place,”—and
give service as you would have it given unto you.”
MR. BURKE: stated that in the absence of Major Fraser his subject would be
taken up by Mr. Milliken.
MR. J. B. MILLIKEN, of the U. S. Veterans’ Bureau, discussed the subject
“Relation of U. S. Veterans’ Bureau to other existing bureaus in caring
for its beneficiaries”, as follows:
“Ladies, Mr. Chairman, and Gentlemen: The subject of my twenty minutes
talk to you might more appropriately be termed the relation of the U. S.
Veterans’ Bureau to all the Executive Departments of the Government, for
indeed, there is not a Department of this government with which the U.
S. Veterans’ Bureau does not have a vital and immediate contact.
Probably there are three Executive Departments of the Government with
which the Bureau has more contact than with the other Executive
Departments—that of the Treasury Department, the War Department, and the
Navy Department. Inasmuch as the U. S. Public Health Service is a part
of the Treasury Department our contact with this Department of the
government is immediate and vital, and is of more immediate importance
than our contact with the other Executive Departments.
As is appreciated, no hospitals are operated directly by the U. S.
Veterans’ Bureau, and all hospitals with the exception of contract
hospitals are operated by the other independent establishments of the
government, the Public Health Service of course having the lion’s share
in providing facilities, and prior to the Act of August 9, 1921 creating
the U. S. Veterans’ Bureau, the U. S. Public Health Service had charge
of the various fourteen district offices where was stationed at each
district office a Supervisor.
The Secretary of the Treasury’s order of April 19, 1921 transferred the
functions of the District Supervisor’s Office to the then Bureau of War
Risk Insurance, and the Act of August 9, 1921 transferred by law the
activities of these offices to the U. S. Veterans’ Bureau, but left
unhampered the jurisdiction and authority of the U. S. Public Health
Service concerning matters of hospitalization.
Without the work of the facilities afforded by the U. S. Public Health
Service it would indeed be impossible for the U. S. Veterans’ Bureau to
function and discharge its obligations relative to the hospitalization,
medical care, and treatment of disabled ex-service men and women.
Co-ordination of their work has led to the fullest cooperation on the
part of every agency, to the end that the disabled ex-service man is
receiving the best treatment which a grateful government can provide.
You have, of course, before you all the data and information relative to
the extent of the work carried on by the U. S. Public Health Service as
it relates to the beneficiaries of the U. S. Veterans’ Bureau.
The relation of this Bureau to the War and Navy Departments is
fundamental, for the reason that before any person can be accorded the
benefits provided for under the act creating the U. S. Veterans’ Bureau,
a record must be obtained from the War or Navy Department showing the
military or naval record of the person seeking benefits either for
compensation, insurance, vocational training, or medical care and
treatment. Something over 900,000 requests have been made to date on the
War and Navy Departments requesting a transcript of the military or
naval record of the person while in the active service and there has
been no diminution in the number of reports requested daily, in that our
average number of requests each day is about 1,000. The matter of
furnishing adequately the transcript of record of an ex-service man or
woman, showing whether or not they received any medical treatment while
in the active service is indeed a most difficult problem. It must be
remembered cases are now arising where a given individual has been
discharged from the military or naval service for a period of
approximately three years, and that in all probability they did not
receive medical care or treatment while in the service, but their health
has become impaired subsequent to their discharge from the service.
Quite true they might have had some slight attack of influenza while in
the service or some other disability, but did not report for medical
care and treatment.
The most of these individuals believe that the War or the Navy
Department should have had a record of such indisposition on their part,
and that, in turn, it is up to the U. S. Veterans’ Bureau to secure such
a record upon which to predicate the service origin of a given
disability. Certainly not in the history of this government has the
military and naval establishments been called upon to complete and
compile the records of statistics and facts comparable to that resulting
from the late war, and while there have been many mistakes made both on
the part of the U. S. Veterans’ Bureau in requesting the information and
on the part of the War and Navy Departments in submitting information,
the great bulk of work has been performed in a most satisfactory manner,
and great benefits have been accorded to those applying for the same
under the beneficent laws passed by our Congress.
On January 1st, 1922 there had been filed with the U. S. Veterans’
Bureau 81400 claims for compensation. In each and every claim filed it
was necessary to request the War or Navy Department for the military or
naval record of the person applying for compensation benefits, and in
many instances it was necessary to make duplicate requests because of
inadequate identification given or of additional evidence which the
claimant submitted which would make it possible for the War or Navy
Department to make a more exhaustive search of their records. To show
the promptness with which reports have been received from the War and
Navy Departments for no claim is either allowed or disallowed without a
report from the War or Navy Department—out of the 814,000 claims filed,
51% have been allowed, 41% have been disallowed, and 8% are pending
awaiting information either from the War or Navy Departments or from the
claimant himself.
Also to December 15th, 1921, 486,884 former service men had requested
vocational training. It was necessary for the Rehabilitation Division of
the Federal Board for Vocational Education, (now a part of the U. S.
Veterans’ Bureau), to request the military or naval record from the War
or Navy Department, and out of that number 299,000 had been declared
eligible for training; 135,000 had been declared ineligible for
training; and 51,000 cases were pending to determine their rights to
vocational training. These figures also represent a tremendous work
required of the War and Navy Departments in that the records of each man
must be obtained before final disposition was made of the case.
