I am not asking you to express an opinion on this now, but I have a bill pending that I have introduced this year for an extension of the Hill-Burton Act and an enlargement for your Department. All the State medical officials are pleading that they need $5 million now for hospitals and $11 million now for renovation and modernization of old hospitals. Many have become obsolete. Now, I have a bill pending for $5 billion. A billion dollars a year. That is very modest compared to the needs. Some people say that California hospitals will be in trouble if they do not get it. I am trying to get it. It is coming up for executive consideration this month in our subcommittee. Finally, I have been working on and have had hearings here in Washington and Fort Worth and San Antonio, Tex., where there is a problem of narcotics in the two different categories you mentioned. I do not question your medical judgment, but I think that the witnesses that we have had testify in secret say that heroin is a hardnarcotic agent. What is found among the students is marihuana, LSD, and then heroin. You find someone who smokes one or two cigarettes and quits smoking marihuana. We have two research and treatment hospitals in the United States at the Federal level. One is at Fort Worth, Tex., and serves the States west of the Mississippi. One is at Lexington, Ky., to serve the States of the Plains and the one at Fort Worth has a problem with personnel. The administration threatened earlier this year to close those hospitals in June. I think it was Secretary Finch that said to me that he would leave Fort Worth open both for research and a treatment center. Incidentally, most of the personnel they train go out to their local States of Illinois, New York, or their State centers. Secretary Finch announced that he would not close the Fort Worth center. The Lexington site was slated for closing next year, and this exposed two problems: One, of course, is the danger of drugs, and the other of narcotics. I ask you to look for special care to those hospitals. I believe your testimony included a statement that California was the only State with comprehensive research and treatment facilities at the State level. That New York City and Chicago had not had such facilities, but served only those cities and not the whole State of New York or Illinois. This is just to mention a few of those problems, but I want to state now, my aim of health care for all the people is for good medical care for everyone. I like your statement and I commend you for it. Your comment about the poor was particularly interesting. They live in a separate world. They look with suspicion on laws and churches. They are very religious, but the church is separate from them. As soon as they hear the sheriff is going down in the county they go where the sheriff will not see them. They get the idea that the sheriff is coming to watch them like a hawk in the sky. They are not lawless people, but they are just suspicious of bankers and suspicious of loans. They live in a different world, and I do not think we have taken that into consideration. They are suspicious of doctors and a little bit afraid of people. They are somewhat suspicious of the basic middleclass institutions. You have touched on that. That is a broad field, and that is why I have illustrated your broad grasp of the social and economic problems of that community. I am glad that the President and the Secretary have found you. I think Dr. Knowles was a good man. I think you are a good man. That illustrates that out of 200 million people in this country there may be other men who are just as good. The problem is finding them. I congratulate you. Are there any questions from anybody else? Thank you, Dr. Egeberg. We have two colleagues of yours who are waiting, unless you have some additional statement. Senator JAVITS. I wanted to say on behalf of the minority how gratified we have been by the cooperation and the character that you have displayed. Dr. EGEBERG. I hope that the job will not be as hard as this. [Laughter.] The CHAIRMAN. I fear you will find it harder. You have discussed with us the matter of conflict of interest. We spoke about this earlier, about whether there would be a conflict of interest with these trusteeships. I will discuss it with the other members. You were director of the following nonprofit institutions: Children's Hospital of Los Angeles, Claremont Foundation, California division of the American Cancer Society, the Good Hope Clinic Hospital, chairman of the Social-Medical Advisory Group, chairman of the California Committee on Regional Medical Programs, chairman of the Los Angeles County Health Service Planning Committee; and you have been associated with other groups which you said you would resign from, if confirmed. We will study those to see if there is any conflict of interest. You are involved as a trustee in a number of cases and have many responsibilities in other areas where you hold a membership. In most of these cases I have seen that you have been the chairman of these boards. We will go over this. Dr. EGEBERG. Thank you. Dr. EGEBERG. Thank you. I will resign from anything you want me to. The CHAIRMAN. Thank you. (The material supplied for the record follows:) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Washington, D.C., July 18, 1969. Hon. EDWARD M. KENNEDY, U.S. Senate, Washington, D.C. DEAR SENATOR KENNEDY: I am pleased to submit the attached answers to the questions you posed in your letter of July 9. I hope this information will be useful to you, and I sincerely appreciate your interest in these vital health matters. Sincerely