Budget Requirements of the District of Columbia

recipients are capable of doing the work that you have to be done, and may be available to you. But you have never been to that source?

Dr. RUHLAND. No; we have not. I would not be able to say whether it is possible and practicable. It would immediately pose a transportation problem, and so forth.

Mr. BATES. Not necessarily, if they live in the area, there would be no transportation problem. There may be somebody who lives right across the street from Gallinger who can be of use to you.

Dr. RUHLAND. That would be a possibility, but I would say that it does not happen to be the fact, unfortunately.

Mr. BATES. Well, that is all right, if you do not have reason to believe so.

Mr. O'HARA. I have one or two questions, Doctor, on this problem which would be in the realm of speculation, but do you anticipate that under the Federal hospital program, which was passed this last year under the so-called Tydings bill, do you anticipate that that will give a more efficient service to the community of Washington so that we may anticipate a reduced cost of hospitalization or do you think it will make any change?

Dr. RUHLAND. Well, the Tydings bill, as I understand it, really makes possible only a merger of certain hospitals in this community. Mr. O'HARA. That is correct.

Dr. RUHLAND. And they are primarily interested in service to paying patients. They may develop an out-patient service, and I hope they do, but I do not foresee that it would immediately help us in our own clientele, which the District must take care of. No; not that bill.

The other bill, however, which is also in Congress, under which the United States Public Health Service may make allotments to districts, might hold the promise on the basis of computations that the Public Health Service has made, that there would be available just short of $300,000 to the District.

But that, in turn, must be matched 2 for 1 because the District— before the District can hope to avail itself of the possible $300,000. So that is not at all an immediate prospect. In fact, the appropriation has not yet been made, you know. So, the money is not actually available. That is all in the realm of possibility.

Mr. O'HARA. Is it true, Doctor, that some of the private hospitals render an out-patient service, and by an out-patient service, do I understand you to mean that people may come in there and get prescriptions and treatment not in the hospital, but in the clinic without charge; is there some of that done by the private hospitals as well? Dr. RUHLAND. I do not know that any of them have entirely a charity service that way; out-patient services in hospitals usually will make some charge, and it is deemed a rather good practice. The patient usually takes a greater interest when he has made some investment. In other cities where I was we came to the conclusion that even to charge 10 cents for a bottle of medicine was a better practice; the patient had a greater interest and did not feel he was pauperized, and they were less prone to lose the medicine and then return for more. Of course, obviously, you must at times simply give it without cost, and we do that in our own health department service. But that service, I think, is conducted very economically. We fill the prescription, which under the former contract practice possibly cost $1 to $1.75 and possibly more, at an average cost of about 17 cents,

so we are using every device to render humane service at the least possible cost to the taxpayer.

We ought to enlarge on regional health centers. The Commissioners, as you know, have approved such a program but building costs and money are the answer, of course, to the problem.

Mr. O'HARA. That is all, Mr. Chairman.

Mr. BATES. To follow my question a little further, Dr. Ruhland, what is the type of hospital help that you need in order to make active those vacant beds?

Dr. RUHLAND. First of all, nurses or nurses aides. I would take almost any type of employee, but we have tried the Federal employment agencies, and the private employment agencies; we have appealed to the Red Cross; we have appealed to the public in general. Mr. BATES. Now you are speaking about nurses and nurses aides. Is there any other type of help that you are short of?

Dr. RUHLAND. Well, ward attendants, and so forth.

Mr. BATES. I have not the information as to unemployment compensation, and the number on the rolls today compared to, say 6 months ago or a year or 2 years ago, whether or not any of those on the rolls are qualified to do that work, and if they are, I think it is a good way to get them off the rolls. Now, has that source been tried?

Dr. RUHLAND. We have made that approach but unfortunately it has proved unproductive.

Mr. BATES. You take a note on this, Mr. Jackson, and contact the Unemployment Compensation Commission here and find out what type of help they have available and why it is not being made available. You have made the request?

Dr. RUHLAND. Yes, sir.

Mr. BATES. Mr. Jackson, find out what the rolls are today and during a year ago, and why they cannot fill the requirements of this kind, which are of an emergency nature.

That is all, Doctor, that I can think about, and you are going to provide some tables for the record.

Dr. RUHLAND. Yes; we have them in preparation now.