When viewed from the stupendous task, the results accomplished are
indeed commendable.
The great assistance of the War and Navy Departments should also not be
overlooked when it is remembered that at the date of the signing of the
Armistice there were approximately $40,000,000,000 worth of insurance in
force which had been written through the service of the War and Navy
Departments in providing insurance officers to make contact with every
man who was a member of the military or naval forces.
The War and navy Departments have always been of tremendous assistance
in the matter of hospitalization of ex-service men and women. On
December 1st, there were 1,410 beds occupied in Army Hospitals, and
2,032 beds occupied in Naval Hospitals. Certainly then from this resumé
of facts the contact with the War and Navy Departments is most vital.
The contact of the U. S. Veterans’ Bureau with the Post Office
Department is apparent. It need only be mentioned that to date the U.S.
Veterans’ Bureau, representing the consolidated agencies since their
organization have received approximately 90,000,000 incoming pieces of
mail, and have dispatched approximately 105,000,000 pieces of mail, and
the daily average receipt of incoming mail in the Bureau, even under
decentralization, is approximately 41,000 pieces of mail per day and the
outgoing pieces of mail from the Central Office of the Veterans’ Bureau
is approximately 58,000 pieces of mail per day.
The Veterans’ Bureau as you have been informed relative to the care of
ex-service men of foreign allied countries and of American soldiers
residing in allied countries has a vital contact with the State
Department in addressing their communications to the various foreign
countries and in the utilization of the various U. S. Consuls.
The Department of Justice has charge of all suits filed against the U.
S. Veterans’ Bureau where suit is brought on an insurance contract. The
department of Justice also handles all prosecutions where irregularities
are found under the act creating the U. S. Veterans’ Bureau.
Under the Interior Department you know of the use made of the St.
Elizabeth’s Hospital and of hospitals under the jurisdiction of the
Commissioners of Indian Affairs.
The contact is also quite vital with the Department of the Interior in
obtaining various information from the Pension Bureau as a person may be
filing an application for compensation and also an application for a
pension.
The Department of Agriculture has been of very great assistance to the
Bureau in rendering advice relative to the training of disabled
ex-service men with a vocational handicap who desire to take up
agricultural pursuits, and at the present time the Department of
Agriculture is rendering most valuable service in mapping out
agricultural courses for the first Vocational School of the Government
located at Chillicothe, Ohio.
Many disabled ex-service men taking vocational training have been
assisted by the Department of Commerce in mapping out their careers for
work incident to that of the Department of Commerce.
The Department of Labor has been of very great assistance in aiding the
Bureau to find employment objectives for disabled ex-service men
undergoing training or who have been rehabilitated by the U. S.
Veterans’ Bureau.
This will give you a general view of the relation of the U. S. Veterans’
Bureau to the Executive Departments of the government. The U. S.
Veterans’ Bureau naturally must have a close contact with the Congress.
Congress continually calls upon the Bureau for data and information
which can only be obtained from the other Executive Departments of the
government but which immediately relate to the work of the U. S.
Veterans’ Bureau.
Inasmuch as you Gentlemen are essentially interested in hospital
administration, I should like to speak briefly on the question of
hospital records, and what data the Bureau is required to have when it
is called before Congress relative to Appropriations. As you know,
Congress makes one appropriation to the U. S. Veterans’ Bureau for
Medical and Hospitals Services. Sums from this appropriation are in turn
allotted to the U.S. Public Health Service, the War and the Navy
Departments, the Interior Department, and the National Homes for
Disabled Volunteer’ Soldiers. When the U. S. Veterans’ Bureau is called
before Congress for every appropriation it must show specifically how
the money has been allotted, for what purposes it has been allotted, and
the result accomplished.
It has become imperative for the U. S. Veterans’ Bureau to have
available comprehensive records concerning all hospitals in which there
are being treated its beneficiaries. It is not sufficient that these
records be only those concerning the admission and discharge of patients
and the physical examination report in each instance, but equally
fundamental data concerning the results of treatment, periodical
turn-over of patients, the hospitals’ administration, and of equal
importance, but from a different angle, the cost of operation with the
resulting per diem cost per patient.
A considerable part of the records on patients, their flow in and out of
hospitals and similar data are available or can be made available, the
value of these data so derived, of course, will be proportionate to the
accuracy or thoroughness with which the records of admission and
discharge are prepared and transmitted. The report of admission and
discharge of patients and the report of physical examination are at
present the only reports common to all Government Hospitals. The
necessity for the prompt rendering of accurate admission and discharge
reports and physical examination reports in all instances is apparent.
Such reports are of very great importance to the U. S. Veterans’ Bureau,
for upon them is determined the medical rating of the hospitalized
beneficiaries and any delay or omission in the rendering of records of
this character reflects upon the administration of the U. S. Veterans’
Bureau.
