of the Public Health Service who had been invited to be present pointed out the impracticability of such legislation. Mr. Rogers himself, who was present at the meeting, will concur in this statement.

Far from serving to coordinate the working of the three bureaus, this proposed measure absolutely disrupts the Public Health Service and its personnel, serves to destroy its carefully constructed corps of medical men, professional nurses, and other trained personnel, and would involve an intricate transfer and separation of hospitals and other property. It attempts to create de novo a separate medical and nursing organization, and has a hitherto unprecedented provision, namely, that the chief of the largest civil scientific and medical organization in the world shall be placed under direction of the chief of this newly created bureau, who will, presumably, be guided in his directions to the Surgeon General as to medical care either by some board irresponsible to the Government or by a subordinate employee. The bill has been studied by those of us who have had the responsibility directly and indirectly of the care and compensation of the ex-service man, and has been disapproved by the Secretary of the Treasury, by the Assistant Secretary in charge of the bureaus, and the Director of the Bureau of War Risk Insurance. The only possible merit in the bill is the decentralization of the work in the War Risk Insurance Bureau, and possibly, though with this I have nothing to do, the coordination of the work of the rehabilitation section of the Federal board.

Mr. SWEET. When you say " Federal board," you mean the Federal Board for Vocational Education?

Dr. CUMMING. Yes, sir. Your attention has been invited by the Secretary of the Treasury to the bill introduced by Mr. Rogers on December 7 and referred to your committee as H. R. 14677, which, in my opinion, as in that of the Secretary, will better obtain the results desired by the legion and by all of us.

So far as the hospitalization and medical and surgical care of the ex-service man is concerned, the bill now under discussion will not add a bed to the facilities now existing, and its passage would seriously and deleteriously affect the welfare of the ex-service man. I can not forebear inviting your attention to the fact that the Public Health Service, almost immediately after it was authorized to take care of the ex-service man, has persistently and unceasingly endeavored to show the Congress the need for additional hospital facilities for this purpose. This is evidenced by House Document No. 481 and by over 350 pages of hearings last spring and summer, with additional hearings this winter, which have happily resulted, I hope, in the inclusion in the sundry civil bill of an appropriation.

Briefly, gentlemen, as the result of careful study of this problem here and abroad I am convinced that the solution of this matter is the coordination, in one department, under one assistant secretary, of the three agencies now concerned in the three phases of the care of the ex-service man-the War Risk Insurance as regards the financial obligations, the rehabilitation division of the Federal Board for Vocational Education as regards the physical and mental educational problems, and the Public Health Service as regards the medical care. And the responsibilities of each should be clearly defined. I can not emphasize this too much, gentlemen, in view of the diffi

culties that we have had, in view of conflicting legislation. The responsibilities of each should be clearly defined.

It is needless to say that the utilization of the hospital facilities afforded by other governmental organizations, such as the Army, Navy, and soldiers' homes, can be as fully utilized under this plan as by any other; and so far as the individual is concerned, a method is provided for securing through a single agency in the field the benefits due the ex-service man. As a matter of fact, this has already been nearly accomplished without legislation.

Therefore, gentlemen, as a medical man, the chief of a great service profoundly interested in the welfare of the disabled exservice man and woman, and as one who may claim, at least, some familiarity with the subject, I feel it my duty and responsibility to warn you of the confusion which will result from the ill-considered transfer and consolidation of medical facilities in a newly created bureau, as proposed in this measure.

If I may add, Mr. Chairman, this matter, it seems to me, is a very clear, easy matter to settle. There has been a good deal of cuttlefish work and attempt to confuse the issue, because of various reasons, into which we need not enter at present; but to those of us who have been among the 14 district supervisors of the Public Health Service who have actually been doing this work in the field, to those in the bureau who have been around and seen the work, the matter is one of easy solution, as I have indicated; that is, to have the three bureaus coordinated under one secretary, one department-legally, of course. There is an assistant secretary who does the work, which could be provided for.

