RINGWORM CONTROL PROGRAM

Senator STENNIS. Thirty-two thousand seven hundred and eightyfive dollars for six new positions, and other costs essential for a ringworm control program. What is that?

Dr. HEATH. We have a problem of ringworm and just recently it has grown more than before. We have been working very closely with Public Health Service on this particular matter. We have outlined the program in concurrence, and they have concurred in this particular approach.

This would require an intensification of the screening in the school with a so-called Wood's lamp, and an intensification also of treatment clinics, and more detailed supervision.

Senator STENNIS. This shows up in the schools? Is that the idea? Dr. HEATH. Yes, sir. This is something which for some particular reason is in the child before puberty and something happens in the body after puberty so that it seems to clear up by itself.

Senator STENNIS. Does the request to create these six new positions indicate that it is on the increase?

Dr. HEATH. Yes, sir.

Senator STENNIS. What is the reason for that?

Dr. HEATH. For the increase, sir?

Senator STENNIS. Yes.

Dr. HEATH. The increase of the persons or the increase of the disease?

REASON FOR INCREASE IN DISEASE

Senator STENNIS. Well, the increase in the incidence of disease. Dr. HEATH. It would probably be due to a multiplicity of factors, and would be hard to point out which specific one it might be, although we know that personal contact and contamination of closely used articles seem to be the predominant agent of spread and transmission of the disease. Also, intensification in getting these patients under treatment, to get them noninfectious, cuts down the infectious reservoirs of the disease.

Senator STENNIS. What has happened to cause the increase? Dr. HEATH. I do not think that we can pinpoint any specific reason, except that it is just one of those things that has spread.

Senator STENNIS. I did not hear that.

Dr. HEATH. I say it is just one of those spreading types of conditions that will need a greater intensification of control measures to destroy the infectious reservoirs.

Senator STENNIS. How many people do you have now in this work?

SCREENING IN SCHOOLS

Dr. HEATH. We have a half-time physician and a half-time clinic aid, and we run one clinic half time. We are doing some screening in the schools, but not as much as should be done. We have ordered additional equipment so that we can go in with teams made up of school physicians and public-health nurses, and do the screening procedures.

Senator STENNIS. What is the treatment?

Dr. HEATH. The treatment is basically of two kinds: Medical, and some done by X-ray. The medical treatment is the use of salicylic acids. In some selected cases they have gone to using X-rays. We thought of that same thing and we had consultations with Public Health Service, and the authorities on radiology and radioactive substances, and it was very definitely suggested that we not attempt any kind of an X-ray treatment program on a mass basis, because it is not without certain hazards.

Senator ELLENDER. That would be a little expensive, would it not? As I remember, we used to use some kind of salve. Why can you not do that?

Dr. SECKINGER. We can, if they are properly watched and supervised, the results are entirely satisfactory, without X-ray. X-ray has its hazards.

Senator STENNIS. The next item here is $13,756.

PSYCHIATRIC AND PSYCHOLOGICAL SERVICES

Dr. HEATH. This is for two positions, a psychiatrist and a steno, to work in the Legal Phychiatric Service of the Department in a program authorized by Public Law 85, giving psychiatric and psychological services to the courts.

Senator STENNIS. Did the courts request this?

Dr. HEATH. I do not know whether they specifically requested it, except that we are not able to take care of the number of requests that the courts and the Board of Parole and Corrections send to us, and we have asked to hold up on some of them, and they have had to use other methods to get the examinations done. We felt that adding another psychiatrist and steno would help.

Senator STENNIS. Excuse me, Doctor. We are pressed for time.

DENTAL PROGRAM

The next item is $30,000 in your dental program. That is to get your extra dentists, is that right?

