*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-
                                                                                                                              r


                                                                                                                                                                     622  (b)

                                                                                IISE(;.  622  (b)            The  number           o@L    beci-@    r@.-c,ui         to         v i,,", e

                                                                                a-',Pr,  -te                       @tf-,v-4ce-         ior          'luber'llilo,@@-l'

                                                                                Oriental.    c)p-tien tE                                                         en i@.           a.

                                                                                                                                                 @fethods' by, ihi@4@
                                                                                                     th              ral-
                                                                                                                             method. or

                                                                                                                     ibuFe'd  thr;-ugho-ut               the     St,7te:
                                                                                @rov-@(2ed,  the t           for         e                       or' 4-his           t;tie @he     @otal
                                                                                                             -C r             -i,.bc-rculcus                              no@,     e:@ c e e,-@

                                                                                ti.--o  an(I   one-hE.-l@                        the                                              f--,-or.,

                                                                                                                       lt@,te          oveT'     the     ve-77e,,.r      -@erio,:'  @'rr-
                                                                                tuoerculo F i s          in    the

                                                                                                                                                           ber'      of  Ioeds     f'or

                                                                                                                           not     @exce
                                                                                                                                                                     thousf-nd
                                                                                              -a           s
                                                                                                 ti  n t       sea                         eci        five @)er

                                                                                -lo-oil                                                                              r
                                                                                                                         o     ir iiuT.,, t) er  o:L                     chron@

                                                                                --isease       @-,,ati                           no@ exc-, ec-,@   t,,@:o,     c-r   'hot   z,,q-ne,

                                                                                    -,ulat@on.

                                                                                                                       ne',                              a           f         b 6r-  c-u  o' s i s
                                                                                                                         if .@f6@                                  xi@   ly    @:!6    000@
                                      in                                                  &on    I                     e                                   0         a@Ue
                                     beaa-'sre  needeci  t@ -E                       ce                      e'@
                                                                                           ob,--ole@           @-c     i t i e  s  .

                                      I;ee    also      S.  He!:  ings          @)age              E,.   le-:ort        @o.

                                                                                                                                    th                 r @yq.
                                                                                                    -Clabe  cii                        ft,-Oc,f@t@on
                                                coim2jittee         o4'       the     t-I one              -,T       O!F  SI           -LI                 i-ev- ous  e,
                                                to  the                         tee  11)(--ri-,               on           o                           ot,
                                                death."                          n--,,,   )--,t;e


                                                                                                           P,@-22  (b)

                               ;yvntal:beds:,

                                                                                     the' Senate  Coir @@ttee
                                 The Surgeon GenerEil testifie                0 e
                                           117@@,a. ,Ind ti -ieed foi-                'beds i-yr -.er-7,ous s.-d  menta
                                                                                     beds   -or replacement       of obsolete
                                 ;.ne,@tu@.ions and of 97$qCO        Additional
                                 facilit

                                   Dr.- Sensen'ich    of -'the  '@r,ican    iiddic'@l' Association testified:
                                           "Chronic     illness   of other types, especially the sloiily progressi.-ig
                                   illness of       the aged, requires.long periods,,of hospitalization and beds
                                                        'over' for' these            @a      hospitals planned for the
                                   cannot   be    -given'                       patien   in
                                   care    o
                                           f ac@e illness.  The. aged- iw rson, having suffered a cerebra
                                   hemorr                                                          for years, cannot be

                                                                                                    w 0
                                                                                                          r      thos,6  are
                                                                                                chfldbi trip
                                                                                     eL           t@,,'the  individual, with,,
                                                                                                              ;-peri d   of      e
                                                                                        or!   o'onsideir'a-oie
                                   @thd   b]          t-'    the  (1            case4, that is     a different      category
                                   entirely,.         doubt   this    fact..vii1l    lead to the   eventual'esta-blishment
                                               sn'ec'l-al hospitals for        chronic  diseases*   It costs less        to
                                   oper6.teo'- yoia   dd no@@-ri@ed. all.   of the facilities you need'for acute
                                   il@ss        Sora   units    of    governreiit    must support the indigent in these
                                   hospitals,     State     and     local     governments @y be  s   Iti.-.ulated to accept

                                         from'tuberculosis -as               reco@nded          sanatorium standards
                                 committee of 4.he l@tional. Tuberculosis Association,,   Previous estimatds.
                                 -6a the@, subcommittee         e@
                                                            tier  based on th&. al(i      standard,    of 2 beds- per annual,


                                                      10.21. @imum state ailowance              the number of beds
                         REGULATIONS.-              required  to  Er ovide  adequate    hospital    services    for    tuber-
                                                    oulous   catients,.   nmnta'   .-cationts   and   chronic ii seeLse

                                                    patienti  in-anv   State,  shall    be-.

                                                             ea ti                 roulosii@  ir             o@r'  the    5

                                                    year period   from 1940    to  1944 inclusive;
                                                    (b) For rental patients,       5 per thousand population;           and
                                                    (e) F6r,chronic disease patients, 2 per thousand

                                                                                                              =e3ital;   and:

                                                       oiii  di s
                                                                                       s   s                the beds     in

                                                                a            I         cti                 es as     defined

                                                    above,  and -also  -beds  in any   general'      hospital which are
                                                    specifically assigned      for the     care, of tuberculous,       mental
                                                    and chronic   disease      tients   respectively', except        ivhere
                                                                                       in'stitu@ion'ii@ber     less@@h'an

                                                                                                                          (is s@

                                                                               al  s@      r  t   Yediar     -Act shall    be

                                                    ,built'in            of       population and    proximity    to general

                                                  .@hosPitals,

                                                                                                            :L@ls receiving

                                                                                           h&l

                                                                                    prox@ty@ tc

                                                                                           pule-tion  and   in  prokimi

                                                    to general hospitals.
                                                                       28


                                                                   "SEC.,692  (c)               The number  of public  health                     centers       and        the
                                                                   general.          iw,-,qod of        distribution        of        such        centers        throughout

                                                                                         h 4 C i-  f or  " h,3  o LL- n o s P, s  ) f  h  i  s    t '@ a ,  s 'la         o
                                                                   the  3ta@ay
                                                                   -a   -made one,        per thir,tythousand            population.,            except.the-t            in

                                                                                                                                         per,,    a       a',
                                                                                                                                                  quELr
                                                                          1:    ot       ceiad one       per    t-tient,,r   @h'ousand       population.'

                                             The     bill      passed      by      the      Senate      permitted      a higher        ceiling        for        public
                                     health  canters..in.-si                                                                 iginally       provided        for        in,.
                                                              +1
                                                                                                                                  ndmient was
                                                  fi6'o@,6t, the@                                                                 Senate           Co@ittei           F'r@@
                                                 p,%es.@                                    S.'iilso@ best           ny      -;4rgi ng,l health@center to,
                                                                                 a       ze_  151.   and one@flhealth             center  to  10.OOG
                                                              pa
                                              For    testi=ny          aL s  to   the    background         and    need      for    public      health              centers
                                     see  Senate        Hearings   ages            102-   115,       187,     351;         @H. Hearings      pages       87,.       141.    et.
                                                                        p
                                     seq*      See          631  (f)  infra,              for the             definition    of public      health  c@nter.

                                                                                                                                             nur

                                                                                                                   .(,a,5uktinp      those@exi's                      Well

                                                                                                                                                  sha
                                                                                              de@@':vii,ti,h aid' under         the    act),
                                                                     exceed       one       per 30,000  State          population,           except       in,Stat6s

                                                                     havinr, less than, 12  persons.                   per       square        mile     the       number

                                                                                                                                                                          ,rat


                                                                           Yhich- the  State Agency, after
                                              (a)
                                                   Ex-Vstin&  facilities
                                                             -Keith the S@@@e health   authority,  has  determine,
                                              ,,onsultation
                                                                              'public  health centers,    an@
                                              to '6 ein s u i ta b 1-- for use, as
                                                                                                  ;i- @nd@ clinics.,

                                                                         o'.a5 the  health department office
                                                      ffi  s        -udtur
                                                  :Ln@  e  ami  str

                                              or in a  separate   structure.

                                                                  ii@ribu-ion.-  The Feneral method of
                                                        10.3      D
                                          @,.@,-@.diatributibh-,of@@"t)ublic health centers throughout the Staf-

                                                            t
                                              sec                    o:f the Federal   Act, the method    of

                                                      tition shall be  deter
                                                                             mined  after   consultation   i7ith

                                              thd-'State health   authority


                                                                                                                    622 (d)

                                                       SE;C    622, (d)    Th@ general mnner  i,n.-which            the State Agency
                                                      shall    detar@e the         priority       of projects    based    on    the

                                                      -,.-la'ui-,,3 need of dff-arent' 3act;-ons of              3  -oT)ulat4 on -and
                                                                                                                 h

                                                                            re as,lacking-@4pqu@@e,hoapital@.facilities

                                                                             areas    with rela  iv                     nenaial

                                                      resources*

                                             Gen

                                                                                       even
                                              wi                   re.4;         bv-the..,Siwgeon.         General, with,,.t
                                                                                      -se  bk-@   th&   note      vm
                                                                                                                           e
                                                     tkdop                   a     n
                            @eLn@l             lly'                          s        i'l@accordance -with'   that    Comnitt@!    s
                                                                                                    '6 -  i6d    t:in   a;ojzor
                            decision        that the, Surgeon     General,$     Dmetions      be   c rr         ou             dance
                            With@ regulations',,-..ITote'-the followin             in  the   Sen'eLt6    -116arings at  page" 67:
                                         Ma y I   ara-k     'senator T'aft?   sattention     tu'-c6i;tain language, on,. page        7
                            of the    bill.,   lan@ge          which does seem     very   broad                   uthority,       It
                                                                          oith  ',ti4  r,61@a'ti-@e'                    ed@;in

                                                    Elie                                                          St
                            whe@  er,   or  no@   it    wotAd    not @;e"'beet to have a-provi@ion, in,'the@@bi'll, that             the
                                  s-shall     f ir s t be U,pd, irL a.  State to build.hospitel.P c
                                                                                                             a @  iliti6  s  @where
                                                                                  'State*_
                          "',ho@tiilization.        id. most ne     ed


                                                                                                             622 (d)

                       Dr.   Smalzer   of   the:;   .-Merican   Health   Association    in    the    House    Hearings corirlented:

                                T
                                @iowever,                 ;dse   that   this   act does not attempt to establish ric-@d
                       standards   of,rela-Llive   need.   :',-   is    im-Doss-,bla    ro,..i to @@e ayiir fin@,l dec-4-s4----r,
                       3s to exactly-,;,@lf,@.'-t  hoso4@-@al                  may oe   necessary    to    offer    adequate
                       service to all2,o2 the people and the act permits, a. chang@ definition -of need
                                -eir
                       to.    fit     0                                                                       tha-t@ in
                                                          t

                                                                                                           as-*    Such     hos-
                            itals migh                 -the key,                   quality of care in        an entire State,
                       p
                       andi     in addition, function       as    training     centers     for     physicians, nurses,      and
                       other technical workers required to staff Outlying hospitals.                          The       definition
                       of   need   should,   therefore,   be    developed    by    the    State agency      in accordance ;iith
                       existing    circumstances    under     the     guidance     of    Federal regulations and standp-rds."
                       Ho    Hearings,     page 50,

                       Priority     --Rural.-

                                        @na          C-O=i@;@                       tt., 'Of,  the@ Farim Se(             nistra-
                       tioli"             O'ii      fb@,  @ur  :,Co,

                                        'd'
                                    voi                s                                                             i@'eve we
                       need   oidy;    make certain    that   abso                              n  to,a.consideration of
                       needs,   In    other   @iordq,     the lang                              me.cl that.,no institution
                       would      be      constructed'in  a l@s's needy          @efo      all  :;ore   needy   areas    7iere
                                                                          ar a        r
                       provided for., mer6'ly because,the            le.s a na e d            ld   assure     fina4cial      rain-
                                                                                 y   @pa    cou
                                                                                           e
                       tenanoe        '(S'*'              pag   1 3)     see  also   :pag   s,.10-5,              .1.65,, 261, 292.

                                                                                    pproval'i
                                    iitvl                                                          the.,House @pa;,ing  see,,
                                                                                    N
                       T@I@,     @'io
                                                          :L

                                            out..   litert                                                                a  t
                                                                                                           "it@sp:ltal   ASSOi

                                  Senator LaFollette,   In viev4      of    your    ansiver,1 will   ask you        another
                       question, if T may,            To  @at extent     do    you thi@    it will   be       possible   for the
                       hospitals      to- meet  the needs:of rehabilitation?"

                                                                                                                               rn-
                                                                                                                       4@orued bi


                                                                                                      622.  (d)

                                                                             'the  larger proportion of vihatever
                                                                     -7iords
                               Senator   LaFallette.      In    other
                       funds   are  a@vroDriated..  sh-otild@   this' bill become    law,,,, ;4ould be     devoted to the
                       constructioW of'ner,, faCJI4 ti.3,5?11

                              '!Raverencl.Sc.ht:Lta,lla.., lo,.  zeet the.@h@er-to unmt need          yes.. Senator-.",-

                              "it may not'Ibe-appr6@riate to        outline-c.onstruction    priorities    in     the
                       bill   i@sel:C.   'Perplexing questions moreover, as to the             relative need  for such
                       fac3'. ities as   general or tuberculosis hospital beds are             bound   to    confront
                       administrators and advisory councils.  ,,-iith regard to general hospitals,
                       ho-wever, I believa%that the first priority in constructing projects in
                       @pproved @Stater- olans should clearly and, explicitly be given. to medical service
                                                             institati             obstruction. should ;3i

                       RE                                          r, of determination.'     The@ izeneral.-  manter@

                                                               Balance among,catqgories     of facilities..    Insofar

                                                                      a. S@ta.:AF-enc-v   shall' develo-o    its con-


                                                                                                     622 (d)

                                                                                          onsideration    shall be
                                                                 ropor-tionate  needs    c
                                               In determine      P
                                                                               ;es and those   under   construction
                                               given  to exis4ing    facilit-

                                                                                     deral Act,,
                                              -mithout   assistance   under    the Fe

                                                                                                      th centers
                                               and  additions    to  x'sting   hospital
                                                                                         s and hee-I

                                                                             over replacemerts, except:
                                               shall    be given  priority

                                                        -(a):
                                                             nere replacement     is of mino:e character,and
                                                                             on,: of needed  additio     1. faoiliti@

                                                        6n@ e    o elimin@

                                                          constitu    a public hazard;
                                                            'ivh a r ein -the case of P   oublic. haELI,@h center
                                               the    State health  authority.has     certified    that  the  existing

                                                                                'i24a a
                                                                            for
                                                                                          a -publi o@h              r

                                                               The relative   need for  beds  11.1 the area (-base,
                                                         .cli@te  ox,            Which@the    Rroject wall be
                                                int

                                                                                                            Der son

                                                                    34;

                                                                                       @"


                                                                                       @2    f,,i)

                                          sirall financial resources,
                                               (b) :i, a7vxten@ @o                 ce ifade

                                               s@   the population.:

                                          s   10.45 Chronic  disease ca@e' o'-ory. Priority shall be
                                          a
                                              en to those projects. in -,-ihi oh the chronic disease
                                            ilities will be,,operated as   subunits of general

                                                                                zhest P;l    ty@
                                                      y  shall be E           e provision   of facilities

                                                                              al   communities an d
                                          for-local health  unius serving rur
                                          areas with relatively  small  financial   resources.  ;there

                                                                    canister    the..,State Dl@

                                                                                               ab

                                          w i @hout af fe c tin gthe priority of hospitals serving rural
                                          com @nuiiitie s and areas, with relatively s rr;a 11 financial

                                                                                                   er     nw

                                                         --35


                                                                                      622 (d)

                                                                                   u       The State
                                          10.77. (b)  Order of --processing applica@iorz-,
                                            cy slaaii process aDp- icat@Lons received ir- the order0
                                                                            nay may  aDorovef,,, re-

                                        out of  the  order'of.prio
                                                                 rity I
                                        (1) The State  Agency  has afforded reasonable Opportunity
                                                         and presentation of projects in the order
                                        for developrBnt

                                        nf priority, and
                                                                            tci, th6@S           al
                                                           7

                                        'tha-
                                                                                     on         nancer@
                                                                           construct
                                                        resouro(

                                                                              Pr ioir, ity ar
                                            --top                          er,
                                                                   0
                                              'ertit on of

                                        available,
                                                                                     State plan shall
                                               The priori-t,
                                                          f of  e- project under the
                                                                  act ti-iat other projects of lovier
                                        not  be affected by the   f

                                                                 @y
                                                 .have.. prev,o


                                                                                                                                   f. constru
                                   LAVI:                                St'       62.2 (e)     General        standards         0
                                                                          c                                                                      ct-@on ctn.@,

                                                                                 n     -'or- hosp-
                                                                    eQu,p                            i  tal   s of                     @,-Iasses     and

                                                  The,@ri-ginal           bill     @i i  dnot           contain any requirement  for                such  re-
                                   Gulations.      It      i@equired      the       State       to       set.forth       a       construction       program,       in
                                   ace   rdance       ivi--h   standards  prescribed                 b                                                              61Z  (b),
                                         0                                                             y  t   h,6 Surgeon       General.    See
                                    @622.0 suprao

                                                                                            t                                                            on    General.
                                                                                                                                                               ibi@
                                                                                                                                                            aser
                                                                                            n   and@:,e    @iii          I      holitals          of-di.ferent
                                   classea'and  3.n d                           ty"pe@--of      locations.           In    our  opinion this             provision
                                   ia         greatly          i@proved'-in      R   9 5629     by providing,,tha@"the  Surgeon General.shall
                                                        S'Qo@ i-6i I      t                                         dards  for  maintenance  and  for
                                   alsd.have  re                                y'for, Er       aserib@nr,       5tan
                                                                                                                                             these  facilities.'
                                                                                                                                    t  o,
                                                    as   vie.11    as.@    for     the construction           and            equipmen
                                                            page
                                         'Hearings,                     138
                                                                                                                                  standards         o@,.-"       @t'e
                                                                                                                                      7-                            r
                                                                                         nanc(                         on.,@ standar,

