MOUNT ALTO HOSPITAL Senator MONRONEY. What will happen to Mount Alto? Senator MAGNUSON. All right. Mr. GLEASON. I mean we are not planning to. It may be taken over by some other agency of the Government and used for some other purpose, which might possibly include a nursing home, but we have no plans for it. Senator MONRONEY. Is it suitable for continued operation as a hospital? Mr. GLEASON. No, sir. Senator MONRONEY. It is too small for VA? Mr. GLEASON. There was a girls school there originally, Senator, and we have had problems in operating out of it ever since we took it over. NP PATIENT LOAD (2) Establishing or strengthening medical and surgical bed sections at nine neuropsychiatric hospitals. Senator MAGNUSON. Put in the record, we get it every year, in the number of patients, the number of so-called NP or mental patients, as compared with the total load. Is it still running about every other bed? Mr. GLEASON. Approximately. The estimate contemplates that of the 110,318 total average daily patient load planned for VA hospitals in fiscal year 1965, 55,386 or 50.2 percent will be psychiatric patient load. Senator MAGNUSON. It hasn't changed much has it? Dr. McNINCH. No, sir. Mr. Chairman, I have made a point recently to point out that in the course of the year the number of patients to be taken care of, only 15 to 17 percent are neuropsychiatric, not half of them, because many individuals get this impression because slightly half of our beds or more are psychiatric patients, that half of our patients are involved. It is important to make this distinction. Senator MAGNUSON. When you make the statement every other bed is such a case Senator ALLOTT. I don't quite get the distinction you make, Doctor. Dr. MCNINCH. In the course of a year, as pointed out, we treated 720,000 patients. Only about 15 percent of those had psychiatric illnesses even though half of the beds are occupied at one time for psychiatric patients. Mr. GLEASON. They are in for a longer period of time. Senator ALLOTT. When you say every other bed is a neuropsychiatric case, you are not including such things as alcoholism? Dr. MONINCH. Actually including the beds we have classified as psychiatric beds in the hospital system. ALCOHOLISM AS A PSYCHONEUROTIC DISORDER Senator ALLOTT. Do you include alcoholism in that? Dr. MCNINCH. We don't have any that are classified as alcoholism. Senator ALLOTT. In my lifetime I have known a lot of these cases. I won't say they grew out of but they were associated with alcoholism. I am thinking of individual cases I have known. What I am trying to determine is whether these are what I as a layman would ordinarily think of as pure neuropsychiatric cases rather than associated with something growing out of alcoholism. Mr. MUSSER. I think the question whether something grows out of alcoholism is psychiatric Senator ALLOTT. Or is associated with it I should say. Mr. MUSSER. By and large alcoholism is felt to be a reflection of some more deep-seated, underlying disorders. What we find in our hospitals is that invariably alcoholism is a secondary diagnosis. Now one of the areas of disease where we find our largest percentage of alcoholism is in tuberculosis, and in some of our tuberculosis hospitals the percentage of those who are alcoholics or have been is surprisingly high. So this problem of alcoholism pervades our hospitals. Senator ALLOTT. I made a mistake in saying "growing out of." I should have said "associated with." Mr. GLEASON. I think that follows our report quite closely, Senator, your association. At page 210 of that report, alcoholism, the number of diagnoses were 22,502, of which the principal was 5,117 and associated 17,385. It is the six line down under section 5 there. Do you find alcoholism under psychoneurotic disorders? Senator ALLOTT. Yes. You have 22,000, the number of diagnoses, principal, 5,117; associated, 17,385. This is what I was really referring to. Mr. GLEASON. Then it is broken down by age group for you also, Senator. Senator ALLOTT. Yes. What I was really trying to find out was about people who through some bad adjustment of their own personality get involved by psychiatric disorders which may contribute to or may be the cause of alcoholism or be associated with alcoholism. How much of our effort in these beds are we putting into this type of case. This is what I was particularly interested in. I think this probably gives the answer. STUDY AND TREATMENT OF ALCOHOLISM Mr. MUSSER. Two years ago we inaugurated a much more vigorous program not only in treating alcoholism but the patient-care aspects too. You may be aware of the fact that in our Kansas hospital we have a 20-bed ward devoted entirely to the study and treatment of alcoholism. Senator ALLOTT. No; I wasn't. Mr. MUSSER. This has been a very excellent operation. In approximately 14 other hospitals now we have quite intensive work in the study and treatment of alcoholism. This is a program that has grown quite rapidly in the last year because alcoholism poses quite a considerable problem to us and fortunately we have more and more physicians who are becoming interested in it, in both research and patient-care aspects. Senator MONRONEY. This is an ideal example of your medical research isn't it? Mr. MUSSER. Yes, sir. Senator MONRONEY. Because you have controlled conditions under which all these men are treated. Mr. MUSSER. That is right; and frankly we know very little about alcohol, the effect of this disease upon the body and also the factors that bring it about in the first place, so it deserves a lot of careful research. Senator MAGNUSON. This is sort of a chicken and egg business, which comes first. I suppose that drinking doesn't necessarily make you neurotic but a lot of neurotic people take to drink. Mr. MUSSER. That is right. Senator MAGNUSON. That is about what it is. But you have got it broken down here fairly well. Senator ALLOTT. I just ask these questions, Mr. Chairman, because I feel that where alcoholism exists Senator MAGNUSON. It is a serious problem. Senator ALLOTT. It is one of the most insidiously devastating problems that can hit a man or woman or their family, and we ought to try to find solutions to it. Senator MAGNUSON. I don't know of a better laboratory for this kind of research than some of these veterans' hospitals