a uniformed services medical facility when available. Should local uniformed services authorities determine that necessary facilities or capability do not exist, they may furnish eligible dependents a medicare permit, entitling the dependent to seek the authorized care from civilian sources.

To enable the military services to remain within funds appropriated for the civilian portion of the program, certain medical and surgical services authorized by the joint directive, but not specifically authorized under the law, were discontinued for all dependents. These services discontinued include: Outpatient care of bodily injuries not requiring hospitalization; pre and post surgical tests and procedures before and after hospitalization; the final visit to a physician who transfers the patient to another physician for hospitalization; neonatal visits; hospitalization for acute emotional disorders; and medical and surgical care which can be planned and scheduled at a later date.

The changes to the dependents' medical care program became effective October 1, 1958. The changes are now increasing the dependent workload in naval medical facilities to the extent that dependent facilities in naval hospitals are being fully utilized consistent with the availability of funds and personnel. Senator CASE. Mr. Chairman, the reason I asked for that in some detail is that this afternoon I spent an hour and a half with three doctors from my State, and the Secretary of the State medical association, and they told me that the State medical association had adopted a resolution that either they would like to see the Defense Department go back to medicare as it was originally set up or abandon the program; and when we get down to specifics, I ran into a lot of arguments on one thing or another that I will not take time to go

into here.

I told them I felt if they were given that kind of an alternative, they would get an abandonment of the program.

I thought they ought to get down to more specific statements of the different problems involved. But in any event it is true, I think, that in all branches of the service the institution of medicare resulted in a reduction in the patient load of existing hospitals over what it was immediately prior to its inception. And in some instances, it reduced the average patient load to the point that you would wonder how you could justify adding to the hospitals. And here we are coming in with a second increment of a station hospital-if you tell me that this is an isolated station, and there is no outside medical care available that may take care of this instance, but it would not in a community where you have medical facilities available.

You can get from the reporter the things listed here, but I would like to have a fairly complete statement on that.

Captain STONE. Yes, sir.

Senator STENNIS. It certainly would be helpful. You refer to the intent of Congress. If you are certain about that, you are more certain about it than I was, because I was not able to tell exactly what we did finally.

Senator CASE. I had reservations on it also. I thought it might be enlightening if in that statement you could tell us what Congress intended.

Senator STENNIS. It will be. On this hospital, too, you know we spoke of another hospital here this afternoon. Let us get the total cost, and then the total capacity and just how many rooms there are in the dental clinic. You say a second increment here, that is your reference to the addition to this hospital, and let us have that.

Admiral PELTIER. The costs here will not be comparable, Mr. Chairman, because we are using an old Army hospital that we started

in World War II, and we are finishing that up. Part of the 22 beds are from an existing foundation and first floor.

Senator STENNIS. All right. Just give us a special statement on this hospital because it is going to come up in other services, too. This is different, because I think-excuse me, Senator.

(This information referred to follows:)

This project for the Roosevelt Roads Hospital, second increment, proposes construction of a 14-chair dental clinic and a 40-bed addition to a 10-bed facility authorized in 1957 and now 30 percent complete. All construction utilizes structures partially completed by the British and subsequently abandoned. For this reason, costs are lower than for similar facilities at other locations.

To show total unit costs, the first and second increments are combined. The hospital part of the 50-bed facility contains approximately 32,000 square feet. The cost attributable to this part is $24 per square foot or $15,400 a bed excluding built-in hospital equipment and air conditioning. The 14-chair dental clinic will contain 9,250 square feet at a cost of $24 per square foot.

Senator CASE. One other aspect of this hospital situation. When I was out at Tripler Hospital in Honolulu, there I saw an excellent example of the use of the hospital facility by the personnel and dependents of the three services.

General Schwarz spent some time with me going through the hospital, and I thought it looked like a good job. At the same time, some question I asked developed the fact that the Navy was withdrawing some of the personnel, and it had assigned those personnel to the staff there.

The hospital apparently is staffed by contributions of personnel from all three services.

This is a question I wanted to ask. Who makes the determination as to the number and the particular skill of the personnel assigned to a hospital that is jointly used?