                                                                                                                                                        0,
                                                                                                                           r-      co
                                      quir                                  O,r:E ',@L,r'o  '6                                  House C or,,mi 'ut e a  did    not
                                                                              '@ted by      th6           Senate.
                                   change                                   o

                                                                                                  pl.                     .@rican          Farm     Bureau
                                                                       tEL.@mnt7  b
                                                                                         @y

                                                                                                                                                    ova

                                                                                                                                                        0

                                                                                                                 835,,         infra.
                                   ne                                                               a

                                                                                                  37


                                                                                                                 622

                           REGULATIO!@TS:               10,'.51   General.;    Plans and     specifica-t;.o.-,.s   for    each

                                                    project submi4.-ted     to the Surc-eon      General     -.or     approval under

                                                    the  Federal @.ct sha         -.e prepared    :L-i accordance            '-.he

                                                                                   ons+,ructio

                                                                                              an

                                                     ocations as     prescribed     by the    Surgeon    '@eneral     set forth

                                                    in Appendix'@.4'@.  The    Sura-eon   General    ray approve plans and

                                                    specifications       -vihich contain   deviations @-om the re-

                                                    quirements@pr6soribed.         if lie  is satisfied      that     the            t

                                                                                       ]3,t4@ hELva beem         fill6dw,

                                                                                                                 the      -ns
                                                                                                  coverec
                                                                                                                          Ip

                                                                                                                           s @te
                                                                                                  th
                                                                                                                             t

                                                          0                                               d      w@th.the a-.c,,oroved
                                                    ai                                  ordinances     ZLII

                                                     tate, plan.     The     plans and  s@ecifi         oris    must be complete

                                                    and  adequate    for contract'purposes         and   have the a proval,
                                                                                                                        p

                                                                                                                   am

                                                                                 0   ta  ar s;                     Agency shall

                                                    @49p@      general standard@.   of@ consl,ruction@and equipmnt for

                                                                                 -o@p@@tals,  and, health center4       assistact
                                                                          s@-!of h

                                                                          38


                               LAW.                      "sEc.  6P,2  (f)     @'t    the Statq,,,@la4      shall          provide-for
                                                         addqu"a'te                     ili@,i e's  f or,,  the peopl'e.  residing

                                                         i P. a, Sta,.a,  -,vi@hour, di                       on. %,ccoun-c of race,

                                                                                             .@efor@..approval of,a   .applica-
                                                                p ri       @q     re.
                                                                                                                           .!IY

                                                         tion  'for,   a- hospital    or',    addit4.on     too hospital,is      recom-

                                                         melidecl  'by,  a State   Agprcy,,    assurance.     shall  be received by

                                                               St  t                                                         -oital or
                                                         th             -:Ci'm the   a;)Pl                       such
                                                            el   a e       0               ican                            hoe

                                                                                                                                    0

                                                         color       but@ an exception      shall be     made in cases.where

                                                                                   facilities                 vided    for   separate@
                                                                                                   axe.     oro
                                                      ,,separate      hospital
                                                         population      groups.     if  the plan         makes equitable     provision

                                                                                             facil:                  e@ices,       of

                                                                                                              -oha
                                                                son,    testifying     on   be'nalf      of'Al.    Kappa     Alpha
                                  @.c?rority stat e@:.,

                                                                                                                                    f6


                                                                                          ces. . . Our
                          income status Prohibits the purchase           of  these    servi
                          organization   asked   for   certain   ant-,.discri-minatory   amendments   to   '.he
                          .Senate  bill  which   were   essentially   included.   In   4-lhe   Senate   version of
                          S - 191,. rage 24, lines 17 th--Ol-i@zh 2L, nna- -g            the %,ord   --ou-o     there
                          is a;-orovision on discrimination because of race, a--eed, or color.                  The
                          designated-. purpose for@ this-provision was, -chat this. statu-koe.       would     pro-
                          'hibi@--@6uitabl6, di                  of. sema@rat e@ facilities  because  of   race,,.
                                                                                          l@@  intent  of,,this...
                                                                                         i      used    n     ine
                         ..We should like t( c@.                0    tp                  equired   by  State  law-',
                          We should like also       to change   tha word 'shall'      in line  20  of  that section
                          to tmayl.  @@a though in a g_rant-ir.-aid program             which  is  to  be    admin-
                          istered. and  financed  partly  by  a  State,  State  law  would  obtain,  hence,
                          separate hospital facilities would be mandatory and the               word lshallt would
                          probably be correct.  However, we prefer the %word Irbayt, which is                  dis-
                          cretio'nary rather than mandatory."  H. Hearings, pages 195, 196.
                          See also,
                                    ..,S. Hearings,. page,, 3
                                                                                        -.mi-tt,ea reports   S...Repor@
                                                                                       o
                                                                             e    ,:iq6re qait@ explicit     as. tb@


                                                                                                     622 (f)

                       REG ULAT IO  3                  10.61  General.       The State plan shall provide for

                                                    adequate  hospital  facilities  for   the   Deor)le   residin@   i,.a
                                                                                                                   'D -

                                                     State  ,'Ii-@,hout  iiscr4-miration  on  account   of   race,   creed

                                                    r:aolor   an&.shall   provide   for   adequate.    hospital    facili-,
                                                    0

                                                    ties   for persons  unable to    pay     therefor,

                                                       10.62   iqon-discrir@unation.  Before a construct-.on

                                                    application is reco=.ended by a State A ency for approval,

                                                    the State '@gency shall obtain assurance from t          he

                                                    applic@.t  that  the  facilities  to   be   built   with   aid   under,

                                                    the Act will be    made   available    without    discrimination    on

                                                    account  of-race,     creed, 'or   color to all  persons      residing

                                                    in the area   to be served by       that hospital.   --ioviever,    in

                                                    any area   where    separate    hospital facilities    are     Provided

                                                    for separate      population groups, the State Agency may

                                                    waive  t'ne requirement    of.assurance    from    the     construction

                                                    applicant  if   (a)   it finds that the plan     otherwise      makes

                                                    eilii:ftabl6 provision  on the     basis of need for       facilities

                                                    ,@d s:er   es' of      equal                   s
                                                                                  ity    for each  uch,'@cipulation

                                                     cup    in the area,   0-nd.

                                                    (b)   such finding is subsequently approved         by the     Surgeon

                                                    General.   Facilities   provided   under   the   Federal   Act    will

                                                    be   considered.as   making   equitable   provision    for    separate
                                                    opulation  groups-when  the  facilities   to   be   buil@L.   for   the
                                                    p
                                                    group  less.  well  provided  for  heretofore   are   equal   to   the
                                                    proportion  of'such  group   in   the   total   population   of   the

                                                    area, except@that the State plan shall not program facili-
                                                    ties  for  a   separate   population   group   for   construction   be-
                                                    yond the level of adequacy for such a-roup.1'

                                                                     41


                                                                                  622 (f)

                   UK:                 "SEG. 622 (f)  (2-) There will be made  available in each
                                        such ,Iospi-@Ial @,,r         a      ital a reasonable
                                                                4c.3s to persons unable to Pay
                                        volume@of hospital serv..@-

                                       @@-theref or-' but an eac
                                                             ep@ion sha.11. be made if such a
                                          auirement is not -feasible from a  -.@4  ncial standpoint."
                                        re                                    --na

                        :-,This provision-. added by the Senate Committee was not in the originated"
                                             674, page 9.
                   bill.  Senate Report No
                          Note that this is  permissive and that the  Surgeon General is not re-
                   quired to issue such- a re@la@i'oni  See S. Report ;No* 674, page 9. H. Report
                   no. 2519, page 8.  Some thought -was given however to a definite requirement
                   that recipients of Federal funds handle  a certain number of indigent patients,
                   S. Hearings, page 190.  Note also the testimony of Dr. Boas of the Physicians
                   Forum:
                         "The provision  exempting hospitals'.trori providing services to persons
                   unable to pay, if it  is financially imoracticable to accept them is unfortunate
                   -3.nldead',, since it id these very patients who are most in need of such care
                   throughout the country.  It would be 4ghly desirable to remove this condition
                   if -at all- possible.- But shoul(i such ez condition- appear to be financially
                   =ev-itable, there should, @t least be an antidiscrimination clause attache<i-
                 @@,--to,-thia'provisoi.for-other wise there is the distinct danger that the in-
                   stitutions, supplyin 'separate facilities for  differe                   p
                                       9                                 nt population grou s might
                        th,6@ indigent of tt minority group' 0311@.'@ H. H&arings, @ge 147.


                                                                                                                 622  (f)

                            REGULATIO.NS:                  10.61  General.  The State plan shall provide for

                                                       adequate hos-oital. facilities for the @eonle r,3s4-dinl-

                                                       a State viil-hout discrimination          on account of races 3read@

                                                                                                 adequat4      hits     I  fac.

                                                                 -fo                                 therefor,
                                                                    r     persons- una       ato

                                                             10.63  HospiteLl    services    for   persons     unable   to  pay

                                                       therefor.     Before      aconstruct4-on           application is i-ecor-@,T:ended

                                                       by   a   State Agency for         approval, the State Agency shall

                                                       obtain assurance,.    that    the    applicant       will furnish a   reason-

                                                                                             'care
                                                                                      igia
                                                                 vo umly.                          ir    S-   use I
                                                                                            t,                      xi this

                                                       section-     'frE              oaret   means    h@pital@     service

                                                       _o        dbelow; Qo@     @r      free to     persons     @able@ to    pay

                                                       therefor,    includizig under        'persons   unable   to   pay  therefore

                                                       both  the legally indigent           and     persons   -aho are othe--wise

                                                       self    u-o
                                                                 portin4    but, are,. unable    to     pay  t4p@ fall cost of

                                                                                                                          wholl
                                                       ne           pit                  izdh care,  rat   I

                                                                                                                            in-

                                                                                                                     tho    expense,,

                                                       of-the    'nosnital     itself.     In determining      ,7hat constitutes

                                                       a. reasonable volume of        free   p@tien'u   care,    there    shall    be

                                                       considered    conditions in the area to@be              served by the

                                                                                                                           ihav    be
                                                                                                       fre@@', c
                                                       pp
                                                                                                                          The: "re-.,
                                                                                                     p    can@  may   be   a'@i'v' 'e di. f

                                                                 ican                 tes@  to!                              he@ @Stata@

                                                                                                                             an

                                                       General, that     furnishing such free patient care is                not

                                                       feasible fi--qancially,


                                                                             62Z (9)

                                       f'SEC. 622  (g).General  methods   of    administration
                                         of the plan,  by the,d-esignated State  agency,
                                                  o  the limitations set forth in      section

                                                             Senate Committee.     Note   the.
                        This- provision was   added,by the
               statement'that the authorization to the       Surgeon.General for issuing
               regulations 1. on 'general ;methods of administration, "relates soley to
               administration    of  the  construction  program  by  the  State  agency.  and.
                 es, not in      -way         'to the  a
             .,do              any    re'! a t -e-     dministration of hosoitals.     c n-.
               strudted-'. under the @pr                   t-.    674;-. Page C

                                 I@@Z                                      I     - I I
                                          -                                   I   , -".         -


                                                                                               623 (a)

                               LAW:              "State    Plans
                                                 "SEC.   623.    (a) kfter such regulations           have   been
                                                 issued, any      State des    "@-ing to take     advantage      of

                                                                     Sul

                                                 plan must

                               See  'the commentary      on  -601 (b)     supra.        Note the  following.
                    discussion bet-weeft Senator         Murray and      Dr. Smelzer of'the        American
                    Hospital          Association.

                                   Er,
                                                                                                     re'
                                      c
                                     @F                                                 inh @ h-- h4.V6, submit
                                                                                 ate        @-C
                                                                 -'@plans ---'Do -you                -is
                                      a                                                think,,. that      a    wise
                    Drovi@i-
                                                    ha@ -'in        States, there.-.,mciy@i-, be" opp6s i@ion-  t'o
                      is- @"an                  h(  fo@   @block
                                                                         dev,e  onme          @h@e T)la
                    ih              y                   re         the'                                ns.
                    'would  it be   fair,    then,@'to deprive localities of the righi                to take
                    advantage of the funds-provided under'tiiis bill because some croup
                    -in. -the@State is--preve tin   them. from g@ing            fori,,,ard unde
                                                 n     g@                                       r this    plan?
                           Dr. Smelzer:   I think        there   ought   to   be   some    op.portunil@-y for
                    appeal there,  but       I think there must be some            safeguard at some level.
                    You cannot-, however,. iihip -a -iState..!@-to takin'  advantage. of this act,"
                                                                                 9
                           ar@rigs.' Pag@@,3;@'.

                                                                  45


                                                                                                                         623          (1)
                                                                                                                     s

                                                           SEC    62 3         (1   desimate        a single State Agency as  the

                                                           sole agency L'or' the air,14              n'stra-ion :)f  -1-e  :)lan,  or des-';,

                                                                                                            ney for
                                                                                                                      @u

                                         This provision vias  contained               in             the.original,bill.

                                         See:              (a)@

                                 construct:
                                 A.1 so not                                                                     the' Stet'
                                             e..                                                                            a
                                                                                                              arr  nor,
                                 De.,par@nts@ to-@-s-pe             6L
                                 Purposes,-_

                                 REGUUTIO                               Def ihitions

                                                                 State,   Ag(               thev@ context     iray require

                                                                                                             ctml:il @t                tbr pla
                                                             t. or;  th@ p.&eney' @@e s,i                       I  :L  e                        -n
                                                           pursuant     to section 623         (a)    (1)    of the   Federal     Act."


                                                                        623 (a) (2)

                       LAI'I:        ,623 (a) (2) contain satisfactory evidence that
                                     the State a-ency designated in accordance iitt,
                                     pa.-agraT)h (1) hel-eof-will have aut',-.ority to

                                                               nformity  with-.'
                                                       aa in: co

                       This Dro@ion was contained in     the original  bill.

                                                 47


                                                                                         623 (a) (3)

                                   ,LAW           IT sEc:.623.(@)'(3,'       cl 'or the desi@--ton
                                                                       pro-7

                                                  of a. State P-d-7i@or-7                3hall L-iolide

                                                                                        )rq@izations
                                                  ra@'reser4            nongove.-L=Qn

                                                                      construction-

                                                  hospitals, including representatives o"the..c@)n@

                                                  st=ers of  heop'Ltal Services selected from amon-

                                                  persons f@liar with the need for        such services

                                                     bx@, or   rural areas to    consult  with  the

                                                                                             a,
                                                                    carry@ dut.: bucli. plan

                                                   (2) -@upra."

                                   Functions   of State councils   are  purely  advisory,  H.  Report
                          ZTQ. 2519, page  6.   "--'ee also 11. Hearings, pp. 163, 182.
                                   The original Senate bill     did- not'Drovide  for  an advisory
                          council  during    the construction phase of a @-tate   pr,-D6-rrn, although
                                                            council (wi@@hoat cop-3u=er representa-
                          provision  was   r-ade for-such a
                                      the survey and.  planning staSe.  The hearings, brought
                                               as th   cl'@abiii@      of  consum-er reDre sentat

                                                               48


                                                                                                   0-623  (a)  (4)

                                                                                                           dl' c
                                                    "Sr@,C.    623i                  -f or th..
                                                                                              a     ho8:0        onstruct
                                                    ion'.@progr@m'    :(,A  wh'io@h  is        based'on a  State-wide
                                                              -r                              -als        -,7-ar-
                                                    invi-.,ito    Y'.Of              hcs-)i-',       and        .rey

                                                                                                            ulation

                                                    Of  a, atA td@- 7 hic'h has     di     bT5eil     program     under
                                                  ".,part      B-0- this   title,,   conforms.'to.'the.program
                                                             'developed excebt    for   any   modi:fi:dation       requir--

                                                          of   t,iis  subse             -rid ap-or   ve
                                                                              ct,ion    a            o  d  b@-'the    Sur-

                                                                  t-     and  (D).,  hich
                                                            Gene al;                 III          meets @lie- require-

                                                                                                  iori on  a

                                                                  ed

                                        Iri-v e nt or:

                                                                       49,


                                                                                                              623 (a)  (4)

                        (b)  Conforirance      to       Regulations.    Under the original t-'        the State      s Drogram
                             was   to  be in accord with            standards prescribed.,     by     Surgeon General and be
                             sufficient to provide adequate facilities.   Sin@,,a  '-he Senate Coumittee Dro-
                                                                                                a;-4
                             7';,ded  -.,@at      Sur.-eon @'eneral -,,iou',-d issue refj,,z'L  @-,@ns  -Ista'oi---zh4-r@g @,4@le
                             number o@' ',-Ieds required to, Pride adequate                                    6)@2. suora,, i@@
                             likewise provided that@the St&ta.,in,its.,prograg'.                -should comply with, these

                                                                                                ai-necl --the              re-
                                              State plan to,c'on*.'                   Drogra,-a developed with the aid of
                             Federal    funds,'for    survey    and    pl.anning   except       where modification was re-
                             quired -,,;o comply with Federal standards  (regulations).   The Senate Co,=ttee
                             added -'@;he second exe9ption, viz., when modification is recommended by the
                             State    a--ency    designator    to    ad,,@ister     the construction       program.       This
                             second exception there         )y   assures    that    the second    State     agency     will have solve
                             ,authority  as  to   the   c6--t-@tents   of the     State plan,   the  administration         of which
                             'Will be its-          responsibility-*

                                                                                                    at
                                                                                                     iii3i.  -#'
                                                                  arigintLI.@ilL. d:ict
                                                                                                                  p
                                                                                                  2?, (f      supra

                                                                                                age
                                     na e                                                       p   s 4     9.1   165    2 .5@
                                    ar@@             5

                         REGULAT I ONa,-                10  I    (ey  CoordirLa@ed    hospital      s-         An interrelated
                                                                                                    @steia.

