Mr. BRADLEY of California. Would you mean to indicate that now the Public Health Service transports people from all over the world and back?

Dr. FULLER. No, sir; they don't, and it was to correct that difficulty that this line was inserted.

M. BRADLEY of California. But this is not to correct it. It is to amplify it. It says a man may live anywhere under the American flag, as I read it, and shall be transported at Government expense to a medical facility whenever it is found necessary. It might be every 6 months or it might be every year. I don't know. It might be once in his lifetime. I am striving to find an answer to it. It seems to me it is one more of those extremely loose provisions.

Dr. FULLER. Again, as a doctor I would be interested merely in seeing the patient, when he presents himself.

Mr. BRADLEY of California. I thought perhaps you had worked it out in your own Department. If not, we will follow that up with other representatives of the Maritime Department and the Public Health Service, because we must have answers to those things.

Mr. MALONEY. Doctor, do I understand you to say that on title V you would not change the language of that title at all? It is on page 22. Particularly, section 501.

Dr. FULLER. I think it is workable. Yes, sir.

Mr. MALONEY. Is there any change in the language of that section that would make it more workable, that you could suggest?

Dr. FULLER. I don't believe so, sir. I haven't thought of any. The Bureau of Employees' Compensation might have some suggestions, because they deal with problems of this kind right along.

Mr. MALONEY. I note on page 8 in section 103 (a) the language

says:

At the time of making application for a certificate of maritime wartime service or at any time thereafter, application may be made to the Chairman for å disability endorsement on a certificate of maritime wartime service.

Why should not that be limited in time also? The language says, "any time thereafter."

Dr. FULLER. I see some marginal notes here which Mr. McCandless has made.

Mr. MALONEY. That perhaps is not a medical department provision because the seaman would not come into the medical department's hands until after that is raised.

STATEMENT OF JAMES V. MCCANDLESS, ASSISTANT TO THE COMMISSIONER, MARITIME COMMISSION

Mr. MCCANDLESS. Part of the basis for that is to take care of these cases of delayed manifestations of tuberculosis or heart conditions which may not have become apparent until a subsequent time.

Mr. MALONEY. How long do you figure on giving these people for different things to become apparent? That is the point.

Mr. MCCANDLESS. The burden, of course, in cases of that sort, is upon the claimant to show a wartime relationship, and of course through the records which the medical director will have, and which will be available to us. Otherwise, of course, it will be used as a check to protect the Government against any claims which cannot be supported.

The need and the justification for giving treatment to a seaman may be just as great 10 years from the time that he has served as it was the day after he served, and I think the purpose of the act is to accomplish that.

I think, through the professional advice and counsel of the medical directors it is possible to check and avoid unsupported claims being cared for. Now, that is true not only in insurance matters, but it is true with the Veterans' Administration and I am sure it is true under certain insurance and industrial accident concepts, and I do not consider this as something new or novel. It is something that is well within the scheme of providing for delayed cases requiring care and treatment that may have arisen out of an antecedent activity or engagement.

Of course, the longer the time that elapses between the service and the claim, obviously the scrutiny will be increased and will be much closer, and the claimant will be under an additional burden to clearly support his claim. I think it is one of those matters of judgment and discretion in which the presumption is that care will be exercised to protect the government on the one hand and also to render that which was intended if the case is deserving.

However, it is a little difficult, I appreciate, to try and place a formal limitation on either the time or the condition. You will notice that the United States Employees Compensation Act has recently had an amendment made, which has substantially extended the length of time in which claims may be filed.

Mr. MALONEY. That has substantially extended it in years, you mean?

Mr. MCCANDLESS. Yes.

Mr. MALONEY. Do you recall how many years now?

Mr. MCCANDLESS. I think it is five years now.

Mr. MALONEY. That is what I am driving at. A five-year provision in a bill like this would be worth-while. It looks to me like I am driving at exactly what has been done. I don't like these things that are just as wide open as the sky.

Mr. MCCANDLESS. I think that is a matter of Congressional intent and that which is reasonable, I think, should be incorporated in the bill.

Mr. MALONEY. Thank you.

