VETERANS' AFFAIRS

JOINT CONGRESSIONAL COMMITTEE ON VETERANS' AFFAIRS, Thursday, December 15, 1932. The meeting was called to order at 10.30 o'clock a. m., David I. Walsh, Senator from Massachusetts, the vice chairman, presiding. The VICE CHAIRMAN. General Hines, I believe you have divided the problems that confront the Congress with reference to veterans' legislation into two groups, the first group being what might be called the lesser controversial question, and the committee would like to have you present to them your views concerning the problems that arise out of this first group.

STATEMENT OF GEN. FRANK T. HINES-Resumed

General HINES. Mr. Chairman and gentlemen of the committee, the chairman has stated correctly that I felt that the recommendations to be presented for the consideration of the committee should be divided into two groups and I have so arranged them, the first group being those items that I feel are not necessarily controversial, although there may be some objection to some of them. However, they are the first matters, in my judgment, which should be given consideration and if any changes are contemplated either for the purpose of economy or the purpose of clarification and simplification of our procedure. The first recommendation of the group (a) has to do with veterans' preference and employment. First, that the existing rules giving veterans certain preference under civil service be continued; (b) that all matters having to do with the Federal Government's effort to assist veterans in obtaining employment and retaining them in employment be placed under the Veterans' Administration.

At the present time the law contemplates that that duty will be performed by the Department of Labor with the cooperation of the Veterans' Administration. It came into the World War Veterans' act during the period that the former Veterans' Bureau had a large problem of rehabilitation, and it was with the view of helping the placement of veterans in employment that that was written into the World War Veterans' act. It has remained there from 1924 when the act was revised up to the present time. The present procedure contemplates a separate section in the Department of Labor which is operating satisfactorily and in close cooperation with the Veterans' Administration. They obtained a separate appropriation for that activity through their regular bill. The amount of it I am not familiar with at this time, but I should say in the neighborhood of $300,000 a year. Regardless of their efforts we find it necessary to have our field offices and the central office in Washington take

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up the matter of employment of veterans. It is quite natural that the veteran coming to the Veterans' Administration for other matters is bound to come to us if he is in need of any help, whether employment, compensation, hospitalization, or anything. For that reason I have felt that merely with a view of avoiding a duplication of effort that the law should be changed around, definite responsibility being placed on the Veterans' Administration, and with the help of the Labor Department, wherever they can, they should assist. The VICE CHAIRMAN. So far as you know is there any opposition from the Labor Department to that proposal?

General HINES. This matter was discussed at one time once before. It was my understanding at that time that the Labor Department felt that their employment on a broader scale should include veterans' employment as well. How serious that opposition will be I am not sure. I doubt if there would be any great opposition. I would say this in the matter of appropriation-that I would not ask for an additional appropriation to carry out those duties. I would asborb them in our present set-up, but we would have to have a change in the law to give authority to meet expenditures from our existing appropriation.

The VICE CHAIRMAN. Have you prepared a legislative bill? General HINES. It will be placed in the record and reads as fol

lows:

SEC. That the Veterans' Administration shall have the power and it shall be its duty, to advise, assist, and provide for the placement of disabled veterans of the World War in suitable or gainful occupations. The administrator is further authorized and directed to utilize, with the approval of the Secretary of Labor, the facilities of the Department of Labor in so far as may be practicable in the placement of disabled veterans of the World War in suitable or gainful occupations.

I call the committee's attention to the fact that we use the language, "disabled veterans," feeling that to follow the policy of not taking and singling out as a special class veterans who were not disabled, feeling that they should receive the same consideration as other citizens of their community. That covers the first recommendation.

The VICE CHAIRMAN. So far as you know is there any opposition to that recommendation from the veterans' associations?

General HINES. I think on the contrary, Mr. Chairman, you will find they are in accord with my views on the subject.

The VICE CHAIRMAN. What is the next topic?

General HINES. The next is No. 2; has to do with hospitalization and domiciliary care, and I believe that the committee can get the best view of that if I refer to the subject together, taking up, however, the items separately but maintaining that some of the principles or changes that are desired must be brought about in connection with both hospital and domiciliary care. In order that the committee may get a complete picture of the problem before I attempt to give you recommendations as to changes, I would like to state to the committee what is found on page 11 of the annual report of the Administrator of Veterans' Affairs of this year 1932:

On June 30, 1932, approximately 131⁄2 years after the armistice, the total hospital load of the Veterans' Administration was 43,841, an increase of 8,702, or about 25 per cent over the number on June 30, 1931. Included in the total

load at the close of this year, however, are 4,174 patients in Veterans' Administration homes who were admitted thereto under laws controlling membership in these homes and who were not prior to this year included as part of the load of the Veterans' Administration. Eliminating these cases from consideration, the hospital load at the close of this year represents an increase of 12 per cent over the number at the beginning thereof, which is consistent with the increase of 15 per cent recorded from the beginning to the close of the fiscal year 1931. With the exception of a relatively slight increase in patients under examination for insurance or disability allowance purposes, all of the increase during this period was due to the hospitalization of veterans for the treatment of nonservice-connected diseases or conditions, the number of veterans under treatment for service-connected disabilities having decreased slightly since 1931.