In regard to the individual hospital operation costs, until very
recently the U. S. Veterans’ Bureau has been operating in the dark on
unit costs. It is demanded that the U. S. Veterans’ Bureau have complete
knowledge of the cost of operating all government hospitals, not merely
as a gross item, but classified by purpose of expenditure and by
department of hospital for which spent. The reason for this point is
made two-fold—First, that the Bureau before it can allot money to the
several services for hospital expense, must be in a position to know for
what purpose the money should be disbursed; and second, because the
Congress of the United States is holding the Bureau accountable for all
moneys appropriated to it and unless this Bureau can tell Congress in
detail this money has been spent, or is to be disbursed, our
hospitalization program will be jeopardized until such information can
be secured.
The per diem rates for hospitals of the several services vary materially
so far as our estimates are concerned. The degree to which such a
variation in rates is only an apparent variation due to the different
bases upon which they are calculated is not at present ascertainable,
but it should be. Not only should this Bureau know what it costs for its
own patients at any one institution, but it should know the per diem
cost over a given period for all the patients hospitalized there. The
cost to this Bureau affects not only our appropriation; the cost to the
service operating the hospital, including this Bureau’s share, but it
affects the U. S. Treasury. If the cost of maintenance of certain
hospitals is excessive, it would be poor business not to evacuate that
hospital, if other conditions made it practicable, or if impracticable
to attempt to reduce its operating cost.
Recently the U. S. Public Health Service inaugurated a system of cost
accounting by individual hospitals. With the perfection of this
procedure the U. S. Veterans’ Bureau will be in a position to talk
intelligently about operating costs with these hospitals whether by
departments of hospitals, purposes of disbursement, such as salaries,
repairs, etc., or by unit costs.
The U. S. Veterans’ Bureau looks forward to the time when similar data
are available and regularly submitted by the War Department, the Navy
Department and the National Homes for Volunteer Disabled Soldiers, not
merely as reimbursements due certain appropriations, but by actual
disbursements of detailed purpose of not only for this Bureau’s share,
but for total operations.
The U. S. Veterans’ Bureau also maintains contact with the various
miscellaneous Departments and institutions of the government. Time will
not permit of going into any details or of mentioning these contacts.
The U. S. Veterans’ Bureau when viewed from its huge task of running an
insurance company with over three and one-half billions of insurance in
force, of making payments on 149,000 insurance claims each month, making
payment on 204,000 compensation claims each month, with approximately
29,000 ex-service men and women undergoing hospitalization, and having
caused to be made over 1,000,000 medical examinations and responsible
for 104,000 disabled ex-service men undergoing vocational training,
representing a task which calls for the closest cooperation and
assistance from every department of the government and only by having
the closest cooperation possible will the government, through the U. S.
Veterans’ Bureau, be able to discharge its obligations to the host of
disabled ex-service men and women of this country.
The Bureau has always enjoyed the fullest cooperation from the various
departments of the government and knows that the same cooperation will
be extended with unstinted measure in the future, to the end that every
pledge will be redeemed concerning the care and treatment of the
defenders of this Republic, and to the end that this administration will
go down in history as an administration that did not forget its sick and
wounded soldiers, and brought peace and contentment to every fireside
where assistance on the part of the government was requested and was
due.”
COLONEL JAMES A. MATTISON, N. H. D. V. S, gave the following discussion of
“Economy of Administration in U. S. Veterans’ Hospitals”:
“The subject is so broad that we can only consider certain phases of it
within the time allotted for this paper. We all recognize that there are
certain fundamental essentials which must of necessity be provided in
every hospital regardless of the number of patients cared for. This
necessarily means that overhead expenses of an institution hospitalizing
small numbers of patients will be out of proportion to those of a
hospital caring for a large number.
The general business management, the purchasing of supplies and
equipment, the conservation and dispensing of the same, the elimination
of waste, etc,. will be considered only casually for the purpose of
emphasizing the importance of adhering as closely to strict business
methods as is done in the case of every successful business man, whether
he be a hospital executive, a merchant, or a man in any other line of
business.
In this connection, it might be said that a mistake which is made in
many government institutions, and one which is not made by the most
successful business men, is to attempt to start on economy at a place
where one can least afford to economize, that is in the pay and
allowances of the personnel immediately responsible for the management
of the institution, the responsible heads of departments, etc. In other
words, we are not always willing to pay for brains, a price commensurate
with the business responsibility involved. Again when we have been
fortunate enough to secure the right man the right place, we do not
always recognize his value by paying him a price commensurate with the
value of his work. Furthermore, when we have made the mistake of getting
the wrong man, who in reality is receiving a greater compensation than
his services are worth, and one who, in reality, is a very expensive
employee, we oftentimes make the mistake of not recognizing inefficiency
and promptly correcting it,
In case there is any decided handicap along the lines of inefficiency in
the responsible personnel in the administrative, utility, service or
professional departments, it should be promptly corrected, as it is to
those in such petitions to whom we constantly look to be on the alert in
recognizing the short comings of all subordinate personnel.
