HOSPITAL CONSTRUCTION

At the commencement of the fiscal year all construction under the first Langley Act, which was carried out under the direction of the Secretary of the Treasury, was completed with the exception of the 400-bed tuberculosis hospital at Chelsea, N. Y. The building activities at this project were considerably delayed due to a change in plans, and it was not until May 20, 1924, that this hospital was finally turned over to the Veterans' Bureau when about 97 per cent completed. This project has since been completed, with the exception of certain minor items of construction. It was during this past year that the effect of the second Langley Act was initially felt, as four neuropsychiatric hospitals constructed from the ground up were completed and made available for patients. At United States Veterans' Hospital No. 57, Knoxville, Iowa, 228 additional beds were completed June 28, 1924, and immediately made available for patients. Hospital No. 53, Dwight, Ill., which had previously been operated as a leased hospital from June 4, 1920, to January 4, 1923, was purchased and reopened for patients on September 20, 1923. In addition to the funds made available for hospital construction under the first and second Langley Acts, there was made available in the appropriation "Medical and Hospital Services, U. S. V. B., 1924" some $5,781,000, which included certain funds for enlarging existing United States veterans' hospitals. At United States Veterans' Hospital No. 78, North Little Rock, Ark., 327 additional beds were provided; and at United States Veterans' Hospital No. 84, Algiers, La., a total of 160 additional beds was furnished. Contracts were also let during the year for the enlargement of the United States Veterans' hospitals at Augusta, Ga., and Rutland, Mass., where construction at the close of the fiscal year was 45 and 93 per cent completed, respectively. There are now being completed seven major hospital projects, furnishing some 1,240 beds for tuberculosis cases, 790 beds for neuropsychiatric cases, and 125 beds for general cases, and plans are being prepared for an eighth new hospital for tuberculosis cases with a capacity of 234 beds. All but one of these hospitals are being constructed from the so-called second Langley Act and will, when completed, be the final projects under the two construction appropriations totaling $35,600,000. Five of these projects will be completed by September. 1924, the other two under construction not to be completed until the spring and summer of 1925. These new facilities will be largely utilized by the contract loads of patients in the second, third, eighth, and tenth districts, and to replace temporary facilities in the twelfth district.

FUTURE HOSPITAL CONSTRUCTION

The present construction policy with relation to hospitals is to provide modern, permanent, fireproof structures as conveniently located to the patient load as possible. The carrying out of this policy embraces not only the construction of new hospitals, but also the replacement at existing locations of temporary unsatisfactory facilities and the substitution for leased hospitals, or structurally inadequate Government hospitals, by permanent construction. The funds made available under the first and second Langley Acts provided permanent facilities to meet the load which was evident at

the time. These two acts did not, however, meet the needs in all instances, nor did they accomplish in entirety what was originally intended. To-day in certain localities there exist unsatisfactory hospital facilities, or inadequate facilities, to meet the load.

To meet this situation, and to round out the hospital program, so far as the needs of the bureau indicated necessary construction, extension, and replacement, the bureau proposed to Congress in December, 1923, an additional hospital program involving an expenditure of $6,500,000. The authorization for this construction was passed by Congress and approved by the President of the United States on June 5, 1924, and is contained in Public No. 197, Sixtyeighth Congress. This act further included authority for the establishment of a National Training School for the Blind at a cost estimated at $350,000. While the authorization for this construction was granted, the necessary appropriations to carry out this authorization were included in the general deficiency bill which failed of passage in the last days of Congress, and the bureau was, therefore, prevented from the actual development of this proposed hospital construction program pending appropriation of funds.

The construction contemplated under Public No. 197 was determined upon after very careful consideration had been given to hospital facilities as they then existed to meet the then evident needs of the bureau to properly carry out its obligations to its beneficiaries, bearing in mind the trend of the hospital load and thebureau's experience.

