Mr. HUFF. Through the mental health commission channels, yes, sir. Mr. BATES. Yes. Now then, the determination of who pays is made by the officials at the hospital, and that usually is on the Health Department here-on the Welfare Department here? Mr. HUFF. Yes, sir. Mr. BATES. So you pay the entire bill irrespective of where the domicile of the person is. Mr. HUFF. Well, that is true only in those cases, first, for whom the dispute between ourselves and the home State cannot be reconciled. We would have to accept them and to continue to pay for them. As to those whose residences are later accepted and determined to be in a certain State and are accepted by the home State, we pay for that period of time only which elapses while finding the proof of residence and the opportunity to transport them home occurs. Mr. BATES. Well, let us assume that somebody domiciled in the State of Minnesota, and while here, is taken to St. Elizabeths. Suppose you find out that that person came from Minnesota 4 or 5 months ago, domiciled legally so in the State of Minnesota. Do the Federal Government or the authorities at St. Elizabeths assess the District for that patient? Mr. HUFF. Yes, sir: he would be assessed, and we would pay that charge for the period of time he was there under the District jurisdiction. Mr. BATES. Now, suppose he remains there, and the State of Minnesota will not accept it, and it might be well at this point to see whether the State of Minnesota accepts these patients or not-do they or not? Mr. HUFF. Generally speaking, the home State will accept them. Mr. BATES. Generally speaking. Is Minnesota an exception to that statement? Mr. HUFF. No, sir; I could not particularize. Generally speaking, and perhaps I could say in all cases, the approach by both the State and our people is wholehearted and of good intent, but sometimes they differ as to the facts and as to the acceptances and it might be Minnesota, it might be Georgia, and it might be any place. Mr. BATES. Suppose it was Massachusetts? Of course, we gladly accept anyone who is domiciled; who would pay the expense of sending them back? Mr. HUFF. We would pay that expense. Mr. BATES. And that runs into considerable money. Mr. HUFF. We have an appropriation for deportation. Mr. BATES. So that has to be met by the taxpayers of the District. On the other hand, if that patient stays there all the time you have to assume the full responsibility. Now, in our State, and I think generally all through the East, a person domiciled in one city and who has not lived in that city, say, up to the last 3 or 4 years, either through the medium of welfare or hospitalization, is taken care of in this other city, and then the other city is billed. They give them 5 years to lose their domicile in the other city, and if they have not been out of that city for a period of 5 years, then the city from which they came must assume the bill that is sent under the law to the community in which they are domiciled, so that protects the community to which he had gone for temporary employment or otherwise for a period of 5 years. Now, that is another indication of the fact that the District of Columbia makes a contribution because of the condition of those who, we might say, are citizens in the United States, which perhaps does not exist on any great scale anywhere else. I wish you would do what some of the other department heads have been told to do, to summarize the services that your Department renders to people who are not what you might call domiciled in the District. We would like to build up that over-all picture. Mr. HUFF. Yes, sir. (The following was later received for the record:) DISTRICT OF COLUMBIA BOARD OF PUBLIC WELFARE EXPENDITURES BELIEVED PROPER CHARGES AGAINST FEDERAL FUNDS A. INSANE AT ST. ELIZABETHS HOSPITAL Because Washington is the Nation's Capital, many persons come here to make appeals to official agencies, such as the Veterans' Administration, to members of Congress, and to the President. Some of these visitors are mentally anbalanced and are found to require hospital care. The cost of this care, while here, is charged to the District of Columbia. The following items are, therefore, believed to be properly charges against the Federal budget. 1. Nonresident floaters who become in need of hospitalization while temporarily in the District of Columbia, but whose residence elsewhere cannot be proven with sufficient sureness to permit deportation to the State of residence: 50 patients at $1,295 per year__. $64, 750 2. Nonresident persons who become in need of hospitalization while temporarily in the District of Columbia, who are cared for while residence is being verified, and permission sought from the State of residence for the patient's transfer to a hospital in that State: 100 patients at $1,295 per year__ $129, 500 3. Occasionally a nonresident insane person is kept in the District of Columbia after transfer is authorized because their physical or mental condition does not permit travel. The number of days' care given such cases in any year will average less than the equivalent of one