In visiting our own or other hospitals we promptly recognize the
presence or absence of evidence of the proper vigilance or efficiency in
every department. In case of a tour of inspection of one of these
institutions there should be found spurting steam valves, leaking water
faucets, extravagant use of electric lights, overheated buildings,
garbage and swill tanks running over with waste food supplies, evidence
of lack of organization and co-operation on the part of the personnel,
professional or otherwise, we should immediately recognize the fact that
there was inefficiency existing in the personnel of such an institution,
and as a result of this, a decided lack of economical and efficient
administration. Finding such conditions in other departments, we should
expect to find unsatisfactory conditions when the patient population was
reached. We should expect to find histories poorly written or not
written at all, patients waiting over-time for special examinations or
special treatments, lack of accurate laboratory and X-ray records, etc.
The matter of such inefficiency and consequent poor administration on
the part of the personnel in any institution would naturally lead to
great dissatisfaction on the part of the patients of such an institution
and to the greatest lack of economy on the part of the administration,
of the hospital.
In connection with the professional department proper, again the
attainment of the most satisfactory results from the standpoint, both of
economy and efficiency, is dependent upon the capacity and co-operation
of the responsible personnel. There has been much discussion in regard
to the number of professional personnel doctors, nurses, attendants,
etc., and on this subject there has been apparently wide differences of
opinion. However, these differences have been based upon differences of
viewpoints of what the actual conditions to be met were.
A definite agreement has been reached in regard to the required
personnel, nurses, doctors, attendants, social service, workers,
etc., to each two hundred patients in a hospital caring for all
acute patients, whether they be major surgical, acute active
neuro-psychiatric, active tuberculosis, or other type of acute
condition requiring active, constructive treatment.
As a matter of fact, however, we all know that in none of our Veterans’
Hospitals, especially the larger ones of 500 to 1000 or more beds, are
all the patients or even a majority of them represented by this type of
patients, on the contrary we have a large group of convalescent patients
who require professionally very much less attention from the standpoint
of active constructive treatment, dietetic attention, etc., and hence
require vastly less personnel, and the expense of their maintenance in
the hospital will be very greatly reduced from that of the acute type.
Again, we have another group which represents the semi-domiciliary type,
many of whom require very slight constructive treatment, and yet they
belong to a type of patients who are capable of being finally
rehabilitated and restored to an earning status in life. This group
requires still less care than the former, and naturally less personnel
and proportionately less per capita cost to the institution caring for
them. Lastly, we pass to a purely domiciliary group who are to a large
measure permanently disabled and are, therefore, many of them, to be
permanent charges oh the Veterans’ Hospitals. The great majority of the
latter group will require little or no special treatment, but will
require only general care and maintenance. In this group we are dealing
with a type who will represent the minimum per capita cost.
As time goes on we shall realize, especially in our larger hospitals,
that the above condition will exist to a larger and larger measure and
the necessity of a very close checking system and a very careful
classification of the patients along the lines indicated above will be a
matter of the very highest importance.
This does not mean that as long as special treatment along any line is
needed that each patient will not have such expert examinations, care
and treatment as his condition calls for. Quite the contrary, the most
careful and competent examinations should be directed by hospital units
composed of the most competent staff of men including surgical; medical;
ear, nose and throat; X-ray., etc., at such intervals as the condition
of the patient calls for. It will be by this system alone that we are to
keep a check on the progress toward recovery of each individual patient
and prevent an undue accumulation of a domiciliary group. By proper
cooperation of such a group with the rehabilitation section, many men
may be selected as suitable persons for rehabilitation in the vocational
schools. The importance of this we all realize as there is a certain
percentage of patients who will be quite content with their state as
long as they are receiving complete maintenance and a liberal
compensation of from $80 to $150 per month and no cares and no
responsibilities to assume in life. That is we should be constantly on
the alert to prevent making permanent residents or charges of any man
who can be restored to an earning status in life.
Contrast, if you please, with the conditions in our hospitals the
patient in private hospital, who is paying from $10 to $50 per day for
private nursing, hospital accommodations, etc., and a correspondingly
high rate for special professional services, and who in addition to this
is losing heavily because of his absence from his personal business. In
the latter case there is a much greater incentive for getting well, a
greater incentive for requesting that special nurses and other expenses
be cut off at the earliest moment it is found that they are no longer
needed and for the additional request that they be discharged from the
hospital as early as possible after the maximum benefits from
hospitalization have been received. In the one case, the private patient
is paying freely a large sum of money to get well. In the other case,
the patients of our Veterans’ hospitals in many cases are paid liberally
for being sick.
In making the above statement, we do not wish to be misunderstood. We
all know that we have among our patients in the Veterans’ Hospitals some
of the best type of men anywhere to be found; some of the most
ambitious; some who are exceedingly anxious to have their health
restored and be returned to an earning status in life at the earliest
possible moment; but, unfortunately, this does not apply by any manner
of means to all the patients whom we are hospitalizing. Out of the
disabled arising from an army of nearly five million men, naturally
there will bob up representative types of every manner of man in
existence. As representatives of Veterans’ Hospitals we owe to our
Government as well as to our patient our best efforts to help, not only
toward the rehabilitation of every soldier who can be rehabilitated but
we are also obligated to help develop this program upon the most
economical basis without sacrificing efficiency and the most
satisfactory constructive results.”
MR. BURKE: stated that the subjects were now open for discussion, and called
on Colonel Patterson for a few words.
