*EOO 21 j t@@ C; l@E 1 El M 11769 ROAD SPR,NG, MI RYL,AND 2090,2 -:rIL VE, R LEG13T,ATnr6' HISTORY ON THE PASSAGE OF THE HOSPITAL Suiv, O',,TSTRTir,TIOTI ACT, PTJBLIC LA.@- 725., 79TH COIT R_,:SS .G @ITCY FEDERAL SECUR,.,Y AG: 'Public Health Service JULY--1948 Division of Hosp4-tal Facilities COITI'EITTS Pages PART-B SURV@-@y @4L7D FL.L,,,i7ING 9 611 Appropriation authorization .10 § 612 (a) Applications for Funds 1 612 (a) (1) Single State Agency 9 612 (a) (2) Advisory Council 12 9 6-12- (-a) (3) Inventory -13 9 612 '(a) (4) Reports and Records 14 i 612 (b)@ Approval by Surgeon General 15 A@llotm@a@ to States PART C' CONSTPTJCTION OF HOSPIT-kL$- 621' Appropriation authorization W.'622,"@ Promulgation of regulations 9 622@ ('a') Number of GianIeral Beds Required. 23-25- I o2P-.(b) Number of tuber@osig, mental, and chronic beds required 26-29:. o,22 (c) Number of i)ublic health centers required 29-30 9 622 (d) Priority' -i6 31 6: Const@tioa standards 7@g Diierimin tion (1-@ Race Color Greed 39-41 @)@indigent Cari 42@4@3, Methot stratiom,' 44@@ Stat e'Al Advisor C6um:cil Constru il6ri program (a) (5) Relative need 53-55 0 9 23 (a) (G)- Methods of Administration 5/-57 1 6P3 (a) (7) 3tandards of Maintenance and 0-oerp.tion 5,9-59 1 62@ (a) (8) Fair Hear4ng 6o l@ 62-@3v (a) (9,) Reports and Records 61 - of,@ Plan@ 6 Appr -Fa.L-@ @plani@ t iort @otments@ to State s@: en era t at I, @6i@ Allotment 68-69 I I . Availability of Allotment fo9-70 I-i.. State Matching of Federal Funds 70-71 V. Allotments for Administrp-tive 3x--enses 71 or 1. 'eneral. 3:1. Maintenanc@- and" 0-oeratiorL T@ d) Limitation on use of funds 92-94 a 625 (e'l 20-Year use' requirement 95 PART D - l-'LISCIILAITE-OUS 0 031 Definitions 1 631 (a) Allotment percentage g@97 9 631 (b) Promulgation of allotment percentage 99 ff. 631, Population- 89 State 9 t. 631, (d),, 91 9 1&31 (@ e) Rospital a 631 (f) Public Health Geri't e@ 95 @631 (g) Nouprofit,a"p al:, 96, $7 6 @(hi co 5&99 nstruct I 631,(i) Cost, of Construction ico 9 632 (a) Withholding of Certification 101-102 6 632"(b) (1) Judicial Appeal 103-lo4 9 632 (b) (2) (3) Finding of Fact 105 1 6.33 (a) Administrptive Regulations 106 8 633 (b) Federal Hospital Council 10T 1. cgmpoe guncil Council Bibliography Interim Pe-@)ort From the Subcommittee on Wartime Health and E(iuca.tion to ,'-'he Committee on Ed,,icati-on and Labor, S. Senate, Subcommittee Rerort 77 t @79th February, D4arch, 1 Senate Report No. 674 on S. 191, October 30, 1945- Senate Bill 191, October 30, la4g Letter from President Truman to the Chq.irman of the House-Conmittee on Interstate and Foreign Commerce, January 31, 1946. 6. @4 n' Educatit 0. the@ Co=ittee@ o U. S. Senate@ th,Gongress, 2nct Session, March,,19460 ntdrstate. and -e kStibco the Committee on I Pbreign Commerce on S. 191 House of Re-,@.)resentatives, 79th Congress 2h& Session, March, 1946. House Rep r o No. 2519 on s- 191, Ju!Y 13, 1946. -'C6@etence R6-port ii 5.7 191 July 29, 1946.. ri t. @r-o@ tlif ti li@ co@@ttee,@ on.@ Education,@ U 0 The ?resident. and varioi-,s o4i Cong-resE r,,reiious',',Il giv@-n sor,e-thought to the estab,.i-s@reni, o i 1 e @i e,r a h cz a c,-. nt u c @, i c r o and t.,iink4 _g 4 n the u,) @p,-,,-v".ce -@as el"' -n @l-.e a @L7,ies- i e ii e o s 7, e S --@a 'n -eCr4 u I-L -on. on; ed:. @'or-;ard @he@ thw,,o6licieT qrt&. 7-,roce@es Lit:orr.-,@h4 rk of -ch, than p're@ 'P 1944 tne Pub'_;_c Health -3er7ice =-ub,-.ilted to the Pos',@,.ar n -o@,.L I.i @OC4 e.t; ,lanning Co,@7iittee of t"he Amf@rltean Hos;;ital As- - on abr4.ef stpterrent setting forth the.,7.ajor c,!L-,Aaracte,:4-,-tics of .',he .@.-ol;ose... hos@i',L-la'- -urvey &.iid cc,nsluri.,ction -,rogrpr.,i. Ln -,%Y. a sii.