You can not make a Poo Bah of one man; there seems to be a feeling that in some way Congress can gather together in one individual a doctor, a financier, and an educator. There have got to be three men at these specialities. If the three bureaus were consolidated, the first day that a man struck there he would have to subdivide it again into medicine, education, and finance. So that the matter is perfectly simple. It is to coordinate these three institutions under one assistant secretary, have the 14 district supervisors in the field-and they need not be doctors; it is a matter of personality, not of profession. Those men would be selected by the Secretary-or, at least, he would be legally responsible for the proper man being selected-and the district supervisor's office would necessarily have a duplicate of the Washington organization. They would be functioning under him. They should be the financial branch, the educational branch, and the medical branch; so far as the service man is concerned, he would deal with only one person. He would go to the district supervisor or State supervisor's office, and all of his transactions should be there.

I think from a practical study of the thing that 95 per cent of the complaints we get about hospitalization when traced by the inspectors are found to be due to the man not getting compensation. And I don't blame anybody for that, because under present law the papers all have to come to Washington. I think if it could be decentralized so that a board-and we already do it, gentlemen, in the field with regard to the Public Health Service and the Federal board now. The medical board sits, makes a report on a blank; the report is

considered by the Federal board representative and the man's rating and what shall happen to him is decided right then and there, exactly the same board which sits to determine a man's compensation from the war-risk insurance, the same blank is used, the same jacket is used for his record. The amount of compensation could be determined there from the same report, and he could step around to the disbursing officer and get a check for the compensation allowed him by the district authority there. If he were dissatisfied with it, he would have the right of appeal to the central reviewing board sitting in Washington, but meantime he could get whatever amount was allowed him. If the central board of appeals and review in Washington found that the local board was giving him too much, it would be disallowed on his future monthly payments. If, on the other hand, he were getting too little, he could get the additional amount.

Mr. RAYBURN. Your idea is that these 14 district offices should be made; in other words, that the Wason bill should be enacted?

Dr. CUMMING. I think, Mr. Rayburn, that that is really the gist of the whole matter.

Mr. RAYBURN. And your idea is to decrease the work of the central bureau by making the decisions of those offices final except on appeal cases?

Dr. CUMMING. Yes, sir.

Mr. RAYBURN. If the man is satisfied, there is nothing that ever has to come here to Washington except the record of the case.

Dr. CUMMING. I would not say that, Mr. Rayburn. I should think that for the protection of the Government there would be the same ultimate coming of the papers to Washington.

Mr. RAYBURN. That is what I say; the record would have to come to Washington.

Dr. CUMMING. The record would come here and be audited, the final auditing. Of course, they may be a year or six months behind, but it would come here finally.

Mr. RAYBURN. Did you say a moment ago that you thought 90 per cent of the cases could be settled in those district offices?

Dr. CUMMING. I would prefer to have Dr. Lavinder answer about any approximate percentages. No; what I did say, though-Mr. RAYBURN (interposing). I thought you used the words "90 or 95 per cent."

Dr. CUMMING. I said about 90 or 95 per cent of the complaints about hospitals, etc., are really due to the man sitting there waiting for his compensation. The ladies who visit these men tell me that. I have talked with a great many of them and they tell me that the men become very much dissatisfied waiting so long.

Mr. SWEET. Doctor, so that we may get the full force of your suggestions, taking into consideration the present situation in the department, we will say that this coordination takes place under the Secretary of the Treasury. We have a Second Assistant Secretary of the Treasury who is the head of the whole matter.

Dr. CUMMING. Yes, sir.

Mr. SWEET. Under the Second Assistant Secretary is the War Risk Insurance Bureau, which for the purposes of this discussion comprises the Allotment and the Allowance Division, the Compensation Division, and the Insurance Division?

Dr. CUMMING. Yes, sir.

Mr. SWEET. And that remains in the Treasury Department where

it is now.

Then we have the Public Health Service, which remains in the Treasury Department. And the Rehabilitation Division of the Federal Board for Vocational Education is put under the Treasury Department. Is that true?

Dr. CUMMING. Yes, sir.

Mr. SWEET. And at the present time the Federal Board of Vocational Education really belongs to no department of the Government; it is a separate commission. Now, in the field we have the 14 regional offices which have already been established, as I understand it, by the Public Health Service?

Dr. CUMMING. Yes, sir.

Mr. SWEET. And these 14 regional officers are also working in cooperation with the Federal Board of Vocational Education?

Dr. CUMMING. Yes, sir; right in the same office.