COLONEL PATTERSON, of the U.S. Veterans’ Bureau,: stated that it had been a
great personal loss to him that he had been unable to attend all of the
meetings. He then spoke on the policy of the Veterans’ Bureau with
respect to the utilization of contract hospitals and Government
institutions. He stated that the Bureau has been for some months
endeavoring to take the beneficiaries of the Bureau out of contract
institutions and put them into Governmental institutions for several
reasons—first, the law says we must utilize to the maximum extent the
Government facilities in existence. Another reason is that the majority
of contract hospitals are unsatisfactory from the treatment standpoint,
if from no other reason, as many of these contract hospitals are purely
boarding houses which originated merely for the purpose of making money
out of the Government, by taking care of beneficiaries of the Veterans’
Bureau. Of course there are many contract hospitals in which this is not
true, but it has been determined that better treatment at least equal
cost can be obtained in the Government hospital. Another reason is that
the civilian hospital is not particularly interested and does not desire
to make the necessary reports. He also mentioned discipline. The
contract hospitals do not like to discipline a man because it may lead
to the loss of that patient. He stated that every time the Hospital
Section of the Medical Division recommends the closing of a contract
hospital the Bureau is immediately bombarded by letters from
Congressmen, Senators, the American Legion, United Veterans, and other
organizations, but the Veterans’ Bureau has been trying to stand firm.
The next subject he took up was the fact that a beneficiary gets more
compensation while he is in a hospital. This, however, cannot be changed
except by Act of Congress, and the Medical Division has recommended to
the Director that the man’s compensation be reduced while he is in the
hospital.
He took up next disciplinary regulations. With regard to payment of
transportation, he stated that this money could not be deducted from the
man’s compensation without Congressional action.
He spoke also on the fact that under the Vocational Rehabilitation Act a
man discharged with a disability not connected with the service, who has
been denied compensation, can get training even if his disability is the
direct result of his own misconduct, and that he is entitled to
treatment for any disease contracted while taking training if it
interferes with the continuance of his training. The Medical Division
recommended some time ago that Section 3 training be discontinued and
that no man be given training unless his disability is the result of
service or aggravated thereby.
He said he hoped that the gentlemen present would express their opinion
as to whether or not meetings similar to this one should be held
annually.
With regard to the attitude of the Veterans’ Bureau towards the various
Services, he stated that when allegations are made all the Veterans’
Bureau can do is to send them to the Head of the Service, asking him to
take the usual steps to find out whether or not those things are true.
On the other hand, if there is a charge a man is mistreated, the
Veterans’ Bureau must investigate it. It is a very peculiar situation
for one Department to investigate something conducted in another
Department.
Regarding complaints, he cited one case. A letter was received from an
insane man in the west Roxbury Hospital, who signed the letter “All the
patients in the hospital”, and complained about everything in the
institution. A letter was immediately received from a Congressman, then
another, and one from a Senator. The institution had been inspected only
ten days previous and the Veterans’ Bureau was sure the allegations were
not true, but sent out another man to investigate the matter. Later the
Bureau received copies of similar letters which the insane man had sent
to President Harding, King George and the Prince of Wales. He mentioned
this as an illustration of what the Veterans’ Bureau has to put up with.
Speaking about coordination and cooperation, he mentioned the fact that
the Public Health Service is represented in the Veterans’ Bureau by Dr.
Guthrie, Dr. Lloyd and Dr. Long, the Navy by Commander Garrison and
Commander Boone, and the Army by Colonel Brooke and Colonel Hutton. In
this way the Bureau benefits by the advice of these men, and friction
between the Departments is avoided.
Another thing he took up was the situation in Arizona. Attempts have
recently been made to get the Bureau to put hospitals in two towns,
Phoenix and Tucson, both of which he stated were so hot that everybody
would have to get out in the summer. There are 431 vacant beds at
Prescott, within 400 miles, and in a few months 422 more will be
available. Transportation has been offered these men to these hospitals
but many have refused to go. He believed that the Veterans’ Bureau could
do more than this, but wanted an expression of opinion on the subject.
MR. BURKE: asked for further discussions on the questions raised by Colonel
Patterson.
DR. KLAUTZ: stated that he would like to ask Col. Patterson whether the
question of furloughs has been taken up in connection with disciplinary
regulations.
COLONEL PATTERSON: informed him that length or frequency of furloughs had
not been determined, but permission to be absent will be obtained from
District Managers under policies issued by the Central Office from time
to time. He asked for an expression of opinion on this subject.
DR. KLAUTZ: stated in regard to the situation in Arizona that probably all
the hospitals available there were situated in an altitude of 5000 ft.
COL. PATTERSON: informed him that Camp Kearny is lower than this. He stated
that the policy of the Veterans’ Bureau in regard to tuberculosis has
the backing of the National Tuberculosis Association, and that the men
asking for hospitalization had been offered transportation to Kearny or
Prescott.
DR. KLAUTZ: offered the suggestion that somewhere in the mountains North of
Tucson there might be places which were not too high and would be good
all the year round.
COL. PATTERSON: reported that there are already at Prescott 131 vacant beds
and within four months will be 432 additional. Why should we go to
additional expense when we have these other hospitals?
