PUBLIC HEALTH SERVICE CODE THURSDAY, MARCH 2, 1944 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE OF THE COMMITTEE ON Washington, D. C. The subcommittee met at 10 a. m., pursuant to adjournment, in the hearing room of the committee, New House Office Building, Hon. Alfred L. Bulwinkle presiding. Mr. BULWINKLE. The committee will come to order. We will hear Dr. Riley. STATEMENT OF DR. R. H. RILEY, M. D., STATE HEALTH OFFICER FOR MARYLAND, REPRESENTING THE EXECUTIVE COMMITTEE OF THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS . Mr. BULWINKLE. Dr. Riley, you are State Health Officer for Maryland? Dr. RILEY. I am. Mr. BULWINKLE. And representing Dr. RILEY. I am a member of the executive committee of the Assocation of State and Territorial Health officers. Mr. BULWINKLE. Dr. Riley, you may proceed. Mr. PRIEST. Doctor, may I ask one question? Dr. RILEY. Yes, sir. Mr. PRIEST. Are the health officers of all of the States represented in the association? Dr. RILEY. They are all members and we get together upon the call of the Surgeon General of the Public Health Service at least once a year and once in a while we are called in for special consideration of special matters that may come up. Mr. BULWINKLE. All right; you may proceed, Doctor. Dr. RILEY. The executive committee met last Saturday and considered House bill 3379. In the meantime we had letters from those who could not attend and from the health officers of the country concerning the bill, and for the most part the bill is acceptable to the State health authorities. In fact, there are only two suggestions made for changes, one on page 17, and when we discussed this with Dr. Thompson, of the Public Health Service, we found that he had already picked it up and had made the change, anticipating the feeling of the State health authorities. Mr. BULWINKLE. What was that? Dr. RILEY. That is on page 17, lines 7 and 8 (sec. 214 (b)). The change we suggested was that instead of "or political subdivision thereof," omit that, and insert "health authority" and it would read: (b) Upon the request of any State health authority, personnel of the Service may be detailed by the Surgeon General for the purpose of assisting such State or political subdivision in work related to the functions of the Service. Now, the reason for that is that it would be very awkward for the State health authority to have counties asking for assistance, or appropriation-counties, or districts, or cities. That has been done. It would be very awkward for the Service to have to deal with it that way. So, there would not be any over-all supervision in the States if these subdivisions were allowed to come in and ask for assistance. Now, that does not mean that these areas are excluded. In fact, they are all benefited; but it is the State's responsibility to make such distribution of allotments to the cities and to the counties as is needed. And, we assume that the State knows better than the Public Health Service could possibly, of the need in any particular area. Mr. SCOTT. Doctor, are you suggesting that it read: "Upon the request of any State" comma-or merely that it should read: "Uponthe request of any State health authority", without the comma? Dr. RILEY. "Upon the request of any State health authority" without the comma. Mr. SCOTT. Would there not be cases in some States where perhaps requests should come from another official, for instance, from the Governor, as representing the State? Would there be any advantage in having it read "Upon the request of any State, or any health authority thereof"? It strikes me that some States may have no acceptable recognized health authority. I do not know whether that is true or not. There may be some cases where requests may only come from the Governor rather than a cabinet officer. Dr. RILEY. I think that Surgeon General Parran should answer that, because he has had that experience. I do not know. In Maryland it would not be necessary. We would not ask the Governor. We might ask him to support us upon any question, but that would not be necessary with the present administration of the Public Health Service, if we showed a real need for help. Mr. SCOTT. Perhaps Dr. Parran can answer it. Dr. PARRAN. I think every State-I know every State has a recognized health authority. That term is used in connection with many of our regulations concerning the grants-in-aid. Mr. SCOTT. Thank you. Dr. RILEY. Now, the only other change is on page 29, which is recommended by our committee, and it is in line 7, page 29. I will read the whole thing: (h) All regulations and amendments thereto with respect to grants to States under this section shall be made And here is where we make our change— after consultation and agreement with a conference of the State health authorities. We felt that while there has been no difficulty with the present administration and as long as Dr. Parran is in his present position we would have no concern, we would not even ask this, but he cannot be there always, and it could be embarrassing for the States if a conference is held on allotments and then the Surgeon General wanted to be arbitrary and did as he wanted to do or could be arbitrary about it; we felt that if we added the words "and agreement" after the words "after consultation," with a conference of the State health authorities that that would be safeguarded. And General Parran has agreed to that, and I understand the other as well. I think probably he would have suggested it himself if he had run on to it before we saw it. Now, those are the only changes. I think it is a remarkable bill. I think it is very timely. I would like to say that our relations with the Public Health Service, the States, has been very satisfactory and we do not want anything to come in, any new regulation that would in any way change it. Mr. BULWINKLE. You knew my old friend, Dr. McCormack, from Kentucky, who died? Dr. RILEY. Yes; he would have said the same thing, and every health officer of the States will tell you the same, and would tell you the same whether Dr. Parran was present or not. I mean, our relations have been very satisfactory and public health in this country has gone ahead in a remarkable way, because of these allotments referred to by Mr. Reece. Now, I realize that everything that is needed cannot be done even on the amount of money we now receive which at one time would have seemed like an immense amount. It is now swallowed up and we are doing very much more, but we are not able to do everything that is needed in every community. Mr. REECE. We have done a great deal, Doctor, but I am not in accord with the view that we have moved rapidly on a matter of such vital importance. I think we have moved very, very slowly, especially considering the resources, professional and financial, that we have had available for this purpose, I think one can hardly go about the country without being impressed with the tremendous work that yet remains to be done. Dr. RILEY. No doubt about that. Mr. REECE. If I may ask-these questions are directed more particularly at Dr. Parran-what was the over-all expenditure of the Public Health Service in 1943? Dr. PARRAN. Mr. Reece, does