Mr. BRADLEY of California. Mr. Hart, do you have any questions? Mr. HART. I have no questions.

Mr. BRADLEY of California. Mr. Havenner?

Mr. HAVENNER. No questions.

Mr. BRADLEY of California. We don't like to let you go so easily, Doctor. Is there anything else you want to tell us?

Dr. FULLER. No, sir. I think not.

Mr. BRADLEY. I think we have covered all the parts of the bill which pertain to your particular calling. Thank you very much. We may have to call you again.

Dr. FULLER. Thank you very much. Except for tomorrow I will be available at any time, at your call.

Mr. BRADLEY of Calfornia. Thank you very much. The hearings will go on for some days yet and if we find ourselves confronted with any knotty problems we shall call you.

STATEMENTS OF OTIS L. ANDERSON, MEDICAL DIRECTOR, CHIEF, HOSPITAL DIVISION; AND R. T. HALLINGER, CHIEF, REGULATIONS AND PROCEDURE SECTION, HOSPITAL DIVISION, UNITED STATES PUBLIC HEALTH SERVICE

Mr. BRADLEY of California. Dr. Anderson, will you proceed to give your position and make any statement you wish.

Mr. ANDERSON. Otis L. Anderson, Medical Director, Chief, Hospital Division, United States Public Health Service. With reference to title IV it might be well to discuss the relationship of the requirements as set forth in the bill as they relate to the operations now of the Public Health Service and any changes that would be resulting from the bill. I believe it would be expedient to refer to the administrator's report. That is, the Administrator of the Federal Agency, in which he commented on H. R. 476 to the chairman of this committee. There are several parts of the administrative report which I think are pertinent to our discussion this morning.

Mr. BRADLEY of California. That is the report of the Public Health Service?

Mr. ANDERSON. Yes; made by the Administrator of the Federal Security Agency.

Mr. BRADLEY of California. Is this the report to which you refer, Federal Security Agency, March 21, 1947?

Mr. ANDERSON. I believe that is correct, sir.

Mr. MCCANDLESS. It is Report No. 21.

Mr. BRADLEY of California. We now have the report. Will you proceed, please?

Mr. ANDERSON. In this report it is stated that the Public Health Service already has authority under the Public Health Service Act to provide such care for merchant seamen.

Mr. BRADLEY of California. Where is that? Will you please desig nate what parts you are speaking of so that we can follow it?

Mr. ANDERSON. On the typed copy of the report it is page 3. It would be paragraph 13, I believe, in your printed copy.

Mr. BRADLEY of California. They are not numbered.

Mr. ANDERSON. I just counted it down. The paragraphs are not numbered as such.

Mr. BRADLEY of California. It is the second paragraph on page 3. Mr. ANDERSON. Therein we state that the Public Health Service already has authority under Public Law 410 to provide such care for merchant seamen employed on United States vessels; and in certain cases for seamen employed on foreign-flag vessels, and for the cadets and others included in the bill's definition of wartime-service seamen. Now the term "employed on" has been construed by us to limit the class covered to those who can fairly be said to be following the sea at the time that need for care arises. Present regulations' limit the class to those who are serving or who have, within the 90 days immediately preceding the application, served on board a vessel. That is provided in our regulations existing now.

Of course, the 90-day rule does not operate to terminate treatment begun during that period, nor does it terminate the right of those treated and discharged, but determined to be temporarily unfit for further sea duty.

The Public Health Service does not, however, have authority under present law to treat those who have left the sea, even though the difficulty of establishing the service-connected nature of their disability might be overcome, and there is some question of its authority to treat for recurrence of illness those persons who have left the calling subsequent to their treatment and discharge with respect to those illnesses. Consequently, we favor amending the Public Health Service Act to make it clear that wartime service seamen may be treated at any time for service-connected disabilities even though they may, after such service, have changed occupations.

Now, continuing after the paragraph you have found it should be pointed out in this connection, however, that if all the disabled seanen-except those of World War I-who are made eligible for Public Health Service care under title IV are compensable cases under section 501 of title V-that is to say, are eligible for medical care or moneyDayments or both under the Federal Employees' Compensation Acthere would be no good reason for the amendments of the Public Health Service Act proposed in section 401 of title IV.