-,ilar su bm on ..,g s Lnalu,_- to the Subr.,oirni ttee on @'."eL 1 -Lcal Ca,-e of the on '@.,--@L-iin,@-ztrative -rictice o@' the -ii@rican Pub"6ic' Health Associations eon '3eiierp-!..in.@ @r, @44,.. te@tifie!l@ bef ore !i succor, ml ue ea r! J.: ermi i t I ;,ruc tio@ .-@,rogr.7 s..,, i F-,@ e 9 in bui-ldi the 'facilities f ai7 conf6@r.,ity@ in_ A. P3, ,te rlirbe.- ol'.natiorial orgr-@ni-za- ons-, inc-'Lu4L!ing'the. Armei-icpn the Ai-ierl- cELn -i'.e(".ic;-! Lssocir..tion, , as as B.rz , LEDO-, and @s, enC.,oi-sed ,-,@e urgt-nt P ities and @@e nee.-I @-r r' need -for.- hosl,.)i tal andi health 'cenluer f c-;@ -0 te-' assistance to su @ly tho ac@Li4.t4-es. L @Q se f -e in ics in . I,-Ci ;-el,7ort @ recor,-zentled --,hat !7eaera'- gran@ls--'@n-aid to L,:-,ates be Ruthorized ',-lo ist@ in :;ost%.-ar construction of hospitals,, ,@eCt:.cal center- an-I health-centers ;,he@ Pu 4earin@ befor@ a- Subcor,..,Pjittee of the lv'orr,.,-,ittL-e c-,i '@-@,ucoticTi and @abo@, U.S. @r,?,O DIJ C r I 0 r @nloruceq, sion of the in ";ay a ne, ;er i tal - -, -' e,-' I' t) i- c h l'o r t t t -;. 7r, eeT-@bo o c. n s o -,e construction o,--- hos-,) f 4 'c, 11 II L Close bet,.,een '-he 'red' t-Iii -,en'er c@ci- -Les e, (,, @' @ he; he, 0 rl!,l i 3 e -U --c)-e .ue@-@-I.cn cz, -,n aau c 0 a Eubcorr-' rise ,.as P-ppo@nteci rt, S..@ 191 ,'Pvorably. 'UNIT @@,-)teriber 19 @hich@@ hands: he 61 the PLmerican I os-@i, 4.,-. A he, S -'-@I Sec sub- con..T,ittee rewrote the b-'Ll',- so- F's ta cl-ar-i-@"Y several- -o.-ov-',-sions in the b-'-, 11 4 the lurceon Genr@r,-]- and apci to f,,larifv the -es.-)ons-bi',-Lty 'oet,:een lioSr '.@.-eciera-l- )4 tLI Co-ancil, on the one hand, anl on the other, between the "Jove-cnrient @-na the c@7'@a.tes. (Dn C@@,,,,ober 30, -'L94,@, the @-enr,-,e @-nd Labor Committee S. 191 favorably. 4@,@ @h,.s re@-,ort inc-@U-,-',ed a minority report by the Corm4-t'lee Cha',-riri-an, c-.enato.- Murray .-:-ho had agreed,. reservations, to re@)orting the 'o -'L 1 a naror vorab@y. ,,,Sp, -,ur7a@ objected to'th-ree features of the bill-: e P-asip m Th -,qen t: of to@ a. .!j rt@ti-' Hos@)ita-L Coun ities t oi-, cil;'@(2) fail@r6, to assure I'ederal. aid to@ needie t co-@riiiin hr' gh the lack of assistance for@the Maintenance and operation of hos-.oitp.1 .@ac@,-12Lties, ancL: standards- fo 6@eration of On 'iovember 'i@, 1945, Preoi-clent Tru@.-.Iar- sent rp-ssa@ge to 'U-ongress ! eg4 re(juest4-ng @slat-'@on for the c!,io@)tion of a i@-7 t--', on a. health pro-r3r.. :,he Pres4@@ient in recomy@,er.%',i-n@ the'. congress adopt , @cir@@.Drehen@, .,re -P.nd mo,@lern ll.)roV@ le f 4nenc; a, an,@ othe.- ss-st,!; ' e 'or -@.'e health 7,rogram iii-ged CongresE to nc loilstruct4@on oL' needed h e t li en a r t. a n u o e r 7,-., e,,-,, c e, -L he 1h and reh,@biiiat'.on 'a C 4 1 e S t 't,ted, the ns. 0 e:7be'T, Lo th &.n.i lith 'the hoe-oi tell :Lez, r)rovls..Q n .2jel-I Se ate rleba-to(i@ the.:bill ana &Iran .. e.,i t @,-of -,e y 7@nC@ en - bills, i.@ent; cal i th 191, 'ii qL dbeen .-rnt@r6,duc-e-l" in" tt,,.e Hcu--e Co, -r e r e @'ee cn (,) n jenue,-y --I ol-e4 gn @n _r.Ce. othe Co: n rt,- end 1946, P-f e side t a lei----er concerl-,4n@.;, 'L9! to i.on,---ess-.n@n Cia.rence Lea, C'iia'@rnan of the ulcuse-@cruiil-u@.ee on Interstate @ind -7ore-@gn Coirr,.erce, @ito r.,hich S. 191 had@also.lbeen referred. The, @res-'@,lent. objected, to t-,@c p ;EederaL Hospital Go to 2 U C T i: On February @@946, r- e-z r c- s e,- I v(--@,ion of h4@ ch ',',,e chr.nDes reco",re,., in n en@. to,- e -c an@ j-e- 0 table @r nt for const,-'Uct4.on ii ref)rec-en@,at-'-on ,)n the Pnt, of @3 113 and -,Iianged the -,ro--'ess;@onal-con@,un,e,-, IqOS-, t!ll @OUII,,4.1 -,.,e -ee to four-'our. ) 4 -f roT,. -@h eleral@ L On u 2 'ID n-1945, S. 1-9'L as r-oc-@,-'Ue 'O' ',' "--he by the House an@' the @enat@, a cori-e-@ c-nce. C-n ju--@l.