*EOO 21 j t@@ C; l@E 1 El M 11769 ROAD SPR,NG, MI RYL,AND 2090,2 -:rIL VE, R LEG13T,ATnr6' HISTORY ON THE PASSAGE OF THE HOSPITAL Suiv, O',,TSTRTir,TIOTI ACT, PTJBLIC LA.@- 725., 79TH COIT R_,:SS .G @ITCY FEDERAL SECUR,.,Y AG: 'Public Health Service JULY--1948 Division of Hosp4-tal Facilities COITI'EITTS Pages PART-B SURV@-@y @4L7D FL.L,,,i7ING 9 611 Appropriation authorization .10 § 612 (a) Applications for Funds 1 612 (a) (1) Single State Agency 9 612 (a) (2) Advisory Council 12 9 6-12- (-a) (3) Inventory -13 9 612 '(a) (4) Reports and Records 14 i 612 (b)@ Approval by Surgeon General 15 A@llotm@a@ to States PART C' CONSTPTJCTION OF HOSPIT-kL$- 621' Appropriation authorization W.'622,"@ Promulgation of regulations 9 622@ ('a') Number of GianIeral Beds Required. 23-25- I o2P-.(b) Number of tuber@osig, mental, and chronic beds required 26-29:. o,22 (c) Number of i)ublic health centers required 29-30 9 622 (d) Priority' -i6 31 6: Const@tioa standards 7@g Diierimin tion (1-@ Race Color Greed 39-41 @)@indigent Cari 42@4@3, Methot stratiom,' 44@@ Stat e'Al Advisor C6um:cil Constru il6ri program (a) (5) Relative need 53-55 0 9 23 (a) (G)- Methods of Administration 5/-57 1 6P3 (a) (7) 3tandards of Maintenance and 0-oerp.tion 5,9-59 1 62@ (a) (8) Fair Hear4ng 6o l@ 62-@3v (a) (9,) Reports and Records 61 - of,@ Plan@ 6 Appr -Fa.L-@ @plani@ t iort @otments@ to State s@: en era t at I, @6i@ Allotment 68-69 I I . Availability of Allotment fo9-70 I-i.. State Matching of Federal Funds 70-71 V. Allotments for Administrp-tive 3x--enses 71 or 1. 'eneral. 3:1. Maintenanc@- and" 0-oeratiorL T@ d) Limitation on use of funds 92-94 a 625 (e'l 20-Year use' requirement 95 PART D - l-'LISCIILAITE-OUS 0 031 Definitions 1 631 (a) Allotment percentage g@97 9 631 (b) Promulgation of allotment percentage 99 ff. 631, Population- 89 State 9 t. 631, (d),, 91 9 1&31 (@ e) Rospital a 631 (f) Public Health Geri't e@ 95 @631 (g) Nouprofit,a"p al:, 96, $7 6 @(hi co 5&99 nstruct I 631,(i) Cost, of Construction ico 9 632 (a) Withholding of Certification 101-102 6 632"(b) (1) Judicial Appeal 103-lo4 9 632 (b) (2) (3) Finding of Fact 105 1 6.33 (a) Administrptive Regulations 106 8 633 (b) Federal Hospital Council 10T 1. cgmpoe guncil Council Bibliography Interim Pe-@)ort From the Subcommittee on Wartime Health and E(iuca.tion to ,'-'he Committee on Ed,,icati-on and Labor, S. Senate, Subcommittee Rerort 77 t @79th February, D4arch, 1 Senate Report No. 674 on S. 191, October 30, 1945- Senate Bill 191, October 30, la4g Letter from President Truman to the Chq.irman of the House-Conmittee on Interstate and Foreign Commerce, January 31, 1946. 6. @4 n' Educatit 0. the@ Co=ittee@ o U. S. Senate@ th,Gongress, 2nct Session, March,,19460 ntdrstate. and -e kStibco the Committee on I Pbreign Commerce on S. 191 House of Re-,@.)resentatives, 79th Congress 2h& Session, March, 1946. House Rep r o No. 2519 on s- 191, Ju!Y 13, 1946. -'C6@etence R6-port ii 5.7 191 July 29, 1946.. ri t. @r-o@ tlif ti li@ co@@ttee,@ on.@ Education,@ U 0 The ?resident. and varioi-,s o4i Cong-resE r,,reiious',',Il giv@-n sor,e-thought to the estab,.i-s@reni, o i 1 e @i e,r a h cz a c,-. nt u c @, i c r o and t.,iink4 _g 4 n the u,) @p,-,,-v".ce -@as el"' -n @l-.e a @L7,ies- i e ii e o s 7, e S --@a 'n -eCr4 u I-L -on. on; ed:. @'or-;ard @he@ thw,,o6licieT qrt&. 7-,roce@es Lit:orr.-,@h4 rk of -ch, than p're@ 'P 1944 tne Pub'_;_c Health -3er7ice =-ub,-.ilted to the Pos',@,.ar n -o@,.L I.i @OC4 e.t; ,lanning Co,@7iittee of t"he Amf@rltean Hos;;ital As- - on abr4.ef stpterrent setting forth the.,7.ajor c,!L-,Aaracte,:4-,-tics of .',he .@.-ol;ose... hos@i',L-la'- -urvey &.iid cc,nsluri.,ction -,rogrpr.,i. Ln -,%Y. a sii.-,ilar su bm on ..,g s Lnalu,_- to the Subr.,oirni ttee on @'."eL 1 -Lcal Ca,-e of the on '@.,--@L-iin,@-ztrative -rictice o@' the -ii@rican Pub"6ic' Health Associations eon '3eiierp-!..in.@ @r, @44,.. te@tifie!l@ bef ore !i succor, ml ue ea r! J.: ermi i t I ;,ruc tio@ .-@,rogr.7 s..,, i F-,@ e 9 in bui-ldi the 'facilities f ai7 conf6@r.,ity@ in_ A. P3, ,te rlirbe.- ol'.natiorial orgr-@ni-za- ons-, inc-'Lu4L!ing'the. Armei-icpn the Ai-ierl- cELn -i'.e(".ic;-! Lssocir..tion, , as as B.rz , LEDO-, and @s, enC.,oi-sed ,-,@e urgt-nt P ities and @@e nee.-I @-r r' need -for.- hosl,.)i tal andi health 'cenluer f c-;@ -0 te-' assistance to su @ly tho ac@Li4.t4-es. L @Q se f -e in ics in . I,-Ci ;-el,7ort @ recor,-zentled --,hat !7eaera'- gran@ls--'@n-aid to L,:-,ates be Ruthorized ',-lo ist@ in :;ost%.-ar construction of hospitals,, ,@eCt:.cal center- an-I health-centers ;,he@ Pu 4earin@ befor@ a- Subcor,..,Pjittee of the lv'orr,.,-,ittL-e c-,i '@-@,ucoticTi and @abo@, U.S. @r,?,O DIJ C r I 0 r @nloruceq, sion of the in ";ay a ne, ;er i tal - -, -' e,-' I' t) i- c h l'o r t t t -;. 7r, eeT-@bo o c. n s o -,e construction o,--- hos-,) f 4 'c, 11 II L Close bet,.,een '-he 'red' t-Iii -,en'er c@ci- -Les e, (,, @' @ he; he, 0 rl!,l i 3 e -U --c)-e .ue@-@-I.cn cz, -,n aau c 0 a Eubcorr-' rise ,.as P-ppo@nteci rt, S..@ 191 ,'Pvorably. 'UNIT @@,-)teriber 19 @hich@@ hands: he 61 the PLmerican I os-@i, 4.,-. A he, S -'-@I Sec sub- con..T,ittee rewrote the b-'Ll',- so- F's ta cl-ar-i-@"Y several- -o.-ov-',-sions in the b-'-, 11 4 the lurceon Genr@r,-]- and apci to f,,larifv the -es.-)ons-bi',-Lty 'oet,:een lioSr '.@.-eciera-l- )4 tLI Co-ancil, on the one hand, anl on the other, between the "Jove-cnrient @-na the c@7'@a.tes. (Dn C@@,,,,ober 30, -'L94,@, the @-enr,-,e @-nd Labor Committee S. 191 favorably. 4@,@ @h,.s re@-,ort inc-@U-,-',ed a minority report by the Corm4-t'lee Cha',-riri-an, c-.enato.- Murray .