where we have these cases. They keep good records, and follow them through. RECORD OF RECOVERIES SCANTY Senator ALLOTT. Along that line, I have never seen any figures on this, but I have know a few reformed alcoholics. I knew one reformed dope addict who did not get on it in what is ordinarily considered to be the habitual way, but rather out of this was years and years agohe got addicted by taking medication over a long period of time from a doctor. Is the record of recoveries or cures at such a point now that you can say that one would be higher than the other with respect to addiction or alcoholism? Mr. MUSSER. I would think that you can't single out one over the other as being more favorable. I think that both of these are addictions of a sort. The tendencies that cause people to become addicted in the first place cause them to become readdicted after treatment. I think you have to consider the results are pretty much the same in both. Senator MAGNUSON. All right; No. 3. OTHER ITEMS IN INCREASE Mr. GLEASON. (3) Provision for improved care for the medically infirm psychiatric patients in our older and larger NP hospitals; (4) Establishing treatment centers at nine general hospitals for dialysis of patients suffering from chronic and severe renal failure; (5) Provision for improved maintenance and repair of our aging medical facilities; (6) Activation and staffing of five new psychiatric day care centers; and (7) Provision for increased usage and cost of drugs, medicines, medical supplies, utilities, and prostheses. A supplemental request under the medical care appropriation for the current year in the amount of $10,457,000 to provide for pay increases for wage board employees is pending before the Congress. MEDICAL CARE SUPPLEMENTAL Senator MAGNUSON. Let me interrupt you right there. This supplemental, I understand from Mr. Cooper, will be heard next Tuesday in this committee? Mr. GLEASON. All right, sir. Senator MAGNUSON. I mean in the full Appropriations Committee. Mr. GLEASON. Yes, sir. Budget policies do not permit projection of future salary increases for wage rate employees in our annual budget request. However, by law, periodic surveys are required to be made to determine that salary levels are in accordance with prevailing rates. We now estimate that the additional cost of wage rate increases approved since July 1, 1962, to June 30, 1964, will amount to $11 million. Income from reimbursement earnings for medical services provided for other than veteran patients will exceed our initial estimates by $421,000. Also, the number of patients in contract facilities for the first half of this fiscal year was less than anticipated and resulted in savings of $122,000. These two items are being applied against the increase for wage rate employees, reducing the net additional requirements from $11 million to $10,457,000. Senator MAGNUSON. Any questions on that item? All right. CONSTRUCTION Mr. GLEASON. Our 1965 construction appropriation request of $102 million represents the fifth increment under our long-range hospital modernization and replacement program. Major items included are: 1. Construction funds for a replacement 1,200-bed hospital building at Hines, Ill.; 2. Construction funds for a new 1,040-bed hospital at Los Angeles, Calif.; 3. Construction funds for a replacement 720-bed hospital at San Juan, P.R.; 4. Design and site funds for a new 760-bed general hospital at Chicago, Ill.; and 5. Funds to continue modernization and improvement of our preWorld War II hospitals. MODERNIZATION AND REPLACEMENT Gentlemen, we are making significant strides in the modernization and replacement of obsolete medical facilities. In fiscal year 1964, we will award construction contracts for five new hospitals located at Memphis, Tenn.; Miami, Fla.; Oteen, N.C.; Temple, Tex.; and Gainesville, Fla., in addition to major bed replacements at Danville, Ill., and Fort Meade, S. Dak. Design contracts will be awarded for new hospital buildings at Los Angeles, Calif.; San Juan, P.R.; and Hines, Ill. NEW HOSPITAL LOCATIONS Senator ALLOTT. May I interrupt there? This means you are going to have two new hospitals in Puerto Rico. Mr. GLEASON. No, sir; one. Senator ALLOTT. Now why Temple, Tex.? Mr. GLEASON. This is a replacement of an existing facility there now, Senator. Senator ALLOTT. Is there a university there? Mr. GLEASON. Dr. Zink tells me that we are affiliated with Scott White Clinic at Temple. Senator ALLOTT. It was my understanding in your justification on the Florida matter that you were insisting on putting these new hospitals where they were immediately adjacent to and could use the facilities and the research facilities of and act jointly with medical schools. Mr. GLEASON. This is correct. Senator ALLOTT. And this is the reason I wonder, even if it is a replacement, why you put one at Temple when it is not adjacent or close to the main medical school in Texas. Mr. GLEASON. Senator, we can't do this every place, but where we possibly can, we want to put them adjacent to medical schools or clinics. Now we have 170 hospitals in our system. There are only in existence right now 84 medical schools, so that we can't have all of our hospitals located at medical schools because there aren't enough medical schools with our hospitals. But where it is possible to relocate a hospital that will be in an approximation or adjacent to a medical school, this is what we want to do. HOSPITALS IN TEXAS Senator ALLOTT. How many hospitals are there in Texas, veterans hospitals? Mr. GLEASON. Dr. Zink believes there are nine Veterans' Administration Hospitals in Texas. Mr. DRIVER. I count 10. Senator ALLOTT. What page is that? Mr. GLEASON. It is a map on page 17, Senator. Mr. DRIVER. I counted those dots in a hurry. Senator ALLOTT. I count nine. Where is Temple, Tex.? Senator MAGNUSON. In western Texas, isn't it? Mr. GLEASON. Senator, we have them at Amarillo, Big Spring, Bonham, Dallas, Houston, Kerrville, Marlin, McKinney, and Temple and Waco. Senator ALLOTT. That is all I have, Mr. Chairman. HOSPITAL LOCATIONS Senator MAGNUSON. I noticed in this map that Hawaii and Alaska do not have veterans hospitals. Mr. GLEASON. No, sir, we utilize the Army. Senator MAGNUSON. They will be taken care of by? Mr. GLEASON. The Army. Senator MAGNUSON. The Army. |