DR. LONG: took up the subject of the speeding up of patients in hospitals,
which is necessary for two reasons—first, in the interest of the man
himself, and, second, in the interest of economy. The average man was
about 25 years of age when he entered the service, and it should be
taken into consideration that his character had not been formed, and
that keeping him in a hospital tends to destroy still further his
initiative, so the sooner a man gets out of the hospital the better it
will be for him. As for economy, it costs about $240 a month to keep a
man in a hospital. He stated that dispensaries are now being established
in the district and sub-offices, where treatment can be obtained, thus a
man should be discharged as soon as he has reached the maximum
improvement. He cited the case of Palo Alto, where arrangements had been
made with Dr. Wheate that when a man had reached the maximum hospital
improvement such further treatment as was needed should be obtained in
the out-patient office. In about six weeks the total number of patients
was reduced from 540 to 417.
DR. ELLIOTT: took up the question of furloughs, stating that at the Naval
Hospital in Washington at Christmas time many Veterans’ Bureau patients
asked for leave, and pursuant to advice from the District Manager they
were given the same amount of leave that the other Naval patients
received, from 5 to 10 days.
DR. DEDMAN: spoke on economy. He said he understood a certain rate per diem
was to be established for the care of patients, and wanted to call
attention to several things in this connection. First, the environment.
Some hospitals have central heating plants; others have stoves. He said
that his hospital was an old cantonment hospital, with a unit heating
system which required the employment of about 45 stokers.
Another thing, some hospitals Are a great distance from markets; also,
prices may be higher. All those things make quite a difference in the
average cost of the care of a patient per day.
With regard to General Order 27, he called attention to the clause which
gives the Medical Officer in charge the privilege of giving the man his
transportation back to his home, and mentioned the case of a man who
come to the hospital from Oteen, where he had been discharged for
disciplinary reasons. The hospital could not admit him, but authority
was obtained from the Veterans’ Bureau to admit him for examination,
and, if active, to hospitalize. The man was examined and found to be
inactive. He then complained to the American Legion because they did not
hospitalize him, and he had no way to get home. However, in this
particular case, transportation was later received from the Veterans’
Bureau. General Order 27–A now gives the Medical Officer authority to
pay transportation.
He then asked whether a man who had been discharged for disciplinary
reasons and was very sick should be hospitalized.
COL. PATTERSON: informed him that General Order 27 has ample authority for
emergency cases.
CAPT. BLACKWOOD: expressed his appreciation of the opportunity to attend the
conference, and of the great value it had been.
He mentioned the fact that the word “discipline” carries with a feeling
of dread. Discipline is purely and simply obedience, and when you have
obedience you have discipline. Orders should be issued in such away that
no antagonism will be created. He gave an example: In the Naval Hospital
the patients are all supposed to stand at attention, if able, when the
Commanding Officer comes thru the wards. The Veterans’ Bureau patients
objected most seriously to this, so an order was issued that they should
sit down, and now you couldn’t make them sit down.
He stated that with regard to the question of absence of a patient over
leave for seven days, under G.O. 27 a man can now stay away six days
without any action other than minor punishments, which he said is
absolutely ridiculous. He thought some other form of punishment, should
be devised, as reduction of compensation would not affect many of the
patients who are not receiving compensation, and believed the Commanding
Officer should be allowed to assign these minor punishments. He did not
believe the patient should be discharged, as in that case he would only
go to another hospital.
Another thing he suggested, with reference to medical records, was that
a skeleton record, at least, of the history of a man’s treatment, his
examination and diagnosis, should be made to follow him around from
place to place. This would save a great deal of work and give the
hospital a line on what has been done for the man in the past. He said
patients had been hospitalized anywhere from one to thirty-five times
prior to coming to his hospital, and it was impossible to get a history
of their previous hospitalization.
HON. CHARLES H. BURKE: I happen to be, as some of you may know, at the head
of the Bureau of Indian Affairs.
In listening to the discussion this morning by Mr. Madden and by General
Dawes, I have had brought to my notice that there are some things in
connection with hospitalization that compare in some respects with some
of the things I have to come in contact with in connection with the
administration of the affairs of the Indians.
Mr. Madden referred to the politicians and the harm they may do by
criticism and comment and so forth. I don’t think he meant when he said
politicians, the men who may participate in politics. I think he had in
mind these demagogues and agitators and sources of propaganda that are
doing more harm in the Government service,—I know it is true of the
Indian Bureau,—than anything else or everything else all put together;
and I think something of that applies to the hospitalization question.
Agitators, I call them. Some of them are perhaps interested in the
Indians and in their purposes, supersensitive, possibly. Others have
selfish motives that they desire to serve; others are just ordinary
trouble makers.
So, in the Indian Service, one of the things that we are handicapped by
is this aggregation that I have just described, that are criticizing and
finding fault with practically everything that is being done. One of the
things that they contend for more than anything else is that the Federal
Government, in supervising and administering the affairs of the Indians
should, before they put into operation any policy for their uplift and
their advancement, have the consent of the Indians. What an absurd
proposition! When you contemplate sending your boy to some educational
institution, are you going to permit him to dictate and say to you what
you shall do, or, when he selects a certain institution and tries it for
a few weeks, say that he does not like it and is going to try some other
institution? How far would a father get with a son if he permitted him
to dictate and dominate the situation?