                                                                             -hospitals    throughout       aState in which
                                                   network     of  general

                                                                       se:,                         dis@-iot

                                                                                          ura;l-  and,  other,-,@sm

                                                                                                     03

                                                                                                    p]7o7i-d          t

                                                                                 YO'
                                                                  General.  The -State       p, 1   shall'pro@ide Llor'g6neral

                                                    methods.   of    administration    :qhich-    are    it
                                                                                                     in  coord@,,,;iith the,..

                                                                           uc                                  h6:ipi

                                                                                                oped.   @'the.,@   rail  2ng; m

                                                                             50


                                                                                                                     fo
                                                    (@).,The-Sta@e       Ageno'y-,rhall,-dete@ne              need     -r-. hospital     facil"
                                      ities    of   all types m d        health-.center-facilities by applyin   the                      ratios

                                                                                                                            eXC-ot     -11OSe
                                       e r la'r. o T@o r               and  @4educting-

                                                             acement under!priori-6y @KegulatiQ@a,.-,

                                      v4hich   needed beds or health centers                  should most       appropriately           be 'built.
                                                    (c) After havinp- determined hospital  and public health                             center
                                      needs, the State Agency              shall establish an overall                construction        proorame

                                                                                                                                              Stan
                                                                                                -,jaeeda  in'@accc

                                                                                                                tha,                        O'.

                                                    ru   tii                 maintenance  End
                                                             The- State A,,enc,7     shall,     L'roni     time to  time           as@nedessar   but
                                                                                                                                             y

                                      at least      annually.-      reviel.,;  "he   overall           hosoital construction       program,

                                                                                                             ec

                                                                                                      d@

                                                    c.-ibd.,    Ins(far as-funds'are-                 available for-  coi                  nd
                                       for   maintenak@ii       @d @c);)eration'  obr-structior-'shall              'o e scheduled       in  the

                                                        pi
                                       able    notice     of    a public.'nearinE;    at     -shi--h     all     interested     persons     or


                          organization Will be    giver. an opportunity to be Heard.
                                    (b) Af,-,6r the Surgeon Geraral' has approved the  State plari, the
                          State --Eency shall- publ4-sh a. i-en--ral.descr4-ption of 4ts pz-ov-:

                                                                                      at

                                                                                      u

                          to all  interested persons  or organizations."

                                                           52


                                        LAIV:          "SEC.     623    (a)    (5)    set forth the        relative       need       deterruned       in
                                                       accordance 'with the             regulations        prescribed       under       section        622
                                                        d)   @r    'he  s(neral                                                          r arr. s ,ar- d
                                                                                        .)ro-je.cts,   -'@-r,--uded  4n, suc"l -Dro,

                                                                 @-f6r-   them   construction.. i@ofar-              as-. f inarci

                                                       Si-ble",@ i      'tfi'e@'o'rder  0,  such     relative need."

                                        See 622  (d),         supra.       The      ori,-inal      bill      contained      a      similar      provision
                        providing that-rele-tive               need,,Nould be                 determined iii. accordance -,,v@-th              "standards"
                        prescribed byte              Si4rpo4: general.
                                                                                      e eLl So    @S.,                 page  71,  H.      He a r i n F,, a
                                                Rf

                        REGUUTIONS-.                                                                                        r       an'            'hi h
                                                                                                       i'c n.  Tne   gene       alm    ner    in   -w    c
                                                       the State        Agency     shall,dete@.ihe                   the,r)riority of  proj'ec'us  in-
                                                       cluded      in   the State       construction         proxram  shall  confort .,rith the
                                                                      lea set   out   in      910..,IC to     10..47., inclusive,

                                                                                                     rie
                                                                                                                      of'@acilitie

                                                       chronic,  an   healt             centers).         In-          determining         proportionate
                                                       needs,               consideration       shall@be given      to existing              facilities,


                                                                                                           623 (a)  (5)

                                                  -to     existing hospitals    and  health    centers    shall be given

                                                  pri.@,-4 -ty  -a@
                                                                     reo-acere-n-ts,       3xcent:

                                                          are.-ea@la6ement.is       of. minor   character. and. necessar

                                                                                                      rep acement is

                                                  essential    to       eliminate ah-e:kisting   needed hospital Nihich

                                                  constitut      sa,. public hazard;

                                                                             se of a public health         center,    t
                                                           were  in  the  c@

                                                                                      (i                          1'7

                                                                                pots shall      be determined     after   con-
                                                              of  tnese   proj

                                                  %ideration, of     the  fo 11 ow ing  fac tor s. in  the  order    of  import-

                                                  ance
                                                           as.given.,,

                                                             ities     areas    vjith relati-7oly small financial

                                                  resources*

                                                                         $4


                                                                                                                        623            (5)

                                                                                        -;,,3 a   E,     0 r

                                                                                                          ,,@the     chron4-c@     disease

                                                                                                                  IL

                                                              10.46      Fu                                                    'ority    -n
                                                                                                               Hi,,he  s  Lpr
                                                                            blic        health centers*

                                                                                                                                              ,ies
                                                                                              iven to     the  provision        of   fa  c
                                                          this category        shall    be   g

                                                                                                             al   communities       and, areas
                                                                local    health    units     serving     r air

                                                                                                                       ed after       con-
                                                          th6@ relative
                                                                                              t,   b6  establish

                                                          saltation      @-jiti-i.  the  State, '4,ie-alth,      authority,

                                                                                                                              oticable      and
                                                               10,47     Size    and   character,        Insofar.     as, pra

                                                                                                                                         r

                                                                                                                      sna

                                                                                                         n.

                                                                                                                       ec(
                                                                      r,. on                       f f:  ien.-,

                                                          operation."

                                                                                   55


                                                                                                                               623   (a,)    .'6)

                              LA-it':                     "S'@C. 623              (6)  provide  such m--@"i..Dds  of ad@-,dnistrat-on o'-
                                                                                                               ui

                                                            -che  --@ta-@e          -Including nat,@.ols

                                                                                @.enanca     o-.'     personn
                                                            ment and main                                   e    standards     on     a     merit

                                                                                                                        s      I      exerciser

                                                            authority with respect             to the  selection,           te@iur3     o  office,

                                                            or compensation of-any             individual employed in accordance

                                                                              "hods),,                     C,
                                                                                           as  the  'ur:7eon      General            prescribes by

                                                            regulat4-on      under  section 622          (g)

                                                  @hd::       original                     d@,&, r)rovisi6ii    for    methods     of   a
                                                                                                                                          d-
                              mi:,                            silent@      o  the@  requirements-        -for" a  merit         system7.- The
                                                                           n
                              @ena@e    Committee             inserted     this        requirement 1,7hi   ch conforms  -Keith      other F--de.@al
                              6Y.-ants-in-aid             pro&rams.  '-@ote  that   the    merit        system requirement           does not
                              apply    to              personn@l-operating ',iospitals..

                              see        622   (g),    supr a
                                    S-

                                                                                           @17

                             -REGULP@O                                                                                                  person
                                                                                                    s ration@@       A-, -system., p@

                                                                                                                     -be:,                    an

                                                                  n  streLticii                                                    eTr  shall

                                                            :Lnclade Provision  L'or:

                                                                                                                        4 t SyS,
                                                                  T                                                                  uem;
                                                            (a.'  -mloartial administration              o f' the  irer
                                                                                                      c.4L' publislie-ci., ruleq--   or.   re

                                                                  'qie, Si   c        I    6   a                    on the@         basis-of duties@

                                                                       po@                  @ct                                     qualificat
                                                                                                                                             io

                                                            necessary      for   @,he'satisfactor,,       performance        of        such duties

                                                                                    56


                                                                                      623
                                                                                           (a) 16)

                                        and responsibilities;
                                        (d) Establish.T---Tit of compensation schedules adjusted to

                                        the residonsibilit-j- and -lifP-cul'-Y, of the work;

                                              lifications and so conducted as to    afford all  qualifie!

                                        applicants  opportunity to  compete;
                                        (f) Advancement  on the basis  of capacit@'6,nd'meritorious

                                             ce,- and

                                                                          0
                                             d to 'reet            events  f .@.he regulations in this


                                                                                                                     S   623    (a)    (7)
                                                                                                                     s

                                                           SEC.  62.z  @a)  (7'   provide un@--mun,. s@andards  (to be  fixed
                                                                                                                  u              u

                                                                                                             for, the maintenance and

                                                                                                              iv'
                                                                                                                  e Federal      air       under

                                                           this      @oart."

                                          !Nlothing    was    contained    in    the-     original     bill on minimum State  standard.;
                              of maintenance and operation.   -Lhe Senate Committee                          added       this        provision..
                                                               7,
                              Co                                                               @ed-,version o:t     S..     191).-provided
                               on
                                        clitio
                                             n    f or-, tli6',
                                  a                            stablis@ent         of       F6derel        maintenance and   operation
                              @tandirds@        -Noip-  the--t' -one -of Senate      li@ra     Is     objectives      was the failure       of
                              the    bill    to       'd'    -fo                                                          '-io.   67,1.    -page l@;
                                                   ovi     e   r     such      Federal @ndards..          S.,RepQrt
                                     nm   tte   a       t         3,,,pag                           r=.entary
                                  co'                  in  ITO                loo;,  Sek     the                  On,    @622          stipra,

                                              the    -    Senate Hearings     the      f6lla,,iing is  noted        at pac.,e 282:

                                          "Senator @,onr-e-@ll.
                                           You    prefer       to have      these matters        of control,       and maintenance            left in
                              local        hands?

                                                                                                          I.Totth      ar       na i7o
                                                                           Stat(i                                    c   oli         u    make
                                                  td  its-  PI  s   'and,   then   the-   --plan ,voulcl  be   submitted,     to     the Sure
                                                               an
                                neial     for

                                                                                                 a@ud     thef    h
                                                                                                 the@  ma:Ln@nance- anc          pera
                                   cL   you%   mthi   r4    hav6 th&    actual     c'o'n@ol     of                               0
                                              -1  le   it      the        tate?
                                          ita

                                           Dr.    Reynolds.
                                           Absolutely.'           Tr     the,H. Hearings     Dr.    SL-elzer      o  the -American Hospital
                              X%ssociatiorL noted:
                                          'tThe,.dangpr       of  excessive     Federal     dictation.     is-     avoided     by     careful
                              -de             0                   -viithin'vihic@.
                                fin:Lt                         a@.                    tied           @#&dq4.@'General. and     tha     Federal-
                                           counci.-L,,         prescribe, standardi..               se    areas     have,
                                                                                               con
                                                      asaur6@thELt     -the     su    r @it         stiuctiori                   will,@    be:-.
                                                                                                                     proizr,ama
                                                               6@ghout        all of@ the"
                                                                                           :.States-'that              participate in the
                                                           @.'iikeivisa'assure-        -th'a@,Federal@         control shall     not'extend
                              tcr.,the@  O'P x                    ectiorL :of,tho@@. hospitals% onca.they have@                  been, con-@.
                                                                  e                                                              @hait'.
                                                                                                          ra
                                         atw e                        dards.  of"maihte-nanc@'and          operatio@'          but th& ac@
                              @iisbly       rec6@iz6s       that  this    is  a state'      responsibility      Nith       -,vhich the Federal
                              Government     should     not     interfere.     H.     Hearinc,,s,     pa6e      46.
                                                                                               c:)

                                                                                                                                            7 -


                                                                                                      /a) (7)
                                                                                                 623

                      osteor,ath,
                                 .,r ar-ci in ir.,jn @tandards:
                                                                                                       p@v   s

                                                                                                        I;ue stj
                                                                                   1. ser-vica@ wou@   be
                      determined. by State, 1ELviw          epo'rt       67,'-,@ page 11.
                                                                   Johnson of the Ar-erA-can HosD-tp.' -.@ssocialon
                               .See  the  statements by    Dr.
                      H.  7earings,   page 103; L.    I.  Gourley,     end Dr. Swope, of   the @eri.can
                      C)s'Lleopathic ".ssociation, H.   Hearings,-pages 179, '@83,

                                                                                eLrds                A

                                                                          of Boom          n

                                            -the variou    --byp@s@- of  s-,oiteL!s.and health  centers
                                                         's             ao

                                           @-assis@e    under, this    pro,
                                                     d                   -ran.  -i"he standards   adopted   shall
                                            not  be.,Iess@than the xeneral standards        Prescribed    by the

                                                                59


                                                                                                    623  (a)  (8)

                         LAW:                    sFr, 6?3    (a)    (9)     ,rov4-de     for            Ove--'Y a-)O

                                                                     'on @ro 'ec-, nn

                                                        the Sta4.' e agency."

                                      Th(                             vi's4.on  in, the  oripinal b--12:-,    it  via s cLO ed
                         by the  Senate     Committee.   Yote the.t  the bill.  @-,s  re-oorted. by the committee
                         also permitted @-ri P.-@onlic@nt  to ar,-,oep.1  to      the U. S.  Circuit    Court   o@   --o)pa" S.
                         -The Worse  Committee do'-elled  such provision.             See  OG32  (o'j  (1),  infra,  H.
                         Heprin;7s, p-?.    69, 90,

                                                       7.
                          -E @7JL"--T T s               4 Fair   Hen r-L nos.     The Stp.te      Agency      sha"@l establish
                                                                                      5.$       -pro-vie_e.   6it oD-portuni,

                                                        n a,-o-pepl'                r@           -'before' 'the  State
                                                     ney'to every 9,p...i    @.aht7         c o'@
                                                                                      or a     ristr@c, -@--on project   ..ho'

                                                 is   disE-P.t-@sf,@ea @,rith F,ny -,ction  of  @',,ie St,-,.t eP.EPency re-

                                               ':@@g@rding  its  a-,op
                                                                        ce,t i o r..


                                                                                     J623 (a) (9)

                     -L A'@              t'Sec..623 (a)   (9)                      Sta@)e a@e:,.cy oiiii :neke)

                                                reports   @-r. c;iich -lorm anc, .-ontai,

                                                                                                  asonably.

                                          to@ the, rdcords u7)on @ihich- s-u-ch information is based; a,nd"

                                 A  somewhat  similor  -orolri-s4.on, lqith the ,iord- "reason@bly":om4-tted,
                     w,?, scontained ir the   origiripl bill.    The lp- @.ge ad.ooted    ,ias siipgested by
                                                                        r_
                     the  -Sena.te Commi-ttee-,  IOPntical. 1,--ngu,-.pe.- is (,,onti-ine
                                                                                       in 9612 (a) (4). infra.


                                                                                                                                         gb23  '%a)  kiU)

                                                                                                                              the    State
                                     LAW:'                            "Sec..- 6@3    (a)    (10)     provide  that                                            will

                                                                                                                                                                    -oro,@a-m
                                                                    from.time          to   time     revie,,.4     its  hospital           constractior
                                                                    anc-    @-ab!n-@     o  ',,he   cu.-@eo-@                    any                                'hereof

                                                                            a  't.-consi  e
                                                                    waic                          rs,, necessa

                                                                                                                          a                  I-YIC    e          provis           r
                                    the-    state                       submission          of            "any            necessary-mojificp-tioiasl"of             its ccn-
                                    struction -orop-,ra-m.    The  question as  to  who                              would             (4-etermine that     necessity
                                    was.    left  to  inte-pretatio@..    As  passed  by the                              Senate           the            requirement refers
                                    to.             icat,ion             "which it.@t@;.e  State @'genc7/                 considers                   necessary
                                                                          gested.  ia       the  heati ngs          t @t ',t he  '6i 1.1           -)rovie,.e for     at
                                                       It:     @wae     suz
                                          s t,, an   annua I      r ev         by@   the,Stp,tes,of                           their'const@-uc,tion           programs.
                                                                               t@e   t@-t@th:e Re,-@atiolis  have?i                                           thi

                                                                                                                                                      to"

                                                                              s         bi            I               annua ly                        ove

                                                                    hos-nital        construction -Dro@ra-m-@                        .@-nrpaelly-.    at a, time      f i.4 ecl

                                                                          th                                                                                          -im  a
                                                                    by        e  Surgeon        General,         the    Agency shall             submit       to    1,

                                                                                                             nta-.'                     isions,-.    of    .the;,    co

                                                                                                                                                    necesar


                                                                                         .9623 (b)

                       LA'g:                "Se--.     62@ (b) The   S,ir,?eon   C-ener,,3,'   si@.11   approve    a,ny    St@te

                                             -olar@   a-id an,.r- :nc d                         @ozml--' es

                                                           o@L subsection (a).       If any- such p@.Ti    or moCLi.Lica-

                                                                                                     t

                                                                                                        (a),   the Feder-

                                             al  Hospital         Coimcil shall, uron request of    the     State
                                             agency.  afford    it an on-cort,-,nity for he--..ring.     If     such

                                             Council determines thEt  'he -olan or medication              co..m-)Iies

                                                      the
                                             with,       prqyisiops     of    such subsection, the Surgeon Generai-

                                                       ere    on  ?7pp   e such'plaa.oi--itbd:Lc@tion.
                                                       th
                                             s

                                     @@The original  bill        contained only ',he    first sentence.  The   Senate
                                                                        L
                       Committee    added   the  remaining    t@.:o       senuerces stating:

                                            "In  an          -n 1                                        -o-croves
                                                      c@,qe  L       !hich the Surgeon General disa   -           0,
                                    plan,   the  FeOeral    Hos-p4@tal    Council    must    afford    the     Stete     @-gency an
                                    o-o-nortunity    for    hLeFrir.--,    end the   @,ou-ncil   determines   that  the
                                                                              n's   the-Surgeon    General    must,
                                    p@a@,complies     ,,iith.. s,,ichL require,,ne
                                                                                                This
                                           ve7,@ the, @fan,@!@ Sr     qe@ort':.-To 674.                      was'ia-,Cc
                                                                                                               a  ord
                                           th                  a i m s@, t@ 1 i Lr. i tadmin@'s@rai-.ve discret:io@'(see,
                                                                 -ine'rea
                                                                        s.6   the rotieiL@@@o@:@@d Fdderc

                                                       t
                                                                         @p-pi
                                                                                                               -nfra
                                                                        Hosm

                                                         al        Snital COIMC4 1
                                            "The     Feder  .-o                   also   has   a    semijudicial
                                    function   in   the   a-c-oroval   of State -olins for hospital construction;
                                    but  again,   it is,exercised from the star-d-ooint of technical wisdom
                                    and  exmerience-      In  the  development  of  this   act   it   was   -ealized-
                                                                             ion,  for  aooea  -from   tossible,,@@
                                                                     r                         -istrati-v@    o@fic@
                                                                                -SI,  li wlim in"
                                        t:                                      stq.t                  @b
                                                                                        -Pi
                                                                  :9 c
                                                                                                             seems
                                                                     dl?peaT: to the -60-art because- of the,


                                                                                               623   (b)
                                                                                       in the   case of  an
                                         -Ilowever, court  a@. eal has be'6n provided
                                                            r@         ion has been refused.    by the
                                  individual projedt whose a-o-plicat
                                  Surgeon General and in the ,,ase  of  a  State  whose  further  f,,ind@s
                                  have been cut off by    the Sur-eon General -@'or alleged
                                  -:i @hese -cases, a.                   -'-.ssue @,-an '-@a
                                  court decision -a-Qon the@ basis of ",,,la law.  3ut  in  the  a-ooroval of
                                                -.t.,@      (in. is, less, a, matter. of legal, right  that it
                                   t    -plans,
                                                      -Guesti
                                  S at a
                                                                                   tter for-,Is

                                      be confi              in  iv4-6--ua some    -ht  of ap-oeal from any
                                  possible arbitrary one    man  decision is neded.  The Federal Hos-nital
                                  council,  with   a   membership of -oarsop_s ,rho are authorities in fields
                                  -oertaining  to hospital  and  health care, anE who will be in everyday
                                                with the working conditions go7e.-ning a wise decision,
                                  day contact
                                  seems to be   the P.T)propriate-body to hear such an appeal with re-
                                     d.to.the   a-odroval of the- State  lan.11  '.q. Hearings  -o. 4s.@
                                                                         p


                                          "Sec. 623, (-'C)
                                                           cTo chan es in a @'tD-te -o--,@,n s@.11. be re uire.

                                           within'two years       after initial   a-o
                                                                                   T)roval thereof, or      ,hin

                                               -ye@rs  aft er              'there,
                                                               -,-ny'c@nge        after reqli  ed thel-,ei--, by
                                           -eaxr  of  any  ch,3nge  @,i the rem-llati-or-s -orescr4-'oed

                                                  ovibion  was-contained-@n    the   ori@inal   bill.  'he@
                                   o,similar    -or                         I
                      Senate Committee adie-d the ,orovision in line with its policT of more clearly
                      delineating Ste.te and Federal-     @@unctions  and  li-,nitinp the Sur,7,eon Gener-l's
                      -powers.   See 'ol2  (b)   su-.ora, 9635 infra.
                                     After@ a  State -,)lan has-- been  a-o-oroved  by  the  Surgeon General,
                      no                                       red@b,,7,rea@on@,7'.,of changes  in the re-,.-
                                                                                   consent' of' the,@@ Siat@@..'
                                                                    n              ver,  t   s   wou
                                                                                                   I  nor,
                                                                                                    1,
                                                                   0                                c
                                                                    e'St               n- its- own
                                                                 t III  atp- agencZr o             initiativ
                                                                   e  t                   e'l b.
                                       d                       i3ff c ive  @les s@; a-oprGv c-, v the Surgjaon
                                    hal@, sam@ -,man                                   Re@6rt ITo
                                                                                                    674,


                                                          23 (d)  if any Stat&.       pr@or to JU71Y 1, 194s, has not
                              L All                 '@i io o
                                                                 i'o'lat@@on prov                          q,nce laith min-,
                                                           d:@                     ideihg   that compli,
                                                                                   nanc6 and operation shall          be
                                                    imilm     standatd8lof mainte
                                                    required   o   o. r to    at               at .le o-ot-4@on of
                                                                      d within:;,-,uch  time'after@enactment of@the@

                                                                                                              v    'Federal
                                                                                     ch  shall   have   recei  ed

                                                                                   ch  State shall      not    be    entitled
                                                    aid under      this title,  su
                                                                                                        ;624 until       such
                                                    to   any    further allotments    under   Section'.
                                                    time  as  such State has      enacted such      legislation.         Upon

                                                                                                     o

                                                        OCtive:  and such Sta-t                      ject to the     her

                                                                                             ntitled to allotments
                                                                nts of   this  art,-    be e
                                                    .,-r,.equlrem               p
                                                              e
                                                    under      Sect--on 624 for'the    fiscal   year in    @thich     ch

                           @m n        a a                                                                                  be
                        a   matter   entirely   for   Determination   by   'the   res    ec'uive    States.    A    Drovision
                        was included, however", to the effect that each State must, prior to Jaly 1,
                           )17,.    enact    legislation    establishing    minimum    standards    for    the    maintenance
                        19-,..
                        and. a-pera.tiorL of -hospitals which shall have received Federal aid under -this
                                                       @,thq p@ca,of@ osteopathy. in, general hospital services                -
                                                                                                lecl::ta. en                gi S7-

                                                                                                             case
                                                                                                             this
                                                                                                             otm
                                         Sect o      2
                                  P.  L-  723, 30th    Cor,.-ress, H.    -7t. 6339 amended    this sect on.
                                                                        .-66-


                                                         ItkLLCTIia,,@TS:  TO  STATESt'

                      LA if                 itszc.-  62-4.   @.ch   Stal'Ie-for    which   State@       hes,been
                                             approved    @,@rior  to or     during  f-sc,-l  year   s",all.   be   en-

                                             .@@le(i -lor-  suc@  i.rea-@  to  nn  F,.-ozment  oi   sum o-,ar4-r-g  I-Iae

                                                                                               be appropriated      -our-

                                                                                                h      o dii         a

                                                                     s@ch  Stat                he  Square   of     its

                                             allotment        percentage
                                                                         "as  defined in section       631   a)      be@,rs

                                             to the   sum  of    the corresponding     -products     for all of    the

                                             States-,
                                                            .provided, that-no     such     allotment to any State

                                                                                                    -Dur-poses   of:-this,
                                                                         00.                    he

                                             I.4lAr  s    Tne        o@t O-'f                      A'State   shall   be

                                                                       arice     I    he         ions   of. this     part

                                             for payment of      33-113   per  --entum  of    the cost  of  approved
                                             proj,ects    within    such State.   The   Sti--geon  '@eneral      shall

                                             calculate    the  allotments       to be made7under    this   section     and

                                                                                                                        o,f
                                                                     ry.

                                             sums                                e for such    next    fiscal    year.
                                                   allotted      for such  Stat

                                           -,-Any @ou   t  of    the sums; auth                                         a
                                                      Ln                         orized  to@be'approp'riate(i for

                                                                                        cil    r                          e

                                             to such Stp,te,  is hereby authorized            ta be       appropriated.
                                                                              --67-


                                               for    the next f iscal  ypplr.. Jr, addition  tb  the  sum    other

                                               w    se authorized
                                                                  ..unde    geo

                          I    Extent   of     federal Par t-'-c

                                                                                                                  n
                                                                                          Gca,         -zrairs,
                                                                '7"4 e  fO-'- a@
                         .Which   the   Federal-contrio,,,ltion   rarged    from      'L'               es'   S tat a
                                                                                                        I-Iearings,, -o-I 75@,

                                         )tte                    ts     whicha                           25,   t 75
                           e c@n   ge
                                                     @eon    G6ne'@al     fixes the Federal               on    the
                          -oer cent.    ...the      s,ur
                          basis of the States'  relative             financial n,3eds.  See ais'o         F@--arings
                          pp.,ges 20,  29,'74, 75, 93,     159.
                                      Consisteiit with    the  S elat e Co-mmi'utee's    efforts    to     nzz,rroli  he
                                                                               i-, @the'Com-,,ittee ure-prtook "to
                          rp.@@e'-o-,             F6deral'Aami,nist@ative:@djs(-retior
                                       e in-it'@                                            which leaves      no
                          it6olto@t                 ai
                                                                                            e-6@,r@t-

                          ce                            e          e
                                                                                   c@
                                                                               o' ri t@e  opose,   ra:Lsin    the
                                                                  t
                                                           P"                   See                        a  -discussion
                                   o 4c6.    Con   e' en e   e-por                                     0
                         :'of th                         F-d eral  participation.
                                 e overall limit     of

                                Determination        of Statets     Allotmp-nt
                                                                                           f                    the
                                                             set forth.   three    ,P-Ctors  o  'determining
                                                                                                    r. of..:the,

                                                                                    n'l ith    t e     r  e   of these
                                                                e.
                                                                                St  tes      the @a's is- of their
                          -percen Fges 'is det@    rmined f or.       the"seve@-al        on,
                         .,.re l&-tive'f ina.:dc:Lat"need--vhi.ch. w" uncle               mathematically      measurable
                           f @@t 6r@.                                See,


                                                                                                                      116
                                                                                                                         24

                                                                                                                                               rmula
                                                    "lor each    St@te       there       would be           determined by      statutory       f6
                                                                                        t              ii  lo   'L            lized.as             a-factor
                                  (sec.    631       (-a), )@"a Yedersil    mercen    age,-'Ipfl-ifc     . ' ul i. @ be ut i
                                                                                                        s t,, t - '  ( ' ec. - 624) .  -and. a'L s
                                  in determining the  allotments  as                    amon,7 t.h,-,          es     S.
                                  to      fix      the -pro-portionof        the'cost         of indi'idual     'oroiects in  the res-oect've
                                  States     which-would      be      raid       fr.om  :,edera'l  funds.        (S 'c.  625  (b)) .   This
                                                                                                                    e
                                  -adera"- @ercen-.,mze  -@t@-4-ch                   'ce -redetermined  e,7erzi, 2 ye  r                          '-51
                                                                                                                               P-   9   (sec.   0    -
                                  is  suc?i that  @')-e  no,-i,-Federai share   f               -oroie  t 'do' ts- w   la v ry  -'ii           -.ro-
                                                                                             0          c        s       o@
                                                                      :Lta@     inco
                                  -oortiozL-..    to;@ the      -oer,ca            m@ -of- thG-@                      'with- upper anli--      lowe

                                                                                     6i
                                  t-r,uc t i o ii     p                  the         Stat                                                  -oita-incom-e
                                                                    in@                              Si'ate       Keith  a: pe r cn.-
                                                                                             .-I,;hole,     the,     Feder,-,l;      qov'rnment@ would
                                  6nly hAl:f         of that        of     .,@tion    as     a
                                  bear      75      nercent@of      the cost  of projectq,           the       @ximum       Federal       -oQrcentc-,-,e
                                  .provided;         @qhile   in    aSi"pte   -@g4@th   a   -oer   ca-oi-t,-i.    income one  and  one-third.  times
                                  the         national a-ver,-     ge the      Fe@.-era,l       -rercentap               33-1/3, 'the  minimum
                                                                                                       e     would     'ue
                                  authorized.          For-pro@ects    in     Al,-,szcs.     P-,id     Ha@iaii,     the  l,ederc.1          percentpge
                                   ould     be     50: for        those in       Puerto.Rico,        75.

                                                                                  i'6   t

                                                                                of     it

                                  4
                                                                              idicl
                                                                                                                    tes
                                                                              i t
                                                     t                            Ur                                r
                                                                                         n            @l                 -c   -portion to popl@la-
                                  from           State and        local sources   combi  ecl      wo  ld v@r,,r in   ro
                                  .t i@n  and       (within       the oe-if,ed.      limi's)            6,-'  'ta  i.,irome-                     Ihi     h,
                                                                                                                                 a        result
                                                                                                     @er   pi
                                                     above,.'     would. mean   an   a-o-oortionment           rc.@laf-hlr adjusted     to         hospital
                                  co-nstruction heeds.                S.    "Re-r,'ort  No                  ll-,    2
                                                                                             674,

                                                         f  o'  fair.
                                                     s@,-   r                           il_ed    @out     0,@     follows:

                                                                                re,  -

                                               n     fi                         onsid-eration      the      difference       in       wealth       among
                                  the,     States     as              pqpulation        since        'the,.d,eficit        in@-.hospital         facilities
                                                                              e   s
                                                     i   Sta@e---               s    f ina-ricial. resource


                                                                                             62

                                                       ar                                           'th   9,
                                      r'Allotments      e to  be made   only to-those Stites-w-L           -o-iiroved
                           ho@ital construction -Dlans.   A State         may     receive     an     allotment f o -,-, a
                           fiscal year if    its     plan @ s been ao-orovea either     -prior  to or durint.-   t@@'@
                           yep-r.11 (S.  '-'e-oort i;o.  674, p.  12.)      See 8s623 (a) s-apra.

                           (b)  Two-.ye@r   provi s   on,

                                                                                                                     ,ed
                                       if 'in any                                                        should be
                           less'..than the authorized amount, Any                             funds appropriated      or
                           of' finds authorized. but not a-c-iro-oriqted is to be added to the following
                                    authorization and to be s-doiect to rean-propriation or a-Q-nro-priation
                           yearis P
                           for the -our-poses of the prop-ran.         (S. ---eoort '.,To.  674 -o.   12.)
                           Survey      and Planning     Allotments,     See,      611  s'u-
                                                                                   ora.

                                                                  Pand B,;-

                                                                               the-@ States.@            however, a
                                                                                   h                    ee..        @liot-

                                                  Bu
                                             ns
                                                                  itteri   the State    is not       required to   -Darti--
                                      "As,the   bill    is no@, Ar
                           c i-Dat e, f i@c'ally,.   unless State fun0s are        available    to pay   part,-O-@ the
                                           I
                           Construdtion    (zosts  when   necessary,-hos-oit--Is    and    health    centers will be
                           constructed  only  where   the   locality   is   able   to   provide   the   full amount that
                           'pubt.,be                 tch the F6cieral grant."  (S.@ Hearings,,, p. 130)..
                                     out u@ to

                                                                                                         ied tqr,.,

                                                                                                        se

                                   i se.      th. of            c                         s at
                                       "I'le,- believe@ moreover,.@' tlat-,sur-h appropriations    .   ought to.    follow
                           the, matching- principle' i@ste@.of following th6-'@ran@-in-aid -principles                of
                                                                                            16va-, t@t@@  t

                                                                             h

                                                                                                                       e-
                                   i@    of'Federal funds in'order' to       assure   facilities for the neediest
                                                                       -70-


                                                                                                            kable and at
                                                                         d which wo-ald. be both wor
                                            olutioa    could   be  folln
                             reas,    no    s
                            a                                                                    intent of this leis-
                                                           ible w'       e obie
                                      e  time     CO=Ell                                             nst any egress re-
                            the sam                    t         ith th
                                                          son, t,@        rait@ee 6,ecided- a-@i
                           -1stion.      For this     rea           e CorL    II                                    -
                                                                        .S@tate Go--rnmert contribute to any
                            quirement@      qt this   time tiip..t- the
                            nroject.
                            V.      Allotments      for Administrati've Fj:menses

                             the  amount     o
                                                                                                                    ist  State
                                                                                      0           0
                                          nDuring     the  first   year
                                                                           t5,000',O      0is  -or video to       ass
                                                                                                      in,                -olans
                             a..ver-cies    in     meeting     administrative     ex-oenses in Carr,,,'  g out State     -.
                                                         there,q.L@ter.   such    o.riniial a-prro-priations as may      be
                           ,.under   this   --ct;    an6                                             lity Of aT)Pro-priati'.I=-
                             necessary are authorized.   We question the advisabi
                                                                                       s       administrative       expenses.
                            -this amount of Federal --'=ds            to @the State       for
                             S. -Eba@iln6

                                                                               tt    6mit ed t hE;  rc
                                                                                                      P
                                                                                         -h   Os tt-ton
                                                                         t @@67 t
                                                                 f6,      le   t I i
                                                                                                                    a
                                 'Report    ';.47o. "674      g

                               I.'.' Mi      mumAl
                                                       l@tment;
                                            'Sect-lon:,.l@ of p   L.  S@0,   80tq   Congress,     H.  R.   4916 aclcled   the
                                                   first senten
                                                                    ce  ;f  $624,,  providing       for a     minimum State
                                             t he.