This new hospital program embraces:

(1) The construction of a 1,000-bed permanent neuropsychiatric hospital in the second district, to replace the existing United States Veterans' Hospital No. 81, Bronx, N. Y., which, because of limited acreage, location, and character of construction, does not permit the greatest benefit from treatment to be derived by patients sent there;

(2) The construction of 300 permanent beds for Veterans' Bureau patients at the United States Army Walter Reed General Hospital, Washington, D. C., to replace the temporary facilities now used there, which are cantonment type of construction and constitute a grave fire hazard;

(3) The construction of a 250-bed neuropsychiatric unit on Government-owned property at Great Lakes, Ill., to meet the very considerable load of neuropsychiatric patients in this area now being treated in State hospitals;

(4) The construction of a modern permanent tuberculosis hospital in the tenth district to meet the large tuberculosis load there, and to permit as soon as practicable the abandonment of one of the leased hospitals in that area so located as not to be of the greatest benefit to the tuberculosis patients now hospitalized.

(5) To purchase the newly constructed permanent hospital at Muskogee, Okla., now leased by the Government, the need for which is permanent and continuous; and

(6) To provide adequate funds to complete the San Fernando project in California for the hospitalization of tuberculous cases now being treated in temporary cantonment hospital facilities in that area.

REHABILITATION

The rehabilitation division of the United States Veterans' Bureau is charged with the responsibility of training into employment Vocational handicap veterans of the World War. In carrying out the program of vocational training the rehabilitation division had on June 30, 1924, received 650,253 applications for training. Of this number 330,943 were declared eligible for training, 173,632 had entered training, 45,347 were in training, and 78,631 had been rehabilitated and completed. This represents a decrease in men in training over the year of 35,012, and an increase in the number rehabilitated of 36,866.

The primary functions of the rehabilitation division in the early days of the administration of the act were, first, the advisement of the individual trainee as to the course to which he was best suited and in which rehabilitation could most readily be effected, taking into consideration the vocational handicap, the physical disability, and the educational background; and second, the securing of training facilities. The number and type of training facilities required to train the large number of trainees was a different problem in so far as the bureau was required to provide training for more than 109,000 ex-service men and women at one time. The demand on the schools was so great that it became necessary to establish schools to be operated by the bureau for special types of training. The extent to which the schools and industrial establishments were utilized in the training program is indicated by the fact that at one time more than 3,200 schools and 28,000 establishments were giving training to the ex-service men and women.

During the fiscal year ending June 30, 1924, the new entrances into training had decreased to such an extent that advisement became a secondary function and the "in training" load no longer taxed the training facilities of the country. The primary functions of the rehabilitation division became the intensive supervision of the progress toward rehabilitation of the individual trainee and the securing of employment for the trainee at the time of rehabilitation.

With a view of facilitating supervision the individual training program was established on which is recorded the required accomplishments and the actual work completed, together with the complete training record of the trainee, as determined by the supervisor after conference with the trainee, instructor, and an individual survey of the work completed.

The result of the intensive supervision to insure rehabilitation within the time prescribed in the training program and permit employment at the time of rehabilitation is illustrated by the fact that the number of trainees rehabilitated during the fiscal years 1923 was 24,799, and for 1924, 36,866.

On June 30, 1924, a total of 123,465 trainees had terminated training and during the fiscal year 64,085 terminations were effective; that is, 52 per cent of total terminations were effected during the fiscal year 1924.

The securing of employment is brought about by contacting firms employing especially trained men and by cooperation with the service men's organization, labor organizations, and with such organizations as the chambers of commerce. The extent to which this employment problem has been successful is shown by the fact that as of

June 30, 1924, after 37,170 rehabilitated trainees had been referred to the employment service, only 1,139 were reported not employed. The majority of the vocational schools operated under the jurisdiction of the United States Veterans' Bureau were established by the Federal Board for Vocational Education before the transfer of the rehabilitation activities of that board to the Veterans' Bureau. The establishment of Government operated institutions was necessitated by the need for special schools to meet the educational requirements of various types of trainees, such as those lacking in educational background, those requiring specialized courses and intensive instruction, and applicants for vocational training declared nonfeasible for tubercular and neuropsychiatric disabilities.

