SECOND SESSION WEDNESDAY, SEPTEMBER 30, 1925, 10 A. M. Chairman: TERRY C. FOSTER, Supervisor of Rehabilitation, Alabama. Chairman FOSTER. The meeting will please come to order. We have with us this morning a man who has been very active in rehabilitation work, especially in the legislative field. He has been responsible for much legislation on labor matters. We are especially fortunate in having him here this morning to tell us what his plans are for future labor legislation and other matters. I am pleased to present to you Dr. John B. Andrews, secretary of the American Association for Labor Legislation. Doctor Andrews. COMPENSATION AND REHABILITATION Dr. JOHN B. ANDREWS, Secretary, American Association for Labor Legislation Mr. Chairman and fellow workers: I am very glad to have this opportunity to discuss briefly some of the topics in this important field of such great interest to us all. As I look over the list of no less than 20 speakers who are to follow me this morning, I am very much impressed with the extent and the variety of these topics, and I assure you I am profoundly impressed with the necessity for brevity. But it isn't necessary any longer to discuss the extent of our problem of rehabilitation which somebody has somewhat superficially stated as 100,000 industrial cripples, augmented to the extent of 10,000 a year. And of course, the urgent need of rehabilitation scarcely calls for public discussion in the general terms we were obliged to use before the adoption by Congress of the Federal law of 1920. Thanks to the work of past years that has been accepted. Thirty-nine States are now cooperating with the Federal Government in this work. The principle is established in the law of the land. Ours is now the duty to see that no light of experience is neglected in the improvement of existing statutes; in the extension of the legislation to areas not yet afforded this protection; and in scrutinizing with special intensity the methods and results of administration. From some 17 years of rather intensive experience in efforts to secure the adoption of legal remedies in the public interest, I appre ciate, I believe, as fully as any of you, the necessity of continuous consistent effort if wise legislation is to be enacted and effectively administered. I recall a very dark hour in the early history of rehabilitation legislation; in fact, just before the dawning of the morning of the Federal legislation. Legislative hearings had been held before the congressional committees in Washington. Months went by with no congressional action. Friends of the measure who had taken part in the legislative discussion before the committees of Congress had scattered and were otherwise occupied. A period of indifference had already come upon Congress, and even the "fathers" of the legislation in the two Houses had given up hope. The congressional session was nearing its end. But finally two men in the House were importuned to make ready for one final effort. Five days and nights of very intensive buttonholing of Congressmen, with frequent reports of progress, so heartened them that they were willing to take the matter up on the floor of the House and lead what they had felt was a forlorn hope. Finally, Mr. Fess, of Ohio, now Senator Fess, said that he was willing to make the trial, although he greatly doubted a successful outcome. When the fight was made it was a short one, as the Congressional Record plainly shows, and it was by a fairly close vote that the Federal Government adopted the principle of Federal-State cooperation in this field. I have always believed that if that vigorous effort had not been made just at that time in 1920, growing indifference and delay would have meant no Federal law. Some of you will recall the period of suspense four years later, at the time the life of the legislation was to be extended, when there were uncertain weeks and months before Congress voted, and then without taking time to pass the appropriation for another half year. Some of you had reason to feel uncertain in reference to the rehabilitation work you were going to have an opportunity to do in the future. Of course, that is a matter which was happily settled for a time, but it is with the constant warning of a possible fate at the next sunrise. That is a thing which everybody interested in the permanence of this work must constantly keep in mind. All experience shows the importance of being ever alert. The first consideration of permanent success is wise legislation efficiently administered. But that alone will not insure permanency for any public work. Partisan cries of "economy" must even then be met through education of public opinion to the point where wise statesmanship in public expenditures will be sharply distinguished from false economy. Justice to the disabled in industry requires that in some form vocational rehabilitation and placement go on. The work must, in fact, be extended. Meanwhile there are nine States that have not accepted the opportunity to cooperate. They are: Connecticut, Delaware, Florida, Kansas, Maryland, South Carolina, Texas, Vermont, and Washington. This is not a sectional, or a nonindustrial, or a naturally conservative representation of laggards. Every kind of State is represented. Connecticut and Vermont in New England; Delaware and Maryland midway between the Northeastern States and the South; Florida and South Carolina in the South itself; Kansas and Texas of the mid-Western area; Washington on the Pacific coast. Why these widely scattered, diversified, outposts of apparent indifference to this humanitarian work? The time has come for analysis and renewed efforts. Next legislative year, 1926, there are only a dozen States in legislative session, and they are all practically on the Atlantic seaboard. There is opportunity for only one or two more States to come into the fold in 1926. And in 1927 this whole matter may again be thrown before Congress. This suggests, in my judgment, that the close of the first five years' practical experience in Federal-State cooperation in industrial cripple rehabilitation, is a fitting time for a survey of what has been accomplished. In this way only may we all understand what has been done and what action we should all take in our various organizations in reference to the future of this legislation. I recall that three years after the New Jersey accident compensation law was enacted-it went into effect in 1911-that we made an intensive survey of the actual operation of that workmen's compensation law which was the first to go into effect and stay in effect in this country. That survey led to half a dozen specific and fundamental recommendations for improvements in the law and especially in its administration. In