-:-ho had agreed,. reservations, to re@)orting the 'o -'L 1 a naror vorab@y. ,,,Sp, -,ur7a@ objected to'th-ree features of the bill-: e P-asip m Th -,qen t: of to@ a. .!j rt@ti-' Hos@)ita-L Coun ities t oi-, cil;'@(2) fail@r6, to assure I'ederal. aid to@ needie t co-@riiiin hr' gh the lack of assistance for@the Maintenance and operation of hos-.oitp.1 .@ac@,-12Lties, ancL: standards- fo 6@eration of On 'iovember 'i@, 1945, Preoi-clent Tru@.-.Iar- sent rp-ssa@ge to 'U-ongress ! eg4 re(juest4-ng @slat-'@on for the c!,io@)tion of a i@-7 t--', on a. health pro-r3r.. :,he Pres4@@ient in recomy@,er.%',i-n@ the'. congress adopt , @cir@@.Drehen@, .,re -P.nd mo,@lern ll.)roV@ le f 4nenc; a, an,@ othe.- ss-st,!; ' e 'or -@.'e health 7,rogram iii-ged CongresE to nc loilstruct4@on oL' needed h e t li en a r t. a n u o e r 7,-., e,,-,, c e, -L he 1h and reh,@biiiat'.on 'a C 4 1 e S t 't,ted, the ns. 0 e:7be'T, Lo th &.n.i lith 'the hoe-oi tell :Lez, r)rovls..Q n .2jel-I Se ate rleba-to(i@ the.:bill ana &Iran .. e.,i t @,-of -,e y 7@nC@ en - bills, i.@ent; cal i th 191, 'ii qL dbeen .-rnt@r6,duc-e-l" in" tt,,.e Hcu--e Co, -r e r e @'ee cn (,) n jenue,-y --I ol-e4 gn @n _r.Ce. othe Co: n rt,- end 1946, P-f e side t a lei----er concerl-,4n@.;, 'L9! to i.on,---ess-.n@n Cia.rence Lea, C'iia'@rnan of the ulcuse-@cruiil-u@.ee on Interstate @ind -7ore-@gn Coirr,.erce, @ito r.,hich S. 191 had@also.lbeen referred. The, @res-'@,lent. objected, to t-,@c p ;EederaL Hospital Go to 2 U C T i: On February @@946, r- e-z r c- s e,- I v(--@,ion of h4@ ch ',',,e chr.nDes reco",re,., in n en@. to,- e -c an@ j-e- 0 table @r nt for const,-'Uct4.on ii ref)rec-en@,at-'-on ,)n the Pnt, of @3 113 and -,Iianged the -,ro--'ess;@onal-con@,un,e,-, IqOS-, t!ll @OUII,,4.1 -,.,e -ee to four-'our. ) 4 -f roT,. -@h eleral@ L On u 2 'ID n-1945, S. 1-9'L as r-oc-@,-'Ue 'O' ',' "--he by the House an@' the @enat@, a cori-e-@ c-nce. C-n ju--@l.- 29, re-)ort i-s-@ue.-@ .,hich )rolo.@ed ',",o. ch@.n@e:, h e 'n i a p@ P-,,z @I)y e @use, rz-,iEinz 1'h,-, flat,. @rant. fro,-;I 33 I/Ic to 40@ an-,, ch,-Ingin- r,,rof' -es.vionF!-- consumerIrepresentation on @@a -Tederal, Hos-.-I:Ltal. 'I'lounc i-l,l f ror,,.. f ou-r-fouT- '@-)H ek o rind t@ t z,@ 'Phe a n. i ".r, 6 LI@ 4%ver o L'. the@ c6n-@e'rp-nce T,erort. h on @'Aii -,6 @a s 109 b-,r I :Hb- se. u,-t n c- '91, obj o -ect--.nF the nt-u,,-,ust 3,..191@6 U two @)rovisions cited i-n @i i-.q e' ter oi' o,-,,- 1 rcunci-@- an,! court -'P, i-, e 7)r of the .@'ede-ra -e,; U 79th Congress. ence Fe-Dort, @:o@se of. '@e, ort o7., '79 th 'C-ni er' -)97 2@ Se@ to- a:-: C. 7@.. 6 9 7, +-o ,.n ':ervicP- @'tc@ -Irp.n@.s 4-C) thei,@ hos @i s tO@ LU4"(lC'Ci7@' grP-r,,tF, sue 3 .-n@l Notice 'le@@. Psentati-,7es e it F@,nictE!"i e Sena@,e ot the, TJnite,' a t;n s le 7.er7.ce :Ln k@cr)--rc- e 1) i-i,: t t.@ C,: MCIY ae c @he 11-Fo-@ ii 1,@,r-,7ev "o- st Rn- n -ricl-ioii .Act'". i@ib" i 6 H Lh 'ervici6 A@,,t. (c.@on@,istill@ e,,3 O'@',+t4-tlea,--- to- 7 i-nclii---Ve, of the i@. c of Ju-,! 9 /4 4 ta 68-2 i-'s hcr hc%,, Qiid 4.-he-.-eof the- i c, o,,, n.-,-,, ne-.-. !,.Lt-te. The- ne a- E6,11 -46+ on@tt@ted.@- P@L79@r th s u sucn eL% 3. Drcr Cram of t character -se tii: in Stdt6 and local Hunts -,Por'@:)lanniiig and (,,-@rr,1-4Lng out @ constl-u@@7-en -- @ -1 4 but will at '-,he s@-e '14@me e@icourace File t(.tes t--c @.he for car@linc ou.-. the @'o -,he @reatest -:o,,,@.'b e ex@@nl- con@-&-en' L J- a proper check u.)on r--x-,.oendi@.urp of 5 c- o ,:i t I construr-tiori @'6 74,v., ,7- .-7 e'fecti ve !-xi @a Long-range, s@oite in @f.,tvor @i.orf, @bjec'iva-@ :,.n bi!3,-, in:-@. cr o@ ier. hove, E s-c n, a from 'so, of @T on @o-"so@ reach o+. one,-r.-vin any thi-F., t,,uanimity o:L- @V _a-'.,zear@h@ r, eason. th;, t@, tried -r n" ontr hi-g-@ -@t@ride a.-I or jcb-nsl,on on a' h C-@ b-z' ot, @,en t th6 IC.-,lr4 'tee, '-'@t-int /@l, floor of ',he Senp te, i-leceTrb6r Statenients in Eu.-) )ort of tlip- b@ 1 F,.rr@ ccn'pi n@@. -.a numerous @-@ia-ces in the hearings, -.ii '-:enate 119, i')@, i66, 1-1@7, 201, 227. Z2,3, "@o7; 2,@o, @i-s, @3, 7, '3, Hos-oilal JO "Tha-American sociaticii, its @-,,embers hove a-.L,;en miicot ed..@ bgttter,,' d-ls-tZt@ttq@@ of,- ho rvi e se e t ri f,'b the t careful extension of facilities for ren.,Ier-ing that care merits your careful and 6-arneslu- con@-iderp-t'-cn. A.-, a'fi-rst ste,-) i-i-i the i,-n-)z-ovement of the distribution of hosn'Ltal and @Tedicc-,l @ere, rlle the -)ro!n,7.t an,,i favorable acti.on by this committee on the, @oF@,Dj.tal- ',,tirvey F,)i,,i Con5trict-@on Act as @-asser.' by the Senate." H@se !--.me.-icar, Iasociat4.or, 'opi'Levp-s than" the Dro-ram by as passed b-,r ("he Senatet -@,rofiiges 'o con'rirAite to ipi,,,roved hosoi@.al -9 L 'ffe-s i's 0 and medical care in thif, co=try,.enclorses the bill stron y, and gl i,.ii @-.q-rrying -gut. -ass, shoul this !:)ill every.6 'Dro on rp of the measure, CO-Tiff be@ law." Ho c-f-aterienta i-.i. onposition to ('he bil'L m4v be f o-an@l in Senate Feai@-Lngs pages,.- 266x,.3,13;@. ffpuser Hearingr).. 16-7, 2 2,4 3 8-. @-e only. se 'ous. Connor., t of t h e op@osi_tion,was mad6 by C'Ong-@eetEmr. esti@7@trig as Ch-,,,irran ou,e @o ronriations Commilv'-@ee. The objection @,h,-: 1', lulic- Fer.Le r,-q 1Gove,-n@en@, p as not 4n a position to -,svw-.e fnanc@a" oo,ijction-- a n@. '-ha" the 4 States and J'.ocar governments 'oettpr finance the r)e -@c- 167, T, a PU s amended by t I @-urve SeTn a y Einr-l Consti-uctic,.i @.ct (Pub!-Lo '725, 79th Congress, '00 tp f,. 