CONSOLIDATION OF GOVERNMENT SOLDIER COMPENSATION BUREAUS. COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, HOUSE OF REPRESENTATIVES, Monday, February 14, 1921. The subcommittee met at 10 o'clock a. m., Hon. Burton E. Sweet presiding. Mr. SWEET. The committee will come to order. Surg. Gen. Cummings, of the Public Health Service, is here this morning. We will be glad to hear you, General, upon H. R. 14677, H. R. 14961, and other bills. STATEMENT OF DR. HUGH S. CUMMING, SURGEON GENERAL, PUBLIC HEALTH SERVICE. Dr. CUMMING. Mr. Chairman and members of the committee, the object sought to be obtained by the legislation proposed in the bills now before you, H. R. 14961 and others, has been concisely described in the previous hearings by the national commander of the American Legion as the desire that the ex-service man shall secure swift justice," by which I think we all agree he means that the sick or disabled man shall First. Be furnished prompt and adequate medical and surgical treatment in suitable hospitals. Second. That he shall receive the compensation and other indemnities to which he is entitled under law promptly and regularly. Third. That he shall receive effective and prompt vocational rehabilitation. Fourth. That these benefits may be secured by him with as little red tape as is consistent with efficient government. I think that we must all agree, from the arguments presented to you by the gentlemen who have appeared in favor of this bill, that the following facts have been established: First. That there are at present insufficient and inadequate hospital facilities for the care of the sick and disabled ex-service men. Second. That the payment of compensation to those entitled to it is apparently unduly delayed, and that this delay is at least in large measure due to the lack of decentralization of the present War Risk Insurance Bureau. You were informed by Col. Galbraith and others that the work of the Public Health Service and of the rehabilitation section of the Federal Board for Vocational Education are decentralized, so far as pertains to the treatment of the individual, and that is a fact. The 5 conditions as they are at present may be briefly described as follows: The War Risk Insurance Bureau under the law is an office centralized in Washington without authority to maintain branch offices. When the Public Health Service was authorized by the Congress to furnish medical and surgical care to the ex-service men it promptly established 14 districts in this country and others in our insular possessions. The Public Health Service not only began its strictly professional work, but, so far as it could do so, endeavored to do the work of assisting both the ex-service man and the War Risk Insurance Bureau in the preparation and forwarding of his application for compensation, etc., meantime taking care of the man when necessary in dispensaries and hospitals. It is generally conceded, I think, by those who have spoken to you that this work has, in view of the enormous task involved, been done as well as any other agency could have possibly performed it, despite the undoubted isolated instances of apparent failure. You may have drawn from the various statements made here and elsewhere that claim papers follow an unnecessarily circuitous course through the Bureau of the Public Health Service to the Bureau of War Risk Insurance. Such, however, is not the case. I wish to emphasize here that, while the Public Health Service officers in the field act for that service in the hospitalization and professional care of the men, in all matters pertaining to compensation they act as direct agents of the War Risk Insurance Bureau; all papers pertaining to these matters are forwarded direct, and all correspondence pertaining to these matters is direct between these field agents and that bureau. Therefore, any delay in the settlement of such matters rests with the agent in the field and the War Risk Insurance Bureau. The statement that the Director of the War Risk Insurance Bureau can not "direct" but can only "request" action from these officials is disingenuous. Instructions relative to matters pertaining to these officers are signed by either or both the director and the Surgeon General and by their common superior, the Assistant Secretary in charge of both bureaus. And in connection with that, Mr. Chairman, with your permission, I should like to put into the record the department circular which ordered that "Hereafter district supervisors and their subordinate personnel shall be held to be the field representatives of the Director of the Bureau of War Risk Insurance and the Surgeon General of the United States Public Health Service." Mr. SWEET. It may go into the record at this point. (The paper referred to follows:) INSTRUCTIONS RELATIVE TO THE EXAMINATION AND TREATMENT OF WAR RISK INSURANCE PATIENTS. TREASURY DEPARTMENT, To medical officers of the United States Public Health Service and others concerned: I. The term "patients of the Bureau of War Risk Insurance," as used in public act 326 of the Sixty-fifth Congress, shall be held to mean, subject to the limitations contained in Paragraph II hereof: (a) Any discharged sick and disabled soldier, sailor, marine, Army or Navy nurse (male or female), applying for compensation for personal injury suffered or disease contracted in the line of duty and not the result of his own willful misconduct, and until such time as claim for compensation has been disallowed. (N. B.-The above authorization is intended to cover emergency cases in which the health of the patient would be seriously injured by delay. Great care should, however, be exercised in the utilization of this authorization, the patient's discharge and other papers being carefully examined to prevent, in so far as possible, persons falling within the limitations of Paragraph II hereof from receiving treatment.) (b) Any person who, after induction by a local draft board, but before being accepted and enrolled for active service, became disabled as the result of disease contracted or injury suffered in the line of duty and not the result of his own willful misconduct involving moral turpitude, or as a result of the aggravation in line of duty and not because of his own willful misconduct involving moral turpitude of an existing disease or injury. (c) Any such person in whose favor an award of compensation has been made or to whom a certificate of injury has been issued by the Bureau of War Risk Insurance. (d) Any such compensable person who has waived his rights to compensation. (N. B.