                                           o:


                                                               0                                      'TTS -107  @07JS"'c  CT  IO!T'T
                                                       "APP@ V@L Ol,' PR@,',J-7@,CTS AITD T

                                                                                                                                    -our
                                                                                                              construction
                             LA!,I:                    "SEC    r.-25.-(,-)    For each 7)roject            for

                                                                                                                      -o           there
                                                       s@ar-t  to    a    State    'olan    an-oraved    under this   .   art,
                                                       shall   be  slYomi'wte@.  to  the Surgeon General              throi-,--h     the

                                                                                                                               rofi

                                                                   -Suc   ha-n lic@,tion shall set  forth (1)                a clescrip-
                                                       agency.               -'P
                                                       tion of    the   sit(,, for  such project.                 -plpns and speci-
                                                       ficnt@ons     therefor     in     accordance      with      the      re,-ulations T)re-
                                                       scribes,   by,-,the, Surp-eon     'seneral.-under section 62@                (e),

                                                                                      he,pp                                  ble   assur-:
                                                                                                            rt l@till be               e- fb
                                                                         e@
                                                                                                ;ect ancl    for    its maintenance         ayid.
                                                       the construction         of the       pro,
                                                       o-oeration when       com-olete6,  P.nd            reasonable assurance that
                                                    ..-the. rates     of  -pa-ir for laborers and.        me@-inics,en @gecl           in con-

                                                                                                                             nt

                                                                                                                           det

                                                                I     shall an ro               a,-pi  A     i n if suf icient fun s
                                                       to-..  -Pay,  33-1/3 -per,    centum    of the     cost of construction of
                                                                                                                               a the S@tate


                                                                                                               in  ac(-      with
                                                            that 'the -ol-a   'a  nd  so         t i O,.q s,.I. r PI
                                                                                       ec.if i C'
                                                                          ris
                                                                                       d  pursupnt to           sectiono     (C)
                                                          'replip,4v-ions     -orescrioe
                                                    t@-e
                                                                                                                         a@ e
                                                                                                     ty
                                                        t     he
                                                                                                     ains a;l    as   v, -.nce that

                                                                                                                    ciibecl 'our-
                                                                                                    at ions nr( s
                                                     of
                                                                                                                      on of   fac
                                                          t                  622 'f)  regp,rainz the            provisi
                                                     suan   @'o-sedtion
                                                     ties   41i-thout 4-iscrim,@.:iation    on  account     of  race, creed,  or
                                                               ancl f oi                 r.@6d@ecl ho"itpi      facilities for
                                                                                                     d fin.assu-rande that-,the

                                                                                                                fo

                                                                                                               ro7v

                                                                                                                   to "Ortority ov-er
                                                        r        y t,                 ncy  P nc               e

                                                                                 in
                                                 @@,@z@.other'-orojects    ,j i t h" the-, St,@.te 'in acc                    -he
                                                                                                                orOance ith t
                                                           rations     Prescribed     -ni,=suant to    section '022 (d).        li c.
                                                                                                    unt il-.' ih@ S@'geon,   qpneral,,.

                                                          r             State     -,genc   0                          ral, -the c@nnel-
                                    -ling
                                            through th'     St t   Agency     was @t s-oeci-'ically reouirea.   The
                                                          e    a, e
                                     Sewt                  @de such Drocedure,man4 :tory..  The orig--nal bill con-
                                            e@ revision:
                                                                                                                      plans and-
                                                                      d                           .@--.Thig@Sem-te Committee
                                                                                                                                        ie -

                                                                                                                                       er


                                            Maintenance          and          @er-tion

                                            See  9'OP-3   (a)  (7)  su-.O,-a.
                                            During  the  course  of the              Senate      Hear4ngs  Senator              T;7.ft  stated at  -,o.        2
                                                     I'@Te     @d.     that     e3iiest-.orL     in.the last  hospital bill and  decided                    i
                                                                                                      h6'                                     e -oreT)arecl to
                                            @,waa.- perfectly- f olish ta,-build,                  the,    -oital unless you wer
                                                                    0
                                                                                                                           her@.a,    grant-     ought.,     @o@

                                            'd.    R.    CE@@    of    the    American  Fn,rm Bureau        FeL'er,-.tion rotecl:
                                                     @tlt    is     also     -7itp-lly  important  to  make  certpin that                    these         newly
                                            constructed  -ac-@lities  can be  maintained  and  supported  after  they are
                                            constructed.    The  language  of -@he  bill.,  therefore,  should be  clarifier
                                            and     strengthened     so     as      to  ass@e  that  before any.  grant  is  made  for
                                            constructing          or          i=roving  local         ho@ital         facilities,         adeqwte          ass@-
                                                            ven.:   that,   :@i@nc    i-a   resaur-c@s@ Wil  @@be@  'avai@ble. f6r mainten-@,,-,.,,/
                                                              e                               a  I. it i-s' @e ..f'-r-     -a
                                                                                the   b'E
                                                                                                                                 resour
                                                                 "Se                                  sor
                                                                                           se  ":,    i                    -                 1  '211.
                                                                        a.a                   e                              ngs, -pages       5
                                                                          ear:                                                          @en@ td       the, -@oro-
                                             lea                 e,.qance            o-o'E -       ion.                         ".lv@ recogniz        d  t
                                                                                                          t@             gene'ia'                     e       @t
                                            -'whi-le'th-'-s   bill'failed           to  -oro-v4      de -for assistance         in           Maintenance -,nd
                                             -o                      -Droblem     ikrL-,s nevertheless  a  serious  o
                                        ...o  erption,        the                                                                  ne     and      would merit
                                            the   attention.         of         Congress.  One        oSenator llurra,y's           objections  to  the            b i,
                                            'was  its      failure      to      prov-L(ie
                                                                                                 6deral funds  for mai7itenace  and  operation
                                            thus  leaving  llinresolved  the @robler-q of aiding the  most  needy com-
                                            munities."   S.@'@Re-oo                                           Discus            s are  to  be  found.  in
                                                                            rt      @o  674,,,        20.,@                 sion-
                                                                                                                                264:,  2F,49.,,i
                                                                                                                                                   32cy
                                                                                                                                Senp-t&         Committ6

                                                                                                                                             '3ii  ea,u Feder2.-
                                                                                                                                     Far,
                                                 ev r,'    the                               R.       0g of   t   6        r-   an        m      r
                                            tion     in     the House meanings,  -p.                 9:
                                                                e s    r        y                     t@@    inclusion          of the  reqiuire!neiat         i-
                                                                                                                             surances;;-in-,.their appli-

                                                                                                                                              lic:, @aw

                                                                                                     re
                                                                                                                                       ions for. rep


                                                                                         o@ some legal a-uthori
                                                                t it is the o-oinion
                                      It should      noted    tha
                                                                            -rav- s and. Walsh-He,-Lley Act 8 I!"Oul-d
                               ties' that th' -Oro-7i sions of '-he Bacon
                                             e
                                                                                                     t even
                               @robably extend to the Hos-oital Surve,?- and Cons4,,ruction Ac
                                                                                           -Act.  it was with a
                               ",his s-cec,@-'A@c -rovision were not incl@).,4-ed i-,i the
                                                                                                  point, howeve-
                               -rie,d to p-Void4r@ an7,, -possi'tie  iisu-derstand-i-io  on  the
                                                                                           @uri.  'he '-.ear :i@s 'n
                                                             Inco
                               t he 'o     efore 'he   ,enate

                               commit  ty.           not  axle te(i 0"'r i'e"Quire(!', therefore, that  the  wages
                               -caid in remote,   rural  areas  hall    be  those -prevailing in metropolitan
                               areas.

                               Discr  mi-atl-or. an
                                       qee            supra'

                                                                       U

                               Pv @T,                                                   the  Sur@peon
                                                    Alter  the State    Agency   has   a-Qrroved  aconstruction
                                                    a-oplical"ion, it   shall recoirmera    it to  the- Surgeon
                                                   ,,Genera@  for  a@rov I er-d shall certify,

                                                                                                           e assur@-

                                                                                                      r @ds:

                                                                                               And., @t

                                                           of                      -,o
                                                                                                     completed:
                                                                                cl7o -rrtion
                                                                 -nt o-rance 'an.
                                                                            f  funds for the ron-Pederal share
                                                           A.Ya 1L,.@b i 1-i t y o
                                                                                                      dg., immeclicttelY

                                                                                                 a cr


                                                                                               ct
                                                                                               1; c
                                                                                                      (a)

                                                                     6epteble    to thp-  Svxgeon   Gereral.
                                                    all sure.nce sac

                                                                                            Y
                                                           To  as-,u.-e  @'he ava.,,Iab;ljt    of  fuhd@ L@or   main

                                                                                                             4.    on
                                                                                                 t   icr, -or
                                                    tp--ance nn@ o

                                                                       n @,i '07. o.jecr,, aust@,.,inaluciEk a--,o oposec-
                                                                                                             r

                                                                              0 ye  r r, e

                                                    its com-olet+-on.     In  the   c s p of an   ?,d-oition to   an ex
                                                        ing @cili@ly,       the   @3 licp @vio," Inis@ include a, stn.te-
                                                       u                           .7

                                                                     that   funds   p,re o-r will, be avE,,,A I able to
                                                    rie-,it shoiiing

                                                                                                             itures and
                                                                     erence   between.   -Droi

                                                     t
                                                                                           'ficp.,tions P,.re ill qccord  i-fith :Nf
                                                          T@@@-, the  plans   @,na.7scec,

                                                                A:,

                                                                                                              ith   the,St,,Lte

                                                                                                                        0
                                                                                                        nts  Of  s s
                                                                              0

                                                                                                         o?  facilities
                                                                            e ga rd. in gthE, prov@io_n
                                                             and.' 1C,'


                                                  P14cant 7will COnfc-rl 4-0 St,-.te stand,-, cis
                                                                   a r. t oP'.1 a-p-ol_icpbl-@ St@-to Li,,Ars F, r@@
                                                     n@,,-.Tit e r.-,r-c e
                                                StL-,te P.rd local costs , -rerilEtions, end or6.1-nances-,

                                                      That *he a-c-                                         o er
                                                                   ,clic@,@4on is entitlzr; to,  -criorit@    7

                                 ... . . ...

                                                                                                 e         -oa
                                                                                            ompli d  with

                                                  arh ('b) of         section; e,.nO,

                                                                 St",@@-c S,.@ncy ?,as -@l,@TDI-oved tli--      0 "I.


                                                                                                              (b)

                                                                                                          1 icat ion   urLd:e rthis
                                                                           Ti-O
                        LAW,-                         "Sec.-@                 pn   arovoTing     an a@D
                                                                                                        C,3 rt  f.7 to th,@   Secr,-
                                                      sr-ict - on, the                          si

                                                                                                                           e
                                                                                                                /7  -ner  c  nt,=   of
                                                                                             e,2
                                                                              --G@ const,-                              ect and     de-
                                                                                              uction    of- the-. -Oro
                                                                      .(i Go,
                                                      the: c

                                                                                                     i--, not -@,u t h o rzi dby
                                                       t,--     exco              i@  thp
                                                      lp,w .to  @-ke   r@@Ym@-.qts  to   'U'-,ie             '@-he cer-     @c@@iOn
                                                               -prcLvid   -or -oa                         th      P,-oT)Iicant.  TTpQn
                                                      sho.ll           -e                   spirit      0    p@
                                                                                         te, Agenc,,v,   b- secl ui)on
                                                                   tion--'                                a

                                                                                                                     0.

                                                                              I-e        can.
                                                      MO       s, @,le  to t.,                              geon   Ge.-i
                                                                                           for        eri        the Se@rel"ary
                                                      Cer@,       catch   -:,-ns'u@'T                    t
                                                                                                                                   af @er.,.


                                                                                                                                       so2,       (b)

                                                                                                                                           i            -ild have 'been
                                         See i624,  su-or@.              Certif-'@c_@-Vi-on                             original   b   11    ivio,
                                                                                 c+ ion @n6.         or)            ccn@'-540r-3                 the Sur@,"On
                                         made  "after siic,.            ins-oe
                                                                                                                                        sxora an@rovP.1 'oy
                                         General shpli                                   'Wrote tfir-"
                                                                                                                                                                  certi-
                                         the Surgeon          C-er@e-a'  i.9                                             -,id,3r       t,)is c-,@'osec@ion
                                                                                                                                                3,-O-C.        i.,D n

                                         an-oroval.

                                                                                                                                                        a.f ter          in-
                                         s-oections        and on       such      cond.i-+,-ic)-,is -aesT@,@d to: -sq-11re Sp-ti-Sfactory                            com-
                                                                                                                         re,! shp-li determi-,e.11                   In @.his
                                         -pl@etion of the jrojec" Ps the Surgeon C-ene
                                             -ection                                     @ere.1                      'li7
                                         con-.               the                    Gen               .s to ut--  -,a the ser,,rices of the '2e6,eral
                                         ".7,0 r                                                             o:nitted  this                                  See F.
                                             ks Agency.             The Ser--.'a Cc--ittee
                                         Hearings.  I).  2,DQ@.
                                                           "Und.er the  ori"7ir-p,.l                       -P.!!  4-ns-,6c',Iions                       r@7e  been  @t,Oe
                                                  leral agencies,  but                                                               -ad             this -F-.inc 4.- i o n w oul (i
                                         b y  I-e c                                     un@,er  the  bill            as,  re-oor
                                                               rily ii@              e,                                    th       the,        Federp-l- Government:,
                                         become  1)r.ima                                reso,,ieibilit@, ,,,wi
                                                       nly'                                                     0 ess@r                                             h!-q,
                                                                             e                                                                                    t     t@the
                                                                                                                                                        itsplf@
                                         Stl@tes were'   -tsc              r g                                             Y'O,-  t-o  in-ve@ti,-te
                                                                                                                                                                  alleged-
                                         clefauits.i!,,        S.    Re-nort.Ti      ITO.                   13'-.
                                                                                                                                                        s'o       'Y@ @of
                                                           Th  s  was  consistent                 @,l 1 t'.@' tile  36@,     a   C o =I i t    6 a'     -Oiic
                                                g'                                                              e   Stgtes.           See            961P (o),    2P    supra,
                                         dele  @ti'-ig                             'lar-c 'o i on s   to    t@
                                         635

                                   .LI.Direct         P@l,,rent.      to  -koT)Iiccints
                                                            This      -.oro-,risio@L ,;as        contained.          in   the  or4l-inp-1  bill  Pn(i
                                                                                                                                           t                  rq
                                                                                         ate     He,.rirgql         P.          :':,No  a  th:=.t I?ey..pnts.             to
                                         t                                                                                        on'.            smaller out' @l 'n  th

                                                                                                                                                   p,?v                to
                                                                                            e                              9   0                               d-

                                                                                                                                                                 ter   4 p@IS
                                                                             1 i c a,- t  -@o-r  the               o      ,:ork   -nerf            or:nedn   n@                  P.nd

                                                                       @(Tii-omer@t       fl,=n.-.sheci-.
                                                                                                                                   co@@@r-ac@i P4 @qo

                                                                                                                                           b
                                                                                                                                                                                  Tn

                                                                       @lpted.,


                                                                                                                     9'025  (b)'

                                                           (2)                                                en    the  In        all  work
                                                                   The    second     instal'L:nent      wh              ech--,.nic

                                                           hp,s   'been

                                                           (3)       h e  t'@lir,4-    9 t i !:re n@,     e n  ,Yo  rk          the    con-

                                                           s t
                                                                            c-ntrac+.  -S                      and               ins   cti@.r-

                                                                                                                     Shp..re

                                                                                                                          -pect   in      St.  -@ncl
                                                          -@@ie  costs       Si-ich  as  E-,rc--Itect's      fee,    ins           -n    co

                                                           cost     of e@-ii-omenl  shp,l'- b-3                      in   requests      for
                                                                                                     of   the     stages      irLe-.icated. in tlii--q.
                                                           ments  made FLt  one  or more

                                                                                                     ede    r?,! shore    of     the
                                                                                                                                        ent re  -oro
                                                                                         of   the
                                                                  f inp@l      y m, en'

                                                                    consent                           eon.:Gc-ner,@l.. the   St

                                                                   c   b    'he    S@,ite   A,-ency- that      i P,yment    of   a@ I      L        nt
                                                                         y
                                                             :ts-                                                                                   to
                                                                 @,e- an    -.-o-plican'u                        _Agencyl iiithout e@x-QenseL


                                                                                                                                                           -o'bl-ic@ tic n
                                                                                                       meF.                                      v el    e@
                                                                            Sec.     625      (c)           ,dT,@,nt      of   any'appro
                                   LAd
                                                                                                                                     in  th        sane      L'F- 11-y'
                                                                                                                                                                     er     .s  P.n
                                                                          s ha--,    'b P-    s ub j e   t   to      P.   ro
                                                                                                                                                                31-ibsect-;.On       ('O)
                                                                                  ,Oa,        ndQd,.  either. -,a-ocr. a:o-oroval-                  of. on-     azter-!i-e-it  o@@

                                                                                                                                                                                allot-
                                                                                                                en    t  ',o  @,d- e    f roir,
                                                                                                                          e
                                                                                     For  the        fiscal            year  in    @!hich      such     -,.,nend-ea  certi,L4@-

                                                                           eption,is           @(i

                                                                                                                                             CF.

                                                                                                     on                                                n . G e r, er,-
                                                                                                                                                 a   1      n.,?-  a -o  1 i c a t i- o -,I
                                                                          -@,rjro-ce                             sp.m@- ranner  P,s  i4,r-
                                                                                      ssee,'in        the                                                            -P
                                                                                          t,nat  th,,       o         r-,F,   -,-o-o    c  t    on       conformity  ,T@-,th

                                                                                                                                                  for         the


                                                                                      9625 (d.)
                                                                              -d          this  section -fo,
                                                                            rja, - under
                                             it@ec. GP5        T@e     funds
                     LAW.
                                                                              -oved.        be  eased
                                                                           -0
                                             the  constriction 0         a.p-

                                                                                                    th,--
                                                                                   c r t

                                                                                                       ,Onst:',Ictio',
                                                                              for  @,r -D
                                                                                                 .@'o r

                                                                           St,?@, eitself  i s ?,n
                                                                      th
                                                                                    -sepi  controls shall\'be
                                                                of, P,,6count

                                                                              e c i ea

                                                                                              t    h(
                                                                                               0; 'S
                                                                             e, local   or  othe   fu@s use(i    f ol'
                                                                                                 r
                                                    '---sb-arseinent of Sta,@@

                                                             @oses
                                               T.Atchino@, T"
                                                                             eauire   th%t  a.-p-oli-op.nts  receiving
                                                    Stn,te  Ag

                                                         f _Lqd   received-'
                                                0
                                                                                           less  of -,Thel"her Fader,@l
                                                reco,@,s- sl,@ll  be               raF,@rd
                                                                                  the  @,t.ate Ager.,--.T.Or  directly

                                                    rr


                                                                                                                          sSG25  (d)

                                                               certifi     ed  for ppymeit  by the  Si:,rgeon  ' nerel  for
                                                                                                                                ,7e

                                                               a--,r r o v 9  -o-.istriic-l-Lon -orojects.