- 29, re-)ort i-s-@ue.-@ .,hich )rolo.@ed ',",o. ch@.n@e:, h e 'n i a p@ P-,,z @I)y e @use, rz-,iEinz 1'h,-, flat,. @rant. fro,-;I 33 I/Ic to 40@ an-,, ch,-Ingin- r,,rof' -es.vionF!-- consumerIrepresentation on @@a -Tederal, Hos-.-I:Ltal. 'I'lounc i-l,l f ror,,.. f ou-r-fouT- '@-)H ek o rind t@ t z,@ 'Phe a n. i ".r, 6 LI@ 4%ver o L'. the@ c6n-@e'rp-nce T,erort. h on @'Aii -,6 @a s 109 b-,r I :Hb- se. u,-t n c- '91, obj o -ect--.nF the nt-u,,-,ust 3,..191@6 U two @)rovisions cited i-n @i i-.q e' ter oi' o,-,,- 1 rcunci-@- an,! court -'P, i-, e 7)r of the .@'ede-ra -e,; U 79th Congress. ence Fe-Dort, @:o@se of. '@e, ort o7., '79 th 'C-ni er' -)97 2@ Se@ to- a:-: C. 7@.. 6 9 7, +-o ,.n ':ervicP- @'tc@ -Irp.n@.s 4-C) thei,@ hos @i s tO@ LU4"(lC'Ci7@' grP-r,,tF, sue 3 .-n@l Notice 'le@@. Psentati-,7es e it F@,nictE!"i e Sena@,e ot the, TJnite,' a t;n s le 7.er7.ce :Ln k@cr)--rc- e 1) i-i,: t t.@ C,: MCIY ae c @he 11-Fo-@ ii 1,@,r-,7ev "o- st Rn- n -ricl-ioii .Act'". i@ib" i 6 H Lh 'ervici6 A@,,t. (c.@on@,istill@ e,,3 O'@',+t4-tlea,--- to- 7 i-nclii---Ve, of the i@. c of Ju-,! 9 /4 4 ta 68-2 i-'s hcr hc%,, Qiid 4.-he-.-eof the- i c, o,,, n.-,-,, ne-.-. !,.Lt-te. The- ne a- E6,11 -46+ on@tt@ted.@- P@L79@r th s u sucn eL% 3. Drcr Cram of t character -se tii: in Stdt6 and local Hunts -,Por'@:)lanniiig and (,,-@rr,1-4Lng out @ constl-u@@7-en -- @ -1 4 but will at '-,he s@-e '14@me e@icourace File t(.tes t--c @.he for car@linc ou.-. the @'o -,he @reatest -:o,,,@.'b e ex@@nl- con@-&-en' L J- a proper check u.)on r--x-,.oendi@.urp of 5 c- o ,:i t I construr-tiori @'6 74,v., ,7- .-7 e'fecti ve !-xi @a Long-range, s@oite in @f.,tvor @i.orf, @bjec'iva-@ :,.n bi!3,-, in:-@. cr o@ ier. hove, E s-c n, a from 'so, of @T on @o-"so@ reach o+. one,-r.-vin any thi-F., t,,uanimity o:L- @V _a-'.,zear@h@ r, eason. th;, t@, tried -r n" ontr hi-g-@ -@t@ride a.-I or jcb-nsl,on on a' h C-@ b-z' ot, @,en t th6 IC.-,lr4 'tee, '-'@t-int /@l, floor of ',he Senp te, i-leceTrb6r Statenients in Eu.-) )ort of tlip- b@ 1 F,.rr@ ccn'pi n@@. -.a numerous @-@ia-ces in the hearings, -.ii '-:enate 119, i')@, i66, 1-1@7, 201, 227. Z2,3, "@o7; 2,@o, @i-s, @3, 7, '3, Hos-oilal JO "Tha-American sociaticii, its @-,,embers hove a-.L,;en miicot ed..@ bgttter,,' d-ls-tZt@ttq@@ of,- ho rvi e se e t ri f,'b the t careful extension of facilities for ren.,Ier-ing that care merits your careful and 6-arneslu- con@-iderp-t'-cn. A.-, a'fi-rst ste,-) i-i-i the i,-n-)z-ovement of the distribution of hosn'Ltal and @Tedicc-,l @ere, rlle the -)ro!n,7.t an,,i favorable acti.on by this committee on the, @oF@,Dj.tal- ',,tirvey F,)i,,i Con5trict-@on Act as @-asser.' by the Senate." H@se !--.me.-icar, Iasociat4.or, 'opi'Levp-s than" the Dro-ram by as passed b-,r ("he Senatet -@,rofiiges 'o con'rirAite to ipi,,,roved hosoi@.al -9 L 'ffe-s i's 0 and medical care in thif, co=try,.enclorses the bill stron y, and gl i,.ii @-.q-rrying -gut. -ass, shoul this !:)ill every.6 'Dro on rp of the measure, CO-Tiff be@ law." Ho c-f-aterienta i-.i. onposition to ('he bil'L m4v be f o-an@l in Senate Feai@-Lngs pages,.- 266x,.3,13;@. ffpuser Hearingr).. 16-7, 2 2,4 3 8-. @-e only. se 'ous. Connor., t of t h e op@osi_tion,was mad6 by C'Ong-@eetEmr. esti@7@trig as Ch-,,,irran ou,e @o ronriations Commilv'-@ee. The objection @,h,-: 1', lulic- Fer.Le r,-q 1Gove,-n@en@, p as not 4n a position to -,svw-.e fnanc@a" oo,ijction-- a n@. '-ha" the 4 States and J'.ocar governments 'oettpr finance the r)e -@c- 167, T, a PU s amended by t I @-urve SeTn a y Einr-l Consti-uctic,.i @.ct (Pub!-Lo '725, 79th Congress, '00 tp f,. 