-Patients falling in classes (a), (b), (c), and (d) will be treated only for conditions definitely connected with their military service or for intercurrent conditions having an untoward effect upon the cure or amelioration of conditions definitely connected with their military service.) (e) Discharged members of the military or naval forces of those Governments which have been associated in war with the United States since April 6, 1917, subject to such regulations as the Director of the Bureau of War Risk Insurance may prescribe. II. Discharged sick and disabled soldiers, sailors, marines, Army or Navy nurses (male or female), are rendered ineligible as patients of the Bureau of War Risk Insurance by any of the following: (a) Discharge prior to April 6, 1917. (b) Discharge or dismissal from the military or naval forces as enemy alien, conscientious objector, or deserter, or as guilty of mutiny, treason, spying, or any offense involving moral turpitude or willful and persistent misconduct. (c) Dismissal or dishonorable or bad-conduct discharge from the service. (d) Refusal to submit to or obstruction of physical examination. III. All persons concerned with the enforcement of the provisions of this circular will provide themselves with copies of war risk insurance act and acts amendatory thereto, public act 326 of the Sixty-fifth Congress, and all acts of Congress relative to the Federal Board for Vocational Education. They will thoroughly familiarize themselves with the contents of these laws, to the end that ignorance thereof shall not be held to be sufficient excuse for failure to properly carry out their provisions. IV. Hereafter 1. The Bureau of War Risk Insurance shall be responsible for the determination of (a) The eligibility of persons mentioned in Paragraph I hereof to compensation and treatment; (b) The service origin or aggravation, nature, and degree of disability of their injuries or diseases; (c) Their reference for treatment; and (d) The payment of all bills incident to the discharge of the above-mentioned functions. 2. The United States Public Health Service will be responsible for furnishing reasonable medical, surgical, and hospital services and supplies, including prosthetic apparatus, to such patients of the Bureau of War Risk Insurance as may be referred to it for the same and the payment of all bills incident to the discharge of these functions. The Surgeon General of the United States Public Health Service is hereby authorized to make such reasonable rules and regulations for the internal administration of hospitals and relief stations operated by or under contract with the Public Health Service for the maintenance of order and as will prevent patients from endangering the health or impeding the recovery of themselves or other patients. In case of discharge from hospital for disciplinary reasons, the Director of the Bureau of War Risk Insurance or his representatives in the district should be notified in order that other hospitalization may be arranged, should it be necessary. In case it is believed necessary to take advantage of disciplinary action authorized under the war risk insurance act or its amendments, particularly with respect to payment of compensation, the case should be laid before the Director of the Bureau of War Risk Insurance with full report and recommendations. V. The Surgeon General will provide in each district medical and clerical personnel and office space necessary to the discharge of the functions enumerated in Paragraph IV. Hereafter district supervisors and their subordinate personnel shall be held to be the field representatives of the Director of the Bureau of War Risk Insurance and the Surgeon General of the United States Public Health Service. District supervisors will carry on their operations under the conjoint direction of the chief of the hospital division and the chief medical adviser for the purpose of carrying out the provisions of Paragraph IV, subparagraphs 1 and 2, under rules and regulations conjointly prescribed by the Director of the Bureau of War Risk Insurance and the Surgeon General of the United States Public Health Service, and approved by the Secretary of the Treasury. In each district there will be a district examiner, who, with his subordinate personnel, will operate under the direction of the district supervisor for the purpose of carrying out the provisions of Paragraph IV, subparagraph 1. In each district there will be a district relief officer who, with his subordinate personnel, will operate under the direction of the district supervisor for the purpose of carrying out the provisions of Paragraph IV, subparagraph 2. The Director of the Bureau of War Risk Insurance and the Surgeon General of the United States Public Health Service will take immediate steps looking to the housing of each district supervisor and the field representatives of the Bureau of War Risk Insurance in the same building with a conjoint central information bureau. Dr. CUMMING. It further provides: D. F. HOUSTON, Secretary of the Treasury. District supervisors will carry on their operations under the conjoint direction of the Chief of the Hospital Division and the chief medical adviser for the purpose of carrying out the provisions of Paragraph IV, subparagraphs 1 and 2, under rules and regulations conjointly prescribed by the Director of the Bureau of War Risk Insurance and the Surgeon General of the United States Public Health Service, and approved by the Secretary of the Treasury. So far as the work of the Public Health Service in connection with the rehabilitation division of the Federal Board for Vocational Education is concerned, I may state that over 200 officers of the Public Health Service are acting with that division in the direction of its medical work. The work of this division is decentralized, and so far as I am aware, there is no question as to the prompt and efficient, and I may add, harmonious working of this arrangement. Moreover, the physical examinations required by the Federal board in connection with its work are conducted by the same district officers of the Public Health Service, who are also the field agents of the Bureau of War Risk Insurance. Besides this, the Public Health Service furnishes medical care to the trainees of the Federal board. All of these cooperative duties are conducted without any friction or lack of coordination. Now, as to the history and merits of this particular bill: This bill was drawn in this city recently by part of a committee of the American Legion, who stated that they were endeavoring to carry out the instructions of the American Legion at its annual convention in Cleveland last September to favor legislation for the coordination of all three Government agencies concerned in the care and treatment of the ex-service man. When it was pointed out to them that consolidation was entirely different from and would have entirely different results from coordination, those members present stated that they considered that this bill carried out their instructions; representatives |