During the past fiscal year 15 resident and nonresident vocational schools were closed. This decrease was brought about to a large extent by the decrease in the training load. July 1, 1923, there were 4,778 trainees in bureau schools. This number had decreased on July 1, 1924, to 1,558. The prime factor in the decrease in the number of schools was the reduction in the training load; however, two other factors entered into this action by the bureau: First, that trainees carried in schools operated for the training of nonfeasible tubercular and neuropsychiatric cases have completed the work assigned and the majority of these trainees have been declared feasible for training in the various training facilities utilized by the bureau; and second, that trainees requiring try-out courses in order to determine the employment objective for which they are best fitted had decreased, due to the limited number entering training during the fiscal year and schools utilized for this purpose were no longer needed.

ADMINISTRATIVE ECONOMIES

Prior to the beginning of the fiscal year, survey letters were addressed to district managers discussing in detail the activities of each subdistrict office under their jurisdiction and making suggestions as to how the administration of these offices could be improved. The survey of letters were accompanied by a statistical evaluation of the activities of subdistrict offices for the preceding 10 months, which enabled district managers to study many of the conditions in retrospect. Many of the conditions revealed in the letters and tables were known in a general way to district managers, but their true significance had not been realized from a management standpoint. At the time the survey letters were forwarded to district managers, the bureau was operating 130 subdistrict offices. The survey letters proposed a reduction of 56 subdistrict offices, leaving 74 subdistrict offices if these proposals were accepted and put into operation. District managers were requested to submit their recommendations after a careful analysis of the situation, and in response to this request, district managers have recommended 52 subdistrict offices. for consolidation. Of these recommendations 50 consolidations were approved by the director and carried into effect by the district managers. Many of these consolidations were effected during the fiscal year ending June 30, 1924. The consolidation of subdistrict offices was never permitted to reduce the service rendered beneficiaries and claimants in the area they served. Sufficient medical and rehabilitation personnel was retained in the offices to perform. the functions necessary for service to beneficiaries. Administrative

personnel, however, was greatly reduced, by reason of removing subdistrict office files to another office where one administrative staff could perform the duties formerly requiring two administrative staffs.

Several communications were received during the past year from people who were interested in having the existing organization of certain subdistrict offices continued. Each communication was answered in detail setting forth the exact changes that were being made; explaining the reasons for these changes and setting forth that actual service to beneficiaries was being continued. Only in very few instances did the Bureau receive the second communication from people who received these explanations. This is interpreted to mean that the public is interested in having maximum service to the bureau's beneficiaries and that they are also interested in having the bureau function along sound administrative lines that will make the administrative cost in proper proportion to the service rendered. The decrease in the number of employees in all district and subdistrict offices as a result of all consolidations was 2,051. The estimated annual saving in salaries is $2,835,836. The estimated saving in rentals due to consolidation is $132,036, and other expenses, $298,690. The total saving to date that can be traceable to consolidations has been estimated to be $3,266,562.

As a result of legislation passed by Congress on June 7, 1924, a reorganization of the field offices of the United States Veterans' Bureau was made possible, which greatly affects subdistrict offices.

The reorganization is discussed in another paragraph, but is mentioned in this connection by reason of its effect upon 30 subdistrict offices that were not designated as regional offices. It is anticipated that when regional offices completely organized are fully functioning, a large portion of the activities of these suboffices will be drawn to the regional offices by reason of the operation of claims and rating boards before which claimants and beneficiaries may appear. It is believed that the service rendered by these claims and rating boards will be of such improved character that claimants will want to have their cases handled by these boards and the need for suboffices will, therefore, diminish. If this reduction of activities occurs, further consolidations of suboffices will become possible.

Similarly, by increased rehabilitation and a consequent diminution in the number of men under vocational training, together with the change in character of training facilities required, due to the fact that many of the trainees had advanced in their instruction to such an extent that better instruction could be afforded by private institutions than through the operation of certain vocational schools, it was possible during the year to close 15 resident and nonresident vocational schools, involving a reduction of 501 employees with an annual saving in salaries of $745,428.

Through these means and by virtue of reorganization in the district offices and simplifying of procedure, for all departments of the bureau, there was effected during the year a net reduction of 2,039 employees, and a reduction of $2,650,790 in aggregate annual salaries.

Coincident with the closing and consolidating of various field activities, there has been a marked reduction in annual rentals, materially augmented through results obtained by extended efforts directed toward securing reduction in the rental of office space, and