Mr. BATES. Thank you, Doctor.

Dr. RUHLAND. Thank you, Mr. Chairman.

(Statement submitted by Dr. Ruhland on increase in appropriations for the Department of Health and Hospitals.)

DISTRICT OF COLUMBIA, DEPARTMENT OF HEALTH AND HOSPITALS

ANALYS ́S OF APPROPRIATION INCREASES, FISCAL YEARS 1937 TO 1946

Total appropriations of the Department of Health and Hospitals have increased from $507,970 in 1937 to $5,777,390 in 1946. The personnel paid from District funds increased from 262 in 1937 to 1,662 1 in 1946. Table No. 1 lists the activities of the Health Department and shows the personnel and appropriations available in each of these 2 years.

Table No. 2 shows how the appropriations made to the Department of Health and Hospitals have grown year by year since 1937. The chief reasons for these increases are as follows:

(a) The transfer of the hospitals and medical charities to the Health Department in 1938.

(b) Expansion and improvement of service with a consequent reduction in death rates.

1 Includes 102 part-time employees.

99538-47-11

(d) The increase in the rates paid to contract hospitals.

(e) Increases in salaries dictated by the rising cost of living.

(f) Increases in the prices of supplies purchased.

(g) Increases in the city's population and in the number of patients receiving care.

An important factor which should be kept in mind when appropriations of this Health Department are under consideration is that the District of Columbia functions as a city, county, and State. The proportion of the budget which is devoted to health and hospitals will therefore be larger than that devoted by the average city alone. Washington itself has to make up for the service which a State would usually provide.

Attention is also called to the fact that the cost of rendering hospital service has increased all over the Nation. New and improved therapeutic procedures require additional nursing and physician time as well as supplies and equipment. The following tabulation for example shows how the cost of operating Gallinger Hospital increased from 1937 to 1946 and how that cost compares with the cost of operating general hospitals of the Veterans' Administration:

Thus it may be seen that the amount of funds available on a patient-day basis for the operation of Gallinger Hospital was below that available to hospitals of the Veterans' Administration in 1937 and is still below that of the Veterans' Administration. In 1937, the conditions at Gallinger were such that patients had to be placed in hallways. Medical service, nursing care, supplies, and equipment were grossly inadequate. The death rates were high and many complaints appeared in the newspapers about conditions at the hospital. The public demanded that appropriations be increased to improve the situation.

In spite of the increase which has been made in appropriations since 1937, it may be seen in table No. 3 that the patient-day cost of operating Gallinger Hospital is still lower than that in any other hospital in the District and metropolitan area.

As a result of the improvement and expansion which has occurred in health services, the general death rate in the District of Columbia from all causes has been reduced from 14.2 per thousand population in 1937 to 9.3 per thousand in 1946. In 1937, the District rate was 25.7 percent above the rate for the United States as a whole, but in 1946 it was 7.9 percent below the United States rate. If the rate in 1946 had remained 25.7 percent above that for the United States, there would have been 3,151 more deaths than were actually recorded. (See table No. 4.)

In 1937, when the 26 largest cities in the United States were ranked in the order of the size of their death rates from low to high, Washington fell into twenty-first place. In 1945, for a similar ranking of 19 cities, Washington fell into first place, with the lowest death rate. (See table No. 5.)

Thus, it may be seen that expenditures for the conservation of human life are the most productive which the community can make. It has been clearly demonstrated that "public health is purchasable; within natural limitations any

community can determine its own death rates." Although there has been a substantial improvement in health conditions in the District, there is still substantial room for further improvement. As long as money can be traded for lives, money should be so traded and lives saved. The community must decide whether it wishes to save lives and spend the necessary money-—or vice versa.

TABLE NO. 1.-Health Department-Number of personnel and amount of appropriations, 1937 and 1946

TABLE NO. 2.-Appropriations for Health Department, hospitals, medicat charities, fiscal years 1938-47

1 $13,000 deducted from Gallinger and added to Health Department for out-patient relief. $26,760 de Jucte i from Gallinger and added to Health Department for out-patient relief. 3 Includes $50,000 for Providence Hospital, $15,000 for Home for Incurables, and $35,000 for Columbi Hospital.

Gallinger
Columbia

TABLE NO. 3.-Patient-day cost in hospitals in Washington and