Part 54

This does not mean that as long as special treatment along any line is needed that each patient will not have such expert examinations, care and treatment as his condition calls for. Quite the contrary, the most careful and competent examinations should be directed by hospital units composed of the most competent staff of men including surgical; medical; ear, nose and throat; X-ray., etc., at such intervals as the condition of the patient calls for. It will be by this system alone that we are to keep a check on the progress toward recovery of each individual patient and prevent an undue accumulation of a domiciliary group. By proper cooperation of such a group with the rehabilitation section, many men may be selected as suitable persons for rehabilitation in the vocational schools. The importance of this we all realize as there is a certain percentage of patients who will be quite content with their state as long as they are receiving complete maintenance and a liberal compensation of from $80 to $150 per month and no cares and no responsibilities to assume in life. That is we should be constantly on the alert to prevent making permanent residents or charges of any man who can be restored to an earning status in life.

Contrast, if you please, with the conditions in our hospitals the patient in private hospital, who is paying from $10 to $50 per day for private nursing, hospital accommodations, etc., and a correspondingly high rate for special professional services, and who in addition to this is losing heavily because of his absence from his personal business. In the latter case there is a much greater incentive for getting well, a greater incentive for requesting that special nurses and other expenses be cut off at the earliest moment it is found that they are no longer needed and for the additional request that they be discharged from the hospital as early as possible after the maximum benefits from hospitalization have been received. In the one case, the private patient is paying freely a large sum of money to get well. In the other case, the patients of our Veterans’ hospitals in many cases are paid liberally for being sick.

In making the above statement, we do not wish to be misunderstood. We all know that we have among our patients in the Veterans’ Hospitals some of the best type of men anywhere to be found; some of the most ambitious; some who are exceedingly anxious to have their health restored and be returned to an earning status in life at the earliest possible moment; but, unfortunately, this does not apply by any manner of means to all the patients whom we are hospitalizing. Out of the disabled arising from an army of nearly five million men, naturally there will bob up representative types of every manner of man in existence. As representatives of Veterans’ Hospitals we owe to our Government as well as to our patient our best efforts to help, not only toward the rehabilitation of every soldier who can be rehabilitated but we are also obligated to help develop this program upon the most economical basis without sacrificing efficiency and the most satisfactory constructive results.”

MR. BURKE: stated that the subjects were now open for discussion, and called on Colonel Patterson for a few words.

COLONEL PATTERSON, of the U.S. Veterans’ Bureau,: stated that it had been a great personal loss to him that he had been unable to attend all of the meetings. He then spoke on the policy of the Veterans’ Bureau with respect to the utilization of contract hospitals and Government institutions. He stated that the Bureau has been for some months endeavoring to take the beneficiaries of the Bureau out of contract institutions and put them into Governmental institutions for several reasons—first, the law says we must utilize to the maximum extent the Government facilities in existence. Another reason is that the majority of contract hospitals are unsatisfactory from the treatment standpoint, if from no other reason, as many of these contract hospitals are purely boarding houses which originated merely for the purpose of making money out of the Government, by taking care of beneficiaries of the Veterans’ Bureau. Of course there are many contract hospitals in which this is not true, but it has been determined that better treatment at least equal cost can be obtained in the Government hospital. Another reason is that the civilian hospital is not particularly interested and does not desire to make the necessary reports. He also mentioned discipline. The contract hospitals do not like to discipline a man because it may lead to the loss of that patient. He stated that every time the Hospital Section of the Medical Division recommends the closing of a contract hospital the Bureau is immediately bombarded by letters from Congressmen, Senators, the American Legion, United Veterans, and other organizations, but the Veterans’ Bureau has been trying to stand firm.

The next subject he took up was the fact that a beneficiary gets more compensation while he is in a hospital. This, however, cannot be changed except by Act of Congress, and the Medical Division has recommended to the Director that the man’s compensation be reduced while he is in the hospital.

He took up next disciplinary regulations. With regard to payment of transportation, he stated that this money could not be deducted from the man’s compensation without Congressional action.

He spoke also on the fact that under the Vocational Rehabilitation Act a man discharged with a disability not connected with the service, who has been denied compensation, can get training even if his disability is the direct result of his own misconduct, and that he is entitled to treatment for any disease contracted while taking training if it interferes with the continuance of his training. The Medical Division recommended some time ago that Section 3 training be discontinued and that no man be given training unless his disability is the result of service or aggravated thereby.

He said he hoped that the gentlemen present would express their opinion as to whether or not meetings similar to this one should be held annually.

With regard to the attitude of the Veterans’ Bureau towards the various Services, he stated that when allegations are made all the Veterans’ Bureau can do is to send them to the Head of the Service, asking him to take the usual steps to find out whether or not those things are true. On the other hand, if there is a charge a man is mistreated, the Veterans’ Bureau must investigate it. It is a very peculiar situation for one Department to investigate something conducted in another Department.