                                                                          71                         ---nc--ract-'@on                                 art
                                                               f                                                                                               fy
                                                                @.ep-tior     by    S'tl-2@te  Igbncy.          The       State-       Agency        shall.certi

                                                               a7pli                           cost    of   t,7 o r I-r- performed  -ind  na4. eriais          a nA-

                                                               eq.ui-.o;,ient        furrisher-!
                                                               -@eql,iests    for     -@@aym@r'     1-i--icer   '-he  construction  contract
                                                               sliall     be     submitted      4-n      each   o-F    three    s,',f,.ges,    as     'Lo!"-Ows:
                                                                        Th4 first                 instillment   w@erL not,-less  than           29       -o6rc,ent

                                                                                                                             the:'building@     la
                                                                                                                                               ha   been       com

                                                               -p@e@ @(i
                                                               (2)      The    second.                installment when  the     mechanical          work       s

                                                               'been            slabs'@anti@ll-@    roiag'--ed  i-n, P. r- d

                                                                        The                                     @,ihon work     lard e r       he         construc-

                                                               tion. ccintract          ia          completed   -.nd  final     ins@dc.tion         mad. e.

                                                                                                                                          f o:6her      allow-I'
                                                                                                                -ce  o

                                                                                           e   or,- more    @d@   t@e:   -s     es   lnd-'      a   c   r.

                                                               All    costs  ',,@-.'u    ha-,re    io t      been d e t e rrr
                                                                                                                            !--qed  qt    the    tire          a

                                                                                                or!;       parts,                  the    'construction.

                                                                                                                                          of        reaue@,

                                                                 C)                                                                             enti-re


                                                                                          9625  (@d

                                             proj'ect.-

                                                                                 o.-i C-eneral             e
                                                                                                 the  SIP'
                                                                    f th-,
                                               @th the  cons,3n@
                                             A,7, e n c y@y                       sc,@dule of   @aymen,


                                                                                          s625    e)
                                                                                          S,

                                                                           os-pital  for which fund
                                               "Sec.  625  ('e)  I f      h
                      LAW:
                                                                                       t any  time  with4-,i 'w-
                                              -naia  urd@er this   section
                                                    s a@ter the    cc--miat@O@n 0    3  s@ ruc4.': or"     'Oa so!L
                                              year

                        .L

                                                                                                          sferee by
                                                                               ot approved     as a  tran
                                                     o,.i, o r
                                                                   @khich is  r
                                                                                           t to  section 623 (P-)
                                                              ency  designs
                                               the  State  A,-F              ted. @urslaan
                                                                             r  (b" cease to be a nonprofit
                                               (1), or its successor        0
                                                                  ined   ii section 631    (g),,.,the United. States
                                                    ital  a s def

                                                                                    ho

                                                    e                             f@the   then              Sri
                                                                   per   c e., it IX..I'0       value   o'
                                                                -ater-nire(i  by   @r e er@- e nt  of the T)arti-es or,
                                               hos   i       as
                                                                              -dis'rict    'court of the  UniteO-
                                              @:-b-i action.broug
                                                                  ht in the


                                                                                                 ss631  (P)

                                                                                     Prt

                                                                                          III)e.@ ini     ons

                                                                                                           ny                   'oe
                                                             ru           t
                                                                           mert     arced

                                                                                                                                      m

                                                                                             t             cs,-oitp, inc C)
                                                                   -50@
                                                             0 It 0-     P P,:

                                                                                                                         ontinentf,l
                                                                                   T                           L
                                                       State    b6p.rs  to the  )er                ir-come o@ the c
                                                       United. States  (excluO@4@ng                        except t'y,@llu (I)     the
                                                                            ent,@,ge s@,11     i n n o cgs e   be more     t,---an 77-, -Oer
                                                       allotment, -nerc
                                                                                               -ner- centum, Pnd       (2)  the    a.'

                                                                                                               shail b

                                                                                                           ent,-ge   for   Puer',o

                                                                                                                         e
                                                                                                 shall     'be   75 per c ntum.
                                                       'Rif; C

                                                 See   ss      s          'or                              t  e  s
                                                                            ro@-ia@eL,  t h,-        @.I.@otm @-,it percentage,,,
                                                 erdent--.g                  e@ e'    14- i@   'by, rp,7u     It io n, rn--i ing
                                                                                 t e r,-,'
                                                                               rel,@", ive  f              l@ neee@s: of the@ S t  t,- s
                                                                                                           c   --e     ir

                                                         Fo                                      bp@     jet              S.        to
                                                 for-..ulp,
                                                             (sec.      631          'e@errl     7:,r-e-itp.7p-,  @rhich w,-juld     'o e
                                                 utilizes, P.s L-, f@ctor in                          the F.Ilotrpnts @s
                                                 the   Stptes   (S'P-c,   6214)   ,   and   -!so   ta    fix t.,le -oro-nortion of   the
                                                             inei-                                         ective Sta,es which
                                                                     zidup,               in    the     resn
                                                                                                           62-5  (b-)                    aT-
                                                                                             I-ete                   2             e d:, &3I
                                                                                                                     0
                                                                                              car,                     lip  S@t,-.t

                                                                             r


                                                                                                                  s
                                                                                                                     -41 (a)

                                                  ca-oita        income equal to  the  r@tAor,@I a,7erRge !tioul6. hive a
                                                  Federal   percen@-@  of                    c,nd            Therefore 'r--,ve  'Llc  fur-
                                                  nish from State or local  sources  one-half  @'he  cost                           of epc"..
                                                                -     -cz!o,ect        '@thi
                                                  co--s'ruct4on                    w-      -i    the    St@te.    In    a     State with       7er
                                                                -n@-.-e                                   @he               as a,
                                                  Federal- 'Voverni-,en@,                 beer    7F    percent    of    the    cost    of     -oro-
                                                   ec,ts,.    the    maximum    Fede@.1    rereen-,?,..ge    -orovidee,;     while.     in     a
                                                                        er-  cati@-                              one-tbi7
                                                                                                                                              t
                                                                             t                               @@a@@      ci'.t  ;        t
                                                                                   910              r!z e
                                                                                   For              t@s  -in, A,'lasim  and         @Hawaii, the
                                                  Federal percentage ,.ioule.             be-go-,    --For    those    in     Puerto     Ri-co, 75
                                                  S.   @Re-rort   @LTo.   674,   -0.   11.

                                                  It   @.y   be   a-pel@le@   c,@-,t   in the  follo,d-.ng @nner:
                                                           100i@,    5O'i4o  X   St,-,te Lover-a@;,@ -)er  c@,-)it--   income
                                                                     Averaee         ner ca,@ita    Continental        U.    S.     i-icc,@e

                                                                                                     P-(                     Senate bills     the
                                                                                                          a@rroved
                                                                                                                    in
                                                                                   wa                                    (let
                                                                                   ti                izi@ individual pro                           s
                                                       elnt   of,                                                                    j6cts.-  Thi
                                                       i,-.'oe  T)                     s.            'by  the.   Worse Committee           to  the
                                                   lat.                      ons'ilniztioa@        Cot
                                                                                                                          t   LT
                                                                                                                                              p
                                                                                                                                    2 5  1.9
                                                                                                                  -@-o or

                                                  s       sunra,

                                                         The'   prov.sion.       -,@,ith respe'ct  to     the    Virgin     Islands         was
                                                  added- by     P.L@    713,        30th Cotgrars,  H@R.         5889-


                                                                                                                                          @-b3l @b)

                                                                                                    -he                       percentages             still be          riro-
                                           LAW:.,                       "Sec.     @63t,  (o)        lu           ot,@    an'

                                                                                                            gbon         Ga-
                                                                                                                           ier@,l  between            J@l     Y 1   and
                                                                        mulgetea       by       the        ur
                                                                                                                                       -ear,      -,n       hp- basis       o@
                                                                        Aug,-, s t'
                                                                                                                                                  of        the Stit a s, anc.
                                                                                   L-ra@e@ of  theater               ca-D   it   a

                                                                        available          f r  o,,,i               the.De@art@,ent of  Co=erce.                Such  nro@-.11-
                                                                        g,a            !,,i 1    be  conclusive  for                 each      of  the  two  fisc@ll
                                                                                                                        qninp                                      eeding
                                                                                                                                   July      1  next       succ
                                                                        vears       in.the       -PErioO.         beg;@'.

                                                                                                                                                                     Ge

                                                               Ili     le  the                      bill      @rovi@eeL 'si@mnly              thn-t        'the eilotme?.it
                                                                                                                                                                                 -ve
                                           -6@icent@ga               dul(I    be
                                                                                                                                io                      s
                                                                                                          'r, y  @e zulp@ t      on   on    the             is: of'   r e I,-, t i
                                           financi,                                                           "tek                          -Tactically  set  forth
                                                                    eae.,                                        ,Is    r        s i@ c n s.
                                                               n
                                                                                                      l@,tive            neeIe,., viz.,  @er        canita  income.
                                           the     basis-      o--@r,,easi-iring  s,@ach  re
                                                                                                          eat    Q.,i s e
                                                                                                   re

                                                                                                                                                                  St  tes.
                                                                                      C,-    t      total-       ex-oer-@itur@.       in        the        roorer     a
                                                                1,-.rger--,rEr
                                                                @Ahere      there       is        the                                     He@rings,
                                                                                                       reater        re    e


                                                                                                                                                            SS63,      (c)

                                                                                                                                                                  severa,l  St@tes
                                                                                              631
                                               LAW:                              "See                  'e)        the     p oTi ul!:, t i 0 r-                the
                                                                                                                             on       le    '@a s    s    of  the  latest   @'g'ires
                                                                                              'o e   O-, et  e  rr.
                                                                                         certi--@'ie(i 'oy    the                Derprtlnelit  3                Cor-merce-

                                                                         y

                                                                      TS:           o@,                   "-.on.          in  corr,-ou@lin@               the
                                                Riwi G7@,T L. k T i 0                                                                                           nopula"ion  of  the
                                                                                                                                            @or         --ci@                          regula-
                                                                                                                  rea  thereo-                              -,oses       of   the
                                                                                                   Or.           a.

                                                                                                 iq   t

                                                                                                                                                         i  t  h. such---@        fusl
                                                                                                       e         rt
                                                                                                     e  necessor7              to     reflect                     chFnging local        connections.
                                                                                                                                                                n       an                         n        the
                                                                                   Si;c h     P,.d.  us    m e n,, s    s@'i 1        not           res-,ilt@            y  -Increase
                                                                                                                                                                                                          ifie@
                                                                                                                                        S ',it e     oirer      the      fi4ures          c.?r t, -.          -
                                                                                        tol@ial i) o-oula t,      o n   o      t    n-e

                                                                                            he@


                                             631 (d) the term "ctatei includes Alaska,
                       LAW:           "Sec.
                                      Hawaii, Pue-to -@ico, the  Virgin@Islands, and '@-3
                                                                                      v

                                      District of "Jolumbia.11

                        gbth  Cong7ess, H. R- 5899-

                                                         C)-


                                                                                                                                                            (e)

                                                                                                                                                                         ed    in
                                                                                                                                                 except,        as  US
                                               AW'                                               e
                                                                                                                                     t
                                                                          ;!'Sec.        63@               the terin            hosT).
                                                                                                                                 @lu     e s             c   I-e@,it,i     ce--ters
                                                                                     tic)n
                                                                            sec                              n                  r.
                                                                            P,@-d   @en                      0,11- 0 s   s       e   n P,'-    i-r-nc           '-sea-,e,
                                                                                                    t lf2 e  i
                                                                                                                                 n:d@:: related        facilities,             SUC4

                                                                                                                                                                                 t

                                                                            ooer@ted            n   con.-bctio--i        with  hbsbita.,Is,  but  aces  not
                                                                                                                                                inarily         domic"li@ry
                                                                              r- c  ii   e  Pny

                                                                            c LA:

                                                                                                                                                                               e

                                                                                                                                                                w,    !i rE
                                                              s         @in'@       far       beyo,-i
                                                                c m                                                                           -,s           -nortar,  con
                                                         -ta:t   in'g  @-!i g@--7,  r-'  n@,.aber     of beCLs  f or          occti-,Ancy- by  s ick -neo-ole.
                                                              r       e-       @nts7-    c c):nb ina t 1        o     @p,        41it-              St
                                                         It.@            's                                                          Les                P.,     that  serves.
                                                              e   U'll,   @@@iose         of       c@ 4 -ri             "tients@',qnci                            Personnel.
                                                         th                                         r           0 r
                                                         140       reover-,
                                                                                   is    a  nucleus          or   organization  for                 medical  service

                                                                                                                                       @q,?,Ith       c,--iters      -.nti  general,


                                                                                       Os-nitAItf ex-
                                               rily domic4-llLary care.   @he term   llh
                                                                      to    Include -,uoli-c h@-P,l',
                                                            a r- e ra I-

                                                                   ricted @o in
                                          ceite--s, shall  be  trest             stitutions rro-

                                                                                          ic
                                          vi(iing com,-nunil,," ser7ic8 for in--getiPnt  med.- P  2
                                                                               this ina:Luf-le,@,obstatri--

                                                          'tute a -@o,.ab 1c hpza.rO@.
                                          founeL..to const
                                                                       I

                                                                                       e,,Kre-ear-nos -a-
                                                                hos-r its!.

                                          throat  isoL,,tior-,  natern;,t,@,.  chile-ren's o-rthon@('-ic,

                                                                w
                                             rL Pnd, -'cancer.. call         as'other       hospitals I)rovi

                                                                                comzonc.L

                                                                               ud.es'. nerttal, tuber-

                                                                 6:,    a no sl)i- t,-. I S.
                                           -1)--.    Chror @-4se   se I-, o s-r                primary
                                                     -ic     a       jit@-.1.  A  ho   it,@,!, the
                                          -olir-nDse    c'L ,.ihich is   treo-t-ient    of chronic  illness,
                                             1,-id   the  C             C,  ise--ses,,-  .,cLne, which furnishes

                                                                     P,-re ac,, m ii       .,.'or itqder

                                                     i6 nen           a! s
                                                    a,-                    n=siig      OT-OS,@ @.ftcl also

                                               stit.utions the -,)rimpry pur:rose of qh;-ch  is


                                                                                                                                           s631         e)
                                                                                                the  ,ep            -r e                                   noble       to  the
                                                                          d@,ys                              @r  a         u           -rilY     L-ssig
                                                                                                                          c      s
                                                                          f o 1 1 o,,.,i i ng cp t e,-                          se     lhron;-C,  co-vplescent,
                                                                                                      cri-es  o.@  cp.           s
                                                                          ar.d.  rest,         @-ug   q,-6        0 O'- c    -'-C,  a-04,le7tic,  :rent,-.'.'-y  @'e-
                                                                                                                            nd. mental. :,@nd,@ 'tubermao.si,s.,,

                                                                                                                                                      the       F'no,,is'
                                                                          I'@reatrient       of    nervous        and     :nent@-1  illness             but     exclue@-'@ng  in-

                                                                          stitutions  fo
                                                                                                       t-.e  @ee'            ,Iin(!eO@.  ar@d  et)ilertics.
                                                                          (1)  Psy--"-o@F.,th-@c  @-os@i-@Ial.                   A  ty-e  of  -"e-.i'u@-1  hosp!tFI-
                                                                                                                           e  intensive           tre,--ti,-ent
                                                                          -where  '-,oatierts  @-,recp:,.v                                                             ,.ncl  where
                                                                                                                                 -tizeatz;ei                      ies@    @ill,     13 eL

                                                                          a:f f
                                                                                 Tuber'                        s@-i+,            A     h  -Di   Al             th     d
                                                                                                      cs_,@                                    t                  e
                                                                          P- n    tra@@tr@ent            o@ t,@, er  cul  c  s  i  s   excludi-,i@        preventorip-.
                                                                          (n)       o s               e            be@         @or 't@ n Result        or  chilO  -or--tient.
                                                                          3a@s @iTicts  .or           the     n e w-@ o r r. -'-, na   nursez-,f,  bbCs            in  lal@or
                                                                                                          'Tth                                     r@@eds          s e cl  ex--,
                                                                                                          a       cp-n'E                       he                u


                                                          Se
                                                                    631 (f)  the   terms   -nublic@      he@l@uh center'
                             LAW:
                                                                                 fc@c; lity    for  the Provision of liu' ii(.
                                                           -oublial-,v   owne

                                                                                                                             -icr
                                                                   s p   4-cL3

                                                                                                                      -of f ices

                                   .,In the    ori@in..q.1  bil'  the    term,        Cefinc@    to    ,ne
                                                                                                         @n    Ila  T)i-lbicly c w,.q e d
                             fp,cility for the -nrovision             of -r)ifolic ',--lth services ane.. r,,ee,.ic-@l cn.re---.
                             '@he list three       wo r, s  were omi',ter@     in        revisi,),-i    by   the Senate    C.-)-.1nittee.

                                    Not ci,-
                                             h6   S          Gene,@l     s  st--tol@.ont,
                                                   @eon
                                                                                                                                        'k

                                                                                                                        w

                                                                                     he  it                     ne

                                                                      FI: M C-
                                                              el  ot  a r e.s         ha
                                     c                                                     1 t h, t @-i t O,.r  ybertha     on     ep,ns,@:'.
                                                                                                    Heirings,    -ci 22
                                            qv   Ling   neec-eo.  em-ercre.@Gy                                              See   ?.!so
                                                        -o. 147
                                           e@,rings,

                                                                          C.            t@  Co,,rter...
                                                           io:          P,    i

                                                                      e?