Of the 39,393 patients hospitalized under the authority of the World War veterans' act, 1924, as amended, 15,460 were World War veterans receiving treatment for service-connected disabilities, while 21,655 World War and 1,817 veterans of other wars were under treatment for nonservice-connected disabilities. The balance of the load under this authority consisted of 461 patients under examination for insurance or disability-allowance purposes. Of the patients in all hospitals at the close of this year 15 per cent were suffering from tuberculosis, 46 per cent from neuropsychiatric diseases, and 39 per cent from general medical and surgical conditions. This represents a marked change in the character of the hospital population since March, 1922, when 40 per cent of the patients were tubercular, 31 per cent neuropsychiatric, and 29 per cent general. At the close of this year there were 338 female patients under treatment, an increase of 44 over June 30, 1931. Approximately 18 per cent of these patients were being hospitalized for tuberculosis, 38 per cent for neuropsychiatric diseases, and 44 per cent for general conditions. Of the total load, 49 per cent are under treatment for disabilities determined to be of service origin.

Colored veterans on the same date numbered 3,384, an increase of 953 over the number one year ago. The hospital load for this class of veterans constitutes approximately 8 per cent of the total. The colored hospital group affords a contrast to the white males with regard to the types of disease treated, in that, while pulmonary tuberculosis is represented to be approximately the same percentage of both groups, 47 per cent of the white males are under treatment for neuropsychiatric diseases and 38 per cent for general conditions, as compared with 35 per cent and 50 per cent, respectively, for colored veterans.

May I call the committee's attention to the chart that I have here? This chart shows the actual number of patients remaining in all hospitals from October, 1919, to date. That includes, of course, both groups, the nonservice and service-connected groups. Starting in 1919 with a load approximately around between seven and eight thousand we see the jump in 1922 to 30,000 and then periods of where it has gone down and up until we make a change in the law in 1924 when we took in the nonservice-connected group, and then the peak went up constantly and has constantly grown. That is the total patients in all hospitals. These other curves are broken down to cover the three major groups, the first being the tuberculous group which back in the early days was quite high but has constantly gone down. The next group, the green line, is the neuropsychiatric group, mental and nervous disabilities. That curve has never tended down and always tended up. Then we have the red group of the general and surgical cases which has first tended up, taking into account the service connected cases and then until the law was changed in 1924 went down quite rapidly, but from the change in the law taking in the nonservice-connected group it has constantly increased and is still on the up grade.

The VICE CHAIRMAN. The largest group is the neuropsychiatric?

General HINES. Yes; that is correct. The neuropsychiatric group, over 18,000, and I will come to the percentages in a moment, contains the greatest percentage of service-connected cases. Our facilities have never been so much in advance of the service-connected cases in that group as they have in the other. Now, the other chart shows the total patients in the Government and contract hospitals and the unoccupied beds-the white bars, patients in Government hospitals; the red-bar curve, which indicates unoccupied Government beds in any month in any given year; and I have the black bars indicating the Government's progress in taking the patient load from contract facilities in the Government hospital, going down quite rapidly, remaining practically constant the last few years, due to the fact that in many cases most of those in contract hospitals are now in the neuropsychiatric group. In facilities generally like in the State of New York, that makes special provisions for veterans, we have left those men in the facilities until our building program could progress, knowing well that they are receiving adequate care and treatment and in that way has enabled us to take care of a great percentage of our load.

Now that indicates a greater neuropsychiatric load but the turnover in that group is not very often, while in the general and surgical cases the turnover is greater. Therefore, a greater number of patients go through our hospitals each year, and I will come to some information on that.

Senator HATFIELD. Do you have any cures in the neuropsychiatric group?

General HINES. Yes; I have that.

Senator HATFIELD. What percentage?

General HINES. That is the fewest, as the Senator knows.

Patients discharged after treatment for neuropsychiatric disabilities numbered 19,799, of whom approximately 28 per cent had been under treatment for a psychosis. Approximately 81 per cent of these patients remained until the completion of the hospital episode and, as a consequence, 9,334, or 58 per cent, were sufficiently improved to be discharged as having received the maximum benefit from hospitalization. The largest single group of neuropsychiatric cases treated and discharged was that of the psychoneurosis, which formed nearly 23 per cent of all neuropsychiatric discharges. The principal psychosis treated, in point of numbers, was dementia precox, 2,233 patients of this type having been discharged from hospitals during this year. However, approximately 62 per cent of these failed to complete the necessary hospital period. The highest percentage of recovered cases in the neuropsychiatric discharges is found among the alcoholic psychoses, approximately 33 per cent of those completing hospital treatment being so discharged.

Now the law permits the hospitalization of women veterans in civilian institutions as well as our own in both groups-service connected and nonservice connected.

Continuing from this annual report:

Constantly increasing hospital accommodations of the Veterans' Administration enable a greater number of veterans to receive care and treatment in Government facilities. Of the veteran population under treatment at the close of this year 75 per cent were in facilities under the control of the Veterans' Administration, 19 per cent were in other Government hospitals, and 6 per cent were in State and civil institutions. Approximately 57 per cent of the patients in State and civil institutions are suffering from neuropsychiatric diseases.

On June 30, 1932, approximately 63 per cent of all veterans were hospitalized within the State of residence reported by them at the time of admission. In addition, there were a good many veterans under treatment in hospitals