29-L (e) 13, 1946.11 5 rpgse@of,,@h4s titie ii to.as5ist, t r construction d' 7ey @he neel fo ---to sljn to e@.Fe'o7@ i.o- con@ili,i-,c'ion of' such ni-i b 1 c @ii other non -rrofit- hos@-litals,-,qs ,L n 6 hc all-the'! o-,,'Le; @nc !,-L -.c -,--nd o -Lllier non (b) to construct ibl-4 -lo--,-)i tals i-. -i Ih c,, i cli @rograns. c c or,. ,n-r., c e @h( le ruc.'ion. of such -,,Diibli-c tinr, other rcyi -rof i- programs for the const hosolt,-,ls as i-, conjunction the 'necessary ,-.,;hys-L@cal @'o@ @-'urrishing adeoua-te hoST)i@lpi., inic @d SLnilar services to all of, the @econ@L, to 6ol Congressman @re been s, .11 ng S L)i.L -7e tai, a]-,,,Drincl-,iles hatre. been:recoanized the, -f act that certain broaLl fundament t ci ed by com-i-) tent local authority, and not as-an incident to a Qublic @!orks @-.,ogra.,,i or som e other purpose no- F,-oi-.c'ficElly an@l Director related to health np-e@Js as such; spcon,- uha,t @ttit6s' rights cLnd locfil initiative be Preserved and encouraged a@ to the success of the undertakin,7: an-; ti-iird, that the 7ol,,-:nrary, non@@--rofit institution is duly recognized L'o-.-- the -jl,-ce -LL" -Ln @@t-- contrioution to '.-he Nationlp health". H. hearings, @,,age 12.. re numerou@ other e -ou 'Pos@es,. of-. There a sta.t me@.@s t6lative to the generaL. the en monsoon C -'on ecem pge 3 a 48, e z)ages 76 8c 274;- H. Hearings,, 14 62.@78 -7 I.- Sur,.re- L -7 and@ Plann4-n@, @ir@iose, --on in pci@l i @,o- irhis feature of the leg sia4L U- LL o. 'ue-@zig -commented r, favorably in most of the L@orego-Lng s@,Etp- en'us,- recei-vet'.. notice anl@ -@p@roval./ on. c.)r .1,@,o 1-@t of the --'eci. @ y je.mer-t of @ir. bl-,,@e ch. E,,@te s- .-.@)ront-L se..@@ z,-n@, rL s- h Of their nd their centers of -hecnlth for'all 'he ne onle serve. 7 e r-!ny that rally of these centers come to -@ei--.res=-nt t-he of all the heaTth mnun to resources in the co iy, '@ssigne-d $-.)'Oly the tec.@-;ques of @Dre- n,, ciiagnosi-,-,., anct coorC..inate-@-' eff6rt.@ to. .3romote, 3 'fac-i-ti" so l' t ink th,,il the 0 i es, 7 601 bill Chile pro-,ii - 4 c 4--n th gr@nc-!, t o m E;,,.c e + r ou@, o e c i- b' c@t h e a -@.se on @n tn -@,-Ih or e a rd S.. Hearings@, i),Ige 16c). ot be placed-udon the 4Tircruance oi a 1".roo@ inuch-emchn.,@is dn-nn 'ta.1 fa.-iliti.e- comprehensive and cril-@ic,-.1- analysis of exislina- hos-.,-)-. n any long-rarig.-, It is an act@-vity @-,h4-ch requires extensive deta@le@- --'-,u,4 oF all of the fp-ctors @:hich affect bch @'.-4e -Y LI 1, use and extent of --.re--en- @E,, C1 4tiez: as -as '-,lie i)or-,sible chon,7es in. public a,,)-creciation of r-@,re, ir@ethoc-@ of' 4nnce, and medical.care practice of the c o r7,,-,un i- t y .A @-tu@l ,;uch as is needed -could, best be Tnade a.,-, the Stite level -ath(,-r thpn.from central national office." S., Hearings _-@age 244. e, so, :Lnf t@e' --le 23@ p infra. no'. a tL" @h ,Programs must be based on a s t e v,,, i de i-,,ivenl,-,orj- and Su.-Vey. TO.72 !lie '-'Uate --onstructi-on ':)e -Ln -piz?nner: 4 rta te n :r l@-ge c@ sholl deterntine need or, f i Lips" of II,, health denter ly: a en, un r -,e 'b) The -F@,ncy s, I! e t e -i e'hroup.@ field investiga-L"-cn, En,:: other,.-se, rlie a,@ ed b s o r 6oi V4 ho @ng @ie'Ue-.,ir-'@necL ho@-!.-.,Lt,.@l @nc' center nee:@s. the L,-,a@e @g-encv shp-,."- 7. 1 in 110.12, and 10-31 an,.! shall sho,,, the relative nee,-@- each !)ro i ec@, i,.-i:-es.')ecti-ve o,-- the-, "&'oil-ty ol lunds for construction and for me'--n- ava@- -ion. etan@e and orL-rat e 2xle.: a- ecessa371@ 'Out,." e y r s@ least -Innua"l i-evie,,,, the: ov -ion -,,rogr @nitel construct, 'Annuill xed 7@, b:,, the @u-r g eon 6ener@,'-,, the. -@i c, P- n i I @ubTr, t to hir-i c, h c' noun L@iich revis;on--, o la repor", 0 @q z t ru c 1-or@ i:i-o@,r8m, s the iA.@ eacy. con,-icier@- ne--essv-ry. const-ri on s P- e let! in the o-der of.relat-'ve r-ee-1. 