Regarding complaints, he cited one case. A letter was received from an insane man in the west Roxbury Hospital, who signed the letter “All the patients in the hospital”, and complained about everything in the institution. A letter was immediately received from a Congressman, then another, and one from a Senator. The institution had been inspected only ten days previous and the Veterans’ Bureau was sure the allegations were not true, but sent out another man to investigate the matter. Later the Bureau received copies of similar letters which the insane man had sent to President Harding, King George and the Prince of Wales. He mentioned this as an illustration of what the Veterans’ Bureau has to put up with.

Speaking about coordination and cooperation, he mentioned the fact that the Public Health Service is represented in the Veterans’ Bureau by Dr. Guthrie, Dr. Lloyd and Dr. Long, the Navy by Commander Garrison and Commander Boone, and the Army by Colonel Brooke and Colonel Hutton. In this way the Bureau benefits by the advice of these men, and friction between the Departments is avoided.

Another thing he took up was the situation in Arizona. Attempts have recently been made to get the Bureau to put hospitals in two towns, Phoenix and Tucson, both of which he stated were so hot that everybody would have to get out in the summer. There are 431 vacant beds at Prescott, within 400 miles, and in a few months 422 more will be available. Transportation has been offered these men to these hospitals but many have refused to go. He believed that the Veterans’ Bureau could do more than this, but wanted an expression of opinion on the subject.

MR. BURKE: asked for further discussions on the questions raised by Colonel Patterson.

DR. KLAUTZ: stated that he would like to ask Col. Patterson whether the question of furloughs has been taken up in connection with disciplinary regulations.

COLONEL PATTERSON: informed him that length or frequency of furloughs had not been determined, but permission to be absent will be obtained from District Managers under policies issued by the Central Office from time to time. He asked for an expression of opinion on this subject.

DR. KLAUTZ: stated in regard to the situation in Arizona that probably all the hospitals available there were situated in an altitude of 5000 ft.

COL. PATTERSON: informed him that Camp Kearny is lower than this. He stated that the policy of the Veterans’ Bureau in regard to tuberculosis has the backing of the National Tuberculosis Association, and that the men asking for hospitalization had been offered transportation to Kearny or Prescott.

DR. KLAUTZ: offered the suggestion that somewhere in the mountains North of Tucson there might be places which were not too high and would be good all the year round.

COL. PATTERSON: reported that there are already at Prescott 131 vacant beds and within four months will be 432 additional. Why should we go to additional expense when we have these other hospitals?

DR. LONG: took up the subject of the speeding up of patients in hospitals, which is necessary for two reasons—first, in the interest of the man himself, and, second, in the interest of economy. The average man was about 25 years of age when he entered the service, and it should be taken into consideration that his character had not been formed, and that keeping him in a hospital tends to destroy still further his initiative, so the sooner a man gets out of the hospital the better it will be for him. As for economy, it costs about $240 a month to keep a man in a hospital. He stated that dispensaries are now being established in the district and sub-offices, where treatment can be obtained, thus a man should be discharged as soon as he has reached the maximum improvement. He cited the case of Palo Alto, where arrangements had been made with Dr. Wheate that when a man had reached the maximum hospital improvement such further treatment as was needed should be obtained in the out-patient office. In about six weeks the total number of patients was reduced from 540 to 417.

DR. ELLIOTT: took up the question of furloughs, stating that at the Naval Hospital in Washington at Christmas time many Veterans’ Bureau patients asked for leave, and pursuant to advice from the District Manager they were given the same amount of leave that the other Naval patients received, from 5 to 10 days.

DR. DEDMAN: spoke on economy. He said he understood a certain rate per diem was to be established for the care of patients, and wanted to call attention to several things in this connection. First, the environment. Some hospitals have central heating plants; others have stoves. He said that his hospital was an old cantonment hospital, with a unit heating system which required the employment of about 45 stokers.

Another thing, some hospitals Are a great distance from markets; also, prices may be higher. All those things make quite a difference in the average cost of the care of a patient per day.

With regard to General Order 27, he called attention to the clause which gives the Medical Officer in charge the privilege of giving the man his transportation back to his home, and mentioned the case of a man who come to the hospital from Oteen, where he had been discharged for disciplinary reasons. The hospital could not admit him, but authority was obtained from the Veterans’ Bureau to admit him for examination, and, if active, to hospitalize. The man was examined and found to be inactive. He then complained to the American Legion because they did not hospitalize him, and he had no way to get home. However, in this particular case, transportation was later received from the Veterans’ Bureau. General Order 27–A now gives the Medical Officer authority to pay transportation.

He then asked whether a man who had been discharged for disciplinary reasons and was very sick should be hospitalized.

COL. PATTERSON: informed him that General Order 27 has ample authority for emergency cases.

CAPT. BLACKWOOD: expressed his appreciation of the opportunity to attend the conference, and of the great value it had been.