                                                                                        t        s irg Io  c -@u@
                                                                 Locel    health    %,-, i -                       Y,   city-

                                                           O'U
                                                                                                                              wel@


                                                                                 63 1  f)

                                                 iction.
                                          jur
                                                                                          ee  thr
                                                                -,-v4 -es. Se
                                                            h

                                                                           the enO-.ea-vor to
                                                            'ty ef-Lort in

                                                                              7Z"

                                                             e corn                          as P.
                                                                  .1riinity alrePLftv
                                           services w,iich t--
                                                                               1 jrclu@-e such aO@'.L-
                                          @..t t er o-Lo nreLctic@,, the term s@.1

                                                                               P-rc:n ui=e to       y
                                                        ces as 'he   om=itY
                                           t i o P-@ er7i

                                             cm-it desirable,  tP -r,


                                                                              s
                                                                              s631 (9),

                                                                                                   ny
                     LAW:                  tisec@. .6@l (,oil ti-e ter- Inon7ro-lit hosritp

                                          hos,,)ita,l o@@Tnet'- -@n@. crer,@@ULI@  cy a
                                           tion,    north of the  net earnings of wh4-ch '@nures, C-r

                           The  orip                                                      Iii,@t the
                                          bill  con4--.ineC- a    si@ii-,r -efirition e%
                                           .L      I                                  -   u
                        r e. s"or r-.,,@y 1,@w@'Ully ir@ure"     "Ier-3      o.,iittoe-. lie Se n,-@ t e C c. =., i t L' e e P,@z IZ,
                                                                                                  ,.e.,-
                        ..these wo rlr-s thus        t h-- (-'- a f i -,i i t i- c,-i t(,  other 2e,,'.eva.1 'Icts such as
                       loi   6) of thA-     Internal      Re@e.-i,-ie 'Yo@e.
                                     s@i'bly.@ f @,r, w.--r'. emerac@cy,                    A6t  there'
                                                                      ia@, une@or,
                                                                          t
                                                             e rp,    -rLt S.,
                                   ly
                                             @Tlie ro.La,:   ar                                   f -
                                                         -v- mn o "P,@n 6 e-' of                 0 1
                                                                                   in ti-,a hearings.
                                    in'the- hos-oit,-.1 syste'm@,,va's welL !,--veloped'
                             eizer of  t  - Am6rican Ho s-DitaL.                      .@,before -both.;
                                                               As socii,t,.ion. t es-t,if led

                               es.
                             t 6
                                   'This            is un@, - ifo F 7-@2'fi,?, rwith the, beckgro-,=,@. of
                           @'the nor,@rof it           hos-@oitni.      n i z e C, 'by the citizens t @-. e
                             the co--muni'ty,     '@hese.@iosl-.it-@l.s     nc,-..l r,@nc-er  @, @@ior tortioii of the
                                  a!    lics7oita"-    care    to     the     c@@llizens o@  this  country. I,.-,iy o @@ these
                             8:ener
                             7olu ntary 'rosnilv,@ls  P                         s
                                                    re  o-rerptee-    tlc,, @r@riou churches.   Their
                                                          esults                                 in
                                                                                           ea-70ts.
                                            h                         of S,@, @-i
                                           fu                         n

                                                                      r,: t ]iO,
                                                    -'Howevel      t   is@ -r t e
                                  th   t@@                                                   gislav
                                         er(    US.                   _or
                                                    -r.0 ic@ltee.' this  bill,. -or
                             wi                                                 ovisir)n is
                               -th the  -.ro-a
                             maintai-nin-.the best  in our -oresent  s-,,sten of hos-,oit-ctl  ser-,,T-;-ce.
                             naie-nz n,-Is'si-ole  gr,-.nts  to both ncni@ro.i-t -.nC@' @overnrer-tal hosr4@'@als.

                                                                                             n


                                                                                                              9631      9)

                                                                                                                                  instruc-
                                                                                                              cipss      of
                                            ma   @be   B!m@le  to  offer its     assist     r@     t 0
                                                                                             the jra.jor.   -@rrden      of   '.'OsPit,-.l
                                            tions    whi cla, are   Fl. er-,.tr: c-.rr;Ti-qz
                                            cp@i-e.     _q  Heq-r in@s            40   e e  ?      c-n. 66.

                                                                       angles     qi'@e-,-t ior              tl,-er  it.  shoiAe.--    not

                                           so                                  -,ublic .2if t, to Pn,.r      ind    of     T)@ivate
                                      rea   nal.-le   than    a
                                                     At'    least,    it  see.,@   0 MO    P. r,-,'U-her            Oerlarture  L@ro,-i
                                      hospital.
                                      es@,P,blis.qea -ninct4.ce. 11       a.  F-e@i-in-s         2".   ElsewY-ere       in- the S,3@te
                                      Hearings                                                                              !i -it s  be
                                                      ,,. 700,  36L@/  there .qas                      thp-t -ublic.gr
                                      confined     to     -.u'olic      institutions    T-,e   Sen@te    Co.@-..iittee    hoi-rever    re-
                                      tainee,. the original -,irovi-si                   rants     to     non-     r'fit      institutions
                                                                             on for     g                      o
                                      ancl a-eL    '9625 (e)        surra,, thus      -',rc@upctinp- .,',he.p-a7blic  investme   nt fdr@'

                                                      r   0                                        er e
                                                                                                                                         i t1
                                      through th-      Stat@@                      e
                                        t  crr)                 r
                                              6rnt e6     ifor@                         a  c,.e    rt,,=e f-.".oL,
                                            :o-L@ :th                     P-re       @,.enoE,,inationa
                                                    os                                             1,   in--    -characters others     ar a:
                                      -Our                    e
                                          al@   c@ri      told!    Or-.irp,"ily I      4,00ule@ not be     in    fa-t,,or:6f    such    a
                                                                                                              Tf  @ve. undertake       'u o
                                      grant;    'ut@  1"he:,.hos-fitil  sitj-pt4on. is.,              ar...
                                             net hospitalized' to. r                               s  in,  ef:f  ect'  we  :fr.O'eZe.  the

                                            t                          ar  ho
                                                                 i                 @,i    n        are a     sac  lo'n.      t see
                                      de   thp.t       that  e   nt    it   is. 7,erf-octly               t 171--        Feeeral'aid   be ex-
                                                                                                                          h
                                      ,ter                                acs-nit.@lEr-as       ,ee-,' s  to, -cun li     0
                                                  it:t ea @.F r i @t-,,;


                                                                                                                                       S031@ (h),
                                  LAW:                                  "Sec.       631  (h)       the          term Iccinstructior-T   inclu@@'Les  con-
                                                                        striicti-on  of  near                                  e@. ansion,  rerioC.elinF-,,                  p.n@
                                                                                                        4   st4@nF@-                       @nd     in!                   i 1; -

                                                                                -n         uh  resp         u
                                                                        CXC6     t'     wi'-            ec'      to  -nublic       '-qeplth  centers,-the  cost  of,

                                                                        the     p@cou'ls4-'@icn                 la

                                              The     orii7,irL@,l@-bill           -,nd the     bill      as  renorte@  by  the  Senqte  Comriittee
                                                      in-  the              -definition
                                              dee,-                                                                    a!    -fees  9.nO-  "-all  other  ex-,oe

                                                                                                                                                               2'    Thd@-I

                                                             t

                                                       itillustr@,tive:              of    c.r,,roll,@ry         c, 1 i t ies@    t@rhich     @-jr7ul@L  be     eligi-ole  for-
                                              Pederil        PiO,  would  be            u--
                                                                                      r,    ses'      'come      or            trpi-iing facilities,            olit--)atiert
                                                                           @pd   i!4ties  4ir.        cornec',icn@With  b-o@itals,                          laboratories,
                                              pnO.    cli--i4cs            connectic)    -Wait
                                                                                            -i        ii  StF,te      or           local health         er,,ir t -,ne nt s

                                                                                                                                                            -rom, Fbdar@
                                                      ..Th                       ion@@which  -might,,be
                                                                                                                                  b'  ii                          @ruc t
                                                                                                                              on,-    o:                                    e
                                                                                                                                                                            h

                                                                                                                                                                unc

                                                              c r -     The'y         c6u!@. be         bo-af7h@@.
                                              Mr'         n   e r       The                    believes          X- r,-- y                     could      'o e, bou,-ht.


                                                                                         s
                                                                                         S631 (b)

                                                                                         -,,,rt of the con-.
                            ,@r. Lp
                                   ,nger-   '-,he Senator          cpl      h  it e,,Ir-
                            s.tri@ction cost?

                                                                                            h
                                                                                                cc-s

                            cost.
                            S. Co=     -Prin@@ ro.  3,, -P. 96.,


                                                                                           @631     i)
                                                                                            s

                                                                                     6f 'construction'     riee,n sthe
                                                       C          t lie,

                                                                                              @u obe r             -'o r
                                                                                                               ry
                                               PI-01=.t f oil--I'                                       ecess@

                                                'he const@@ic440-     of a  -)-04ect-11


                                                                                                    's"0'3;' ( a)
                                                            "Wit,@'-oldin4    of    Cert:'L@'l@tion
          r
                                                  liSeC.  67P                                C, e r. e r:,,'
                       1,AW                                       Whenp.-,-er th@ S@29-'O-ll
                                                                                    -cr he@rin@ @Ic t-e St@.+e
                                                  agency  as4@:7nr.,Ue@- -Li ac--o,-,rce   wih    sect    onc
                                                     s  that the State     -agency.- is not  com     lying  s          @lly
                                                                                                            ubstanti,
                                                  with  the nro .visions     required by section 612 (a) to 'be
                                                  cort,@ined. 4-r@ its FL-r.-licat4  on for flanO-s urie-er I,,@rt 3,  or
                                                                      r,-@ti-e @nO.  5,,-rortuni-,!-  @or  he--ril,7  'o
                                                  ,@'ter  reason,@c  ,      -          -         I'@  -     :,      u
                                                  the  State   ?,goncy e.eS4,-  ate@..  in  @--,)re-ance   with   section
                                                  623  (a-)  (1)  finds      that  the  Stete  E@.geTicy  is  riot  com-
                                                          s-ubst-.ntip.17,.- with the      Provisions reTairee, by
                                                  section 62-,,        or b-, r       'u i o n sPrescribed             T)ursaa.nt

                                                                                                 its r,,Ian    s
                                                  to section    62r'  to '@e ccnt--inee-  in
                                                  i=eer  section 623  (n)     or   ( 2@) t !iL-,, 'LI  c-.ny fa-nOs   @-ee'.
                                                  diiarte@. .@,.,O".                --Fcr @ihi-ch they have  been

                                                  allo
                                                      ttee@- or naie@,  or       tbpt  any assi@ence -ivei in an
                                                                 filej.- i)-ne@er  section 625     is not  being car c,-, n-
                                                      be  carried-   out,  or       that   there  is  a  substantial
                                                  failure   to  car         -olans  ane.-  sl)e
                                                                   ry  out                   (:;if i cp-t i o  ns P-1@p-roveci
                                                  by     the      Surgeon General under section 625,        the Surgeon
                                                  General        L@or'@h,q-'@th no',ify the Secreta,-,,      o--F the
                                                     asury    and     the     St@.@e     P,,onc-     t--t     no     further Cer@if4Cp,t4-
                                                  Tre                                                                     -on
                                                  will     be -@-Oe under -cort 3  or  -nart C,  as  the  case     y 'c e
                                                  or    that no further   certification              will be maee  for     any
                                                            or  -projects desi,.c@,toO,   by      the Surgeon General as
                                                          qffecteo- 'by  the &efe                          -eon General
                                                  being                            @ult,  as      the Sur.
                                                  mpy  0 e t  e--i 4-ne to 'ie  FLr,-ronri@,te   under the circumstances


                                                                                                                  632 (a)

                                                           @ne@.,  excent  Keith                to   any   -"'@i-2ct   for    .,ihich    the
                                                           ,q,T,,T,lic,:-tio-i has              ',---er.                    @,.-hich   is   qot

                                                                                        y                        '-c :Jay
                                                              -ectl.r a@@ecte,

                                                           certifications until there  is                no    lon@er    any     failure     to
                                                           Com-nlyj,, or,.,if'comliance  is             impossible,  until the State
                                                           rerc-,ys or          P-@es  for the re-nE;.y,-ner-t  of :@'e6-eral
                                                                            r r a,.                                                     ..cnies

                                                           which '--P-ve been :.i-vortaO  or  i7rorerly

                                             -k some,qpat  sin; il,--r                    @!as   contp.in-,f-'-   in   t'@ie   original    bill
                                      which-       uired thp-                  Ixene@ral to  @with'.--.o'10 -,nay-ments  to  the States',-_I'
                                                er hearin,,z,  '.-.e fc-!,inO. f,-,iluz-e  to --O.,@ly with Pni, requir@ients
                                      if,  aft                                                                         li
                                      of a State a,-,i)lici'uion for server and- rl,-.ri-,                      an@s   or   of    a    State
                                                                                                -      I-ine@
                                      T)lan.                                conlui_n,,-ie 1-7nti-I there was  no       longer failure
                                      to comply.        The Senate Cornm4ttee revised the r.-o-,ri-sion to @er:r@it with-
                                      holdine under such circu-,nstz@rces as .qell as  i                    i  the   event   of   f=C,.   C,.i-
                                      version or failure to  comply with construction -nians Pne--  s@-)eci'Lic-@tions;
                                      also'   t@-a@,   -.,P.yments   to   the   S'p@tp-   or   c,,)nstni.--tion   !?r-nii-c@nt   eight   're
                                      @iith-@id,  as FtT.-,7                  pn@                     @y --ont4--luo until  there  is
                                      no  longer -@-.ilure to cr..,-@-ily or until  @-e-,-,-.y:rent  of '-7eO-erq,l                       is
                                      ,.rran@ec-.

                                                                                                                                           la
                                             Llote that. the bill as reported by Senate C(-,.7,,.ittee pnve si-.Li-  r
                                      opport-anity to i         construction-,@-,-nl-icant         for a hearings before  t           'e
                                      ,Sir@eon Genera!.          ,S.  Re-rort I'To .. 67-' ,       - 13,  14.      The House @@-iittee
                                      restricted the o-p' ortunity to               the       State.                 (b),  infra.
                                                                p                                      see  632

                                                                                      IC

                                                                                          --- - -- ---- --  --


                                                                                                           9632@  (.b)  (1)
                           LkW:                             t'Sec.  67@                l@  trips  S,-ir@eon General        reflises    to
                                                              a-@nr@7e                         an@.@ r  section  625,  th@  State
                                                              -4enc-,-                    t-    a:-.- 1 c a t   c  was  sub:,.i@@P-e--,  or
                                                                      -r  1: -Zrl 'Af n

                                                                                            i

                                                                                          on
                                                        @may    ar-)eal   '@o   '.he   Tin4-t    eC. S-IL@tes  circuit  Court    of a-,-oe,@ls
                                                                                                 -,lach       State is loc,-.t ee.    i'lie
                                                           or   the  circuit      in   !i h
                                                               s@,;mons P-n@  notice   of               :n,-,y  'be serve@-  at  any
                                               i          place     in    'the;-Unit     ed @tates.@    @Thp,  S-u            era!  siall

                                                                                                                                   transc

                                                                                                                                     s  e

                                    The    6ri  inal     bill   c on@u-@@nea-,  no  's  imi  71.,-.r  e a!  s   rp-7is-.on:
                                             "Senator     S,-ni    th, T   L-as   I-eeTi                 that  there.ought  to be  so-me
                                    sort:    of appeal          cnr@' set  u-n.
                                                                                   -,xave you -@ven consideration to that                    il

                                                         r    e                      ro  @c
                                     it     is recoillzne@-ee   oy    the    S,-,te    @Agen,--y.
                                                                    g',-;i6r   e@.ir6                r        t ion:,
                                             :T                                                                        Senp-tor,  it
                                              hen.   coir.,rent   -ri     e        etl@-r   0--i yoa   clut's
                                                                    easi'@le-@  I-,, ehou@L @thi)ak@,    t@,                   @1)  eal,

                                                                                                                                      r.


                                                                                                                  16
                                                                                                                   32,

                                                                                                                           ee.  in  t
                                                                                                                                      he
                                      o'b @ec@ed    to   t'-,id' cnutt             'OrOvis'on-'
                                     House     v
                                                 ersion     of  t    eb ill,      H  R.   5'98          i-ntro@UcOci by  @'o  n  e s s rAn
                                     Priest)

                                                                                  D               st,@t@
                                              I,,i the,  H,),i s e

                                                                                                                                         ouncil,- I
                                                      In   res:oect'of      the   o'b'-ections  to       the      rower of    the  c
                                                                                                                                   e      Sen?,ta
                                              WPnt    to   be'r,-3rfactlv -@l.ir       @,ne,- r-,-r. at' th@t  I     seri6 to  th
                                              Comnittee       t@,t       this    is   -.,itter -for the           Con@ress  to         Determine.
                                              The  Sura@,,D'n,   "To ,ie r,- 1    .I feel.  coulfL ad-@i-'-.nister the        '",ill either
                                              WP                                  s  s-nokan on this  score-and..I su7;-
                                                -Y.                             ha                                                  .3or' -his
                                                        'he       Presi@,.ent
                                                   nt-  of,

                                                                                     th4
                                                                                            the "b:   -I-!,           c  h,   snot    satisfie
                                             .-with    tl,.e @@e@    i7,ir- 'r,@o
                                                                                                 Ir , r                  oily
                                                                    er                  the Su .,e.,n G@nei-,l @6'.  @ing a. c.ons,u-ruc_-
                                                                                                           Stat-es, Circui
                                                                                                                               t     Court     of
                                                                                          t he Tjn i t  e,
                                                                                                                   h
                                               t ha t  i-t           f   or   -the, first    ime  .@,id e r     FeOerp.1    -nrozram of
                                                                                                 arr:ul in                    inistrptiv
                                                                                                        e,;- a

                                                                                                 c-

                                                                                          t

                                                                                                                      -by: @he    Senate     the
                                                                                                                                  his   a-Q


                                                                                                                                9632. (b).  (2)

                                                                                                                                                             -eon
                                                                               632  (-O)  (2@       The     f i -IC' in@s      of
                                                                                                                                  .@t  by the  Siir-
                                 LA:                                   sec.
                                                                    Genorp,,I,       unless                               --ontrp-rT      to  the  vieiaht
                                                                    of  the  ev4.,Im-rce,                                                'Out  the  --c,,ur@@.