611 U VLY3 4 @ta,,es @n n 601 there is out t4q@ -,ur-@oses of @ecti-o .,.carryin b-e tell 'he s,@!r. of .'3 000,@000, 'liere@ autnorizea o rer@n-in @v@-iiLb'Lp- unt-'.-',- e @ur.-s u-.-Ier thi@- section shal-i uL4e-.:t 'l,@,yT7,entl@- to St,-,@-es i,ii@-ch ha%re s,-ib7@@-tte-@l, anci ha,,;'. a-,,),,Irovect o-@f th=- Surgeon ""Ieneral, State aoiD-ILJ-'ca. tions for funds f or ca..-r7.rinL 'oi the reporter the lena @.e @ -,n, i' ee, The or4@,,-inal an, . . I @U authorized a-,a anpro:)--,4-a'uion o-@ 4@ m i 1i c@n ' ,:-'L oa r3'-nce the Hoiise CO=4ttee had cut ["he .7ederal share of sur-vey and planr-Lng 'un@,@- to 33 113',.- it also cut 'the authorization to three Tiillion r-@,oll-aro, H. -T'f. eo r t 11 a219 @pag@ 2. I- 4 101 -lef6-.ni@@-onv@ ur@eon Gener@l The "uri,7@on Gen al ea- @ic. ife@-,. -ice. er o:t' @ited': @tat b l@h: Serv" t'DI2 LAV: Le ati on on -or -c@es ct, e c tc-, P-pency the sole. agency for carrying out such nurnoses: -T'he@ t -ecti-on ar-Y 1 R n 'L-L FLs 'Dean a.) ove'l.i uil- .ter aSteta sliEll be further survey or furction@ out c@urs-u,:nt to section /o23 (a).(10), by the a@en@ y C16.5j-@.at@d-- irr. aqcor@l@cia Zenith-. section@@ 623,. (a) A s la r !Dr o,,ri s i oii con@@.F; --nea- -1-n :-@he o--ri-,,:---nal bill the @4 @ee. exception of t,,,Ic; proviso 7.as bt,@ the '@'enate h i- -.te a@@,M4 niztra'-:ve after L-.ddi-tional -;rovis -on as,-,rrc-c --ont-'-nu-'-, c,@," @10 @-t@ . 11-1 " - 7 L iyas no sa-eg7ja-r' that appro-val of the It-,-e ?icn. he @ll bjlL I-,Iiei-e -n Sta tp- -v;oulel c on @irue -i z-,'I- z-o.-rvey ;-,.nd ing. -j C',-,ivi i--i e se e3Hear =gsr ani'2.72--.- -1-19 ancl' "I 'hat,the @.'106 gFe,@tidr-s on )c 7es 2u 'icallr'fia-m e e@: i.r@ th e- 1 I-e "rtmen t -bp- e tibri as, the -.,sing@ Def ini f,'ions S: -F-a.k'e a.,.-ency.s the c c r, e @x -f-eci re, -U- eithe.- @.he a@enc,,j c. lesignateO, by the S'Ua'ue r s-Lie-n'.- to Hd@,,3i,tal, Surve7,f-,azid. th@ cy -iesignat ,4gpn ed ta mi i.-"-Ier th, a@,e to secl-ion@.r)23- (al. a 4 :-,I !D -State, advi ,ha I l@' inc,!uL'e re@ agenciec-,, conc the operation, ccn,-'-Irur-t@.on, or ul-,-'Llizat4-on of hospitals, 4Lncl-u,'ii-@g re;).-esen4-lat@-vss of the consumers o-L 'ho.-i)-,tal seriT@ceE selected from among persons -.aifiliir 'U C.,, e@v--i c e s@,'ur. b agen( ep-tion.muz -he e@-,'@abl-Lshriient SU@ 11 e e e gest-I.on in HeE:i@-Lngc-, 23" for of local advisory councils. u (a) llshc. 612 provi@te for -,a!,Lny an inventory @-ct@ on 6C)i an-A ey in acco.-n-4-n-@e -.:it cn e Surgiaon. General, and -"or devi,-' oPi ng a crogr,-m 62)- section .,,,-as. @lear in.@ t b-i!T that'one of its T)uriosea@.. S@n te.. -on e activities 6iii-.e-yer e Ie@ tirror L:,l r-c toll (;Omm @the.Stud S Rea.,ings, pace 2'18 et seq. Yi. ,nnot f a "Too ,much ej7,.oha,lig c, e the -;,i,,Dor',,,nce c comnrehensiie and cr@it4-cal analys@Ls of x s t n Lr ho s i t a, 'L -@ c. c e in any ion.--ranize --lanni-ng progr.-3,.q. !L@ 4-s an acti-vi'uy ;,.@h-Lch i@ecuire.7 ex,-,ensive detailed s*.udy of a-VI of the -,-'actors i@-li-ich @-.@L@ect- both-- the use and extent o.' Represent, faci '@elL, a s,@ t-b S'4 Note Flso the te U.L.-,,ony relative to the North CLirolint- E-Lir-;ev Hearing-, pages27"1,--t seq., '82 e@ seq. The com@.@)en@.s on 'reha',-4' o@L' '.be i-@,Tr--r@-can TnsI.-4--tulp- of Architects at',@age "69 are F.Iso o-.-' -Lr@,'-erest. @ee- also H.I;epri-ngs, a e ion ough,@ob@,, .Oion; t of e legiel@qtion, su,@ra. 13 6 !2 ,,s C. ,@-L2 that the. S',ite agency @n( 1 1 Tr-,,ke si-ic,ki rerr-, i ng, such e ".@ur@-eon -7,-znera@ riay e rea-- na es to the @urgeon General, ui.-@on C%CC s record ,.hi-cla such i-P.@,orts are based th ea i@'o@' 01 P- 1'6n sonably" For r so e at Pr g-e a ae-itr.-d 'nv @,!as@@dontaa'm6d@in@'-@he ori@,inAl: bill. d o ei sug. omtnittee. ' -itical lanE-uag,e seca@ in 623 (9) Lnfra. Ldei -is the Senate-C f 612- (b) C. 612 (b) The "ur,"eon General shLll p@. 