29-L (e) 13, 1946.11 5 rpgse@of,,@h4s titie ii to.as5ist, t r construction d' 7ey @he neel fo ---to sljn to e@.Fe'o7@ i.o- con@ili,i-,c'ion of' such ni-i b 1 c @ii other non -rrofit- hos@-litals,-,qs ,L n 6 hc all-the'! o-,,'Le; @nc !,-L -.c -,--nd o -Lllier non (b) to construct ibl-4 -lo--,-)i tals i-. -i Ih c,, i cli @rograns. c c or,. ,n-r., c e @h( le ruc.'ion. of such -,,Diibli-c tinr, other rcyi -rof i- programs for the const hosolt,-,ls as i-, conjunction the 'necessary ,-.,;hys-L@cal @'o@ @-'urrishing adeoua-te hoST)i@lpi., inic @d SLnilar services to all of, the @econ@L, to 6ol Congressman @re been s, .11 ng S L)i.L -7e tai, a]-,,,Drincl-,iles hatre. been:recoanized the, -f act that certain broaLl fundament t ci ed by com-i-) tent local authority, and not as-an incident to a Qublic @!orks @-.,ogra.,,i or som e other purpose no- F,-oi-.c'ficElly an@l Director related to health np-e@Js as such; spcon,- uha,t @ttit6s' rights cLnd locfil initiative be Preserved and encouraged a@ to the success of the undertakin,7: an-; ti-iird, that the 7ol,,-:nrary, non@@--rofit institution is duly recognized L'o-.-- the -jl,-ce -LL" -Ln @@t-- contrioution to '.-he Nationlp health". H. hearings, @,,age 12.. re numerou@ other e -ou 'Pos@es,. of-. There a sta.t me@.@s t6lative to the generaL. the en monsoon C -'on ecem pge 3 a 48, e z)ages 76 8c 274;- H. Hearings,, 14 62.@78 -7 I.- Sur,.re- L -7 and@ Plann4-n@, @ir@iose, --on in pci@l i @,o- irhis feature of the leg sia4L U- LL o. 'ue-@zig -commented r, favorably in most of the L@orego-Lng s@,Etp- en'us,- recei-vet'.. notice anl@ -@p@roval./ on. c.)r .1,@,o 1-@t of the --'eci. @ y je.mer-t of @ir. bl-,,@e ch. E,,@te s- .-.@)ront-L se..@@ z,-n@, rL s- h Of their nd their centers of -hecnlth for'all 'he ne onle serve. 7 e r-!ny that rally of these centers come to -@ei--.res=-nt t-he of all the heaTth mnun to resources in the co iy, '@ssigne-d $-.)'Oly the tec.@-;ques of @Dre- n,, ciiagnosi-,-,., anct coorC..inate-@-' eff6rt.@ to. .3romote, 3 'fac-i-ti" so l' t ink th,,il the 0 i es, 7 601 bill Chile pro-,ii - 4 c 4--n th gr@nc-!, t o m E;,,.c e + r ou@, o e c i- b' c@t h e a -@.se on @n tn -@,-Ih or e a rd S.. Hearings@, i),Ige 16c). ot be placed-udon the 4Tircruance oi a 1".roo@ inuch-emchn.,@is dn-nn 'ta.1 fa.-iliti.e- comprehensive and cril-@ic,-.1- analysis of exislina- hos-.,-)-. n any long-rarig.-, It is an act@-vity @-,h4-ch requires extensive deta@le@- --'-,u,4 oF all of the fp-ctors @:hich affect bch @'.-4e -Y LI 1, use and extent of --.re--en- @E,, C1 4tiez: as -as '-,lie i)or-,sible chon,7es in. public a,,)-creciation of r-@,re, ir@ethoc-@ of' 4nnce, and medical.care practice of the c o r7,,-,un i- t y .A @-tu@l ,;uch as is needed -could, best be Tnade a.,-, the Stite level -ath(,-r thpn.from central national office." S., Hearings _-@age 244. e, so, :Lnf t@e' --le 23@ p infra. no'. a tL" @h ,Programs must be based on a s t e v,,, i de i-,,ivenl,-,orj- and Su.-Vey. TO.72 !lie '-'Uate --onstructi-on ':)e -Ln -piz?nner: 4 rta te n :r l@-ge c@ sholl deterntine need or, f i Lips" of II,, health denter ly: a en, un r -,e 'b) The -F@,ncy s, I! e t e -i e'hroup.@ field investiga-L"-cn, En,:: other,.-se, rlie a,@ ed b s o r 6oi V4 ho @ng @ie'Ue-.,ir-'@necL ho@-!.-.,Lt,.@l @nc' center nee:@s. the L,-,a@e @g-encv shp-,."- 7. 1 in 110.12, and 10-31 an,.! shall sho,,, the relative nee,-@- each !)ro i ec@, i,.-i:-es.')ecti-ve o,-- the-, "&'oil-ty ol lunds for construction and for me'--n- ava@- -ion. etan@e and orL-rat e 2xle.: a- ecessa371@ 'Out,." e y r s@ least -Innua"l i-evie,,,, the: ov -ion -,,rogr @nitel construct, 'Annuill xed 7@, b:,, the @u-r g eon 6ener@,'-,, the. -@i c, P- n i I @ubTr, t to hir-i c, h c' noun L@iich revis;on--, o la repor", 0 @q z t ru c 1-or@ i:i-o@,r8m, s the iA.@ eacy. con,-icier@- ne--essv-ry. const-ri on s P- e let! in the o-der of.relat-'ve r-ee-1. 611 U VLY3 4 @ta,,es @n n 601 there is out t4q@ -,ur-@oses of @ecti-o .,.carryin b-e tell 'he s,@!r. of .'3 000,@000, 'liere@ autnorizea o rer@n-in @v@-iiLb'Lp- unt-'.-',- e @ur.-s u-.-Ier thi@- section shal-i uL4e-.:t 'l,@,yT7,entl@- to St,-,@-es i,ii@-ch ha%re s,-ib7@@-tte-@l, anci ha,,;'. a-,,),,Irovect o-@f th=- Surgeon ""Ieneral, State aoiD-ILJ-'ca. tions for funds f or ca..-r7.rinL 'oi the reporter the lena @.e @ -,n, i' ee, The or4@,,-inal an, . . I @U authorized a-,a anpro:)--,4-a'uion o-@ 4@ m i 1i c@n ' ,:-'L oa r3'-nce the Hoiise CO=4ttee had cut ["he .7ederal share of sur-vey and planr-Lng 'un@,@- to 33 113',.- it also cut 'the authorization to three Tiillion r-@,oll-aro, H. -T'f. eo r t 11 a219 @pag@ 2. I- 4 101 -lef6-.ni@@-onv@ ur@eon Gener@l The "uri,7@on Gen al ea- @ic. ife@-,. -ice. er o:t' @ited': @tat b l@h: Serv" t'DI2 LAV: Le ati on on -or -c@es ct, e c tc-, P-pency the sole. agency for carrying out such nurnoses: -T'he@ t -ecti-on ar-Y 1 R n 'L-L FLs 'Dean a.) ove'l.i uil- .ter aSteta sliEll be further survey or furction@ out c@urs-u,:nt to section /o23 (a).(10), by the a@en@ y C16.5j-@.at@d-- irr. aqcor@l@cia Zenith-. section@@ 623,. (a) A s la r !Dr o,,ri s i oii con@@.F; --nea- -1-n :-@he o--ri-,,:---nal bill the @4 @ee. exception of t,,,Ic; proviso 7.as bt,@ the '@'enate h i- -.te a@@,M4 niztra'-:ve after L-.ddi-tional -;rovis -on as,-,rrc-c --ont-'-nu-'-, c,@," @10 @-t@ . 11-1 " - 7 L iyas no sa-eg7ja-r' that appro-val of the It-,-e ?icn. he @ll bjlL I-,Iiei-e -n Sta tp- -v;oulel c on @irue -i z-,'I- z-o.-rvey ;-,.nd ing. -j C',-,ivi i--i e se e3Hear =gsr ani'2.72--.- -1-19 ancl' "I 'hat,the @.'106 gFe,@tidr-s on )c 7es 2u 'icallr'fia-m e e@: i.r@ th e- 1 I-e "rtmen t -bp- e tibri as, the -.,sing@ Def ini f,'ions S: -F-a.k'e a.,.-ency.s the c c r, e @x -f-eci re, -U- eithe.- @.he a@enc,,j c. lesignateO, by the S'Ua'ue r s-Lie-n'.- to Hd@,,3i,tal, Surve7,f-,azid. th@ cy -iesignat ,4gpn ed ta mi i.-"-Ier th, a@,e to secl-ion@.r)23- (al. a 4 :-,I !D -State, advi ,ha I l@' inc,!uL'e re@ agenciec-,, conc the operation, ccn,-'-Irur-t@.on, or ul-,-'Llizat4-on of hospitals, 4Lncl-u,'ii-@g re;).-esen4-lat@-vss of the consumers o-L 'ho.-i)-,tal seriT@ceE selected from among persons -.aifiliir 'U C.,, e@v--i c e s@,'ur. b agen( ep-tion.muz -he e@-,'@abl-Lshriient SU@ 11 e e e gest-I.on in HeE:i@-Lngc-, 23" for of local advisory councils. u (a) llshc. 