yours, ROGER O. EGEBERG, M.D., Assistant Secretary for Health and Scientific Affairs. Enclosure. ANSWERS TO SENATOR EDWARD M. KENNEDY'S QUESTIONS OF JULY 9, 1969, IN A LETTER TO DR. ROGER O. EGEBERG, ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS, DHEW 1. You were quoted in the Washington Post of July 8, 1969, as saying that a reasonable goal for achieving one standard of health care for the entire Nation is "probably 50 years from now." I find that discouraging, and feel that we should set, and try to achieve, a more ambitious goal. Do you feel that if we gave top national priority to achieving good health care for all citizens we could do so in a shorter period of time? In referring to one standard of health care for the entire Nation as being achievable in 50 years, I was referring primarily to the disparity in behavior among various ethnic groups, among various economic levels-for instance, the difference between the foibles and patterns of action of the middle class of America and of those living in the slums, the differences between east and west, north and south; and of many other differences. We should be able to attain a high level of medical care as high as they will accept for each of these groups within a decade, possibly within five years, but it will be delivered differently, and only through the education and unification of the country will it become uniform in the sense of being the same throughout the land. 2. I am particularly concerned with some of the problems of mental health and mental retardation, and I hope that you will give them careful attention and priority. I have several questions in this regard: (a) Where in the Department do you feel mental retardation programs should be placed so that they develop better than perhaps they have in the last few years? (b) Do you feel that putting mental retardation activities together with other health programs could help them to grow in a coordinated fashion-so that when a child is given a general health check-up, for example, he can also be checked for mental retardation? I understand that the DHEW is trying to meet its responsibilities to the mentally retarded within the frame of a number of broad, general programs in which the mentally retarded participate along with other groups. The Division of Mental Retardation in the Social and Rehabilitation Services Administration administers programs designed to serve only the mentally retarded. All mental retardation programs are coordinated in the Office of the Secretary, DHEW, through the Secretary's Committee on Mental Retardation. This structure is designed to assure a balanced mental retardation program within the Department. I intend to examine this organizational structure to be sure it is the best possible way to meet our responsibilities to the mentally retarded. (c) The low level of funds requested in contract to funds authorized, for vocational education will curtail programs for training the mentally retarded. Do you feel that such training is important, and will you support it in your new job and in your dealings with the Commission of Education? I support vocational education for handicapped children. One of our big problems is to overcome the shortage of qualified educators trained to deal with the individual needs of the handicapped, especially in the area of vocational education. I can assure you of my interest and cooperation in this area. (d) Do you favor training support for personnel in the field of mental retardation, for example, under the "University-Affiliated Facilities Program"? I favor training personnel for special needs in the field of mental retardation. The University-Affiliated Facility Program is making a contribution to this effort. (e) Do you have other plans or ideas in the area of mental retardation? I think mental retardation is a problem that must not be neglected. The President's Committee on Mental Retardation has submitted a number of recommendations, and I plan to work closely with this Committee as well as the Secretary's Committee on Mental Retardation. (f) What is your view on improvement grants for mental retardation facilities under the Hospital Improvement Program? This program, as well as others designed to reach institutionalized mental retardates, will receive my attention and concern. I hope we can more fully explore a number of methods in which the Federal Government can improve services to the mentally retarded who need residential care. 3. It has been reported that the Department of Health, Education and Welfare is considering a reorganization of programs currently under the Children's Bureau. Certainly our primary and overall concern in assessing whether and what reorganization is appropriate should be simply what is best for children. What, in general, are these reorganization plans—and in particular what is to be done with the child and maternal health care programs? I would appreciate your spelling out what you feel are the merits and drawbacks of different possible institutional arrangements within the Department for handling these health programs? I sure think there is great need to look at ways to make sure we organize all our programs concerned with child health so that they will do the job that needs to be done. I know that Secretary Finch is now considering possible ways to rearrange the various DHEW programs to do this. You can be sure I will get on board with these plans just as soon as I possibly can. This is to me a crucial and most immediate priority. 