This is so because the Federal Employees' Compensation Act already grants all the authority necessary for all the care and treatment equired by persons eligible under the act. Section 503 of the bill uthorizes the waiver of the time limitations provided in the act. Such care and treatment can be authorized in Public Health Service acilities or any other facilities, and expenses of transportation, ppliances and supplies, and even loss of wages, are provided for. Of course, selection of the facility for treatment would be in the iscretion of the administration and the injured person could not select he Public Health Service as a matter of right.

Mr. BRADLEY of California. Will you explain what is meant by that? Do you mean that a person might be sent to a Veterans' Administration ospital, or something on that order?

Mr. ANDERSON. The point of selection would be wherever the Bueau of Employees Compensation would elect to place this person for he medical care they are entitled to under their law. That may be 'ublic Health Service, or it may be a private hospital, or it could be veterans' hospital, if they were accepting persons from the Emloyees Compensation Commission.

Mr. BRADLEY of California. The Employees Compensation Comission after deciding then designates the place of treatment?

Mr. ANDERSON. That is correct, sir; and in their mechanism of peration they are functioning in that fashion at this time, and in hich some cases will come under the case of the Public Health Serve because of the direction of the Commission.

If you will skip two paragraphs, Mr. Chairman, I will comment n the following part of the report. In subsection (b) of the proosed new section, an incidental reference is made to domiciliary care, ut such care is not mentioned in subsection (a) of the proposed. mendment to the Public Health Service Act and is, therefore, not. xpressly authorized.

By contrast it will be noted that in section 402 of the bill, subsecion (b), there is provision for domiciliary care for veterans of the merchant marine of World War I who are permanently and totally isabled. Domiciliary care, as distinguished from medical care and

curative hospitalization, is a function foreign to the present responsibilities of the Public Health Service.

The circumstances under which it is intended to require the Service to furnish such care should, I believe, be clarified. Such clarification should also extend to the question arising under section 402 (c) as to which agency should certify as to the eligibility of a World War I seaman for domiciliary care under section 402 (b). The primary interest I have in commenting on this paragraph is really to point out that domiciliary care has not been and is not a function of the medical care program that the hospitalization of the Public Health Service has been responsible for.

Mr. BRADLEY of California. That would require the establishment of new facilities for domiciliary care?

Mr. ANDERSON. It would, sir. Subsection (d) (2) of the proposed new section, regarding the furnishing of seeing-eye or guide dogs and mechanical electronic equipment for aiding seamen in overcoming the handicap of blindness, as well as the furnishing of necessary travel and other expenses incurred in connection therewith, is believed to go beyond the general scope of medical care. This subsection seems to have a more direct relation to the provisions of part II of title IV concerning vocational rehabilitation.

The provision for clothing in subsection (e) appears to be unneces sary for the reason that there is ample authority in the Public Health Service Act to provide hospital clothing to the patient while undergoing hospitalization in hospitals of the Service and to those patients requiring special clothing in connection with the wearing of appliances.

If it is intended that regular street clothing be furnished to indigent seamen, it is believed such a provision should be placed elsewhere in the bill, as this obviously is not related to medical care and treatment.

The proposed new section of the Public Health Service Act does not include the provision found in section 402 (a) of the bill for treatment of seamen at public or private facilities other than those of the Service. Section 322 (e) of the act contains such a provision, but it would not be applicable to the new section 22A. This omission should be corrected. Also, although this provision of section 402 of the bill is similar to section 322 (e) of the act, it contains no reference to regulations as does section 322 (e).

We recommend redrafting section 402 so that its provisions become amendments of the act. Those, Mr. Chairman, are the pertinent comments that we feel might be made on the bill that is being considered this morning.

If it is not off the subject at this time, I should like to comment very briefly on the report of the Maritime Commission on H. R. 476 under date of May 12, 1947, on page 20.

Mr. BRADLEY of California. I believe this report of the Federal Security Agency should be made a part of the record. Mr. ÅNDERSON. I would think so, sir.