Dr. HEATH. Yes, sir; that will be two dentists. There will be a coordination between the 14 dental clinics throughout the city and in District of Columbia General. It will also incorporate into the activities of the two dental schools, Howard and Georgetown, and the department of dentistry at George Washington-they do not have a dental school at George Washington. They will send visiting dentists in to work in this clinic at District of Columbia General or elsewhere in the Health Department, and will also send their students, their advanced students, and their postgraduate students, and it would be in that case on the same principle that they do the medical work in our clinics of the Department.

PAY INCREASES FOR INTERNS AND RESIDENTS

Senator STENNIS. You have $126,000 for salary increases of internes and residents at District of Columbia General Hospital.

Dr. HEATH. This has been a delicate problem. It affects 132 residents. The problem has been studied with the Public Health Service Advisory Council, and we have discussed it with the District of

Columbia Personnel Office, and we have talked it over with the Commissioners. We have run into a situation where we cannot compete in this area for interns.

As you know, internes' positions far exceed the number of candidates. It is 2 to 1. We have been unable to get sufficient internes this year. We have only a little more than half of what we need.

The salary range is so far out of line that it was determined that a study should be made. Such a study was made in an appropriate manner and it was advised that the salaries be increased from $1,545 to $2,500 with increments of $300 increase for the residents for various years, and this compares then favorably with the hospitals in this particular area, although it will not give a stipend as high as St. Elizabeths or Freedmen's Hospitals or other hospitals in the District, which will still pay a much higher salary. That will amount to $126,000.

EMERGENCY AMBULANCE SERVICE

Senator STENNIS. Now, you have $14,000 for 9 first-aid assistants to replace 7 medical internes for emergency ambulance service.

Dr. HEATH. We have been unable to recruit sufficient internes. We have only 36 internes now for 52 positions that are needed, therefore, it is necessary to try to find another way to cover it. This can be covered in 1 of 2 ways: First, in some of the vacant positions which we have we can employ residents temporarily for this year to get over the hump. We feel that the problem will be solved when we get to this new salary scale, if we are permitted the increases requested here.

Now, there is one thing that I would like to point out, that we have not duplicated anything. There were 7 internes originally assigned to ambulances, so that, presuming that this increase would be granted, then we would deduct 7 internes at $2,500, giving us $17,500, and the cost of the first-aid assistants is $32,000. Therefore, it would be a net of $14,500.

However, if the requested amount in salaries for the internes is not granted, then we would have to have some adjustment by the committee.

Senator STENNIS. Will you make a note of that, Mr. Clerk?

CASE OF INDIGENT PERSONS

The next item is Department of Public Health, 1955, $75,000 for unpaid bills rendered by voluntary hospitals providing care in the fiscal year 1955 to indigent persons. Will you give us something on that, Doctor?

Dr. HEATH. Yes, sir.

For that particular year we had services rendered $109,000 in excess of the appropriations. The Health Department had some funds left over in 1955, in which it was felt that $34,000 could be applied against this deficiency. Therefore it would leave a net of $75,000. Senator STENNIS. Did you ask for that in the regular budget for 1956 or 1957?

Dr. HEATH. In 1957 there was an increase of $175,000 over the $870,000 base.

Senator STENNIS. Suppose we do not allow this? Will the bills just remain unpaid?

Dr. HEATH. They just remain unpaid.

Senator STENNIS. All right. Let us get down to your big item.

COLLECTIONS FOR DISTRICT OF COLUMBIA GENERAL HOSPITAL SERVICE

Senator DwORSHAK. Doctor, if I recall, 2 years ago when I had this same position that my colleague has, we were bothered a great deal by the inability to collect for services rendered at the old Gallinger Iospital, which is now the District of Columbia General. What progress has been made in that situation? Are you collecting for many of the services or is it virtually operating now on a free basis as it was a few years ago?

Dr. HEATH. No, sir. I think the last collections I know about were $1.7 million a year, which included St. Elizabeths. It was about $500,000 which is collected each year on contracts written by the Medical Assistance Division.