0 -)roTrp ny @or f-,) n @i s hi-cl-i !,ci.,T)l h e -oro,ii-s-Lons. of' @,ubzec t-', on lln,-.Ier the original bil'. to comply w4-th si-,ch -r the U'ener@il, .-ith the o.@' tl-ie 'o, u t, -incil, ri-ht Dresc-ribe. 'rhe Senate felt i - @,esi.rtblr-, to limit the range of Fe,.Ierf-I -.'Ziscret4.on ancl --.@vi le!'. thp-t . t,iese functions be carried,'OLt in P-ccord=- ce V!it,@, @,e@,-.tio@s.@ Rer)@.- t 'Md. 671,,@ -@ri t i power roi- @q .-Q6m, ri t Note@@t i he t ienp- s@@ a '@P- "037. on, the,.re.Lq.rlveF ee r,@ Hee--il See", @,he@ ir Pa L s 0 -,p 635, s o the s of e f, c i e s 61@3@ T6 'PO C a 4,, C- ,-ach c:t,,.te @-or i.-:hich a 613 (a) on ;:,I", @-n -:n:@ -lotment -,uch. ;,,,.o,)o-Ltion of be e n r@- ci to an le t' o o p '6c- r a@, n opula o@i' and ::ithii-i such el-,L,ot,-ent ---hai'L 'o e en@QL t."Ie@, to, ,-ece-tve of --arr-vi-ng oli@ the O+' Se.Ci-4 on 601 (a I i@1, e-:i accoi@tanc _:t"l its a c,-,tion: Join t n,(, the be 1 @t6 :any @qtF s te, hz: e, 0 t -E@geon Gen6--l s 11 be entities est,'_,,,,rlalu-e 'Q.Lle su,,i toh c heach @q t:F,e under this sect4Lon, @,"U,-!-n-,- @uch ensuin@ ,@p-ri-od as he 17!ay e t e r. e a n,-.@ s h,,i 1 @L,hE;@c,.u.,,,on c@--- to the estimated -e.c-f e te.r-.v of the- Ti:easury I-,ie E+nount so the c E Is@ 'auce o h t the: ain()Imt to@ the, @tdtia n T.-as e ti tll L -ec@s l' th '7r.- h!nll @ucli- ;Deri-od. 'he y o e - -,4 @i-iry s -he the-@e,,,-,on,, -,.-io@- to au, or settlement, b@r th .:,Gener e el@, th-- @,@,-,,o'unt: '@4 d@ ijaid-@ tc c er@ ei for t"115@ e to the. -t- i,, ----7 o;@ '@i e e:-i 1 3 'The OT o@kief .Lac+.or-@ az lie f i, e 1 0 -lie ar"@, C) T.,.. r@i tio the snelledoutta def:Lnite@ fc -1 i t i on;- 1 survey ar.@d is flat 50@@, grant &n'@ .,.-ov-'Lsion 71@@s i,-,a.de -for lo,@., to the States. , e pou@,,e Co,-;n; @.,,--ee cu@, tied f"-a-t gr,-,iit to nlanni-ng flancis th - I the s-u, @uti-,o-,,i ze@ -o be de'et@,"- 'he @-rovi.s@on for 'oans an@ cu' i -()ro 4 ,.e t 0. 19, geS a,r). priateci @'rom f;-ve ,-r@illion to 4@-hree 7. -72. - -)ra. S. Hear-ngs, -)age 62-1 su. IlotTq nt@-@-a-rov,-6iona. repay-me p ng f-uiie@s unex@l-ndeLi- 'oy the State. The Senate tD21 'O'@ T'GT70i t 0 he c:7 r-r@T'n@, e 6oi- (,b) L, 'C'k, f 6@@- t 71 l- 'to o. ze, 'e @-id@ng e .7 u-n e, 30, 1947, an@-,-foi ach of the 'oiir succeeding ol-' 7 r, C,-j E@ L FU years, the O,-300 -@or the con ct'on of nnr--, other non laos:)itals-, Fn@ the-,-e i-re fur@ier authorized to be ai)proQriated for such consLrucr,.- --I -qurf I E @)rovicie @secti6@ 624'. The,@.sumsl-app:roi)ria@ed -his se ti6n sliall'be used for uant to I maL-- n- payments C. --to ctates which h ave- submitted, and@ h,-, ai-)proved- by the Suroeon Genera'L, State @-.Iaiis L'or carrying oul.- the iDur@-Jo--es of sec-@'-, on 60'L ('D) anc' for -,making -,@ayments to i?ol@ tica'- sub.. v o n c -),jb'L i ca other non -)roL' i t Agencies in such Stalu-es." ll@ Introduced, p r o vi --L'@ Ct fora prog.@ar.,,- of indefinite dura'L-l-Lon, @.'If-NO,000,00!3, for the -@ 4L --st year and, afte- the firs'u year, set no ce4@li-rg on the -@imds th@t t cou'L@- '7i-i e b re,Dcrted out oL' '-.he Senate con-Di-'Utce 7;ith a 7. i-, t 4 t -L o n o5 ;,,ears on the @Ura@,-Lon of the program End a of 7 5 q,. 4- on do s -.er year on --Fun,-@ c- t ;?@ge 81 P@, Is 1-4o@.,. te, tif ied: -tha t - 0 f)rl @'fo tli e ations,. e )-io,-rital construction ;Drogram CU qave been. o 75,000,OGO per- r e -@ i- for. b 6e+,@ one@7lart6 d 'e, @)i of'-th or @.Tieii s T-h -ovi e or- 01 oo-,ooo@)OOO the' year, plus necessp_.@,i' @l-@.0unts irl succee@ ir.g yeerq- iodine "-e e-@,-Lble. @71-, i s IL D,@ a -2 t i- car ru e since the coz-t of -i-iecesc-,,-@ry constriicti.