612 provi@te for -,a!,Lny an inventory @-ct@ on 6C)i an-A ey in acco.-n-4-n-@e -.:it cn e Surgiaon. General, and -"or devi,-' oPi ng a crogr,-m 62)- section .,,,-as. @lear in.@ t b-i!T that'one of its T)uriosea@.. S@n te.. -on e activities 6iii-.e-yer e Ie@ tirror L:,l r-c toll (;Omm @the.Stud S Rea.,ings, pace 2'18 et seq. Yi. ,nnot f a "Too ,much ej7,.oha,lig c, e the -;,i,,Dor',,,nce c comnrehensiie and cr@it4-cal analys@Ls of x s t n Lr ho s i t a, 'L -@ c. c e in any ion.--ranize --lanni-ng progr.-3,.q. !L@ 4-s an acti-vi'uy ;,.@h-Lch i@ecuire.7 ex,-,ensive detailed s*.udy of a-VI of the -,-'actors i@-li-ich @-.@L@ect- both-- the use and extent o.' Represent, faci '@elL, a s,@ t-b S'4 Note Flso the te U.L.-,,ony relative to the North CLirolint- E-Lir-;ev Hearing-, pages27"1,--t seq., '82 e@ seq. The com@.@)en@.s on 'reha',-4' o@L' '.be i-@,Tr--r@-can TnsI.-4--tulp- of Architects at',@age "69 are F.Iso o-.-' -Lr@,'-erest. @ee- also H.I;epri-ngs, a e ion ough,@ob@,, .Oion; t of e legiel@qtion, su,@ra. 13 6 !2 ,,s C. ,@-L2 that the. S',ite agency @n( 1 1 Tr-,,ke si-ic,ki rerr-, i ng, such e ".@ur@-eon -7,-znera@ riay e rea-- na es to the @urgeon General, ui.-@on C%CC s record ,.hi-cla such i-P.@,orts are based th ea i@'o@' 01 P- 1'6n sonably" For r so e at Pr g-e a ae-itr.-d 'nv @,!as@@dontaa'm6d@in@'-@he ori@,inAl: bill. d o ei sug. omtnittee. ' -itical lanE-uag,e seca@ in 623 (9) Lnfra. Ldei -is the Senate-C f 612- (b) C. 612 (b) The "ur,"eon General shLll p@. 0 -)roTrp ny @or f-,) n @i s hi-cl-i !,ci.,T)l h e -oro,ii-s-Lons. of' @,ubzec t-', on lln,-.Ier the original bil'. to comply w4-th si-,ch -r the U'ener@il, .-ith the o.@' tl-ie 'o, u t, -incil, ri-ht Dresc-ribe. 'rhe Senate felt i - @,esi.rtblr-, to limit the range of Fe,.Ierf-I -.'Ziscret4.on ancl --.@vi le!'. thp-t . t,iese functions be carried,'OLt in P-ccord=- ce V!it,@, @,e@,-.tio@s.@ Rer)@.- t 'Md. 671,,@ -@ri t i power roi- @q .-Q6m, ri t Note@@t i he t ienp- s@@ a '@P- "037. on, the,.re.Lq.rlveF ee r,@ Hee--il See", @,he@ ir Pa L s 0 -,p 635, s o the s of e f, c i e s 61@3@ T6 'PO C a 4,, C- ,-ach c:t,,.te @-or i.-:hich a 613 (a) on ;:,I", @-n -:n:@ -lotment -,uch. ;,,,.o,)o-Ltion of be e n r@- ci to an le t' o o p '6c- r a@, n opula o@i' and ::ithii-i such el-,L,ot,-ent ---hai'L 'o e en@QL t."Ie@, to, ,-ece-tve of --arr-vi-ng oli@ the O+' Se.Ci-4 on 601 (a I i@1, e-:i accoi@tanc _:t"l its a c,-,tion: Join t n,(, the be 1 @t6 :any @qtF s te, hz: e, 0 t -E@geon Gen6--l s 11 be entities est,'_,,,,rlalu-e 'Q.Lle su,,i toh c heach @q t:F,e under this sect4Lon, @,"U,-!-n-,- @uch ensuin@ ,@p-ri-od as he 17!ay e t e r. e a n,-.@ s h,,i 1 @L,hE;@c,.u.,,,on c@--- to the estimated -e.c-f e te.r-.v of the- Ti:easury I-,ie E+nount so the c E Is@ 'auce o h t the: ain()Imt to@ the, @tdtia n T.-as e ti tll L -ec@s l' th '7r.- h!nll @ucli- ;Deri-od. 'he y o e - -,4 @i-iry s -he the-@e,,,-,on,, -,.-io@- to au, or settlement, b@r th .:,Gener e el@, th-- @,@,-,,o'unt: '@4 d@ ijaid-@ tc c er@ ei for t"115@ e to the. -t- i,, ----7 o;@ '@i e e:-i 1 3 'The OT o@kief .Lac+.or-@ az lie f i, e 1 0 -lie ar"@, C) T.,.. r@i tio the snelledoutta def:Lnite@ fc -1 i t i on;- 1 survey ar.@d is flat 50@@, grant &n'@ .,.-ov-'Lsion 71@@s i,-,a.de -for lo,@., to the States. , e pou@,,e Co,-;n; @.,,--ee cu@, tied f"-a-t gr,-,iit to nlanni-ng flancis th - I the s-u, @uti-,o-,,i ze@ -o be de'et@,"- 'he @-rovi.s@on for 'oans an@ cu' i -()ro 4 ,.e t 0. 19, geS a,r). priateci @'rom f;-ve ,-r@illion to 4@-hree 7. -72. - -)ra. S. Hear-ngs, -)age 62-1 su. IlotTq nt@-@-a-rov,-6iona. repay-me p ng f-uiie@s unex@l-ndeLi- 'oy the State. The Senate tD21 'O'@ T'GT70i t 0 he c:7 r-r@T'n@, e 6oi- (,b) L, 'C'k, f 6@@- t 71 l- 'to o. ze, 'e @-id@ng e .7 u-n e, 30, 1947, an@-,-foi ach of the 'oiir succeeding ol-' 7 r, C,-j E@ L FU years, the O,-300 -@or the con ct'on of nnr--, other non laos:)itals-, Fn@ the-,-e i-re fur@ier authorized to be ai)proQriated for such consLrucr,.- --I -qurf I E @)rovicie @secti6@ 624'. The,@.sumsl-app:roi)ria@ed -his se ti6n sliall'be used for uant to I maL-- n- payments C. --to ctates which h ave- submitted, and@ h,-, ai-)proved- by the Suroeon Genera'L, State @-.Iaiis L'or carrying oul.- the iDur@-Jo--es of sec-@'-, on 60'L ('D) anc' for -,making -,@ayments to i?ol@ tica'- sub.. v o n c -),jb'L i ca other non -)roL' i t Agencies in such Stalu-es." ll@ Introduced, p r o vi --L'@ Ct fora prog.@ar.,,- of indefinite dura'L-l-Lon, @.'If-NO,000,00!3, for the -@ 4L --st year and, afte- the firs'u year, set no ce4@li-rg on the -@imds th@t t cou'L@- '7i-i e b re,Dcrted out oL' '-.he Senate con-Di-'Utce 7;ith a 7. i-, t 4 t -L o n o5 ;,,ears on the @Ura@,-Lon of the program End a of 7 5 q,. 4- on do s -.er year on --Fun,-@ c- t ;?@ge 81 P@, Is 1-4o@.,. te, tif ied: -tha t - 0 f)rl @'fo tli e ations,. e )-io,-rital construction ;Drogram CU qave been. o 75,000,OGO per- r e -@ i- for. b 6e+,@ one@7lart6 d 'e, @)i of'-th or @.Tieii s T-h -ovi e or- 01 oo-,ooo@)OOO the' year, plus necessp_.@,i' @l-@.0unts irl succee@ ir.g yeerq- iodine "-e e-@,-Lble. @71-, i s IL D,@ a -2 t i- car ru e since the coz-t of -i-iecesc-,,-@ry constriicti.(-)n t yp-p-rq --n E7ubsecuen c@)nno'u )o@s'Lb l@-i I,- -,i r @ F. e 1 17 p tile rres@-n@, L-;I,,e. e v@2 e F. c-n c r C C e @@-eref 6 ra, @'l; e i-e ec c c., on c u 'o e o r e e- o@ definite! future H.,@ H @-7he -@ur,7eon Gene.-r.'!L cf7 c-IL o' tIDr. Parran:ll T !:.,Ol) e-,,- to l@e-ave I-. e T-, P. n h e L Cti---cret@-rn o--P 'L'i.rst y-@pr, -Inci Cray al),)--,-o,,riat-@on of -."7@,OC)0,000 a fea r, E,-!@-o 'Lo liaie the bill ol@erete ove-r -ye,-ir on the other 'tir-nd, 10 ,eri o,-'.. If@ ess h ea to impose a c@il@ner @ihich @I ho-@De:tli,--t the- ..Iif a f ter,@@ th 0 ral hzt Oil!.