patient for the year. 4. The cost of transporting nonresident insane to their State of residence, is borne by the District. The estimate of this cost for 1948 is: For travel cost, 224 patients at $113-. For investigation and attendants.. Total___ B. TEMPORARY HOME FOR SOLDIERS AND SAILORS $25, 347 24,000 49, 347 The purpose of this institution is to give temporary lodging with meals to veterans of former wars who are in this city with reference to claims, etc., and without resources for their maintenance. The institution has its own board of managers chosen by veterans' organizations. The services of this institution, described above, are limited to veterans who are in the District temporarily, and usually on business with Federal agencies. It is a private institution. To the extent that public funds are justified, they should come from a Federal agency. Appropriation for 1947, $19,085. No item asked for 1948. Mr. BATES. I forgot to ask Dr. Ruhland if he extends any services in the hospitals here in similar cases of those who are domiciled, say, in other States, similar to those who are domiciled and treated at St. Elizabeths Hospital and also who have domiciles in say, Maryland or Virginia. We have no reciprocal arrangements there, do we? Mr. HUFF. We have none in our Department, and I think the doctor has none. Mr. BATES. And these hospitals were under your jurisdiction until recently? Mr. HUFF. No; 1938. Mr. BATES. I presume that there are a lot of people who are domiciled in neighboring States who take advantage of hospitalization here? Mr. HUFF. We hear such reports; the numbers I could not say. Mr. BATES. I wish that the budget officer would ask Dr. Ruhland to give you an estimate on that. I had that question in mind to ask him here and to what extent he would take care of so-called out-oftown patients. Mr. HUFF. Yes, sir; we will be glad to supply that for you. I made reference to the increase of St. Elizabeths figure alone being 174 percent, which is a figure separate from our over-all, which included St. Elizabeths, of 110 percent. A figure, then, with St. Elizabeths Hospital removed from our calculation would give another base for 1937, which would be $3,152,000. For 1948 the figure would then be $5,342,000, an increase of $2,190,000 or a 69-percent increase. So the figure we speak to is a 69-percent increase without reference to St. Elizabeths Hospital. Now, when I speak of 1948 data, I refer to the President's bill; that is the data now included in the President's bill. Perhaps I should interpolate in passing that we may have amendments-we do have amendments-that we would offer to that bill. I would like to pass those amendments and complete this statement. Mr. O HARA. Before you leave that phase of it, may I ask this question of the justification for the increase in the appropriation for St. Elizabeths? Mr. HUFF. Yes, sir. Mr. O'HARA. Is that due to the increased costs of maintenance of people or do you anticipate that there will be more people? Mr. HUFF. There are two figures. The one figure is population and the other figure is money. The money is the per diem cost and the per diem cost for next year is $3.55 per day. That figure is arrived at by the institution based on statutory instructions, and that figure is in a sense legislative in its origin; the other figure for increased cost is the figure of population. For example, in 1937 the cost per patient-day was $1.80. The same cost per patient-day in 1946 I have indicated to be $3.55; the average number of patients in 1937 was 3,458; and the figure projected for 1948 is 4,800 patients. Mr. BATES. About a 50-percent increase. I would like to give then a figure that indicates the numbers of personnel before I proceed further with the general statement. The figure of 1937 gave us a total personnel of 483, and the 1948 figure gives us a personnel of 763, an increase of 260 of such persons. I would like to say a word to that general situation with respect to personnel. This will be of particular application to the institutions, although it affects any one of the positions to which we would refer. The situation in 1937 was in fact before the so-called pay act, before the 40-hour workweek and similar acts. Now, in practice, and especially with reference to the institutions, we would have a number of personnel employed, and these personnel would work a different number of hours than they worked in 1948. Many of them resided in District-owned houses on the institution. grounds, and many of them worked very long hours. In some instances that was as much work as 72 hours a week. It varies, of course, institution by institution. In one institution, for example, when we measured the personnel against the 40-hour workweek test, we found that they were exceeding the allotted number of man-years by as much as 30 percent. Now, this was not an involuntary activity on the part of the personnel. In other words, there was willingness and it was done. However, that is no longer possible under the 40-hour workweek. The correction of such a situation is in some part a reason for increased