So it seems to me that this question of hospitalization and caring for
the ex-service man is very largely a medical question and it ought to be
administered with a view to what will be most productive in
rehabilitating and restoring these men to full health; and so it
occurred to me that before this meeting adjourns, and because possibly
the impression may have been given this morning that the principal
question was one of economy, that we should, just for a moment, consider
this other question of what can be done and what should be done for the
best interests of these ex-service men. It will require regulations; it
will require legislation.
If you have not been repaid in the other sessions of this Conference
until this forenoon, I think every one of you who has come from some
distance will feel that he has been fully compensated in listening to
the discussion by General Dawes and Mr. Madden with reference to what
the Government, under our present Chief Executive, is endeavoring to
accomplish in the matter of administering Government. And so we have
this hospitalization proposition and all of the Departments having to
deal with that subject. We have this Federal Board of Hospitalization
made up of representatives or the heads of these different departments.
Now what I want to ask you gentlemen, and I am talking to you now as
experts, as men who are in the field in charge of hospitals, in a
position to see this Question from every angle,—what can you do now that
will help the situation. This is what I want to bring to your attention:
that is, that each and every one of you, through your proper officers,
communicate freely and from time to time what you believe ought to be
done to strengthen and improve this service; and then, these suggestions
coming from every part of the country and all of those different
institutions and services will be concentrated and ultimately have
consideration by the Federal Board of Hospitalization, and a regulation
will be prepared where needed and necessary legislation will be
suggested to Congress in the interest of better caring for and
administering these different hospitals throughout the United States.
My opinion, gentlemen, is this: that when a man goes into a hospital he
is presumed to be ill and should be governed by such regulations and by
such control as will best enable him to recover from his disability at
the earliest practicable time; and if he ought to have considerable
money and if he ought to be permitted to go his way, let him go; but if,
on the contrary, he should be required to live within certain reasonable
discipline as to his personal conduct, if he should be limited in the
amount of money that he should have to spend as he desires he should be
limited by you, who are expert and who have no possible thing in mind
except the welfare of these men.
Now don’t get the impression that you can get all the legislation that
you think perhaps you ought to have. I am not going to speak of the
Congress as constituted now, because a person in the administrative side
of the Government and in a bureau is not supposed to talk about the
Congress and so I am not going to say anything about the present
Congress; but up to about six years ago and for a period of many years,
I happen to know that there were men in Congress that don’t measure up
to what my friend, Mr. Madden, said a member of Congress ought to be.
There used to be members of Congress who kept their ears very close to
the ground listening constantly for any criticism, for any comment on
any part of the Government service, perhaps through a magazine or
newspaper; and they rose on the floor in their might to denounce some
policy or administrative action on the part of the Government simply
because they lacked the courage of their convictions.
Mr. Madden does not come within that class of members of Congress. He is
a man who has always been known to have the courage of his convictions.
Perhaps the entire body is now made up of that type of members, but such
was not the case up to 1915.
These agitators that I have spoken of, these demagogues, have learned
what you can do with a scared member of Congress, and we used to say
that the thing that emphasized most a scared Congressman was two. We
don’t have them I think any more.
My friends, let us hope that Congress is so constituted at the present
time, and we will assume that it is, that it will courageously and
fearlessly and without any regard as to what the results may be to
themselves, rise up and respond to what you gentlemen, through the heads
of these various Departments and the Federal Board of Hospitalization
may indicate and will enact into law such legislation, and if there are
any in the Congress who may have any fears about the results if they do
so act, I would say to them they have less to fear by keeping courageous
and standing for what is right, regardless of the comment at the time,
or the criticism that may come from certain sources.
Gentlemen, I thank you for the privilege of these few words and I hope
that all of you and each of you will be generous and diligent in
communicating, whenever you have any suggestions to make with reference
to bettering this service, in order that they may have the consideration
of these co-ordinating Departments that were so ably described this
morning by General Dawes. I thank you.
GEN. SAWYER: General Ireland, have you anything to say?
GEN. IRELAND: I don’t believe I have. I think it is time well spent and I
trust that there will be further meetings of this kind.
ADMIRAL STITT: I can only repeat what General Ireland has said. I have
learned a great deal from this Conference and feel sure that everyone
agrees that we should have a similar Conference, possibly every year.
GENERAL CUMMING: I have nothing to say except to express what I know is the
appreciation of everybody here to you as Chairman of the Board for
having inaugurated such a Conference, and, secondly, I think we owe
something to Colonel Forbes as an agent for having brought us all
together.
COL. MATTISON, N.H.D.V.S.: I can voice the sentiments just expressed. I
expected this meeting to be exceedingly valuable and it is vastly more
so than I had ever anticipated. I am very glad indeed to have had this
opportunity.
DR. WHITE: I want to express my personal appreciation for having had the
opportunity of coming into personal contact with all of you men who are
engaged in this work. I have long felt that one of the very great values
of a congregation of this sort is that resulting from personal contact
with men who are doing the same work.