-,I 'not,' give 00.000:@or@@ QDG that@: you,, e ha P,,rila especi call as YOU iiroi,,-n, in conne .-@i-on. Doin teC, out c th the mentp-1 he a 1 'I@i bill, nobo@7,, Isno-,t.@s, ho@., @uch a, @o'@-la@ '()UY 5 year-,- L'rcm no-,%,," -,-@n. il@@Thp-t 4-s right. 11 D-r.:. -r@.r @'@.n:4 thp i-I s the ree -@n f-.t,-st -c-CoTr@,rendp-tion vl!ouid be to leave ,@e,@r to to determire t@ b-" !I: fter a s@ the am-ounts to be ap un Piece f'ic ;Eition fbr th@.'f i @@t o,,r. -r, sot-@ t t -L h o s i s T. erect the' co@nc--, @n c@-@.1 e@-",Ilc@ on nd tF o @,'ie L-,er4 can b-l-,;ons o' -ov-@n -ur for ex i7.. ing@ ii.-' the s,, s @t;@p-b6ut 500,@. -@unc (H. ffear-Lng du on. -Base .-IC 3. Cofj,4t,ee r,@@o@ized the @n ;,"@le 01@: 4 r i- 'j, e(i ,e hos"ic,@ .@'nu Ofic 20 oerce-,qL-1 of the. _u eon @eriera' to 'L)P-@ by Sii-rg U Orr_. "onstrudti. neces. @s@a to in- tlUCt4 .,qssi'L@anc6 -IL-or cons -on, crea the. 'Lin either -o7j increasing the aiithorz-at2on ce4lin@, or b,@ e,,,- u tending the @,ir,,Ie (@ur-'ng ,.,!i@-ch funds t,ell i-or th@-,- e, throll@,zli both re hoci@ - (S. P,e@o@ t ,@o. 'O't4, ),7.@,e L .1 'll Senator ',aft in Uliie e'eb.ate on the, b--- -ren,-,iture 6 11-e hf4,.v r 'traded a 5 c e D 0 -year 'or srv e:z ',be su-Ifi6ient t' enabl e the ,900..OOG;,.d y@ar4;; Th,,L, aff' 0 'be. i t'@t ed. @,,,ran t a. ge a e enCious n -of in,@uci.na 'ever,@ Otate to make a -corc@I@ reheftsive hos@i,'al th6@, -i.. 1 be given--,.a L-ire '-o t4e to67e'@-Ler for itself. 't' he 61@ the h6@@.- it@,l@, @syaf@@l ta includes .,ubli@ v a t e ho then to @7ecide ,.hether a-,-!-t@onpl an(! -lee ho,-:.,i tcll.- ae jet e S. C ,01_ .,p,, 4 no matter l-i-. e be. 11 Print No. 3, -@a-e 8'@ . .-ee 624, infra. @o3.- ot-' @@.e -rob!eTn. o@l- @,',-,o@,e-r,,atching non .Jrof ta-1 s. see arants-tq hos@,:L 4si6 gr6es,@ provides:: e th assa@ i cre tment onstr otio@ of sr n-6- c -df Se6tion', 624 Publi c@' 'H al'@th rvice Ac, as amended by the first' @ection of this act."' 622 LA'-, G TJ 1 O'@ 2- thin,.@ix IT:onti@,s aL@,@er the of la-tion i, oe . . . shall b7i zeiieral- @-egu. re,.cr- Ci4- Th67 CQTI-E re ere r,,, a d e rr o P- been in -@th Te@- eral and,. e- e s'., lot@ h t at po@,.,er @@d, the States. 6. t 1.@ n to the@ St fo d:- or- ru a:", .q n s orii. g7@ I e io pt :d the: -,Drov-is4-on o!-ii tted. -:her rel'orte,,7t out bY the Senate p6li@ @dc e , e 7 E, r t,-,,- c"etps shou'i L Prd Committee. _lr i e e took Luhe cosit4-cn tha'@ Re,iort c 6 @w6ul@l be able 0 handle thi-s f 'qeiere'- ai-d. @.ge 8. zr @age 47, CoTr.. r,4 re '-.he Fp, H. @IeF, @ngg, qee also Hear;-ni, ant @or-um. 'qgo@@,146)@:. p testi@, bnY. of Dr-.,: Boa-i 622 G U i 0 il@ OP Ti ? V.;" Iect-ions 10.1 to @O@79- inclvsi,,@e,, of this 6e ,,ur.-u@in' to ',he ,rovisions o@' e c oi-@ 622 of the HeL.Ith Servi-ce ,Ic@ !3,s q,!; P. n u e (i by @- 1-i eH o,@,i a E!n@, Cci,.,-7ti-uct@.on Act (--@ibli-c L'@, 7'.'@, -lc,)@Lh -Fred to the -u Congress) a, ved A@8 t l@, 19@@o, -i'ch a, s act- a n t4-tled ,(,'on.-ztruc,tion of,Hos, @ion@ -6@2, -requires' th-t.,i!ithin- ik t -he,'ne enactment bf't t@@l@y ;the- @t5u@,,e6n@.General@ -r g ,e -@e,@ilations -Describing q-enerp- -@io l.-@ c,. e s ri OmUl ,i I-o-- be :Collot;,eci in se'.tin@, u-,D an@i P-@,.7,4@nistering State s for con@trjct,-@on c-@' .-@ubl'-c P-n(.-I other non,-)@-(D'L it hos, @Ltrl a rD.ec@oii. are% I o-,r5@l@4 ,Ye a, E tlni Y, nital bee-S req.,-tirec', to ,,sEc. 622 (a,) The )-umber of @neral hos -,rovie-e qO-equp,te hos-oitp.1 services to the reoole resi@in4 in a File @eneral :method -ethics ,,r.ii-ch -such 'ced.s State shalL ba Distributed. -,,.iong 'case @,-eas inter:necl i-ate areas a--@@- t exceed f ur e-n one .@lf per thous@)rO. noTuip.tion, excert th,@t in Sta.tes @.ving less t h,-- n twelve ane,. :more thp.,@a six rersons rpr saiLi.re the limit sh@ll be five 'oeds -,er thcusane. -no-oulation, and. in States ix'nersons, or-, less -mar s@re mile the limit s-@ll, be Or@thousanE topulat1cf1l, 0 ns) within thee Sta gte more 'beeLs tlan -re by the s t ene,.a r e s -rrescr-'l e 'oy the Surgeon Gpn,-ral, the excess over such s@are.ards @-y be eliminete@@- in calculat in,7 "his mpxirnam P,l o,,var-ce. f tosti ie n T)eo-nle- P.s A reasonAbl,@'a',bEitimate ities in h i I think 4u c ink- n h@. -. u er.@thousan@ t I,. D-r P,-rr@ see". th fizure .5 'be's 7-)er thousancl, an-6 other Authorities i-r- other -nl-pco-s -11-so l@ve @ VP-ri,-.tic-- of that ninber, but I think it is the consensus nf o-nin'@o-i now th-@t require -rer thousaneL. (S. F@e--trin,-s, 24) in su.-gesti-n--7 the limit a the, Co=.ittea reporters-, wit@p, Gur. coriLnittee concl&..ed- '-ha it 5 e@tenile 1-tshed iCA-rL.@fe&@al Associ@. -12 13 @larch 3 s- itrary aqsi an tb,-..t, at -f ',i@ i-T 4 y obs, o', e,e-- merge al@, o@c he., estirn+,e@,,@. givea tell the, d ttE Arere n,se on a re.; n t@ s re,r 1,000 @-)r nersons in' cities of 10.000 a.nO. over, aT,@ 3. 1, 00 for smaller towns Pne, riarp.1 -@-reas "I 7rol-l'i,117 '-os-nitpls, -nr,2se.., - -:rptes @re @ 1. 3acn,use of the use Sti -0-se@ oa 'beds for P.11 the ro-nuln.tio,,i -- 9 n r 1 e U7- t e -.I e e,@ -23- 622 Your c or,,T-. i t t'l.erei-c.,e set 4.gl e -er the u.@@)cr d @n. -ttaei- @-.gi t f'or @erier@l a,- -la rea,.,, c,.nl-"! @n ,i rn (,@ n @ 1, oaoe area@ @"revent, ;4neciuj-ti-es iq. ap-,:jlic:s-bion 0 it is also or(:l tfitio of, at)er,-'@e to t@)reven@ @he imis ing,'Of a,-@c-qu,@ta 'Fcilit-Les i-.n other, sre,-@ o a @t,@te, the b e n o n e.?. c e s. F o t.'IeSe -,,@y lDe In e C- so lc,,ulF, t-; n oi E,,',)le e '@c, )r, I e i) or -.,z e ,,, 8' o e. 1-io@ the e 0 7 statement by E,. iones c." 'Uhp- j@@@.o,-.tern @io@-:@ I.,21- P-,@bl.i- -li --n@ -,nc: Ili3v ex,.