your question refer to the amount that we spent for operation of hospitals, quarantine, or only for the grants to States direct for public-health work? Mr. REECE. Well, first, the over-all expenditure for all purposes. Dr. PARREN. I do not have the figure here, but I think under the several titles which I will read, I can give you the individual items. Division of Venereal Diseases, $12,300,000; Grants for public-health work, $11,000,000. Mr. REECE. Pardon an interruption there. Of course, I infer from the statement you made yesterday the $12,000,000 for venereal-disease control does not represent the full amount expended for that purpose. Dr. PARRAN. To that amount should be added approximately the same amount during the current year for the acquisition and operation of rapid-treatment centers for infectious cases under the provisions of the Lanham Act. The appropriations made to the Public Health Service for the fiscal year 1944 are as follows: Division of Venereal Diseases__ Grants to States for public health work. Training for nurses (national defense). Interstate quarantine service‒‒‒‒ Prevention of epidemics-- Emergency health and sanitation activities (national defense). Pay of personnel and maintenance of hospitals_. Division of mental hygiene___ Foreign Quarantine Service National Institute of Health_ States' Relations Division____ National Cancer Institute_. Commissioned officers, pay, etc-- Salaries, Office of Surgeon General__ Miscellaneous and contingent expenses Total--. $12, 367, 000 11, 000, 000 52, 500, 000 28, 000 300, 480 11, 279, 000 12, 510, 700 1, 134, 680 1,250,000 2, 025, 020 306, 800 530,000 2,822, 000 450, 000 195, 000 108, 698, 680 Mr. REECE. How much was spent by way of grants to States in cooperating with State health services? Dr. PARRAN. $23.300,000. That includes venereal disease control. Mr. REECE. Then, independent of venereal disease control. Dr. PARRAN. $11,000,000 for general public health purposes. Mr. REECE. Out of an appropriation of how much? Dr. PARRAN. Generally speaking, the largest single item is for training of nurses, about $52,000,000. All other appropriations, public health appropriations, approximate $63,000,000. Mr. REECE. Do you not rather feel, addressing again my statement or question to Dr. Riley, that of all of these appropriations $11,000,000 for cooperation with the States is rather inadequate in proportion to the whole expenditures? Dr. RILEY. I think it is. In fact I know it is. The States are not always able to get the amount of money that they should have for carrying on the program. It cannot be done. Maryland is, I think, as liberal as any State in the Union, but still there is a limit to the amount we can get, and we cannot begin to do the work in Maryland we are carrying on now without this allotment from the Public Health Service, and if that is ever withdrawn I do not know just what will happen to the program. Mr. REECE. Well, the other States are probably experiencing the same difficulties even in a greater degree than you are experiencing in Maryland. Dr. RILEY. Yes; I believe Maryland is better off. Mr. REECE. That gets back to the point that I had in mind. Now, so far as the people in the more remote areas are concerned or in the other areas, for that matter, this money spent in cooperation with the State public health service is the only phase, or about the only phase, of the public health work with which they come in contact or by which they are benefited directly. Of course, they are the beneficiaries of the research in public health and which I am heartily in favor of being continued on whatever scale can best accomplish the highest result. But what has impressed me is that we are spending relatively large sums; that we are spending large sums of money, and a relatively small part of it is finding its way out in cooperation with the local health authorities for public health work in the communities, after all, where the people live, and which need the work, and I sometimes am impressed that in painting an over-all picture we have a tendency to overlook the family away back out in the country for whom the whole activity is carried on; and I would like to see a study made with a view of seeing if something more cannot be done. Now, the conditions, the health conditions, in certain areas are not at all satisfactory, and we have too much of a tendency, I think, to chase off after the phantom in some remote part of the world and undertake a responsibility, whereas we have work here that ought to be done, and if that responsibility which we have recognized as being a responsibility of the Federal Government is discharged adequately then I think there is going to be a much less demand arise for what is generally referred to by the medical profession as socialization of medicine. The demand for that, I think, arises unconsciously out of this need to which we are referring. Mr. BULWINKLE. May I say to you, if you are through, Mr. Reece, that the Public Health Service has gone a long way. I can remember since I have been in Congress that it was pretty hard to get appropriations. It was due largely to the constant advertising, the constant bringing to the attention of the public the case of venereal diseases by Dr. Parran and by the State health officers that we were enabled to get that through, and even at the time that we did get the appropriation, the authorization for the appropriation, there was quite a tendency in the House to cut down the amount of that appropriation. All of this is a matter of public education that you have to bring to the public. There are two things. One, of course, is-and you find this, in a great many instances, in connection with the talk of this socialized medicine-I venture to say that now in the Public Health and in the State health authorities you will hear this thing, "You ought to stop that, because that is getting to socialized medicine." I introduced, and we passed, the cancer bill, and yet I had doctors in my own State criticize me very severely for it, saying, "You are bringing on socialized medicine." I said, "No. All I am doing is to give, so far as we can do it in the United States Government, the idea of prevention, and that is the work of the health department." Now, as to this, what do you say about work overseas, there is very little of that that has been done, but most of it has been done for the purpose of studying diseases which might be brought back to this country by our own troops, and to preserve the health of the civilian employees as well as the members of the armed forces who are abroad. As stated, there are only 12 members, or about 12, now of the Public Health officials who are attached to civilian duties across. I know we had a man come down to our country, a mosquito-control man. He could stop you on the street and talk for 2 hours about mosquitoes, and it would be the most interesting and entertaining speech you ever heard, about the different kinds of mosquitoes and different kinds of diseases carried by them. But he, I think, is across now studying this question, of what diseases there are abroad that might be brought back here. 96248-44-5 |