I have listened to all of the discussions. I don’t know what I have
learned, but I feel, as I go back to my desk, that during the coming
year I will, in my various decisions, hark back to something that has
been said here that will help me solve the questions of the day. The
real things that one learns on occasions of this sort it is almost
impossible to formulate in one’s mind at the moment but they are always
brought up and proven valuable day by day. Thank you very much,
gentlemen, for the privilege of meeting you and I am going to ask you to
come out to St. Elizabeths and visit with us.
COL. PATTERSON: I have already occupied a great deal of time and so I can
only voice the sentiments expressed by the previous gentlemen. I know
those of us in the Bureau have learned a great deal and I hope that it
will be possible to let us have the benefit of a similar Conference next
year. We in the Bureau will be in a much better condition to profit by
your suggestions than we are this year and we will know better where we
stand than we do at present. Most of us are rather new to the job and
are in a very receptive mood.
In passing I would like to tell Captain Blackwood that the new order,
G.O. 27, covers most of the things he brought up. Some of the other
suggestions as to the way patients got into hospitals I fear will take
some time to rectify. We are in the hands of our agents in the field.
Many of them are not up to the standard. We hope to rectify that. As far
as the hospital question is concerned, I think you understand that the
Medical Bureau is with you and I hope you will take to heart what
Commissioner Burke has said and give us in writing the benefit of your
opinions and send them in through your chiefs. I hope you will give that
your attention and let us have the benefit of your advice. We want
constructive criticism and we need your help.
GENERAL SAWYER: How many of the Commanders present are accompanied by their
wives. Those that are, please stand. (Six stood up) I want to say
furthermore that the reception at the White House is at 8:30; entrance
by the North Portico. I feel sure that I can predict for you a very
pleasant evening.
In summarizing, just in a few words, I would like to give you something
of an idea of the impressions that have come to me and I believe that
you will agree that they are fair and that you should accept the same
impression for yourself.
First, it has been a great delight to me, personally, to meet you
Commanders of these various hospitals. I have a very much better idea of
the kind of men that are caring for these institutions and wish to say
to you that I am more than pleased with the capacity and the efficiency
that you demonstrate. Your contact here with each other has helped you
very greatly. To me the whole hospital question is visualized in a much
broader way. I thought I had a fair conception of what this proposition
meant, but I must say I have enlarged my horizon very materially. As for
myself I have received an inspiration such as I have never had before to
make of this hospitalization subject a matter for consideration and of
engagement of a much higher type. With the idea of its immensity, with a
better understanding of many of the details and requirements and
difficulties, I myself go forth to the undertakings I have before me as
the Chief Coordinator of this Board with much more determination than
ever before, with an ambition that has never quite possessed me before,
so I feel that I myself have been very greatly benefited.
There are some things you will take back with you out of this crowded
program. As the days come and go you will have the experience of
referring to this Conference as having given you new light and as having
given you an assistance you hardly record today.
It is my own wish that we may be able to put in the hands of each of you
quite extensive minutes of all of these proceedings. If I can bring that
about in the course of a reasonable length of time, you shall be
possessed of such a record.
I wish to thank the speakers for conforming so regularly to the
suggestion as to time limit. I wish to thank you for the care with which
you have prepared your papers and presented them. I wish to thank those
of you who have participated in the discussions. I want to express my
appreciation of those of you who have listened so intently and
apparently with such interest.
I would be unfair to the occasion if I did not express my gratitude for
the assistance that has been given us by the nurses in their association
with us here.
One thing I would have you do. You are but single representatives of the
institutions from which you come.
It would be somewhat selfish if you were to go home and bottle up within
yourselves the experiences that you have had here and the observations
you have made. Now, fellows, let me tell you what to do: Go back to your
various fields. Call in your associates and your assistants, take up
your whole administrative family and try to inject into them a little of
the enthusiasm, a little of the spirit, a little of the determination;
give to them some of the ideas you take away from here.
I want you to go while you are still under the influence of the
inspiration of the occasion, and I want to urge that each of you, as
soon as you get home, take up with your administrative family the
various things that have been discussed here, and try to instill in them
the same renewed earnestness and enthusiasm that you possess this
evening, and convey to them for us, this Board of Hospitalization and
the great President of this United States of America, Warren G. Harding,
the assurance that he appreciates every effort that you are putting
forth.
Coming from a doctor’s family, he realizes more fully than you can
possibly guess the difficulties that are confronting you every day; and
be assured that when you act upon your best judgment that you will find
him standing by whatever you may have regarded as necessary to the
bringing about of the end-results in this war veteran’s case.
Let me emphasize once more that the concern that the Administration has
is not how you may entertain them while they are in the hospital, is not
how easy and sympathetic you may be with them, but it is how you
engender in them a spirit of determination to get back into the world
again as productive citizens. That is your job.
In closing, let me say that at the suggestion of Colonel Patterson and
the Veterans’ Bureau which we are serving, that we are hoping that
somehow before another year shall have passed around that we will have a
real place to which we may invite you to participate in the most
interesting program that could possibly be produced. Fellows, I thank
you for your presence.
COMMANDER BOONE: I am sorry we are not able to raise our glasses to a toast
to the Chief Coordinator and the members of the Federal Board of
Hospitalization. The least we can do is to stand for a rising vote of
appreciation.
All stood up.
The meeting adjourned at 4:45 P.M.
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