Hearings

STATEMENT OF GILBERT HAHN, JR., PRESIDENT OF THE BOARD OF TRUSTEES, WASHINGTON HOSPITAL CENTER; ACCOMPANIED BY RICHARD M. LOUGHERY, ADMINISTRATOR, WASHINGTON HOSPITAL CENTER

Mr. HAHN. Mr. Chairman, I appear here to testify in favor of S. 1228, and to present to you the plan that we have devised for longterm care facilities at the Washington Hospital Center.

The Washington Hospital Center is a private, voluntary, nonprofit hospital serving the greater metropolitan area of Washington as a hospital center. It has approximately 820 beds, is one of the most modern and is actually the 10th busiest of all hospitals in the Nation. We think it is extremely well run, in great measure due to our administrator, Mr. Loughery. We have the most modern equipment, an excellent staff, a school of nursing, a research foundation, and are a teaching hospital.

The steep rise in the cost of care-particularly "in hospital"—has concerned us and commencing in 1962 caused us to review carefully the utilization of expensive manpower and facilities. (When I say "expensive", I do not just mean in terms of money; I mean in terms also of scarcity of these commodities in the community.) It is obviously better in the case of those patients who need less than intensive or constant care to be treated either out of the hospital proper and in "after care" or "extended care" or "long-term care" facilities where there would be a lower cost and lower utilization of facilities and manpower.

Mr. Richard Loughery and his staff have assessed the community needs and developed a workable program; thus I have asked him to present to you some of the details of what we have already done in trying to provide optimum patient care at the lowest possible cost. Senator MORSE. Thank you, Mr. Hahn. I am delighted to have Mr. Loughery here to give his statement. I might say off the record. (Discussion off the record.)

Senator MORSE. Back on the record.

Mr. Loughery, I am delighted to have you make whatever statement you want to make for this record.

Mr. LOUGHERY. Mr. Chairman, thank you for the privilege of appearing at this hearing. Mr. Hahn indicated that our hospital has made a careful review of area health facility needs in preparation of our plans for service to this community. If I may elaborate just a bit : In 1959-60, the long-range planning of our own management group indicated a need for a type of health care less intensive than a general hospital but far more complete than could be provided in a nursing home; also such a facility should not be free standing but should be part of an existing general hospital. These concepts were verified by a consulting firm we retained to review our approach and to advise on the economic feasibility of this type of operation.

1. The District of Columbia Department of Public Health survey showed a need for 2,100 long-term care beds and recommended 300-400 bed convalescent-rehabilitative service at the hospital center.

2. A survey of District of Columbia Medical Society indicated 971⁄2 percent of doctors urged expansion of long-term care beds. Senator MORSE. Ninety-seven and one-half?

Mr. LOUGHERY. Yes, sir.

Senator MORSE. Mine says 97.

Mr. LOUGHERY. Beg your pardon. Ninety-seven percent. A survey of our hospital's 1,200 doctors and their planning committee's advice was to plan for 500 long-term beds.

The analysis of our hospitalized patients showed that over 25 percent of our patient days represented patients who would be better and more economically served in an "extended or after care" facility.

Since our studies in 1962, other parts of the country have arrived at conclusions similar to ours.

In order to serve this demonstrated need we then developed a program and retained hospital architects to provide detailed plans for a facility specific to this type of health care. It was our purpose to avoid critical manpower shortages and duplication of facilities by extending existing central service from our hospital to the planned convalescentrehabilitative long-term care facility.

By this I mean the whole range of supportive services; that is, dietary, housekeeping, engineering, accounting, medical records, purchasing, laboratories, X-ray, and so on, just to name a few of them. By doing this, we would be able to provide very real savings to the patient and the community. Our savings are expected to be from one-third to one-half of current hospital costs. These savings are consistent with the observations that were published in 1965 by the former Secretary of HEW, Marion Folsom, who now chairs the Rochester, N.Y. Regional Hospital Association.

We are ready to proceed with this detailed plan and program today. This project as conceived, will cause the least strain on manpower and will provide the most economical and best possible health services. It is particularly appropriate to persons over 65.