                                                                                                                                t                      -the

                                                                  :@S       6on  C-erer@,l       rray  thp-re,.iron           make- noli or  rroe@ifielft
                                                                      u:r   g
                                                                                     ,)f  fact            -r@,y r,,r,,e-ify     his Previous  action,
                                                                     ,-,n@. shall      certify  to  the  court  the  transcript  ana  re-
                                                                    @ccrd,@of      the@f                     -,ceedings..         Such new        or modified
                                                                                                           pr,

                                                                                                                                                          stentially...

                                                                     action         o@ the    Sar 7, e   n   'enerpi           or t   set    it-  PsiO e,-     i- n
                                                                     %@rho"-.,e or- in T)ar@v.            The7 j,,id   e n'u    of  the    --curt  shall

                                                                                                      by  the     Su
                                                                      su:oject  to       revie,                      -nreir.-e  Cc-ur'u-,    o   the    -,n it ed

                                                                                 S.
                                            un(!er  the  wi                                                                                  -onrove  an a,
                                                                  thholdi-ng      I)rovision,,o'r      if      he      refuses      to       a
                                             ce,tion,        there        may be   an a@n@eal  to  the  Uriteci  States  Circu4-t  of
                                                  eais.      which         wo                                      u                'his  P-ctioi  or to  set
                                                                            ul6       ve.       IurisOicticn       to        affi'r=.
                                                          L-@@ i     ,v@a   a 'ol,@                   The    !,.e.,arin-L-    @n    court    woule.-     be u-oon

                                                                                                                                                          t


                                                                                        33

                                                                                              -n@D@   Title
                                                                                   iinistr
                                                          Eo s T)ti'@  uric

                                                             The  Surgeon General     i.s
                                                  '33

                                                                                               'be subj'ect- tc,
                                                                                t   n
                                                              An      h   e,@@       c,
                                          the             Of  the A6-.ministrp_tcr.11

                                                                                         o P-tpileo, Oisci-issions.,
                                                                              for  more
                                     See, 622. su-orp-,      @@6359-.@
                                                                                            strati,7e regulati
                                                    e                         tj
                                      "S    e6n,           S -T)OW


                                                                                                                                             0633  (b)@
                                                                                            637             'n       Fd,,i4niste-,,ing       this        title,        t-"O

                                                                                                                                               h      a
                                                                                                                                          @,ii t
                                                                              Coun i@         ce)nsist-:ng o'             t@e,o-urgeon                General,     who   shall

                                                                                                                                                                embers,
                                                                                                                                               L

                                                                                                                                                              he    eight          p,p-
                                                                                              'by  t he             i yi i s t r,?. t o r         'Four of      t

                                                                                                                                                                                    'n,
                                                                                  inted       meml-,,erc       s'-qp, 1 1 be    nersons             who are     outs@anel L 7,

                                                                                                                                                                      acti-@-it4es,
                                                                                     f i e 10, s    er t       ni,-q@-   to  '-osritil          a -.q 6- heplth
                                                                               three      of  whom             sh-all    be                 authorities in          matters rel@ting
                                                                                     the     o-)er.-tt      ia'n:s  of  ho @-I   1. tp.1 s    and             'v@Le.other four

                                                                                       e'rs-   sha-ll,..'o    e, ar,-no 4 n@ ed-            to@-,re-ore
                                                                                                                                                      s6at,the        consume
                                                                                     ho S-Q i t,-                                                     jersons-     famili--r
                                                                                                                                @shall       be       r
                                                                                                  -1   S6@vices          and.
                                                                               with      -the    neeO,.        for  ho s-r, i t .9, 1          seriices in,urb@,n  or'
                                                                               rural       areas.              Eac-,i @,@-)ointe@-       in er; i,@ e r shall      @o   1.@  o     i.c e
                                                                                   for a   term      of         -@our yaprs,       exce-fi  that  any               :member        a.@-
                                                                                          e(i   to    @L,ill        vacancy                   occurlnr, Trior    to  the       ex

                                                                                                                                                         e
                                                                                                                    rm    -for  w
                                                                                          101

                                                                                                                                        a             3P      e
                                                                                Adiiin-' str@t,,)r                          i.              -orointTent ,           tiqo    ?.t   the
                                                                                                               t    'he   t4me      of    a
                                                                                              .the           first  yeL-. r   t -,,i o@          L--tlthe end. of     the second.
                                                                                                                                                     a- y6er,i  atJ.    ti4o'l@"gt--the
                                                                                                                                the     thir

                                                                                  eligible  fcr                                        if  he         has  not  served-

                                                                                                                       _107


                                                                                                             -53 (b)

                                                                                                          4-nt-.,ent  The   c ou-Tl,- i- I.

                                                         j.& qu tlio r-i z e 0, t o    i@@@     U(zh,;                scr:,    a
                                                                                                                       .21

                                                                                             c                              v ng on
                                                                  vis     o r tbchn!cRl     @m-mittees     ,vhile     ser     i

                                                         'busia-Dss   of  the   Col=ci'     -s@'     1receive      o mj-j e n s at i oi
                                                                                                                 c

                                                         at -ra t,@ s. fix e(i @by the                         but  not exceed@in,-

                                                                                                               ed
                                                                                                    b@   6nt:Ltl'

                                                                                        cser                     or

                                                                                     sees necesse,ry,@but           not:.less    t@-n

                                                         0
                                                               each. y@AT.     .@.-Llron request     by @hree    or  more    members,

                                                                                           the     Sul                  @t o,,

                                                                                                                         the  c
                                                                           eral Ae                              whidli
                                        Powers      @a@o.Lts        in                               ng to   hospital       and
                             hepItii   acti                                                          @@,u'l,-br-ities. on. hos-pital
                                                                                                 e
                                                                                                                                 com


                                                                                                                     'b
                                                                                                           9633
                                                                                                     @..riendmen 4-    for      equal -oublic
                                        The    Senate    rejected'SEr@tO'r
                                                                                          Print    @-0               66      70 -
                                   qa'-Drofe  son,@l

                                                                                                                             a-s o
                                                                               --ee.:7
                                                                                                                        29, .,75,
                                                                                                                                   re-o
                                              s  c6,--,n6iLti@                                                                        re-,

                                                                                                                     Sena    e   s5  ti 3
                                                                                o-nosed.P- 're
                                                 h        no     a opte6,,7r
                                                            C.   , eTi          @2607,,,@   13-
                                                 t i'o n.,       @R-   o rt
                                                                                                                                 members,
                                                                                litic:@l    ?_f  f   i-lia@.ic)n of  Council
                                                 the Discussion on                                                               onfir,@ea
                                          ,To t e                                                          aT)r,.Ointrients      c
                                                                                                '@ving
                                                                                   sabilit" Of
                                                         14!,  the
                                        e        s p                                                           -opthic re-nresentq,tion,
                                                                                       140, 1;; 5; os,eo
                                      the' Serat e       S                                                          16 m6zibers
                                                             He@rings,                             Of

                                                                                                                             on.
                                                                                                                                 f
                                                                                                               e                     h,
                                                                                                                1-@rv    luion   6.
                                   out  t                                                                                                re-
                                                                                                      -the
                                                                                                               Sezipte Committ6e.
                                                                 t                        council,,
                                   It                   qcil   a                                         ge
                                                    co@                                                      Oil                 gr@nt
                                                                                              the-'Sil
                                             t  e                                         ni@                                             ,   .     .: .  I
                                    @ineo-                 ql    @) 0
                                                    gen@r,                                                                       edmnis-
                                                                 roval   of @eeuiations  on           the        f@,r,-iatio-n
                                   power    for   @rior      P.n-,
                                                                                                  for    the           coneuct of hearings    on
                                                                      a   ,. @FLntee,: rriwe@
                                   tration   of    St?-te    '01-_
                                                                                                               to                iich @-plaris

                                                                         ions 1                in       clup-si.         i,:Ll    tlai@y-
                                               its   an  e E, I    unct
                                           ZLIittee          Print               0'0."      Tne      P-resiaent's       letter of Jp,nuary
                                    S- Go                         i  , 3, P
                                                                     rmrn of  t-',i@@'@l@rOUS,3,  ",CrL-littea        Ct'd  to  the pro
                                                   t(i-th6       0                                              Cb    e      e
                                                                                                                      r,    to   veto

                                                                                                               c             a
                                                      .sh
                                                                                      -109-


                                                                                                   9633  (b)

                                                                        e@e the PCtio:is @)f     ti,.e res,@onsib',-,3  n,d-
                                            witq ro7qer     to  cverri
                                      ministrat-@r,    the    Slargoon     General             r
                                      -,)Ose" of @lembers w'-io continue w@.t.i t,.ei.- usual occupations                -@ld
                                        c s e                                to                                       st@   e
                                                                                                                  Sen-a@or
                                      ,,he F,-e@.eral :;cvernment, are 4iicl@                                  s       u
                                      '4urra              - - - "The@ -oro-nosec., c-@u4cil is, -o                )re-.
                                                has statd                                           roba:oly    unj

                                      an(i.the'Administrzttor.        There     is no-@,ri ced-u                              e
                                      a'ction or inactions of this council                     14                             0
                                      nooo(ly,    rerons'ible    to    nobody.   Yet this new      kind of irdepe.-idd.'It
                                      agency has  in-2ortant  -@C-.-.iinislurati-ie  euties,       @@Si_jU(liC4Lq,l fUlCt-,)nS,
                                      and    a    -,reto    -oo%,jer    o-,er    the    S,,2rgeon     Gener-n-1     in carrying  out
                                      a     T)rograr,     t@@t     involves     -,ranting     1,-,r--e     slir,.s     of     money     from     the.
                                      Fe
                                             derpl Treasury.''        Such         acouncil  thus  becomes  a  semi-nutonomous
                                      administrative                      bcay,@which is     insu'Ltated      from      the      gal adminis-
                                                                                                            pner
                                                     'the  et@tii@e-        and inac
                                      tr'at   iorL@ of                           ces@ible  to@'con,,rol @hrqllgh
                                               ion.
                                                                ,@y,
                                                                "the tanne       sugp-,
                                                ory Council    in,
                                                                              r       es
                                      b   :'t    4iild            ,ssiire,'.'t@t
                                           L    0                                 c6un-il..woula-@be donsulte(i
                                              wouie, mak
                                                       e@
                                                                   1  6LneL'@. t   tt  he':     a---it           re
                                                  r@oon            uenera                                  done             ss@-ccul&
                                      be  in@br,-,ied- of ivihat@ is      n  raise
                                               ..See hbwe7e.L@     the            at  -p. .9 6 by D -r.. Sensenich    of       the
                                      A.'@4 A.
                                             The F-ouse' Co-4imittae-    e4l@. no L' c,-2p.n@e, the       Co,,mc-.1.@s       far-e.lrj.,Lis.
                                                         @in at-,rov                                SI @origi@


                                                                                                                  g633 (c)

                                                                                                                                                  th4 s
                                                                   11 cec.                                terin@ the         ro,72@sions      o,
                                                                                                  -in' s
                                                                              33 (c)       r- ae

                                                                                                                          he   e.,n rova@l    0
                                                                          a                        e  era           th t

                                                                   -once   with an agreembnt            with the       ',-IeaO- thereof        PaY
                                                                   ment    for    s,,ich ser,7ices      an6.  facilities  sh-@ll             be      e
                                                                   ir. a:4 va'                    y 0-- roi  3ursement,  as            L-,ay b e
                                                                               nce  or  oy     @!a      -      m
                                                                                                                    s t rat o r. an(!  the    head
                                                                   a   r e ei-                     e-@thd     Adrin;@

                                           This                           c
                                                                   was   onta@@                             in--,I  bill.      Sea    S'..@ Y4ear


                                                                                        9634
                                                            fe
                                                       'IC
                                                         on   ren,.e o fStita

                                                          -Whene-ver in his G-oini
                        LAW--                                                     on  t he. -o-qm, o se sa f
                                                 S, title                     -ty  -on-Far@@nc;3, the

                                                                     a-7Lt@, renr'e@sen'tatives of   aS@ ina

                                                                                              er   as he

                                              seems -,ipc.e s s,,4 r@.- or.:7@rooer.,   UTon   the  of
                                              five  o rmo-e o f such. St-ate a,,encies, it sh-,ll  be the
                                                           Sur@eon Ce,,ierai  o cp.]:l a,conferencp,.Of

                              :This            %.jas 6ont@i-nn-e..nthe  r i,7 1   bill.


                                         r
                                                                                 S  t@,t     c -@i s t    of O@erations!'.,

                                                                                                                                         O'S  confe  rin

                                                                     0                                                    e    the    ri@ht    ta    ex-
                                                                     n   any Tedet@l        C-+-icer        or       employe
                                                                     arcise     any      surervz@si@n      c.r @-ontrr)l   o,,ror    the    r-tC.',minis-
                                                                     tra.'Uion,  -ncrsornol,  i.-aintena-Tice,  or  o@,erp,tion of any

                                                                                                        -'o  which    any, funOs  have,          bEc-n@,
                                                                     hospit                      e      u
                                                                                  git4    rpsl, c,t,                                                   or

                                               e  0           -inal:,b
                                           Th      r ig                        'no,-                                 -,-nh.           S
                                                   ncorr
                                  urged      ta .1              .@rate Such                          nto. the   leEil@ti,:in.         See
                                                                                       -ocrt'
                                                                                      Re        To.    tD            15.
                                  HeRrings       1@,7, 146,       292, 366;    S                        74,
                                        "Senptor        '-7L-,ft  on the  Senpte       floor          stptee.@
                                                           Presie,,nnt,      in 67ener@l       iqe    ?-ave  triej,     therefore,        to       throw
                                          E6 s much     initiat4ve  on         t'no  St@115-tes  -@s,        -ossible-   S') P.$, to,@ rem
                                          much     Ci                4s@@pr,@ib4le  from,        t
                                          T
                                                                               i7y.an            -a,,I'mi'nfstrativa"o
                                               SC                       7,47,ppopee@ s,t@@                fa@       as
                                             tif.

                                                                                                                        ar.

                                                     a  a_nc                       -i        n s
                                                  So   ,ihat      ,,re   e  '@ris-@ t-)         4@'s,  first,       to got   aivay   f r o ri,. too
                                         much    ftelegat          ion of c@,ngress-Lor@,1,-nc,@,,,er  -'lo  the Pe-mini-strative.
                                         boards;       is..       some c+' tile  socif,l-seclirity lrws          lin,v!a , e- o ne,,, nd ea-6 a@.
                                                                         scret@a
                                                                                                                    s'sible

                                                                                                                        e.,
                                                       ii   ti,@tive                     res,@onsibili'y,           to                  -lize@
                                        0                                                                                      centr,
                                        control.         One        of the                   in the  @i-11  as  originally  intro-


                                                                                                     9635@

                                                                                                    Discretion         ana control
                                                el. uc e l@las t   let it
                                                                                               an   r@,l.    I-i    or,,er to  correct
                                               ,of   the  -nro   @rp-m in   the   Sui:@e,r    '7
                                                                                                                              y
                                                 hi s ,ief- -@-ne s s ,nu-- a r o,,@ s
                                                                                        S    "an !rtich                  '017' these
                                                Ser-- te-.      'ghile the b4.1-1    hp-
                                                                                                               inuch.0  termina'iOns:",
                                               @pmendment         tb@eL ineasLre     stairs  .,nlaces tob                e

                                                                  -hand
                                                           'o the r         Geiieril    'le:rin,    ")f the Feder,-,l @t!ori@s A,,min       i:s
                                        tr@,tion felt  that   P,-nnlica.,its for             federal      fumes       shoulJ nn@, be re-
                                         q-uiree@ "'o @o  throii--h Stpte         agencies.       E.    -tearin@s,    -n-r.. 213.
                                         See   p,lao   9612


                                                                                                            mis

                                                                                                                                           --e
                                                                 tfs ec.        Pa@@gre-ph      (2)   of ser-t4Lon      209@

                                                                                                                                                ILY
                                                                                      S2rv@ce         t    P, s a  e re, e      s  @M-2ne_l

                                                                                                                       ,to a,ss; St      by
                                                                                          @ef@re     the ,ir@d

                                                                the    r,@riod -.t  t@ e,@i@      of s,-,ch       r            i,ne.-' in@ertin@

                                                                                                                                          n@-
                                                                     lia-u   the.-e@)@' a              @nO,. t he   f r) 1 1 o@,r inn:
                                                                                                  -,inL-  out,  -he    T,.ur @ses     Df title
                                                                 (b)   to ascist       in   c,@rr"

                                                                                      t  6                          C;   E P.'@

                                                                   s

                                                                  it
                                                                   Sec-".4LOr.  1.    T-ities    I  t,-) VT,-inclusi-je,,        of   this       t
                                                                 ma:i  b    cit                   P U"-'l i c F-ee,l'h   Ser-@-i@e    Act@.    It

                                                                                                                      ly.,
                                                                                           712,

                                                                                Ai-               1