where they are needed. We will need to know where we can go or the most convenient place to pick up a bulldozer or a special truck or a special piece of construction equipment in order to use it to combat the danger at any point. The only way that we will be able to know where we can get these individuals or the special supplies or equipment we need is by maintaining a record of them. There was such a record developed during the last war and maintained, but of course, that record has not been touched for 5 years, and probably under those conditions it is of very little value now, and we will practically have to start from scratch. Next, microfilming. We have certain valuable records here in the District that, if they are destroyed, there would be no possible way of replacing them. This microfilming we have asked for here is not a part of our over-all District program. That is concerned with microfilming vast numbers of records in order to conserve space, files and so forth. My present concern is the protection of vital public documents. As to the contingencies, as I say, that is not padding, but rather is something that we are putting in because we realize that with our present status of civil defense there are bound to be things which will arise which are necessary and they are not questioned, but which today we cannot foresee, and therefore have not been able to include in this appropriation by individual subject and justification. There is a great deal about this field of civil defense that we do not know, and we are trying to find out. NECESSITY OF SPECIAL EQUIPMENT Mr. BATES. I believe you told us that this does not provide for a fully implemented program, and yet your last item, special equipment, according to your justification, is based on a fully implemented program. Why is there this conflict? Colonel HAYES. That item of special equipment does not include all of the special equipment which will be needed in a fully implemented program; only some of the equipment we will need. It is the equipment that we estimate we will need during the current fiscal year for that program. * * * General YOUNG. The justification says that "Several types of special equipment will be needed in a fully implemented plan. A limited amount of this should probably be acquired in the near future." It is the limited amount that we have in mind now. USE EDUCATIONAL FACILITIES Mr. YATES. With respect to the education item, is it not possible that the movie houses would cooperate with you on their off-hours so that you would not have to buy the projectors and the other equipment of that type which you testified to? Colonel HAYES. I would certainly expect that they would assist in every way that they could, and if I said "buy" projectors, and equipment like that, I was considering more the rental of films and the rental of projectors to the extent we needed them. Certain of our training courses will be neighborhood training carried out by the volunteers within each small block, and they will gather housewives in the house of one of them and conduct training there. COST OF SURVEY OF STRUCTURES Mr. YATES. With respect to the surveys of structures and the service that you provide for contractors and home owners and others who are interested in their properties, would you not expect that until the actual emergency does arise, that that could be done on a fee basis, so that that amount could be recovered? Colonel HAYES. It is quite possible; and your thinking may be a little in advance of ours on that. Nevertheless, though, it seems to me we should do something along this line as a public service. Mr. YATES. I was wondering. Here is a specific service that you are rendering to particular individuals rather than to the public-atlarge, and I thought that perhaps if they want particular knowledge, they might pay a nominal fee for obtaining it, which would cover the cost of such an office. Colonel HAYES. That might very well be appropriate. MICROFILMING Mr. YATES. Could not the microfilming project that you are speaking of be properly a part of the appropriation of each of the public offices, rather than the Department of Civil Defense? Colonel HAYES. It might be, but it is something that we had not provided for in the budget for the particular offices, and since our chief interest in it now is to get the most critical of the documents microfilmed as a part of our civil defense program, we have incorporated it in this budget. Possibly in subsequent budgets it might be included with the individual departments; but that, of course, ties us down to making a survey ahead of time, of the various departments, in order to know which departments to start with, and which documents to cover. Mr. YATES. I remember the testimony, I think, on the principal appropriation, of some of the officers in the departments, that they had under contemplation the desirability of microfilming the records, and they did not think it was particularly necessary now. It is not possible that this may alter their views? Colonel HAYES. That is quite possible. General YOUNG. At the time of the testimony on the basic appropriation, we were thinking primarily in terms of saving the District money or space by getting these records. This is a wholly different angle of safeguarding essential records. For example, there are records of land ownership, or records of utilities underground, and if those were lost it would be almost an impossible task to replace them. Mr. YATES. I would think the company would want to do that. General YOUNG. The companies would, but we have our utilities, too, water and sewer. Mr. STOCKMAN. In reference to microfilming, you say that you want $5,000 to start that. Have you made any estimates of what it would take to do the microfilming you might want to do? General YOUNG. No, because the microfilming that would be visualized under this would be far less than a program of microfilming documents in order to cut down on space and storage requirements. We are concerned only with those that would be vital. Your survey for such a purpose would be considerably different from any survey that has been undertaken in the past. Mr. STOCKMAN. There is a question of what is vital. Do you have any list? Colonel HAYES. None at all. Mr. STOCKMAN. What about the departments and companies. Maybe they would not want you coming in and microfilming. Would you have legal authority to do that? Colonel HAYES. Of course, in the municipal departments we would, and that is where we would start in the first year. In addition, undoubtedly you will have certain private companies who will consider it is to their best interests to provide their own microfilming of their own documents. Mr. YATES. At their own expense? Colonel HAYES. Yes. Mr. STOCKMAN. Then you do not have any estimate of what the microfilming charges would amount to for what you term the vital points? Colonel Hayes. No, sir. From the microfilming we have done so far, we know that it will considerably more than this $5,000, but this bill will enable us to get started on the program. Presumably, when we come up next time, we will have a better idea of what we would need to complete the program. Mr. STOCKMAN. Who determines what should be microfilmed? Colonel HAYES. In this particular case, it might be done by the Commissioners or by the department heads or by the Director