MEDICAL CHARITIES

I would like to point out that we were talking about medical charity, that every case is properly screened on the medical charities, and we point out that further, in the year 1955, the rejection rate by the Health Department was 18 percent, so that your deficiency would have been even 18 percent higher than now without these screening procedures, and properly executed contracts, and those who have contracts and do not pay them are referred to the special Financial Unit of the Tax Collector's Office, and processed there.

PERCENTAGE OF FREE HOSPITAL WORK

Senator DwORSHAK. What percentage of your District of Columbia General Hospital work now is free?

Dr. HEATH. I don't have that. I will try to supply it for you, sir. (The information referred to follows:)

In 1954, 95 percent of the services rendered at District of Columbia General Hospital were free; and in 1955, 94 percent of the services rendered were free. Of the $5,769,335 expended in 1954, $311,961 was collected as payments from patients; and of the $6,132,342 expended in 1955, $360,000 was collected as pay. ments from patients.

Dr. SECKINGER. There has been much improvement in the collection situation because of the fact that we are able to interrogate these people as to their finances.

Senator DwORSHAK. I recall that back in 1947 or 1948 it developed that very little effort was made at that time to make collections, and that Gallinger was operating on the basis of rendering free service to the people here.

Dr. SECKINGER. It is supposed to do that, fundamentally.

Senator DwORSHAK. Is it?

Dr. SECKINGER. I mean, it is that type of institution, but later Congress made provision so that, for instance, if you were struck down by an automobile near District of Columbia General, you could go in there; and we had to get those people to pay, as in private hospitals, if they are financially able.

Senator DwORSHAK. But it is supposed to render free service?
Dr. SECKINGER. Yes.

Senator ELLENDER. Is the rate for the indigent people the same as for anyone else?

Dr. SECKINGER. It is based on a per diem cost.

TAX EXEMPTIONS FOR HOSPITALS

Senator ELLENDER. I just learned that all privately owned hospitals pay no taxes. Why could you not get a few beds in there to assist in treating the indigent?

Dr. SECKINGER. I do not know that I understand exactly what you mean?

Senator ELLENDER. Well, they get tax exemptions. All privately owned hospitals get tax exemptions.

Mr. KARRICK. All that take charge of patients get tax exemptions if they take charity patients. Doctors' Hospital does not have it.

Mr. FOWLER. Doctors' doesn't take any so-called charity patients, but all the charity patients taken by the other hospitals, we pay for. Senator ELLENDER. I understood that there was a tax exemption. Mr. KARRICK. All who take charity patients get a tax exemption. Senator ELLENDER. Do you get that free?

Mr. KARRICK. No, we pay for the patients.

Senator ELLENDER. What do you get out of the tax exemptions then?

Mr. KARRICK. We get a low rate.

Mr. FOWLER. That is all we do get. As far as I know, we get the rate that we presumably pay at District of Columbia General Hospital, and sometimes under that.

Dr. SECKINGER. Those institutions that are participating in the medical care program for the indigent are supposed to get paid on a per diem basis for the cases they care for.

COST OF FREE MEDICAL SERVICES

Senator DWORSHAK. Can you tell us about how much free medical services are costing the District of Columbia today through District of Columbia General Hospital and through payments made to other hospitals?

Dr. SECKINGER. We have a budget of $25,503,400. A great deal of that goes to St. Elizabeths for that.

For District of Columbia General budget it is $6,939,838.

For Glenn Dale, it is $2,657,608.

These medical charities to these private hospitals take about $1,045,000.

Senator DwORSHAK. It totals about $25 million.

Dr. SECKINGER. That is all services, preventive and medical care services.

Senator DwORSHAK. Does that make allowance for the payments that are made?

Dr. SECKINGER. Well, we have certain collections that we get. This is just a total budget.

Senator DffioRSHAK. The collections would be deducted from that amount. To what do they amount?

Dr. HEATH. About $1.7 million.

Chairman HAYDEN. Would it be convenient to come back at 3 o'clock and finish the hearing?