(-)n t yp-p-rq --n E7ubsecuen c@)nno'u )o@s'Lb l@-i I,- -,i r @ F. e 1 17 p tile rres@-n@, L-;I,,e. e v@2 e F. c-n c r C C e @@-eref 6 ra, @'l; e i-e ec c c., on c u 'o e o r e e- o@ definite! future H.,@ H @-7he -@ur,7eon Gene.-r.'!L cf7 c-IL o' tIDr. Parran:ll T !:.,Ol) e-,,- to l@e-ave I-. e T-, P. n h e L Cti---cret@-rn o--P 'L'i.rst y-@pr, -Inci Cray al),)--,-o,,riat-@on of -."7@,OC)0,000 a fea r, E,-!@-o 'Lo liaie the bill ol@erete ove-r -ye,-ir on the other 'tir-nd, 10 ,eri o,-'.. If@ ess h ea to impose a c@il@ner @ihich @I ho-@De:tli,--t the- ..Iif a f ter,@@ th 0 ral hzt Oil!.-,I 'not,' give 00.000:@or@@ QDG that@: you,, e ha P,,rila especi call as YOU iiroi,,-n, in conne .-@i-on. Doin teC, out c th the mentp-1 he a 1 'I@i bill, nobo@7,, Isno-,t.@s, ho@., @uch a, @o'@-la@ '()UY 5 year-,- L'rcm no-,%,," -,-@n. il@@Thp-t 4-s right. 11 D-r.:. -r@.r @'@.n:4 thp i-I s the ree -@n f-.t,-st -c-CoTr@,rendp-tion vl!ouid be to leave ,@e,@r to to determire t@ b-" !I: fter a s@ the am-ounts to be ap un Piece f'ic ;Eition fbr th@.'f i @@t o,,r. -r, sot-@ t t -L h o s i s T. erect the' co@nc--, @n c@-@.1 e@-",Ilc@ on nd tF o @,'ie L-,er4 can b-l-,;ons o' -ov-@n -ur for ex i7.. ing@ ii.-' the s,, s @t;@p-b6ut 500,@. -@unc (H. ffear-Lng du on. -Base .-IC 3. Cofj,4t,ee r,@@o@ized the @n ;,"@le 01@: 4 r i- 'j, e(i ,e hos"ic,@ .@'nu Ofic 20 oerce-,qL-1 of the. _u eon @eriera' to 'L)P-@ by Sii-rg U Orr_. "onstrudti. neces. @s@a to in- tlUCt4 .,qssi'L@anc6 -IL-or cons -on, crea the. 'Lin either -o7j increasing the aiithorz-at2on ce4lin@, or b,@ e,,,- u tending the @,ir,,Ie (@ur-'ng ,.,!i@-ch funds t,ell i-or th@-,- e, throll@,zli both re hoci@ - (S. P,e@o@ t ,@o. 'O't4, ),7.@,e L .1 'll Senator ',aft in Uliie e'eb.ate on the, b--- -ren,-,iture 6 11-e hf4,.v r 'traded a 5 c e D 0 -year 'or srv e:z ',be su-Ifi6ient t' enabl e the ,900..OOG;,.d y@ar4;; Th,,L, aff' 0 'be. i t'@t ed. @,,,ran t a. ge a e enCious n -of in,@uci.na 'ever,@ Otate to make a -corc@I@ reheftsive hos@i,'al th6@, -i.. 1 be given--,.a L-ire '-o t4e to67e'@-Ler for itself. 't' he 61@ the h6@@.- it@,l@, @syaf@@l ta includes .,ubli@ v a t e ho then to @7ecide ,.hether a-,-!-t@onpl an(! -lee ho,-:.,i tcll.- ae jet e S. C ,01_ .,p,, 4 no matter l-i-. e be. 11 Print No. 3, -@a-e 8'@ . .-ee 624, infra. @o3.- ot-' @@.e -rob!eTn. o@l- @,',-,o@,e-r,,atching non .Jrof ta-1 s. see arants-tq hos@,:L 4si6 gr6es,@ provides:: e th assa@ i cre tment onstr otio@ of sr n-6- c -df Se6tion', 624 Publi c@' 'H al'@th rvice Ac, as amended by the first' @ection of this act."' 622 LA'-, G TJ 1 O'@ 2- thin,.@ix IT:onti@,s aL@,@er the of la-tion i, oe . . . shall b7i zeiieral- @-egu. re,.cr- Ci4- Th67 CQTI-E re ere r,,, a d e rr o P- been in -@th Te@- eral and,. e- e s'., lot@ h t at po@,.,er @@d, the States. 6. t 1.@ n to the@ St fo d:- or- ru a:", .q n s orii. g7@ I e io pt :d the: -,Drov-is4-on o!-ii tted. -:her rel'orte,,7t out bY the Senate p6li@ @dc e , e 7 E, r t,-,,- c"etps shou'i L Prd Committee. _lr i e e took Luhe cosit4-cn tha'@ Re,iort c 6 @w6ul@l be able 0 handle thi-s f 'qeiere'- ai-d. @.ge 8. zr @age 47, CoTr.. r,4 re '-.he Fp, H. @IeF, @ngg, qee also Hear;-ni, ant @or-um. 'qgo@@,146)@:. p testi@, bnY. of Dr-.,: Boa-i 622 G U i 0 il@ OP Ti ? V.;" Iect-ions 10.1 to @O@79- inclvsi,,@e,, of this 6e ,,ur.-u@in' to ',he ,rovisions o@' e c oi-@ 622 of the HeL.Ith Servi-ce ,Ic@ !3,s q,!; P. n u e (i by @- 1-i eH o,@,i a E!n@, Cci,.,-7ti-uct@.on Act (--@ibli-c L'@, 7'.'@, -lc,)@Lh -Fred to the -u Congress) a, ved A@8 t l@, 19@@o, -i'ch a, s act- a n t4-tled ,(,'on.-ztruc,tion of,Hos, @ion@ -6@2, -requires' th-t.,i!ithin- ik t -he,'ne enactment bf't t@@l@y ;the- @t5u@,,e6n@.General@ -r g ,e -@e,@ilations -Describing q-enerp- -@io l.