4. The problems of health are of critical importance, of course, to our senior citizens. Would you outline for the Committee some of the more significant programs for providing health care and assistance to the aging over which you will have jurisdiction? Do you feel that this is an area of serious concern? Do you have any particular plans or new ideas in this area? The most significant Federal programs providing health care and assistance to the aging are Medicare and Medicaid. I understand that my role in the administration of these programs is one of development, review, and approval in matters of overall policy. I have the identical role in health related programs of the Rehabilitation Services Administration, and the Administration on Aging. I have direct jurisdiction over the programs of the Public Health Service. This means that I have a great deal of responsibility for important programs of research into the health problems of the aged. In addition, the Public Health Service is deeply involved in trying to deal with the problems of delivery of health care to the elderly. We simply must find ways of creating a system which will meet the particular needs of older Americans and insure that this system is within the financial reach of all who need it. We will have to give serious consideration to broadening the coverage of Medicare to include additional services. Methods must be found to encourage greater use of preventive care and to insure the safety and efficacy of the food and drugs which are so vital to the health and well-being of the elderly and to all of us. 5. What role do you envision for the health professions and services in meeting the problems of hunger and malnutrition. First, major emphasis should be placed on the prevention of malnutrition and hunger. Second, we must find and alleviate malnutrition wherever it exists. Professionals and Allied Health professionals in the field of health need to be aware of the symptoms and sequelae of malnutrition. The Administration and DHEW are working along these lines to fight malnutrition. I mean to do my part. 6. What recommendations do you have for changes in medical school curriculums, to make them more responsive to society's health and nutrition needs and to the changing expectations and interests of medical students? We need to show medical students the problems of the distribution of medical care, its present maldistribution, to help them to understand all segments of society but still not to forget the need to acquire the basic knowledge that will make them physicians. 7. How can we help to form and coordinate a stronger "health constituency" in the Nation? Get all of the groups that are deeply interested in health and can do something about it together to focus on the person and his community. I use the word person because that person hopefully will be well most of his life, will be sick and should be a patient at times, but should be helped, well or sick or recovering from an illness, toward the attainment of the best possible level of health. This implies a great deal of community of understanding and heightening of the focus on the man, woman or child with some lessening of the intense feelings about one's organization. 8. What ideas do you have for increasing the opportunities for, and extending recruitment of, minority persons in health professions? First, we must find ways to reduce the high cost of such education as well as the burden of inadequate financial resources of prospective students. Second, we must find ways to increase the number of academically qualified applicants from among minority groups. It is clear that Negro and other minority groups are underrepresented in all health occupations. A lot of our medical and other health professions schools already are trying to increase minority representation in their student bodies. Active recruitment programs are under way and some of the results are encouraging. It seems clear to me, however, that we still have a long way to go. I think that one of the keys to the problem is more involvement by the Negro and other minority group leaders. This I intend to seek. 9. What do you see as being the problems and the potential of the Public Health Service? Do you envision a more active role for it in the years ahead? With the continuing Federal concern and commitment to programs affecting the public health, the potential for the Public Health Service has never been greater. PHS has been a focus for Federal leadership for many years and it is now in the process of being revitalized and redirected to better meet its changing and expanding responsibilities. One of the major goals of this reorganization to date has been to provide more pertinent and more effective focus on the urgent needs for finding ways to better use the knowledge we already have to insure the best possible health services for the greatest numbers of people. Re Roger O. Egeberg, M.D. FORT WORTH, TEX., June 30, 1969. SENATE COMMITTEE ON HEALTH, EDUCATION, AND WELFARE, Washington, D.C. GENTLEMEN: While you are taking under consideration the appointment of Dr. Egeberg to the post of Under Secretary for Health and Scientific Matters, will you please take note of the many years that he has devoted to the care of the people of his county, state, and country. Dr. Egeberg gave up a very lucrative private practice in Cleveland, Ohio, to join the Veterans' Administration shortly after World War II. If he had been interested in the money side of medicine, as are so many of our physicians these days, he could now be a wealthy man. We think Roger Egeberg is the man for the job. GERALDINE C. WEST. Lieutenant Colonel (Retired) U.S. Air Force. (Whereupon, at 12:45 p.m., the committee moved to other business.) о |