Mr. SWEET. Now, in order to coordinate the work of these three branches under the Second Assistant Secretary of the Treasury the War Risk Insurance Bureau should have 14 regional offices. You will remember that in the Wason bill provision was made for 14 regional offices. At these regional offices we would have a district supervisor.

Dr. CUMMING. As at present; yes, sir.

Mr. SWEET. And all complaints within a certain territory or region would come to the regional offices?

Dr. CUMMING. Yes, sir.

Mr. SWEET. And at these regional offices you would have a board which would pass upon all matters pertaining to allotments and allowances, compensation, and insurance, as far as the Bureau of War Risk Insurance was concerned?

Dr. CUMMING. Yes, sir.

Mr. SWEET. On the other hand, they would also pass upon all matters pertaining to the Rehabilitation Division of the Federal Board of Vocational Education?

Dr. CUMMING. The same examination, Mr. Chairman; the same jacket.

Mr. SWEET. The same papers, the same jacket, and all brought together in that regional office?

Dr. CUMMING. Yes, sir.

Mr. SWEET. And each department would have access to the papers in that particular jacket?

Dr. CUMMING. Yes, sir.

Mr. SWEET. And all matters pertaining to each soldier would be in that jacket?

Dr. CUMMING. Yes, sir.

Mr. SWEET. Then, as the board passes upon a question of compensation, your suggestion is that that is to be final?

Dr. CUMMING. It is as far as the Federal board is concerned right now, Mr. Chairman. It shows the practicability of it.

Mr. SWEET. What is true as to the Federal board you want to be true as to compensation, allotments, and insurance. Now, as I said, the decision of that board is to be final, unless there is an appeal

taken by the soldier, and he is to have a certain length of time in which to take an appeal to the board at Washington. Do you believe that by adopting that plan it would coordinate the whole work of these three departments under the Second Assistant Secretary of the Treasury?

Dr. CUMMING. I think so, Mr. Chairman. I can't see why it would not.

Mr. SWEET. Your chief objection to what is known as the Rogers bill, H. R. 14961, is to the fact that according to the language of the bill, as it now stands, such part of the Public Health Service as pertains to war risk insurance, is put under the direct supervision of the Bureau of War Risk Insurance. In other words, there is a part of your service that remains wholly under your control and a part of it does not.

Dr. CUMMING. And a part of it half and half.

Mr. SWEET. And a part of it is half and half, and that is true in some of the hospitals.

Dr. CUMMING. Yes, sir. I don't think it could be made workable, Mr. Chairman. We have thought over it very carefully.

Mr. SWEET. Do you believe that this matter could be worked out under the first Rogers bill, known as H. R. 14677, to advantage? Dr. CUMMING. Is that the bill introduced last spring, or on December 7?

Mr. SWEET. That is the December 7 bill.

What I want you to do, Doctor, is to point out more in detail the reasons why you believe that these various bureaus can not function to the best advantage under the provisions of the Rogers bill.

Dr. CUMMING. Of the December 7 bill?

Mr. SWEET. December 7; yes.

Dr. CUMMING. Mr. Chairman, the Secretary has forwarded you a letter which discusses that matter, I think.

Mr. SWEET. Yes; at some length; but I thought it would be advisable to get it directly from you or from some person in your department at this hearing.

Dr. CUMMING. Section 7 in this bill, the first part, Mr. Chairman, is going along the line of decentralization and coordinating the Federal board with 4, 5, and 6.

Now, with regard to section 7, "That the duties heretofore performed by the United States Public Health Service in the physical examination and assignment of hospitals to beneficiaries," etc., "shall hereafter be performed by the Bureau of Veteran Reestablishment," I must say that when I came here last spring and began to study this question from a bureau standpoint and talked to the officers of the service in the field I was an ardent advocate and so are all of my officers without any exception, from a service standpoint-of having just that thing done, because we did not care about being put in the position of a rating board and a pension board.

After I got out into the field, Mr. Chairman, and went to these offices and saw the thing at work from a field standpoint, I saw this is what would happen: We would have a clinic unit, a dispensary, in these district offices to determine whether a man is sick or well; whether he ought to go to the hospital or not. That board at present also acts for the physical examination at the same time. You have got to make a physical examination to find out the condition of the