In the first 6 months of this year our proposed program could have considerably reduced the cost to some 2,178 of these same patients who used 32,363 days of care in our hospital. The need for this special approach to health care will continue to increase for this portion of the population. Further, the type of hospital-integrated care we plan cannot be served in nursing homes.

The endorsements of the Health Facilities Planning Council, our own medical staff, GHI (Blue Cross-Blue Shield), the findings of the Hospital Advisory Council to Hill-Burton, the testimony for the District of Columbia and the Department of HEW in September 1963 for our specific request for legislation for this type of facility, vouch both for the validity of this need and our plan and program.

We certainly favor the legislation being considered as we see it as the only way to overcome the major obstacle of financing this type of facility in the District of Columbia. The very nature of this Federal community makes it particularly difficult for us to promote by fund drives the matching funds required under existing legislation. This proposed legislation would alleviate this dilemma.

Thank you, Mr. Chairman. If there are any questions I shall be glad to try to answer them.

Senator MORSE. I have no questions. The testimony speaks for itself and is very helpful. Thank you very much for testifying. I have nothing further.

Dr. ECKER. Is he here? Come on up.

Mr. LOUGHERY. Thank you, Mr. Chairman.

Senator MORSE. Dr. Ecker, we are glad to have you. He is president of the Medical Society for the District of Columbia. You may proceed in your own way.

STATEMENT OF DR. HENRY D. ECKER, PRESIDENT OF THE

MEDICAL SOCIETY FOR THE DISTRICT OF COLUMBIA

Dr. ECKER. Mr. Chairman, I am here to present the position of the Medical Society of the District of Columbia with reference to S. 1228. The Medical Society of the District of Columbia wishes to be placed on record as endorsing S. 1228, the "District of Columbia Medical Facilities Construction Act of 1967," with certain suggestions which we believe will make the enactment of such legislation more effective.

The greatest need in health facilities construction in the District of Columbia is for extended care facilities both long term and short term. S. 1228 includes

Grants to assist in the modernization of public or nonprofit private hospitals and in the construction or modernization of public health centers, long-term care facilities, diagnostic or treatment centers, rehabilitation facilities, facilities for the mentally retarded, and community health centers.

While continuing to update and increase all health facilities is important, primary emphasis in this supplementary-grants bill should be on facilities designed to relieve the load on the general hospital. Despite all efforts by the medical profession to help reduce hospital costs to the family, to insurers, and to government, we all recognize that many patients could be released earlier from general hospitals to less costly facilities, either the short term requiring less expensive personnel and equipment, or the long-term nursing home type with a general hospital affiliation. This situation will be aggravated when title XIX of the Social Security Act is implemented in the District of Columbia. Whether such emphasis or priority can be included in S. 1228 or should be made a part of the intent of Congress, is a matter for your committee to ascertain. We do believe, however, that some such emphasis or priority is essential to best serve the immediate needs.

I would be happy to answer questions, if there are any.

Senator MORSE. You have been very helpful. I will comment on your statement very briefly. We could, of course, cover your suggestion in the report of the committee, but I never consider that very satisfactory. You have testified, Mr. Bucher testified, and I think it was clearly implicit in Dr. Grant's testimony, so I want the attention of the counsel for a moment. Dr. Ecker quoted from the language of S. 1228, as it now is written in the second paragraph of his letter:

Why should we change this language or insert in this language additional language that makes very clear that there shall be included by legislation the direction for extended care facilities and call them such?

Dr. ECKER. This is what the doctors would like, Mr. Chairman.

Senator MORSE. Well, I want counsel to have legislative counsel prepare an amendment for me that I will present to the subcommittee, introduce and present to the subcommittee, and unless it can be shown why it should not be included in the bill itself, I am going to support its inclusion. If you have any further suggestions that you wanted to make available to the legislative counsel, Mr. Judd, between now and the time we introduce the amendment, you may do so. But, it seems to me, it is only a matter of draftsmanship now.

It might be argued, I suppose, that the present language, "long-term care facilities", covers it, but I felt this morning what we were talking about in addition to this is extended care facilities. Why do not we say so in the bill?