Captain STONE. That is worked out by mutual agreement between the respective Surgeons General with Dr. Berry of OSD acting as a mediator on any differences.

In this case at Tripler, the Navy was staffing for a higher percentage of personnel than it has patients in the hospital. It was actually staffing for Army patients, and the request reduced personnel for the purpose of bringing it into adjustment with its patient load that it had at Tripler.

This reduction was also necessitated to staff for other medical responsibility given to the Navy in the Pacific area where the Navy will provide medical care and treatment to personnel of the three

services.

Senator CASE. But from month to month there must be some fluctuation in the respective representations of the different services in patients.

Captain STONE. That was taken into consideration for the past several years in arriving at the staffing ratios for this facility.

Senator CASE. Did the head of the medical section for both the Army and the Air Force agree that the Navy was being drawn upon out of proportion to its responsibilities?

Captain STONE. A recent correspondence between the Surgeons General indicates that.

Senator CASE. Of course, Mr. Chairman, that is a difficult matter of evaluation. One service provides a specialist in this field, and another provides a specialist in another field.

I saw through one of the windows there where they were operating on a patient, and the general assured me that in the group that were there there were nurses and doctors from the several services. It was rather a complicated operation that was going on, and he said he was unable to tell me which man was from the Navy, which was from the Army and which was from the Air Force. They were working there as a medical team, which I thought was very good.

But it seems to me that it would be very difficult to evaluate one or equate one specialist against another specialist or one corpsman against another corpsman. It calls for a certain amount of cooperation.

I do not suppose you can really get a specific division, but I do know at that particular time some question that I asked indicated that they felt they were going to be short, perhaps, in some categories because of the Navy was withdrawing some of its men.

Senator STENNIS. May I ask one question there on page 66? You have this rehabilitation of laundry and dry cleaning plant. That item, as I read it, is listed at $443,000. It seems to me that is a large amount just to rehabilitate a laundry.

Captain CHEW. That is based on an engineering study, Senator Stennis, and it is the only laundry service now available.

There is a laundromat setup which is entirely inadequate for the relatively small base loading we have now, and with a steady buildup to over 10 times the current base loading, there is no possibility that the present service could be expanded to meet the needs.

Senator STENNIS. You are going to build it up to 10 times the present base load?

Captain CHEW. The base loading is going up; yes, sir. Incidentally, the existing building will be rehabilitated and altered to provide this adequate facility.

Senator STENNIS. All right. Anything else on this item?

Captain CHEW. No, sir,

Senator STENNIS. Next item.

(The project sheet is as follows:)

NAVAL AIR STATION, ROTA, SPAIN

Location.-Nearest city, Cadiz, 15 miles southeast.

PERMANENT STATION

Mission.-Maintain and operate facilities and provide services and material to support operations of aviation activities and units of the operating forces of the Navy and other activities and units, as designated by the Chief of Naval Operations.

Line item.-Dredging of harbor, $11,934,000.

This item is vital for accomplishment of the mission assigned to this station. Naval Air Station, Rota is strategically located to serve the combat-ready units of both the Atlantic Fleet and the Sixth Fleet. The harbor will be dredged to depth necessary to accomplish this mission.

Captain CHEW. The final project for the unclassified portion is for the dredging of the harbor at Rota, Spain, at an estimated cost of $11,934,000.

The mission of this station is to maintain and operate facilities and provide services and material to support operations of aviation activities and units of the operating forces of the Navy. The location

of Rota on the southwestern part of Spain facing the Atlantic Ocean enables it to serve not only for the Atlantic Fleet units but also the Sixth Fleet. It is also a POL delivery point for the Air Forces in Spain.

While the original plans call for at least a 40-foot harbor depth to permit its use by our larger carriers and new tankers, dredging today has only provided for 10 meters or approximately 33-foot depth.

However, all construction in the harbor, the piers, and wharf, was designed for the 40-foot depth.

Senator STENNIS. Yes. But this takes $12 million additional now, and I have been telling people everywhere that you fellows did a fine job over there and had this all completed. I thought it was finished. I will have to go around now and take back all I have said. It takes $12 million just to dredge the harbor there?