-leri-ence in. ha@in@., hundredc. of hos tal ications to the l@,, ar rlr6f:iu uion Boarl ax, @i@, the t no.on_@-se@ bed - ra ti-o ner w)ulatioii, s-@di aI carE hen Ss f a'- ho S,- ea.1 c t.. "-i ab c r i t 61- r 4- a tli y -ti red thE 1) o'blem@ ho-,!!ever i @oiis@en, of certa.i,.i grouos- of individuals s e -L z -L ri u-,-@on tiie@ s P, n -,! n -f - @t- bed r--: io of 4, b e s @@er g_ ,thousand for urban.,?orula@ui or@, '@a'nd'2 beds -,-,er Luhbuse-nl for rural ,!here sr@ctly to'such the only@yardstick. to.usc-. .-,ts, to R a set Standard -ciie@te tl -inevitably -lead- to serious r---rrors. I kLhis 1-@bc-u i.-,erely_ to ie co-,nrlexity of tl-,e -,@bler.." .(S- Hear4.ngs @-a-e- 372) For discussions to the.riumber of,,beds'-needed@' reas- see. S.. -ie qse,il n the. regu'@ t- ons. 4n ,h-s nert,: T,, L n 24. 0 1-22 h,- ",he -'S F@ -nter- is en @li-@si,,n Io -n the t@-ons -'Ln or 'u r,-, gree:7@@en f the ro o it qhall I e (I ixres cr)n L -.in @,h i n O' schoo rL jr.,u,@:- be ,3uitaoie. use s i@teci:-hos m -,.'Ithin the @r-,,tite;'Or (2),-, the R rea e. COI,@E a ee. on' th6' (F g@n6 -f' 0 I'a e, --or @eneral i i.-l- e'7his 't fui-ni ies n tT,,o or hos-[-)-;. al -sh ni i,esi@ienc le for rise a s, F@ base more S.:)6c, e g ha@, a c o, on enera' ho s of 'LCO or -ore 'oe @table@ or:uFe a- r 622 (b) IISE(;. 622 (b) The number o@L beci-@ r@.-c,ui to v i,,", e a-',Pr, -te @tf-,v-4ce- ior 'luber'llilo,@@-l' Oriental. c)p-tien tE en i@. a. @fethods' by, ihi@4@ th ral- method. or ibuFe'd thr;-ugho-ut the St,7te: @rov-@(2ed, the t for e or' 4-his t;tie @he @otal -C r -i,.bc-rculcus no@, e:@ c e e,-@ ti.--o an(I one-hE.-l@ the f--,-or., lt@,te oveT' the ve-77e,,.r -@erio,:' @'rr- tuoerculo F i s in the ber' of Ioeds f'or not @exce thousf-nd -a s ti n t sea eci five @)er -lo-oil r o ir iiuT.,, t) er o:L chron@ --isease @-,,ati no@ exc-, ec-,@ t,,@:o, c-r 'hot z,,q-ne, -,ulat@on. ne', a f b 6r- c-u o' s i s if .@f6@ xi@ ly @:!6 000@ in &on I e 0 a@Ue beaa-'sre needeci t@ -E ce e'@ ob,--ole@ @-c i t i e s . I;ee also S. He!: ings @)age E,. le-:ort @o. th r @yq. -Clabe cii ft,-Oc,f@t@on coim2jittee o4' the t-I one -,T O!F SI -LI i-ev- ous e, to the tee 11)(--ri-, on o ot, death." n--,,, )--,t;e P,@-22 (b) ;yvntal:beds:, the' Senate Coir @@ttee The Surgeon GenerEil testifie 0 e 117@@,a. ,Ind ti -ieed foi- 'beds i-yr -.er-7,ous s.-d menta beds -or replacement of obsolete ;.ne,@tu@.ions and of 97$qCO Additional facilit Dr.- Sensen'ich of -'the '@r,ican iiddic'@l' Association testified: "Chronic illness of other types, especially the sloiily progressi.-ig illness of the aged, requires.long periods,,of hospitalization and beds 'over' for' these @a hospitals planned for the cannot be -given' patien in care o f ac@e illness. The. aged- iw rson, having suffered a cerebra hemorr for years, cannot be w 0 r thos,6 are chfldbi trip eL t@,,'the individual, with,, ;-peri d of e or! o'onsideir'a-oie @thd b] t-' the (1 case4, that is a different category entirely,. doubt this fact..vii1l lead to the eventual'esta-blishment sn'ec'l-al hospitals for chronic diseases* It costs less to oper6.teo'- yoia dd no@@-ri@ed. all. of the facilities you need'for acute il@ss Sora units of governreiit must support the indigent in these hospitals, State and local governments @y be s Iti.-.ulated to accept from'tuberculosis -as reco@nded sanatorium standards committee of 4.he l@tional. Tuberculosis Association,, Previous estimatds. -6a the@, subcommittee e@ tier based on th&. al(i standard, of 2 beds- per annual, 10.21. @imum state ailowance the number of beds REGULATIONS.- required to Er ovide adequate hospital services for tuber- oulous catients,. nmnta' .-cationts and chronic ii seeLse patienti in-anv State, shall be-. ea ti roulosii@ ir o@r' the 5 year period from 1940 to 1944 inclusive; (b) For rental patients, 5 per thousand population; and (e) F6r,chronic disease patients, 2 per thousand =e3ital; and: oiii di s s s the beds in a I cti es as defined above, and -also -beds in any general' hospital which are specifically assigned for the care, of tuberculous, mental and chronic disease tients respectively', except ivhere in'stitu@ion'ii@ber less@@h'an (is s@ al s@ r t Yediar -Act shall be ,built'in of population and proximity to general .@hosPitals, :L@ls receiving h&l prox@ty@ tc pule-tion and in prokimi to general hospitals. 28 "SEC.,692 (c) The number of public health centers and the general. iw,-,qod of distribution of such centers throughout h 4 C i- f or " h,3 o LL- n o s P, s ) f h i s t '@ a , s 'la o the 3ta@ay -a -made one, per thir,tythousand population., except.the-t in per,, a a', quELr 1: ot ceiad one per t-tient,,r @h'ousand population.' The bill passed by the Senate permitted a higher ceiling for public health canters..in.-si iginally provided for in,. +1 ndmient was fi6'o@,6t, the@ Senate Co@ittei F'r@@ p,%es.@ S.'iilso@ best ny -;4rgi ng,l health@center to, a ze_ 151. and one@flhealth center to 10.OOG pa For testi=ny aL s to the background and need for public health centers see Senate Hearings ages 102- 115, 187, 351; @H. Hearings pages 87,. 141. et. p seq* See 631 (f) infra, for the definition of public health c@nter. nur .(,a,5uktinp those@exi's Well sha de@@':vii,ti,h aid' under the act), exceed one per 30,000 State population, except in,Stat6s havinr, less than, 12 persons. per square mile the number ,rat Yhich- the State Agency, after (a) Ex-Vstin& facilities -Keith the S@@@e health authority, has determine, ,,onsultation 'public health centers, an@ to '6 ein s u i ta b 1-- for use, as ;i- @nd@ clinics., o'.a5 the health department office ffi s -udtur :Ln@ e ami str or in a separate structure. ii@ribu-ion.- The Feneral method of 10.3 D @,.@,-@.diatributibh-,of@@"t)ublic health centers throughout the Staf- t sec o:f the Federal Act, the method of tition shall be deter mined after consultation i7ith thd-'State health authority 622 (d) SE;C 622, (d) Th@ general mnner i,n.