personnel. The base, however, for 1947 was a variable base. I would like to mention that point because it will differ one institution by another. It differs because of the structural organization, because of living quarters on the place and other things that are consistent. I will give one small example which is very striking, as I see it, with respect to money figures when we figure the effect of the 40-hour workweek on institutional management. Take, for example, our District Training School, which is a sizable institution, now holding about 650 children. We have there a central switchboard. The switchboard has to be covered. There is a child located in one place or another. He may be injured, he may become sick. There must be a switchboard, and that must be covered. If that be covered on a full-time 12-hour day, the coverage could be made, let us say, by two persons. The two persons at a salary and in round numbers would be $2,000 apiece, which would cost us $4,000 to do that jɔb. However, in order to cover a single post such as that under the 40-hour workweek it is necessary to have five positions because the 40-hour workweek does identify a man-year. It identifies a manyear as 1,760 hours. We cannot use and we cannot accept overtime; we cannot accept voluntary time by the persons employed; so we have to go to the man-year calculation which that 1,760 hours gives to us. That is a very small illustration, but it is a real one and a concrete one which I think illustrates some of the money problems involved by that 40-hour workweek. Mr. SMITH. Do you mean by that the effect of the 40-hour week is where you previously did a job with two men you now take five? Mr. HUFF. That would be the position with respect to that illustration at the PX board. Mr. SMITH. Yes. Mr. HUFF. I will give you another illustration. That illustration has to do with the same school, and this illustration is related to physicians. Now, a physician would come up to a P-3 grade; that is, the associate physician. It is necessary to provide stand-by service or on-call service for that school at all times, 24 hours of the day. We have some 650 children, many of them are incompetent, as you know, and such service is necessary as a protection for their health and safety. In order to provide such stand-by service we must pay for stand-by service; that is, a person who is commanded and is in fact on call must be paid. So that requires just like the PX board, a minimum of five physicians; whereas formerly such calls might have been accepted now we cannot permit the voluntary exercise of time by the physician. So the same type of illustration would apply to that example as it does to the PX board. Mr. O'HARA. Mr. Huff, you have indicated that before the institutions had a 40-hour workweek, many of the personnel of these institutions would be perfectly willing to work the 12 hours a day, and some of them as high as 72 hours a week. Do you notice any difference in the efficiency of those institutions with the 40-hour week and the old conditions existing? Mr. HUFF. That is a very hard question for me to answer because the records which would establish such efficiency in a sufficient degree to make a strict comparison are not available. I think that certainly 72 hours a week is too long to work. Mr. O'HARA. Right. Mr. HUFF. With the exposure to the emotional situations which people in our institutions are exposed to, and I am pointing out this difference specifically to the point of money differences. Mr. O'HARA. I was just wondering what the situation was as to the extension of the 40-hour week-if we are going to consider it as a permanent proposition or whether we are going to have to consider that again sometime. Mr. HUFF. Yes, sir. It has this relation to institutional administration: It does definitely raise the personnel costs. In the considerations given to the operation of a cottage, where you use a cottage type of operation, the usual number assigned to such a cottage was two. That cannot be done any more. The number now assigned to a small cottage is five; that is, it is a single post, so that it is making the costs of small-unit operations very high, and we have taken into account that situation in two parts. The first part has to do with institutional organization as we have it; the second part has to do with institutional planinng as we plan it. For example, a unit, a multiple unit, of small institutions would be very heavy in costs of personnel, so we need to find means to consolidate administrative costs while at the same time seeking to preserve the benefits of small groupings. I think that background explains the situation quite a little bit. I perhaps should explain one other thing in that regard, and that is as to the strict control of operations in our institutions and agencies as well, but with special reference to the small-unit institutions; they first had to be corrected to meet the requirements of the 40-hour week. Second, in terms of money costs for personnel-locally especiallywe find ourselves in competition with all the other Federal depart |