subsequent years all of those changes have been brought about by timely pressure at the State capitol. Meanwhile accident compensation legislation has swept over the United States until we have only five Southern and nonindustrial States, in addition to the District of Columbia, which are not covered. But year by year it has been necessary to cooperate with the administrators of accident compensation in improving the existing statutes, while at the same time the movement went on to extend the legislation to the noncompensation areas. Perhaps this should suggest to us the desirability of a similar course if we are to build permanently and on a firm basis of effective administration and legislation for the future in this newer field of rehabilitation. The greater part of the accident compensation work, closely related to the field of industrial rehabilitation, has been since about 1915 one of steady improvement in the existing laws, based upon practical experience with their administration. I wish to point out the fact that in practically all States, although there are some exceptions still, the workmen's compensation commissioners have regarded it as well within their field to suggest, out of their practical experience, the improvements which should be made in the legislation. They have not hesitated to prepare documents, to present memoranda to the governor of the State and to the legislature, showing the need of strengthening the weak places in the program. It is possible that in some States there is an opportunity to do more of that kind of work in the industrial rehabilitation field. Recently, in looking over the literature of five years on the subject of industrial rehabilitation, I was somewhat impressed by the lack of general popular articles in a field which certainly lends itself to publication. And I am wondering if the public is fully appreciative of the important work that is being done under these rehabilitation laws. It is impossible for one like myself, who is busy with a number of things, to keep in very close touch with what is happening in the 39 States in this field. How can one expect a Congressman to keep in touch with the movement and to appreciate the importance of this work? How can the members of a State legislature keep in touch with this growing movement? Those of you who are actually on this rehabilitation job day by day have, in my judgment, an important duty to perform in telling the public what is being done. Fortunately, in the extension of the accident compensation legislation as an aid in the rehabilitation field, the United States Supreme Court has, within the last year, given us full assurance that we can go ahead. Beginning in 1916, in the State of New York, we started the social experiment of providing special funds for purposes which would aid in this field, and we also more recently, in 1920 and 1922, on the basis of practical experience, extended that legislation in another direction, until now the United States Supreme Court has upheld the legislation and makes it clear that in every compensation State we can now take away from the employer any financial temptation that he may think he has to decline to employ a crippled man. We can also provide under workmen's compensation a special fund out of which maintenance of industrial cripples may be provided during the period of their rehabilitation. In the New York law to-day in every case where an injured worker is killed, leaving no dependents, $1,000 is set aside by the insurance carrier in a special State fund, and out of this fund $500 is available for second injury cases and $500 is available for maintenance during rehabilitation. This maintenance fund is, we discovered as a result of a brief inquiry which we made more than a year ago, more than adequate 83530-26- 3 for the purpose. And in our standard drafts, and in our memorandum for new legislation in the nonrehabilitation States and in the compensation States, we specifically suggested last year that the maintenance provision under the compensation laws be broadened. so that the scope of the work might extend beyond the mere maintenance allowance to actual industrial rehabilitation. In that way there is opportunity to go still further toward supplementing the` Federal-State provisions. New York, in 1925, under the direction of Doctor Little, did to some extent broaden that provision, but still the funds are more than abundant. For the second injury cases there are now 11 States which have legislated; for the rehabilitation maintenance 9 States are ready to help through these accident compensation amendments or through maintenance funds created under special statutes.2 Through social invention of this kind we can take further steps for the future. permanence of this work in all States. One other respect in which compensation and rehabilitation appear to me to have a close relationship is in the medical care provided under all of the State accident compensation laws. In the beginning many of the State compensation laws were rather niggardly in the provision of medical care. It is only again, as a result of about 14 years of continuous work with State legislatures, in cooperation with the administrators of the accident compensation laws, that these medical provisions have been extended and made more generous, until now practically half of the workmen's compensation States provide all necessary medical care. Medical care is surely as important as cash compensation and is of especial importance in view of the interpretation of the Federal act which makes impossible the use of Federal funds for the physical retraining side of rehabilitation. The interrelation of social legislation is a thing that impresses me more year by year. It is impossible for accident compensation to be completely successful without efficiently administered industrial cripple rehabilitation, and that job is nowhere near done until the rehabilitated worker is placed in the right job. Neither can rehabilitation legislation be more than a partial success until it has the supplemental advantages of "all necessary medical care" and the assurance of "maintenance" and "second-injury" funds through special legislation or preferably, in the interest of greater permanency, through the workmen's compensation laws. 1 Special second-injury funds are found in Illinois, Massachusetts, Minnesota, New Jersey, New York, Utah, and Wisconsin; similar result is accomplished through exclusive State compensation funds in North Dakota, Ohio, Oregon, and West Virginia. * Maintenance through workmen's compensation is found in Arizona, Minnesota, New York, and Wisconsin; through special statute in Massachusetts, Montana, New Jersey, Pennsylvania, and Wyoming. |