Captain CHEW. Yes, sir.

Admiral WILSON. It could very well have then; yes, sir. that makes it a more expensive operation.

Captain CHEW. I think they also have to get in more elaborate equipment to do this additional dredging. I believe Admiral Peltier can answer that.

Admiral PELTIER. We have in the first initial dredging hit some rock, but most of this extra depth will be in rather hard rock.

Senator CASE. What is the life of your use agreement covering Rota?

Admiral PELTIER. Well, the initial agreement, you may recall, expires in 1963, with a provision for renegotiation for another two 5-year periods, I think it is.

Senator CASE. If it were renegotiated it would only be for 5 years beyond then. How long will it take to do this work?

Admiral PELTIER. About 18 months, Senator Case, to do this work. Senator CASE. Half of the time remaining in the present lease agreement then will be consumed in doing this work?

Admiral PELTIER. Yes, sir.

Senator CASE. Or close to that?

Admiral PELTIER. I am sure that it is intended that we renew that agreement.

Senator CASE. Mr. Chairman, I would like to suggest before we are committed to spending $12 million more on a project which would be regarded as a very large project in rivers and harbors work in the United States, that the Navy ask the State Department to try to get an extension of the leasehold.

It seems to me we are in a bargaining position if we are about to spend $12 million on something of this sort, that once we have spent it we have lost whatever bargaining strength this represents.

Senator STENNIS. We could just hold this installation here until we got it, because I do not think we could justify it until there is an extension, because you would not get your money until August of this year.

What is your purpose, what is your mission there? Give us a little more on it. I know that that is the beginning of the pipeline, and so forth, but it is in full use now, is it not, the supply line? Admiral WILSON. It is in operational use; yes, sir.

Senator STENNIS. You do not have to have this additional depth to take care of that mission, do you?

Admiral WILSON. You do with large tankers, Senator, which are becoming more and more common in the commercial tankers. Senator STENNIS. Where does that oil come from that you are taking in there now?

Admiral WILSON. Most of it is from the U.S. gulf, aviation fuels, particularly.

Senator CASE. Won't this make the city of Cadiz a principal port for supply of not merely oil but other imports into Spain? This will be usable by all classes of ships, won't it?

Admiral WILSON. Yes, sir. But this, of course, is not in Cadiz. Senator CASE. Well, it is 15 miles from there.

Admiral WILSON. Fifteen miles, yes.

Senator CASE. It would be the entry port, would it not?

Admiral WILSON. No, this is a military reservation, sir.

Senator CASE. Will we be the only ones that will use it?

Admiral WILSON. Yes, sir.

Senator STENNIS. It is ours.

Admiral WILSON. It will be a NATO use, I am sure, in time of

emergency.

Senator CASE. There will be no civilian use of this harbor once it is 40 feet?

Admiral WILSON. No, sir.

Senator CASE. Suppose they kick us out; who then will use it? Admiral WILSON. Then it becomes the same as any other oversea base we are in. In that sad event

Senator CASE. Has it no commercial value to Spain?

Admiral WILSON. Sir?

Senator CASE. Has it no civilian value to Spain?

Admiral WILSON. Not so long as we are occupying it.

Senator CASE. But if they got us out of there, would it have? Admiral WILSON. It could very well have then; yes, sir.

Senator CASE. It seems to me that would establish an inducement for them to get us out and make it available to them unless we had some reasonable protection or assurance of its usability after the work is done.

Again, Mr. Chairman, I think that illustrates the importance of getting these base agreements renewed when we are in a bargaining position, not waiting until they have got us over a barrel.

Senator STENNIS. Yes.

Well, this is a very fine installation there. I flew around over it and visited there, too, and I went through a great part of it.

I hope Senator Case can go over there. I came in, incidentally, gentlemen, up Barcelona, and went to the far end of the line to start my mission, and then followed it all the way down to Rota. Admiral PELTIER. The pipeline.

Senator STENNIS. Yes, the pipeline; and visited all the installations along the way.

Well, you are in complete operation there now except for these larger tankers?

Admiral WILSON. Yes, sir.