-which the State Agency shall detar@e the priority of projects based on the -,.-la'ui-,,3 need of dff-arent' 3act;-ons of 3 -oT)ulat4 on -and h re as,lacking-@4pqu@@e,hoapital@.facilities areas with rela iv nenaial resources* Gen even wi re.4; bv-the..,Siwgeon. General, with,,.t -se bk-@ th& note vm e tkdop a n @eLn@l lly' s i'l@accordance -with' that Comnitt@! s '6 - i6d t:in a;ojzor decision that the, Surgeon General,$ Dmetions be c rr ou dance With@ regulations',,-..ITote'-the followin in the Sen'eLt6 -116arings at page" 67: Ma y I ara-k 'senator T'aft? sattention tu'-c6i;tain language, on,. page 7 of the bill., lan@ge which does seem very broad uthority, It oith ',ti4 r,61@a'ti-@e' ed@;in Elie St whe@ er, or no@ it wotAd not @;e"'beet to have a-provi@ion, in,'the@@bi'll, that the s-shall f ir s t be U§,pd, irL a. State to build.hospitel.P c a @ iliti6 s @where 'State*_ "',ho@tiilization. id. most ne ed 622 (d) Dr. Smalzer of the:; .-Merican Health Association in the House Hearings corirlented: T @iowever, ;dse that this act does not attempt to establish ric-@d standards of,rela-Llive need. :',- is im-Doss-,bla ro,..i to @@e ayiir fin@,l dec-4-s4----r, 3s to exactly-,;,@lf,@.'-t hoso4@-@al may oe necessary to offer adequate service to all2,o2 the people and the act permits, a. chang@ definition -of need -eir to. fit 0 tha-t@ in t as-* Such hos- itals migh -the key, quality of care in an entire State, p andi in addition, function as training centers for physicians, nurses, and other technical workers required to staff Outlying hospitals. The definition of need should, therefore, be developed by the State agency in accordance ;iith existing circumstances under the guidance of Federal regulations and standp-rds." Ho Hearings, page 50, Priority --Rural.- @na C-O=i@;@ tt., 'Of, the@ Farim Se( nistra- tioli" O'ii fb@, @ur :,Co, 'd' voi s i@'eve we need oidy; make certain that abso n to,a.consideration of needs, In other @iordq, the lang me.cl that.,no institution would be constructed'in a l@s's needy @efo all :;ore needy areas 7iere ar a r provided for., mer6'ly because,the le.s a na e d ld assure fina4cial rain- y @pa cou e tenanoe '(S'*' pag 1 3) see also :pag s,.10-5, .1.65,, 261, 292. pproval'i iitvl the.,House @pa;,ing see,, N T@I@, @'io :L out.. litert a t "it@sp:ltal ASSOi Senator LaFollette, In viev4 of your ansiver,1 will ask you another question, if T may, To @at extent do you thi@ it will be possible for the hospitals to- meet the needs:of rehabilitation?" rn- 4@orued bi 622. (d) 'the larger proportion of vihatever -7iords Senator LaFallette. In other funds are a@vroDriated.. sh-otild@ this' bill become law,,,, ;4ould be devoted to the constructioW of'ner,, faCJI4 ti.3,5?11 '!Raverencl.Sc.ht:Lta,lla.., lo,. zeet the.@h@er-to unmt need yes.. Senator-.",- "it may not'Ibe-appr6@riate to outline-c.onstruction priorities in the bill i@sel:C. 'Perplexing questions moreover, as to the relative need for such fac3'. ities as general or tuberculosis hospital beds are bound to confront administrators and advisory councils. ,,-iith regard to general hospitals, ho-wever, I believa%that the first priority in constructing projects in @pproved @Stater- olans should clearly and, explicitly be given. to medical service institati obstruction. should ;3i RE r, of determination.' The@ izeneral.- manter@ Balance among,catqgories of facilities.. Insofar a. S@ta.:AF-enc-v shall' develo-o its con- 622 (d) onsideration shall be ropor-tionate needs c In determine P ;es and those under construction given to exis4ing facilit- deral Act,, -mithout assistance under the Fe th centers and additions to x'sting hospital s and hee-I over replacemerts, except: shall be given priority -(a): nere replacement is of mino:e character,and on,: of needed additio 1. faoiliti@ 6n@ e o elimin@ constitu a public hazard; 'ivh a r ein -the case of P oublic. haELI,@h center the State health authority.has certified that the existing 'i24a a for a -publi o@h r The relative need for beds 11.1 the area (-base, .cli@te ox, Which@the Rroject wall be int Der son 34; @" @2 f,,i) sirall financial resources, (b) :i, a7vxten@ @o ce ifade s@ the population.: s 10.45 Chronic disease ca@e' o'-ory. Priority shall be a en to those projects. in -,-ihi oh the chronic disease ilities will be,,operated as subunits of general zhest P;l ty@ y shall be E e provision of facilities al communities an d for-local health unius serving rur areas with relatively small financial resources. ;there canister the..,State Dl@ ab w i @hout af fe c tin gthe priority of hospitals serving rural com @nuiiitie s and areas, with relatively s rr;a 11 financial er nw --35 622 (d) u The State 10.77. (b) Order of --processing applica@iorz-, cy slaaii process aDp- icat@Lons received ir- the order0 nay may aDorovef,,, re- out of the order'of.prio rity I (1) The State Agency has afforded reasonable Opportunity and presentation of projects in the order for developrBnt nf priority, and tci, th6@S al 7 'tha- on nancer@ construct resouro( Pr ioir, ity ar --top er, 0 'ertit on of available, State plan shall The priori-t, f of e- project under the act ti-iat other projects of lovier not be affected by the f @y .have.. prev,o f. constru LAVI: St' 62.2 (e) General standards 0 c ct-@on ctn.@, n -'or- hosp- eQu,p i tal s of @,-Iasses and The,@ri-ginal bill @i i dnot contain any requirement for such re- Gulations. It i@equired the State to set.forth a construction program, in ace rdance ivi--h standards prescribed b 61Z (b), 0 y t h,6 Surgeon General. See @622.0 suprao t on General. ibi@ aser n and@:,e @iii I holitals of-di.ferent classea'and 3.n d ty"pe@--of locations. In our opinion this provision ia greatly i@proved'-in R 9 5629 by providing,,tha@"the Surgeon General.shall S'Qo@ i-6i I t dards for maintenance and for alsd.have re y'for, Er aserib@nr, 5tan these facilities.' t o, as vie.11 as.