-@ c,. e s ri OmUl ,i I-o-- be :Collot;,eci in se'.tin@, u-,D an@i P-@,.7,4@nistering State s for con@trjct,-@on c-@' .-@ubl'-c P-n(.-I other non,-)@-(D'L it hos, @Ltrl a rD.ec@oii. are% I o-,r5@l@4 ,Ye a, E tlni Y, nital bee-S req.,-tirec', to ,,sEc. 622 (a,) The )-umber of @neral hos -,rovie-e qO-equp,te hos-oitp.1 services to the reoole resi@in4 in a File @eneral :method -ethics ,,r.ii-ch -such 'ced.s State shalL ba Distributed. -,,.iong 'case @,-eas inter:necl i-ate areas a--@@- t exceed f ur e-n one .@lf per thous@)rO. noTuip.tion, excert th,@t in Sta.tes @.ving less t h,-- n twelve ane,. :more thp.,@a six rersons rpr saiLi.re the limit sh@ll be five 'oeds -,er thcusane. -no-oulation, and. in States ix'nersons, or-, less -mar s@re mile the limit s-@ll, be Or@thousanE topulat1cf1l, 0 ns) within thee Sta gte more 'beeLs tlan -re by the s t ene,.a r e s -rrescr-'l e 'oy the Surgeon Gpn,-ral, the excess over such s@are.ards @-y be eliminete@@- in calculat in,7 "his mpxirnam P,l o,,var-ce. f tosti ie n T)eo-nle- P.s A reasonAbl,@'a',bEitimate ities in h i I think 4u c ink- n h@. -. u er.@thousan@ t I,. D-r P,-rr@ see". th fizure .5 'be's 7-)er thousancl, an-6 other Authorities i-r- other -nl-pco-s -11-so l@ve @ VP-ri,-.tic-- of that ninber, but I think it is the consensus nf o-nin'@o-i now th-@t require -rer thousaneL. (S. F@e--trin,-s, 24) in su.-gesti-n--7 the limit a the, Co=.ittea reporters-, wit@p, Gur. coriLnittee concl&..ed- '-ha it 5 e@tenile 1-tshed iCA-rL.@fe&@al Associ@. -12 13 @larch 3 s- itrary aqsi an tb,-..t, at -f ',i@ i-T 4 y obs, o', e,e-- merge al@, o@c he., estirn+,e@,,@. givea tell the, d ttE Arere n,se on a re.; n t@ s re,r 1,000 @-)r nersons in' cities of 10.000 a.nO. over, aT,@ 3. 1, 00 for smaller towns Pne, riarp.1 -@-reas "I 7rol-l'i,117 '-os-nitpls, -nr,2se.., - -:rptes @re @ 1. 3acn,use of the use Sti -0-se@ oa 'beds for P.11 the ro-nuln.tio,,i -- 9 n r 1 e U7- t e -.I e e,@ -23- 622 Your c or,,T-. i t t'l.erei-c.,e set 4.gl e -er the u.@@)cr d @n. -ttaei- @-.gi t f'or @erier@l a,- -la rea,.,, c,.nl-"! @n ,i rn (,@ n @ 1, oaoe area@ @"revent, ;4neciuj-ti-es iq. ap-,:jlic:s-bion 0 it is also or(:l tfitio of, at)er,-'@e to t@)reven@ @he imis ing,'Of a,-@c-qu,@ta 'Fcilit-Les i-.n other, sre,-@ o a @t,@te, the b e n o n e.?. c e s. F o t.'IeSe -,,@y lDe In e C- so lc,,ulF, t-; n oi E,,',)le e '@c, )r, I e i) or -.,z e ,,, 8' o e. 1-io@ the e 0 7 statement by E,. iones c." 'Uhp- j@@@.o,-.tern @io@-:@ I.,21- P-,@bl.i- -li --n@ -,nc: Ili3v ex,.-leri-ence in. ha@in@., hundredc. of hos tal ications to the l@,, ar rlr6f:iu uion Boarl ax, @i@, the t no.on_@-se@ bed - ra ti-o ner w)ulatioii, s-@di aI carE hen Ss f a'- ho S,- ea.1 c t.. "-i ab c r i t 61- r 4- a tli y -ti red thE 1) o'blem@ ho-,!!ever i @oiis@en, of certa.i,.i grouos- of individuals s e -L z -L ri u-,-@on tiie@ s P, n -,! n -f - @t- bed r--: io of 4, b e s @@er g_ ,thousand for urban.,?orula@ui or@, '@a'nd'2 beds -,-,er Luhbuse-nl for rural ,!here sr@ctly to'such the only@yardstick. to.usc-. .-,ts, to R a set Standard -ciie@te tl -inevitably -lead- to serious r---rrors. I kLhis 1-@bc-u i.-,erely_ to ie co-,nrlexity of tl-,e -,@bler.." .(S- Hear4.ngs @-a-e- 372) For discussions to the.riumber of,,beds'-needed@' reas- see. S.. -ie qse,il n the. regu'@ t- ons. 4n ,h-s nert,: T,, L n 24. 0 1-22 h,- ",he -'S F@ -nter- is en @li-@si,,n Io -n the t@-ons -'Ln or 'u r,-, gree:7@@en f the ro o it qhall I e (I ixres cr)n L -.in @,h i n O' schoo rL jr.,u,@:- be ,3uitaoie. use s i@teci:-hos m -,.'Ithin the @r-,,tite;'Or (2),-, the R rea e. COI,@E a ee. on' th6' (F g@n6 -f' 0 I'a e, --or @eneral i i.-l- e'7his 't fui-ni ies n tT,,o or hos-[-)-;. al -sh ni i,esi@ienc le for rise a s, F@ base more S.:)6c, e g ha@, a c o, on enera' ho s of 'LCO or -ore 'oe @table@ or:uFe a-