of Civil Defense. Probably the Commissioners would determine initially which types of documents they considered essential. Mr. STOCKMAN. Then in any bureau, board or commission, or department, if they wanted to get their records microfilmed, if they could sell the Commissioners, or whoever was in power on this civil defense program, on the idea, they could get a free job of microfilming. Colonel HAYES. If they had the idea the records were so vital that they would have to be microfilmed for their protection, and could sell the Commissioners, why, they would be microfilmed under this program. Mr. STOCKMAN. This could run to almost any figure, then, that the Commissioners might see fit to give a nod to. Colonel HAYES. Assuming the Commissioners did not properly monitor it. General YOUNG. We could spend no more than what your committee gave us. First, we have documents that establish the ownership of real property. If those were completely wiped out in the District, you can readily see the chaotic condition that would result. Secondly, these District utilities buried underground, the location of which cannot be determined without a record of where they are; those are important. Now, we do not know how much it would cost to microfilm those particular types of records. Also, we do not know whether any other types of records might be deemed essential in the same sense. Mr. STOCKMAN. You are planning on the actual microfilming of those two items with this $5,000? General YOUNG. Those would be the two that I would start with, yes, sir. Mr. STOCKMAN. Start with, not do, with $5,000? General YOUNG. I do not think that we can do it with $5,000. General YOUNG. I do not know. It is a guess. It is one of the three or four items in here which are of the nature of guesses. Mr. STOCKMAN. Is this whole budget mainly guesswork? General YOUNG. No, sir. The items for the staff, the items for setting up the central defense headquarters and communications, and the items for the warning net, are as accurate as most of our estimates we submit to Congress. The principal elements of guesswork are four of those under project 4, namely, microfilming, contingencies, surveys, and training. We know those things should be done. We have no definite idea of what they will cost. We have put in, relative to the total appropriation, fairly small amounts for them. Something should be spent on them, and I think that more will need to be spent than is put down here. Mr. STOCKMAN. Your idea for these two amounts was to get into it, and then you think you would have a better idea of what should be done? General YOUNG. That is correct. OTHER SUPPLEMENTAL ITEMS Mr. BATES. I understand that authorizing legislation has been passed or is now pending for the day-care centers and the 5-day week for policemen. Although there is no official budget estimate available for these items, the committee would like to hear testimony concerning them, and the proposed out-patient clinic at Gallinger's, this after noon. You understand that all the committee wants to do is to hear this testimony to avoid another hearing. We will abide by whatever the Commissioners want to do, but if you do send a request up later, then we will have our testimony and we will not have to have another hearing. Mr. FOWLER. That is fine. OUTPATIENT CLINIC AT GALLINGER HOSPITAL WITNESSES DR. DANIEL L. SECKINGER, HEALTH OFFICER, DISTRICT OF COLUMBIA DR. PHILIP A. E. STEBBING, SUPERINTENDENT, GALLINGER HOSPITAL DR. JOSEPH F. FAZEKAS, CHIEF OF STAFF, GALLINGER HOSPITAL Mr. FOWLER. At the request of the committee we have before you Dr. Stebbing, Dr. Fazekas, and of cource, the Health Officer, Dr. Seckinger. Dr. SECKINGER. Mr. Chairman, as I understand it, we are to talk about the formation of a program for integrating the care of the indigent sick and also for caring in a larger way for chronic illness. I might say that for at least 6 or 8 months we have had many conferences with interested groups to see what may be done to better coordinate such care. Among those attending have been members of our own budget office and from time to time the Commissioners, our medical societies of the District, and the white and colored medical schools. The U. C. S. also are very much interested in this problem. So, at the present time we have a committee working on the over-all picutre and we hope to have a report by the time the Commissioners have us up for our budgetary hearings, which usually come in the latter part of August. But in the very beginning it will be necessary, as we see the picture, to do more for Gallinger Hospital in the way of out-patient clinic service facilities than that institution has had, before we will be able to go farther in an integrated program. Now, that institution has approximately between 1,400 and 1,500 beds and has a very poor out-patient clinic set-up. I do not know of any hospital of that size anywhere in the country that has such a poor set-up. The clinics are here and there over the entire reservation and they are not properly coordinated. Besides, we have no medical clinic. I could go into considerable length but I shall not do so because we have both Dr. Stebbing and Dr. Fazekas here to tell us what that situation is. I do know that any general hospital should have out-patient clinic services. It is economical. Theoretically the patient should be fed to the hospital through the out-patient service except of course the emergencies coming in under emergency conditions. There have been different figures as to how many clinic patients the hospital of a certain size should have. I have heard figures mentioned that the number of daily visits in the clinic should approximate the number of beds that the hospital has. So, if you have a hospital of 800 beds, theoretically you might have 800 visits in the out-patient clinic. I think Dr. Stebbing has some figures on that. I will not dwell on that longer except to say that I do know in Baltimore the Johns Hopkins out-patient service has about 1,500 visits per day and they have a bed capacity of something around 900 beds. Now someone says, "Well, you cannot do here what you do in Johns Hopkins," but they have 50 percent of the load of the indigent service for that city of Baltimore. In conclusion we are greatly understaffed so far as our out-patient clinic is concerned. As far as what can be done to better integrate the service, we would say that we need at Gallinger a better out-patient setup, better coordinated, and we do have a location for that in the Communicable Disease Building. That will not be the ultimate so far as Gallinger is concerned. The Commissioners know that we have had under consideration for some time an out-patient building at the Gallinger Hospital. It will have the medical records, a pharmacy, an out-patient clinic staff and X-ray service just as other big hospitals have. It will house many out-patient clinics. That is in the building program and we have asked that that be put high on the list of priorities so that we can get that building under way. Even if that were approved today, it would be months and probably years before it could be made available. Dr. Fazekas and Dr. Stebbing and members from our staff at the Health Department and Dr. Oppenheimer have discussed with the committee from time to time what can be done to start this program 69887-50-pt. 1- -7 |