@ for the construction and equipmen page 'Hearings, 138 standards o@,.-" @t'e 7- r nanc( on.,@ standar, 0, r- co quir O,r:E ',@L,r'o '6 House C or,,mi 'ut e a did not '@ted by th6 Senate. change o pl. .@rican Farm Bureau tEL.@mnt7 b @y ova 0 835,, infra. ne a 37 622 REGULATIO!@TS: 10,'.51 General.; Plans and specifica-t;.o.-,.s for each project submi4.-ted to the Surc-eon General -.or approval under the Federal @.ct sha -.e prepared :L-i accordance '-.he ons+,ructio an ocations as prescribed by the Surgeon '@eneral set forth in Appendix'@.4'@. The Sura-eon General ray approve plans and specifications -vihich contain deviations @-om the re- quirements@pr6soribed. if lie is satisfied that the t ]3,t4@ hELva beem fill6dw, the -ns coverec Ip s @te th t 0 d w@th.the a-.c,,oroved ai ordinances ZLII tate, plan. The plans and s@ecifi oris must be complete and adequate for contract'purposes and have the a proval, p am 0 ta ar s; Agency shall @49p@ general standard@. of@ consl,ruction@and equipmnt for -o@p@@tals, and, health center4 assistact s@-!of h 38 LAW. "sEc. 6P,2 (f) @'t the Statq,,,@la4 shall provide-for addqu"a'te ili@,i e's f or,, the peopl'e. residing i P. a, Sta,.a, -,vi@hour, di on. %,ccoun-c of race, .@efor@..approval of,a .applica- p ri @q re. .!IY tion 'for, a- hospital or', addit4.on too hospital,is recom- melidecl 'by, a State Agprcy,, assurance. shall be received by St t -oital or th -:Ci'm the a;)Pl such el a e 0 ican hoe 0 color but@ an exception shall be made in cases.where facilities vided for separate@ axe. oro ,,separate hospital population groups. if the plan makes equitable provision facil: e@ices, of -oha son, testifying on be'nalf of'Al. Kappa Alpha @.c?rority stat e@:., f6 ces. . . Our income status Prohibits the purchase of these servi organization asked for certain ant-,.discri-minatory amendments to '.he .Senate bill which were essentially included. In 4-lhe Senate version of S - 191,. rage 24, lines 17 th--Ol-i@zh 2L, nna- -g the %,ord --ou-o there is a;-orovision on discrimination because of race, a--eed, or color. The designated-. purpose for@ this-provision was, -chat this. statu-koe. would pro- 'hibi@--@6uitabl6, di of. sema@rat e@ facilities because of race,,. l@@ intent of,,this... i used n ine ..We should like t( c@. 0 tp equired by State law-', We should like also to change tha word 'shall' in line 20 of that section to tmayl. @@a though in a g_rant-ir.-aid program which is to be admin- istered. and financed partly by a State, State law would obtain, hence, separate hospital facilities would be mandatory and the word lshallt would probably be correct. However, we prefer the %word Irbayt, which is dis- cretio'nary rather than mandatory." H. Hearings, pages 195, 196. See also, ..,S. Hearings,. page,, 3 -.mi-tt,ea reports S...Repor@ o e ,:iq6re qait@ explicit as. tb@ 622 (f) REG ULAT IO 3 10.61 General. The State plan shall provide for adequate hospital facilities for the Deor)le residin@ i,.a 'D - State ,'Ii-@,hout iiscr4-miration on account of race, creed r:aolor an&.shall provide for adequate. hospital facili-, 0 ties for persons unable to pay therefor, 10.62 iqon-discrir@unation. Before a construct-.on application is reco=.ended by a State A ency for approval, the State '@gency shall obtain assurance from t he applic@.t that the facilities to be built with aid under, the Act will be made available without discrimination on account of-race, creed, 'or color to all persons residing in the area to be served by that hospital. --ioviever, in any area where separate hospital facilities are Provided for separate population groups, the State Agency may waive t'ne requirement of.assurance from the construction applicant if (a) it finds that the plan otherwise makes eilii:ftabl6 provision on the basis of need for facilities ,@d s:er es' of equal s ity for each uch,'@cipulation cup in the area, 0-nd. (b) such finding is subsequently approved by the Surgeon General. Facilities provided under the Federal Act will be considered.as making equitable provision for separate opulation groups-when the facilities to be buil@L. for the p group less. well provided for heretofore are equal to the proportion of'such group in the total population of the area, except@that the State plan shall not program facili- ties for a separate population group for construction be- yond the level of adequacy for such a-roup.1' 41 622 (f) UK: "SEG. 622 (f) (2-) There will be made available in each such ,Iospi-@Ial @,,r a ital a reasonable 4c.3s to persons unable to Pay volume@of hospital serv..@- @@-theref or-' but an eac ep@ion sha.11. be made if such a auirement is not -feasible from a -.@4 ncial standpoint." re --na :-,This provision-. added by the Senate Committee was not in the originated" 674, page 9. bill. Senate Report No Note that this is permissive and that the Surgeon General is not re- quired to issue such- a re@la@i'oni See S. Report ;No* 674, page 9. H. Report no. 2519, page 8. Some thought -was given however to a definite requirement that recipients of Federal funds handle a certain number of indigent patients, S. Hearings, page 190. Note also the testimony of Dr. Boas of the Physicians Forum: "The provision exempting hospitals'.trori providing services to persons unable to pay, if it is financially imoracticable to accept them is unfortunate -3.nldead',, since it id these very patients who are most in need of such care throughout the country. It would be 4ghly desirable to remove this condition if -at all- possible.- But shoul(i such ez condition- appear to be financially =ev-itable, there should, @t least be an antidiscrimination clause attache