Dr. ECKER. If I might make a comment, Mr. Chairman, the medical society objects to the "long-term" phraseology because what hospital boards and hospital administrations and the medical profession are trying to develop in these days is progressive care. This range is in the spectrum from the intensive care unit to the domicilliary care type for elderly people who are unable to care for themselves. The greatest gap in this chain of progression from intensive care of a seriously and a critically ill patient to the well patient is in the extended care phase of movement. The general hospital is still taking care of people who do not require the sophisticated nursing care and equipment that exists on the acute wards. They are not quite able to go to self-care units which have been developed in a number of hospitals. So, they are kept in the standard ward environment and it is not only costing them more but they are depriving other potential patients from entry into our already overcrowded hospital system. Senator MORSE. That gives me just the clarification I needed. Longterm care facilities really refers to domicilliary care rather than extended care.

Dr. ECKER. It can be so interpreted and that is what we wish to avoid.

Senator MORSE. All right. Now, Mr. Counsel, I want an amendment drafted that leaves no room for doubt that we will want this bill to cover extended care as has been described here by Dr. Ecker, and also by Mr. Bucher earlier.

While he is still in the room, may I ask you, Mr. Bucher, if you have exactly the same understanding that I have as a result of the testimony of Dr. Ecker?

Mr. BUCHER. Yes, sir. Dr. Ecker has given to you the link of this chain which we find no facilities available for.

Senator MORSE. As far as I am concerned-I do not speak for the committee as far as I am concerned, I want the bill broadened to include extended health care.

Thank you very much.

I want the attention of Mr. Judd. I would like to have you advise the witnesses that appeared this morning that all the answers and supplemental memorandums that I called for from them this morning are to be

submitted to the committee not later than 5 p.m., Monday, August 28. That will include the additional questions that I asked counsel to prepare from the material that I inserted in the hearing record concerning the criticisms that appeared in the press some months ago on the operation of District of Columbia General Hospital. Senator Kennedy's questions related to many of those criticisms. My comments did, too. But, I think in fairness to Dr. Grant and also for the needs of the committee, counsel should extract this afternoon a list of questions-he should prepare a list of questions relating to the operation of District of Columbia General Hospital-and get those questions down to Dr. Grant and Commissioner Duncan and to the press sometime tomorrow so that they can include their answers in the memorandum now requested for the hearing record not later than 5 p.m., August 28.

I want them to give us a sufficient number of copies so that the material can be made available to Mr. Bucher for any comments that he wants to make, if any, and I want any supplemental memorandum 2 that he wishes to supply filed not later than 5 p.m. on August 30. He was here this morning. He heard the testimony. He can start preparation of any supplemental documents he may wish to file or expand his testimony this morning long before Monday, August 28. I believe that he is familiar with the material that I inserted in the hearing record. Will you see to it that he gets a copy of the transcript and be sure that Dr. Grant and Commissioner Duncan get copies of this transcript tomorrow so they can use it in preparation of the memorandums. The record of the hearings will be closed at 5 p.m., August 30. That gives the staff time to get the full hearing record ready to go to the Government Printing Office. Almost immediately I will take up with Mr. Smith, director of the professional staff of the committee, the question as to when we can have a meeting of the full committee.

I want to get this bill in shape so that we can proceed with action immediately following Labor Day. Therefore, may I change the dates. I am going to request the answers to these questions from Dr. Grant and others by 5 p.m., Friday, August 25, and any supplemental memorandum by Mr. Bucher not later than 5 p.m., August 28, for it might be possible with that stepped-up schedule that we dispose of it in the full committee before Labor Day. No question about the subcommittee. We will conclude action in the subcommittee because I do not think it is going to take any time in the subcommittee. The subcommittee will quickly recognize that it should be recommended to the full committee. Then during the Labor Day recess the whole record can be printed and be available for the Senate immediately after Labor Day.

Let the record show that I am asking counsel to get galley proofs on the hearing record so that can be available to the full committee. I want to try to get action on this bill just as soon as we can get it to the floor of the Senate following Labor Day. Is that clear?

With that understanding, I will close the formal hearings. I now declare the hearing on S. 1228 closed.

(Whereupon, at 1:05 p.m., the hearing was closed.)

1 See page 99.

2 See page 113.

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